June, 2000 (from Dr. David C. Anderson)

Several months ago, Milt Ettinger gave me a folder containing his collected reflections on the history of the department of neurology, Hennepin County Medical Center. The history was reported in installments with entries from 1965, 1972, 1975, 1980, and 1986. The reports detail the growth of the department and the professional trials and triumphs of its members. There have been no entries since 1986. I will write installments for 1990 and 1995 checking with Milt about accuracy and perspective. I will also update the account at this point (2000) and promise to continue the history as long as I am Chief.

August 1966 (Milton G. Ettinger)

HISTORY OF DEVELOPMENT OF NEUROLOGY DEPARTMENT AT HENNEPINCOUNTY GENERAL HOSPITAL

(Formerly Minneapolis General Hospital)

In early 1953, the Medical Director of the Hospital, Dr. Thomas Lowry, approached Dr. Harold Noran, who was a practicing neurologist in Minneapolis, regarding the establishment of a neurological unit at Minneapolis General Hospital. Prior to that time, neurologic problems had been referred to downtown consultants who, for many years, had volunteered their time to provide the hospital with adequate neurologic consultation but no teaching program in neurology had been developed for the interns or residents. After discussion with Dr. A.B. Baker, Professor and Director of Neurology at the University of Minnesota Hospitals, a neurology program was initiated at the Minneapolis General Hospital in July, 1953.

The first neurology patients were admitted principally on the Medical Service, but at times they were placed in available beds throughout the hospital, often on the Urology and ENT Services. Approximately 15 beds were designated as belonging to Neurology. Two rotating interns and one resident from the Medical Service were assigned to care for these patients on Neurology, and their instruction was received from Dr. Noran who made daily ward rounds on the Service.

This situation continued for approximately one and a half years when, late in 1954, again in collaboration with Drs. Noran and Baker, a geographically independent Neurology Unit was established on Station 7 of the Annex Building (where it still resides.) At that time 28 beds were assigned to Neurology, and Dr. Baker appointed the first full-time instructor from the University of Minnesota Hospital to supervise the teaching program in Neurology. Dr. John Logothetis held this position from 1954through 1956. In addition, Dr. Noran continued as Chief of the Department, making frequent ward rounds and supervising the administrative problems of the Department. Also, in 1954, the first University of Minnesota neurology resident was assigned to the General Hospital on a three-to six-month rotation basis. In addition, the Medical Service continued to assign a resident to Neurology for a three-month period.

In 1957, a three-year training grant in Neurology was obtained from the United States Public Health Service through the efforts of Dr. Noran and Dr. Baker. This training grant established some salary items for a full-time instructor as well as support for residents and an EEG technician. Throughout this period of time, Dr. David Mendelson was assigned from the University as a full-time Neurology instructor and Dr. Noran continued as Chief of Service. The residency coverage was maintained by a resident from the University Neurology Department and a resident from the Minneapolis General Hospital Medical Department assigned on a three-to six-month rotating basis. By this time, interns were rotating in groups of three, and at any onetime three interns were assigned to the Neurology Department for a one-mouth period. In 1960 Dr. Milton G. Ettinger was appointed as full-time instructor. The training grant from the Public Health Service had lapsed by that time, and support for the neurology program was contributed principally by the University of Minnesota with a minimal contribution from the Minneapolis General Hospital. Seventy percent of Dr. Ettinger's salary and the principal share of the salary of the residents assigned to Neurology from the University were obligations honored by Dr. Baker at a time when the General Hospital was contributing very little financial support to the program. In addition, Dr. Baker increased the number of residents in Neurology rotating to the General Hospital (from one to two), so that at all times the Neurology Service had three residents and three interns in attendance to care for the patients. In 1962, Dr. Ettinger was certified as a specialist in Neurology by the American Board of Psychiatry and Neurology, and in January, 1963, Dr. Noran relinquished his position as Chief of Service and Dr. Ettinger van appointed to that position. (Noran continues in an active consulting role to this time.)

In 1963 arrangements were made with the Psychiatry Department, University of Minnesota, for rotation of psychiatry residents through the Neurology Service at the Minneapolis General Hospital to meet their requirement for three months training in Neurology. In addition, a number of third-year neurology residents from the University began to return to the General Hospital to act as senior residents. From 1963 to the present time, we have had from four to five residents on service at all times, one or two first-year neurology residents from the University, a resident from Medicine, one from Psychiatry, and a senior resident in Neurology from the University. We continue to have three interns assigned in rotations of approximately 25 days each. In 1961, Dr. Anna Ellington joined Dr. Ettinger as the second full-time neurologist in the hospital. Her salary was obtained from research grants Dr.Ettinger had secured from the Public Health Service. The General Hospital contributed nothing toward her support.

In 1964, Dr. Ellington accepted a position with the University Neurology staff and Dr. William Riley was appointed the second full-time neurologist at the General Hospital. By this time, the hospital had been transferred from the city to the county administration and Dr. Ettinger's and Dr. Riley's salaries were considered to be a reasonable obligation of the county hospital. In addition, three full-time resident stipends, ranging from $4500 to $5500, were included in the hospitals contribution to the neurology program. At the present time, the Neurology Service staff and teaching program are strongly supported by active consultants and attending physicians from both the downtown area and the University of Minnesota neurology program. (Appendix 1)

In anticipation of eventually requesting Public Health Service support for a neurology training program at this institution, certain requirements for such programs are currently being met. In addition to full-time clinical instructors, we currently have available special training for neurology trainees in Pediatric Neurology, Neuropathology, and electroencephalography.

The latest development in the growth of the neurology training program was the decision made by Dr. Baker in September, 1964 that the training had now approached the point where he could with confidence; assign medical students from the University Medical School for their neurology training to the Hennepin County General Hospital. Since that time, we have included in our complement of personnel, 8 to 10 medical students on full-time duty for a ten-week period as indicated above. (Appendix II)

Appendix II illustrates the growth of the Department with respect to inpatients, outpatients, EEG and consultations during the past twelve years of operation of the Neurology Department in this institution. As will be evident from examination of the statistics, with the present size operation and the present number of personnel, the Department is working at maximum capacity. There can be little anticipated increase in the number of inpatient or outpatient services under the present situation. Limitations are principally those of space with respect to in-patient services, and space and clinic time with respect to outpatient problems. The consult service has been rapidly enlarging and makes great demands on our present staff.

