The University of Michigan, an encyclopedic survey ... Wilfred B. Shaw, editor.
University of Michigan.
Page  931

THE DEPARTMENT OF ROENTGENOLOGY

THE Department of Roentgenology was officially created by the Regents in July, 1913, when a budget of $1,000 for current expenses was allocated to it and an additional $360 was appropriated for repairs in the X-ray quarters in the Hospital. Long before, however, the medical application of Roentgen rays at the University had been begun, and it was the importance which activities in this field eventually assumed that culminated in the establishment of a separate department.

On April 26, 1896, only five months after the announcement of Roentgen's discovery, occurred the first recorded medical use of the newly described "X rays" at the University. Mr. Stanislas M. Keenan, of Eloise Hospital, who had become interested in Professor Henry S. Carhart's work with X rays, brought to Ann Arbor a patient with a bullet in his foot. Using X rays produced in the Physics Laboratory, Professor Carhart and Dr. William James Herdman ('72, '75m, LL.D. Nashville '97), Professor of Diseases of the Mind and Nervous System and of Electrotherapeutics, photographed the foot and demonstrated the presence of an opaque foreign body.

At that time there was no X-ray equipment at the University Hospital, but Herdman, who for some years had conducted a course in electrotherapeutics begun by Professor John W. Langley in 1880, was in the habit of demonstrating to his students with the static machine in his office the production of X rays and their medical uses. Sometime about 1900 the first piece of equipment for the production of X rays in the Hospital was purchased personally by Dr. Charles B. G. De Nancrède and Dr. Cyrenus G. Darling. This original induction coil was preserved by Dr. D. Murray Cowie and sometime before his death was presented to the Department of Roentgenology. X rays were first mentioned in the University Calendar in 1901-2, in a revised description of the electrotherapeutical laboratory. The late C. Perry Briggs, for many years Pharmacist of the University Hospital, is credited with having developed the technique employed during the early years when the original equipment was in use, having first familiarized himself with the subject in the laboratory of Professor Carhart.

The first X-ray equipment purchased with University funds was acquired in 1903 with $1,000 appropriated by the Regents (R.P., 1901-6, p. 65). This apparatus was placed in the custody of the Department of the Diseases of the Mind and Nervous System and Electrotherapeutics, then directed by Herdman, and a small X-ray laboratory was set up in the basement of the Palmer Ward building. Additional small appropriations were authorized by the Regents from time to time, the "Treasurer's Report" of June 30, 1907, listing an expenditure of $514.63 for the Roentgen Laboratory during that fiscal year.

Vernon Justin Willey (Michigan Agricultural College '93, A.M. Michigan '02, ibid. '09m), appointed Instructor in Electrotherapeutics in 1901, was given the additional title of Director of the Roentgen Laboratory in 1906, and in the same year Almus A. Hale was appointed his assistant in the laboratory and clinical photographer. Willey continued in charge of the laboratory, after attaining considerable prominence in the field of roentgenology, until 1909, when he resigned to join the staff of the Mayo clinic.

Page  932In 1907 Carl Dudley Camp (M.D. Pennsylvania '02) was appointed Clinical Professor of Diseases of the Nervous System and assumed immediate supervision of electrotherapeutics and consequently of the Roentgen Laboratory, and Dr. James Gerrit Van Zwaluwenburg ('98, '08m), later identified with the work in roentgenology at the University, was appointed second assistant in internal medicine. Through close association with Almus Hale, Van Zwaluwenburg became deeply interested in the clinical use of Roentgen rays.

During the two years after the resignation of Willey in June, 1909, Lyle Steen Hill ('08e, M.D. Detroit College of Medicine and Surgery '14), previously an assistant in the electrotherapeutics laboratory, was Director of the Roentgen Laboratory. Van Zwaluwenburg, who was made Instructor in Internal Medicine and Demonstrator of Clinical Medicine upon the resignation of Dr. Frank Smithies in 1908, took a special interest in the use of X rays in examinations of the heart and of the stomach. His interest, combined with the desire of De Nancrède, of the surgical service, to make greater use of the possibilities of Roentgen apparatus, resulted, early in 1910, in the transfer of the supervision of the laboratory to the departments of Internal Medicine and Surgery, acting jointly. Van Zwaluwenburg took over direct charge of activities, and De Nancrède represented the laboratory in meetings of the faculty. Under the new arrangement, X-ray examinations were becoming so numerous that the Regents established an X-ray fee schedule in September, 1912.

