SOCIAL, economic, religious, and governmental interests have contributed to the growth of public health in this country since the 1850's. Until about 1870, however, little professional health education was needed, since community health efforts were confined, for the most part, to the appointment of a "sanitary inspector," who had charge of the disposal of rubbish and environmental filth.
With the work of Pasteur and the birth of modern preventive medicine, departments or institutes of bacteriology and hygiene were established, and bacteriologist laboratorians were trained. Before this, Snow had indicated water as a cholera route, and in 1873 Budd discovered that it was a carrier of typhoid. Trained sanitary engineers were employed, and procedures for blocking disease transmission were set up.
As the prevention or control of endemics and of most of the major epidemics became possible, the necessity for wide-spread systematized attention to other important health factors was seen. Findings of World War I draft examinations emphasized the extent of this need. The present phase of the public health movement came with the recognition that sanitation should be improved and communicable disease controlled. The necessity for health education, periodic health examinations, the prevention, early detection, and amelioration or correction of physical and mental defects was recognized. Public health work calls for the physician, dentist, nurse, nutritionist, and psychologist — with prevention rather than cure as the goal — as well as for the bacteriologist laboratorian and the sanitary engineer. The educator, the sociologist, economist, and political scientist all play a part, since many ailments have to an increasing extent social and economic etiological factors.
It is a common experience for a social need to meet with delay before a public act results unless an emergency compels action. Progress in public health work has not infrequently come as a result of epidemics. One may say that cheese — or, rather, outbreaks of illness from the eating of cheese — promoted the University's early participation in public health work (Kleinschmidt, MS, pp. 310-17). In 1883 reports came to the State Board of Health from several communities in Michigan that "persons eating cheese had become suddenly and violently ill." In 1884-85 some three hundred such cases were reported. Dr. Vaughan and his associates "finally isolated a poisonous principle," which Dr. Vaughan named "tyrotoxicon." This outbreak and a later one, in Milan, furthered the cause of the laboratory.
The University of Michigan was one of the first universities to recognize its public health obligations. The Hygienic Laboratory was established in 1887 for investigations concerning the causation, nature, and prevention of disease and to serve as an educational center in hygiene subjects. Two dates mark important points in the University's public health activities subsequent to the establishment of the laboratory; the inauguration of systematic professional public health education in 1911; and the organization of the Division of Hygiene and Public Health in 1921. The School of Public Health was established in July, 1941.
The early establishment of a state board of health in Michigan contributed to the University's pioneer work in public health. Only a few states preceded Page 1150Michigan in this respect — Massachusetts, 1869, California, 1870, Virginia and Minnesota, 1872, and the state of Louisiana, which, in 1855, organized in conjunction with New Orleans a board of health which exercised authority in the city and quarantine stations. Impressed by a report of the Massachusetts State Board of Health, Dr. Henry B. Baker, of Winona, Michigan, framed a bill, which, enacted in 1873, established the Michigan State Board of Health.
Dr. Victor Clarence Vaughan (see Part V: Medical School) was appointed assistant in the Chemical Laboratory in 1875, and his achievements in research, medical education, and in hygiene and public health are widely known. He became a member of the State Board of Health in 1883 and served for many years. He stimulated interest in the laboratory work and at a meeting of the State Board of Health on January 8, 1884, spoke of "the need of a fully equipped sanitary laboratory at the University" (Rept. Mich. State Bd. of Health, 1884, p. xxxvii).
The State Board of Health, in October, 1886, adopted a resolution requesting the Regents to consider the advisability of establishing a laboratory of hygiene which would regularly report important results of laboratory work to the State Board of Health. The Regents referred this request to the medical faculty and the State Board of Health "to consider fully, and report at some future meeting …" (R.P., 1886-91, p. 73). As recorded in the minutes of the State Board, Dr. Vaughan called the Regents' attention to typhoid in the state, estimating about fifteen thousand cases a year. He emphasized the importance of instruction in methods of preserving health and preventing disease as well as of doctors to cure diseases, and stated:
Some place was needed where every health officer could have samples of drinking water or articles of food tested. He said that such a laboratory should be made an educational center in hygiene subjects and should carry on original investigations concerning the causation, nature and prevention of disease. Instruction offered by such a laboratory would fit students to be advisers in sanitary matters.
On July 8, 1887, a special committee appointed to prepare a "scheme" for the organization of such a department recommended that a Department of Hygiene be established and that "inasmuch as hygiene is closely related to physiological chemistry, … these two subjects be united under one chair," and also "that the title of the chair be that of Professor of Hygiene and Physiological Chemistry and Director of the Hygienic Laboratory" (R.P., 1886-91, pp. 143-44).
