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

IN 1912, students and faculty members recommended that an organized medical service to students comparable to services at several other universities be established at the University of Michigan, Professors M. P. Tilley, L. A. Hopkins, and F. N. Menefee, Dr. C. L. Washburne, and Elizabeth Holt, R.N., taking especially active interest. Student petitions from the Union, the League, and the Druids probably hastened action. A unit for ambulatory patients was opened in the fall of 1913, under the direction of Dr. Howard Hastings Cummings ('10m), with a staff of two physicians, a nurse, and a clerk. A budget of $10,000 was provided. During the early years, a large administrative board was in control of what soon came to be known as the University Health Service. President Hutchins, Dean Vaughan, Dean Cooley, and Secretary Smith constituted the executive committee of the first board, with Mr. Benjamin Hanchett of the Board of Regents, chairman of the committee representing that body.

Attention was first directed to the sanitation of the campus, but care of student illnesses and efforts toward their prevention soon occupied all the time of the meager staff. Minor illnesses of students were cared for in the rooms of students, while the more critical conditions were provided for in the University Hospital. An addition of $2.00 annually was made to all tuitions and a small fee was collected for house calls. A converted residence located on the present site of the Burton Memorial Tower was the first University Health Service building. The meager professional staff required the assistance of senior medical students during the first few years.

In June, 1915, recognizing the inadequacy in building, personnel, and equipment, the Alumni Association urged an enlargement of the service. In October, 1917, an addition to the building was provided, services were extended, which included compulsory vaccination against smallpox, and upon resignation of Dr. Cummings, Dr. Warren Ellsworth Forsythe (Oregon Agricultural College '07, Michigan '08p, '13m, Dr.P.H. Johns Hopkins '25) became the head of the service. By 1919, a complete medical examination was required of all entering men students and six lectures on the more urgent health requisites were given for freshmen.

New quarters with infirmary beds. — The need for improved and extended service, including bed care, was becoming increasingly apparent. In 1921,

the Division of Hygiene and Public Health was created and the University Health Service was included therein. This Division was planned to bring under one administration all interests and activities concerned with the physical health and welfare of students, and was directed by John Sundwall (Chicago '03, Ph.D. ibid. '06, M.D. Johns Hopkins '12). The annex of the Homeopathic Hospital was assigned to the Health Service; this provided a modern forty-by-seventy-foot building of three stories, twenty beds, offices for clinic purposes, including X-ray, laboratory, and pharmacy. With the increasing demand for service, enlarged quarters, and bed-patient care, the staff was increased to six full-time and two half-time physicians, five nurses, one clerk, two stenographers, a pharmacist, and a laboratorian. Since about 1922, each new entering student has received the complete medical examination during registration week. Since 1935, this examination has included an X-ray film study of the heart and lungs, and defects found at this time have been carefully followed and corrected whenever possible.

Expansion and reorganization. — Because of the growing student population and the ever increasing demand for improved service, funds were appropriated in 1928 to provide for a larger staff, more space, and modern equipment. The ground floor of the old Homeopathic Hospital was allotted to the Health Service. This provided a waiting room, two offices, and extended facilities for physiotherapy with a full-time technician and, in accord with the general policy, it was supervised by the head of that department at the University Hospital. Modern X-ray equipment and facilities were installed, and four infirmary beds were added.

At about this time it became apparent that the extreme cost for a few individuals restricted the services to the student body as a whole. It was thought necessary, therefore, to reduce the provision for sixty days hospital service to thirty days.

The desirability of employing physicians on a full-time basis had become increasingly apparent. Accordingly, part-time attendants were gradually replaced by full-time practitioners, except in the more highly specialized fields. In order to maintain a closer relationship with students, a full-time physician was appointed as adviser to each entering class and continued in that relationship throughout the four-year period of the college course. This more intimate acquaintance has fostered the ideal patient-physician relationship. Similar services are rendered to women students by full-time women physicians, one of whom devotes part of her time to the duties of Director of Physical Education for Women — Margaret Bell (Chicago '15, M.D. Rush Medical College '21), who was appointed with these dual duties in 1923. The staff also obtained the valuable services of a general medical adviser, James Deacon Bruce (M.D. Detroit College of Medicine '96), who is now Vice-President in Charge of University Relations. In 1928, a staff surgeon assumed full-time duty with athletes and in the treatment of surgical conditions at the Health Service Building.

