The Period Ending in 1908
THE first step in organizing the Department of Medicine was the appointment in 1848 of Abram Sager (Rensselaer Polytechnic Institute '31, M.D. Castleton Medical College [Vt.] '35, A.M. hon. Michigan '52) as Professor of the Theory and Practice of Medicine. He had been Professor of Botany and Zoology since 1842, but apparently never conducted classes in medicine, as in January, 1850, Samuel Denton (M.D. Castleton Medical College [Vt.] '25) was appointed to the professorship in medicine as well as to that in pathology, and Sager was assigned to the professorship of obstetrics and diseases of women. In 1874 Sager was made Emeritus Professor, but he continued to act as Dean until June, 1875, when he resigned as a protest against the proposed establishment of a department of homeopathy in the Medical School.
The first active head of the Department of Medicine was Samuel Denton, who had been appointed Professor of the Theory and Practice of Medicine and Pathology in 1850. In 1837 he had been appointed one of the first Regents and he had served for three years; later, his interest in state politics led to service in the state Senate from 1845 to 1848.
According to Dr. William Fleming Breakey, Denton was very dignified in manner and always wore a high hat. He had a large general practice and was much sought in consultation, for he had an excellent reputation for sound judgment and skill in diagnosis and treatment. A great advocate of the use of alcohol in many types of illness, he especially recommended it in "consumption" and in the later stages of protracted fevers. The discrepancy between his views and those of Dr. Alonzo B. Palmer, who bitterly opposed the use of alcohol in all forms, was quickly noticed by the students, who sometimes submitted written questions in class calling attention to the opposing opinions. According to Dr. Victor C. Vaughan, Denton "possibly had something to do with the inauguration of the Medical School, but so far as I can learn he contributed but little to its reputation" (Vaughan, A Doctor's Memories, p. 195). He died in Ann Arbor, August 17, 1860. To succeed him Samuel Glasgow Armor (M.D. Missouri Medical College '44, LL.D. Franklin '72) was, in 1861, appointed Professor of the Principles of Medicine and Materia Medica, although the title was changed at once, by his request, to Professor of the Institutes of Medicine and Materia Medica. He had held teaching positions in several middle western medical colleges and was in private practice in Dayton, Ohio, when he accepted the appointment, which he retained until the close of the session of 1867-68.
Dr. Armor, a man of great personal charm, was characterized as an able teacher and lecturer, although he will not be remembered as one who contributed importantly to the advancement of medicine. He made his home in Detroit and was in practice there, for a part of the time, in professional partnership with Dr. Moses Gunn, who was then Professor of Surgery in the University.
Alonzo Benjamin Palmer (M.D. College of Physicians and Surgeons [West. Dist., N. Y.] '39, LL.D. Michigan '81) became associated with the University Page 834in 1854, when he was appointed Professor of Materia Medica, Therapeutics, and Diseases of Women and Children. Appointed Professor of Anatomy two years before, he was listed as "not on duty," presumably because of his desire to accumulate more funds before beginning an academic life. For a time Palmer attempted to maintain a residence in Chicago, but soon gave this up and came to Ann Arbor to live. On the death of Denton in 1860 he assumed the professorship of the theory and practice of medicine and of pathology and materia medica, becoming, a year later, Professor of the Theory and Practice of Medicine and of Pathology, in 1864 Professor of Pathology, the Practice of Medicine, and Hygiene, and in 1869 Professor of Pathology and the Practice of Medicine. His title from 1880 until his death was Professor of Pathology and of the Practice of Medicine and Clinical Medicine. Thirty-three years of his life were devoted to teaching medicine in the University; the last twelve of these he served as Dean.
During the years of his residence in Ann Arbor Dr. Palmer was an active member and vestryman of Saint Andrew's Church, where as a lay reader he often conducted services and taught a students' Bible class. With Mrs. Palmer he gave a substantial sum toward the erection of the church tower. After his return from Europe in 1879 he became a warm friend of Bishop Harris of the Detroit diocese and took the deepest interest in the founding of the Hobart Guild. In 1859, when he was forty-four, he made his first European trip. His diary shows that in London he attended clinics and lectures at Guy's Hospital, Saint Bartholomew's Hospital, the London Fever Hospital, King's College Hospital, Saint Thomas Hospital, Middlesex Hospital, and the Children's Hospital. He met many prominent medical men, among them Charles Murchinson, famed for his studies on fevers and for emphasizing the importance of milk in the spread of typhoid fever. He spoke of having met Sir Benjamin C. Brodie, then seventy-six years of age, the president of the Royal College of Surgeons, and Sir Alfred B. Garrod, well known for his studies on gout.
