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

IN 1869, almost two decades after the establishment of the Department of Medicine and Surgery in the University, the first little hospital on the campus was authorized. The idea of utilizing hospitals as centers of clinical training had developed slowly in this country, although bedside hospital teaching was highly advanced in Europe, especially in Germany and in France.

A few medical schools, notably Yale, Harvard, and Virginia, arranged to have their students use the local hospitals for clinical study, but a report by Professor Cabell, of the University of Virginia, reprinted in the Peninsular Journal of Medicine, maintained that "the plan of making clinical instruction follow, instead of accompany, elementary teaching is so obviously the natural and effective plan, that all our better students adopt it in spite of the absurd attempts of the schools to impose upon them a different system" (R.P., 1837-64, p. 776).

The number of adequately equipped hospitals was small, and the difficulties of maintaining them in connection with medical schools seemed at that time insuperable. The schools themselves, for the most part small proprietary institutions scattered over the country, were very weak and depended almost entirely upon student fees for their support. Instruction was, therefore, almost entirely by lectures.

In the early years of the University of Michigan Medical School, then called the Department of Medicine and Surgery, the few patients who came for treatment to members of the medical faculty gave some semblance of the clinical instruction advertised in the Announcement. The main emphasis, however, was on didactic instruction; clinical instruction was in practice a negligible part of the program. The prevailing lecture system was considered the only acceptable method as far as work in the University was concerned. Although the desirability of actual bedside experience for the young physician was recognized, it was difficult to obtain such instruction except under the supervision of a preceptor — an established practitioner with whom the young doctor served an apprenticeship as assistant.

The Regents, not unmindful of the increasing public demand for a hospital, in March, 1861, asked the medical faculty to submit a plan for the conversion of one of the faculty residences on the campus into a hospital. The faculty, however, took no action, and the committee was discharged the following June. During the Civil War, because of the large number of wounded treated in Army hospitals, the public became more aware of the need for hospitals. The Regents in 1864 considered the establishment of a military hospital in Ann Arbor, but no action was taken in the matter, probably because the end of the war was in sight.

After 1865 a great increase in medical school enrollment in this country resulted in further agitation both for bedside hospital instruction and for expert care. In 1868 the medical faculty reported that even though there were no hospital facilities available, over three hundred patients, more than six times the number cared for in any previous year, had come to the University for consultation and help.

In 1868 Dr. A. B. Palmer, Professor of the Theory and Practice of Internal Medicine, headed a movement in the Page  954American Medical Association to obtain more clinical instruction in American medical schools. As a result of his efforts, as well as of the increasing community demand in Ann Arbor for a hospital, the faculty finally asked to be allowed to establish a hospital. The Regents authorized, in 1869, the use of the northeast professorial residence on the campus for that purpose, at a total expense of $582.18 for necessary changes. This building, which afforded room for about twenty beds, was a small two-story, stucco structure, with two rooms on each floor opening from either side of a central hall.

In the words of Dr. Victor C. Vaughan, this little hospital was "nothing more than a receiving home, in which patients brought in for the clinics could be kept before and after presentation to the class. There were no wards and no operating or dressing rooms, no place where students might receive bedside instruction" (Vaughan, A Doctor's Memories, pp. 197-98). While such a makeshift was not well adapted for hospital purposes, it was a significant beginning because it represented a most important landmark in the history of American medicine — the first instance of a university owning and controlling a hospital in connection with its own medical school. The University Hospital has remained entirely under the control of the Regents and of the Medical School and has provided teaching facilities under the most favorable conditions.

Before the opening of the University in the fall of 1869, Dr. Abram Sager, Dean of the Medical School, submitted a plan for the management of the new Hospital which indicated that the faculty proposed to utilize all of the patients who applied, rich and poor alike, as material for clinical study. This rule was changed later at the insistence of the medical profession of the state, so as to exclude as far as possible those able to pay a minimum fee for professional services. Nevertheless, until about 1920, all who entered the Hospital did so with the understanding that they were to be used, if necessary, for teaching purposes. The charge for maintenance was to be placed at the lowest rate consistent with the avoidance of actual loss. This was the basis of a long-standing argument among the Regents, who insisted that the Hospital be self-supporting, and the clinical faculty, who maintained that low hospital charges were necessary to furnish the maximum amount of teaching material.