Mental hygiene. — Staff service in personality adjustment began in 1927, with a part-time worker and psychiatrist. Since 1930, a full-time psychiatrist, Dr. Theophile Raphael ('13, A.M. '15, '19m), has directed the unit, with two full-time and one part-time psychiatric workers and a secretary. A full-time neuropsychiatrist and another part-time social worker were added in 1935. This work includes, in addition to time-consuming interviews with students themselves, numerous contacts with faculty

members, administrative officers, friends, parents, and class medical advisers.

Allergy. — In 1928, a sensitization clinic which deals with the body's reaction to foreign proteins was established under the direction of a physician, on half-time service, with a clerical assistant. It has been necessary to secure a full-time physician, six assistants, and other clerical help. Intradermal tests are being made now by this unit at a small personal charge to the student, many desensitization treatments are given, and diets are arranged.

Health education. — The educational program includes six freshman lectures given by members of the staff, and health education is further promoted by the contact of students and physicians in their patient-physician relationship, and by the distribution of pamphlets on health topics in the waiting rooms. During their incumbency staff physicians are encouraged to avail themselves of educational opportunities in fields of special interest in the regular University program.

Sanitation. — From the beginning, campus sanitation has received attention by the Health Service. A part-time member inspects swimming pools, student eating places, and campus buildings. Proprietors are encouraged to adopt improved sanitary measures, without effort upon the part of the University to take over the authority of the city health officer. The deans of men and women are assisted with inspection of rooming houses, dormitories, sororities, and fraternities. The three University swimming pools have been regularly tested. The sanitarian acts as deputy health officer of the city.

Camps. — Since 1915, students in summer session camps of the University have had Health Service privileges. This has required the residence of staff physicians and, at times, nurses at two camps.

Dormitory nursing. — For several years registered nurses who were resident students in the dormitories for women have worked under the direction of Dr. Bell in the care of these students. This arrangement has proved to be valuable for all concerned.

In 1938, with a student population of 15,358 and a budget of $142,000, the total visits to the Health Service numbered 132,946. The staff consisted of about sixty regularly appointed members, including a dietitian, added in 1933. A small addition to the building provided five more offices and six additional beds. Every available square foot of building space was utilized to the utmost and much more was needed. Many ill students who required bed care and most major surgical cases were sent to the University Hospital. Some were hospitalized at private hospitals. In November, 1938, the twenty-fifth anniversary of the establishment of the Health Service was observed, at which time President Alexander G. Ruthven announced a PWA plan for a new, beautiful, and ample building for the department. The new building was occupied in April, 1940. It is one block north of the campus on Fletcher Avenue. It is fifty feet by two hundred feet in dimensions, including a short rear wing, and has four floors. The ground floor provides kitchen, dining-rooms, and other service and storage facilities. The first floor has general physicians' offices, nurses' treatment space, a pharmacy, a classroom, an entrance lobby, and an administrative section. The second floor provides for special services to ambulatory patients, and the third provides a sixty-bed infirmary divided into small rooms. The use of the building with its new equipment has shown it to be the most satisfactory for the present program and suitable for expansion of activities.

Almost constant additions to staff and

equipment have been made to keep up with demands and opportunities for service. Co-operation on the part of the members of the University Hospital and Medical School has from the beginning helped to make this very complete medical service available to students. Data have been collected upon which many reports have been given. More than forty papers dealing with these data have been published. These are of value in the study of many health questions in young adults. Many problems of research in this population have been recognized by staff members, but resources and energy have generally been so much absorbed by student illness that not much original invesigation could be fostered. Deaths have been much fewer than among nonstudents of the same age.

The University Health Service appears to be well recognized and established as a vital factor in student welfare at Michigan and is constantly improving its facilities for service.

Warren E. Forsythe