TRANSACTIONS OF THE AMERICAN CLINICAL AND CLIMATOLOGICAL ASSOCIATION, VOL. 127, 2016

PRESIDENT’S ADDRESS THE CLIMATOLOGICAL: A HISTORICAL PERSPECTIVE ANNE MOORE, MD NEW YORK, NEW YORK

Thank you to the Officers, the Council, and the members of the Climatological* for giving me the extraordinary opportunity to be your President over the past year. It has been a great honor and privilege for Arnie and me to serve the Association in this role. I would like to express my admiration and gratitude for all the work that Secretary-Treasurer Richard Lange and his wife Bobette have done to keep the Association thriving since Rick’s election in 2013. At the very first meeting of the Climatological in 1884, the management of the Association was described during the Presidential address (1). Dr. Frederick I. Knight, speaking for President Alfred L. Loomis, was very clear that this was not an association to be run by committee. Dr. Knight said “The one-man power is what is wanted. We want a man to run the association who is elected for a term of years.” Dr. Knight describes all the duties of the Secretary-Treasurer and closes with “Without such a head we will fail.” Of course, what is not mentioned in that historic speech is the role of the spouse of the Secretary-Treasurer who shares equally in all the work! Thank you, Rick and Bobette, for organizing this wonderful meeting in Ponte Vedra. The position of Recorder was designated in 1918 and there have only been 12 Recorders in the history of the Climatological. Our current Recorder, Dr. Fred Schiffman, has done a heroic job of documenting the words of the speakers and the discussants at the time of the meeting, of getting all the papers in and edited, and of assigning the Memorials. He has handled crises of deadlines and delinquent authors with grace. He met many challenges with resourcefulness and imagination such as this year’s last-minute notice from Correspondence and reprint requests: Anne Moore, MD, Weill Cornell Breast Center, 425 East 61st Street, 8th floor, New York, New York 10065, Tel: 212-821-0550, E-mail: [email protected] med.cornell.edu. Potential Conflicts of Interest: None disclosed. *The Climatological is the informal name the members have used over the years when referring to the American Clinical and Climatological Association and its predecessors, The American Climatological Association, and The American Climatological and Clinical Association.

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the publisher that they ran out of the green cloth that has covered our volumes from the very earliest days. Dr. Schiffman’s work as Recorder will resonate throughout history as a record of this Association and the very important papers presented and discussed at our meeting today. In preparation for this talk on the history of the Climatological, I relied on the Transactions of the American Clinical and Climatological Association. The members of the Climatological are right to be proud of the richness and the depth of this record of our history. The Transactions are complete records for every annual meeting from 1884 to 2014. Each volume of the Transactions contains the manuscripts of the papers delivered, the discussions by the members (which sometimes are more enlightening than the paper!), and a report from the Secretary-Treasurer that includes other deliberations from the meeting agenda. The history of the first 100 years of the organization is eloquently told in Dr. A. McGehee Harvey’s 126page supplement to our Transactions, “The American Clinical and Climatological Association: 1884−1984.” It is a terrific resource. The electronic version of the complete Transactions is available to all on PubMED as a very readable and easy to use pdf. I have provided wallet cards for each of you to help find the website, http://www.ncbi.nlm. nih.gov/pmc/journals/323/ (Figure 1). I hope you will peruse the site when you have an extra minute or two. But beware, as a quick look may trap you and you will look up and find a morning or an afternoon has gone by while you enjoy reading the extraordinary papers published through the years. Other resources that I used were The New York Academy of Medicine library that has a complete edition of the Transactions available for study. I also visited The Alan Mason Chesney Medical Archives of the Johns Hopkins Medical Institutions and The National Library of Medicine where catalogued boxes of paper records are available for research. These records are notes and correspondence provided by members and Officers of the Association. Much of the

NATIONAL LIBRARY OF MEDICINE ARCHIVE OF TRANSACTIONS ACCA 1884-PRESENT http://www.ncbi.nlm.nih.gov/pmc/journals/323/ Fig. 1. 

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archives were records of the Secretary-Treasurers, some of whom were hoarders and others who saved little. I am grateful to Arlene Shaner, Nancy McCall, and Stephen J. Greenberg for their help at these institutions. My original plan was to proceed logically through the years and point out various contributions and discussions along the road. However, as I read more about our past, I was distracted into various detours and side roads. I hope you will fill in the missing years on your own! I will start my talk on the history of the Climatological here in Ponte Vedra, the venue for 10 annual meetings and a number of important events in our history (Figure 2). We will then return to our beginnings in 1884. Ponte Vedra was the first real Southern venue for the annual meeting in 1966, and our members were entranced with the pleasant, invigorating weather and the location — they couldn’t wait to come back. Four years later, the weather was not great, but the papers were presented by a Who’s Who in American Medicine with clear and beautiful scientific papers by Attlalah Kappas, Jim Hirsch, Mac Harvey, George

Fig. 2.  Ponte Vedra Inn and Resort, Ponte Vedra, Florida. Site of 10 meetings of the ACCA between 1966 and 2015.

