Tinsley Harrison, M.D. Teacher of Medicine

Dr. Joe B. LaRussa

June 5,2016

Tinsley Harrison, M.D.

Teacher of Medicine

Medical Giants of Alabama

November 12. 2012

“Clearly, this was going to be no simple book project. Equally clearly, we would be working with a brilliant if eccentric author whose warmth and wit were as obvious as his somewhat challenged filing abilities.”Horace Randall Williams-editor.

He was the quintessential dean: steely blue eyes, glasses, balding, white goatee, bowtie, and long, white, starched lab coat, with name embroidered, and pens in the pocket.

TRH Timeline• 1900- Born on March 18th at the family home in Talladega, Alabama.• 1904- Family moves to Birmingham, Alabama.• 1906- Tinsley starts grammar school-Lakeview School. Skipped 3 grades,

graduated from high school at age 15.• 1915- Marion Inst. Could not enter college at age 15.• 1916- Entered Michigan as a sophomore.• 1919- B.S., University of Michigan. His senior year fulfilled his 1st med-

school requirements. Enters medical school at age 18. ( 4yrs early). • 1919-summer, qualifies to play in the U.S. Open-tennis. Lost in 3rd round to

Bill Tilden- Open winner 1920-1925, 1929.• 1922 – M.D., Johns Hopkins School of Medicine.• 1922-1924- Residency Peter Bent Brigham Hospital, Boston.• 1924-Senior Resident at Johns Hopkins.• 1925- Chief Resident- Vanderbilt.• 1926 – Joins the faculty at Vanderbilt.• 1940- Chairman of Internal Medicine dept. at Bowman Gray Medical

School, NC.*

Timeline con’t

• 1944- Chairman and Dean, Southwestern Medical School, Dallas, TX. **

• 1950- Publishes Principles of Internal Medicine.

• 1950- Chairman of the Dept. Medicine, Acting Dean, Director of Cardiology, UAB. ***

• 1957- Resigns as Chair of Medicine.

• 1964- Names Distinguished Professor by University of Alabama Board of Trustees.

• 1965- Resigns as Cardiology Director.

• 1968- Named Veterans Administration Distinguished Physician.

• 1970-Breaks collar bone slalom water skiing –Lake Martin (rumor has it, he was the oldest to slalom ski on Lake Martin at that time!!)

• 1978- Dies on August 4th, at his home in Birmingham.

• Jim Pittman met Tinsley Harrison in 1956. He left the NIH -came to UAB because of Tinsley Harrison. Despite poverty, civil rights, etc.

• Tinsley Harrison- Physician, teacher, researcher, editor, writer, father. “Chief.”

• Dean Pittman was Tinsley Harrison’s last CR. 1958.

• 7th generation physician. More than 200 publications. Taught for 54 yrs.

• Friendship and colleague 1956-1978.

• Interviewed TRH from July 1973 to his death Aug. 1978. 15 hand held cassette recordings-in UAB archives. Took 41 years to publish book.

• Leading causes of death 1900. (1) Pneumoniae, Flu (2) TB (3) infant diarrhea (4) Cardiac. Life expectancy, 45.

• Leading causes of death 1950 (1) Cardiac (2) Cancer. Life expectancy, 67.

• The greatest period of medicine in all of history-20th century, (1) research, (2) patient care, (3) education.

• Is was Osler who said to Groce about Tinsley, “That boy should be a teacher of medicine.”

Nine Generations of Harrison doctors

Family

William Groce Harrison, Jr. M.D

Louisa Marcia Bondurant (Lula)

• Emily Bondurant Harrison

• Tinsley Randolph Harrison, M.D.

• William Groce Harrison, Jr., M.D.

• Louisa Dabney Harrison

• Alexander Bondurant Harrison

• Sarah Elizabeth Harrison

• Lemuel Woodward Harrison (Woody)

• Emily Louisa Harrison “Mimi”

• Tinsley Randolph Harrison“Randy” DMD.

• Helen Elizabeth Harrison“Betsy”

• John Bondurant Harrison, DMD. M.D.

Tinsley Randolph Harrison, M.D.

Elizabeth (Betsy) Woodward

The Patient

• W. Groce Harrison Sr. M.D.

• “The doctors home was his clinic.”

• Made more money with his cotton crops.

• Chapter 1. The patient. Page 6,10.

Growing up in Alabama

• Sunday mornings- 9:30 Presbyterian church, Sunday school, big lunch. After lunch to his room to memorize scripture. Age 7-verses, age 9 he was required to memorize whole chapters from the bible. ..considered a “guiding point in my life.”

