The University of Michigan, an encyclopedic survey ... Wilfred B. Shaw, editor.
University of Michigan.
Page  833

THE DEPARTMENT OF INTERNAL MEDICINE

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.)
That he was thorough and meticulous in the examination of patients may be surmised by his comments on Dr. Walshe, whose clinic he visited in London:

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.)
Vaughan commented, in A Doctor's Memories (p. 199):

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.)

During Dock's early days at the Hospital the clinical facilities of the Medical School were greatly improved by the completion of the Catherine Street Hospital in December, 1891, providing at first sixty-four beds. This was later known as the West Hospital.

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.

The Years 1908-27

After the resignation of Dr. Dock, the dean and faculty of the Medical School (then called the Department of Medicine and Surgery) attempted at first to obtain Dr. Rufus Cole of Johns Hopkins University as his successor. In Page  839declining their offer Cole mentioned Albion Walter Hewlett (California '95, M.D. Johns Hopkins '00) as a possibility and recommended him in the highest terms to the Regents, who in 1908 appointed him Professor of Internal Medicine and Director of the Clinical Laboratory. This position he held until 1916, when he resigned to become professor of medicine at Leland Stanford Junior University. While at Ann Arbor Hewlett made a rather extensive study of the blood flow in the arm in various clinical conditions and wrote a book on the Functional Pathology of Internal Diseases, accepted as an authoritative work on this subject.

Hewlett was one of the first men appointed to the chair of medicine in an important medical school whose chief interest lay in the functional rather than in the structural aspects of disease — in pathologic physiology rather than in pathologic anatomy. He had a strong instinct for research, and his reputation rested more upon his attainments in the field of productive scholarship than upon his renown as a clinician. During his stay at Ann Arbor he was continuously engaged in research himself and did his utmost to stimulate his assistants to do likewise. Although the salary he received from the University was small, judged by present standards, he refused to open an office for the practice of medicine and would not grant this privilege to his assistants.

Dr. Hewlett was not a spectacular teacher or clinician, unlike Dr. Dock, whose striking personality immediately made a strong and lasting impression upon those who came in contact with him. One of Hewlett's most striking traits was his intellectual honesty. When he made a mistake in diagnosis he acknowledged it freely and without embarrassment and never offered an excuse. His mind was of the very first caliber, but he never paraded his knowledge or sought to dramatize his lectures and clinics. In his character there was no taint of selfishness. He took pride in the accomplishments of his assistants, and when he worked with them on a problem or directed their research he saw to it that they received more than their full share of credit for the work done. When the time came for them to leave the department he did all in his power to help them pursue their chosen careers and followed their progress with great personal interest.

Of the men who were associated with Dr. Hewlett, Dr. James Howard Agnew ('07, A.M. '08, '10m) became, for a time, professor of medicine at the University of Alabama; Dr. Luther Fiske Warren ('07, '09m), professor of medicine at Long Island Medical College; and Dr. Van Zwaluwenburg, Professor of Roentgenology in the University.

Soon after his arrival at the University Hewlett called attention to a recent epidemic of scarlet fever in the medical wards and pointed out the great need for a contagious hospital. It is not surprising, in view of what has been said of his chief interests, that in a discussion as to whether the primary function of the University Hospital was to supply the Medical School with the clinical material necessary for the instruction of its students and for the investigation of disease, or whether one of its major functions was to furnish medical service to the citizens of the state of Michigan, he championed the former view.

When he first came to Michigan the instruction in the Department of Medicine was confined to the junior and senior years. A junior course in clinical microscopy, given four times a year and once during the summer session, had as its purpose instruction in the technique employed in the examination of the blood, sputum, stomach contents, and excreta, Page  840and dealt also with the diagnostic significance of the data furnished by these methods. It was under the charge of the junior instructor in the department and was given in turn by Dr. Warren, Dr. Harry Burke Schmidt ('11m), Dr. Frank N. Wilson ('11, '13m), and Dr. Quinter Olen Gilbert ('09, A.M. '10, '14m). In a second junior course, at first called Auscultation and Percussion and later Physical Diagnosis, instruction was given in the technique of the physical examination of the patient and in the interpretation of the data obtained. This course was conducted at first by Van Zwaluwenburg and later by the senior instructor in the department.