After three months in London he spent five weeks in Paris. There he visited Charles Eduard Brown-Séquard, who succeeded Claude Bernard as the professor of experimental medicine in the Collège de France in 1878 and who is chiefly remembered for his experimental investigations of the nervous system. He also saw Auguste Nelaton, one of the surgeons to Napoleon III, and Alfred Armand Louis Marie Velpeau, surgeon at the Charité, well known for his work on surgical anatomy and his New Elements of Operative Surgery. Palmer was especially interested in the clinic of Pierre-Adolph Piorry, inventor of the pleximeter and a pioneer in mediate percussion. In his diary he recorded: "Piorry [is] famous for his percussion; pretends to tell more by percussion than anyone else, and probably can do it." This is of interest because Palmer was a master of physical diagnosis himself and drilled his students thoroughly in its methods. He also visited the clinic of Armand Trousseau, one of the leading clinicians and medical teachers of France.
In Dublin he spent a morning with William Stokes, regius professor of medicine, who, as early as 1825, had published an Introduction to the Use of the Stethoscope. He had also written on cholera, having observed the Dublin epidemic of 1832, and was well known for his description of the Stokes-Adams syndrome and for his contributions to the literature dealing with diseases of the chest, heart, and aorta.
As a delegate of the American Medical Page 835Association, Palmer attended the meeting of the British Association for the Advancement of Science at Aberdeen, where he met and heard the most illustrious scientific men of Great Britain. Later, at Edinburgh, he called upon Sir James Young Simpson, one of the most remarkable personalities of his time, who was the first to employ chloroform as an anesthetic. He also made many contributions to obstetrics and gynecology and was greatly interested in improving the status of hospitals.
The European trip was doubtless a great inspiration to Palmer, for he came in contact with the finest type of physicians and medical teachers of Great Britain and France and visited most of the important hospitals and medical schools. Why he did not visit Germany is not known. The French, however, had contributed most of the advancements in medicine until about 1850.
On his return Palmer entered into his work with enthusiasm. Apparently he was an inspiring teacher; he sincerely enjoyed lecturing and was always ready to substitute for other lecturers in emergencies, or to add new lectures of his own if he thought there was a need for them. The memorial to him stated:
His lectures were at first fully written out but latterly he took briefer notes into the lecture room, carefully and systematically arranged. He never appeared before his class without looking over his notes and getting his subject well in hand; he was constantly rewriting and rearranging his lectures, to keep them abreast of scientific advancement.
(Memorial of … Palmer, p. 167.)
I have been particularly interested in Dr. Walshe's clinical exercises in the hospital. I have never witnessed more searching, exact, and intelligent examination of patients, particularly in all cases of diseases of the chest. Nothing could exceed the minute care exercised in physical explorations, and, so far as I could judge from witnessing his procedures, and hearing his remarks, with occasional examinations of particular sounds, he is unusually discriminative and precise in his observations, and very just in his conclusions.
(Memorial of … Palmer, p. 27.)
Breakey says that Palmer was "energetic, ambitious, industrious, and loved teaching." To the alumni attending the Commencement of 1888, the year following Palmer's death, Dr. Elijah H. Pilcher characterized him as follows:
[He was] earnest and methodical, learned and painstaking, pure and stainless in his life, kindly and benevolent, tenacious of what he thought to be right, devoted to the interests of the University; for more than a generation of years he was one of the most conspicuous figures of the medical faculty.
(Memorial of … Palmer, p. 170.)
He drilled his students ad nauseam in the employment of instruments of precision; auscultation and percussion were not only his favorite hobbies, but in their use he showed great skill. I remember how proudly he exhibited to me the first laryngoscope I ever saw.
Although he was an ardent Whig and abolitionist, his Civil War service was relatively brief. He resigned a commission as surgeon of the 2d Regiment of Michigan Volunteers on September 23, 1861, after a service of five months, to resume his University teaching.
