The University of Michigan, an encyclopedic survey ... Wilfred B. Shaw, editor.
University of Michigan.
Page  899

THE DEPARTMENT OF PEDIATRICS AND INFECTIOUS DISEASES

THE first regular course in pediatrics* in the Medical School was given in the year 1905-6 by Dr. David Murray Cowie ('96m), who had been appointed Instructor in Pediatrics in the Department of Internal Medicine. Prior to this time, however, the subject of children's diseases had not been neglected. It was included in the course on the Theory and Practice of Medicine. The title of Dr. Alonzo Benjamin Palmer (M.D. College of Physicians and Surgeons [West. Dist., N. Y.] '39, A.M. hon. Nashville '55, LL.D. Michigan '81) in 1854 was Professor of Materia Medica, Therapeutics, and Diseases of Women and Children. This was later changed, on the death of Dr. Samuel Denton (M.D. Castleton Medical College [Vt.] '25) in 1860, to Professor of Pathology, of Materia Medica, and of the Theory and Practice of Medicine. His successor, Dr. Henry Francis LeHunte Lyster ('58, '60m, A.M. '61) was Professor of Theory and Practice of Medicine and Clinical Medicine from 1888 to 1890; but up to this time no emphasis had been placed on diseases of children. There is no mention of children or infancy in the index of the two 900-page volumes of Palmer's excellent and then very popular text, The Science and Practice of Medicine. It is noteworthy that Dr. Walter Shield Christopher, who followed Dr. Lyster, was a pediatrician, and in his courses on internal medicine, he must have more or less continuously pointed out the differences between childhood and adult types of disease. It was his interest in pediatrics that led Dr. Christopher to resign his chair at the University in 1891 and to take up the practice of that specialty in Chicago, where he became professor of diseases of children at the Chicago Polyclinic.

After graduating from the Medical College of Ohio in 1883, Dr. Christopher was elected Demonstrator of Chemistry at his alma mater, and consulting chemist to the Rookwood Pottery, where he perfected some of the glazes which have since given world-wide fame to Rookwood ware. Soon after his graduation he was made clinician to the children's clinic of the Medical College of Ohio, in Cincinnati.

Dr. Christopher was elected to membership in the American Pediatric Society in 1889 and served as its president in 1902. He was greatly interested in "the perversions of the chemism of the body," and was one of the first to see the importance of such studies in diseases of infancy: "It is in these conditions of perverted chemism of infancy," he said, "that we find many of the difficulties of infant feeding." Dr. Christopher died in Chicago, March 2, 1905, "one of the best known and best beloved physicians of this country."

In 1891 Dr. George Dock (M.D. Pennsylvania '84, A.M. hon. Harvard '95, Sc.D. hon. Pennsylvania '04) was appointed Professor of Theory and Practice of Medicine. He had been an associate of Osler, and he continued to be an ardent follower and exponent of this great teacher and clinician. Osler was particularly interested in pediatrics and was a member of the American Pediatric Society, being its president in 1896. Medical men of that time were particularly interested in the childhood types of disease, and it should be pointed out that Page  900Dock did not neglect pediatric training while he was abroad. He made every effort to encourage doctors to send sick children to the University Hospital. He taught a simple milk dilution method of infant feeding, which soon went out of vogue, overshadowed as it was by the newly developed "percentage method," but since reinstated with a better understanding and appreciation of its merits. Sterilized and pasteurized milk dilutions, cereal and vegetable additions, yolks of hard-boiled eggs, milk and cane sugar, were all that were needed then as now, if intelligently employed, to carry the infant successfully through the then more perilous period of infancy.

Because of the alarming increase in the infant mortality rate about this time, general interest was aroused in the conservation of infant life. Few medical schools had instituted required courses in the diseases of infancy and childhood, and pressure was being brought to bear on their faculties to establish such courses.

