THE first instruction in ophthalmology at the University of Michigan of which there is record was given in March, 1870, when George Edward Frothingham ('64m) became Lecturer in Ophthalmology. He had come to the University three years before as Prosector of Surgery and Assistant Demonstrator of Anatomy, but had become interested in ophthalmology, which had been established as a separate chair in the Miami Medical College in 1860, and in the College of Physicians and Surgeons in New York in 1869. His successor, Dr. Flemming Carrow, wrote regarding Frothingham's part in making Michigan the third medical school in America to establish a Department of Ophthalmology: "Not only did he demonstrate the necessity for this chair, but he clearly showed his ability to fill it … The clinics in ophthalmology were the most numerously attended of any … west of Philadelphia" (Carrow, p. 443).
Dr. Frothingham was born in Boston in 1836, received his early education at Phillips-Andover Academy, and for some years taught school in Massachusetts. Later, he began the study of medicine under Dr. William Warren Greene ('55m), eminent New England physician and surgeon, but came to Michigan in 1864 to complete his medical studies. After his graduation he engaged for a time in general practice in North Becket, Massachusetts, but when Greene, his old preceptor, was called to Michigan in 1867 as Professor of Surgery, he brought young Frothingham with him. It was undoubtedly Frothingham's increasing interest in ophthalmology and aural surgery that led not only to a gradual decrease of his work in anatomy but also to his appointment to the professorship of ophthalmology and aural surgery in 1872.
Evidence, however, of the minor position of ophthalmology in Frothingham's teaching and clinical duties may be gathered from a report submitted to the Regents in June, 1875, by Acting Dean Maclean:
That in addition to his present work as Professor of Ophthalmology and Otology, the incumbent of the proposed chair give his attention to daily teaching and demonstration in the dissecting room on such topics and matters as may arise in the every day work of dissecting; and that the direction of this work shall be under his personal supervision.
That he shall, on consultation and by mutual agreement with the Professor of Anatomy, give lectures on such topics as may be decided upon, for the purpose of allowing the Professor of Anatomy more time for the special instruction of the students in the Dental School in subjects not usually brought before general classes in medicine.
That he be required to hold the students to a strict examination and account for their work in the department of Practical Anatomy, giving certificates of the same on the completion of such work.
That he shall have charge of the finances of the department, and shall make a yearly report of the same to the Board of Regents.
That he shall have supervision of, and shall give attention to, the procuring of anatomical material; but on account of the labor in this work, and the extra duties required of him, he shall be allowed an assistant, who shall be styled the Demonstrator of Anatomy. The duties of the Demonstrator of Anatomy shall be defined by the Professors of Anatomy and of Practical Anatomy, and he shall be required to devote his entire Page 877time to the practical work of this department.
(R.P., 1870-76, pp. 448-49.)
The addition to his title of the professorship of practical anatomy at this time suggests the difficulty of obtaining anatomical material. Frothingham had taken this part of his responsibility so seriously and had advanced the matter so vigorously before the legislature that a law was passed in 1876 which became a model for subsequent enactments in other states.
Frothingham continued to hold the chair of ophthalmology and aural surgery, under various titles, for nineteen years, until he withdrew from the University as a result of his advocacy, together with that of Dr. Donald Maclean, of the removal of a part of the University's medical curriculum to Detroit. Neither man felt that adequate clinical material could be obtained in Ann Arbor. One of them was said to have remarked that "one might as well undertake to raise oranges in Canada as to have a complete clinic in Ann Arbor." There ensued a bitter battle which was greatly publicized by the newspapers of the times. Largely as a result of President Angell's masterly analysis of the situation, the plan for a change was rejected. Frothingham accordingly resigned and devoted his entire time to his Detroit practice. He died in Detroit, April 24, 1900.
Dr. Frothingham's personality was pleasant and agreeable; a man of original ideas, great energy, and ability as a speaker, he took a prominent part in discussions within the Medical Department, as well as in the State Medical Society. He was active in a movement toward a general elevation of requirements for the degree of doctor of medicine, and he deplored the tendency to specialize without first having attained a proper proficiency in general medicine. He was equally emphatic in his rejection of the idea that the so-called "classical" education is the best preparation for a course in medicine. He was also one of the first members of the medical faculty in 1875 to defend the Regents' position in regard to the establishment of the Homeopathic College, contending that knowledge was the most effective antidote to false theories. His position was later sustained by the American Medical Association, in which in 1888 he was chairman of the section on ophthalmology.
