THE DEPARTMENT OF SURGERY
WE have the word of Dr. Corydon L. Ford for the fact that the first Professor of Surgery in the Medical School, Moses Gunn, foresaw the establishment of the Medical Department in the University and hurried to Ann Arbor on the day following his graduation from Geneva College in 1846 to be available for appointment. It is also stated, without substantiation, however, that he brought a cadaver with him in a trunk from Geneva, New York, by stagecoach through Canada and used this anatomical material for teaching anatomy and surgery, obviously in an extramural fashion, as soon as he arrived in Ann Arbor.
Moses Gunn (M.D. Geneva Medical College [N. Y.] '46, A.M. ibid. '56, LL.D. Chicago '67) was born in East Bloomfield, New York, in 1822. After completing his early education in the local academy he spent some years in the office of Dr. Edson Carr in Canandaigua studying medicine. In 1844, at the age of twenty-two, he enrolled as a member of the medical class in Geneva College, where he became an assistant in anatomy to Corydon L. Ford, his roommate and later his associate on the Michigan medical faculty. After coming to Ann Arbor, he seems to have established a busy general practice, especially among the Germans, for he could speak that language. He described the long, arduous drives through the country on poor dirt roads while making his calls, but he did not mention any teaching activities prior to his connection with the University (Jane Gunn, Memorial Sketches, pp. 23-60).
Abram Sager and Silas Hamilton Douglass were the first members of the medical faculty. They were appointed in 1848, and in July, 1849, Moses Gunn was appointed Professor of Anatomy, with the understanding that he would teach surgery as well. The Department of Medicine and Surgery did not open its doors to students, however, until October, 1850, the first class having the surprising number of ninety-one students. Before the school opened Gunn spent several months in New York, Philadelphia, and Boston preparing for his new duties. When it was decided to separate the chairs of anatomy and Page 939surgery in 1854 Gunn became Professor of Surgery, and his friend of Geneva days, Corydon L. Ford, was made Professor of Anatomy, undoubtedly at Gunn's suggestion.
Aside from the weekly clinical class, at which patients might present themselves for free treatment by the professor, on condition that students be permitted to witness it, the teaching of surgery was at first entirely didactic, and Moses Gunn is said to have been a forceful, enthusiastic lecturer and an outstanding teacher. Well-groomed, dignified and handsome, full of energy and self-confidence, he was a distinguished mentor held in high regard by pupils and the medical profession. In 1853 he moved to Detroit, where he maintained a general practice, coming to Ann Arbor twice a week to deliver his lectures on surgery. In September, 1861, he joined the Army of the Potomac as surgeon to the Fifth Michigan Regiment. A three-week leave enabled him, apparently, to give his fifty lectures and return to the army. He was with McClellan's army in the Peninsular campaign and in July cared for the wounded at Gettysburg. Exposure and overwork brought about his return to Detroit, and there he remained until 1867, when he resigned to take the chair of surgery in Rush Medical College.
The contributions he made to surgery and medical science while he was in Ann Arbor were more personal than scientific. As a coeditor of the Medical Independent and its successor, the Peninsular and Independent Medical Fournal, he made numerous case reports, but his sole original work was a study of the mechanism of dislocation of the hip, carried out on the cadaver. This work remained his chief surgical hobby, and he insisted on the correct surgical principle of intelligent, gentle manipulation for reduction of the dislocated hip as opposed to the crude, forcible traction used by his surgical predecessors. Gunn's greatest contribution to medicine was his teaching. By his insistence that medicine should be treated as a science he aided in raising the standard of medical education and practice.
After Gunn's resignation, William Warren Greene ('55m), of Boston, was appointed Professor of Civil and Military Surgery in 1867, but he served for only a year. He was succeeded by Henry Francis Lehunte Lyster ('58, '60m, A.M. '61). Dr. Lyster also served for only one year, since he did not feel that he could give up a good practice in Detroit to reside in Ann Arbor, as was necessitated by a new ruling of the Board of Regents, but he returned some time later and for two years had charge of the Department of the Theory and Practice of Medicine.