Dr. Cowie was particularly interested in the field of gastroenterology and infectious diseases. When, in 1905, it became advisable to develop the subject of pediatrics as a permanent course in the Medical School, because of the frequency of these two types of disturbance in infancy and childhood, he was selected to teach this branch in addition to his other work. The staff had been trying for several years, without much success, to increase the admission of children to the University Hospital. Parents who could afford to pay for their children's medical attention would, of course, not send them to a charity hospital which possessed no special equipment for their care. There was no state children's fund and no way whereby the indigent medically sick child could enter the hospital unless a cash deposit was made or the child's expense in some way guaranteed. This was done insofar as possible by the organization of King's Daughters, the Palmer fund, and by private donations. The interest on the Palmer fund amounted to $750 a year and was used for surgical as well as medical child patients and for some time for the defraying of the expense of glasses for children.

The opportunity to develop a clinic under these conditions was discouraging. A bill had been passed by the legislature some years previously providing hospital care for children with congenital deformities, but the medically or acutely sick child was discriminated against. Only children with certain states of mental deficiency could be admitted to the clinic under this provision. This helped to increase the number of children at the Hospital. Where children are gathered the disturbances to which they are heir sooner or later show themselves, and, developing under the eyes of the staff, they were sooner recognized and more properly handled. The staff, however, began to think that these children, in spite of popular belief to the contrary, were more resistant to the vicissitudes of childhood than those not so afflicted. Medical material for teaching purposes did not perceptibly increase with their attendance, but they proved excellent cases for the study of this ever-increasing and important form of juvenile disturbance. Children with "epilepsy" could also be admitted under the provisions of this act. They are always of great interest and importance as medical problems, and much could be done for them.

There was some technical difficulty in bringing about the establishment of this separate division of internal medicine, since there was already a chair of diseases of women and children, the Bates professorship, first given to Dr. James N. Martin. An adjustment was soon made, and the subject of pediatrics was permanently Page  901established as a required course for graduation — one of the first in the United States.

As early as 1902-3 in the description of the Department of Medicine in the yearly Calendar there appeared a statement of the teaching of diseases of children: "The peculiarities of medical diseases in childhood are discussed in the lectures and recitations. Clinical instruction is given in the various hours mentioned above. Most of the infants born in the Obstetric Clinic are artificially fed, and furnish abundant material for instruction in this important branch … Contagious Diseases are demonstrated in an Isolation Ward." This latter statement was perfectly correct.

In 1901 Mrs. Love M. Palmer, widow of the late Alonzo B. Palmer, made a bequest of $20,000 to the University for the building of a memorial ward, to be known as the Alonzo B. Palmer Ward. She also established an endowment fund of $15,000 to be used for the medical care of patients brought there. The building was completed in 1903. It was decided by the Board of Regents to dedicate the ward to the service of children. The urgent need for quarters for obstetrical patients, however, persuaded the Hospital staff, with the permission of the Regents, to use the first floor of the building for that purpose. Another pressing need determined them to use the second and third floor for a nurses' home. Accordingly, there was no special place in which to house the patients of the children's division of clinical medical study.

The children's clinic grew very slowly. The greatest number of yearly registrations during the first eight years was 228 (1912). Much pressure was being brought to bear on the Regents to transfer the clinical years of medical study to Detroit, and the need for more adequate teaching material in pediatrics was being stressed. Dr. Cowie decided to organize a campaign for a revision of the congenital deformity act (No. 42) of 1897 or for the passing of a new act by the legislature that would permit any indigent sick child in the state who needed medical care to be sent to the University Hospital as a so-called free case. Dr. Peterson, hearing of this, informed Dr. Cowie that he had been thinking of a similar plan for the admittance of pregnant women to the Hospital and requested that he be allowed priority for his plan. Cowie agreed that his was the greater need. The babies born at the Maternity Ward were turned over to the Department of Pediatrics for feeding and medical care (see Hospital, p. 975).

In due time the proposal for the new children's act was revived and pressed with vigor. It was not difficult to secure favorable legislation when the legislators saw the needs. Accordingly, in 1913 the now well-known children's act (No. 274) was established. In Michigan the legislature has always acted wisely in matters pertaining to public health. Michigan stands second to none in devising ways and means for the care of its unfortunate and underprivileged children.