• Page 46

• His mother taught him from two sources; the Christian Bible and Shakespeare.

• Age 6 moved to B’ham. 3818 Cliff road, now 4142 “The Harrison House.” Moved back to the house in 1950 to help build UAB. 1962-house given to UAB.

Harrison Home in Talladega, Alabama where Tinsley Harrison was born March 18, 1900

Tinsley Harrison, circa 1903/04

Nature Study in the South

• Age 12, dad and boys – 8 day hike to Talladega to visit his grandfather, John Tinsley Harrison Jr. M.D.

• Learned names of birds, trees, flowers, animals, also their Latin names.

Michigan, Hopkins, Brigham (1916-1925)

• 1915- At age 15, Tinsley is accepted to Harvard ($650.00/yr.) , with plans to go to law school.

• Cotton prices drop, so goes to Marion Inst.

• Age 16 enrolls at Michigan(cheaper), as a Sophomore. Skips Organic labs, makes an “A,” but summer has to do the lab.

• Age 17 wants to enlist for the war. “The French will take me in the ambulance corp.”

• Summer works for B’ham water works, walks 17 miles/day, Ensley to East Lake.

• 3rd year at Michigan counted for 1st yr of medical school.

• Fall 1918 enrolls in navy. On the tennis team.

• Transfers to Johns Hopkins, “State why you want to enter this school?” TRH replies..” My father believes Hopkins is the best place in the entire world to get a real medical education-a spirit of work.”

• Osler stood as Tinsley’s lifelong model as the perfect internist.

• Met Alfred Blaylock, Jonesboro,GA. Played tennis together. Vivian Thomas. “Something The Lord Made.”

• 1922-1924- residency Peter Bent Brigham Hospital, Boston.

• Feb. 21, 1924 marries Elizabeth Woodward-nurse.

• 1924-Senior Resident at Johns Hopkins.

• Tinsley, who was on call full-time every day ,24 hours a day, had a room in the hospital and was expected to be there all the time. Betty lived in a nearby boarding house.

• Nov. 10, 1924. Lemuel Woodward Harrison (Woody).

• Moves to Nashville. CR and running the chemical laboratory of the dept. of medicine. “ He added that if I did well in both jobs there would in all probability be a place for me on staff should I desire it, to climb upward on the academic ladder beginning as Instructor,” Tinsley said. “ I would be getting in on the ground floor during the development of a great medical school.”

The Vanderbilt Years (1925-1941)

• “His Vanderbilt period was marked by study and intellectual rigor and friendship and success.” JP

• Blalock follows TRH to Vanderbilt as CR in surgery. Excited about joining a school that had just been founded.

• May 21, 1926, 2nd child. Emily Louisa Harrison. “Mimi.”

• 1927 Fellowship Vienna.

• Feb. 8, 1928, 3rd child. Tinsley Randolph Harrison, “Randy.”• “The students were impressed that he could come into a room, ask the students to

suggest a topic they would like to hear about or review-any topic at all-and he would proceed with the topic and deliver a highly informative, well-organized, complete review of the subject if reading from carefully prepared notes. His theatrical style captivated listener. He would walk back and forth across in front of the audience with his eyes nearly closed as he spoke. Then he would stop, face the audience, and give some striking example or illustration, such as the hearts sounds in a patient with a valve seriously damaged by rheumatic fever. Lub-dub,swishshshshsh,Lub dub,swishshsh, explaining pathophysiology with complete blackboard drawing of EKG, pressure curves, polygraph tracings, pulse waves, etc. Any topic, anemias, malaria, lymphoma,etc.”

TRH and Al Blalock at Vanderbilt, 1940

Vanderbilt

• 1932 Full time faculty- salary $5,000.00/yr.

• July 17, 1934, 4th child. Helen Elizabeth Harrison. “Betsy” TRH called her “Sunshine.”

• Dec. 26, 1938, 5th child. John Bondurant Harrison.

• One of Dean Pittman’s favorite stories..Lab exp., asst. Tom. Pots and pans.

Publications and Professional Activities• Prolific medical scholar…Brigham- As a resident. 4 papers published.

All cardiac.

• 1925, Vanderbilt – published 4 papers. 1925-4, 1926-4, 1927- 9 papers. 1929-1932- total of 35 articles published. By 1933, he had published 55 articles. 1940-41 , 20 articles.

• By the age of 28, he was a leader in understanding cardiac output and cardiovascular physiology and pathophysiology.