Meanwhile, the State Board of Health presented a petition to the legislature to the effect that since knowledge "which tends directly to the preservation of life, and to the perfection of physical and mental health and strength" was not well provided for at the University, the legislature "take such action as shall lead to the maintenance of a well-equipped laboratory of hygiene at the University of Michigan and of such instruction in sanitary science at that institution, as shall place that subject on a plane not inferior to that of any other subject taught at the University" (Rept. Mich. State Bd. of Health, 1887, p. xlv).
In 1887 the legislature appropriated $35,000 for the construction of a building and for its equipment (P.A., 1887, No. 243), and in 1889 authorized two grants of three thousand dollars each, one to be made in 1889 and one in 1890, for "furniture and apparatus" (P.A., 1889, No. 145).
The Hygienic Laboratory was first situated in the left wing of the West Physics Building, but moved into the Page 1151West Medical Laboratory in 1903 (see Part V: Medical School). It was moved again in 1926, with the Department of Bacteriology, into the East Medical Building. Dr. Vaughan and Dr. Frederick George Novy, successively directors of the Hygienic Laboratory, began the work in October, 1887, "using rooms and apparatus belonging to the chemical laboratory." One of Dr. Novy's early achievements in connection with the laboratory was the exposure of the stenocarpine fraud, showing that the so-called "new local anaesthetic" contained cocaine. Others identified with the early days of the laboratory were Dr. Henry Sewall (see Part V: Department of Physiology) and Albert B. Prescott, Dean of the School of Pharmacy (1876-1905). Pharmacy played an important part in public health work, particularly with reference to food adulterations.
A state legislative act in 1897 provided for the analysis of water in use by the public (P.A., No. 43). According to this measure, a sample of water "which might be the cause of disease or "epidemic" could be sent to the University for analysis, free of charge except for the actual cost of materials. In 1903 the legislature enacted a law providing for the immediate treatment of indigent persons supposed to have been infected with rabies (P.A., No. 116).
The State Board of Health began to develop public health laboratory work at Lansing. An act passed in 1907 provided for the appointment of a bacteriologist by the State Board, and for equipment for bacteriological examinations, including water analysis (P.A., No. 109); another, in 1915 (No. 164), provided for a branch bacteriological laboratory in the Upper Peninsula; one in 1919 (No. 146) provided for the appointment of a state commissioner of health and an advisory council.
Through its Bureau of Laboratories the State Department of Health has taken over some of the original functions of the Hygienic Laboratory. The Medical School Announcement for 1939-40 states, relative to the Hygienic Laboratory: "The Pasteur Institute and the Department of Bacteriology are divisions of this laboratory. Parasitology and Medical Jurisprudence are also included."
From 1881 to 1911, first in the School of Political Science and later in the Hygienic Laboratory, public health practices were taught under the direction of Dr. Vaughan, Dr. Novy, and others (see Part V: Department of Bacteriology). The first degree in hygiene was conferred in 1897, ten years after the establishment of the Hygienic Laboratory. Between 1897 and 1911, the first year of systematic professional public health education, the degree of master of science in hygiene was conferred on six students and the degree of master of arts in hygiene on two.
Systematic professional public health education and the degree of doctor of public health were established May 11, 1911, when the Regents approved the recommendations in the following communication from the Dean of the Department of Medicine and Surgery:
I am instructed by the Medical Faculty to request … that you give permission to said Faculty to provide for a course of two years' instruction, leading to the degree of Doctor of Public Health (D.P.H.)… There is a great demand, and a growing one, for health officials who should know not only medicine, but the principles of heating, ventilating, plumbing, sewage and garbage disposal, water supplies, methods of purification of water, etc… We propose to demand for admission to this course the degrees of B.S. and M.D. from this medical department, or a medical school of equivalent standing. The course will extend through two years, about half of it will be given in the Medical Department, and the other half Page 1152in the Engineering Department…
(R.P., 1910-14, pp. 143-44.)