Alpheus Benning Crosby (Dartmouth '53, A.M. and M.D. ibid. '56), whose father, Dr. Dixi Crosby, at one time held the professorship of surgery at Dartmouth College, followed Lyster, first as Lecturer on Surgery in 1869 and the next year as Professor. Crosby had previously taught surgery at the University of Vermont and had become an intimate friend of its president, James B. Angell, whose correspondence with him concerning the Regents' offer of the Michigan presidency to Angell was amusing and instructive (Vermont to Michigan, pp. 167-68, 216-19). Though Angell decided to accept the Michigan offer, Crosby resigned his Michigan post in 1871 to take the chair of surgery at Dartmouth made vacant by the retirement of his father. Dr. Crosby died at the age of forty-five, with the reputation of being one of the best teachers and surgeons of his years in the country.
Dr. Reuben Peterson, in his account of University Hospital, recorded a legend concerning Dr. Crosby, who is said to Page 940have asked the faculty to reduce his lecture and quiz hours, for he felt he could use his and the students' time more profitably. This was rank heresy, according to Peterson, and the request was refused, whereupon Crosby promptly resigned. The Regents obviously felt that the way to teach medicine was almost entirely by the spoken word, and many years were to elapse before a more well-rounded system became firmly established. During his incumbency, Crosby, as a member of the faculty committee on the Hospital, signed the first annual report of the Hospital to the Regents.
Theodore Andrews McGraw ('59, M.D. Columbia '63, LL.D. Michigan '05), of Detroit, followed Crosby as Lecturer in Surgery. His work in the little Chemical Laboratory in the University had turned his interest toward scientific studies, and this interest led him eventually to complete his medical education at the University of Bonn. After a period of service as assistant surgeon in the Civil War he returned to Detroit and helped found the Detroit College of Medicine in 1869. The inadequacy of hospital facilities in the University led to his withdrawal from the faculty when he had delivered but one course of lectures. His subsequent career was highly distinguished, and he became a national figure because of his pioneer work in abdominal surgery, particularly intestinal anastomosis. An address which he delivered before the section of surgery and anatomy of the American Medical Association in 1891, concerning the use of the elastic ligature in the surgery of the intestines, gave him an international reputation. His success in teaching is attested by the large number of able men who obtained from him their early training and their enthusiasm for surgery, and by the almost idolatrous worship they had for him. He always advocated longer and more careful training for surgeons and condemned the attempt to operate without sufficient training and education. He died in Detroit in 1921 at the age of eighty-two.
The succession of short tenures in the chair of surgery ended with the calling of Donald Maclean (M.D. and C.M. Edinburgh '62), one of the most notable personalities and teachers to serve the University in this position. He was born at Seymour, Canada, in 1839. His education was varied; after attending Oliphant's School in Edinburgh, Scotland, from 1845 to 1851, he completed his precollege education in Canada. He entered Queen's University at Kingston, Ontario, in 1855, but left two years later to take up his residence at Edinburgh University Medical College. There he was, for a period, assistant to Syme, then one of the world's renowned surgeons, and he became acquainted with Lister and his work.
On his return to America in 1863, Maclean entered the Union Army as assistant surgeon and served creditably until 1864, when he was called to the chair of clinical surgery of the Royal College of Physicians and Surgeons at Queen's College, Ontario — a position which he left five years later because of ill-health. After maintaining a private practice in Kingston for a few years he accepted appointment as Lecturer on Surgery at the University of Michigan in 1872. In the following year, when he was but thirty-four years old, he was promoted to the professorship of surgery.
He was a man of spare build and average height, with sandy hair, blue eyes, rapid movement, and a kindly and magnetic personality. His manner was, however, markedly fluid and volatile and made him staunch friends of some and bitter enemies of others. He had no sympathy for quackery. His antipathy for homeopathic medicine, which was gaining marked headway in Michigan, as in Page 941other sections of the country, was so violent that when that system was recognized by the University and a homeopathic school was established, the altercations in University faculty meetings were in part not printable. Even though Maclean did not live to see the downfall of the homeopathic system, the fact that it is no longer taught in the University is a tribute to his foresight.
Dr. William J. Mayo, a student of Maclean's at Michigan, said:
Maclean was in the prime of life, vigorous, not a fluent speaker, but a forceful one, and one of the best surgeons of his generation and day. He was a fine diagnostician and a courageous, skillful, and conscientious operator.
In my Junior year at Ann Arbor, Maclean was trying out the merit of the carbolic acid spray which Lister had introduced to prevent surgical infection. From it he developed a toxic absorption of carbolic acid, with bloody urine and related manifestations, as a result of which he was confined to his bed for several weeks. Thereafter, the carbolic acid spray was discontinued, but he was always cleanly in his work, and one could see that he had early Listerean principles in mind. …As I progressed in surgery after leaving Ann Arbor, and attending schools and clinics both at home and abroad, I realized more and more fully that Maclean was an outstanding surgical teacher.