Throughout Frothingham's years at the University, ophthalmology developed steadily. In 1877 President Angell reported the success of a large number of surgical operations performed on the eye and ear, and in 1878 he noted that of two hundred operations performed in the Hospital thirty-three were for cataract, and of these, thirty were successful. In 1881, an eye and ear ward was added to the University Hospital at a cost of some $2,500. At that time few men in the country were doing cataract surgery. Frothingham developed and perfected his technique as rapidly as knowledge of the times permitted. After the first use of cocaine in 1884, as a local anesthetic in eye surgery, operations for cataracts greatly increased. Dr. Frothingham became more interested in intraocular surgery. He kept accurate and complete records of his surgical cases, and he frequently reported his results in the Journal of the American Medical Association. Probably 90 to 95 per cent of the surgery done during those years was for cataracts, since glaucoma surgery of any extent was as yet unknown, and squints were treated most frequently with corrective glasses. Reports on the technique of the cataract operation were prevalent, the so-called "flap" type being the most universally accepted. Frothingham took part in the dispute among ophthalmologists regarding the kind and Page 878extent of postoperative care to be accorded cataract patients. Then, as now, there were advocates of a long and strict confinement of the patients to bed with both eyes covered, whereas others allowed their postoperative cases to be out of bed on the first postoperative day. Dr. Frothingham pursued a middle course. He felt neither of the extreme views was justified.
The teaching of ophthalmology through the early formative days of the department was decidedly limited compared to the amount of instruction and clinic material which students now receive. In 1880 three courses in ophthalmology were given. One was entitled Eye and Ear Clinic and consisted of seventy-two lectures; another, listed in the Announcement as Ophthalmology and Otology, offered twenty-four lectures; and the third course, Clinical Ophthalmology, included 128 lectures and demonstrations. Dr. Frothingham operated before the students twice a week. In his opening lecture of the year he often told the students: "… you must know you will profit none by my operations unless you know the anatomy and physiology of the organ thoroughly. I can demonstrate the fundamental principles. The world will be your clinic" (Vaughan, A Doctor's Memories, p. 201). One may imagine the operating amphitheater in the old Pavilion Hospital crowded with students straining to see a cataract extraction. Those students in the uppermost benches must have had difficulty seeing the eye, let alone a lens being tumbled from it. Today students are allowed to stand by the surgeon's elbow to watch the operations. Many great ophthalmologists received their initial tutelage under Frothingham. Among them may be mentioned Dr. John E. Weeks, of New York, and Dr. Harold Gifford, of Omaha.
Upon Dr. Frothingham's resignation in July, 1889, Dr. Flemming Carrow (George Washington '70, M.D. ibid. '74, A.M. hon. Michigan '03) was appointed his successor, as Professor of Ophthalmic and Aural Surgery, and Clinical Ophthalmology, at a salary of $2,000. By that time both ophthalmology and otology had become of great importance in the medical curriculum, and it became necessary to devote more and more time to these subjects. Thus, when Carrow assumed his new duties, he gave up his work in anatomy. Dr. Carrow had had a varied experience. He had studied ophthalmology with Dr. C. R. Agnew in New York City, and in London, Berlin, and Vienna. In 1875 he was appointed surgeon in charge of military service for the Chinese government at Canton. During this period he was also medical officer to the British consulate (1878) and customs-medical officer in 1879. He saw active service with the Chinese army at the Gulf of Tonkin, and two years later he became American vice-consul. Later, he returned to America and practiced medicine in Bay City, Michigan, until he was appointed in 1889 to a professorship in the University.
Many of Dr. Carrow's lectures to the students have been saved and are still available. They are written in beautiful handwriting, giving the fundamentals of diagnosis and treatment of many diseases affecting the eye, ear, nose, and throat. Characteristic of these lectures are the bits of philosophy and hints to the student on the practice of the art of medicine. Dr. Carrow had a flair for the dramatic. He enjoyed telling the students how they should run their offices. He said that there should always be a neat pile of clean towels on a table in the examining room. When the patient entered one should fasten a towel about his neck and place another one over his lap and another one over the near-by table. When the patient got up to go the Page 879towels should be nonchalantly tossed into a corner. After the patient left, however, one should pick up the towels, shake them off, and place them back in the clean pile.
