200 Years of Internal Medicine at Yale

The story of the Department of Internal Medicine begins in 1813, when Yale recruited Nathan Smith, MD, one of New England’s best-known physicians. Smith had already established a thriving medical school at Dartmouth when he came south to help found the Medical Institution of Yale.

Smith had farmed, hunted, and fought Indians in the Vermont militia before stumbling upon medicine at age 24 when he witnessed an operation. By 1813, he was exceptionally well qualified for his era. He’d earned a medical degree from Harvard (which began offering medical education three decades before Yale), trained in Edinburgh and traveled through the wilderness on horseback visiting patients.

Distressed by the sight of unqualified physicians abroad in northern New England, Smith had singlehandedly initiated the course of medical lectures at Dartmouth in 1797. In the words of Smith’s Yale colleague, Jonathan Knight, the new school in Hanover produced “a race of young, enterprising, intelligent physicians who all justly looked up to Nathan Smith as their friend and professional father.”

Smith was indeed the father of internal medicine at Yale: he gave the first lectures on the theory and practice of “physic”, surgery, and obstetrics. Smith’s three fellow professors included Knight, who taught anatomy; Benjamin Silliman, the chemist and geologist; and Eli Ives, who taught materia medica. Only Smith and Silliman were salaried, with Smith earning $1000 annually plus fees (50 cents for a house call with a prescription, $5 for surgery). Tickets admitting students to lectures provided income to the two unsalaried professors. When Smith died following a stroke in 1829, Ives succeeded him as the professor of medicine. Ives was the first American physician to teach a course in pediatrics. He had a profound knowledge of botany and kept a garden connected with the medical school.

In 1845, the medical school faculty elected its first dean, Charles Hooker, MD. Hooker’s cousin, Worthington Hooker, served as professor of medicine beginning in 1852. A graduate of Yale College and Harvard Medical School, Hooker had practiced medicine for more than 20 years in Norwich, Connecticut, before coming to Yale. His groundbreaking book on American medical ethics, Physician and Patient, had been published in 1849. Charles Linnaeus Ives, MD, succeeded Worthington Hooker, MD, as professor of medicine in 1868. Ives was the son of a local doctor who proved to be a popular teacher. When Ives resigned in 1873, David Paige Smith, MD, gave up a lucrative practice in Springfield, Massachusetts, to serve as Yale’s professor of medicine. A grandson of [Nathan] Smith, he would leave a bequest establishing a professorship in his name.

[David Paige] Smith taught under a new dean, Charles Augustus Lindsley, MD. Lindsley took charge in 1863 during a period of important advancements in medical education. These developments were made possible by two important changes in the structure of the medical school. In 1877, the school assumed responsibility for the New Haven Dispensary, the local outpatient clinic for impoverished patients. As a result, opportunities for Yale students to observe and take part in patient care expanded greatly. Lindsley oversaw a Friday afternoon clinic at the Dispensary, designed exclusively for students. Although the attending physicians at the clinic did not have faculty appointments, they instructed students about their areas of specialization.

In 1879, a charter by the state legislature granted the medical school autonomy from the state medical society, strengthening ties between the school and Yale College. The charter allowed the medical school faculty to set the requirements for a degree. The faculty lengthened the course of lectures from two years to three and augmented clinical and laboratory instruction.

A physician with a “genius for teaching,” John Slade Ely, MD, served as chairman of internal medicine at the turn of the century. Ely had a strong grounding in the sciences and had trained in Europe. After Ely died in 1906—thrown from his horse on Chapel Street—an anonymous donor endowed a professorship in internal medicine in his name.

The first to be honored with the Ely professorship was George Blumer, MD, who, taking over as dean four years later in 1910, would help transform the medical school. The school had repeatedly verged on bankruptcy during the 1800s, in part because when the professors periodically raised standards, enrollments sank.

The Yale Corporation customarily ignored pleas for more funds, and professors even lent the medical school money and pledged shares of their incomes to keep the school afloat.

Blumer used a sweeping indictment of medical education in North America to garner support for improvements. The Flexner Report, sponsored by the Carnegie Foundation for the Advancement of Teaching, deemed only 31 of the nation’s 155 medical schools worth saving. Yale was among them. Blumer cited the report in pushing for better funding, for stronger support from the Yale Corporation, and for medical school control of the local hospital (despite the resistance of local doctors). Under Blumer’s leadership—through diplomacy, networking, and skillful fund-raising—the School of Medicine finally achieved a firm footing. The New Haven Hospital accepted a plan to give full-time posts to medical school faculty, establishing a modern teaching hospital.