(Letter, Jan. 19, 1937, to Dr. Frederick A. Coller.)
Maclean was not an investigator, and his numerous publications were clinical observations only. However, at the author's request, he brought out an American edition of Syme's Surgery (1866) which was well received in this country.
After serving the University for seventeen years he attempted to have the clinical departments of the Medical Department moved to Detroit. When this proved unsuccessful, he resigned to begin the practice of surgery in that city. For twenty years he was surgeon-in-chief for the Michigan Central and the Grand Trunk railroads. During this period he hastened the evolution of the Michigan State Medical Society from a mere convention with political methods into a society for mutual instruction and scientific betterment. At the outbreak of the war with Spain, he again entered military service and for the war's duration was stationed at Old Point Comfort, Virginia, as surgeon in the United States Army.
Maclean's real worth to the school and to the medical profession may be summed up in the words of W. J. Mayo:
I have always been very happy that I had the privilege of attending the University of Michigan, and I cherish the memories of my association with the men of the faculty. Especially do I recall with gratitude and affection Donald Maclean, who stimulated and sustained my enthusiasm and love for the science and art of surgery.
(Letter, Jan. 19, 1937, to Dr. Frederick A. Coller.)
Maclean was followed by Charles Beylard Guérard De Nancrède (M.D. Pennsylvania '69, M.D. Jefferson Medical College '83, A.B. hon. Pennsylvania '92 [as of the class of 1868], A.M. hon. Michigan '93, LL.D. Michigan '19). De Nancrède was born in Philadelphia in 1847. His grandfather first came to this country as a lieutenant in the French Army under Rochambeau. He went back to France, but returned to this continent in 1785. Because of the intense republican feeling at that time, he dropped the "de" from his name, but it was restored by his grandson about 1905, when the University Calendar first gave the name of Charles De Nancrède.
His early life was spent in a cultured home, and his early education, fundamentally classical, was acquired in private schools in Philadelphia. He attended Page 942a military academy and, after two years in a general arts and science course at the University of Pennsylvania, entered upon the study of medicine. He began his teaching career while he was a student in the Medical Department of the University of Pennsylvania, as an assistant in physiology in the University and also in the Philadelphia Dental College. After a year's internship in the Protestant Episcopal Hospital of Philadelphia, he began general practice in that city, but soon entertained a decided preference for surgery. Because of his interest in teaching and the added prestige associated with an academic position, he served as assistant demonstrator of anatomy at his alma mater for more than a decade after 1871, and later as a lecturer on regional anatomy and demonstrator of osteosyndesmology, a position he held until his call to Michigan in 1889.
He was the first surgeon in Philadelphia to operate upon patients with bullet wounds of the stomach and intestines: his results were good considering the handicaps under which he worked. He also pioneered by attempting to treat cortical epilepsy and cortical abscesses surgically and was one of the first in that city to remove appendices for "inflammation of the bowel."
In addition to being affiliated with the University of Pennsylvania, he acted as attending surgeon at the Episcopal Hospital and as surgeon and clinical lecturer on rectal surgery at Jefferson Medical College Hospital, and as attending surgeon at Saint Christopher's Hospital for Crippled Children. For the year 1871-72 he was chief of the clinic in one of the eye and ear services at the University of Pennsylvania. In 1883 he was appointed surgeon at the Philadelphia Polyclinic, where he later was made an emeritus professor of general and orthopedic surgery.
De Nancrède was called to the chair of surgery at the University of Michigan in 1889. At that time he was a man of forty-two years, described by contemporaries (Mich. Alum., 27 : 572) as being spare in build, jauntily erect in carriage, nervously quick in movement, meticulously dressed, and overconscious of his own rights and dignities, and therefore inclined to take quick offense at even fancied slights. These qualities were evident in his teaching. His lectures consisted largely of the reiteration of personal experiences, the reading of his work, Lectures on the Principles of Surgery, and tirades against certain surgical practices of the time. He firmly believed that inflammation and infection were the same. He championed antiseptic surgery during the early years of the Listerian era, yet, contrary to his usual resistance to policy changes, quickly accepted the tenets of aseptic surgery when they were established.