The work in ophthalmology and otology flourished under Dr. Carrow's direction. Both fields were developing so rapidly that there was more work than one man and his assistant could handle. Dr. Carrow remained at Michigan until September, 1904, when he resigned to take up the practice of his specialty in Detroit. After some years he retired to Traverse City, where he died June 23, 1928.
At the time of Dr. Carrow's resignation in 1904, Walter R. Parker ('88, M.D. Pennsylvania '91, Sc.D. hon. Michigan '35) was appointed Clinical Professor of the Diseases of the Eye, becoming Professor of Ophthalmology the following year. At the same time R. Bishop Canfield ('97, '99m) was appointed Clinical Professor of the Diseases of the Ear, Nose, and Throat. After some years' experience in various hospitals in the East, Parker began the practice of ophthalmology in Detroit in 1894, interrupted in 1896 by a year's postgraduate study in Vienna. From 1899 to 1904 he was clinical assistant in ophthalmology in the Detroit College of Medicine.
During his period of twenty-eight years of service in the Medical School wide recognition came to Dr. Parker in his special field. During World War I he was colonel in charge of the Division of Head Surgery in the Surgeon General's office, under General W. C. Gorgas. His numerous contributions to ophthalmic literature, his service on the editorial staff of a number of journals, and his membership in the Council of the International Congress of Ophthalmology bear witness to the recognition accorded his work in the University.
The postgraduate training in ophthalmology developed by Dr. Parker is still followed and is considered the model for the teaching of clinical ophthalmology to undergraduates and as specialized training for postgraduate students. Today, the Department of Ophthalmic Surgery has one of the outstanding clinics in the country.
Because there were no volunteer assistants to be obtained in Ann Arbor, it became necessary to develop a large resident staff. Gradually, within the Medical School, a three-year rotation service was instituted. A graduate is actually appointed for four years of service — one year spent in a general hospital of his election and three years on the ophthalmic service at the University — one year as assistant resident, one year as resident, and one year as instructor. While this service was inaugurated primarily to assist in teaching ophthalmology to the undergraduates, it has in reality developed a postgraduate service that is well recognized and is generally known as the Michigan rotation system. Each year one or two men are graduated who are thoroughly trained in ophthalmology and who have had some experience in teaching. No degrees are given, but it is now so arranged that members of the staff holding a collegiate degree may enroll in the postgraduate school as candidates for the degree of Master of Science in Ophthalmology. That the results have been rewarding is shown by the responsible positions attained by graduates of the department.
Upon Dr. Parker's resignation in July, 1932, to become Emeritus Professor of Ophthalmology he was succeeded by George Slocum ('89m). After four years' general practice in the state of New York, Dr. Slocum spent a year in postgraduate work in the University Medical School, becoming Demonstrator in Ophthalmology in 1904, which title he held Page 880until 1913, when he became Instructor in Ophthalmology. He continued to serve the department as Assistant Professor until 1930. At the time of his appointment as Professor of Ophthalmology in 1932 he had been Associate Professor for two years. Dr. Slocum had been in the department throughout Dr. Parker's term as chairman. As Dr. Parker practiced and lived in Detroit and came to Ann Arbor two days a week for surgery and clinic, Dr. Slocum did a large share of the student instruction and supervising of the outpatient clinic. He also had a private practice in Ann Arbor. Dr. Slocum was a member of many medical and scientific societies and the author of numerous publications in various journals, as well as of a textbook entitled Junior Ophthalmology. He died on March 24, 1933.
Dr. Slocum was succeeded by Francis Bruce Fralick ('27m, M.S. '35) as Associate Professor of Ophthalmology and acting chairman of the department. In February, 1938, he was appointed Professor of Ophthalmology and chairman of the department. Under Dr. Fralick postgraduate research and training have shown much progress. Men who are in their fourth year of training now do a large part of the clinic surgery. They are well qualified on ophthalmic surgery when they have finished their four years at the University and are as thoroughly trained as possible for the American Board Examinations in Ophthalmology.