The Campus Pavilion Hospital, 1876-91. — The original little campus residence Hospital, although inadequate, served its purpose by demonstrating that such an addition to the facilities of the school was both desirable and practicable. Efforts to secure a legislative appropriation for a larger hospital resulted in 1875 in a grant of $8,000 for an enlarged University Hospital, contingent upon a contribution of $4,000 from the city of Ann Arbor. Within a year the new Hospital was opened. It provided sixty beds and was widely heralded, although actually rather a sorry affair, judged by modern standards, consisting of two frame pavilions 114 feet long and 30 feet wide, which extended from the rear of the original little Hospital. Without a basement, poorly ventilated, originally without an operating room, it was typical of the era and was, in fact, designed to last only five years.

At first the Hospital had been kept open only six months of the year, but eventually special support from the legislature, first granted in 1877, permitted full-time operation. It was, however, closed for many summer periods during the succeeding two decades. In 1897 summer operation was made the condition of continuing legislative support for the Hospital.

Page  955The Regents directed in 1878 that one-fifth of the beds available be assigned to patients of the newly created Homeopathic faculty. This resulted in an increase in the total number of beds to about seventy. In 1879 an appropriation was made for converting another residence on the north side of the campus into a Homeopathic hospital. The University Hospital thus recovered all the ward space in the original pavilion building. At this time funds were granted for further expansion and for the building of an operating amphitheater and of a dining room and kitchen in connection with the matron's home. In 1881 an eye and ear ward was added — the first special ward to be erected as a separate building. The "older [or residence] portion of the Hospital [was] occupied by the Resident Physician, Matrons, and private rooms for very sick patients" (R.P., 1881-86, pp. 223-24).

This enlarged Hospital remained the center of clinical instruction of the Department of Medicine and Surgery until 1891, a period of fifteen years. It provided for the clinics which were gradually developing — in medicine under Dr. A. B. Palmer, in surgery under Dr. Donald Maclean, in obstetrics under Dr. Edward S. Dunster, and in the new field of eye and ear service under Dr. George E. Frothingham. After 1891 this old campus building was utilized for many years by the College of Dental Surgery before it was torn down to make room for the present Chemistry Building.

The Catherine Street Hospital, 1891-1925. — Throughout almost the entire life of the campus Pavilion Hospital, agitation continued for better hospital facilities. It was not until 1889, however, when the city of Ann Arbor once more came forward with a contribution of $25,000 to augment an appropriation of $50,000 by the legislature, that the construction of an entirely new hospital on Catherine Street was made possible. This building, completed in 1891, although a great improvement over the old Hospital, was designed before hospital architecture had become a specialty, and there were many architectural faults, corrected to a certain extent as additional buildings were added.

Eventually, the old Hospital group, as it is still called, comprised a congeries of some twenty buildings, large and small. Originally, two main structures were erected on the site, one on the east for the Medical Department and one on the west for the more recently established and smaller Homeopathic Medical College, which demanded facilities equal to those of the Department of Medicine and Surgery. The small heating plant built between these two buildings proved inadequate to the growing needs of the Hospital, and a larger heating plant (the present Wood Utilization Laboratory) was erected at the rear of the group in 1897. The new heating plant permitted the alteration and extension of the old building which was remodeled and used continuously as a home for nurses from 1898 until Couzens Hall was opened in 1925.

When the new Homeopathic Hospital on North University Avenue was occupied in 1900, the west building of the Catherine Street group, which had been the Homeopathic Hospital, became the Medical Ward of the University Hospital, and the Department of Surgery took over practically the entire east building, which for the past nine years had been the University Hospital. The Surgical Ward, the Nurses' Residence, and the Medical Ward were then connected by corridors. The westernmost of these three buildings, the first Medical Ward, was destroyed by fire in 1927. Some of the congestion in the Hospital was relieved in 1896 by the erection of a small office building, the capacity of which was Page  956more than doubled by an addition made in 1918.

In 1901 Mrs. Love Maria Palmer, widow of Dr. Alonzo B. Palmer, bequeathed $20,000 to establish a special ward as a memorial to her husband, and an additional $15,000 as an endowment for its support and for the maintenance of free beds. This building, which was opened in 1904 and formally dedicated in 1907, was placed directly in front of the nurses' home and made a part of that building. It was known as the Palmer Ward and was assigned to the surgical and medical care of children. Originally, it provided sixty-four beds. As few children were referred to the Hospital at first, much of the new wing was used to house nurses and to accommodate maternity cases. An X-ray laboratory was set up in the basement.

