University of Virginia Health System

SELECTED HISTORICAL MILESTONES

1819 - Charter for the University of Virginia established by Thomas Jefferson.

1824 - The University of Virginia School of Medicine established as the “School of Anatomy and Medicine.”

1824 - Robley Dunglison, M.B.B.S., a British physician, was chosen by Jefferson as professor of anatomy and medicine. Dunglison served as personal physician to Jefferson, Madison, Monroe, and Andrew Jackson. Dunglison became the most widely read American medical writer of the 19th Century, having authored the first American medical dictionary and textbook of physiology and having edited the first medical journal. Dunglison is recognized as the first full-time professor of medicine in the United States.

1826 - Anatomical Hall designed and built by Jefferson.

1827 - Faculty expanded to include John Patton Emmett, Ph.D., Jefferson’s professor of natural history, who later became professor of chemistry and materia medica, and Thomas Johnson, M.D., professor of surgery.

1828 - First University degrees awarded to four medical graduates.

1832 - Medical catalogue describing the first admissions requirements to any medical school.

1840 - Policy initiated that a comprehensive examination would be the sole criterion for the M.D. degree.

1846 - Description of inflammation by Augustus L.Warner, M.D., professor of anatomy, physiology, and surgery.

1850 - John Lawrence Smith, Ph.D., professor of chemistry and material medica, invented the inverted microscope.

1859 - Publication of “The Testimony of Modern Science to the Unity of Mankind” by James Lawrence Cabell, M.D., professor of anatomy and surgery.The work advanced the idea of evolution one year before publication of Darwin’s “Origin of Species.” Cabell founded the National Board of Health which in 1880 became the U.S. Public Health Service. Cabell was a full professor at the School of Medicine for 52 years (1842-1889) and was an early pioneer of the sanitary preparation of the surgical patient following Lister’s principles.

1869 - Walter Reed received his M.D. degree from the University of Virginia. Reed determined the transmission of yellow fever by the mosquito.

1888 - Clinical description of epidemic pleurodynia by William Cecil Dabney, M.D., professor of medicine, obstetrics, and medical jurisprudence.

1892 - Medical course lengthened to two years.

1893 - Hugh S. Cummings received his M.D. degree from the University of Virginia. Cummings was surgeon general of the U.S. Public Health Service, 1922-1936, and vice president of the Health Section of the League of Nations. He was a member of the National Academy of Sciences and an honorary fellow of the American College of Surgeons.

1894 - Hugh Hampton Young received his M.D. degree from the University of Virginia. Five years later he was made head of the Department of Urological Surgery at Johns Hopkins. His operation for excision of the prostate stands as one of the milestones of modern surgery and urology.

1895 Medical course extended to three years.

1896- Paul Barringer, M.D., LL.D., professor of physiology 1903 and surgery, was chairman of the faculty of the University of Virginia. Barringer oversaw major revision of the medical curriculum with the addition of the clinical years of education. He also was the main driving force behind the construction and staffing of the first University of Virginia Hospital. He later became president of Virginia Polytechnic and State University in Blacksburg.

1898 - Medical course lengthened to four years.

1901 - Opening of the University of Virginia Hospital (25 beds). Dr. Paul Barringer named superintendent.

1903 - Wade Hampton Frost received his M.D. degree from the University of Virginia. Frost established epidemiology as a science. He introduced the cohort theory of tuberculosis and was the founding dean of the Johns Hopkins School of Public Health.

1904 - William Gay Christian, M.D., professor of anatomy and surgery, appointed dean of the Department of Medicine.

1905 - Richard Henry Whitehead, M.D., LL.D., dean of the University of North Carolina School of Medicine named first dean of the University of Virginia School of Medicine.Whitehead reorganized the hospital to a primarily teaching facility. He emphasized scholarship and basic science well in advance of the Flexner Report.

1916 - Theodore Hough, Ph.D., professor of physiology and biochemistry, named dean. Hough engaged Abraham Flexner, his personal friend, to campaign against removal of the School of Medicine and Hospital to Richmond.

1924 -  James Carroll Flippin, M.D., professor of clinical medicine, became dean. Flippin brought all medical departments together in the medical school building, constructed in 1929.

(1925 - 28) - Homer William Smith, M.D., commonly acknowledged as the founder of modern renal physiology, was professor of physiology. Smith developed the concepts of clearance methodology for measurement of renal plasma flow and glomerular filtration rate.

1929 - New medical school building opened (cost $1.4 million).