Course I. A one-year course leading to the degree of Master of Science in Public Health. Candidates must possess the degrees of B.S. or A.B., and M.D.… In addition to the taking of the prescribed courses and the successful passing of these courses the candidate shall carry out a piece of original investigation of sufficient value, and shall present a thesis on the same,…
Course II. Course leading to the degree of Doctor of Public Health. Candidates must possess the degree of A.B. [or] B.S. in addition to that of M.D., and must pursue a course of two years after the degree of M.D. has been received. The first year's course is identical with that prescribed for the degree of Master of Science in Public Health. The second year's work must be spent in research work in one or more of these subjects, with the presentation of a thesis containing original work of sufficient merit,…
The first announcement of these programs of study appeared in the 1912-13 Announcement of the Department of Medicine and Surgery. The Graduate School's first statement regarding public health degrees, in its 1912-13 Announcement, called attention to the statements in the Medical Announcement. Through 1913-14 these statements were in accordance with the 1911 action of the Regents (R.P., 1910-14, p. 179) that a candidate for public health degrees must possess the bachelor's degree and the degree of doctor of medicine.
For some unexplained reason a radical change in admission requirements for public health degrees appeared in the medical and graduate announcements for 1916-17 and the ensuing years; "and" was changed to "or," to the effect that candidates for public health degrees must possess the bachelor's degree or the degree of doctor of medicine. The work requirements also were changed. The Medical School Announcement from 1915 to 1921 stated: "For the degree of Doctor of Public Health no course is outlined as the work required of an individual student will be in charge of a committee of the faculty who will arrange the course according to the special needs of the applicant for the degree." In the Graduate School Announcement for the same period it was stated: "The degree of Doctor of Public Health is reserved for those candidates who specialize in public health work."
The courses reflected the public health interests of the time. Personnel were trained, for the most part, as bacteriologist laboratorians, who acquired an understanding of the nature, sources, identification, and distribution of bacteria and other parasites, and sanitary engineers, whose knowledge dealt particularly with environmental conditions, disease-transmission routes, and procedures for blocking or controlling these routes. William C. Hoad, who came to the University in 1912 as Professor of Sanitary Engineering, and other members of the engineering faculty co-operated with Dr. Vaughan and the medical faculty in this training.
Marion L. Burton, who became President of the University in 1920, was interested in broadening professional public health education at the University, so that it would be in keeping with developments in the public health field and with increasing demands for trained personnel. He wanted to establish a "University division" which would correlate professional public health education programs, public health courses for the various schools in the University desiring such courses, general courses in hygiene and community health for college students, a more comprehensive University Health Page 1153Service, the Department of Physical Education, and the Department of Intramural Recreational Activities.
In June, 1921, a committee consisting of Regent Murfin and President Burton recommended to the Regents that there be established two departments: "(a) A University Department of Hygiene and Public Health, including a Department of Physical Education, and (b) A Department of Intercollegiate Athletics."
The Division of Hygiene, Public Health, and Physical Education was established by the Regents in June, 1921, and its functions outlined as follows:
Section 1. This Division has for its objects (1) the promotion of the physical welfare of the students; (2) the dissemination of knowledge concerning the application of hygiene and sanitation as affecting both the individual and the community; (3) co-operation in the training of experts in these subjects.
(Organization and Aims …, p. 70.)
To organize and direct the work John Sundwall (Chicago '03, Ph.D. ibid. '06, M.D. Johns Hopkins '12), Professor of Hygiene and Public Health and Director of the University Health Service at the University of Minnesota, in 1921 was appointed Professor of Hygiene and Public Health and Director of the Division of Hygiene, Public Health, and Physical Education.
Before the organization of the Division six noncredit health lectures were required of freshmen. A course in hygiene and public health was given for sophomore medical students and as an elective for upperclassmen in the College of Literature, Science, and the Arts. The course was given by Dr. Vaughan, who made reference to "students who in relays of from two to three hundred for quite some forty years listened to my talks on hygiene" (Vaughan, p. 249). Medical students are now given three courses in public health and preventive medicine. An elective college course in hygiene and community health has also been given.
The Health Service, opened in 1913 as a "dispensary," was doing excellent work in cramped quarters, but was still equipped for ambulatory patients and room calls only. Two months of instruction at the University, with two months of field work, made up a public health nursing course, for which a certificate in public health nursing was given; and the annual Announcement of the Medical School and of the Graduate School included statements relative to graduate work in public health.
During the Division's first year, its interest centered on student physical welfare and physical education needs, and plans were made for a larger Health Service with infirmary, increased services, and a larger staff.