A third course consisted in the presentation of typical cases illustrating the more common internal diseases occurring in the Hospital. At each meeting the class was quizzed on the subject presented at the preceding meeting. These clinics, given by Dr. Hewlett, covered etiology, symptomatology, and physical signs. Differential diagnosis and treatment were left for consideration in the senior year. A second part in this course, given by an assistant, consisted in assigned reading, quizzes, and frequent written tests, and dealt with diseases less common and not ordinarily encountered in the Hospital. This didactic work was later given up in favor of additional clinics.

In the senior year Dr. Hewlett gave two clinics weekly, at which cases were presented and the diagnosis, differential diagnosis, and appropriate treatment were fully discussed. On each clinic day he selected the cases and spent some time in preparing his material. The major course of the senior year was "case taking," in which the students, by sections, were assigned the patients admitted to the medical wards. Ordinarily the students worked in pairs, were responsible for the history and routine laboratory tests, and were expected to complete these with as great dispatch as possible. The data collected by them were incorporated in the Hospital records, and their work was supervised but was not repeated by the house officer in charge of the ward. The students were also expected to make a complete physical examination and to keep progress notes, but this material was collected solely for their own use and did not become a part of the permanent record. During daily ward rounds by Hewlett or the senior instructor the students presented their cases for discussion.

For a number of years a "medical staff" was appointed, consisting of a small group of students, selected because of their scholastic standing or interest in internal medicine. These students were assigned medical cases throughout the year instead of merely during the period when the section to which they belonged was on the medical wards. Hewlett made special rounds each Sunday morning for their benefit, and the cases assigned to them were then presented.

In 1911 an introductory course in physical diagnosis for sophomore students was given for the first time by Dr. Warren. It was continued by the junior instructors who followed him. In 1915 Hewlett offered a one-hour course in pathologic physiology.

Up to this time very little provision for the care of outpatients had been made in the Department of Medicine. In a small room adjoining the office of the Department of Neurology an occasional outpatient was seen by the assistant in medicine, but the number of outpatients gradually increased, and it became necessary to make some provision for them. After declining an offer from the University of Minnesota in 1915-16 Dr. Hewlett requested and received a special appropriation for the construction of an outpatient service in the basement of the medical wing of the old University Hospital. Page  841Shortly after this he accepted the chair of medicine at Leland Stanford.

Dr. Hewlett was succeeded by Nellis Barnes Foster (Amherst '98, M.D. Johns Hopkins '02), who had pursued postgraduate studies in various European institutions before becoming associated with Cornell Medical College in New York City.

Foster arrived in Ann Arbor in the fall of 1916 and found the department established in the old Medical Ward, which burned in 1927. This building had twenty-three beds, and there was no formal outpatient service. A small room, measuring about five by ten feet, provided the only available space for experimental work. From this the work in experimental medicine developed. In order that the department could have more space Vaughan permitted Dr. Louis Harry Newburgh (Harvard '05, M.D. ibid. '08) to work in the Hygienic Laboratory in the basement of the West Medical Building.

Shortly after Dr. Foster arrived he was assigned space in an old building which had formerly housed the Hospital laundry, and the Regents appropriated about $2,000 for the purchase of laboratory equipment for it. The one large room of this building was over the Hospital furnace and was very hot in summer, especially as the structure also had a sheetiron roof. The room was so dark that it was necessary to have the electric lights turned on in the middle of the day. An L-shaped room was partitioned off, and arrangements were made to divide it into four small laboratories. Small experimental animals, such as guinea pigs and rabbits, were kept at one end. The remainder of the room was used for teaching purposes.

Dr. Foster had a very high regard for Vaughan, Novy, Warthin, Huber, and others of the faculty, and it was, perhaps, on account of their reputations that he was attracted to Ann Arbor. He was full of enthusiasm and did much teaching. He acted in consultation with Dr. Newburgh and Dr. Mark Marshall (Earlham '02, Michigan '05, '08m), each of whom had charge of a ward.

Dr. Foster had served in his position for only five or six months when the United States entered World War I. Shortly afterward he suddenly left the University, as a result of a misunderstanding with Dr. Vaughan, who was then Dean, and joined the Medical Corps of the United States Army. The differences with Dr. Vaughan probably were not initiated by Dr. Foster, and apologies were offered to him later. He was a most pleasing type of physician, exceedingly well grounded in clinical medicine, and beloved by all members of the department.