Upon the urgent representations of the heads of the clinics in ophthalmology and otolaryngology, a new building to serve as an eye and ear ward was recommended by the Hospital Committee in 1904. It was not until 1909, however, that $25,000 was voted by the Regents for this purpose. In addition, equipment was later purchased for $9,000. This ward was completed in 1910 and was connected with the main building by a covered passageway.

In the early days of the Hospital, the question of contagious diseases was always serious, and pressure from the community for a contagious disease hospital speedily developed. Nevertheless, this need was not met until 1897, when a small building north of the new Homeopathic Hospital, formerly a laundry, was converted into the University's first separate contagious disease hospital. This primitive structure could accommodate only the few patients who contracted contagious diseases while in the various hospital wards, and when an epidemic of smallpox developed in the city of Ann Arbor in 1908 patients perforce were isolated in another hastily prepared building.

The situation did not improve until 1914, when, following an appropriation of $25,000 for this purpose by the city, a contagious disease hospital was built northeast of the hospital group. Two houses which had been moved near the Hospital and designed originally for patients with contagious diseases were never used for that purpose, but were soon taken over as housing for maternity patients.

A separate building for each contagious disease was out of the question because the expense of separate units would have been about four times the amount voted by the city. A hospital in Providence, Rhode Island, had undertaken the treatment of a variety of contagious diseases under one roof, however, and such a hospital, 40 by 100 feet, was designed by J. H. Marks, then Superintendent of the University Buildings and Grounds Department. A nurse was sent to Providence to learn the technique of directing such a hospital, and the system was inaugurated and carried out by Dr. D. M. Cowie. Under his skillful administration there were few cross-infections.

A very substantial increase in the actual facilities of the Hospital came through the authorization of a Psychopathic Hospital by the state in 1901. It was completed in February, 1906. This building, maintained by the state and not by the University, was erected east of the Hospital group of buildings and accommodated forty patients. It was described as follows:

The Legislature of Michigan at its last session … made provision for an addition to the University Hospital of a ward especially equipped for the care of a limited number of acute cases of insanity. This was done with the view of furnishing an opportunity Page  957for the more thorough study of the conditions attending insanity in its incipient stages, and with the hope that, by the aid of specialists in all branches of medicine and surgery, and the laboratory facilities available at the University Hospital, there might result the discovery of causes of these diseases at present unknown, and the development of methods of treatment that might increase the number of cures. The advantages to the medical student of such an addition to our hospital are apparent to all.

(Announcement of the Department of Medicine and Surgery, 1902-3, p. 51.)
With a laboratory and an addition for violent patients, this was the State Psychopathic Hospital until the legislature in 1937 turned it over to the University.

Facilities for the clinic in obstetrics and diseases of women and children were at first practically nonexistent, but by the time the first campus Hospital was built, an increasing number of cases was reported every year. In 1903 provision had been made for temporary housing of maternity cases in Palmer Ward, but this was a makeshift arrangement, and in 1906 a building originally moved from North University Avenue was utilized by the Department of Obstetrics. A second building was moved to an adjacent site in 1908. These two frame houses were in use until the old Eye and Ear ward of 1910 was rearranged for the care of obstetrical patients in 1925.

A small frame dermatology ward, providing space for twenty-five beds, erected in 1918 at the rear of Palmer Ward, was the last addition to the old Hospital group. Of temporary construction, it was torn down in 1932.

Despite its many drawbacks, scattered buildings, long passageways, crowded wards, and unsanitary corners, the old Catherine Street Hospital group, during a period of nearly thirty-five years, had become one of the great teaching hospitals of the country. As in the case of the earlier hospitals, however, the obvious deficiencies of the Hospital and the ever-increasing demands upon it, once more led to agitation for new and better facilities.

The present University Hospital. — In 1915 the Regents appropriated the sum of $1,500 to cover the expense of plans for a new hospital. The legislature, in December, 1916, was asked for an appropriation of $1,050,000, to be distributed in equal payments over a period of six years, for construction of the hospital. The request was granted in the spring of 1917. Albert Kahn, of Detroit, was designated as the architect for the building.