In 1921 the activities of the Division of Hygiene, Public Health, and Physical Education were divided into two general classifications: (1) instruction in hygiene, public health, and physical education and (2) the physical-welfare activities, regarded as a laboratory correlative to teaching. Instruction was given in the Graduate School, the School of Education, the Medical School, the College of Dental Surgery, the College of Literature, Science, and the Arts, the College of Pharmacy, and the School of Nursing. Included in the physical welfare activities of the University Health Service were the required freshman hygiene lectures, special health lectures, individual instruction, campus and off-campus sanitary inspection and surveys, and the service of the hospital "dispensary." Separate programs were planned for men and women in physical education, intramural sports, and recreational activities (P.R., 1921-22, pp. 293-313).
Page 1154The staffs of the units were headed by John Sundwall, Warren E. Forsythe, Barbara H. Bartlett, George A. May, Elmer D. Mitchell, Elton E. Wieman, Marion O. Wood, and Marion Dawley. In 1923, in order that women's physical education might be supervised by a woman trained in medicine as well as in physical education, Margaret Bell (Chicago '15, M.D. Rush Medical College '21) was appointed Physician in the University Health Service and Associate Professor of Women's Physical Education in the Division of Hygiene.
A four-year program of study in physical education and school health in the School of Education was arranged. In 1925, with plans for a large stadium, it was suggested that physical education and intramural recreation be placed under the direction of the Board in Control of Intercollegiate Athletics. In May, 1925, Acting President Lloyd, at the request of the Senate Council, named a committee (E. E. Day, Chairman; R. W. Aigler, J. A. Bursley, A. H. Lovell, and A. E. R. Boak) "to survey and study the whole subject of intercollegiate athletics at Michigan." The report of the committee calling attention to the need of more funds and better facilities for physical education and intramural recreation and sports was interpreted by President Little as follows:
… the committee recommended a reconstitution of the Board in Control of Athletics to include beside the present members five more faculty representatives (including the Director of the Division of Hygiene, Public Health and Physical Education)… It was proposed to charge this board with responsibility for all athletics and physical education — not simply intercollegiate games.
(P.R., 1925-26, p. 49.)
Said Board in Control shall likewise … have general supervision of intramural sports, physical education, and allied matters, being expressly hereby charged with the duty of forthwith providing an adequate and proper plan for giving speedy effect to the general program outlined in the Senate Committee report on University athletics dated January 18, 1926.
The Department of Physical Education for Men, the Department of Intramural Sports, and the Department of Physical Education for Women were accordingly separated from the Division of Hygiene, Public Health, and Physical Education and placed under the direction of a board of fourteen, composed of two students, three alumni, and nine faculty representatives, of which group the President of the University and the Director of Intercollegiate Athletics were to be permanent members, the other seven to be appointed by the President.
When the Regents placed physical education and intramural recreation under the Board in Control of Athletics, later the Board in Control of Physical Education, the Division of Hygiene, Public Health, and Physical Education became the Division of Hygiene and Public Health, including general health education, the University Health Service, and the professional education of public health personnel. The history of the development of the University Health Service, one of the most important parts of the Division of Hygiene and Public Health, is given in a separate article (see Part II: University Health Service).
In 1922-23, for the first time, a separate bulletin was issued announcing professional courses in public health. With increasing recognition of the widespread need that attention be directed to other Page 1155factors in health conservation, man himself became a center of public health interest.
In addition to professional programs of study for public health personnel, the Division of Hygiene and Public Health has given public health courses in the School of Medicine and in the School of Dentistry as well as general courses in hygiene and community health.
Public health nursing education at the University, as initiated in 1918-19 under Miss Dora Magdalene Barnes (Mt. Holyoke '03, R.N. Johns Hopkins '06, A.M. Peabody '22), had consisted of a four-month course, half the work being done at the University and the other half devoted to directed field work in Detroit. Mrs. Barbara Haecker Bartlett (Columbia '17, A.M. Michigan '23, R.N.) succeeded Miss Barnes in 1920 as Professor of Public Health Nursing and served from 1920 to 1938. Four of these short-term courses were given, with an average of nineteen students. Public health nursing was transferred in 1922 to the newly established Division of Hygiene and Public Health, and its curriculum, leading to a certificate in public health nursing, was expanded to one academic year and later to a year and a half. In 1923-24 with the co-operation of the School of Education, a four-year curriculum in public health nursing leading to the degree of bachelor of science in education was established. Following Mrs. Bartlett, Miss Ella Elizabeth McNeil ('23, R.N. '23) was appointed to direct the public health nursing courses.