As a physician, he was gentlemanly, hypersensitive, highly egocentric, hypersolicitous, and very cautious and conservative in applying surgery, as compared with other surgeons of his time. As a surgeon, he was very careful and meticulous, and he had a fine flair for showmanship when being watched from the gallery. An excellent diagnostician, he opposed the then common dangerous practice of exploratory laparotomy as a diagnostic measure, a practice which had come into vogue as soon as it was realized that the abdomen could be relatively safely opened under aseptic precautions.
He was not particularly interested in research. His investigations in a lifetime were meager; they consisted of a minor study of the nature of the gastric juice of the dog and studies of inflammation, the sterilization of catheters, the effects of missiles, and the effects of blood-letting. He made no attempt to use or fit the surgical laboratory as a center for purely Page 943scientific investigations; for him it was only a clinical adjunct. Of his voluminous clinical writings many were published in various surgical systems and cyclopedias, but added little to the fund of modern medical knowledge. His two books, The Essentials of Anatomy (1887) and Lectures on the Principles of Surgery (1889 and 1905), enjoyed only local usage. He was, however, a master at organization. When he accepted the chair of surgery at the University, the Hospital facilities were of the meanest sort, as viewed by modern eyes. Only makeshift frame barracks, without an operating room, instruments, or nurses, were available. Plans for a new hospital had been made, however, and late in 1891 the building later known as West Hospital was completed. This building was well planned and well appointed for the time. The nursing school was organized in 1892. With these improvements, De Nancrède set up an efficient department, which, besides affording much better care to patients, provided more adequate training of students.
His career paralleled that of Dr. Alpheus Crosby in that they held the chairs of surgery at Dartmouth and at the University of Michigan simultaneously, the necessary lectures in New Hampshire being given during the summer months, when the Medical Department of the University of Michigan was not in session. De Nancrède held the professorship of surgery at Dartmouth from 1900 until 1913, when he was appointed to an emeritus professorship in that institution.
In 1904 De Nancrède's title was lengthened to indicate his directorship of the surgical clinic. His teaching career at the University of Michigan ended with his appointment as Emeritus Professor of Surgery in 1917. The scholastic honors conferred upon him by the schools in which he taught gave proof of the excellent quality of his work. He was active in both local and national medical societies and served as president of the American Surgical Association in 1908. During the war with Spain he saw duty in Cuba as a chief surgeon, United States Army major, 1898, and was later recommended for the rank of brevet lieutenant colonel.
Records of De Nancrède's family life are sketchy. He married Alice Howard Dunnington, of Baltimore, in 1872, and nine children were born, of whom five survived. His outside interests included music, sketching, and athletics. It is said that the women of De Nancrède's family did more to popularize athletics at the University than did all of the student body and the faculty. As the first faculty women regularly to attend athletic events they made themselves interesting subjects for gossip. In time, however, attendance at student contests lost its social stigma.
One of his greatest disappointments came in 1917, when he hoped to have an active role in the United States Army during World War I; this was not to be. He was nevertheless appointed major in the Reserve Officers Training Corps in April, 1917, which somewhat softened the blow to his pride. His last years were relatively inactive. He died in Detroit in 1921, leaving, as do most physicians, little tangible evidence of the great service he had rendered to humanity.
Because of the chaotic events coincident with our participation in World War I, no outstanding figure could be found immediately to fill the vacancy made by De Nancrède's retirement. Cyrenus Garritt Darling ('81m), then Professor of Clinical Oral Surgery in the College of Dental Surgery and Professor of Surgery in the Medical School, was put in charge of the department, but, according to unwritten report, the appointment, when made, was understood Page 944to be effective only until an individual of national reputation could be found.
Dr. Darling was born in Bethel, New York, in 1856. He attended the public schools of Bethel and an academy at Monticello, New York. After several years of private practice he returned to the Medical Department and served as an assistant to the chair of surgery from 1889 until 1892, when he was appointed Demonstrator of Surgery. Though he reentered private practice in the early nineties and also was engaged in community affairs, serving as mayor in 1895, he continued to teach in the University for many years, not only in the Medical Department, but also in the Dental College. His membership in the dental faculty, begun with his appointment as Lecturer of Oral Pathology and Oral Surgery in 1892, continued until his retirement in 1926. He was promoted to the professorship of clinical oral surgery in the College of Dental Surgery in 1905, and from 1903 to 1907 was Acting Dean. In the Medical Department he was Lecturer on Minor Surgery from 1896 to 1906 and Lecturer on Genitourinary Surgery from 1899 until, in 1906, this subject was assigned to Dr. Ira Dean Loree ('01m), who for the past three years had been an assistant in the department. Darling was Clinical Professor of Surgery from 1905 to 1914 and dropped the last of his previous minor positions in the department in 1907 (Medical School Announcement, 1906-8). His success in surgical correction of cleftpalate and hare-lip cases was commended in the Report of the University Hospital for 1908, in which the Hospital superintendent drew attention to the University's facilities for teaching the combined skills of dentistry and surgery for relieving complicated fractures of the jaw and facial bones as well as oral deformities.