When Dr. Foster left Ann Arbor, Newburgh was advised by Vaughan that he was to be the acting head of the department, but was cautioned that he could not have a free hand in conducting the department, as he could not have control of its budget, and that he would not have the privilege of recommending new appointments. Newburgh was then made chairman of a committee to select a successor, but after considering several physicians of prominence in the Middle West and East, the committee was discharged, as it could not obtain a suitable man for the position.

Newburgh had come to the University of Michigan in 1916 as Assistant Professor of Medicine, upon the recommendation of Foster. He had served for four years as alumni assistant at the Harvard Medical School, working with Dr. James Howard Means, later professor of medicine at that institution, and Dr. William Townsend Porter, then professor of physiology. His investigations during this interval were concerned chiefly with studies on the respiration, Page  842the circulatory rate, and the effect of strychnine on the blood pressure in patients with pneumonia. Upon arrival in Ann Arbor he immediately began to develop an experimental laboratory which, as a result of his efforts, has now grown into the splendidly equipped nutrition laboratory that functions as a unit of the Department of Internal Medicine. Dr. Newburgh served as active head of the department in 1917-18, and was appointed Professor of Clinical Investigation in Internal Medicine in 1922.

Hugh Cabot (Harvard '94, M.D. ibid. '98), then Dean of the School, in his report to the President for 1921-22 stated: "It is believed to be essential for the satisfactory conduct of this Department that we should obtain the services of a well-trained physician with broad clinical experience and a wide knowledge of the practice of medicine." He recommended Louis Marshall Warfield (Johns Hopkins '97, M.D. ibid. '01), stating that "his experience in the practice of medicine and as a consultant assures us a broad type of approach in the problems of medicine." Dr. Warfield's appointment began in 1922, and he continued to serve as Professor of Internal Medicine and head of the Department of Internal Medicine until 1925. He was not happy in his position at the University, however, because of certain changes occurring in the School and because of various controversies which had arisen, both before and after his arrival in Ann Arbor. He resigned in 1925 and returned to his practice in Milwaukee.

Warfield was followed by Preston Manasseh Hickey ('88, M.D. Detroit College of Medicine '92), Professor of Roentgenology, who kindly consented to be temporary administrative head of the department until a suitable successor to Warfield could be appointed.

James Deacon Bruce (M.D. Detroit College of Medicine and Surgery '96) was Director of the Department of Internal Medicine for the years 1926-28. He resigned to become the Director of Postgraduate Medicine and Vice-President of the University in charge of University relations. During his directorship of the department, the Tuberculosis Unit was started, an allergy service was developed, and the Simpson Memorial Institute was built.

The Period Since 1927

The present Director of the Department of Internal Medicine and Director of the Thomas Henry Simpson Memorial Institute for Medical Research is Cyrus Cressey Sturgis (Washington '13, M.D. Johns Hopkins '17). Before coming to Michigan in 1927 as Professor of Medicine and Director of the Simpson Memorial Institute he was a member of the faculty of the Harvard Medical School and physician of the Peter Bent Brigham Hospital in Boston.

The last year that Dr. Bruce was Director of the Department of Internal Medicine, there were twenty-eight members of the staff — a director, two professors, three assistant professors, eight instructors, one instructor in dietetics, four research assistants, one assistant, and eight interns. During the following year, 1928-29, the medical staff was increased to three professors, four assistant professors, fifteen instructors, eight senior interns, and eight junior interns, a total of thirty-eight. All members of professorial rank of the original staff were retained, with the exception of John Barlow Youmans (Wisconsin '15, M.S. ibid. '16, M.D. Johns Hopkins '17), who resigned to accept an assistant professorship in internal medicine at Vanderbilt University.

Among the additions to the professorial staff of the department in 1928 was Charles Leonard Brown (Oklahoma '19, Page  843M.D. ibid. '21), who had been an instructor in the Harvard Medical School. He came to the University as Assistant Professor of Medicine.

The Department of Internal Medicine had previously been divided into several services, consisting of a service in metabolism headed by Dr. Newburgh, a cardiology service under the directorship of Dr. Wilson, a private medical service which had been directed by Dr. Bruce, and a tuberculosis service under the directorship of George Alexander Sherman (McGill '19, M.D. ibid. '24). During the year 1928-29 Sturgis combined the cardiology, metabolism, and private medical services with those of general medicine. This allowed Newburgh, Wilson, and their staffs ample opportunity to continue with the excellent experimental work that they had done in the past and which they had found difficult to continue because of the heavy clinical load they were required to carry.