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Cahill, Arnold Relman, and Dick Johns, among others. The paper by Nicholas Christy on Gustav Mahler and his illnesses presages our Dupont lecture during this meeting entitled “Music and Medicine: George Gershwin” by Dr. Richard Kogan. Ponte Vedra in 1976 was different, with gusty winds, rattlesnakes reported on the golf course, and a memorable event that I thought was important to share with all of you as we start our long weekend here. Buried in the footnotes of Dr. Harvey’s history of our organization comes the following letter to posterity from member Lewis E. January: “Many members who were present at the 1976 meeting in Ponte Vedra will remember that Thornton Scott (a member from Lexington, Kentucky) set himself up as the unofficial mycologist and as such gathered a basketful of lovely-appearing mushrooms growing wild on the hotel grounds. He and Peggy invited the Beans, Russells, Warthins, and Januarys to share in them over drinks in their room. Within a short time all of us became ill to some degree, but Eloise and I over-sampled the delicious fungus, becoming ‘deathly ill.’ I did remember during the night, after Walter Kirkendall somehow had found atropine, that you could die from mushroom poisoning. Walter and Meg Kirkendall.… played physician and nurse to us throughout the night…. Our hotel room resembled a cholera ward when the maid came to clean it up. She said to me: ‘You all must be the ones who ate the poisoned mushrooms. That’s too bad, because we all know these around here could kill you.’” (2)

All those stricken survived and rejoined the meeting — but please heed their message and just be careful what you pick! Ponte Vedra in 1994 was another banner year. Jeremiah Barondess of New York was President (Figure 3) and he gave a resounding speech complete with photos of Yogi Berra and other NY Yankees. A major contribution that year was that of his wife, Linda, who started the separate spouses’ program for Friday mornings with speakers on various topics. This has added a wonderful dimension to the meeting. This year’s Presidential spouse, Dr. Arnold Lisio, is hosting the spouses’ Friday session. I think that this may be a historic first for our organization! At the 1981 meeting, “the Ponte Vedra syndrome” was described by hematologist Daniel Deykin of Boston (3). This paper describes the potentiation of the bleeding time, a measure of platelet function, by alcohol in the presence of aspirin. In Figure 4 from Dr. Deykin’s paper, we see that the bleeding time is not prolonged by the ingestion of 125 cc

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Fig. 3.  President Barondess and Vice-President Billings discuss the meeting at Ponte Vedra in 1974.

Fig. 4.  Alcohol potentiates the effect of aspirin on the bleeding time.

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of 100% vodka. The bleeding time is prolonged by aspirin. When alcohol and aspirin are added together, there is marked prolongation of the bleeding time. In the discussion following the paper, Deykin speculates “as to whether the putative beneficial effects of aspirin are confined to those who take a nip or two.” I am not sure why Dr. Deykin named this observation for Ponte Vedra. Certainly, we can envision our members enjoying the good wine at the festive dinners, taking aspirin to ward off a morning headache, and then struggling to stem the bleeding after an innocuous cut while shaving the next morning … but that is only a speculation! At Ponte Vedra in 2008, President Frank Abboud named a task force to think about the name of the organization. This brings us to a question that all new members ask, “Where did we get this name?” I am sure all of you have had the experience of telling colleagues that you are going to this meeting and their quizzical looks about the name. One of my associates recently told me that she always thought I was going to an annual meeting about menopause — the Climacteric Association! The archives references a telegram sent to Dr. Jim Halsted in 1950 by his colleagues to congratulate him on his election to the Climatological. The Western Union operator interpreted the message as: “Your clinical climb illogical.” We have had two changes in the name since the first meeting in 1884. The original American Climatological Association was founded by a group of physicians who were linked by their interest in tuberculosis and their conviction that climate was important in the cure of the disease. The group had its first meeting in Washington, DC, in conjunction with the AMA meeting. Fourteen of the 40 members came and there were rumbles from the AMA that this topic did not need a separate association and could be section of the AMA — but our leaders prevailed. The original constitution stated “The object of the association shall be the study of climatology and diseases of the respiratory organs.” Benjamin F. Westbrook from Brooklyn gave the very first paper, “On the Etiology of Pulmonary Phthisis” (4). He was well aware of the recent findings of the tubercle bacillus but he knew that this was not the only cause of phthisis, a major problem for the clinicians of the day. His description of phthisis is so clear. “Phthisis pulmonalis is a chronic, wasting disease, of varying aetiology and pathology, whose essential anatomical lesion is the result of a destructive process in the lungs, and whose prominent symptoms are emaciation, cough, haemoptysis, fever and colliquative discharges.” He goes on to write about other contributing factors to this disease: “a low vitality … exanthematous fevers, defective nutrition, emigration from Ireland and long confinement indoors.”