Since the establishment of this law the children's medical clinic has had a phenomenal development. It progressed from twenty-two patients for teaching purposes in the first year, to a yearly registration of 6,346 in 1932 and a monthly attendance of 2,580 in August, 1935.

The new law stipulated that a place should be provided for all children brought to the Hospital by properly authorized agents. The space that could be used for them was soon exhausted, and more beds had to be provided. The Palmer Ward originally had been set aside for the care of children. As arranged, the space assigned to obstetrics became inadequate, and buildings were moved to the hospital grounds to provide better accommodations for the patients of that Page  902clinic. The first floor of Palmer Ward was turned over to the Department of Pediatrics in 1911. This served the need, however, for only a short time. The increasing number of children made it necessary to crowd the wards and the sun porch beyond their capacity.

Finally, the glass-enclosed corridor between the old Surgical Building and Palmer Ward and the one between Palmer Ward and the Medical Ward (destroyed by fire, 1927) had to be filled with beds for children. Their smiles and cries made a great appeal to the passerby. They were a daily reminder that more space had to be provided; in 1913 the nurses' quarters were removed from the second and third floors of the building to attractive cottages near the Hospital, and the entire Palmer Ward was devoted to the use of children, with the exception of space in the basement for the Department of Roentgenology. Soon space was again inadequate, and again the nurses had to be disturbed. An orthopedic ward was opened in the building occupied by them adjoining Palmer Ward, leaving more space for children in Palmer Ward.

It was largely the appeal of the children that finally resulted in the passing of the bill for the erection of the new University Hospital and in the establishment of the present modern clinics in all branches of practice that have brought widespread fame to the University of Michigan Hospital and Medical School.

In planning the new Hospital, space for the care of two hundred children was allotted on the sixth floor, to be designated as the Palmer Ward. It was decided to use the Palmer Building as an overflow or convalescent ward. It has always been hoped that a complete children's unit, connected with the main hospital building, ultimately would be provided. Because of this possibility and because of a belief that the new Hospital would become inadequate for the needs of the other clinics, little if any architectural change for the special care of children was made on this floor.

Although there is need for better arrangement of wards, the children are in no way neglected. They are provided with well-equipped roof-garden service, manual training rooms, recreation and class rooms, occupational therapy rooms, and teachers. The Galens, a medical students' society, supports a shop in woodcraft, known as the Galens Shop for the training of convalescents. Physiotherapy in all its forms is provided, including a swimming pool for paralytic cases and the most modern X-ray facilities. But these advantages are scattered, and many of them could be brought together in a special children's unit where the special methods of juvenile care could be better stressed and carried out, thus, in many instances, making the situation for children and adults equally advantageous. There are no quiet wards for children — these are very necessary for the care of children with rheumatism, chorea, and heart disease. Nowhere has the state provided a place for the care of very young children with tuberculosis. Much can be done to benefit or cure these patients.

The specific infectious diseases. — In 1910 a resolution for the construction of a contagious hospital was passed by the Board of Regents:

On condition that the City of Ann Arbor will furnish $25,000 for the purpose of building a contagious disease hospital, the University of Michigan will furnish the site for the same and agrees to equip and maintain it after completion. Such hospital shall be for the sole use of patients taken sick of contagious diseases in the City of Ann Arbor, and such hospital shall be conducted under such conditions as shall be arranged between the City of Ann Arbor and the Board of Regents.


(R.P., 1910-14, p. 12.)

Page  903Four years later, in June, 1914, the Contagious Hospital was opened to the public for inspection. The new building with its new aseptic method for the care of contagious diseases, the second in America to adopt this plan, became the show place of the University Hospital group. Very pleasant quarters for nurses were fitted up on the second floor of the building, but as in all divisions of the departmental work, it was not long before more space was needed, and the second floor had to be used for patients. Again the nurses had to be moved. The size of this clinic, like that of all the others, rapidly increased after the opening of the new Hospital, and the building soon became, as it is today, entirely too small for requirements. In times of epidemic, which are not infrequent, auxiliary wards have to be opened, the working of the Hospital is greatly handicapped, and the time of the staff is greatly encroached upon.