Projected Plans and Recommendations:

It is quite obvious that, with the increasing number of patients entering the old age group, the burden weighs heavily on the Neurologic Service to anticipate an increased service responsibility in this community. At the present time we would not be capable of handling a five to ten percent increase in our yearly patient load in either the in-patient or outpatient areas. In anticipation of such an increase in the very near futures it would seem reasonable to make the following request.

l. That there be a slight increase in beds available to the Neurology Service,

2. That the Hospital support a third full-time neurology staff position (if, beginning in 1967, the U of M does not support the position100%),

3. That increased Clinic time be made available to the Neurology Department in view of anticipated increases in patient load,

4. That appropriate increases in nursing personnel and ward personnel commensurate with any contemplated increase in bed assignments to Neurology be made.

Respectfully submitted

M.G. Ettinger

Chief of Neurology

Hennepin County General Hospital

EEG DEPARTMENT HENNEPIN COUNTY GENERAL HOSPITAL

The Minneapolis General Hospital first acquired an electroencephalographic machine in June 1948. Sporadic records were obtained and interpreted by consulting neuro-psychiatrists who volunteered their help. In 1954, at the time the Neurology Service began functioning as an independent unit, statistics became available regarding the total number of records performed per year as well as a breakdown into patient classification by diagnosis, by location in the hospital as well as outpatient Department. A glance at Appendix I will reveal that there was gradual and steady growth in the EEG Department with respect to the number of records performed, utilizing one machine on a half-time basis until 1961 at which time the hospital saw fit, at Dr. Ettinger's recommendation, to hire a full-time EEG technician. From that time to the present, there has been a continued growth. In 1965, 1,344 EEG's were performed. This is sorely taxing the capacity of one unit and precludes the possibility of performing a number of special studies utilizing EEG which could be applied with advantage to our patient population at the present time.

UPDATING OF THE HISTORY OF THE NEUROLOGY DEPARTMENT, HENNEPIN COUNTY GENERAL HOSPITAL

In 1970 Dr. Riley left the staff to become a neurologist in private practice in Houston, Texas, and Dr. Alan Rubens was hired as his replacement and as Assistant Chief of Neurology. Dr. Rubens was trained in neurology in Philadelphia and subsequent to his training in neurology had trained at the Boston VA Hospital, under Dr. Geschwind and Dr. Benson, in Aphasia. Dr. Rubens, in addition, had spent a year on staff at the Boston VA and Boston University Neurology Departments. In addition to his active role in clinical neurology, he inaugurated an Aphasia Program at the General Hospital.

Dr. Manfred Meier, by this time, was consulting in neuropsychology and one of his trainees, Mrs. Leslie Arthur, a full-time psychometrist, was assigned to the Neurology Department.

Dr. Manny Stadlan was a consulting neuropathologist and was holding regular weekly teaching conferences in gross neuropathology. These proved to be very exciting and often were approached as C.P.C.s.

In July of 197 Dr. Ronald Cranford completed his training in Neurology and became the third full-time Neurology staff member to be supported by the General Hospital. Dr. James Moriarty was assigned part-time from the University to assist in the undergraduate education. In November 1971, under Dr. Cranford's direction, the Neurology ICU was opened as a three bed unit onAnnex 7. Throughout 1970, 1971 and 1972 Dr. Anna Ellington, who had been on sick leave from the University, returned on a half-time position, supported by General Hospital, to take care of our EEG program and read all of our EEGS. On July 1, 1972 Dr. William Hosfield joined our staff as the first Pediatric Neurologist in our institution, full-time. He was considered initially as 20% neurology and80% pediatrics, but from the beginning at least 50% or more of his time was devoted to Pediatrics Neurology. In addition, he was appointed Administrative Head of our EEG Unit and assumed responsibility for reading all the EEG records on children fifteen years and under. Dr. Ellington retained responsibility for reading all of the adult records.

In 1972 we obtained a Midliner Echogram and placed it under the direction of our EEG Technicians. By that time Joyce Markham had been joined by Rita Bednarek, who had become the second full-time EEG technician on June 29, 1971. Throughout the remainder of 1971 and 1972 Dr. Cranford developed the ICU with an increasing number of monitoring devices and a great deal of attention paid to training the nurses to recognize early changes in neurologic conditions.

Budget requests for 1974 included two new monitoring devices. One is a respiratory monitor and the second is equipment for monitoring continuous changes in intracranial pressure. The 1974 budget requests also included a fourth staff position requested to implement the new program called ‘Neurology Nurse Clinicians". It is our hope that we could provide some continuity of care to our ambulatory patients by nurses who follow up certain selected groups of neurology patients who return to our clinic repeatedly, for example: epilepsy, cerebrovascular disease, etc. At the time of this dictation, ie. June 1973, we have a vigorous and effective social worker, Paul Goldstein, who has, in addition to his routine chores as Neurology Social Worker, been busy organizing therapeutic groups, who meet on a regular basis. One group consists of relatives and friends of patients who recently had strokes and the second group is of young seizure patients. Both groups seem to be progressing very well. This has significantly contributed to the understanding of patient's problems by the participating members.

Our new hospital is planned for occupancy in the late summer of 1975, which is about two years from the time of this dictation. Dr. Ettinger has been a member of the Building Committee and we hope to have adequate office and working space in the out-patient area. Our in-patient unit will remain approximately the same size with twenty-one general beds and a six bed Neurology ICU.

M. G. Ettinger, M. D. Chief of Neurology

 February 26, 1974

During the past year the following events of significance have occurred:

Dr. William Hosfield, who was our first full-time pediatric neurologist, resigned on January 1, 1974, but beginning in July, Dr. Stephen Smith will join us as full-time pediatric neurologist. We are very fortunate in securing the services of Dr. Smith who will be completing his pediatric neurology training program. Not only is he a competent clinical pediatric neurologist, but he has done some excellent research work with electron microscopy, and is also vitally interested in neuromuscular diseases. We are looking forward to a significant contribution from Dr. Smith.

