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CHAPTER THREE
Case Western Reserve University and MetroHealth
They were the wild days of ‘medicine.’”
“
Nearly one in four physicians in the US practiced without a degree.
In 1850, newspapers ran ads for “doctors” who claimed they could detect disease without “asking the patient a question.”1 Nearly one in four physicians in the United States practiced without a degree. Most had little contact with hospitals, which primarily housed the homeless, the mentally ill, and the orphaned. Even in the 1870s, medical schools at some of the best universities in the country admitted young men who had not completed high school.2 Grave robbing, to provide cadavers for the study of human anatomy, was common, too. In Cincinnati, in 1878, the body of John Scott Harrison—the son of President William Harrison—was discovered by a search party, which included John’s son, in the dissecting room at the Ohio Medical College.3
In Cleveland, things were different. In 1855, Cleveland Medical College of the Western Reserve College arranged with City Hospital to appropriate the dead from the Infirmary at City Hospital, if the bodies were not claimed by relatives or friends. The arrangement undermined local accusations that grave robbers were selling bodies to medical faculty, a practice that thrived elsewhere into the late 19th century.
Western Reserve College and City Hospital collaborated once again in 1857.4 Gustav Weber, MD, the city physician from 1857 to 1860, treated up to 400 patients per year at the Infirmary on Scranton Road.5 Dr. Weber also served as professor of surgery at the Western Reserve College, as well as dean of the medical school. His joint affiliation represented the first official use of City Hospital as a place of learning for medical students at Western Reserve.
For years, this collaboration remained largely informal, due to the limited facilities at the Infirmary. From the 1860s to the 1880s, when Western Reserve faculty offered clinical instruction at City Hospital, the priority was education, then patient care. That began to change in 1889, when City Hospital added a 175-bed general hospital to its Scranton Road campus. This three-story brick building included the most recent advances in medical science, and City Hospital began its journey toward becoming an institution of medical care and discovery.6
In July 1891, faculty from Western Reserve University, along with Wooster Medical College and Cleveland Homeopathic Medical College, met with the City Hospital superintendent to arrange for their faculty to take turns caring for the hospital’s poor. In exchange, City Hospital provided a place for them to train their medical students. By 1913, the double system of charts and records, as well as a lack of accountability, resulted in unacceptable patient care.
In spring 1914, City Hospital Superintendent Howell Wright submitted a report to City Council entitled “Cleveland City Hospital: Its History, Its Functions, Its Possibilities.” His report described how City Hospital was doing little more than “boarding and treating sick people.” The “modern hospital” needed to do things in a modern way. City Hospital, he argued, needed to deliver science-based care. It also needed to provide education to aspiring physicians and nurses. Most importantly, the hospital needed to work with other social service organizations to promote public health and ensure “more days of life, work and happiness [for our] citizens.”7
In spring 1914, City Hospital Superintendent Howell Wright submitted this report to City Council.
Science and Technology Department.
Interns/students at Cleveland Medical College c. 1900.
Nurses administering care, c. 1930.
To that end, the City of Cleveland needed to convince its residents that City Hospital was no longer the “Poorhouse.” Nor was it the place of last resort for paupers and the infirm. Tolerance for such mediocrity had run out, Wright noted. And he proposed a new plan: “The interests of patients . . . can best be promoted if the Medical and Surgical management of the Institution is entirely under the control of Western Reserve Medical School.”8
With that, the Western Reserve faculty—which included some of the top research clinicians in the country—created and managed one administrative system for the hospital. This 1914 arrangement included City Hospital’s first classes of medical residents and surgical residents. In 1922, its first two women interns followed. And, in 1931, City Hospital became the second major academic hospital in the United States to admit a Black American intern: Frederick Douglass Stubbs, MD.
Two decades later, Joseph Wearn, MD, Professor of Medicine at Western Reserve University, led an overhaul of the medical school curriculum. In the process, he helped City Hospital assemble one of the most accomplished teams of research clinicians in the country.
Dr. Wearn joined the faculty at Western Reserve University in 1929, after completing his studies at Harvard Medical School. In 1945, at the age of 52, he became dean of the school of medicine and gradually moved control of the curriculum from individual departments—many of which were led by aging professors—to the general faculty, which was much younger and open to new ideas.