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The second paper at the first meeting represented the Climatological side of the new organization. Charles Denison from the University of Denver read his paper on dryness and elevation as treatment for phthisis (5). He used six detailed charts to demonstrate a comparison between the 25 most dry and 25 most wet localities in the United States. He showed various weather maps that he discussed in detail such as one showing the mean cloudiness across the United States in the spring of 1882. He spoke for over 2 hours on the subject. Remember, it was May in Washington, DC — there was no air conditioning, and despite their interest in pulmonary diseases, there is reference in later correspondence to the thick smoke from cigars at the meetings of the Association. Dr. Denision submitted a 42-page manuscript for publication in the Transactions! In the first 20 years or so of the Association, the members focused on the climate and mineral waters as therapy for illness. The group realized that the United States was far behind Europe in the development of health spas and the science of hydrology and balneology (the science of the therapeutic use of baths). The group started going on “field trips” or site visits to see how they could improve the situation. Their meetings were held in Richfield Springs, New York; Hot Springs, Virginia; Lakewood, New Jersey; Niagara Falls, New York; Atlantic City, New Jersey; White Sulphur Springs, West Virginia; and Saranac Lake, New York. Other examples of the focus on climatology included papers on the “Climatology of Nudity: Partial and Complete” (6) and “A Note on the Fresh-air Treatment of Acute Insanity” (7). In 1902, the Association meeting was held in early June in Los Angeles. The members hired a private railroad car to travel with the Atchison, Topeka, and the Santa Fe railroad through Kansas and the southwest United States to Los Angeles. Dr. Guy Hinsdale, Secretary of the organization from 1895 to 1918, wrote up the experience in a monograph entitled “The Tour of the American Climatological Association, 1902” (8). The members planned to visit various potential health spas and springs along the way. When they arrived in western Kansas they were hit with a terrific storm and several railroad bridges were destroyed. The group spent 40 hours in the mud in Kansas and there is a reference to learning much about the habits of prairie dogs. But our forebears soldiered on. They visited the Grand Canyon traveling on mules. They finally reached the Pacific Ocean in Santa Monica where they took advantage of the opportunity for a swim (Figure 5). This trip and others convinced the members that the United States had great potential for the development of health spas for patients and the members felt a responsibility to be sure they were up to their standards.

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Fig. 5.  1902: Members of the American Climatological Association arrive in Santa Monica after an arduous trans-continental train trip [8].

One common denominator for all the papers and the discussions of those early years was the earnestness of our members. They were very focused on improving the health of their patients and they were eager to share their discoveries and to seek comments and help from their colleagues at the meetings. I think these traits have marked every meeting since. An example of the enthusiasm about new ideas is Dr. Denison’s paper on the Sleeping Canopy published in 1907 (9). Dr. Denison, like many of the Climatologists, was convinced that sleeping in the fresh air, the colder the better, was a very good treatment for patients suffering from pulmonary diseases. He understood that his patients were not able to sleep in tents outside so he invented the Sleeping Canopy. His paper shows the construction of the frame of a sleeping canopy in great detail (Figure 6). The bed is placed near the open window and the canopy is made of denim. At night the tent is closed and the patient’s head is essentially outside while the rest of the body is warm inside the room. During the day, the tent can be partially opened for comfort. 1913 marked a turning point for our organization. Dr. Charles Minor delivered a very stern and important President’s Address (10).

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Fig. 6.  (A−C) The Sleeping Canopy: A denim canopy is draped over a frame by an open window. At night, the tent is closed so that the patient can breathe cold fresh air while the body stays warm inside the room. During the day, the canopy can be partially opened for the comfort of the patient (9).