The School of Medicine gained national prominence under pathologist Milton Charles Winternitz, MD, Blumer’s successor as medical school dean. Winternitz is credited in 1925 with establishing the “Yale system” of medical education. The new curriculum reduced the number of mandatory courses and increased elective offerings; encouraged collegial relationships among students and faculty members; and eliminated tests and grades, instead requiring students to take two comprehensive examinations and to write the thesis that had been obligatory for Yale students since 1839. Winternitz also helped the medical school to realize the full-time system for faculty.

In 1921, Winternitz appointed the first full-time chairman of the Department of Internal Medicine, Francis Gilman Blake, MD. Blake oversaw the department’s transformation from a single salaried professor and some part-time faculty to a full-fledged academic department. Blake encouraged his colleagues not only to teach but also to do research. Blake himself focused on infectious diseases, investigating the pathogenesis and therapy of pneumonia and the viral etiology of measles. His intense interest in research was reflected in his directorships on influential boards, including that of his previous employer, the Rockefeller Institute for Medical Research.

Blake brought with him from the Rockefeller Institute a brilliant clinical investigator and outspoken nonconformist, John Punnett Peters, MD. Peters conducted research in metabolism, writing books and articles at a fierce pace. His 1932 reference book, Quantitative Clinical Chemistry (written with Donald D. Van Slyke, PhD) had a tremendous impact on clinical research. Peters urged residents to ground patient care in scientific principles and probed–even badgered– residents to justify every decision about patient care. He was a generous mentor for clinical clerks and supervised a large coterie of research fellows, many of whom went on to distinguished careers.

In 1937, Peters joined a committee of eminent physicians to promote a system of comprehensive health care in the United States. The medical establishment fought the proposal. The Journal of the American Medical Association editor Morris Fishbein, MD, argued that it would inhibit individual initiative. Peters contended that society is obligated to provide good medical care to people of all classes. Peters was accused of being a Communist during the McCarthy era. Although he denied the charge, the Loyalty Review Board of the U.S. Civil Service Commission refused to withdraw the accusation. Peters protested his treatment all the way to the U.S. Supreme Court – but to his bitter disappointment, the Court threw out the judgment on a technicality rather than ruling on its merits.

Under Peters’ tutelage, liver specialist Gerald Klatskin, MD, became prominent in the department and in his field. Klatskin came to Yale as an intern in 1933 and only left to serve in the U.S. Army during the war. He spent part of his tour in India, where the prevalence of hepatitis sparked his interest in liver disease.

Affectionately called “The Klat,” he possessed an encyclopedic knowledge of liver function and over the years developed a collection of 50,000 slides of liver biopsy specimens. Known as “a clinician’s clinician,” Klatskin was remarkable for his exhaustive history-taking, which sometimes unearthed a detail holding the key to a diagnosis.

Another prominent physician of the era was Allan V. N. Goodyer, MD, the first full-time faculty member to serve as chief of cardiology. Goodyer joined the faculty as an instructor in 1948, a few years after developing fetal electrocardiography. Known as a consummate teacher and committed clinician, a colleague described Goodyer as a man of “quiet dignity.”

The department grew dramatically in numbers and prestige under Francis Gilman Blake’s beloved successor, Paul Bruce Beeson, MD. Appointed chairman in 1952, Beeson focused his attention on the housestaff. He worked to attract strong interns, and competition for training at Yale intensified. He encouraged housestaff to participate in research, seminars, and small group discussions. He made sure that they were exposed to the full spectrum of internal medicine, discouraging overspecialization. Beeson insisted that physicians pay personal attention to their patients and did so himself. At attending rounds, he did not stand at the foot of the patient’s bed and discuss the case but rather sat down, looked the patient in the eyes and said, “Tell me your story.”

Beeson advocated a high rate of post-mortem examinations; he sponsored a competition culminating in a trip to a research meeting in Atlantic City, N.J. for the intern and resident accumulating the highest percentage of autopsy permissions. When the Veterans Administration (VA) Hospital opened in West Haven in 1953, Beeson made sure that Yale and the VA would be closely linked. This partnership provided access to facilities and teaching opportunities that strengthened research and medical education at Yale. Housestaff began working at the VA during Beeson’s tenure. Beeson carried on his own research in infectious disease and coedited two influential textbooks.

In his 13 years as chairman, Beeson built a strong faculty, tripling the number of full-time appointments to almost 70. Beeson brought Philip Kramer Bondy, MD, with him from Emory University. Bondy headed the metabolism section of the department and succeeded Beeson as chairman of internal medicine in 1965.

Enthusiastic and well liked, Bondy worked effectively with the faculty and fostered an expanded role for the department in clinical service. In his first year as chairman, a formal agreement between the university and the hospital created Yale-New Haven Hospital (YNHH). Bondy played an important role in bringing the fulltime and community faculty closer together. Elisha Atkins, MD, arrived three years after Bondy, sharing with Beeson an interest in the mechanism and biological importance of fever, which he continued to investigate through animal studies. Atkins was an avid birder and was well read in the humanities. He pursued his interest in the liberal arts and in undergraduates by serving as master of Saybrook College at Yale College beginning in 1975.