Dr. Wearn and his team created a curriculum focused on systems teaching, developed by the faculty as a whole. Rather than a semester-long anatomy class taught by an anatomy professor, for example, faculty from several departments taught lessons on the structures and functions of organ systems in lectures, labs, and clinics. The standard medical school curriculum of the time introduced new students to anatomy via a cadaver. At Western Reserve, students met first with a pregnant mother, witnessed the birth, and worked with her and her newborn in the mother-and-child section of the curriculum. “It became the greatest recruiting mechanism we had,” one professor noted. “That one single thing.”9 For first-year students, integrated lessons and patient interactions replaced single-subject lessons from siloed departments. For City Hospital’s Robert Ebert, MD, the new curriculum produced “physician[s] educated to think scientifically, but imbued with a human concern for the individual patient.”10
Dr. Wearn also ensured that his students were mentored at City Hospital by clinicians free of the demands of private practice. In 1948, Dr. Wearn negotiated an agreement with Cleveland Mayor Thomas Burke that gave the medical school the power to appoint physicians at City Hospital. They included full-time physicians in surgery, pediatrics, medicine, and obstetrics who worked closely with Dr. Wearn’s students and offered patients at City Hospital the highest level of medical care.11
The agreement also called for a new research building at City Hospital. Top-notch scientists needed top-notch facilities. In 1950, Dr. Charles H. Rammelkamp, Jr., became the Associate Director of Medicine and Director of Research Laboratories at City Hospital. He was also promoted to full professor of medicine at Western Reserve University. Within two years, Dr. Rammelkamp assembled one of the most accomplished collections of academic physicians in the country. By some accounts, “Rammel” willed a mid-level public hospital into a premier medical institution. In 1954, City Hospital ranked first among US hospitals in terms of honors and awards, including a Nobel Prize in Medicine. (See Chapter 5.) Much of that credit belongs to Dr. Wearn, Dr. Rammelkamp, and the hospital’s ties to Western Reserve University.
In 1950, Dr. Charles H. Rammelkamp, Jr., became the Associate Director of Medicine and Director of Research Laboratories at City Hospital.
The partnership between Case Western Reserve University (CWRU) and MetroHealth, said Bernard Boulanger, MD, MetroHealth’s Executive Vice President of Provider Enterprise and Academic Affairs, attracts better physicians, residents, and fellows to MetroHealth, in large part because of the outstanding reputation of the CWRU School of Medicine. The school is consistently ranked among the top 25 medical schools in the country and is highly ranked among the world’s medical schools. All physicians at MetroHealth are faculty of the School of Medicine. Dr. Boulanger is Professor of Surgery at the school and serves as Senior Associate Dean, overseeing the School of Medicine’s teaching and research programs at MetroHealth. MetroHealth trains hundreds of CWRU medical students each year.
“We couldn’t recruit the outstanding people we recruit if we didn’t have this partnership,” Dr. Boulanger said. “It’s the reputation for excellence, known around the country. CWRU School of Medicine is recognized for its groundbreaking research. Similarly, MetroHealth has a long history of research discovery. The synergy between CWRU and MetroHealth creates a unique environment that benefits both organizations and the people we serve. With this partnership we have higher-quality physicians, high-quality residents, and research that advances medical care. Our patients benefit from that.”
“We couldn’t recruit the outstanding people we recruit if we didn’t have this partnership.”
Rammelkamp, Jr.
STILL STRONGER TOGETHER
A Century of Hope, Health,
and Medical Education
In 2014, MetroHealth and Case Western Reserve University celebrated 100 years of educational partnership. Three years later, MetroHealth signed an affiliation agreement with the Case School of Dental Medicine, allowing its students to train at MetroHealth. The following year, another affiliation agreement opened the doors of MetroHealth to the students of Case Western’s Frances Payne Bolton School of Nursing. In 2021, MetroHealth and Case Western extended their partnership in medical education and research through June 2031: MetroHealth agreed to increase its support for research, and both institutions committed to finding new opportunities for students at Case Western working toward degrees other than MDs. These agreements will allow MetroHealth physicians to continue training hundreds of medical interns, residents, and fellows—many of whom go on to work at hospitals and clinics across the country. It’s the next stage of this partnership, though, that has the potential to make a significant mark on the history of medicine.
In 2018, MetroHealth elevated its commitment to research once again—this time to save the lives of cancer patients who would not otherwise have access to the most advanced and innovative care.
A 2021 study of MetroHealth’s cancer patients found that 43 percent were from households earning less than $38,000 a year; 40 percent were underrepresented minorities; a third lacked food, housing, or social connections; and 32 percent were underinsured or uninsured.
To provide state-of-the-art, cutting-edge cancer therapies for them, MetroHealth began the work to become a consortium member of the Case Comprehensive Cancer Center, one of the elite cancer care facilities in the country. That center—led by nearly 400 cancer researchers and clinicians at Case Western Reserve University, University Hospitals, and Cleveland Clinic—is one of 51 across the country that meet rigorous standards for transdisciplinary, state-of-the-art research focused on developing new and better approaches to preventing, diagnosing, and treating cancer. Becoming a member would give MetroHealth and its large, underserved population of patients access to those innovative, cutting-edge therapies.