Darling was selected to serve as temporary head of the Department of Surgery in 1912, during De Nancrède's absence on leave. In 1914 he was made full Professor of Surgery in the Medical Department and at about the same time became Professor of Oral Surgery in the College of Dental Surgery.
All of Darling's professional life was spent in Ann Arbor. He contributed little to medical literature; his main concern was his own practice. As a surgeon he was competent but not brilliant, and his diagnostic abilities, though outstanding, left very little impression on his contemporaries. He had no great interest in teaching, although his sincerity and operative skill impressed his students over many years. He was idolized by his few personal assistants, but his strong individualistic ideas kept him from contact with world progress in surgery and made him a strong local rather than a national figure. He was the product of his time — a great individualist with the provincialism of the clinical groups, then overshadowed by the preclinical departments, and constantly on the defensive but lacking the material or the support with which to fight. He had the respect of all and, in the light of his times, accomplished much as a person, for which he received much local acclaim. His personality was rather strong. Occasionally, patients whom he treated return to the clinic, and their first inquiry is frequently concerning Dr. Darling.
During his administration no changes were made in the organization or teaching practices of the department. He resigned from the medical faculty at the time of the appointment of his successor in 1919. A member and past president of the Michigan State Medical Association and a member of the Washtenaw County Medical Society and of the Ann Arbor Medical Club, he was preoccupied with surgery alone; as far as is known, except for temporary participation in local politics Page 945he had few outside pursuits. He died at Ann Arbor, April 21, 1933.
Darling was succeeded by Hugh Cabot (Harvard '94, M.D. ibid. '98, LL.D. Queen's University [Belfast] '25), a man in part responsible for the present notable reputation held by the Department of Surgery. Born in 1872 at Beverly Farms, Massachusetts, to James Elliot and Elizabeth (Dwight) Cabot, Hugh Cabot enjoyed the benefits of an environment which was conducive to the full development of the individual's innate capabilities. In 1900, two years after his graduation from the Harvard Medical School, he was appointed surgeon at the Baptist Hospital in Boston, a position which he held for nineteen years. He became an assistant surgeon at the Massachusetts General Hospital in 1902 and shortly thereafter, surgeon, and served in that capacity until 1919. He also served at Harvard, first as an assistant professor of surgery for eight years and later, in 1919, as a clinical professor of surgery; between 1916 and 1919 he held a commission of honorary lieutenant colonel in the Royal Army Medical Corps.
He came to the University of Michigan with a greater previous experience than that of any of his predecessors, and his philosophy concerning educational methods embodied many advanced ideas only now being generally applied. He was a good surgeon, but lacked interest in technique. In his specialty, urology, he was widely known and respected. Because of his great analytic ability, his associates considered him an unusually skilled diagnostician. His relation to the Hospital patients was not intimate, yet those who knew him never forgot him. He believed in calling a spade a spade, and his candor and sincerity, often expressed in homely simile, set a precedent which still influences the relations of staff and patients. He greatly admired directness and efficiency, and his aggressiveness and seeming lack of tact made many enemies of erstwhile admirers. His lectures to the students were excellent. His use of double negatives and of simple, earthy figures of speech and allegories served admirably to emphasize certain points and made his discourses vivid and interesting.
His greatest attribute, a keen judgment of men, is probably responsible for the imprint he left on the Medical School. Shortly after his arrival he surrounded himself with unknown young men who, he felt, had great capabilities, and these men and their assistants have given the present Department of Surgery an enviable national and international reputation. Furthermore, they are at present in the most productive phase of their careers, and their active influence will probably be felt for years to come. During the period of his service to the University, the new Hospital was constructed and occupied. One of the tasks which he admirably performed was the reorganization of the Department of Surgery. He believed that the organization should serve three purposes — the care of the ill, the teaching of students and interns, and original investigation. As he considered the first two of greater importance, the third was in great part neglected, and although a fairly large number of clinical observations by staff members were published during his administration, these contained no fundamental contributions to medical science.