(1928 - 52)  - Sidney William Britton, Ph.D., professor of physiolgy and Herbert Silvette, Ph.D., professor of pharmacology, demonstrated that the adrenal cortex contained a hormone, not epinephrine, which influenced carbohydrate storage and metabolism.

(1935 - 67) - Alfred Chanutin, Ph.D., professor and chair of biochemistry, discovered the role of red blood cell 2,3-diphosphoglycerate (2,3-DPG) in oxygen transfer from hemoglobin.This finding had enormous impact on the preservation of blood for transfusion therapy.

1938 - Harvey F. Jordan, Ph.D., D.Sc., a distinguished histol-ogist and embryologist, became dean. Jordan was the first to suggest that intercalated discs are contraction bands of cardiac muscle and that vascular smooth muscle does not differentiate into striated muscle. Jordan organized the Eighth Evacuation Hospital Unit and appointed Dr. Staige Davis Blackford as director in 1942.

1939 - Dupont Guerry III, M.D. intern, and William Wirt Waddell Jr., a pediatrician, discovered the role of vitamin K in the etiology, treatment, and prevention of hypoprothrombinemia and hemorrhagic disease of the newborn.

(1939 - 43) -  Eugene M. Landis, M.D., who performed the first direct measurements of capillary pressure and permeability, was professor and head of the Department of Internal Medicine.

1943 - Leonard Malis received his M.D. degree from the University of Virginia. Malis became professor and chair of Neurosurgery at Mount Sinai School of Medicine. He introduced new instruments and techniques to neurosurgery, was the first to use a microscope in the operating room, and introduced the field of microsurgery. He set world standards for removal of meningiomas and acoustic neuromas.

1949 - Vernon W. Lippard, M.D., became dean.At that time there were 48 medical faculty. Lippard served for 4 years and became dean at Yale medical school. He pushed for the modernization of the University of Virginia Hospital.

1953 - Thomas H. Hunter, M.D., became dean. Hunter established international outreach programs in medical education. He also demonstrated synergism between penicillin and streptomycin in the treatment of subacute bacterial endocarditis and, together with Joseph Fletcher, developed the discipline of clinical ethics. Hunter received the Thomas Jefferson Award of the University in 1970 and the Abraham Flexner Award of the Association of American Medical Colleges in 1988.

1954 - Gerald D.Aurbach received his M.D. degree from the University of Virginia.Aurbach isolated and purified parathyroid hormone, determined that parathyroid hormone acts through cyclic AMP, and demonstrated that pseudohypoparathyroidism is a disorder of the parathyroid hormone receptor complex. Aurbach was a member of the National Academy of Sciences.

1960 - New University Hospital (682 beds) completed at a cost of $6.5 million.

1962 - Kenneth R. Crispell, M.D., a noted endocrinologist, named dean. Crispell built the main section of Jordan Hall, the Primary Care Center, and the Health Sciences Library. He recruited 10 clinical and 5 basic science department chairs.

1962 - Henry B. Mulholland, M.D., professor and chair of the Department of Medicine and a noted diabetolo-gist, received the Thomas Jefferson Award of the University of Virginia.

1972 - William R. Drucker, M.D., a noted general surgeon, named dean.

1971 - S.Ward Casscells, a medical alumnus, introduced arthroscopy of the knee joint into practice in the United States.

(1971-81) - Alfred G. Gilman, M.D., Ph.D., professor of pharmacology discovered G-proteins, cellular mediators of hormone action, for which he received the 1989 Albert Lasker Award and the 1994 Nobel Prize in Medicine or Physiology.

(1970 - 83) - Ferid Murad, M.D., Ph.D., professor of medicine, discovered that endothelium-derived relaxing factor is nitric oxide, which acts as a vasodilator by stimulating guanylyl cyclase. Murad received the Albert Lasker Award in 1996 and the Nobel Prize in Medicine or Physiology in 1998 for this discovery.

(1954 - 76) - William H. Muller Jr., M.D., was professor and chair of the Department of Surgery. He pioneered the surgical treatment of pulmonary hypertension and invented one of the first artificial aortic valves. Muller was president of the American College of Surgeons and received the Thomas Jefferson Award of the University in 1982.

(1966 -88) - Robert M. Berne, M.D., professor and chair of physiology, pioneered adenosine in cardiovascular function and introduced adenosine as a therapeutic agent in the treatment of supraventricular tachycardia. Berne was elected to the National Academy of Sciences in 1988.