In the winter of 1909 the demands of a contagious epidemic were met by boarding up the two summer houses, heating them with stoves, and using them as three-bed scarlet fever wards. It is hard to realize that not so many years ago it was necessary, because of Board of Health regulations and lack of isolation space, to have large wards in the general Hospital under quarantine for long periods of time. Three times during the college year of 1909-10 strict quarantine had to be observed, totaling an inactivity of over three months. In 1911 Palmer Ward was under quarantine for five months, and the surgical wards were rendered inactive, except for the most urgent cases, for as long as a month at a time. The effect this had on teaching in general and on the patience of teachers and clinicians in particular can well be imagined.

Since the opening of the contagious unit (1914), the introduction of the aseptic technique plan of caring for contagious patients, and the inauguration of the present method of handling contagious cases, a general quarantine has not been necessary, and partial quarantines have been of comparatively few days' duration.

For some years the work of an infectious disease institute has been carried on. Immunizations of all kinds are made in this division of the clinic, not only for the patients but for the entire personnel of the University Hospital. These immunizations consist of vaccinations against smallpox, typhoid fever, diphtheria, and whooping cough, the giving of antitoxins, of immune serums, and of immune blood transfusions, and the carrying out of desensitizations of various kinds for those who are allergic. The Contagious Hospital laboratories employ a full-time chemist and a full-time bacteriologist.

By 1922-23 ultraviolet light had become a popular therapeutic measure. The knowledge that this modality was being used indiscriminately caused members of the profession to guard its use very carefully. Other hospitals had reported favorably on its use. More than $400 had accumulated in the Mary J. Furnum fund, and with this and an addition from the current budget a lamp was bought for the department. A technician was necessary, and finally a full-time nurse was engaged. The baggage room in Palmer Ward was released for use, better lighting was provided by a new window, and a quartz light division of the clinic was organized. Very soon the lamp was in constant use.

Sensitization clinic. — In 1910-11 Dr. Cowie became very much interested in the work von Pirquet was doing in Vienna on allergy, and he conducted observations on cowpox disease and serum disease from that point of view. Oscar Schloss in New York had demonstrated Page  904food sensitization in children and had prepared an egg allergen, ovo mucoid, for use in testing the skin for sensitivity to that substance. With Dr. Albert By-field, Cowie immediately began work with this substance and carried on with all allergens as they became obtainable on the market. Up to this time the allergic therapy and testing had been limited to the use of pollen and horse serum antigens and eliminations. Hay fever had been treated by the use of commercial pollen extracts for some years.

General interest in sensitization developed rapidly because of the ease with which testing materials could be obtained and testing could be carried out by the simple scratch method. In 1921-22 John P. Parsons ('14, '19m) became interested in this work. Appreciation of his quick understanding, versatility, and dependability resulted in a happy association continuing many years. Because of rapidly developing enthusiasm concerning allergy at that time it was very necessary to make conservatism the watchword. The examinations soon became time-consuming, and the teaching and administrative duties were already very heavy. Extra help became necessary. In 1924 Buenaventura Jiménez ('05m, M.S.P.H. '27) applied for graduate work. He became interested in the sensitization clinic, then carried on in the basement of the Contagious Hospital. Cowie assigned "Studies on Allergy" to him as the subject of his thesis. Dr. Jiménez soon became proficient in the technique of testing and in following and recording the clinical course of the increasing numbers of patients sent to the clinic for examination and advice. To him more than to anyone else is due the development of the large clientele that finally came to the clinic. His enthusiasm, devotion, honesty, and personal appeal were all that was necessary. The daily attendance at the clinic became so large that a few years later it was necessary to work out a plan to decrease it and yet at the same time to increase the number of new patients. This was accomplished by devising treatment schedules, diagrams, and instruction sheets so that the bulk of the treatments could be turned over to the referring physician, with whom the staff co-operates in every way possible. In order to compass the work two more assistants were necessary.