He pointed out that 30 years had passed since the founding of the American Climatological Association and, despite the major contributions of the group in this field, climate was no longer the primary interest of the membership. He made a firm plea for the association to maintain its focus on the patient. He stressed the need to recruit younger members to the Climatological — and to be sure the new members were not, he said, “just good fellows but would contribute to the intellectual distinction on which, after all our reputation must be based.” He proposed the name be changed and thus we became The American Climatological and Clinical Association. A very handsome logo appeared on the last page of the Transactions of 1919 with a motto

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Fig. 6B. 

for the organization: “Fiat Lux” — let there be light (Figure 7). The sun and the rays represented the belief in heliotherapy, a topic that Dr. Hinsdale covered in his Presidential Address that year: “The Sun, Health and Heliotherapy” (11). In 1932, there was great discussion about dropping Climatological from the name and renaming the organization the American Clinical Association. To some members the term Climatological seemed irrelevant to the mission of the association. Those in favor of retaining Climatological noted the historical interest in the name and the fact that the members referred to the organization among themselves as “The Climatological.” The solution was to keep Climatological in the name but change the emphasis. In 1933, the name became The American

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Fig. 6C. 

Clinical and Climatological Association. The constitution now read “The object of this association shall be the clinical study of disease.” The last discussion of the name was in 2008 when President Abboud’s Task Force on the Name of the Association made its recommendation. The group voted that the name remain the same and that we affirm the importance of the name as intrinsic to our unique and historical position. I think that will be the last word on the name of this Association. The Climatological has always been a very sociable group and the evening formal dinners are a long tradition. Wives accompanied their husbands to the meetings from the earliest years but did not join all the evening festivities until Dr. George Thorn’s presidency in 1959. One description of the earlier dinners comes from President Waring in 1941 (12). “In the evenings … both members and their ladies met for a cocktail together before the banquet scheduled for Friday evening.

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Fig. 7.  The stamp of the American Climatological and Clinical Association, 1919.

Thereafter the members staggered to the annual banquet and ladies went to dinner as they had previously arranged in small groups.” The archives are full of references to singing and music at the dinners. In 1951, Dr. HM Thomas sang “Alouette” in the bass with Dr. Andre Cournand in the treble, and in 1952 Coke Andrus gave a charming rendition of ballads. There is reference to the “Prickly Heat Quartet” (we are not sure who was in that group) and one member was often moved to recite “Casey at the Bat” as part of the evening’s entertainment. At one meeting, the orchestra for the evening’s entertainment did not show up — no problem for our predecessors. They pulled out a piano and sang jolly songs till 2 o’clock in the morning! You remember, the ladies were not there. One surviving annual dinner menu from 1896 shows that this was quite an epicurean group (Figure 8)! The 10-course meal consisted of such delicacies as turtle soup, caviar, shad and roe, larded filet of beef aux champignons, sweetbreads, lamb chops, and golden plover. Punch Lalla Rookh accompanied the dinner. This was named after a voluptuous character in an Eastern romance of 1817. In the archives of the earliest days of The Climatological, there was no discussion of women at all. Thus, I was surprised and excited to read Dr. Beverley Robinson’s name as a Founding Member and later President. I quickly searched for Beverley’s picture but the mustachioed

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Fig. 8.  Dinner menu for the thirteenth annual meeting in 1896 (12).

figure was certainly not a woman (Figure 9)! Although women members were not part of The Climatological, wives were very much part of this meeting. They were invited to attend the talks and all the women sat together in the back rows until the late 1960s. In the group photo of 1908 (Figure 10), we see the spouses in the back but no mention of them in the Transactions of that year (13). This is surprising because one of our early Presidents, Abraham Jacobi of New York, was well known for his liberal views. (Jacobi Hospital, our largest public hospital in the Bronx, is named after him). He supported women in medicine and he was married to one of the most prominent early American physicians, Dr. Mary Putnam Jacobi. Abraham Jacobi believed women should fully participate in the medical profession and he was proud of opening the doors of the New York County Medical Society to women. But neither Abraham nor Mary Putnam Jacobi seemed interested in integrating women into the Climatological. That was a long way off. In 1979, Dr. Carol Johns, a prominent internist at Johns Hopkins Hospital, wrote a letter to President Dick Ross about women becoming members of The American Clinical and Climatological Association (14).

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Fig. 9.  Dr. Beverley Robinson, Founding Member and President ACCA, 1899.

