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

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

declining 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,

and 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.

Shortly 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,

the 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.

Frank N. Wilson