In the meantime Dr. Peterson, then engaged in war duties, resigned as Medical Director, so that a medical superintendent and director could be secured who would give his whole time to the Hospital and superintend the plans and specifications for the new building. Dr. Christopher G. Parnall ('02, '04m) was appointed Medical Superintendent in April, 1918, and with his coming the whole scheme of management of the Hospital was changed. At that time yearly admissions numbered approximately nine thousand patients.

Early in 1919 the University acquired a site for the Hospital on Ann Street, a block south and east of the old Hospital on the hills overlooking the Huron Valley, and early in 1920 the construction of the new building was under way. The original plan to erect the building by units as the successive appropriations of $350,000 for each biennium were made available was found impracticable, and it was constructed as one unit, designed for six hundred beds. The shell of the Hospital was completed in 1921, but, unfortunately, no more funds were available, and for two years the building remained with the windows boarded up, until a further appropriation of $2,300,000 in 1923 permitted its completion. When the Hospital was actually ready Page  958and equipped in 1925, it represented an expenditure of $4,440,000.

On August 12, 1925, 597 patients were moved from the old buildings on Catherine Street, and a new era began in the history of University Hospital. In his report for the year 1924-25, Harley Haynes ('02m), who in September, 1924, had succeeded Dr. Parnall as Director of the Hospital, stated that 23,010 patients had been registered in the Hospital, about half of them inpatients and half of them outpatients. Couzens Hall, the nurses' residence, was also completed in 1925.

The opening of the present Hospital inaugurated an expanding program. The clinics in the old Hospital were all given new quarters carefully designed for their special requirements, and new clinics were gradually organized.

When the older Hospital was built in 1891, it was one of the few large hospitals of the country and one of the very few maintained under university auspices, but hospital design and methods of hospital administration had made such great advances that it had become very unsatisfactory. The new University Hospital was at once recognized as one of the most up-to-date institutions in the country, skillfully designed both for the care of the sick and for medical instruction. Its facilities were utilized almost from the first days of occupancy, and usually there has been a waiting list of patients.

The building is 460 feet long and is constructed of light sand-colored brick with stone trimmings. It has branching wings at either end, which give it the general form of a double Y (> — <) connected at the stems. Its thirteen stories are carried on regularly spaced piers which form the units for the separation of wards, classrooms, laboratories, and offices. The main structure comprises nine stories with an additional sub-subbasement devoted to shops and storage, two floors over the central section forming a one-hundred-bed tuberculosis unit, with a smaller unit on the roof forming a thirteenth story, designed as a recreation center and school for crippled children.

A three-story administration wing rises directly before the main building. At the rear are a large ten-story surgical wing, a five-story Neuropsychiatric Institute, and an interns' home, built since the original construction of the Hospital. All are connected with the main building by a long corridor so that they form, in effect, integral parts of the Hospital. The two additional floors devoted to the care and treatment of tuberculosis were added in 1931, the Neuropsychiatric Institute in 1937, and the interns' home in 1939. Other minor additions have been a small animal house built in 1925, a root-cellar addition in 1927, and a building for storage of inflammable X-ray film in 1929. Additional storage space, a machine room, and a penthouse for the elevator machinery were added in 1939.

The building stands at the crest of the line of hills which define the Huron Valley, so that the rear is actually several stories higher above the ground than is the front of the building, thus giving added light and ventilation to the lower floors. The first floor of the main building and the ground floor and the first floor of the surgical wing constitute a diagnostic clinic in which every department of the Hospital is represented. Here all patients are examined and referred to the proper department for treatment. The main entrance to the Hospital is through the administration section, to the second floor, on which are the general offices and nurses' headquarters. On the floor below are the general administration, finance, and social service offices. There is space in the basement for the storage of records.

The Hospital has 823 beds, some of Page  959which are in private rooms. The ten acres of floor space include wards, laboratories, operating and diagnostic rooms, and offices. With land and equipment the Hospital cost about $5,350,000. The value of the old hospital group on Catherine Street is given in the University inventory at about $400,000. These old buildings have since been used as convalescent wards and special research laboratories.