Clinic classes. — In 1920 a hay fever and asthma class was organized to bring the patients together to be instructed as a group and to ask questions and relate experiences. In this way they learned much from each other and gained a better idea of what the staff was trying to do for them. Diabetes, infant feeding, and cardiac classes were conducted in the same way.

Work in allergy had its beginnings in 1912, as publications from the department attest; it passed through the first few years of general interest and the succeeding years of doubt and ridicule; it now stands as one of the most important special divisions of medicine in all medical schools and in medical practice. There has never been a pause or diminution in the work of this clinic since its beginning. The clinic of the department continued to be known as the sensitization clinic; the one in the Department of Internal Medicine is the allergy service, which has been under the competent directorship of Dr. John Sheldon. Many clinical and scientific reports were published from the sensitization clinic. All of this work is now carried on in the allergy service.

Teaching. — In the early days of the department teaching material was so meager and the demand for it was so great that removal to Detroit seemed to be the only answer. The clinical material has now become so rich as to Page  905be unexcelled in variety and importance from the standpoint of teaching. This record is one of which the Medical School and the University Hospital may well be proud.

A subject as large as internal medicine and infantile and child nutrition had to be covered in some way with an almost insignificant budget and a part-time staff. One part-time clinical professor, one instructor, and a half-time intern constituted the entire staff. An assistant and a full-time intern were added. Later, an extra stenographer was provided. The registration list had reached 3,251. The working staff gradually was increased to one professor, two assistant professors (one at Children's Center, Marquette, Michigan), four instructors, one chemist, one bacteriologist, one instructor and two assistants in sensitization, one child psychologist, one teaching fellow, three rotating interns, eight assistant residents, a secretary, a clinic nurse, a clinic clerk, and a clinic ward helper.

With the increase in the size of the staff came the phenomenal increase in the size of the clinic, as stated before, to 6,346 patients a year (1932), and the outpatient attendance reached a monthly peak of 2,580 in August, 1935. The teaching load of 768 clock hours had to be divided between five instructors. The other members of the staff were necessary to help care for the patients.

The teaching in 1939 consisted of forty-eight hours for the entire junior class; sixteen hours for the entire senior class; sixty-four hours for the senior morning bedside section work, repeated four times during the year by each of four instructors; eighty hours of afternoon bedside instruction, repeated four times a year by each instructor; and 320 hours elective courses for junior students. The junior elective bedside section met twice a week for a two-hour period. There were from fifteen to twenty students in these sections, which lasted eight weeks, thirty-two hours, and were repeated four times during the year.

The regular bedside section work consisted of rotation through the four divisions of the clinic: outpatient and sensitization, nursery and metabolism wards, boys' and girls' medical wards, and contagious hospital.

The teaching load included familiarization with all patients coming to the clinic. The average number of patients per instructor over a period of years is shown in the following table:

Year Number of Members of Teaching Staff Total Number of Patients Average Number of Patients per Instructor
1928-29 5 4,100 820
1929-30 5 5,000 1,000
1930-31 6 5,686 947
1931-32 6 6,141 1,023
1932-33 6 6,346 1,057
1933-34 6 5,404 900
1934-35 6 5,398 899

City clinics. — In the beginning of the work of the department it was almost impossible to induce parents in the city to bring their children to the outpatient clinic at the Hospital. Dr. Cowie decided to move the afternoon outpatient clinic to the business section of the city. The Hospital Circle of King's Daughters (later, the Public Health Nursing Association) gave its co-operation, and patients became so numerous that in 1920 a second clinic had to be opened in "lower town." One instructor and an intern were assigned to each clinic. The nursing and the general management were attended to by the public health nurse. When the new Hospital was opened the clinic was moved there, where it is known as the Well Baby Clinic; it still co-operates with the Public Health Nursing Association.