When the full-fledged Department of Roentgenology was established in July, 1913, Van Zwaluwenburg was chosen as the first Clinical Professor of Roentgenology. He brought to this newly developed clinical specialty of the University a rare combination of background and point of view admirably suited to the work in hand. His preliminary training in engineering, his sound grasp of internal medicine, and his inquisitive attitude all came into play in the development and firm establishment of roentgenological methods in the clinical activities of the Hospital. "Van," as he is affectionately remembered by colleagues, assistants, and students, rapidly attained a national reputation in his field through his energetic and untiring efforts as a Roentgen diagnostician, a teacher, and an investigator; and, in recognition of his accomplishments, the Regents appointed him Professor of Roentgenology in July, 1917. During the war the new department, in conjunction with the United States Army and the Michigan Antituberculosis Society, took an active part in the examination of men discharged from Camp Custer because of suspected tuberculosis.

From correspondence and reports of the period, the need for additional equipment to meet increasing clinical demands appears to have been ever present. There was but a single generator, a ten-kilowatt high-tension transformer, one radiological table with a tube stand, and a Groedel fluoroscope with orthodiagraphic attachment. Gas-filled X-ray tubes were costly and unreliable. The number of examinations conducted each year had risen from less than 600 in 1911 to 4,203 in 1917-18, by which time the activities of the department had far outgrown the quarters which it occupied in the basement of the old Palmer Ward. Late in 1918 a separate machine was acquired for the production of medium-voltage X rays to be used therapeutically. A new scale of charges adjusted to the financial status of patients, the adoption of which had been advocated by Van Zwaluwenburg to avoid unfair competition by the University with Page  933private practitioners, was approved by the Regents in 1920.

Heedless of his own personal welfare, unsparingly devoted to medicine, Van Zwaluwenburg died of pneumonia on January 5, 1922, after a very brief illness, and thus the formative period of the department came to an abrupt and untimely end. More than ten thousand X-ray examinations were made by the department in the year of his death. His boundless energy, his wholehearted devotion to clinical roentgenology, his great human kindliness, his important contributions to the examination of the heart, of the great vessels, and of the organs of the abdomen by Roentgen methods, and his insistence that Roentgen diagnosis of disease must be primarily objective led American roentgenologists to regard him as one of this country's outstanding pioneers in his field.

After Van Zwaluwenburg's death the Regents placed Samuel Wright Donaldson (Tennessee '12, Michigan '16m), a senior assistant, in temporary charge of the department. Donaldson was assisted by Elmer Forrest Merrill ('20m) and later by Clyde Knapp Hasley ('15, '18m), formerly an instructor in dermatology.

Preston Manasseh Hickey ('88, M.D. Detroit College of Medicine '92) was appointed Professor of Roentgenology in the fall of 1922. An outstanding clinician of Detroit, Hickey had previously been a professor of pathology and otolaryngology in the Detroit College of Medicine and Surgery and had won international acclaim as a roentgenologist. His interest in the subject had developed from his hobby — photography. Together with Dr. Augustus Warren Crane, of Kalamazoo, Dr. Henry Hulst, of Grand Rapids, Dr. James Case, of Battle Creek, and Dr. J. G. Van Zwaluwenburg, Hickey had already achieved recognition as one of the five great Michigan radiologists who had distinguished themselves in the early years of roentgenology.

During the war years Hickey had rendered unusual service to the Army Medical Corps by participating in the organization of specialty schools for roentgenologists and by serving as chief consulting roentgenologist to the American Expeditionary Forces. Outstanding pioneers in roentgenology in England, France, Sweden, Germany, Italy, Austria, and Canada were his personal friends. He founded the American Quarterly of Roentgenology in 1906 and for ten years was editor of this publication, which in the meantime (1913) became the American Journal of Roentgenology. With this rich background he was ideally equipped to be a teacher of roentgenology, and as such he is remembered and revered.

Under Hickey's forceful guidance the department expanded rapidly. From his appointment in 1922 until the new University Hospital was occupied in August, 1925, he devoted much time and attention to planning the new quarters for the department. High-voltage therapy equipment was installed temporarily in the basement of the Palmer Ward. The professorial staff of the department was enlarged in April, 1925, when Ernst Albert Pohle (M.D. Frankfurt [Germany] '20, Ph.D. Michigan '28) took up his duties as Assistant Professor of Roentgenology and was placed in charge of the work in radiation therapy. In August, 1925, the Department of Roentgenology was moved into spacious new quarters in the present Hospital building (Hickey, pp. 113-25).