His ideas concerning the requirements for entrance to a medical school differed somewhat from those prevailing at the University, and when he was appointed Dean of the Medical School in 1921 he strove to have his ideas adopted. They were tried, but later were thought to be inferior to the system previously used. At present it seems that, could a compromise have been possible, the more desirable Page 946features of his plan of requirements might have been retained.
It was Cabot's opinion that the part-time medical professor was often forced to slight his teaching assignments because of the press of private practice, and he considered it imperative for the good of the students and of the Hospital that the chairs be held by full-time professors. The inability of the commonwealth to provide adequate salaries to compensate for the loss of income from private practice made it impossible to keep men of the desired caliber on the full-time basis, however, and this program was therefore discarded, even though everyone now considers the fundamental principle sound.
In 1930, after eleven years of active service to the University, Cabot resigned. Shortly thereafter he was appointed surgeon at the Mayo clinic and professor of surgery in the Graduate School of the University of Minnesota.
Frederick Amasa Coller (B.S. and Ph.G. South Dakota State College '06, M.S. ibid. '08, M.D. Harvard '12) left private practice in Los Angeles to come to the University of Michigan in 1920 as Assistant Professor of Surgery while Cabot held the chair. Coller was born in Brookings, South Dakota, in 1887. He attended the public schools of Brookings and the South Dakota State College, where, in addition to completing the regular collegiate science course, he did advanced work in biochemistry. He was an intern at the Massachusetts General Hospital from 1912 to 1914 and resident surgeon during the year 1914-15. After completing his formal training, he entered the Harvard unit of the American Ambulance Corps and saw service overseas with the Royal Army Medical Corps of the British Expeditionary Force in 1915 and 1916. With the entry of the United States into the war he was commissioned a captain in the Medical Corps of the United States Army and in 1917 was promoted to major, a commission which he held on discharge.
Having come to the University as an Assistant Professor, he was successively advanced; he became Professor of Surgery in 1926 and after Cabot's resignation was asked to assume his present position as Chairman of the Department of Surgery.
Development of specialization. — By 1900 the techniques of modern surgery were formulated, and with ever-increasing speed the new science was applied to the old art. The scope of surgery became too inclusive for any one individual to comprehend, and through the limitation of endeavor, specialization developed. De Nancrède had a catholicity of interest; he carried out operations on the eye, on abdominal organs, and on bones and joints — in fact, on every part and system of the body. Ophthalmology and otolaryngology were the first subdivisions of surgery in which special courses were developed, and even before Maclean's administration these were entrusted to a separate department, which was divided in 1904. Genitourinary surgery next received special consideration within the department, first under the charge of Dr. Darling from 1899 to 1906 and then under the charge of Dr. Loree. De Nancrède and Darling were interested in the acute and chronic lesions of bones and joints, and eventually most of the work now classified as orthopedics was given to the supervision of Charles Lee Washburne ('08m), under whose charge an active organization devoted to this specialty was developed within the department. The fields of specialization have never been sharply circumscribed, but have been developed in accordance with the bent and energy of individuals. Darling, closely affiliated as he was with the school known until 1927 as the College of Dental Surgery, stimulated and Page 947gave opportunity to Chalmers John Lyons ('98d, D.D.Sc. '11) in the field of oral and faciomaxillary surgery, and the teaching of these subjects has remained a part of the work of the professor of oral surgery in the School of Dentistry.
Neurological surgery was conducted by the general surgeons until 1916, when it was assigned to Max Minor Peet ('08, A.M. '10, '10m, M.Ed. hon. Michigan State Normal College '34). Dr. Peet had interned in the Rhode Island General Hospital and had later served in the University of Pennsylvania Hospital as an assistant to Dr. Charles Frazer, one of the pioneer neurological surgeons of this country. He spent three years there in study and investigation and then returned to his alma mater to become a member of the staff. As the opportunities for work in his special field increased, he limited himself to it more and more, until, in 1925, the section of neurological surgery was formed; thereafter he devoted his entire attention to this specialty.
In 1930 Edgar Adolph Kahn (B.S. Med. '24, '24m) joined him in this work, and under the stimulus of their accomplishments the types of disease treated and the number of patients have steadily increased until the University section of neurological surgery is one of the most active of such units in the country. From Dr. Peet* and Dr. Kahn and their associates have come many original contributions, the most notable of which have been studies on hypertension, on surgical methods for the abolition of pain, and on the treatment of brain abscess and of subdural hematoma.