County clinics. — In 1919, clinics, under the auspices of the Washtenaw Page  906County Public Health Nursing Association of the Red Cross, were begun in many villages of the county. The medical work of these clinics was carried on by members of the staff of the Department of Pediatrics and Infectious Diseases. These clinics, in addition to rendering valuable service to the children of the county, furnished excellent experience for the graduate group in child welfare work. Unfortunately, because of lack of funds, they were discontinued in 1922.

Child psychology. — For many years the importance of giving the students instruction in child psychology and in child psychiatry had been recognized — particularly with regard to behavioristic problems and personality changes. Helen Bradford Thompson Woolley (Chicago '97, Ph.D. ibid. '00) came to the department when the Merrill Palmer School was opened. Appreciating her ability as a teacher and lecturer, Dr. Cowie encouraged her to volunteer several lectures each year (1924-26) to the senior class. An effort was being made to have her given a regular appointment in the department when Columbia University called her to head its Child Development Institute. Janet Stetson Barnes (Buffalo '24, Michigan '28m) was appointed to the position of Pediatrician in the Elementary School and Instructor in Pediatrics. She was well trained in child psychology and psychiatry. Her teaching and clinical care of this group of children, very much handicapped as it was, was greatly appreciated. Lavinia MacBride MacKaye ('17, A.M. '20, '31m), who worked with and succeeded Dr. Barnes, was unable to continue because of increased duties on the campus, and the work finally had to be abandoned at the end of the 1936-37 session. Since the reorganization of the Department of Psychiatry as the Neuropsychiatric Institute, a division of child psychology and psychiatry has functioned under Paul H. Jordan (M.D. Iowa '29), who was trained as a pediatrician and as a psychiatrist. The members of the staff gain much stimulation and knowledge from the close association that has been established with that department. Children enter the Neuropsychiatric Institute through the Department of Pediatrics and Infectious Diseases. About thirty beds were provided for their care in the institute.

Michigan State School for Children, Coldwater. — Through an arrangement with the Superintendent of the State School for Children in 1930, a pediatrician was appointed to look after the medical needs of the children there. Dr. W. W. Redfern (M.D. Chicago '30), the first appointee, was particularly interested in immunology and continued his studies. Harold B. Rothbart (M.D. Toronto '30) was appointed to fill the place made vacant by Dr. Redfern's untimely death in February, 1932. Dr. Rothbart completed observations on basal metabolism in children, which were published the following year. Unfortunately, just as Coldwater was becoming known as an active center for pediatric investigation, it was decided to close the school, the oldest of its kind in the state, and to devote the buildings to other state purposes. The work of the school has been continued by the Michigan Children's Institute, situated in Ann Arbor in a new building near the Hospital grounds.

Service to the Institute for Human Adjustment. — All children applying for study and care in this institute receive through the Department of Pediatrics and Infectious Diseases a complete physical examination and record of laboratory tests. If medical conditions are found other than those for which the patient was previously admitted, they are cared for by the department. The institute has been of special service to the Page  907department, particularly in the management of speech defects of various kinds.

The Couzens Children's Center at Marquette. — Through the generosity of the late Senator James Couzens, funds were provided for the building of a children's center in connection with St. Luke's Hospital at Marquette. In 1931 Moses Cooperstock (Yale '23, M.D. ibid. '26), an instructor, was put in charge with the rank of assistant professor in this department. Four assistant residents serve in Marquette for a period of three months each. The opening of this clinic made it unnecessary for a large percentage of children in the Upper Peninsula to continue to come to the University Hospital, although many selected and unusual cases are referred to the department from this clinic. The center is rich in clinical material and furnishes another link in the chain of services designed to round out the special training of young physicians in pediatrics and infectious diseases.

