Dr. Robert F. Loeb (1895-1973)
A common phrase heard at many medical centers is “Days of the Giants”, referring to an earlier era in which legendary physicians supposedly strolled the wards. In its most common usage, the term implies that these earlier doctors were somehow superior, either due to their dedication, knowledge, or teaching skills. For decades, medical school alumni magazines have promoted this idea by publishing laudatory feature stories and obituaries about past professors. These articles provide fond memories for alumni and reflect on past accomplishments by the institutions in question.
As time marches on, virtues are recalled and blemishes forgotten.
Lately, however, alumni publications have begun to publish pieces that recount darker episodes in the history of medical centers and that even criticism renowned physicians.
The study of medical history is inextricably intertwined with the reverence of earlier physicians. The first historians of medicine were themselves doctors, often retired, who decided to document past medical achievements, many of which they themselves had witnessed. Characteristic of these works was the assumption that as each new generation of physicians marched forward, they stood on the shoulders of the previous one. Among the best known of such works is the Pulitzer Prize-winning 1925 biography of the acclaimed early 20th-century physician William Osler by his former trainee and colleague Harvey W Cushing, himself a renowned neurosurgeon. Occasional scholars, most notably Swiss-born physician-historian Henry E Sigerist, bucked this trend, studying both “great men” as well as the economics and politics of medicine, but it was not until the rise of social history in the 1970s that equating historical progress with the achievements of great doctors was formally challenged. These social historians not only situated medical history in a social and cultural context, but often criticized past physicians as having been autocratic, sexist, and racist.
For the most part, medical school alumni magazines have been immune from this historiographical trend. But over the past several years, this has begun to change. For example, in 2004, Dartmouth Medicine published an article on a 1966 episode in which eleven Dartmouth professors resigned in protest of organizational decisions made by an “authoritarian” dean, Gilbert Mudge. 2 years later, Yale Medicine ran a piece on Cushing, whose family was donating his collection of brain specimens to Yale, stating that many of the revered neurosurgeon's contemporaries saw him as “an egotistical, hard-driving, selfish, mean son-of-a-bitch”. Nevertheless, it was surprising when, in 2007, the P&S Journal (now Columbia Medicine, the alumni magazine of the Columbia College of Physicians and Surgeons), began to publish a series of frank assessments of the career of Robert F Loeb, a legendary physician and professor who was the chairman of Columbia's Department of Medicine from 1947 to 1960. Not only are there physicians still at Columbia who worked directly with Loeb but his son, John, remains on the faculty. The writers—largely alumni—have fiercely debated Loeb's legacy, terming him, among other things, “abusive” and “scornful”. What lessons can be learned by revisiting the past in such a provocative and honest manner?
Loeb was born into a medical family. His father was German-born Jacques Loeb, a world-renowned physiologist and a founding member of the Rockefeller Institute for Medical Research. After completing medical school at Harvard and training in internal medicine at the Massachusetts General Hospital and Johns Hopkins Hospital, Loeb moved to Columbia-Presbyterian Medical Center, where he would spend 37 years until becoming an emeritus professor in 1960. In his early years at Columbia, Loeb spent much time in the laboratory, where his seminal studies of Addison's disease clarified how the adrenal gland and kidney maintained electrolyte balance in the body. With enormous ramifications for diabetes mellitus and many other diseases, Loeb's research, many believed, warranted a Nobel Prize. Meanwhile, Loeb climbed the academic ladder at Columbia, becoming the Bard Professor and Chairman of Medicine in 1947. He was often the first physician to arrive in the morning and spent many weekends on the wards, expanding his encyclopedic knowledge of medicine, mentoring house officers and students, and paying extra visits to ward patients he had met during rounds. Loeb was for years the co-editor of the Cecil-Loeb Textbook of Medicine, the bible to generations of internists. In addition, Loeb had an uncanny ability to remember patients he had not seen in many years. In one case, he not only remembered a 35-year-old woman he had treated 25 years before when she was a child, but what bed she had been in and who her residents were. One former student called Loeb the “mentor of mentors” and credited him with his own “life-long dedication to scholarship and the pursuit of knowledge”. With this sort of biography, how could Loeb's legacy become so tarnished?
The critical assessments in the P&S Journal began with a remembrance by Clifton K Meador, who had trained with Loeb and had written a book on famous physicians. Meador painted a complicated picture of Loeb, describing how the senior physician had first effusively praised him for making a diagnosis of Budd-Chiari syndrome but then unfairly turned on him for failing to examine a diabetic patient expeditiously. Meador also described how he later redeemed himself by preventing unnecessary surgery in another patient, but his image of Loeb as arbitrary and judgmental nevertheless persisted. Meador's article inspired other negative recollections by former Columbia medical students and residents who recalled having been put on the spot when making rounds with Loeb on the wards. For example, Alex Caemmerer, Jr, wrote that Loeb had taught by “humiliation and intimidation”, treating students as “the lowest of the low”. When Ollie Cobb suggested that a patient might have Rocky Mountain spotted fever, Loeb responded with a booming “Fiddle-De-Dee”, the phrase he used when a reply did not meet his standards. David Marshall recounted a story in which Loeb told a student who had missed a question to “go down and see the dean and tell him you are through at P&S”. Although Loeb quickly called the student back, the event was nonetheless disturbing. This type of behaviour, Norman Spencer wrote, showed Loeb's “very public and destructive personality failure”. Another anecdote came from Lawrence W Norton, who wrote an article commemorating the 50th anniversary of Loeb's retirement. Although Norton's patient, who had lung disease, felt perfectly fine and had been diagnosed by chance, Loeb repeatedly demanded that Norton describe the patient's symptoms. This interchange apparently infuriated the patient, who barked at Loeb to “leave my doctor alone, you old man!”