A number of other new personnel are joining us for varying periods of time on July 1, 1974. Dr. Mark Mahowald, who will be completing three years of neurology residency training program, will join us for one year to train with Dr. Rubens in aphasia and higher cortical function. He will bean associate physician on our staff for one year. Following that year, Dr. David Anderson will have completed his three years of training in neurology and will join us, hopefully, for an indefinite period of time as a fourth full-time neurology staff man. Dr. Anderson has background training in internal medicine, as well as neurology and is vitally interested in the number of acute medical problems that relate to our ICU and stroke patients. She will work closely with Dr. Cranford in further developing our interest and activities in these areas. In addition, he will probably be responsible for the Neurology Nurse Clinician Program. That was one of the principle justifications for the new staff position.

Dr. Barbara Patrick is current an intern in the RO program and has long been interested in the possibility of a neurology residency. She is a University of Minnesota student and is well known because of her part-time research activities on our service while she was a student. Dr. Patrick is looking for some kind of break between her internship and residency and has agreed to join us for one year as a research fellow in Neurology, concentrating on one or two clinical research project. She will be with us from Sept 1, 1974through June 30, 1975, at which time, hopefully, she will become a neurology resident with us at the University of Minnesota and affiliated hospitals.

Mr. Paul Goldstein, our Social Worker, resigned in January, 1974 because of an offer to become administrative head of a number of nursing homes in town. We have a very able new replacement, Barbara Johnston, who, I'm sure, will carry on adequately in Mr. Goldstein's absence.

Dr. Cranford passed his neurology boards this past year and has been concentrating on some work with blood levels of Dilantin utilizing intravenous Dilantin in the treatment of status epilepticus and frequent recurrent seizures. He has some very nice clinical data and will be presenting his first paper at an epilepsy meeting in the fall of 1974.

We have a new head nurse on the Neurology unit, Mrs. Carol Bird. She arrived in the fall of 1973 and has gradually been instituting a number of new and innovative changes in our nursing program, all oriented towards the final objective of "primary nursing care". Hopefully nurses will be assigned to specific patients they will not only work with during their inpatient period, but with whom they will relate on long term basis as the patients return to clinic. I would like to develop this nurse clinician concept so that many of our nurses can see their patients in the clinic in addition to caring for them when they are acutely ill in the hospital.

The new hospital is progressing satisfactorily. It is approximately 50% completed. The target date for completion is about fall or early winter of 1975. Since the center hospital will be completed by January of1976, our target date for moving into the new hospital will be approximately two years from now, i.e. February, 1976. Dr. Manny Stadlan, who for many years was an outstanding consulting neuropathologist, has left during the past year to accept a position in Memphis, Tennessee, at the University of Tennessee, with Dr. Robert Utterbach. He was replaced by Dr. Angeline Mastri, who continues to give us high quality neuropathology service and the teaching conferences in our weekly neuropathology sessions are of the highest quality.

UNIVERSITY OF MIAMI

MIAMI, FLORIDA 33152

June 26, 1975

Dear Milt:

This is just to express my thanks to you for your graciousness in picking me up, taking me to your conference and showing me around your shop. I did enjoy that morning a great deal. I was very much impressed by Ron Cranford and his especially lucid explanation of the work that he is managing in status. I feel I came away with a slightly different view of the problem, despite what I thought was a lot of prior experience. I am quite sorry that I didn't have an opportunity to spend more time with Rubens. Everything I have heard about him is good.

The real purpose of this letter is to congratulate you on having put together what is clearly an outstanding part of the University of Minnesota neurology training program. I had a chance to speak to some of the residents, feel that the clinical exposure under your aegis was superior in every way, and I thought it would please you to know this.

Best wishes.

Very truly,

Peritz Scheinberg,

M. D. Professor and Chairman

Department of Neurology

May 3, 1976

I mentioned in my last report (February 26, 1974) that Dr. Mahowald would be with us for one year and Dr. Anderson would come on full-time after that. Dr. Mahowald proved to be such a stimulating, enjoyable colleague that after letting him "dwindle" at the VA for nine months, I finally pressured Administration long enough and hard enough for a salary, and we were able to get Mark back with us in April of 1976. We now have six full-time people as follows: myself, as Department Chairman; Dr. Rubens as Assistant Chief of Neurology and Head of Aphasia and Higher Cortical Function Unit; Dr. Cranford; Dr. Stephen Smith, who is a pediatric neurologist; and Dr. David Anderson and Dr. Mark Mahowald, two young graduates of our training program.

Dr. Mahowald will assist us with EEGs, and Dr. Rubens will turn over the outpatient clinics to him. The most exciting news is the new hospital. I'm sitting in my new office today, having just returned from a week at the meetings of the American Academy of Neurology in Toronto. In my absence, the hospital move was initiated beginning with our offices. On Wednesday of this week, two days from now, all the patients will be moved. After so many years of waiting and planning and longing, we finally made it! It's a beautiful new hospital, and I'm sure it will help us give much improved care in both inpatient and outpatient areas. Our Neurology unit, as a whole, came out pretty well regarding space. We have nicely organized and coordinated Neurology Office and Aphasia Clinic areas, EEG has more than adequate space, and we have ample class and conference rooms for a change. Well, that's what comes from my being on the Building Committee for all those years ... we had to show some profit! Dr. Baker is retired officially as of March 31 of this year. Dr. Joe Resch is currently the Head of Neurology at the University of Minnesota. The Search Committee is active at the University, and Dr. Erland Nelson seems to be a front-runner. I would predict that Dr. Nelson can have the job if he wants it. If he doesn't take it, I think we may let Dr. Resch keep the job until his forced retirement in five or six years. It's a very difficult and not very attractive position because of the money problems, large tenured faculty, etc.

No new staff physicians are contemplated for the near future. Our primary personnel concerns relate to an additional secretary, and then building up our Aphasia program. Carol Bird continues to do an excellent job as head nurse, is gradually winning a number of the nurses over to her way of approaching clinical nursing. Barb Johnston, our social worker, is doing a good job and getting interested in doing something special with our stroke patients. Sue Mahanke has really risen to great heights this last year. She took the nurse practitioner course at the University, and was their outstanding student. She's shown great aptitude for being able to care for patients on her own, has been handling a number of seizure clinic patients very skillfully, with minimal backup now from Dr. Cranford. I think we will train her to takeover the continuity of care for some of our stroke patients. If we had two or three more like her, we'd be able to offer excellent continuity of care to outpatients.

