P&S Journal: Fall 1994, Vol.14, No.3
Robert Federick Loeb 1895--1971
By Nicholas P Christy '51
The years 1947 to 1960 were especially bright ones in the history of P&AMP;S: Robert Loeb was Bard Professor of Medicine, chairman of medicine, and chief of Presbyterian Hospital's Medical Service. In those years P&AMP;S had an immense reputation: Of the 27 departments of instruction, 14 were the acknowledged leaders in their fields. The faculty comprised dozens of luminaries: Loeb was the star. When P&AMP;S came up in conversation among outsiders, the name immediately associated with it was Loeb. Inside CPMC, it used to be said-only half in jest-that Columbia had two medical schools-one based in the Dean's Office, the other in PH 8-Stem, the site of medicine's departmental headquarters. The institution's view coincided with Loeb's own: He used to say, referring to the Department of Medicine's educational role, that "Medicine is the hub of the wheel."
Loeb's career at Columbia spanned 52 years, starting in 1921 when he came to New York, fresh from internship at Massachusetts General and residency at Johns Hopkins, ending only at his death. Young Robert began his formal education in San Francisco, finished it at Horace Mann in New York, attended the University of Chicago where he completed the bachelor's requirements in two years, and entered Harvard Medical School. There, in his first year, he suffered his only academic reverse: He did not do well in anatomy. He almost resigned but was persuaded by his father to stay, fulfilling everyone's expectations by graduating magna cum laude, first in his class, in 1919.
At Columbia, the young physician soon established himself as the most brilliant clinician and teacher in a department already famous for superb instructors. Loeb eclipsed them all, including the chairman, Walter Palmer, a learned, quietly forceful man and the main architect of the department that would become, under Loeb, the leading academic internal medicine unit in the country. Lacking Loeb's verve at the bedside, Dr. Palmer acknowledged the younger man's pedagogic flair and let him spread his wings.
Over the 45 years of his productive research career-1918-1963-Loeb's work embraced a wide range of chemical, biological, and clinical problems. His publications, numbering nearly 90, include several masterpieces and all fall into five broad categories. His earliest studies, in the 1920s, emphasized the application of physical chemistry to biology. This work, notably austere, comprised examining the role of proteins in regulating osmotic pressure, the physiologic action of potassium, alkalosis, and topics in colloidal chemistry. I think this basic work stemmed in part from the interest of Loeb's father in the bearing of physics and chemistry on biology. Jacques Loeb, dean of world physiology, presented to his son a scientific ideal hard to live up to, so much so that Robert, feeling overshadowed, "relegated" himself to "the less precise science of medicine." Out of such sentiments arose Robert's lifelong habit of excessive self-criticism.
From those fundamental chemical studies-what Loeb would have called "hard science"-he turned in the 1930s to investigating the physiologic actions of deoxycorticosterone in animals. With Atchley, Richards, and others, he found that large doses of this steroid induced a diabetes-insipidus-like syndrome, with hypertension and hypokalemic alkalosis. These findings enabled Loeb to predict that the normal adrenal secretes a salt-retaining, kaliuretic hormone, a forecast borne out 20 years later by the discovery of aldosterone and by the first recognized occurrence of Conn's syndrome: aldosteronism owing to adrenal adenoma.
At the same time, he and his group launched pioneering studies of electrolyte abnormalities in human adrenal disease and uncontrolled diabetes, work that would make Loeb-and the department-world-famous. To appreciate the novelty of this work, one must go back to the first three decades of this century, when internal medicine was largely descriptive, and science had not yet reared its head at the bedside. Loeb et al. precisely defined the electrolyte lesion of diabetic ketoacidosis, laying the scientific foundation for its management; Loeb, alone, conceived of Addisonian crisis as a form of "medical shock" due to renal loss of sodium and water. Colleagues in those days referred to Loeb and his co-workers as "millimolers," not a term of respect but of ridicule. After those two discoveries, which spawned many practical everyday clinical applications, e.g., you could now treat Addison's disease with table salt, they stopped laughing.
In the 1940s and 50s, by now arguably the most revered and influential internist in the United States, he found time to write many didactic articles on Addison's disease, nephritis, diabetes and hypoglycemia, and clinical topics ranging from oxaluria to obesity. During World War II and the Truman, Eisenhower, and Kennedy administrations, he rendered notable public service, coordinating the national wartime efforts that yielded chloroquine as the first synthetic anti-malarial and, later, serving on the President's Science Advisory Committee. From 1951 to 1959, Loeb further extended his pedagogic influence by co-editing, with R.L. Cecil, "A Textbook of Medicine," presiding over three editions.