The number of patients admitted to the Hospital clinics in 1938-39 was approximately 24,000. An additional 30,000 were treated in the outpatient department. This number dropped sharply in 1939-40 because of a change in the state law which effected a reduction in the amount paid for the care of patients referred by the counties and state, so that more patients were sent to local hospitals and infirmaries. In that year admissions dropped to 16,500, with nearly 27,000 outpatients.

Clinical services. — From the opening of the Department of Medicine and Surgery in 1850, persons suffering from various ailments either applied for diagnosis and treatment or were brought to Ann Arbor by their doctors. These patients, at first not more than fifty or sixty a year, consulted the medical faculty on Saturday mornings, when they were demonstrated "before the class." As previously mentioned, this was a negligible part of the instruction.

There was no hospital, however, for nearly twenty years, and such operations as were necessary were performed in the anatomical lecture room, and patients were cared for by relatives, medical students, or untrained nurses. Since this was before the days of antisepsis, there seemed no incongruity in operating in an anatomical lecture room. Even when the first little Hospital on the campus was enlarged and became the Pavilion Hospital in 1876, no operating room was included, and the old arrangements prevailed until the Homeopathic Medical College, in 1879, equipped its new hospital with an operating amphitheater, whereupon the "regulars" were given a similar addition to their hospital.

For a few years after the Department of Medicine and Surgery was established in 1850, it was stated in the medical Announcement: "Clinical instruction, it is believed, is far better imparted in … private practice … The hasty walk through the wards of a hospital … furnishes but a sorry substitute for the close and accurate study of cases …" The statement was dropped in 1857, which can be taken as indirect evidence of a growing realization of the importance of clinical instruction. Another evidence is the establishment of a summer clinical course in Detroit in 1857 by Dr. Zina Pitcher. This was discontinued after two years, despite the appeal of forty students for a continuation of the course in Detroit.

General recognition of the necessity for clinical instruction was growing, although the faculty for the most part clung to the old didactic methods of teaching. The American Medical Association held a convention in 1867 to consider suggested reforms in medical education. Dr. Alonzo Palmer was a delegate to it. A graded medical course of three years was recommended, each year to have a minimum duration of six months, and the third year to be devoted to clinical instruction in a hospital. These recommendations were laid before the Regents.

In 1868 Palmer, as chairman of the Committee on Medical Education, in a report to the American Medical Association, stated:

[The importance of clinical instruction can] scarcely be exaggerated [but] clinical medicine cannot be properly pursued while the student is listening to from five to seven Page  960didactic lectures a day … If the present system of short courses of lectures be continued, the most imperative need … is the establishment of distinct schools of clinical instruction … where students shall be required to attend before presenting themselves for graduation.

(Trans. Amer. Med. Assn., 19 [1868]: 111.)

These progressive steps were not realized immediately. It was not until 1880 that the three-year course was required at Michigan, though the third year was suggested in 1875 and offered as an option in 1877. But in these measures can be seen the germ of the present medical curriculum in which the third and the fourth years are given increasingly to clinical instruction in the Hospital.

The question of financing a hospital was a major problem. After their unsuccessful attempt to have an Army hospital established in Ann Arbor, the Regents became interested in the possibility of a state hospital for indigent patients in connection with the University, but nothing came of these plans.

Though a few patients came to the University even before the first Hospital was opened, little in the way of clinics in the modern sense existed. The clinics originally associated with the Hospital were indicated by the titles of the first professorships, but it was probably not until 1880, when the amphitheater of the campus Hospital was completed and the additional title of clinical professor was given to the professors of internal medicine, surgery, obstetrics, and ophthalmology, that the first real steps toward systematic clinical instruction were taken. As new members of the faculty specializing in different fields were appointed other clinics came to be established.

Internal Medicine and Pediatrics. — By 1860, when Alonzo B. Palmer took charge of the didactic and clinical instruction in internal medicine, students were given some opportunity to study cases, and up to the time of his death in 1887 many improvements were made in conditions affecting the efficiency of all the clinical departments. Several of these took place within the twelve years when he was Dean — the building of the amphitheater, the recognition and fostering of the departmental clinics, the passage of a law authorizing the treatment of dependent children in the University Hospital at state expense, and the extension of the medical course from two six-month terms to three full college years, partly with a view to providing throughout the senior year frequent bedside instruction accompanied by clinical lectures.