Dr. Johns was married to Dr. Richard Johns and had accompanied her husband to a number of the Association meetings. Dr. Carol Johns suggested to President Ross that women should be considered for membership and Dick Ross promptly named a Committee to study the question. The Committee was headed by F. Tremaine Billings Sr., known as Josh, of Vanderbilt University. The Committee studied the constitution that stated in Article III, Section 1: “This Association shall consist of active members not to exceed (100), and honorary members not to exceed twenty-five (25).” The Committee made the following recommendation at the Williamsburg meeting in 1980: “No changes in the constitution or by-laws need be made. Women can be elected to the Association on the basis of their own merit. This is as it should be” (15). Carol Johns was the first woman President at the annual meeting in Hot Springs, Virginia, in 1995 and Mary Allen

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Fig. 10.  The meeting of the ACCA in Boston in 1908. Dr. Abraham Jacobi is in the front row, 5th from the left (13).

Engle, who served as Recorder from 1993 to 2000, was President at the meeting in Sea Island, Georgia, in 2004. The Billings family, Josh and his son Frederic Billings, have played a very active role in the ACCA for over 50 years. Billings, Sr., elected in 1947, became Secretary-Treasurer in 1958 and was President in 1969 and Billings Jr, our 2014 President, served with his wife, Susan, as Secretary-Treasurer for 8 years. In 2004, both Josh Billings at 94 and Frederic gave talks, and Josh Billings won the Woodward award for best clinical paper! One very special feature of the Climatological is the emphasis and care given to the subject of Memorials. When a member dies, every effort is made by the Recorder to work with a member who knew the deceased well to write a personal and professional Memorial to his life as a physician and Climatologist. These essays are another treasure of the Transactions and could be published all together as a testimonial to what this Association has contributed to American medicine. Is the Climatological pertinent to our lives today? I think it is. The papers and the minutes remind us that we are an organization of clinicians. We are intensely interested in our areas of expertise be it breast

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cancer, leukocyte lipid bodies, or the future of academic medicine. We want to share our experience with our fellow members and learn from them. In this way, we strive to keep American medicine grounded and focused on our primary goal, the care of the patient. ACKNOWLEDGMENTS Special thanks to Stephen J. Greenberg, MSLS, PhD, Coordinator of Public Services, History of Medicine Division, National Library of Medicine, National Institutes of Health, Bethesda, MD; Nancy McCall, Archivist, The Johns Hopkins Medical Institutions, Medical Archives, Baltimore, MD; and Arlene Shaner, Historical Collections Reference Librarian, Center for the History of Medicine and Public Health, The New York Academy of Medicine, New York, NY 10029. I am also grateful to those members of The Climatological who answered my calls and emails about the history of the Association, especially Frederic Billings, Jerry Barondess and Don Lindberg.

REFERENCES 1. Knight FI. The opening address. Trans Ann Meeting Am Climatol Assoc 1884;1:2−5. 2. Harvey AM. The American Clinical and Climatological Association: 1884−1984. Trans Am Clin Climatol Assoc 1985;96(Suppl):289. 3. Deykin D, Janson P. The Ponte Vedra syndrome—an unexpected interaction between alcohol and aspirin. Trans Am Clin Climatol Assoc 1982;93:121−6. 4. Westbrook BF. On the etiology of pulmonary phthisis. Trans Ann Meeting Am Climatol Assoc 1884;1:5−21. 5. Denison C. Dryness and elevation the most important elements in the treatment of phthisis. Trans Ann Meeting Am ClimatolAssoc 1884;1:22−51. 6. Robinson W. Climatology of nudity: partial and complete. Trans Am Climatol Assoc 1898;14:231−8. 7. Brown S. A note on the fresh-air treatment of acute insanity. Trans Am Climatol Assoc 1909;25:167−72. 8. Hinsdale G. The tour of the American Climatological Association. 1902; NML Archives. 9. Denison C. The sleeping canopy: designed to afford tent advantages indoors, with brief remarks on the need of such means of ventilation. Trans Am Climatol Assoc 1907;23:183−99. 10. Minor C. President’s address: “a retrospective and a prospect.” Trans Am Climatol Assoc 1913;29:1−13. 11. Hinsdale G. President’s address: the sun, health and heliotherapy. Trans Am Climatol Clin Assoc 1919;35:1−11. 12. Letter from James J. Waring to Dr. Francis W. Rackemann, September 26, 1941. NML Archives. 13. Harvey AM. The third decade: 1904-1913: the twenty-first annual meeting. Trans Am Clin Climatol Assoc 1985;96(Suppl):62−76. 14. American Clinical and Climatological Association. Paper, 1895−1941. MS C 246, in the History of Medicine Division, National Library of Medicince. 15. Secretary’s report. Trans Am Clin Climatol Assoc 1981;92:xxxi.

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President's Address: The Climatological: A Historical Perspective.

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