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History of The Medical Practice of Neurology in St. Paul

 

The earliest records of medical practice in the territory of Minnesota date back to 1819 when Dr. Edward Purcell arrived with the Fifth Regiment of the Army at Fort Snelling.

In the next 30 years physicians trickled into the Minnesota territory along with the influx of adventurers and pioneers. The formally trained physicians were outnumbered during this time by a poorly trained ragtag of charlatans, apprentices and snake oil salesmen. To distinguish themselves from this rabble, the “regular” practitioners met in 1853, at the invitation of Dr. W. Finch of St. Paul, and formed the Minnesota Medical Society with Dr. Thomas Reid Potts as its first president.

These early physicians were primarily trained in the east with some pursuing, as was fashionable, additional studies abroad in Vienna, London, Paris, Edinborough and centers in Scandinavia and Germany. The first effort to train local physicians was the short-lived St. Paul Medical College formed as a division of Hamline College in 1880. They deferred to the University of Minnesota in 1888 recognizing it as a more likely cite to establish a medical college. In the last years of the nineteenth and first few years of the twentieth century, continuing improvements and advancements were taking place in the field of public health and health delivery systems. The Minnesota Board of Health was formed, anatomic dissection legalized and immunizations started. Physicians, through their societies, performed reviews of their member's academic credentials. Membership in the Minnesota State (Minnesota became a state in 1858) Medical Association and the Ramsey County Medical Society (RCMS) therefore conferred a certain level of competency as judged by their peers.

The earliest libraries were in the homes of physicians. It was a measure of academic and professional pride if one had a large library. The concept of sharing one's collection of books evolved in the late 19 th century in St. Paul and led to the development of the RCMS library. The medical library of the Ramsey County Medical Society and the St. Paul Medical Journal was put on firm financial footing by Dr. Edwin Boeckman. He turned over the profits of his successful absorbable suture company to the Journal and Medical library.

By 1909 there existed enough physicians interested and trained in “diseases of the nervous system” to respond to an invitation by Dr. C. Eugene Riggs to meet at The Minnesota Club to form The Minnesota Neurological Society(MNS). Dr. Riggs became it's first president. Dr. A. I. Hamilton was elected society secretary. The other charter members were Drs. A.W. Drunning, Leo M. Crofts, B. Johnson, Charles Balk, R.O. Beard, and W. A. Jones. The minutes of the meetings of The Minnesota Neurological Society were carefully recorded in exquisite handwritten cursive script in a 350 page red leather bound volume by the elected physician “secretaries” themselves. These were no “arm-chair shrinking violet” neurologists but serious and involved physicians who presented, at each meeting, at least two cases of interest, accompanied when possible by pathologic specimens. The cases, as the minutes attest, were then thoroughly discussed. Over the period of a calendar year, a wide variety of central and peripheral neurological cases would be discussed, care being taken not to repeat similar pathology.

From the minutes I read about a variety of tumors including c-p angle, pituitary, epend ymomas and gliomas. Other cases included MS, various vascular pathologies such as infarcts and aneurysms, spinal cord damage from trauma and pernicious anemia, infectious diseases including tuberculosis and meningococcal meningitis, encephalitis, myasthenia gravis, muscular dystrophy, plexus injuries, dementia praecox, etc.

The membership gradually changed with new members added and deaths occurring. Obituaries contained interesting information about this period. They are fascinating, not only about the deceased, but about the nature of neurological practice and of the status of neurological patient care as well. The following are some examples:

Dr. A. C. Rogers died in 1917 and was lauded for his kindness and benevolent nature. He was superintendent of the Faribault school “for the feeble minded” which became a model for similar schools across the country. During his 31 year tenure, the institution's population increased in the number of “inmates” from 50 to over 1600.

Arthur Sweeny who died in 1929 was trained at Harvard. He practiced in Minnesota in a general practice setting then returned to Harvard where he took postgraduate training in nervous and mental diseases. Upon returning to Minnesota he practiced in neuropsychiatry and lectured in jurisprudence at the University of Minnesota. His special expertise was in expert witness testimony.

Membership additions to the Minnesota Neurological Society included Dr. Ernest Hammers, recorded in the minutes as a new member in 1911. Dr. Ernest Hammes Jr. followed his father into the private practice of neuropsychiatry in St. Paul and bridged the early period of neurology described above, into what we now regard, as a more modern era of formal residency and certification.

In 1909 Dr. Abraham Flexner surveyed the University's fledgling medical school and found its future hopeful. It lacked a central, primary hospital but the future seemed bright.

McKinley was added as a society member in 1921 and later became the successor to Dr. A. I. Hamilton as head of the department of Neurology at the University. Dr. Riggs, the first Chief of Neuropsychiatry, had resigned, from his position. His resignation was secondary to a variety of irritations. He was upset with the Minnesota legislature over its lack of financial support for the University. He also, along with other faculty, was annoyed about obvious conflict of interest resulting from William Mayo's position on the University's Board of Regents. Dr. W. W. Mayo, they alleged, had managed to help deflect a million dollars of legislative support, a part of which was destined for the University, to the Mayo Clinic. The final straw occurred when an official affiliation between the University and Mayo was passed by the University Regents over the objections of 200 leading Minneapolis and St. Paul physicians, the state and both twin city medical societies as well as the state's medical alumni. Particularly galling was the statement issued to the University faculty that they were not to oppose this agreement.

After the contentious affiliation with Mayo was passed by the University Regents, and with the accompanying resignations of key faculty, the University was set back in it's development while Mayo was given a boost.