(1969 - 98 ) - Edward W. Hook Jr., M.D., professor and chair of the Department of Medicine, received the Thomas Jefferson Award of the University in 1996. Hook performed pioneering research in infectious disease, developed an outstanding Department of Medicine, and initiated the Humanities in Medicine Program. He was president of the American College of Physicians and the American Clinical and Climatological Association.

1971 -  Richard F. Edlich, M.D., a leader in plastic surgery ---- and emergency medicine and a revered teacher, received the Thomas Jefferson Award of the University in 1990.

1977 - Norman J. Knorr, M.D., a psychiatrist, became dean. Knorr initiated shared facilities for medical science and built the first section of the Medical Research Building (MR-4).

1976 - Michael O.Thorner, M.B.B.S., D.Sc., professor of ---- medicine, discovered a new hypothalamic hormone, growth hormone releasing hormone.Thorner received the 1995 NIH General Clinical Research Centers Award for his work in clinical neuroen-docrinology.

1986 - Barry Marshall, M.B.B.S., associate professor of ---- medicine, discovered that a bacterium, helicobacter pylori, is the cause of peptic ulcer disease and also is associated with gastric carcinoma. Marshall received the 1995 Albert Lasker Award for this discovery.

1989 - University of Virginia Replacement Hospital (556 beds), planned and developed by William H. Muller Jr., M.D., vice president for health sciences, was dedicated.

RESEARCH PROGRAMS

Research programs in the School of Medicine have shown steady and impressive increases in recent years. Grants and contracts for biomedical research amounted to 121.0 million in 1999-2000 (58 percent of the total awarded to the University of Virginia); the expansion of research programs since 1990-1991 is reflected in the following bar graph.To accommodate the growth in research funds, new laboratory space for biomedical research has increased by from 288,698 square feet in 1990 to 435,116 square feet in 2000, an increase of 33.7 percent.

School of Medicine Sponsored Program Awards

150

Fiscal Year

SELECTED HIGHLIGHTS OF ONGOING RESEARCH

Hepatitis. Basic studies of the mechanism of immunologic injury occurring during hepatitis C infection; clinical studies of changes in hepatitis C virus after liver transplantation and methods to prevent hepatitis B recurrence after transplantation.

Peptides on the Surface of Melanoma Cells.Characterization of unique peptides identified on the surface of melanomas and other cancers and clinical evaluation of these antigens in anti tumor vaccines.

Endoscopic Surgery. Reduced surgical morbidity and mortality in minimal access intra abdominal surgery performed using endoscopic techniques.

Inflammation and Tumor Invasion. Study of the role of cellular adhesion molecules (integrins, cadherins,...) in the physiologic and pathologic functions of white blood cells and the spread and invasion of cancer cells.

Asthma and Allergic Diseases. Recognition of the role of cockroach and dustmite allergens in the increasing prevalence of asthma in developed countries.

Kidney Development. Novel approaches for understanding abnormal kidney development, the leading cause of renal failure in infants and children.

Implantable Hearing Aid. Development and testing of miniaturized, implantable electromagnetic devices for correction of hearing impairment.

Gene Therapy. Use of viral vectors for genetic intervention in cancer and vascular and neurological diseases.

Cell Adhesion Signalling. Researchers in microbiology were the first to identify key protein tyrosine kinases that regulate signals from the extracellular matrix (the surface on which cells grow) to the inside of the cell.These enzymes control cell motility (how cells move) during process of growth and differentiation.

Development of New Cancer Drugs. Investigators at UVA have developed new drugs that exhibit antitumor activity through inhibition of ras and other oncogenes, and clinical trials are underway.

Hypertension. Studies focus on the mechanisms by which certain hormones, synthesized in the kidney, act to control kidney function, body fluid composition, and blood pressure.

Neurological Disease. Discovery of mitochondrial dysfunction as a fundamental factor in the pathogenesis of Parkinson’s disease. Demonstration of the efficacy of a 2thrombolytic agent (rTPA) as an effective therapy for acute stroke.

New Approaches to Treating Diarrhea. Basic and field studies of phospholipase A2 inhibitors, PAF antagonists and stable glutamine derivatives in treating C. difficile, childhood and AIDS diarrheas; and simple assay of fecal lactoferrin in diagnosis.

Nitric Oxide in the Lung and Brain. Biochemical and molecular regulation of nitric oxide signalling and application to understanding pulmonary vascular physiology and lung disease. Role of nitric oxide in consciousness, anesthesia, and analgesia.