John Blair Barnwell (Trinity College '17, M.D. Pennsylvania '23) was brought to the department as Director of the Tuberculosis Unit in November, 1928. He had been research instructor in pediatrics at the University of Pennsylvania, and a fellow and acting first assistant of the Trudeau Foundation.

With the addition of the special branches of medicine to general medicine it became necessary to reorganize teaching on the various medical wards. In order to facilitate handling the large number of students at that time, the medical service was divided into four general medical services, a medical outpatient service, a private medical service, a tuberculosis service, and a diabetic outpatient service. The work of the students was divided equally among the four services. They devoted half of their time to the medical section on the wards, and each group alternated between two instructors. The other half of the time in the medical section was spent in the private medical service, the tuberculosis service, the diabetic outpatient service, and the medical outpatient service. The new arrangement allowed more individual attention for each student and more cases for the student to examine than had heretofore been possible. The general medical services were also reorganized so that each attending man who taught the senior students was a member of the permanent staff and of professorial rank. His assistant was a third- or fourth-year staff member of the rank of instructor who also taught the junior section in the afternoon. Each ward was under the direction of an assistant resident and an intern. Better care of ward patients was possible, and teaching for both the student groups and the younger staff men was more comprehensive and individual.

The department by 1940 had a staff of fifty-one members — three professors, six associate professors, five assistant professors, seventeen instructors, three research fellows, one instructor in dietetics, nine senior interns, and seven junior interns. The large staff made it possible to provide postgraduate instruction for the younger members. Interns were selected, who, if they were satisfactory, could be given a total of four years' training in internal medicine. Such an opportunity for postgraduate training greatly increased the number and quality of men who applied for internship in the department. In the early period of Dr. Sturgis' directorship of the department it was difficult to obtain men of the first rank for appointment to the intern staff. The situation changed greatly, until in 1937 sixty-five applications were received for seven internships; many of the applicants were in the first 10 per cent of their respective classes, and most of the best medical schools in the country were thus represented.

During the first thirteen years Dr. Page  844Sturgis was Director a number of the younger men were appointed to professorial positions elsewhere. Dr. Wilson, Dr. Newburgh, Dr. Paul Shirmer Barker (Westminster '15, M.D. Washington University '20), Dr. Henry Field, Jr. (Syracuse University '16, M.D. Harvard '20), Dr. Herman H. Riecker (Marietta College '17, M.D. Johns Hopkins '23), and Dr. Arthur Covell Curtis ('23, '25m), all members of the earlier medical staff, were still active in the department as of 1940.

In addition to providing the routine teaching of medical subjects the department has doubled the length of the courses in clinical microscopy and physical diagnosis, and numerous elective courses are offered to students interested in the various special phases of general medicine. The Department of Internal Medicine teaches more hours a year than does any other department in the Medical School. That such teaching has not been burdensome to students can be seen in a statement in "A Criticism of the Teaching at the University of Michigan Medical School by the Class of 1935": "In general, we feel from the standpoint of teaching, that the Department of Internal Medicine is outstanding in the Medical School…"

Several services of the department benefited during the thirties, either by new accommodations, marked growth, or special grants. Two additional floors costing $250,000 were erected on top of the Hospital to serve as a new unit for the care of patients with pulmonary tuberculosis. The floors were first occupied by patients in July, 1931. Accommodations were provided for ninety-eight patients in six single-bed rooms, ten two-bed rooms, and seventy-two four-bed rooms. Ample teaching rooms and workrooms for examinations, treatments, laboratory work, and fluoroscopy are also available.

The allergy service has slowly grown from a part-time interest of one man in 1927 until it occupies three rooms on the second floor of the Hospital and has a permanent staff of three men and, in addition, one man part time.

The diabetic service has likewise slowly grown until now it has entire care of all diabetic patients assigned to the department and also supervises the care of all diabetic patients on services other than the medical service.

It was found possible in 1936 to rotate the senior instructors who were members of the medical service, in periods of a month each, through the electrocardiographic service, the allergy service, and the Simpson Memorial Institute. This allowed these men to spend all of their time for the period in pursuing the special work given in the three divisions and greatly added to the training that they received.

In 1937 one million dollars was appropriated from the Horace H. Rackham Fund, the interest on which was to be used for a period of not less than five years and not more than ten years, for the study of arthritis. This work was organized in the University Hospital under the directorship of Dr. Richard Harold Freyberg ('26, '30m).

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