• Regularly attended AAP, SMA, AMA, Young Turks meetings and presented.

• 1935- publication of first book, “Failure of the Circulation.”

• 1950-PIM. 1968-Along with Joe Reeves. Principles and Problems of Ischemic Heart Disease.

• Awards: to name a few: 1961-Gold Heart Award-AHA. Hon. Doctor. U. AL. Elected “Master” highest rank in ACP. First Distinguished Faculty Lecture, UAB’s highest honor for medical faculty.

Harrison’s Principles of Internal Medicine

• 1892-1927. Osler’s, Principles and Practice of Medicine dominated.

• 1927- Cecil’s, The Textbook of Medicine.

• 1950- Harrison’s, Principles of Internal Medicine.

• Harrison, Wintrobe, Phillips, Beeson, Resnik. Would gather at a resort or lodge.

• 1st year over 14,000 copies.

• 18th ed. And 18 different languages.

• Largest selling textbook of Internal Medicine in the world.

• Novel approach book is …..Based on presentation of symptoms notdisease. Patients do not usually come to physicians with known diseases but rather with complaints or symptoms. Likewise, many patients present with abnormal physical signs. These manifestations of disease, and especially the symptoms, provide the initial clues to diagnosis. Therefore, a textbook should began with the major manifestations of internal disorders and then discuss the specific disease.

Bowman Gray (1941-1944)

• 5 children in tow-Nashville to Winston-Salem. WS was always the loveliest city the the Harrisons. Reynolds Tobacco, Hanes textile industry.

• Bowman Gray,Pres. of R.J. Reynolds. $750,000., 1941-4 yr. medical school , Winston-Salem. TRH was excited about being the first Chairman and the founding of a new school.

• Letter from Dean Leathers (Vandy.) to Bowman Gray.

A conscientious and untiring worker and at the same time possesses a degree of brilliancy that is unusual; that he was eminently qualified for the position; and that he had unquestioned research ability; I regard him as a man of superior ability in dealing with clinical aspects of cardiac conditions; Tinsley’s qualities as a teacher elicited the greatest praise, “The students tell me that he has remarkable ability as an instructor …In other words, possesses marked inspirational qualities as a teacher.”

Coy Carpenter-Dean Bowman Gray

• “The election of Tinsley Harrison as the first professor and chairman of the Dept. of Medicine brought the institution a national image that was greatly needed at that time. Focus on medical students-taught 1st and 2nd year students, started weekly journal club, CPC-clinical-pathological conf. Tinsley’s proposed curriculum would look good 50 yrs. Later, and it did. Medical students, patient care, research, attract top faculty, administration, funding, an excellent chance to build the best medical school in the country.”

• Funding issues, not as great as Duke. WWII-The War Dept. draft, 2nd-3rd yr. MS, interns left to enlist.

• Lack of resources, Administrative, political issues, organizing depts. And faculty, difference in vision.

• “ But something about his personality enjoyed building a new program, and Southwestern looked like a place with promise, with better resources over the long haul, and a larger city and population base. “

• Dean Carpenter later said, “ Tinsley Harrison was the most dynamic, inspiring medical teacher I ever knew, and one of the most exciting medical scholars this country has ever produced. He is due more credit than any other person for leadership that produced high academic and professional standards in Wake Forest University medicine.”

• Smoked a pack of cigarettes a day. 1940’s, WWII, Tobacco country, liked to socialize. Known to like a bourbon.

Southwestern Medical College(1944-1950)

• Something about his personality enjoyed building a new program.

• En route to Dallas, one of the moving trucks catches on fire on the highway. Papers were burned, planned 3rd ed. of Failure of the Circulation, and John’s red tricycle!

• The physical buildings at the new medical school in Dallas: If the facilities and resources at BG had been constrained, those at Dallas were were a calamity. Because of the war and scarcities of materials and equipment, the medical school consisted of 8 pre-fabricated military barracks-type structures.

• Dean and Chairman of the dept. of Medicine. Arrived at the hospital at 6:00 am, returned home at 10:00pm.

• Oct. 24, 1944, oldest son, “Woody,” not quite 20, dies flying a Navy fighter plane during a training mission in Florida.

• Schedule once again included; teaching, patient care, research, administration, juggling budgets, traveling to meetings, helping raise funds, trying to maintain the highest standards in the face of chronic shortages.

• Ben Friedman hired as Chief of Medicine VA, Dallas. (1st research fellow under TRH,Vandy).

• John-1st grade. “My daddy is a rat-tail doctor.”