Clinical photography, a hospital activity of constantly growing importance, had been fostered first by Van Zwaluwenburg and then by Hickey as a part of the Department of Roentgenology. Page  934When the new Hospital was opened, Harry Franklin Minkley, a former commercial photographer, was placed in direct charge of this work in the new studio provided for the purpose. Burr Anderson, technician for many years, resigned in 1925, and the technical work was distributed among assistant residents assigned to the department — an important feature of the training program instituted by Dr. Hickey.

Instructional and research activities were materially accelerated during Hickey's incumbency; interdepartmental clinical conferences were established, and formalized teaching of roentgenology to undergraduates was further developed and extended. There was an increase in the number of graduate students, most of whom remained for two years of postgraduate instruction after their internship. Other physicians holding fellowships from various national foundations were attracted to the department.

The first radium owned by the department was purchased in 1928. Previously, the only stocks available had been owned privately by members of the faculty, or had been rented.

In 1927 Pohle had been promoted to an associate professorship in recognition of his experimentation with ultraviolet light, high-frequency currents, X rays, and the radiations of radium. Before Pohle's departure in 1928 these activities led to the formation of a subdepartment of physical therapy, later combined with the physiotherapy section of the Department of Surgery. Closely adjacent to the Department of Roentgenology was the work in hydrotherapy and in electrotherapy, supervised by Dr. Hickey and conducted by Willis Seamans Peck (Syracuse '22, M.D. ibid. '24), who in July, 1928, had become Instructor in Physical Therapy, Assistant Director of the Department of Physical Therapy of the University Hospital, and part-time physiotherapist in the Health Service. In March, 1929, all physical therapy activities were amalgamated to form a new department of the Medical School (R.P., 1926-29, pp. 939, 1020), administered by Dr. Hickey and an advisory committee consisting of Dr. Warthin and Dr. Huber. Courses for medical students and technicians served as models for similar work in other institutions.

Hickey's intensely active and valuable service to the University came to a close with his death on October 30, 1930. Because of his gentle kindliness, he will long be referred to by former assistants, students, and colleagues as "Pop" Hickey — a form of endearment accurately expressing the character of his relationship to a large band of physicians. Hickey's influence upon American roentgenology was nation-wide, and he earned recognition for the University as an outstanding teaching center in this subject. On the wall of what once was his private office hangs a memorial bronze bas-relief presented by his associates in the name of the American Roentgen Ray Society as a testimonial to his eminence in American medicine.

Carleton Barnhart Peirce ('20, '24m, M.S. '27) was appointed Acting Director of the Department of Roentgenology immediately after the death of Dr. Hickey, under whom he had begun his specialized training in 1926 as an instructor. He had resigned to take a position at the University of Nebraska, but returned early in 1929 as Assistant Professor of Roentgenology, relieving Carl Lewis Gillies ('26m), who left to become an associate professor of roentgenology at the University of Iowa. In 1928 Dr. Pohle resigned to accept a professorship of roentgenology at the University of Wisconsin, and until 1930 the work in radiation therapy was supervised by John McGregor Barnes (B.S. Med. '24, '24m), Instructor and later Assistant Professor, Page  935whose colleague and successor, William Macauley Gilmore (M.D. University of Western Ontario '27), was in charge of this work at the time of Hickey's death. Dr. Gilmore was in turn succeeded by Daniel Maurice Clark (M.D. Minnesota '27), who supervised the work in radiation therapy during the first three months of 1931.

On January 23, 1931, the Regents appointed Fred Jenner Hodges (Wisconsin '17, M.D. Washington University [St. Louis] '19) Professor of Roentgenology, effective April 1. Hodges had been a lecturer in roentgenology at the University of Wisconsin and roentgenologist to Saint Mary's Hospital and to the Wisconsin Memorial Hospital in Madison. Vincent Clifton Johnson (M.D. Wisconsin '27), who was Associate Professor in 1940, was appointed Instructor in Roentgenology July 1, 1931. Peirce became Associate Professor in 1933 and continued in that capacity until, in 1938, he resigned to succeed Dr. Howard Pirie at the Montreal General Hospital.