In 1921-22, the Division's first year, two professional public health curriculums were offered: (1) a general program of study in public health, open to graduate students with the necessary preparation; and (2) the public health nursing work leading to a certificate in public health nursing. In 1940-41, with the co-operation of other University units and of public health agencies in the state, in order to provide a specialized type of training for the various fields of public health, thirteen curriculums leading to the degree of master of public health were presented: I. Public Health Administration, II. Epidemiology, III. Public Health Nursing, IV. Public Health Engineering, V. Public Health Laboratory Practice, VI. Public Health Statistics, VII. Industrial Health, VIII. School Health Programs, IX. Public Health Education, X. Public Health Dentistry, XI. Venereal Disease Control, XII. Public Health Nutrition, XIII. Health Councils and Voluntary Health Agencies.
The Division began early in its professional public health teaching to co-operate with the Medical School, the College of Engineering, the School of Nursing, the School of Dentistry, the School of Education, the College of Pharmacy, the College of Literature, Science, and the Arts, and the Graduate School. This was done because it could be foreseen that work in public health and administration would be closely related to the health-medical professions and to social and public welfare services. Co-operation also made it unnecessary at that time for the University to equip and operate additional science laboratories.
The co-operation of the Michigan State Health Department and of other state health agencies was invaluable. Students in public health laboratory methods, for example, have worked at Lansing in the laboratories of the State Department of Health, and those taking the venereal disease control program have studied special laboratory methods in the clinical laboratories of the University Hospital. Those studying epidemiology and acute syphilis have completed part of their work in Detroit Page 1156under the auspices of the Detroit Department of Health.
In 1936-37, because of the Federal Social Security Act and the designation of the Division of Hygiene and Public Health by the United States Public Health Service as a training center for public health personnel, the Division began to receive federal funds amounting to $22,500 annually. This has been supplemented by $3,000 a year for a program of study in venereal disease control.
In the development of its professional programs the Division aimed (1) to engraft professional public health education to those educational disciplines or channels in the University through and from which come the professional public health students and the basic materials (sciences) of public health work and public health education; (2) to emphasize the concept of unity of public health work and administration — bringing out the position and role played by each of the special fields of public health in making up the whole — and their interrelationships, also the relation of public health administration to other agencies concerned with public and social services; (3) to make direct preparation for the effective practice of public health the primal objective of the curriculums; (4) to foster a genuine professional spirit; and (5) to give due consideration to the costs of this education, and, when possible, to avoid unnecessary duplication of expensive laboratories and equipment.
In 1921-22 there were three graduate public health students and seventeen nurses in the public health nursing curriculum, and three graduate public health degrees were granted. In 1939-40 there were 338 professional public health students — 181 graduate students, 146 public health nurses, and eleven special students. In 1921-22, in the five courses offered, including professional and general courses, the enrollment was 400. In the fifty-three courses offered in 1939-40 the total enrollment was 4,004. In 1921-22 there were two staff members, in 1939-40 there were eighteen.
In addition to persons already referred to in connection with various interests of the Division, the following deserve mention: Nathan Sinai (M.S.P.H. '24, D.P.H. '26), Allan J. McLaughlin (London Collegiate Institute '88, M.D. Detroit College of Medicine '96), Herman H. Riecker (Marietta College '17, M.D. Johns Hopkins '23), Mabel E. Rugen (Wisconsin '25, Ph.D. New York University '31), Leon A. Fox (M.D. University of Cincinnati '12, M.S. American University '31, Ph.D. ibid. '32, D.P.H. Johns Hopkins '35), Marguerite F. Hall (Oberlin '14, Ph.D. Michigan '34), Harry Edgar Miller, Sr. (B.C.E. '16, M.S.P.H. '44), Lloyd R. Gates ('28, M.S.P.H., '29, D.P.H. '32, '47e), Catherine F. Mackinnon (Montana '24, M.S. Michigan '36), Lavinia G. MacKaye ('17, M.D. '31, M.S.P.H. '41), Hazel G. Herringshaw (B.S. '31, A.M. '38), Claire E. Healey (Mt. Holyoke '17, M.D. Rush '31).
Nonresident lecturers in 1939-40 came from the Institute of Public and Social Administration, the Detroit Department of Health, the Detroit Visiting Nurse Association, the Children's Fund of Michigan, the Michigan Tuberculosis Association, and the State Department of Health. For several years a special lecture each week at a public health assembly has been given by some man outstanding for his work in public health or in fields related to public health.
In addition to extension work and instruction offered each summer, during the year the Division has held short conferences and institutes. A Public Health Review published by the Division each month from October to June, has had a wide circulation.