Noninvasive Imaging Techniques. Research involving new echocardiographic techniques for assessment of myocardial blood flow and investigation of new radionu-clides for detecting coronary artery disease and determining prognosis.

Oncogenesis and Cellular Signalling. Researchers in microbiology and medicine were the first to identify and characterize protein kinases involved in relaying signals from the outside of the cell to the nucleus (the MAP kinases).These enzymes are key regulators of cell signalling in normal and cancer cells. Identification of these enzymes has led to new strategies for the development of cancer chemotherapy.

Ulcer Disease Caused by Infection. Work on an antibiotic cure for peptic ulcers caused by Helicobacter pylori, whose pathogenic role was first demonstrated by a UVA faculty member.

Targeting of blood-born pathogens. Researchers in biochemistry and molecular genetics have developed immunochemical approaches to disease based on complement and bispecific monoclonal antibodies.

Modulation of gene expression and mitosis at the chromatin level. Researchers in biochemistry and molecular genetics have discovered enzyme systems responsible for the covalent modification of histone proteins, the structural proteins that package DNA in the nucleus. Present studies are focused on determining how these modifications work with each other to regulate chromatin functions such as transcription and cell cycle processes such as cell division.

Estrogen replacement in postmenopausal women.Studies are using extremely low (2 one-millionth of a gram) doses of estrogen applied as a vaginal insert to improve urinary tract symptoms, while limiting potential absorption of estrogen into the blood.This strategy will aid women who are at risk for breast cancer, and who cannot safely receive oral or transdermal estrogens.

Evidence based medicine and information mastery.Faculty in the Department of Family Medicine are developing new systems that provide clinicians with the best information for the care of their patients. Information Mastery is a method for understanding and applying the best research information and uses informatics and filtered databases.This semantic translation system bridges the gap between the language of epidemiology and biostatistics and that of clinical medicine.

Wound healing. Optimum repair of injury requires understanding how management techniques—such as debridement, cleansing, antimicrobial agents, closure devices, adjunctive agents, growth factors, and dressings—influence wound healing.We have developed animal models of acute and chronic wounds to evaluate these parameters.

Clinical data repository. Development and integration of a comprehensive Intranet-based collection of clinical and administrative data that can be used directly by researchers and practitioners to study outcomes and evaluate quality of medical services.

Transmembrane signaling. Research to understand the actions of drugs via study of the signaling mechanisms used by hormones, neurotransmitters, and growth factors. Systems under study include G protein coupled receptors, G proteins and the ability of insulin and other growth factors to regulate ras and protein kinase and/or protein phosphatases cascades.

Drug discovery program. PharmaBiologicals is a new drug discovery program that will develop high throughput screening assays to isolate bioactive compounds from a diverse collection of botanical extracts in the Department of Chemistry.The bioactive compounds should prove to be useful research tools and have the potential for therapeutic applications.

Nuclear-Cytoplasmic Shuttling. The transport of proteins and nucleic acids between the nucleus and cytoplasm is an essential and fundamental process in cells. This has led to the recent discovery of the function of two proteins called NTF2 and NXT1 and has shown how these are involved in viral infections.

Robotics and laboratory automation. Development of novel automation technologies, including robotics, are designed to improve the efficiency and quality of health care.

Molecular genetics of prostate cancer. Tissue microdissection and molecular genetics are being used to determine genes that are important in the development of human prostate cancer.This research may also lead to new techniques for diagnosis and therapy of this human malignancy.

Attention Deficit/Hyperactivity Disorder (ADHD) Test. ADHD is a relatively common illness in children and adults, and it often is treated with medications even though there are no reliable objective criteria for diagnosis. UVA researchers have developed a quantitative test of brain wave activity that differentiates ADHD children and adults from normals.

Changes in sexual functioning. A validated assessment tool of changes in sexual functioning is used to evaluate men and women who have mood disorders and who are taking certain medication treatments for depression and anxiety. New treatments are being developed for sexual dysfunction and for women with menstrual mood disorders.

Reproduction. Ongoing studies focus on polycystic ovarian syndrome (PCOS), a disorder of unknown etiology, which effects 7 percent of women causing infertility and significant morbidity. Research focuses on establishing the cause. Present studies address signals from the brain to the pituitary, the synthesis of pituitary hormones, the role of hyperinsulinemia, and ovarian secretory responses to pituitary hormones.