In 1863 he accepted the chair of the theory and practice of medicine at the Berkshire Medical College in Pittsfield, Massachusetts, and during his first summer of service there also gave the lectures on materia medica. The plan of holding two professorships simultaneously at different medical institutions was not Page 836unusual and apparently was sanctioned by the University. At least two other medical teachers of the University had a similar arrangement: Corydon L. Ford, Professor of Anatomy, lectured in his subject at the same institution, and Armor, Professor of the Institutes of Medicine and Materia Medica, lectured at the Long Island Hospital Medical College. This arrangement was possible because the University's term of medical instruction lasted only six months. In 1877 the annual term of the Medical Department at Ann Arbor was extended to nine months, causing a conflict with Palmer's chair of the practice of medicine in the Medical School of Maine, which he had held since 1869. During the school year 1877-78, by lecturing twice daily, he managed to give the full number of lectures at both places.
At the suggestion of many of his former pupils Palmer wrote a textbook, A Treatise on the Science and Practice of Medicine, which appeared in 1883 in two volumes of about nine hundred pages each. Although its immediate reception was flattering this work could not be regarded as a great success. According to Vaughan, "Had it been presented fifteen years earlier it would have had a wide circulation, but it came just when the new medicine was supplanting the old and is now unknown and unused" (A Doctor's Memories, p. 199).
Dr. Palmer was not a prolific writer, as there are only twelve publications recorded in his memorial book. They deal with homeopathy, the effects of alcohol and temperance teachings, the cause of typhoid fever, sulphate of quinine, epidemic cholera, the treatment of inflammation of internal organs, and medical teaching. His president's address before the Michigan State Medical Society in 1873 had the title, "Law and Intelligence in Nature, and the Improvement of the Race in Accordance with Law."
During the last decade of Palmer's life many changes occurred in the Medical School which had his support and the benefit of his influence. Two pavilions were added in 1876 to the residence which served as a hospital on the north side of the campus, and this greatly increased the bed capacity; in 1877 the sessions were extended from six to nine months; in 1880 attendance for three years was required for graduation; a more extended course in physiological chemistry was begun in 1878; and in 1879 practical work in physiology was instituted (the course in physiological chemistry had previously been limited to urinalysis).
The following items from the Calendar of 1884-85 illustrate the subjects considered as belonging to the department and the time devoted to them: Urinalysis, twelve weeks of afternoon work; Physical Diagnosis, thirty-two hours in lecture room and hospital; the Practice of Medicine, 180 hours in the general lecture room; and Clinical Medicine, 148 hours in the Hospital amphitheater.
After the death of Dr. Palmer in 1887, Dr. Henry Francis LeHunte Lyster ('58, '60m, A.M. '61) was made Professor of the Theory and Practice of Medicine and Clinical Medicine, and he served in this capacity in 1888-89 and in 1889-90. Apparently he continued his practice in Detroit while he was head of the Department of Medicine in the University. It was during Dr. Lyster's regime that the separate Department of Pathology was created.
No professor of internal medicine was appointed for the year 1890-91, but the acting head was Dr. Walter Shield Christopher (M.D. Medical College of Ohio [Cinn.] '83), who was listed as Lecturer on the Theory and Practice of Medicine and Clinical Medicine. Dr. George Dock's explanation was as follows: Page 837
All professors were elected as lecturers and only given the title of Professor if, toward the end of the year, they were recommended for full title with indefinite tenure. Christopher was a very bright fellow but more interested in pediatrics. He went to Chicago in 1891 and became a very popular consultant, but died young.
George Dock (M.D. Pennsylvania '84, A.M. hon. Harvard '95, Sc.D. hon. Pennsylvania '04) was the next appointee to the chair of the theory and practice of medicine and clinical medicine. This was an important appointment, as he probably contributed more to the development of the department than any other professor before or since. In addition to his remarkable natural ability as a physician, teacher, and investigator, he had received the advantages of the best medical education obtainable at that time. After his graduation from Pennsylvania, he served as an intern at Saint Mary's Hospital in Philadelphia and then spent two years in study at Berlin, Leipzig, Frankfort, and Vienna. Medicine at this time was developing at a rapid rate, and German medicine was conceded to be the most progressive in the world. Dock returned to Philadelphia in 1887 as an assistant in clinical pathology, under the influence of William Osler and John M. Musser, two of the most inspiring medical teachers of all time. These experiences must have had a large share in developing his scientific knowledge and his teaching ability, which endeared him to many classes of students at the University.