Chris, our former secretary, is no longer with us. She's been more than ably replaced by Michele Fatze, with the backup from Marilyn Sullivan. Vickie Voigt in Aphasia is doing an excellent job, and all three secretaries will be together in a secretarial office area in our new building.

M. G. Ettinger, M.D.

Chief of Neurology

Hennepin County Medical Center

October 13, 1976

The Neurologic Service at the Hennepin County Medical Center (which moved into new quarters May 1976) is a 26 bed, administratively independent department. It has a six bed neurology intensive care unit and a 20bed general neurology ward. Admissions to the neurology inpatient service numbered over 700 last year, including many acutely ill patients. There is a large complement of patients with cerebrovascular disorders, seizure problems, and neurologic complications of alcoholism, diabetes and other medical diseases, many dementia syndromes, plus a smattering of coma patients of unknown etiology. There is a large neurology outpatient clinic which meets daily and serves a population of approximately 3,000 patients per year. In addition to the general neurology clinic, specialty clinics are held currently in the following subspecialty areas: epilepsy, cerebrovascular disease, neuromuscular disorders, and aphasia. Soon to be developed new clinics include headache clinic and possibly a vertigo clinic. A very busy consultation service renders neurologic evaluations for over a thousand referral cases per year from other inpatient units through the institution.

The current staffing includes six fulltime neurologists: the chief of service (Dr. M. G. Ettinger), four other fulltime adult neurologists (Drs. Rubens, Cranford, Mahowald, and Anderson), and one full-time pediatric-neurologist (Dr. Smith). In addition, special paid consultants contribute weekly to teaching conferences in the following areas: electroencephalography, electromyography, neuropathology, neuropsychology, pediatric neurology, and neuroradiology. Beside the six full-time neurologists in the institution, the practicing neurologists in town contribute their time to the Neurology Clinic, where they assist in the evaluation of patients and the teaching programs for both medical students and graduate students in the neurology residency program.

The hospital offers a full complement of diagnostic facilities including EEG, EMG, brain scanning, computerized tomography, neuroradiology, etc. The house staff (GI and G2) assumes the responsibility for patient care, generally under the direction of a senior neurologic resident.

The house staff complement at any one time consists of one senior neurology resident, two second year neurology residents, two second year medical residents, and three GIs who rotate from other services in the hospital through the neurology service. In addition, medical students are assigned from the University of Minnesota to our neurology program as follows: six (6)third or fourth year neurology students are assigned full-time (six weeks);twelve (12) second year medical students are assigned two half days per week for eight weeks. A number of advanced students in special or elective assignments also constitute part of the personnel complement of the department. The Neurology Department has developed a large aphasia and higher cortical function program within the department. This program it under the direction of Dr. Alan Rubens. Other employees currently active in the aphasia and higher cortical function unit include three full-time speech pathologists, a psychometrist, a full-time neuropsychologist, and a consultant in neuropsychology from the University program. A number of speech pathology students from the University of Minnesota are assigned to work in the program for varying periods of time.

The EEG lab currently is performing approximately 1,800records per year using two 16-chaniiel recording units. An additional portable8-channel unit is used for emergency recordings throughout the institution. The pediatric neurology program has been rapidly developing the past two years since the acquisition of our first full-time pediatric neurologist. A school learning disorder evaluation program has been a very vital outreach program into the Minneapolis community and suburbs, and pediatric neurology residents from the University program are now assigned to rotate through the pediatric neurology program at the Hennepin County Medical Center in addition to the pediatric residents who are also assigned on a two month rotation basis. A wide variety of clinical and basic research projects are being performed by various staff members of the Neurology Department. Opportunities for individual research experience are available in all areas.

June 29, 1977

The new Hennepin County Medical Center (opened May 5, 1976) is a 400-bed hospital, which it physically connected to a 700-bed private complex (Metropolitan Medical Center) via a 100-bed "center hospital” unit resulting in a 1,200-bed medical complex, containing a full complement of physicians specializing in all areas of medicine including internal medicine, surgery, pediatrics, ophthalmology, ENT, psychiatry, neurosurgery, rehabilitation, etc.

The Neurology Department is an administratively independent unit which includes six full-time staff neurologists, all currently certified in neurology, one in pediatric neurology. The inpatient neurology service contains two units: one, a 20-bed inpatient unit of 10 two-bed rooms, and the other, a 6-bed neurology intensive care unit. The inpatient service admits in excess of 800 patients per year, has a rapid turnover with a relatively short hospital stay, and admits a large number of acute neurologic problems, including all forms of cerebrovascular disease, coma, seizures, toxic and metabolic diseases, etc.

The outpatient department has a "neurology only” area which includes seven examining rooms and one larger conference room. It is staffed by full-time clinic personnel plus a recently acquired full-time neurology nurse practitioner. "General" neurology clinics are held every afternoon with the exception of Fridays, and specialty clinics currently in operation include stroke, aphasia, epilepsy, neuromuscular disease, and headache. The outpatient department sees approximately 3,200 patients per year.

A busy neurology consultation service renders opinions regarding approximately 700 patients a year. One of the full-time staff is assigned to cover the consult service at all times, and is available immediately for emergencies as well as daily consult rounds. The neurology residents. As signed for three-month periods to the Hennepin County Medical Center, will be assigned to all areas described, including inpatient, outpatient, and consult services.

A full range of diagnostic facilities is available within the institutional complex, including neuroradiology (brain scans, subtraction and magnification angiography, computerized tomography, etc.) along with a neuroradiologist who conducts weekly X-ray conferences. Also available are EEG and EMG; bacteriology and toxicology; electronystagmography; nerve, muscle, and brain biopsy studies with light microscopy and differential staining techniques, plus electron microscopy studies, etc.

A special aphasia unit that has 1,400 visits per year has been developed within the Neurology Department under the direction of Dr. Alan Rubens, and currently contains three additional full-time speech pathologists, a research neuropsychologist, and a number of graduate students in linguistics, speech pathology, etc. Neurology residents may elect to study aphasia and higher cortical function during their elective time.

Our EEG lab has two 16-channel EEG machines and performs many bedside studies including a large caseload of "brain death” diagnoses. The number of EEGs performed in 1977 was 2,300.