The Couzens Children's Center at Traverse City. — Also known as the Central Michigan Children's Center, this clinic was opened in 1936 with Mark Frederick Osterlin (Capital University [Ohio] '25, Michigan '29m) in charge, with the rank of teaching fellow. The organization is the same as at Marquette and the same rotation of an assistant resident is carried out. Here, again, while this clinic made it easier for children in the western part of Michigan to secure special medical care, it has had a distinct influence in decreasing registrations at the University Hospital.

To show the position of the clinic in the medical group of specialties the figures for 1929-36, of the "clinic classification percentage of patients," from the Hospital reports (P.R., 1929-36) are given in the accompanying table, and, by way of contrast, percentage figures for larger surgical specialties are added.

Clinic Classification Percentage of Patients Admitted
Year Pediatrics Internal Medicine Neurology Dermatology General Surgery
1929-30 15.30 12.77 3.66 13.00 15.99
1930-31 16.22 13.14 3.77 13.99 13.98
1931-32 14.88 12.65 4.26 13.10 14.31
1932-33 15.34 12.75 3.45 11.52 14.73
1933-34 13.53 13.43 4.02 8.54 15.17
1934-35 12.79 15.23 4.00 7.29 14.75
1935-36 8.31 17.05 4.56 6.25 15.64

The chief reason for the decreasing number of children coming to the University Hospital has been legislative Act No. 248 (P.A., 1933). The act dealt a serious blow to the long and successful effort to develop a children's clinic entirely adequate for the needs of teaching medical students.

Because of the nature of the Hospital monthly statistical reports, the work of the clinic has not appeared to full advantage, and the needs of the department accordingly have not been very apparent. The guarding of the entire group of hospitals against epidemic disease, for example, is in itself a difficult task. The clinic, however, receives credit only for the three hundred or four hundred cases that enter Contagious Hospital each year. The admitting of a smallpox patient means vaccination of the members of the entire working staff of the Hospital who have not been successfully vaccinated within two years. In one year three smallpox patients made it necessary to vaccinate sixteen hundred people. In 1938 the bacteriological division examined and reported on 7,138 cultures. If a measles case develops on a ward a prophylactic serum, prepared in the department laboratories, from blood taken from suitable donors, has to be given intramuscularly to all who have been in contact with the patient. In 1935-36, 95,040 cc. of blood were collected, from which 38,040 cc. of serum were prepared and 2,460 children were immunized.

Page  908Bequests. — Among the bequests for the care of sick children and research in diseases of children and infectious diseases may be mentioned the Palmer bequest of $20,000, to be expended in the erection of "an appropriate and handsome ward of the University Hospital, to be known as the 'Dr. A. B. Palmer Memorial Ward,' and $15,000 in trust, the income … to be devoted to the support and maintenance of free beds, in said building or ward …" (R.P., 1901-6, p. 222).

The income from the Mary J. Furnum fund of $1,000 is used for the purchase of apparatus for the study of children's diseases. This small fund has been of remarkable assistance.

When the Merrill Palmer School of Detroit opened its extension project in Ann Arbor in connection with the University for the purpose of affiliation with various departments for further investigation, particularly in child psychology, the Department of Pediatrics and Infectious Diseases was asked to undertake the medical aspects of the project. Accordingly, an instructor from the department was assigned to this duty. Physical and laboratory examinations were made for each pupil, and all pupils were inspected daily. At the end of the first year the Merrill Palmer School authorities offered a grant of $3,000, which paid the salary of one instructor, for the purpose of carrying on the work of the school in conjunction with the Medical School, and furnished necessary equipment. Dr. John P. Parsons was relieved of all teaching responsibility for the year in order that he might study the protein requirement of children. A creditable investigation was carried on and published in the American Journal of Diseases of Children.

The University of Michigan Elementary School may be said to be the outgrowth of the Merrill Palmer School. With its completion and its administration in the hands of Professor Willard C. Olson, the Merrill Palmer authorities felt that their work in Ann Arbor had been accomplished. The department carried on the same type of work as was done in the Merrill Palmer School. The salary of one instructor was provided, whose duties required that half time be spent at the school and half time at the clinic.