In March of 2021, MetroHealth announced a new cancer research team made up of eight nationally and internationally recognized researchers. Backed by millions of dollars in grants and other support along with dozens of research assistants, their work would focus on ending the racial, ethnic, social, and economic inequities that affect the diagnosis and treatment of cancer. That same month, MetroHealth began operating its new linear accelerator, which targets tumors without damaging the healthy tissue around them. In 2021, MetroHealth was also accepted as a member of the National Center for Regenerative Medicine, a leader in cellular manufacturing and regenerative medicine. The center, based at Case Western Reserve University and operated by the university, Cleveland Clinic, and University Hospitals, focuses on research leading to the discovery of stem cell and other cell-based therapies to improve patient outcomes.
Since 2020, The MetroHealth System has recruited seven new hematology/oncology specialists and research scientists. And in March 2022, MetroHealth began constructing a GMP facility on its main campus that includes three clean rooms that will enable MetroHealth to become the first healthcare system in Northeast Ohio able to produce CAR-T cell vectors and cellular products. CAR-T cell therapy is a highly effective, cutting-edge cancer therapy that combines cellular, gene, and immunotherapy to teach a patient’s blood cells how to recognize and kill cancer cells. This personalized and precise method of using a patient’s own cells to beat cancer is more effective and greatly reduces the traditional chemo and radiation therapy-related toxicities such as hair loss, nausea, and other side effects. The production facility will be the only one of its kind in Northeast Ohio. In 2022, MetroHealth also added a Stem Cell Transplant Unit to the Glick Center, its new main campus hospital, which opens in October 2022 with an 18-bed cancer unit. A new two-story outpatient cancer center and a separate breast health center are scheduled to open in 2023.
All of these changes at MetroHealth are focused on providing the very best care to underserved patients, who have an increased chance of being diagnosed with aggressive forms of cancer. With these advancements, they’ll also have an increased chance of beating that cancer, said William Tse, MD, MetroHealth’s Division Director of Hematology/Oncology.
“This innovation allows The MetroHealth System to continue as one of the nation’s pioneers in research,” Dr. Tse said, “and to make outstanding medical testing, screening, and cancer treatment available to a large, diverse population and, in many cases, to patients who haven’t had access in the past.”
MetroHealth began the work to become a consortium member of the Case Comprehensive Cancer Center, one of the elite cancer care facilities in the country.
Since 2020, The MetroHealth System has recruited seven new hematology/oncology specialists and research scientists.
THE FIRST 50 YEARS:
NURSING AT CITY HOSPITAL
On September 2, 1898, nine students at the Training School for Nurses at City Hospital took their seats at the school’s first graduation ceremony. Addresses that day came from a local minister, a city councilman, and the school’s superintendent, Caroline Kirkpatrick, who established the school in 1896. Known as a stern figure, Ms. Kirkpatrick used her turn at the podium to rail against the 72-hour workweek of her nurses and to urge hospital leaders to build her students an on-campus residence. In 1914, City Hospital opened its first dormitories for nurses. The following year, the hospital limited nurses’ work to eight hours a day.
In September 1930, the first Black women enrolled in the training school at City Hospital. (See Chapter 6.) Gradually, some of those same students joined the nursing staff. In 1937, a Call and Post reporter celebrated the tally of four Black nursing students and 19 Black nurses on staff. “This experience,” the author noted, “should hearten more of our leaders to strike out along new paths and demand more of the things we are now denied.”
During World War II, a federal program covered nursing students’ tuition, room, board, uniforms, and a monthly stipend. In March 1945, a shortage of medical staff in the armed forces led the US House of Representatives to pass a bill to draft nurses into service. As soldiers took the fight against fascism abroad, City Hospital was the only one of the 56 nursing schools in Ohio to admit Black students.
A few years later, a Call and Post reporter toured City Hospital. “Here doctors, nurses, technicians, social workers, and clerical people of various races,” he reported, “are working together in complete harmony and fellowship.” The attitude of these workers, the reporter noted, “will eventually rid America of racial discrimination and give meaning to the word ‘Democracy.’”
In 1996, after a century of training, the school closed its doors, having graduated 100 classes of students who practiced at MetroHealth and across the globe.
Today, MetroHealth offers clinical training for students attending area nursing schools. More than one in five of MetroHealth’s nearly 8,000 employees are nurses.