The house staff consists of the following: one senior neurology resident who is in charge of the inpatient service, two G2 neurology residents assigned for three-month intervals from the University, two residents from internal medicine at the G2 level or above assigned for two-month rotations, three to four GI level personnel (interns) representing all services having GI residents in the institution, six "full-time" Phase D medical students assigned for six weeks on Neurology, and twelve part-time Phase B students who are assigned two half-days a week for lecture and demonstration purposes.

The schedule of weekly activities includes many conferences and clinical round sessions conducted by staff, plus specially assigned review presentations by residents and weekly conferences in pediatric neurology, neuropathology, neurosurgery, electroencephalography, and neuroradiology.

There are available special research opportunities relating to ongoing research projects being conducted by neurology staff personnel. Students may participate in these projects during elective time. Currently, research is being conducted in the following areas at the Hennepin County Medical Center: cerebrovascular disease, clinical (special studies of therapy in the ICU, studies of predicting outcome in stroke patients) and basic studies(coagulation, platelet, and fibrinolysis abnormalities in stroke patients);multiple studies in aphasia and higher cortical function being performed under the direction of Dr. Alan Rubens in the aphasia program; studies in pharmacokinetics of anticonvulsant drugs; studies of etiology and therapy of dialysis dementia, study of memory and cognitive disturbances in Korsakoff's syndrome.

June 27, 1978

It's been a few years now since the last update. First, to fill in some personnel changes: The medical staff is essentially the same with a new addition July 1, 1978 of our second full-time pediatric neurologist, Dr. Gerald Slater. Gerry trained with us in pediatric neurology, and looks like a welcome addition. I am sure he will be of considerable help to Steve Smith, who's been overburdened with teaching and service activities in pediatric neurology. In addition, Dr. Smith has been developing very active programs in electronmicroscopy studies of nerve and cerebral biopsies. We have replaced Marilyn Sullivan, who was a neurology secretary for a number of years, with Pamela Thinesen. Michele is doing an excellent job and soon will be promoted to senior departmental secretary. Vickie is still with the aphasia program, and we have a fourth secretary assigned primarily to EEG, Mary Jorgensen.

We have been funded for our first G5 position and have hired Dave Good, who will be finishing our program to begin July I for one year as aG5 resident. Actually, he will be doing some research in the ICU with ICP monitoring, working generally on our stroke programs, doing some medical student teaching, and serving as an additional young staff man. At the same time, Dr. Rubens has hired another one of our recent graduates, Dr. Gary Platt, to spend a year as an aphasia fellow doing some research in aphasia plus helping out on the ward, with clinics and consults, and also with some medical student teaching.

We might as well let the record show now that Dr. Rubens has scored a major coup receiving a large, five-year contract from the federal government for the study of spontaneous improvement in aphasia following stroke. This grant has allowed him to hire large numbers of support people: neuropsychologists, speech therapists, biostatisticians, computer experts, nurse practitioners, and secretaries. There has been a major expansion of personnel in our department as a direct consequence of this research effort. It is certainly a tribute to Dr. Rubens that he was able to procure this project in competition with the rest of the country. The initial plans were to fund two or three projects as feasibility studies, but Dr. Rubens' grant was so far superior to all the others that the people with the money in Washington decided to put all their eggs in this basket and funded only one major study and that's ours.

We've been through a few social workers since my last dictation. Barb Johnston left and was replaced by Susan Bondow, who will be leaving soon and will be replaced by Paul Goldstein. Paul's now gone the full circle, as he initially started out as a neurology social worker and left the hospital to run a nursing home, came back to the hospital as a social worker in medicine, and has finally returned to the spot where he really belongs, and that's neurology. We're delighted to have Paul back.

Carol Bird has left as neurology nurse supervisor, and we have an excellent replacement in the form of Kathy Miller, who comes from Ann Arbor, Michigan. There was a rather long period following Carol's departure when we had no effective leadership on the ward and nurses' morale deteriorated. Kathy's gradually reestablishing the kind of nursing service that we all feel we need and can have on neurology. She's recently hired a head nurse from within our ranks which should further bolster our morale, Bill Borgman.

In our outpatient clinic, Sue Mahanke has left to go to the Comprehensive Epilepsy Program. A more than adequate replacement is Diane Dusek, who was ten years in practice with an internist, had extensive experience in other hospitals, and is a very mature and experience nurse practitioner. She's proving every bit as valuable as Sue was, and is rapidly developing expanded interests and capabilities.

Dr. Resch has been running the University reasonably effectively since taking over for Dr. Baker. The University has finally lost the large cerebrovascular research center grant but that was expected. A few people have been released. The one of most immediate concern is Phyllis Krull, who had been running our coagulation laboratory for over 15 years and who is no longer going to be with us. Funds for her salary came from the stroke research center grant, and in June of 1978 we closed the coagulation lab. Phyllis at that time was looking for a job elsewhere in the University program.

Dr. Resch has brought in some new staff people at the University, Dr. Birnbaum from New York who has a special interest in neuroimmunology, and Dr. Robert Roelofs who's been at Vanderbilt University for years. Dr. Roelofs was a former resident of ours in Minnesota and returns with expertise in nerve and muscle biopsy work, so I think we're gradually diversifying and strengthening the University neurology faculty. The situation at Ramsey seems stable and strong, although Al Hauser is leaving to go to a good job in epidemiology in New York. Probably our weakest link is the VA where Dave Webster has been holding things together, but does not seem to be able to recruit very strong faculty.

Our own situation here has been characterized not only by some problems with inpatient nurse morale, but also problems with staff morale. We've been forced to move from 33H (which we designed as our neurology inpatient unit) to 32G because of low occupancy figures. 32G was not well suited to our needs, and we are currently completing some fairly extensive remodeling which has improved the situation considerably. We need to improve the kinds of neurology admissions to continue to make this a high quality training program. It looks like one of my principal projects for the next year or so is going to be to convince the staff that we do have a favorable long-range capability and to replace some pessimism regarding our inpatient program with some enthusiasm and optimism. I don't think this is going to be too difficult. I believe we have a strong, viable department and are simply experiencing, in a somewhat more exaggerated form than usual, the ups and downs of departments in municipal hospital programs. We've been through these cycles before and have survived them; I am certain we will again.