Harold William Jacox (B.S. Med. '26, '28m), just completing his specialized training, was placed in charge of the work in radiation therapy in 1931. He resigned as Assistant Professor of Roentgenology in December, 1935, to become radiation therapist to the Western Pennsylvania Hospital, Pittsburgh, and Willis Peck, who had been Assistant Professor of Physical Therapy since 1931, succeeded him. In September, 1937, Dr. Peck was transferred to an assistant professorship of roentgenology, and he continued in diagnostic and later in therapeutic roentgenology until September, 1939, when he entered practice in Toledo.

At the time of Hickey's death the splendid plant conceived and developed under his direction had been outgrown because of increasing departmental activities, and in the next year, 1931, it was extensively repaired and altered. An additional four hundred square feet of floor space was acquired by the transfer of the medical illustrator's quarters to another part of the Hospital. The highly specialized departmental activities were provided for by the careful subdivision of floor space and by the acquisition of new equipment. Dental roentgenology was transferred to the oral surgery service, a fluoroscope was installed in the newly opened Tuberculosis Unit of the Hospital, and filming for urological diagnosis was provided for in the urology outpatient quarters. On April 4, 1932, about fourteen months after the appointment of Professor Hodges, the redesigned departmental quarters became available. In the interim the varied activities had been conducted under most trying conditions in temporary quarters on the ground and basement floors. For the first time there were well-arranged facilities for patients needing radiation therapy. These activities had been constantly increasing until patient visits had reached the total of 9,446 annually. In July, 1935, the medium- and high-voltage machines which had been transferred from the old Hospital ten years before were replaced with shockproofed 200-kilovolt instruments, and in the following year, because of the constantly increasing number of cancer patients, equipment limited to the treatment of superficial skin lesions was provided in the dermatology outpatient quarters.

In the 1932 reorganization the work in clinical photography ceased to be a subsection of the Department of Roentgenology, and all hydrotherapeutic and electrotherapeutic activities were united to constitute a subdepartment of physical therapy, which was later, in 1937, transferred to the Department of Surgery. In the meantime, many somewhat disconnected activities in this field had been brought together in quarters specially developed for them on the basement Page  936floor of the southeast wing of the main Hospital. An exercise pool for poliomyelitis patients, contributed by the Rackham Foundation, was built. After the remodeling of 1935, when the adjoining Hospital stores addition was erected, the department was better able not only to carry its ever-increasing clinical load efficiently, but also to provide greater opportunities for its graduate and undergraduate students. An entirely new method of case reporting, film filing, and cross indexing was established, and the departmental business office, film-processing facilities, film storage, and viewing rooms for the staff were brought into close proximity to conserve effort and permit rapid service. Dressing rooms for the specialized technical branches in therapy and diagnosis were installed close to the exposure rooms, and transformers were housed in closed lofts to conserve floor space. A student laboratory for the demonstration of X-ray physics was built and equipped, and one room was utilized for a departmental library designated as the Hickey Memorial Library and maintained largely by Dr. Hickey's bequest of $1,000.

The teaching of roentgenology has also been changed since 1932. Previous efforts to train nonmedical technicians were discontinued in order that undergraduate and graduate medical students might be more thoroughly trained in roentgenology. In a typical year, 1939-40, thirty-two hours of lectures for juniors were offered in the first semester, augmented by thirty-two hours of required clinical instruction conducted on the block system throughout the year. Several courses were discontinued as electives and were replaced by a six-week summer course of intensive laboratory, lecture, and clinical instruction open to students and practitioners alike.

The plan of interdepartmental clinical conferences already instituted was materially expanded. In 1933 the program for postgraduate students in roentgenology was revised and was placed upon a three-year-training basis. Carefully selected medical graduates who had completed a year of internship were accepted as assistant residents in roentgenology, eligible for reappointment for a second year as residents and for a third year as instructors. Modest stipends provided by the Hospital and the University made it possible for more than forty young men of limited means to obtain this training in the next ten years. The plan previously in vogue, of delegating trainees in rotation to a month's service at Detroit Receiving Hospital, outgrew its usefulness and was discontinued in 1933.

Some ten nonprofessional workers brought together under Hickey's direction before 1931 readjusted themselves to the rapidly changing conditions and, with but few exceptions, remained in the employ of the department. They have contributed greatly to the successful provision of roentgenological service to the University Hospital, as have the less numerous veteran workers in physical therapy.

The Department of Roentgenology has assisted in the extensive reorganization of the general Hospital records since 1932 by actively participating in the development of a mechanical tabulation system.