What can we learn from this discussion of Loeb's faults?
For one thing, such dialogue can produce a more honest assessment of past medical practice and education. As Dana C Grossman, former editor of Dartmouth Medicine, wrote: “There is surely no P&S alum of the Loeb era who didn't know both sides of his character.”
Such candour thus avoids whitewashing the past.
But more importantly, Loeb's story reminds us of the importance of placing physicians and medicine in proper historical context. Decades ago, it was common for medical students to be drilled with questions, often uncomfortably. Professors genuinely believed that such hazing helped students learn to think on their feet and thus become better doctors. Presentations had to be memorized, again as a way to show mastery of knowledge. The large, impersonal type of rounds that Loeb led, in which dozens of physicians, students, and distinguished visitors crowded around the bedside, often uninterested in the patient's input, also happened routinely.
Paternalism ruled medicine.
Expectations were also drastically different 50 years ago. Physicians, taught to have an almost fanatical devotion to their patients, spent most of their waking hours either in the hospital or reading about diseases.
They spun their own haematocrits and made their own Gram stains.
The terms “house officer” and “resident” bespoke the idea that physicians-in-training were expected to reside in the house—that is, the hospital.
In retrospect, Loeb took this philosophy to its zenith. He had “extremely high standards for himself”, Wendell Hatfield wrote, and believed that all doctors (and nurses) under his command should show the same dedication. When students, residents, or even attending physicians made mistakes or—even worse—cut corners, Loeb saw this as an affront not only to himself but, more importantly, to the patients who deserved their doctors' complete and utmost attention and devotion. “There is no such thing as a dull patient,” he liked to say, “only a dull physician”.
Indeed, Loeb cherished—and remembered—particularly good diagnoses made by young physicians under his tutelage, especially ones that he himself had missed. Years later, he walked by one such doctor and said “You really got me on that one.”
Robert F Loeb (1895–1973)
Copyright © 2012 Archives & Special Collections, Columbia University Health Sciences Library
Medicine today has changed vastly from the mid-20th century. Concerns about excessive workload and sleep deprivation have led to the institution of night floats and the use of physician assistants. Having an outside life is now seen as crucial to the professional development of physicians. Meanwhile, patients are active participants on rounds; members of the team are expected to introduce themselves and never treat patients as “teaching material”. Perhaps Loeb's “true” legacy is to remind us that great doctors, like other heroic figures, often have character flaws. While we should reject how Loeb taught students, we should remember why he acted as he did: his fanatical devotion to the care of patients.
Dr. Robert F. Loeb Dead at 78; Metabolic Expert, Noted TeacheR
Dr. Robert F. Loeb, Bard Professor of Medicine Emeritus and former chairman of the department of medicine at the College of Physicians and Surgeons of Columbia University, who was considered one of the nation's leading medical teachers, died Sunday at his home, 950 Park Avenue. He was 78 years old.
Dr. Loeb was a specialist in diseases of metabolism and was widely known as a foremost clinician and clinical investigator. In 1922 he was one of group of physicians at Columbia who administered the first insulin treatment for diabetes.
Ten years later, Dr. Loeb first demonstrated the role of the adrenal glands in control of Salt and water metabolism. He went on to demonstrate that patients with Addison's disease could be maintained indefinitely by having large quantities of salt their Until then Addison's disease was invariably fatal.
In one of Dr. Lobb's bestknown studies at Columhia, he and other members of the department of medicine undertook a detailed examination of the fluid and electrolyte, abnormalities that accompany the withdrawal of insulin from diabetic patients. The group was able to provide a rational basis for the modern management of diabetic acidosis.
Research on Malaria
During World War II, Dr. Loeb served as chairman of the Board for Coordination of Malarial Studies. Studies under his direction led to the development of chloroquine and a number of other important antimalarial drugs still in use today.
Dr. Loeb served for many years as vice chairman of the board of trustees of the Rockefeller University, as a trustee of the Rockefeller Foundation, as an overseer of Harvard College and as a member of the President's Scientific Advisory Committee under Presidents Truman, Eisenhower and Kennedy.
He was a past president of the American Society for Clinical Investigation, the Assodirtion of American Physicians and the Harvey Society, and was a member of the National Academy of Sciences, the American Philosophical Society and the Century Association.
Born in Chicago on March 14, 1895, Dr. Loeb studied at the University of Chicago. After two years he entered Harvard Medical School, from which he graduated magna cum laude in 1919. He served his interneship at Massachusetts General Hospital and in 1921 after a year at Johns Hopkins Hospital joined the staffs of Columbia University and Presbyterian Hospital.
Co‐editor of Textbook
Dr. Loeb continued to teach and do research at ColumbiaPresbyterian Medical Center until his retirement as chairman of the department of medicine in 1960. From 1947 to 1960 he was co‐editor of the Cecil‐Loeb Textbook of Medicine. He was editor of Martini's “Principles and Practice of Physical Diagnosis,” and in 1962 he served as Regius Professor of Medicine at Oxford University.
The recipient of honorary degrees from numerous universities, including Harvard, Columbia, Oxford, Rockefeller and the Universities of Paris and Strasbourg, Dr. Loeb was cited by Harvard in 1969 as “a man whose career epitiomizes both the compassion and the brilliance of medical science.”
Surviving are his widow, the former Dr. Emily Guild Nichols; a son, Dr. John N. Loeb; a daughter, Miss Elizabeth G. Loeb; a brother, Prof. Leonard B. Loeb of Berkeley, Calif., and a sister, Mrs. Anne L. Osborne of Hampton, Conn.
A funeral service will be held Thursday at 2 P.M. at the Brick Presbyterian Church, Park Avenue and 91st Street.