Just as an illustration of our strengths, a listing of current projects includes the following: Huntington's Disease Clinic, Neuromuscular Clinic, muscle and cerebral biopsy program, aphasia and higher cortical function unit, special intensive care unit programs, Headache Clinic, and Diane Dusek's offer to our ambulatory patients neurocutaneous stimulation, relaxation therapy, and intensive outpatient education. New projects include a comprehensive stroke care program, a stroke evaluation study with Dr. Kiresuk and the people from Mental Health, participation in the International Cooperative Study of Extracranial/Intracranial Bypass Surgery for Stroke, the establishment of a sleep disorders center, expansion and formalization of our Headache Clinic, institution of intracranial pressure monitoring study in the ICU, and purchase of new equipment for auditory evoked potential studies.

I think with our current staff, current activities, improving situation on inpatient nursing, plus a little leadership from myself, we can get over this slight "slump" and look forward to new and exciting activities in the department. The long range viability of our institution looks reasonably secure. There is currently a long-range planning committee looking specifically into available options for us. I am sure the next report will sound a more optimistic note.

November, 1979

In reviewing my last dictation on June 27, 1978, 1 noted a good bit of attention was devoted to morale problems. To begin this update, I think those morale problems have largely been alleviated. I believe we have a strong, viable, active and exciting group now, who have all developed special interest areas of their own. For example, Dr. Rubens continues to actively lead the Aphasia contract as well as supervise the Aphasia and Speech Pathology section of our department. Dr. Cranford has developed national as well as local reputation for bio-ethics and the hospital has just formed one of the first Bio-Ethics Committees with Dr. Cranford as head. Dr. Anderson is working with non-invasive vascular studies and investigating Doppler and oculoplethysmography techniques. Dr. Mahowald is in charge of our EEG program, has developed an interest in auditory evoked potentials and is working with me in the Sleep Disorders Center. Dr. Smith is very active in neuromuscular disease and he and Dr. Roelofs have established a Neuromuscular Disease Clinic at the Universityof Minnesota and have been approved by the Muscular Dystrophy Scoiety ofAmerica as a muscular dystrophy clinic. Steve is also doing biopsy work, both peripheral and neuromuscular disease and central, with respect to brain biopsy, utilizing electron microscopy. Both he and our other pediatric neurologist, Gerald Slater are providing some outside consultation in pediatric neurology. Further Dr. Slater is very interested in sodium valproate as an anticonvulsant and has had some papers published and is currently writing a chapter in a textbook. Dr. Ettinger has been working hard along with Dr. Mahowald on developing the Sleep Disorder Center. We haven't widely advertised the Center yet. We've already seen 50 patients. We're remodeling an area on the floor above us for our sleep center, and have ordered some new equipment; including a Grass polygraph and Hewlett-Packard ear oximeter and we'll be ready soon to do all-night sleep recordings in our new sleep laboratory facility. We have recently been approved by the hospital administration for a full-time secretary for the Sleep Center. We'll probably transfer one of our current secretaries, Susie McKitterick and hire a new secretary to replace Susie in the neurology unit. The Huntington's disease program continues to do well and meets once month. Dr. Ettinger, in collaboration with Dr. Jack Sheppard from the University, has submitted a research proposal for a Huntington's disease Center without Walls and we're currently working with the state grant to initiate some epidemiologic, genetic, and basic research activities in Huntington's disease patients and families. Dr. Ettinger's recently had some conversation with the Alzheimer's disease organization, and collectively, they are considering the possibility of opening an Alzheimer's disease Clinic at our institution.

There has been some change in our secretarial personnel. After almost five years, Michele Fatze has left us to return to school and has been ably replaced by Vicki Kent. Susie McKitterick has indicated an interest in becoming the Sleep Disorder Center secretary and has been assisting Dr.Ettinger with sleep patients, has been active in getting out the sleep newsletter and also participates in the narcolepsy group meetings that have been held to date. Sue Counter has left us and we are currently looking for anew aphasia secretary. Mary Jorgenson is still working with us and we will be recruiting for a new secretary as indicated above, shortly.

We had an addition to our medical staff as of July of this year. Dr. Barbara Patrick joined us. Dr. Patrick, who is a familiar face around here, was first a medical student with us, then took some research time with us, interned with us; after her internship, spend a year as a research fellow with us and then had her residency with us. We're glad to have Barb back. She's doing an excellent job. She's in charge of our out-patient program and will be training in our new nurse practitioner. Which brings me to the next point. Diane Dusek, who has been our nurse practitioner for three years, will be leaving to pursue other professional interests December 1, 1979. We are currently interviewing for a replacement and Barb Patrick will be training in Diane's replacement. We'll surely miss Diane. She's helped us understand how a nurse practitioner can function effectively within our unit and we're looking forward to working with her replacement. Barb Patrick is continuing the work Dave Good started with the Comprehensive Stroke Care Program and that seems to be going very well. In fact, the Wednesday chart rounds are becoming a very popular place for many disciplines to meet and interact and the room is getting too crowded to hold the number of people in attendance. Barb further has improved our relationships with MMC rehab. She is spending a fair amount of time over there with our patients. We're keeping more direct control over our patients who are transferred to rehab and Barb is interacting with the people over there, giving lectures, attending conferences and generally improving our image in MMC rehab as well as sharing continuity of care, and seeing that proper patient referrals are made back to our own hospital personnel, when appropriate.

There have been a few additions to Dr. Ruben's contract personnel. Loren Jordan has come on board. He's a computer man with a neuropsychology background. He has promised to help us computerize some of our departmental activities, once he gets the Aphasia contract information flowing as smoothly through the computers.

Pat Wahoske has taken over for Mike Johnson as head of our speech program. She has had a number of new people working with her including Thelma Fung, Jan Schaub, and Nancy Niccum. Since Pat's taken over, there has been a significant increase in activity in this area. We're supplying more services; the group is considering long-range objectives and in short, seems to be functioning much more efficiently than it has in the past.

I think I've covered our EEG department in the past. We now have three very capable EEG technicians, Katie Junhke, Linda Dagrud, and Claudett Yutesler. They're doing an excellent job and have taken a real interest in the sleep program and are alternating in the overnight and all-day sleep studies. I think we have a very strong EEG department. I hope we can hold on to all these people for awhile.