The status of the Department of Medicine apparently was none too satisfactory in the few years prior to Dock's arrival. At the time of his appointment, the Michigan Daily reported that the chair of the theory and practice of medicine had had a "checkered career, as more than the ordinary changes [had] caused a feeling of uncertainty in the minds of the medical students. This feeling [had] been dissipated by the appointment of Dr. Dock." He took up his work in September, 1891. In the following year Aldred Scott Warthin (Indiana '88, Michigan '91m, Ph.D. ibid. '93, LL.D. Indiana '28) was appointed Demonstrator of Clinical Medicine. According to Dock:
There were no available doctors in the city to act as volunteers and on account of my late appointment there were no senior men available to assist with the teaching. Warthin and I were literally on full time, working in the hospital or on outpatients from eight to six, and often seeing patients at night.
The condition of affairs on his arrival may be summarized by his own words:
Before my time medical patients were rarely admitted to the hospital. The space was filled with operative cases. When I arrived on the ground there were no medical patients in sight, and I gave my first clinic on a private patient of Dr. Breakey who had pleurisy with effusion. Very soon we sent out, with the consent of the faculty, letters to physicians and preachers saying that there was an outpatient service in the hospital for medical cases and that the attendants (Warthin and I) would see indigent patients or any referred by physicians at their homes. We quickly gathered up a lot of good stuff. (From a letter written on March 1, 1937, to Richard C. Boelkins, a fourth-year medical student at the University.)
Dr. Dock will be remembered for his many fine qualities and for the important innovations he introduced into medical teaching at the University. He was chiefly instrumental in organizing laboratory Page 838methods of teaching and in reorganizing the course in auscultation and percussion. He likewise insisted that the work in medicine should not consist of the repetition of lectures in two successive years, as had previously been the custom.
His bibliography for the eighteen years he was on the staff of the Medical School contains eighty-three medical articles. They deal with many different topics and indicate his thorough knowledge and broad interest in clinical medicine. Among the subjects to which he made original contributions were chloroma, leukemia, Banti's disease, Hodgkin's disease, malaria, amoebic dysentery, osteomalacia, endocarditis, coronary thrombosis, tuberculosis, diabetes, and lobar pneumonia. In addition, he wrote the section dealing with endocrinology in Osler's Modern Medicine, published in 1909 and recognized as the leading system of medicine in the English language at that time. Dock edited and contributed additions to the volume Diseases of the Heart (1908), in Nothnagel's Encyclopedia of Practical Medicine, which was the translation of one of the outstanding systems of medicine published in Germany. Dr. Dock's interest in tuberculosis is shown by his publications on this subject, including one in 1902 on "Some Reasons Why There Should Be a Hospital for Consumptives in Connection with the University Hospital."
His wide interest in the constant advances of medicine led him, in association with Vaughan and Warthin, to devote much time and thought to the development of the Medical Library. As a result, early in the history of the Medical School a remarkably complete library was organized. His interest in this work led in 1907 to an article on "The Medical Library of the University of Michigan."
Many young medical students, stimulated by Dock's teaching, later came to occupy positions of prominence in this country. Dr. Aldred Scott Warthin, one of his first associates, became Professsor of Pathology in the University. Dr. David Murray Cowie became Instructor in Pediatrics in 1905, and in later years served as Professor of Pediatrics and Infectious Diseases and head of that department. Dr. James Rae Arneill (Lawrence '90, Michigan '94m, LL.D. Lawrence '23), of Denver, Colorado, was Instructor in Internal Medicine from 1898 to 1903, and later became professor of medicine at the University of Colorado. Dr. Roger Sylvester Morris ('00, '02m) was later associated with the Medical Department of Johns Hopkins University and finally became professor of medicine at the University of Cincinnati. Dr. James Gerrit Van Zwaluwenburg ('98, '08m) became Professor of Roentgenology in the University. In addition to the group named, many others who were his students and who in some instances were associated with him on the staff of the Department of the Theory and Practice of Medicine went to different parts of the country and became the leading consultants and practitioners in their communities.
In 1896 Dr. Dock was offered a position as professor of medicine at Jefferson Medical College in Philadelphia, but he declined it. He left in 1908 to become professor of medicine at Tulane University, and later accepted a chair in Washington University, St. Louis, which he resigned in 1922 to take up private practice in Pasadena.