Dr. Cabot was primarily interested in genitourinary surgery, being an outstanding authority in that field as well as in general surgery and medical education. He continued and developed this specialty during his years with the Medical School, and the achievements of the section of the Department of Surgery devoted to it received national recognition. Reed Miller Nesbit (Stanford '21, M.D. ibid. '24) came to the department as an assistant resident in 1925. After training for five years in general surgery he became associated with Cabot, and upon Cabot's departure in 1930 he assumed charge of this subdepartment. Through Nesbit's energy, skill in organization, and abiding interest, the section in genitourinary surgery has grown in importance and usefulness. Among the outstanding contributions to the knowledge of urology made by him and his associates are significant studies concerning the surgical treatment of prostatism, anesthesia in this branch of surgery, cystometry, the relation of urology to endocrinology, and problems of renal and bladder functions. Nesbit's insistence upon long, fundamental training of his students and associates before their entering on specialization has been influential in the firm establishment of this branch of surgery.
As mentioned, an organization for instruction in bone and joint surgery was built up within the department by Dr. Washburne. He began this work in 1911, when orthopedics was introduced into the course on special surgery. He resigned in 1920 to take up private practice, and LeRoy Charles Abbott (M.D. California '14), an appointee of Cabot's, undertook the supervision of the section in orthopedic surgery. Dr. Abbott had served as intern in the University of California Hospital and later had taken special training in orthopedic surgery at the Massachusetts General Hospital. Upon the entrance of the United States into the war he became a consultant in orthopedic surgery. He served actively with the American Expeditionary Forces in France and England and after the termination of hostilities spent a year of Page 948further study with Sir Harold Stiles in the University of Edinburgh. Under his energetic leadership the scope and size of the bone and joint section and its importance as a teaching unit rapidly increased. Student interest was aroused, and many young men who, stimulated by the accomplishments of Abbott and his predecessors, entered this field of surgery have made important additions to the knowledge concerning it. When the Shrine hospitals for crippled children were developed, in 1923, Abbott accepted the post of chief surgeon to the Mother Shrine Hospital in St. Louis. He was succeeded at the University by Carl Egbert Badgley ('17, '19m), whose professional skill and alert and progressive attitude brought about not only the continued growth of the orthopedic section, but also a marked increase in its importance as a successful clinic and educational center. In the late twenties the state-wide interest in the problem of the crippled child threw a great responsibility on the orthopedic section, which has now become one of the largest and most important units of its kind in the United States. Badgley resigned in 1929 to take charge of orthopedics in the Henry Ford Hospital in Detroit, and for the next three years the subdepartment was under the charge of Vernon Lewis Hart ('24m), associated with Mr. Norman Leslie Capener (F.R.C.S. '22), who was graduated from Saint Bartholomew's in London and was trained in surgery at Michigan also. Badgley returned to reassume charge of the bone and joint section in 1932, and, by enthusiasm and skill, he has developed the staff in this specialty into a mature group with fine traditions and of the widest usefulness.
The subdivision most recently formed within the department is the section of thoracic surgery, the newest surgical specialty. Over a long period, such operations on the chest as the drainage of empyema and the drainage of lung abscess had occasionally been performed in the University Hospital. Conrad Georg ('96, '99m), when a teaching member of the department, had carried on experimental investigations on problems of thoracic surgery, but after he left the University for private practice no more studies of this character were made.
John Alexander (Pennsylvania '12, A.M. ibid. '13, M.D. ibid. '16, Sc.D. hon. ibid. '40) came to the department in 1920, at the invitation of Dr. Cabot, with the assignment to develop a clinic in thoracic surgery. During the four years since his graduation from the University of Pennsylvania Medical School he had been a member of the surgical and teaching staff of that school. For some years the clinical material was scanty, and Alexander had an opportunity to investigate, study, and clarify the problems of thoracic surgery. The publication of his book, The Surgery of Pulmonary Tuberculosis, in 1925 greatly stimulated interest in the subject in this country and abroad. In January, 1927, the first thoracoplasty for tuberculosis in the state was performed in the University Hospital. The number of patients referred to the Hospital for treatment of surgical diseases of the chest steadily increased, and therefore, in 1928, Alexander limited his work entirely to thoracic surgery. He was probably the first surgeon to confine his efforts to this field. The clinic developed to such an extent that in 1931 it was found advisable to augment the staff, and Cameron Haight (California '23, M.D. Harvard '26) joined the faculty to work with this section. Haight had served an internship in the Peter Bent Brigham Hospital in Boston and also, for three years, had been on the staff of the surgical department of Yale Medical School.