The department has made important contributions to the establishment and maintenance of the concerted program of the University's cancer committee, having taken an active part in the two tumor conferences conducted by the Department of Obstetrics and Gynecology and in the two general tumor conferences held each week in conjunction with the departments of Pathology and Surgery. In succession, Dr. Jacox, Dr. Peck, and Page  937Dr. Isadore Lampe (Western Reserve '27, M.D. ibid. '31, Ph.D. Michigan '38), who became Assistant Professor of Roentgenology in 1938, have served energetically and efficiently in this field. In association with the Department of Physics, the Department of Roentgenology began to participate in 1935 in the University's nuclear physics program centered about the construction of the University's cyclotron and its subsequent employment in research. As an outgrowth of this venture, which was supported by the National Cancer Institute and the Rackham Foundation, both Lampe and Hodges have been associated with Professor E. O. Lawrence and the radiation laboratory at the University of California, where Hodges served as a research associate while on sabbatical leave for one semester.

Interested in the broad-scale investigation of the incidence of pulmonary disease in general, the departments of Roentgenology and Internal Medicine have since 1931 been actively concerned with various mass surveys. As a result, a periodic X-ray chest examination has become a routine practice for all Hospital employees as well as for all students entering the University. In June, 1935, chest filming of all patients registering at the University clinics during a two-week trial period proved convincingly that this procedure should be instituted, but it was not until July, 1941, that, through the financial assistance of the Kellogg Foundation, a plan of chest survey based upon the use of photofluorography was put into effect. Facilities were installed in the Hospital admission office, and during the first twelve months nearly 23,000 patients were so examined, of which 10 per cent showed sufficient evidence of intrathoracic abnormality to warrant more extensive X-ray examination.

Charged with the supervision of the X-ray activities at the University Health Service, the Department of Roentgenology took an active part in the planning of the X-ray Laboratory in the new Health Service Building, completed in 1939, and has provided medical supervision of the work of this laboratory.

The Neuropsychiatric Institute building, long under contemplation, was finally opened for patients in April, 1939. Direct communication with the main Hospital building made it necessary to alter the central section of the X-ray quarters materially to provide a corridor thoroughfare. As a by-product of this remodeling, the business office of the department was enlarged, and space for the stenographic staff and for film-interpretation facilities was added.

The amount of work in the Department of Roentgenology has steadily increased, the annual number of patient visits having risen from 33,803 in 1932-33 to 54,750 in 1938-39.

Since the private purchase of primitive X-ray equipment by De Nancrède and Darling in 1900, the medical use of X rays at the University has undergone a phenomenal and constantly accelerated development, naturally divisible into four major periods — the formative period before 1913 and the three administrations of Van Zwaluwenburg, Hickey, and Hodges as professors of roentgenology and heads of the department. New and immature as a full-fledged clinical department of the Medical School, the Department of Roentgenology has risen to a position of unquestioned importance in a relatively short period.

Page  938
SELECTED BIBLIOGRAPHY

Announcement, Department of Medicine and Surgery [Medical School, 1915 — ] (title varies), Univ. Mich., 1896-1940.
Annual Report of the University Hospital of the University of Michigan, 1896-1911, 1918-20.
Bruce, James D., , and G. Carl Huber. "Noted Alumnus-Teacher Passes Away — An Appreciation of Preston M. Hickey."Mich. Alum., 37 (1930): 108, 114.
Calendar, Univ. Mich., 1896-1914.
Catalogue …, Univ. Mich., 1914-23.
Crane, A. W., and Others. "In Memoriam, Preston M. Hickey, 1865-1930."Amer. Fourn. Roentgenol. and Radium Therapy, 27 (1932): 109-13.
Hickey, Preston M."The X-ray Department of the Hospital of the University of Michigan, Ann Arbor, Michigan."Methods and Problems of Medical Education, ser. 12 (1929): 113-25.
Peterson, Reuben, , D. Murray Cowie, , and Udo J. Wile. "James Gerrit Van Zwaluwenburg, 1874-1922."Mich. Alum., 29 (1923): 757-60.
President's Report, Univ. Mich., 1896-1909, 1920-40.
Proceedings of the Board of Regents …, 1896-1940. (R.P.)
Van Zwaluwenburg, , James G."X-ray Department of the University Hospital."Mich. Alum., 23 (1917): 269-70.