A key collaborator with Atkins was Phyllis Tuck Bodel, MD, an international leader in the study of fever. Bodel came to Yale as a research assistant in 1961 after a brilliant debut: while still at Harvard Medical School, she was the first student to read a paper in the general session of the American Federation of Clinical Research. A vigorous and creative investigator, she was known foremost as a generous mentor for students. In describing Bodel, Atkins remarked that her “hatred of oblique devices of power and oppression … made her an outspoken champion of women’s rights.” She died in 1978 at the age of 44.

By then, a dynamic new chairman, Samuel O. Thier, MD, led the department. During his tenure from 1974 to 1985, Thier strengthened the department and widened its influence within Connecticut and internationally. The faculty grew by a third, and Thier increased the responsibility and authority of the section chiefs. He helped the School of Medicine create a program linking the departments of medicine in 11 hospitals in southern Connecticut. Yale faculty began lecturing frequently at sister hospitals. Thier also established affiliations with hospitals and clinics abroad through the International Health Program, founded in 1981 by Michele Barry, MD, and Frank Bia, MD, MPH. The program allows residents to work in underserved areas overseas as well as at remote Indian Health Service hospitals in the United States.

Thier set high standards for his housestaff, engendering lifelong devotion in his trainees as well as occasional high anxiety. (Housestaff mythology includes the story of a resident who fainted during questioning by Thier, hence the nickname “Syncope Sam.”) Known for his clear vision and his ability to articulate his positions in a logical and forceful manner, Thier revitalized the Department of Internal Medicine so that it achieved national prominence. Thier’s work grew out of his commitment to one of medicine’s most enduring values, that physicians have a responsibility not only to their individual patients, but also the obligation to serve the greater public good. Thier left Yale in 1985 to become president of the Institute of Medicine at the National Academy of Sciences. He went on to serve as president of Brandeis University and then ledthe Partners HealthCare System, which includes the Harvard teaching hospitals, clinics, and medical practices, which he left in 2003

When Thier departed, Edwin C. Cadman, MD, filled the post as chairman of the Department of Internal Medicine. Cadman had spent several years on the Yale faculty before moving to the University of California at San Francisco to direct its Comprehensive Cancer Center. When he returned to New Haven, Cadman created the position of director for the residency program, naming Rosemarie Fisher, MD,; helped establish Yale’s residency in primary care; and created the ambulatory component of the medicine clerkship, allowing students to choose rotations in such places as outpatient clinics and community physicians’ offices. These initiatives continue to enrich the educational programs of the department.

Under Cadman’s leadership, the department worked with the School of Medicine and YNHH to adjust successfully to changes in the health care system. Cadman left the chairmanship in 1994 to become senior vice president and chief of staff at YNHH. Five years later, he headed west to become dean of the School of Medicine at the University of Hawaii.

Ralph I. Horwitz, MD, was selected to lead the department after Edwin Cadman moved on to become Senior Vice President for Medical Affairs of YNHH. A member of the department since 1975 when he came to Yale as a fellow in the newly created Clinical Scholars Program, he later led the Section of General Medicine and co-directed the Clinical Scholars Program with his mentor, Alvin Feinstein, MD. During his tenure as chairman, Horwitz strengthened patient-based research in the department, worked successfully with the Medical School to double the research space for the department in the newly built Anlyan Center and developed the Investigative Medicine Program, a unique MD to PhD program that offers rigorous training to physicians planning a career in the laboratory or patient-based research. This program is now administered by the School of Medicine and accepts applicants from all clinical departments. The Internal Medicine Residency Training Programs flourished under the guidance of Horwitz, remaining among the most competitive programs nationally. In addition, he was instrumental in partnering with the Department of Pediatrics to establish the Combined Medicine/Pediatrics Residency Program in 1998. This program quickly became highly successful, competing for the brightest students in the country. The medical service at (YNHH) increased dramatically during Horwitz’s tenure, putting further pressure on our training programs, and challenging our ability to continue to provide first rate patient care. To deal with this challenge, the Department of Internal Medicine, in partnership with the hospital, reorganized and expanded the Hospitalist Service dramatically. This expansion, by providing care to an increasing number of patients, protected the educational programs of the department, allowing us to create an optimal educational environment while meeting the accreditation standards set by the Accreditation Council for Graduate Medical Education. Horwitz’s first love has always been to mentor young colleagues, whether medical students, residents, fellows, or junior faculty. He continued to do so despite the challenges of leading a large department, reflecting his personal commitment to the education and academic missions of the department.