In 1927 an arrangement between the University and the Michigan State Sanatorium at Howell was effected, through Page 949which the thoracic surgery staff members became consultants to the Sanatorium, and two floors added to the Hospital in 1930 and 1931 for the care of patients with pulmonary tuberculosis provided excellent clinical facilities. The influence of Alexander and his associates on the development of this specialty has been extremely important in surgical circles throughout the world. These men have been pioneers in all phases of thoracic surgery, Haight having performed the first pneumonectomy in the Western Hemisphere and the second in the world, and many of their graduate students are now leaders in this subject in various parts of the country.
With the development of special fields in surgery, justifiable because of the opportunity thus afforded to advance knowledge by intensive study of limited objectives, the activities of the so-called general surgeon also became circumscribed. The field remained a large one, nevertheless, and with the increase in the amount of clinical material it became necessary to divide this service into two sections. In 1930 Henry King Ransom ('20, '23m, M.S. '34) and Eugene Breckenridge Potter ('25m) were given charge of these, the "red" and the "blue" services.
After his graduation in 1923, Ransom's professional training at Michigan was continued by an internship and an assistant residency in the department. He held a National Research Council fellowship for a year and then took graduate work in Johns Hopkins University. Returning to the department, he advanced through the residency and an instructorship and was made Associate Professor of Surgery in 1933.
Dr. Potter also continued in the department after his graduation, eventually becoming Associate Professor of Surgery. In 1936 he left to become chief surgeon to the Virginia Mason Hospital and Clinic in Seattle, Washington, an important and enviable post. His place was taken by Walter Grierson Maddock ('24, 27m, M.S. '34), who in 1940, at the close of the period here recorded, was Associate Professor of Surgery. As undergraduate instruction in surgery should be largely confined to the fundamentals of the subject, which are still in the province of the general surgeon, the teaching load of this part of the department is by long odds the heaviest one. To many men who have held the positions of resident and instructor, the department is indebted for sustaining and carrying on undergraduate instruction.
Before 1920 the arts of surgery dominated surgical practice. Anatomy and pathology were traditionally the professional equipment of the surgeon. In recent decades it has been increasingly recognized that physiology, chemistry, and bacteriology are likewise of fundamental importance and that surgery can advance only if this concept is kept in mind.
From 1920 to 1930 the department grew at such a pace, with increasing clinical loads and with the development of true specialization and of new teaching methods, that investigation of surgical problems was carried on only in a fragmentary way. Since then, as the organization has become stabilized, it has been possible to maintain a program of more thorough research in the basic problems of surgery. Encouragement and financial aid from the Rackham Foundation have helped maintain laboratories for many important and practical studies, principally in the field of abnormal metabolic conditions of patients with diseases seen in the surgical wards. These studies are carried on by young surgeons, in succession, as part of their graduate training, but are supervised by the members of the permanent staff. The departmental publications have numbered about seventy a year since the introduction of this policy.
Graduate training. — Opportunities Page 950for advanced training in surgery and its specialties were available in the department throughout the administration of De Nancrède, and many of the advanced students of the department in his time are now outstanding in the profession. Under the stress of advancing medical opinion, both local and national, Cabot was enabled to mold the system of graduate training into modern form. The national boards of all surgical specialties set standards, and at an early date the departments of Otolaryngology, Ophthalmology, and Obstetrics and Gynecology met these demands by offering residencies leading to five years of sound training in these specialties. The Department of Surgery, by 1930, had likewise adopted a pyramidal system of graduate training in general surgery and in each surgical specialty leading to certification by a national board. Certain difficulties with relation to advanced training in the fundamental medical sciences demanded by these boards but only partly available with the present facilities have been encountered, and not all these difficulties have been overcome. In spite of this situation the graduate training now offered in surgery at the University is on a high plane when compared with that given at other similar training centers throughout the country, and the surgical staff is proud of the many men carrying on the highest type of training and practice in every part of the nation who have been trained in our graduate school of surgery. The department has been in the forefront in developing and formulating this new and important part of medical education.
The staff may now justifiably consider the development of the department in clinical surgery, in undergraduate teaching, in research, and in graduate teaching worthy of the high standards of the University of Michigan.
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