This was the chaotic situation present when Dr. Flexner made his 4 year follow up visit in 1923. He expressed disappointment with the lack of progress shown by the University's Medical School. Dr. Flexner's influence and prestige in medical education at the time was enormous and thus his stinging assessment was too much for some of faculty to bear.

There was little improvement during the Great War (WWI), and it was only in the depression and especially post depression years that real progress was made.

Royal Gray became a member in 1929 and was later appointed Chief of Neurology at Minneapolis Veterans Hospital.

The meetings of The Minnesota Neurological Society, later known as the Minnesota Society of Neurology and Psychiatry reveal a change in the group's cohesiveness and collegiality by the mid-1930's. In the first 25 years meetings alternated between St. Paul and Minneapolis and case discussions were the primary agenda items. The practice of medicine gradually became more complex and regulated and no doubt the depression years affected medical practice as well. Case presentations gave way to invited speakers and guests.

In 1940, Dr. J.R. McKinley, a member, invited Dr. Stark R. Hathaway (Psychologist) as a guest to discuss their new approach to the differential diagnosis of mental diseases. This “new method” led to the development of the Minnesota Multiphasic Personality Inventory (MMPI) which is ubiquitous now and used in situations far different from the original intent.

William Mayo from Rochester, Minnesota attended a meeting as a guest and gave a talk on a subject not described. There was some interaction with neurologists at Mayo Clinic and to a lesser extent with Duluth, but the neuropsychiatric specialty developed largely independent of one another at the local level.

In the 1930's the generation of older neurologists who formed a small but dedicated group in the first quarter of the 20 th century whose interests were predominantly neurological had all but disappeared. It was at this time that psychiatry became more popular and clinical neurology interest declined. Whether it was due to the popularity of analytic psychiatry with a wave of prominent figures such as Freud and Jung or the promise of treatments where none previously existed is unclear. It may have been at about this time that neurology got the reputation of a nihilistic clinical specialty, a criticism which kept the numbers of clinical neurologists down for the next 30 years.

The formation of The American Board of Psychiatry and Neurology in 1934 established a five year tract leading to certification. This included three years of formal residency followed by a two year practice experience and then a thorough testing by senior neurologists on live patients.

This credentialing took much of the onus off the local societies as to who was indeed qualified to regard himself as a specialist in Neurology and/or Psychiatry. At first equal amounts of time devoted to psychiatric and neurologic topics were expected. Dr. A. B. Baker became neurology section head in 1938 and quickly anticipated the national trend which soon accepted the reality that trainees were going to specialize either in psychiatry or neurology. With his first residents Dr. Zondal Miller in St. Paul, Drs. Harold Noran and Joe Resch in Minneapolis it became evident early that trainees from his program were neurologists first and foremost.

Despite the predominant training in neurology during his residency, it was with some trepidation that Zondal Miller opened his practice as a neurologist while still doing enough psychiatry, including electroshock therapy to keep busy.

Dr. E. Hammes was associated with Dr. Norman but it was Dr. E. Hammes Jr. who trained at the Mayo Clinic that continued a practice of both psychiatry and neurology

and did both with distinction.

Dr. Miller added young neurological associates in the 1960's in the form of Dr. Richard Foreman, Terrance Capistrant, Thomas McPartlin and Paul Schanfield. Neurological Associates of St. Paul was started by the 3 founding members of Foreman, Capistrant and Schanfield. This group, under the same name now, consists of nine active neurologists and two retired members. They are Richard Foreman (retired), Dr. Terrance Capistrant (retired), Dr. Paul Schanfield, Dr. Charles Ormiston, Dr. Thomas Jacques, Dr. Dr Nadeem Iqbal, Dr. Zohreh Mahavi, Dr. Scott D. Callaghan, Dr. Laura Li, Dr Peter Boardman and Dr. Kenneth Hoj.
Both Dr. Thomas McPartlin and Dr. Brian Krasnow carried on long and successful careers entirely in St. Paul for the most part as solo practitioners.

Drs. Neil Dahlquist, John Floberg and Craig Hyser practice under the name Capital Neurology.

Ancker Hospital was staffed until it's last year, 1964 by residents and interns under the guidance of private, also known as “downtown” physician consultants. This was “the public hospital” in St. Paul and despite caring for the population who could not afford a private hospital it was widely and also correctly perceived to be an outstanding emergency center where anyone would wish to be taken in the event of incurring multiple complex injuries, burns, etc. A new public hospital was built and the name was changed from Ancker to St. Paul Ramsey Hospital.

The teaching staff, that is private verses salaried University faculty, changed gradually in some departments. In some others the University faculty assumed complete control in short order. Dr. Gill Ross in 1963 was appointed the first full time Chief of Neurology at the new hospital by Dr. A. B. Baker, U of MN Neurology Department Head. Dr. Bob Gumnit, recruited by Dr. Ross, assumed the Chief of Neurology title in 1964. He served as chief until ?.... and then founded The Minnesota Epilepsy Care Center in Minneapolis. He was followed by Manuel Ramirez until physician staffing was assumed by a large HMO.* The latter physicians are beholden to their parent administration and do not, for the most part, interact or associate with the private St. Paul Neurological community.

HealthEast has inaugurated a new quasi-neurological practitioner called a neuro-intensivist. This person is hospital based and trained to diagnose and treat urgent

neurological conditions such as post operative complications involving b.p., cerebral edema, seizures, fluid and electrolyte imbalance, etc. This physician does not, as yet, correspond to a recognizable clinical neurologist but is an example of how much the field of neurology, indeed all fields in medicine, are changing.

I suspect the future neurologists will be as unrecognizable to many of us “hangover types” as we will appear quaint and primitive to them.