• “Tinsley has been called a poor administrator. He certainly was disorganized, sometimes on purpose. He had little regard for schedules. He was prompt for his teachings and careful with his patient care duties. If he didn’t like a schedule, however, he would change it arbitrarily to more to his liking, sometimes without warning those involved. He was willful and disregarded bureaucratic hierarchies. In the most important aspect of administration, Tinsley was truly outstanding; recruited excellent faculty. Tinsley was also skilled in keeping good faculty once they were recruited.”

• 1949, Southwestern finances faltered towards failure. The state gov. voted requiring the school to take 100 students.

• Tinsley was exhausted,(PIM), family was falling apart. Randy oldest, 21, inherited $5,000, dropped out of Hampton Sydney- bought a top of the line Buick convertible roadmaster-moved to Dallas and got married. Betty moved to Nashville with Betsy (15)-Bellmont, John(10) was sent to Maine to live with his uncle. Tinsley was by himself in an apt. and resigned.

Southwestern Anatomy Labs, 1944

The Patient at Mid-Century (1950’s)

• Page 240.

• Answer: Choricarcinoma-gestational trophoblastic disease.

• Myxedema.

The Alabama Medical School (1950-1958)

• Dr. Groce Harrison(79), almost blind, deaf. and Dr. Seale Harris Sr. wanted Tinsley at UAB.

• Buris Raye Boshell-Bear Creek Winston Ct., 1st yr. med student living with the Harrisons, earning some money helping with the Harrisons.

• Dr. Roy Kracke-Dean of medical school. 1944 became a 4-yr. program. Champ Lyons-1st full-time Chief of Surgery.

• Did not want to be Dean and Chief. His secretary was Katherine Morgan.

• Moved to B’ham to be with his parents and gIve back. Did not think UAB would mount to much. “Worst prognosis I have ever made.”

• March 5, 1951- Lula dies of a heart attack.

• Difficult to recruit, state was poor, violence, racism, “was viewed with pity and scorn.”

• Dr. Richard J. Bing. A world leader in cardiac cath. 1st in the south, Sept. 1951. Dr. Joe Reeves. Frommeyer-Chief of VA, later Chief Medicine.

• Others Dr. Harrison mentions from the community: Keehn Berry, Joseph Weldon, Joseph Hirsch, Sam Cohn, Stanley Kahn, Howard Holly.

• Dick Hill and Lister Hill- senator-funding, VA. Joe Volker, 1948-Dean of Dental school, 1969-1st Pres. of UAB. Just to name a few who grew UAB.

• Grand Rounds page 251.

UAB area, circa 1950

Department of Medicine faculty and house staff on the steps of University Hospital, 1957-58. The front row includes (from left): Tinsley Harrison (third), Walter B. Frommeyer (fifth), James A. Pittman, Jr. (sixth), S. Richardson Hill, Jr., (seventh), and Howard L. Holley (eighth)

UAB• Retires from Chief of Medicine 1957, at the age of 57.

• Old Turks meeting and surprise-tribute party for Harrison.

• Inducted as a Fellow into the American Academy of Arts and Sciences.

• 1958-Director of Cardiology-UAB. Cecil Coghlan.

• Annual Tinsley Harrison lecture.

• Struggled with specialization of medicine..but was partly responsible. 1960’s, cultural changes, language, dress.

• 1959- Hill Heart Center. Named after U.S. Senator Hill’s dad.

• 1950-when Dr. Harrison arrived, UAB was 2 small blocks-two buildings, Jefferson Hospital-gross anatomy was taught on the 17th floor. 1961-Monday Morning football club-100-bed Cripple Children’s Hospital.

• 1962-S.R. “Dick” Hill becomes Dean. Dr. Joe Reeves, Dr. “Mac” Bargeron.

• 1966- Dr. Kirklin comes to UAB, Dr. Pacifico.

• 1968-Dr. Harrison was appointed as a VA Distinguished Physician, faculty position, traveled to other Vas, worked with fed. Gov.

• 1970- taught at VA in Tuskegee, Montgomery- medical students would drive him and then spend time at “Coronary Seclusion.”

At the Lake Martin cabin “Coronary Seclusion” are (left to right) Drs. T. Joseph Reeves, John Holt, and Tinsley Harrison, circa 1970

Harrison at his cabin on Lake Martin, named “Coronary Seclusion,” circa 1970

The Patient 1978

• 1965- myocardial infarct.

• 1977-falls and breaks hip. Carribean cruise. Ms. Hazel Taylor-renal transplant nurse, Betty did not want to go.