In 2006, Jack A. Elias, MD, was appointed Chair of Internal Medicine, a position he held until 2013 when he left Yale to become Dean at Brown University School of Medicine. Elias had arrived at Yale in 1990 from the University of Pennsylvania to become Chief of the Section of Pulmonary and Critical Medicine and he oversaw remarkable growth of the clinical and research missions of the section during his 18-year tenure. As Chair of Internal Medicine, Elias recruited nine outstanding section chiefs, reinvigorated the research programs of the Department leading to a 50% expansion of funded research, invested in collaborations with Yale New Haven Hospital to develop new and expanded clinical programs, and brought a focus on quality and patient safety to the teaching programs. He also restructured central departmental leadership for Clinical Care, Research, Education, and Finance. Elias was instrumental in the development of an Academic Hospitalist Program emphasizing scholarship in quality and safety. Through partnership with the YNHH physician and nursing leadership, he guided a refocusing of the inpatient Firms to encourage interventions and programs specifically designed to improve the patient’s experience. Elias was a strong and tireless advocate for the Department of Internal Medicine, its faculty, staff, and trainees, and this advocacy is one of his enduring legacies.

In September 2013, Gary V. Désir, MD, was named interim chair of the Department of Internal Medicine, after working as chief of medicine at the VA Connecticut Healthcare System for nine years. He was named department chair in April 2016. With this honor, Désir became the first person of African descent to be appointed as chair of a department at YSM. Désir set out to define the culture of the department and create a mission statement. Programs to train faculty were instituted to improve leadership skills. Additionally, team dynamics were looked at to improve cohesiveness. Vice chairs, associate chairs, section chiefs, and program directors were empowered to become agents of change.

A longtime advocate for diversity, equity, and inclusion (DEI), Désir and his leadership team appointed the first associate chair for Diversity, Equity & Inclusion for the Department of Internal Medicine. A Diversity Committee was formed, which evolved into the Office of Diversity, Equity, and Inclusion in Medicine (ODEIM) in December 2020. The work, which has become a cornerstone of the department, is making a difference. Over the past four years, 55% of faculty appointed or promoted to the rank of professor in our department were women and/or members of minority groups underrepresented in medicine (URiM). In addition to his chair role, Désir was appointed as Yale University’s Vice Provost for Faculty Development and Diversity in March 2020.

Since the start of Désir’s tenure as chair, the areas of quality and safety, collaborative research, and educational scholarship have become additional areas of focus for the department. New programs in faculty mentorship were launched, along with new educational initiatives within the department.

Désir and department leadership were instrumental in the management of the COVID-19 pandemic, helping to earn a “Leading Hospital” distinction for YNHH by Healthgrades.

During the COVID-19 pandemic, two internal medicine faculty were chosen to step into roles within the national and state governments, Marcella Nunez-Smith, MD, MHS; and Manisha Juthani, MD.

In November 2020, Nunez-Smith co-chaired the COVID-19 Transition Advisory Board with Vivek Murthy, MD, MBA, and David Kessler, MD. Since being named co-chair of Biden’s coronavirus advisory board in November, Nunez-Smith has talked publicly about the ways that economic pressures are impairing the ability of communities of color to take preventative measures, and how existing health disparities are exacerbating the pandemic’s unequal burden on Black and Hispanic people. The following month, Nunez-Smith was chosen by the Biden administration to lead a White House task force dedicated to health equity.

Juthani, along with others across the department, took to the airwaves and social media to inform the public about COVID-19 transmission, treatments, and vaccinations, and to dispel myths about the virus. Her work caught the attention of the governor of Connecticut, Ned Lamont. In June 2021, Juthani was nominated by Governor Lamont to be the commissioner of the Connecticut Department of Public Health. She assumed her new role on September 20, taking a public service leave of absence as Yale faculty.

Close collaboration between the Yale Department of Internal Medicine and the community physicians has over the years been facilitated through the efforts of the associate chiefs of the medical service. The first, Samuel D. Kushlan, MD, was an enduring presence at Yale from 1935 when he graduated from Yale School of Medicine until his death in 2010. He was associate chief of the medical service from 1967 until 1982 and was then succeeded by Frederick L. Sachs, MD, who served in this position until 1999. Sachs was succeeded by Michael Bennick, MD, who brought a major focus on the patient’s experience to his efforts as associate chief of the medical service. Adam Mayerson, MD, stepped into the role in 2017 and continues to work in this role to present day.

The Department of Internal Medicine has come a long way from its modest beginnings two centuries ago and has grown remarkably under the stewardship of its leadership, along with its clinicians, researchers, educators, trainees, and staff. Today, the department has more than 715 full-time faculty, over 530 voluntary, adjunct, visiting, and emeritus faculty, 400 staff, and over 560 residents, fellows, and trainees.