SUMMARY: At least the perspective on the department in November 1979 looks good. We're busy, new programs seem to be developing or expanding, everybody is busy with patient care and teaching in addition toothier own special interests, and I hope the next report can forecast as optimistic future as this one.

January 1984

It appears as if I have let allot of time lapse since my lost update which was dated November 1979.

Regarding our neurology staff, we have essentially the some group with one recent addition. Drs. Rubens, Anderson, Cranford, Mahowald, Patrick, Smith and Slater have all been around for a number of years now and we have just received approval from both the hospital and the fledgling practice plan, Hennepin Faculty Associates, for a new addition to our staff of Dr. Scott Bundlie. Scott come through our residency program, spent two years as a post-graduate fellow, working full-time with us and has developed skills in both the sleep area and the evoked potential area. He is being hired primarily to help us with our sleep center expansion plans.

Regarding the Sleep Center. My last update indicated we were just getting started. We now have a very active sleep center program. Our two rooms are being used every night of the week and we are beginning to fall behind in referrals. We have a large and active multidisciplinary sleep center faculty. Our staff includes a sleep center secretary, Susan Seeman; four techs including a senior sleep laboratory technologist, Andrea Patterson, Stephanie Thole, Michele Trufant, and Mary Stock. We have just convinced the hospital to purchase some ambulatory equipment for us for in-home sleep monitoring. Drs. Mahowald and Bundlie will develop that program. We are also interested in the very near future of working with Urology, Psychiatry, and other departments in developing an impotency evaluation program.

There has been quite a bit of turn over in our secretarial staff. Currently Kathleen Hein has replaced Vicki Kent who was the senior department secretary for a number of years. Mary Brown remains the EEG secretary. Cynthia Kleinendorst is the Neurology secretary and Doreen Engebretson is the Aphasia secretary.

The EEG department has been expanded to include evoked potentials and that is gradually becoming a larger and larger component in this groups activities. We have the some capable three EEG techs we have had for some years now; Katie Juhnke, Linda Dcigrud, and Claudett Yutesler.

On the ward, Bonnie Watkins is our nursing supervisor and is doing an outstanding job. There is better stability and improved morale amongst the ward nurses than we have noticed for a long time. They are improving their nursing skills. They are learning more ICU techniques and things are very stable in that department. Our new social worker is Ed Biren who has been very active in special clinic activities and support group activities.

Our clinic operation under the direction of Dr. Barbara Patrick is slowly improving and enlarging. Our Huntington's disease clinic continues as a very active and important program which is multi-disciplinary which involves people from genetic counseling, patient advocate (Sally Hogan), our nurse practitioner Beryl Westphal, and a new program that has opened in our area is the decision by Oak Ridge Nursing Home to become a center for Huntington's patients requiring hospitalization. In addition, they are offering daycare and temporary lodging programs. This is probably the first such in-house program for HD patients in this country and is modeled after the Furst unit in Australia.

Probably the biggest news is the decision of the medical faculty to organize into a practice group. After long difficulty negotiations with the County a contract between the new practice group called Hennepin Faculty Associates (HFA) was signed and we are now busy with many committees trying to reach a target date of 1 April 1984. Dr. Ettinger is right in the middle of all of this activity. He is a member of the Board of Directors, Secretary of the Organization, a member of the Executive Committee, and was on the negotiating committee. Dr. Schultz is Chairman of the Board of Directors and Executive Committee. Dr. Fred Shapiro is the President of the Practice Plan.

Our Speech and Language program is an excellent one thanks to Pat Wahoske's expertise and guidance. Currently members of her department include Karen Orcutt and Maxine Slobof.

Dr. Gail Risse is our Neuropsychologist, and Elizabeth Destafney is our psychometrist rounding out our staff of professionals. They have been with us for a long time and continue to do outstanding work. They are collecting data for a number of publications including a longitudinal serial study of the Huntington's patients, special testing of corpuscavernosum patients in collaboration with the University Epilepsy program and a number of other projects.

The report would not be complete if I did not pay some special attention to our Nurse Practitioner, Bootz Westphal who is doing an outstanding job of providing continuity of care to large numbers of patients with chronic neurologic conditions such as epilepsy and to our outstanding clinic nurse Jan Schluter who has also become very active in our sleep center program. Jan has been called upon to give a number of lectures and presentations to nursing groups and other groups on various sleep topics and has just been asked to write a chapter on sleep disorders in a nursing textbook.

In summary, the perspective on our department in January1984 suggests that is it a strong viable and well functioning department that should enjoy a good year assuming I can get the physicians to document all of their charges for the practice plan. I will try to make the next update within a year or so.

M.G. Ettinger, M.D.

Chief of Neurology

Hennepin County Medical Center

August 6, 1986

In early 1953, the Medical Director of Minneapolis General Hospital, Dr. Thomas Lowry, approached Dr. Harold Noran, a practicing neurologist in Minneapolis regarding the establishment of a neurologic unit at the Minneapolis General Hospital. Prior to that time hospitalized neurological patients had been seen by downtown consultants who had volunteered their time to provide the hospital with neurological coverage. No teaching program in neurology had been developed for the interns or residents. Following discussion with Dr. A.B. Baker, Professor and head of the Neurology Department at the University of Minnesota Hospitals, a neurology program was initiated at Minneapolis General Hospital in July 1953 which was affiliated with the University of Minnesota and under the direction of Dr. Harold Noran. Dr. Baker agreed to assign a neurology resident to the service and Dr. Lowry who was also the Chief of Internal Medicine assigned a medical resident. Two rotating interns were also assigned to the service at that time.

The first neurology patients were admitted principally on the medical service, but were placed in beds wherever they were available throughout the hospital, often on urology or ENT services. Approximately 15beds were designated as neurologic beds. Two rotating interns and two residents were responsible for the evaluation and care of these patients and they were supervised by Dr. Noran who made daily word rounds on the service.

In late 1954 in cooperation with Drs. Noran and Baker, a geographically and administratively independent neurology department was established on station 7 of the annex building. 28 beds were assigned to Neurology and Dr. Baker appointed a part-time instructor from the University of Minnesota Neurology staff to assist Dr. Noran in the supervision of the teaching program in Neurology. Dr. John Logothetis held this position from 1954 through1956.