In 1932, because of an unused balance in the salary account of the department, the Regents authorized the use of $500 for the purpose of bringing distinguished lecturers and teachers to the Medical School. Professor Armand de Lille of Paris and Professor Franz von Groer of Lemberg each delivered a series of very enlightening lectures and carried on bedside clinics and conferences. A few years previously Professor Heinrich Finkelstein of Berlin had come on a similar visit.

In 1929 Parke, Davis and Company made a substantial grant for the purpose of studying the comparative antirachitic effect of irradiated ergosterol made from ergot and from yeast. The investigation entailed the co-operation of the Department of Roentgenology and of the Department of Pathology. The work was carried on jointly by Katharine Mabone Jarvis (New Brunswick '21, Ph.D. Michigan '28), A. D. Emmett, and Dr. Cowie. The results of this investigation were published in the Transactions of the University of Michigan Pediatric and Infectious Disease Society (1929-30). In 1931 Parke, Davis and Company made a grant for the observation of the effect of certain carbohydrates on the growth and development of infants. The work was satisfactorily carried on by John Lealis Law (M.B. Edinburgh '29, Ch.B. ibid. '29, M.D. ibid. '34).

In 1930 Mead Johnson Company of Page  909Evansville, Indiana, gave $1,600 for investigations in diseases of infancy and childhood. As a result a study was made of the action of the various sugars used in infant feeding on the blood sugar curve; information was sought on the comparative assimilation and utilization of these sugars. Investigations with indirect relation to infant feeding were conducted, and three papers were published.

Postgraduate teaching. — After Dr. Cowie's death in 1940, the W. K. Kellogg Foundation gave a grant of $100,000 to effect a reorganization of the Department of Pediatrics in the Medical School. The plan of postgraduate work consists of a year's rotating internship here or in some other accredited hospital, a year as assistant resident in this clinic, a year abroad or in some other clinic, and an additional two years at the University as instructor — in all, five years of special training after graduation.

Professors Morse, Talbot, and Blackfan of Boston, Schloss, Schick, Holt, and Wilcox, of New York, Gerstenberg of Cleveland, Mitchell of Cincinnati, Brenneman, Hess, and Poncher, of Chicago, Marriott and Hartman, of St. Louis, Finkelstein, of Berlin, Armand de Lille, of Paris, and Franz von Groer, of Lemberg, co-operated with Dr. Cowie in giving young men and women sent to them every possible advantage.

The University of Michigan Pediatric and Infectious Disease Society. — This society was organized in 1921 to bring the men in the field of actual practice back to the clinic at least once a year for an exchange of views. It has proved an unquestioned success.

In 1938 two amendments to the bylaws of the society were adopted, whereby all individuals completing one year's residency in the Department of Pediatrics and Infectious Diseases become eligible for membership, and all those completing a rotating junior internship in the University Hospital and who, at the time of the meeting of the society, are assistant residents in the department become eligible for membership. This greatly stimulated interest in research.

Previous to this time journal club work was carried on by a selected group of students in the senior class. Assigned subjects were carefully reviewed by them, and the results of their studies were presented to the entire senior class. The reviews presented in 1913 were of such importance that they were published in the Archives of Pediatrics, and the reprints were bound in booklet form.

Social service. — Long before the designation "social service" was in vogue, much of this type of work was admirably carried on by the society of King's Daughters. The members of this society had provided books and amusement for children and for years had done many things to meet their needs.

Dr. Cowie finally prepared a report detailing the scope of social service as carried on at the Massachusetts General Hospital and at other large hospitals and presented it at one of the meetings of the University Hospital Clinical Society as a means of bringing about a general discussion on the subject. The members of all the clinical staffs favored the idea, and before long, with the co-operation of the Public Health Nursing Association, Miss Sarah Burrows was brought to Ann Arbor to begin social service work. Out of this work has grown the present organization. Without this service the Hospital could not function effectively.

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Cowie, D. Murray. "University Hospital Clinic for Diseases of Children."Mich. Alum., 23 (1917): 265-66.
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