Loeb's papers on medical education insistently emphasized the primacy of basic science in the curriculum. During the 1950s and 60s, he heaped scorn on then-popular innovations arising from sociology. He made enemies among those who would have replaced science with home care, apprenticing students to general practitioners, and the like, calling those ideas "romanticism."
Loeb's contributions earned him many honors: membership in innumerable honorific scientific societies and on many national committees, 13 honorary degrees, and nine major awards; two distinctions that he valued particularly were memberships in the Harvard Board of Overseers and on the Board of Trustees of Rockefeller University.
Here at P&AMP;S, Robert Loeb is remembered for the indelible imprint he made on generations of medical students, house officers, and members of the medical staff. While building a superb department-including Berliner, Bradley, Wˇgria, London, Mudge, Taggart, Ragan, Ranney, Marks, Laragh-and despite his administrative burdens and countless, demanding outside commitments, he never forgot his first responsibility and his first love: teaching students and residents, in whom he inspired respect, veneration, terror, awe, worship, and love. A man of enormous energy and imposing aspect, Loeb had deeply tanned skin, penetrating dark eyes behind steel-rimmed spectacles, and a shock of startlingly white hair, which students enshrined by nicknaming him "the silver fox." Demanding the highest standards of himself, he expected no less from his pupils. He had no patience with sloppy work or slipshod thinking; his disapproval, often publicly expressed on rounds or in the conference room by a "no" wag of his head, was dubbed-not in his hearing-"the negative shake test," guaranteed to chill the blood of the offender. For third-year clinical clerks, presenting a patient to "The Professor" was the major ordeal of the entire four years, entailing all-night preparation, frantic boning up on relevant literature, endless rehearsals, and anxiety bordering on psychosis. In the face of a poor presentation, Loeb could be severe, even ferocious. But his rounds were not devoid of fun. One student, thinking no one was looking, tried during rounds to ease the pain of staying on his feet for two hours by hanging, or seeming to hang, by an arm from the bed-curtain rod, giving an unmistakably simian appearance. Loeb, missing nothing, remarked casually, "Rourke, let's watch these atavistic tendencies." One thing students knew for certain: Loeb's rounds were exclusively devoted to them: no guests, no interruptions. He lavished the same intense concentration on these sessions as he did on every other activity.
For residents, a high point of the day was Loeb's "sunrise service," starting in his office at 8 a.m. Ostensibly, this was the time for discussing new admissions, problem cases, the latest medical advances. But the meeting also drew other staff members and distinguished visitors, and the function expanded to embrace conversation about every imaginable topic, during which Loeb spoke with astonishing candor. He launched verbal thunderbolts at famous physicians, inside and outside CPMC. Indiscreet, perhaps, but his free and open critique made the house staff feel like insiders, privy to the secrets of the mighty. An exacting taskmaster, Loeb was forgiving and supportive when someone made an honest mistake. A special feature of those informal gatherings was the chance to see Loeb's incredible memory at work. He read everything, rapidly, and remembered all of it. He knew the names of students within days of their arrival on the service. He easily recalled the minutiae of laboratory data on patients he had seen once, years before. More impressive still, he had the knack of calling up material-broad principles, small details-from his vast reading and making it creatively pertinent to the matter at hand.
He unstintingly fostered the careers of his young colleagues. No paper left the department for publication without his painstaking scrutiny, which often involved several meetings with the writer, sessions that could be excruciating. Himself endowed with an excellent prose style, he was a sharp and helpful critic. Always pressing his staff toward clarity and completeness, he would say to an erring investigator: "If someone in your field wrote a paper like this one of yours, you'd hate him for the rest of your life." Hyperbolic, but unforgettable.
An intense and driven man, Loeb retired in 1960, and it was pleasant to see him visibly relax in his last years. He visited medical services, worked on committees, continued in various trusteeships; characteristically, he stayed away from CPMC, wishing to leave his successor unhampered. When he died in 1973 of carcinoma of the lung, he could depart with the assurance that he left a unique legacy. His salient quality as a teacher was to imbue everyone around him with the need to stretch, to surpass his or her own best. No one knows how he did this. Partly, it was by his own example. A P&S graduate 20 years out of school once said of Loeb: "Every time I sit down with a patient in front of me and start taking down the history, I sense that man leaning over my shoulder. And I cannot-I will not-let him down."
The sources for this profile included an obituary written by Alexander G. Bearn, former chairman of medicine at Cornell,
for the National Academy of Sciences.