In 1957, a three year training grant in Neurology was obtained from the United States Public Health Service through the efforts of Dr. Noran and Dr. Baker. The training grant supported some salary items for residents, an EEG technician, and part-time staff. Throughout the three-year period from 1957 to 1960, Dr. David Mendelson was assigned from the University and Dr. Noran continued as Chief of Service.

In 1960, Dr. Milton G. Ettinger was appointed as the first full time faculty in the program. The training grant from the Public Health Service had lapsed and the support of the Neurology program was contributed principally by the University of Minnesota with some slight contribution from the hospital. From approximately 1963 to the present time, the Neurology Department has had three residents assigned from the University Neurology program, generally one senior resident and two first or second year residents. Additional residents from Internal Medicine, Psychiatry, and Family Practice rotate through the program and interns from a wide variety of training programs also receive some training in Neurology.

Beginning in 1964, medical students were assigned by the University of Minnesota to the Neurology Department at Minneapolis General Hospital. That assignment has continued to date with both Phase B and Phase D students rotating through the service.

Early neurology staff, in addition to Dr. Ettinger, included: Dr. A. Ellington who was on staff from 1964-1969 and Dr. William Riley who was on staff from 1965-1970. Dr. Riley was awarded the Distinguished Teaching award by the University of Minnesota Medical Students in 1966.

In 1970, Dr. Riley left the staff to become a neurologist in private practice in Houston, Texas. Dr. Alan Rubens was hired as his replacement and was appointed as Assistant Chief of Neurology. Dr. Rubens, in addition to being trained in Neurology had received additional training in Behavioral Neurology and shortly after his arrival at our institution developed an active Behavioral Neurology program with the addition of Neuropsychology and Speech and Language Pathology programs. Dr. Rubens left the Hennepin County Medical Center in June of 1986 to become the Chief of Neurology at the University of Arizona, Tucson. During his 16 years on staff, Dr. Rubens made many major contributions as an outstanding teacher and clinician. In addition, he was awarded the largest single grant ever awarded in aphasia by the National Institutes of Neurologic Diseases for a five year study on the Recovery of Aphasia Following Cerebrovascular Accident. Dr. Rubens collected a large, multi-disciplinary research team. The publications that continue to eminate from that research project are providing the framework for understanding the natural history of the recovery of aphasia following stroke and have proven to be a valuable contribution to the literature in that area.

In 1971, Dr. Ronald Cranford joined the staff. In addition to his work in developing our Neurology Intensive Care Unit and being the first to publish guidelines regarding the utilization of intravenous Dilantin for the treatment of acute seizure disorders, Dr. Cranford has developed a national reputation as an expert in biomedical ethics. He currently enjoys many prestigious appointments including Associate Editor of the journal Law, Medicine and Health Care. He is the President Elect of the American Society of Law and Medicine and was a participant on the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research.

Additional Neurology staff and their special areas of interest or expertise include: Dr. David Anderson who has also received the Outstanding Teacher Award from the University of Minnesota Medical Students. Dr. Anderson's commitment and dedication to medical education are widely recognized. In addition, he has numerous publications in cerebrovascular disease, evoked potentials, etc.

Dr. Mark Mahowald was for many years the supervisor of our EEG Department and along with Dr. Ettinger developed the Minnesota Regional Sleep Disorders Center. Currently he is spending full time with the Sleep Disorders Center.

Dr. Barbara Patrick has maintained the Huntington's disease Clinic since joining our staff and also has developed expertise in electromyography. Dr. Patrick also holds specialty clinics for patients with movement disorders (and/or Parkinson's disease.

Dr. Scott Bundlie is a fairly recent addition to our staff. He has a special interest in ambulatory monitoring for both EEG and Sleep Center patients. He is developing our program in the Sleep Center for monitoring nocturnal penile tumescence in the assessment of impotence. Dr. Bundlie is also interested in stroke and head injury.

Dr. Stephen Smith, a pediatric neurologist, has developed a major referral activity in the area of nerve and muscle biopsy interpretation. In addition, he is active in assessing brain biopsies using both light and electron microscopic techniques. Dr. Smith also has an active interest in Huntington's disease Clinics, has been involved in national and local ataxia societies, and conducts special clinics for patients with neuromuscular disease at both the University of Minnesota and at our facility.

Dr. Gerald Slater, our second pediatric neurologist, has been actively involved in research of anti-epileptic drugs and more recently has conducted a study of the efficacy of hyperbaric oxygen therapy in patients with chronic multiple sclerosis. In addition to his clinical activities, Dr. Slater is currently actively involved in the administrative aspects of Hennepin Faculty Associates and serves as Treasurer of that organization and Chairman of the Finance Committee.

Our newest arrival, Dr. Frederick Langendorf, began with us in July 1986 as Dr. Rubens' replacement. Dr. Langendorf, following his neurological residency has had a one year Fellowship in EEG and evoked potentials and has taken over our EEG and evoked potential programs for Dr. Mahowoild. In addition to these activities, Dr. Langendorf will be developing a head injury clinic for the evaluation of patients with mild to moderate head injuries.

The current areas of interest in the department are:

1. The growth and development of the Minnesota Regional sleep Disorders Center which will probably be expanded from a four to an eight bed unit in the near future.

2. the continuing major commitment of all the faculty to education of the house staff and medical students which as resulted on two occasions in the awarding of the Distinguished Teaching Award by the medical students to a neurology faculty person.

3. Recent interest in a coordinated institution-wide head injury program with a particular emphasis on an evaluation clinic for patients with mild to moderate head injuries.

4. Continuation of special programs in Huntington's and other extra pyramidal diseases, neuromuscular disease, and cerebrovascular disease.

1990-1995 by David Anderson

The department faculty has changed since last entry and the change includes an increase in size. Al Rubens left to be Chair of Neurology at the University of Arizona in 1986. Fred Langendorf, an electroencephalographic ande pileptologist, took his place. Two years later William David was recruited. Dr. David, an MD PhD trained in neurology in the Harvard-Longwood Program, had just completed fellowship training in EMG at the Lahey Clinic. Expansion of EMG services and of Steve Smith's neuromuscular program was envisioned with the addition of Dr. David. It became quickly apparent that Dr. David was not only a talented electromyographer but also an outstanding clinician. Dr. Ettinger had become increasingly convinced that a pain program would be a valuable addit