• Wanted to be admitted to private hospital, Baptist, Montclair, Dr. Donald Deinlein. University hospitals “had deserted personalized bedside medicine, too many technologies, impersonal bureaucracies.”

• Internist Abraham Russakoff. Son Randy get him admitted.

• “Russ, I fire you as my physician and I fire you as my friend! You, too, my own physician, have deserted me. You’re fired as my physician and as my friend. Tinsley, “may I make a statement please” Russ asked. “Yes but I’m not going to listen. Dr. Harrison pulls the blanket over his head and covers his ears. Russ, states decisions are based on their love for him. “ You can fire me as your physician, but you can never fire me as your friend.” Dr. Harrison pulls down the blanket, “Well, all right,” he said. “You’re still may friend, as always. But you’re fired as my physician.”

Tinsley Harrison in his hospital bed in Alexander City, Alabama, 1968

Education equations

• E= iI2 E= education, i -instruction, I – inspiration.

• E=hH 2 E= education, h-teachers heart, H-his head

• E=mc 2 E= education, m-mental interaction teacher/student, c= mutual, partial cardiac transplantation.

Final days (1978)

• Last lecture. Nashville, Dr. Clifton Meador.

• August 4th, 1978, Betty notices Dr. Harrison is giving himself repeated tablets of Nitroglycerin.

• The disease that killed Dr. Harrison, myocardial infarction, was not even recognized in the 1920. By 1950, coronary heart disease was considered the leading cause of death in the U.S.

• Although in the end he disliked technology, subspecialization, and big University hospitals he played a big role advances the fields of internal medicine and cardiology through his patient care, teaching, and research.

• Dr. Coghlan lures him to the hospital.

• TRH, “Teacher of Medicine,” page 345.

TRH said, “He valued many things in academic medicine-the tear in the eye of a grateful patient, the sudden gleam of understanding in the eye of a student, and the dawning of understanding in his own consciousness.”

No greater opportunity or obligation can fall the lot of a human being than to be a physician. In the care of suffering he needs technical skill, scientific knowledge and human understanding. He who uses these with courage, humility and wisdom will provide a unique service to his fellow man and will build an enduring edifice of character within himself. The physician should ask of his destiny no more than this and he should be content with no less.

Tact, sympathy and understanding are expected of the physician, for the patient is no mere collection of symptoms, signs, disordered functions, damaged organs, and disturbed emotions. The patient is human, fearful, and hopeful, seeking relief, help and reassurance. To the physician, as to the anthropologist, nothing human is strange or repulsive. The misanthrope may become a smart diagnostician of organic disease, but can scarcely hope to succeed as a physician. The true physician has a Shakespearean breadth of interest in the wise and the foolish, the proud and the humble, the stoic hero and the whining rogue. The physician cares for people.

• The editors of the 9th edition of PIM (in press when Dr. Harrison passed away) dedicated it to Dr. Harrison.

“From time to time a personality scintillates across the medical firmament who dazzles all beholders. Tinsley Harrison was such a person. A delightful, vivacious, passionate physician, he stimulated everyone with whom he came in contact, and he placed an indelible stamp on the medical events of the day.”

Conclusion

“Medicine is first of all an interaction between warm-blooded, breathing, feeling, living people, which we forget at our own peril. It is at least half poetry rather than technology, and as life progresses towards its inevitable end, the poetry must increase and the technology decrease.” J. Pittman.

In closing:Let’s pause and reflect on why Dr. Tinsley Harrison is considered a medical giant and remember the contributions that he made to:(1) The field of IM (2) PIM (3) Cardiology (4) Three different schools of medicine(5) The City of B’ham., steel industry, UAB 3rd largest

public hosp.-11 blocks, largest employer of the state, economic impact $5 bill annually. TCHA 3rd largest. In just 66 yrs.

(6) More than anything, TRH set “the standard” for us to follow……WWTRHD.

I hope this has been a tribute to Dr. Tinsley Harrison and a way to honor his friendship with Dr. Jim ( Dean) Pittman.

It is up to us to pass down to the next generation of physicians how they practiced medicine and to preserve the “art of medicine.”

It was Tinsley Harrison who believed and said, “Learning is more a matter of the heart than the brain.”

Thank you to:

Scotty McCallum, M.D., Wayne Finley, M.D., John B. Harrison, M.D., D.M.D., Dick Briggs, Jr., M.D., Glenn Cobbs, M.D., Timothy Pennycuff, UAB archivist.