AIDS molecular pathogenesis. Research is directed at further understanding several key molecular events in the life cycle of HIV, the virus that causes AIDS. Increased definition and understanding of these events is expected to lead to new strategies for preventing and treating AIDS.

Biology of human cancer virus. Research is focused on two viruses that cause human cancer: HTLV-I and Kaposi’s Virus.These viruses are important in their own right for the diseases they cause and also as models to further increase our understanding of the molecular events involved in human cancer.

Imaging of the lungs and hollow organs.Investigation of using noble gases (e.g. helium, xenon) as contrast agents for magnetic resonance imaging of the lungs and hollow organs.The gases are hyperpolarized using a laser.The technique, which recently entered clinical trials, has potential for early detection of disease and determining the effectiveness of treatment.

Cutaneous sarcoidosis. Analysis of the effects of a tropical immunosuppressive agent to prevent cutaneous granu-loma formation.Topical tacrolimus ointment will be studied in a double-blinded placebo controlled clinical trial for the treatment of facial skin lesions in patients with cutaneous sarcoidosis.

Ethics and history of human subjects research.Several center faculty continue to work on ethical problems and historical dimensions of medical research involving human subjects, especially on the topics of informed consent and subject protections.

FINANCIAL AFFAIRS

The annual budget of the School of Medicine exceeds $250 million per year.This includes revenues from all sources, including physician fee income, and expenses for operating costs as well as capital expenditures for facilities and equipment.

Sources of Financial Support: 1998-99
	$		% of total
State appropriations	24.3M		9.4
Tuition	8.2M		3.1
UVA Medical Center	14.5M		5.6
Grants and contracts	81.9M		31.6
Faculty practice plan	108.5M		41.8
Endowment, gifts, & misc. sources	22.0M		8.5
Total	259.3M		100.0
Expenditures: 1998-99
	$		% of total
Faculty compensation	122.5M		47.2
Staff compensation	59.1M		22.8
Scholarship/fellowships	8.0M		3.1
Equipment	9.1M		3.5
Construction/renovation	52.4M		3.2
Other	22.0M		8.5
Total	259.3M		100.0

ENDOWMENT
The School of Medicine endowment plays an increasingly important part in ensuring a stable base of support for education and research. Endowed professorships provide support to many of the school’s best faculty. Fellowships and scholarships provide financial aid to students who otherwise could not attend this institution. Endowment funds also play an essential role in fostering strategic decision-making within the school, allow the allocation of funds for program innovations.

* In fiscal year 1999-00, the distributed income from the School of Medicine endowment will total approximately $13.7 million.These funds will support medical student financial aid, endowed chairs, and other academic activities.

Take U.S. 29 South. Upon reaching Charlottesville, go past the U.S. 250 Bypass and remain on 29 South. Remain on 29 South Business (Emmet Street) and continue past the intersection of University Avenue and Ivy Road. Pass the Ruffner Hall-Curry School of Education on your right. Proceed under the overpass and follow the road to the left (it now becomes Jefferson Park Avenue). Keep left and follow the signs to the Medical Center/University Hospital.Watch for signs that indicate parking on Lee Street to the right.

From the South

Take U.S. 29 North. Upon reaching Charlottesville, take the U.S. 29 North Business exit and turn right when coming off the exit ramp onto Fontaine Avenue. Follow the signs to the Medical Center/University Hospital. Continue on U.S. 29 North Business to the traffic light.After the traffic light, you will be on Jefferson Park Avenue. Follow Jefferson Park Avenue as it bears to the right. Watch for signs indicating parking to the right on Lee Street.

Take I-64 West to Exit 118 and follow the sign to the University of Virginia. Proceed on U.S. 29 North, then take the U.S. 29 North Business exit.Turn right onto Fontaine Avenue after coming off the ramp. Follow signs to the UVa Medical Center. After the traffic light, you will be on Jefferson Park Avenue. Follow Jefferson Park Avenue as it bears to the right.Watch for signs indicating parking to the right on Lee Street.

From the West/I-64

Take I-64 East to Exit 118 and follow the sign to the University of Virginia. Proceed on U.S. 29 North, then take the U.S. 29 North Business exit.Turn right onto Fontaine Avenue after coming off the ramp. Follow signs to the UVa Medical Center. After the traffic light, you will be on Jefferson Park Avenue. Follow Jefferson Park Avenue as it bears to the right.Watch for signs indicating parking to the right on Lee Street.