George Dock, who became head of the Department of Theory and Practice in 1891, built up a laboratory of clinical medicine for the dual purpose of carrying out instrumental investigations of disease and for teaching techniques of diagnosis, and his success in making laboratory work an important part of the study of clinical medicine led to the adoption of similar teaching devices in the other clinical departments.

The erection of Palmer Ward made possible the organization of a special children's clinic in 1906 within the Department of Internal Medicine. The work in both pediatrics and contagious diseases was separated from that in general medical practice by the formation of a new department under Cowie in 1921.

Dock was followed in 1908 by Albion W. Hewlett, who before his resignation in 1916, added new equipment, particularly for the study of the cardiovascular system. In 1916-17 the medical clinic was headed by Nellis D. Foster. He in turn was succeeded by Louis H. Newburgh, acting head of the Department of Internal Medicine. Imbued with the idea that investigation and research are essential to a growing clinic, Newburgh Page  961carried on studies in diabetes which led the Rockefeller Foundation to give funds for a diet kitchen, a dining-room for diabetic patients, and a small laboratory. This simple clinic was the forerunner of the present diet therapy clinic. Studies in metabolism and heart diseases were inaugurated with the purchase of an electrocardiograph and the establishment of a heart station. Newburgh was succeeded in 1922 by Louis M. Warfield, who resigned, however, in 1925 to return to private practice.

With the opening of the Palmer Ward for children, the demands of pediatrics developed so rapidly that the number of patients grew from fewer than fifty in 1905 to more than 2,300 in 1920. This necessitated the removal of the maternity cases to two dwelling houses near the Hospital, which had been fitted up for that purpose, so that the first floor of Palmer Ward in 1911 was finally given over entirely to pediatrics. A new food laboratory, diet kitchen, and pediatrics laboratory in the basement were added. By 1913 the nurses on the two upper floors of Palmer Ward were also compelled to find quarters elsewhere, and the space thus gained, together with the passageways leading to the building on each side, was used for children. In 1907 an orthopedic ward had also been opened in the building.

Upon the completion of the new Hospital in 1925, the children's ward was removed to the sixth floor of the new building, where a tablet marked it as the Palmer Ward, in memory of Dr. Palmer and in recognition of Mrs. Palmer's generous gift a quarter of a century earlier.

The first professorship in obstetrics and gynecology included the diseases of children. A separate clinic in pediatrics was not established until some years after the completion of the Palmer Ward in 1905. Dr. D. M. Cowie became Clinical Professor of Pediatrics and Internal Medicine in 1907 and continued in charge of this clinic until his death in 1940. Cowie was also in charge of the program in infectious diseases after the erection of the Contagious Disease Hospital, for which funds were given by the city of Ann Arbor in 1913. He was made Professor of Pediatrics and Infectious Diseases in 1921.

Children had been treated in the University Hospital before 1908, but it was not until Dr. Cowie's appointment that they were reported separately by the Department of Internal Medicine. The clinic grew with the large number of patients referred to it under the state laws, particularly those of 1927 authorizing care of crippled children in the state. When the laws were changed in 1939 under Act No. 283, and the appropriations for the care of children were reduced, the number of children referred to the University Hospital substantially decreased.

Dr. Cowie was succeeded by Dr. Charles Fremont McKhann as Professor of Pediatrics and Communicable Diseases and chairman of the department.

To expand further the service of the University Hospital for sick and crippled children, the Northern Michigan Children's Clinic at Marquette (a unit supported by the Children's Fund of Michigan), was designated by the Regents in 1931 as a part of the University Hospital, and the acceptance of children for state care by the clinic was authorized. A similar action for the Central Michigan Children's Clinic at Traverse City was taken in 1936. Each of these clinics in 1940 represented the expenditure of some $5,000 annually.

The appointment of Dr. James D. Bruce as Director of Internal Medicine and Chief of the Medical Service almost exactly coincided with the opening of the new Hospital. He came shortly after the receipt of the endowment of the Thomas Page  962Henry Simpson Memorial Institute for Medical Research, which enlarged the already extensive fields of research carried on in internal medicine. When the Regents approved the establishment of the Department of Postgraduate Medicine, Dr. Bruce was named its head, to begin the organization of the department during the year 1927-28. Dr. C. C. Sturgis, who in 1927 had been named Director of the Simpson Memorial Institute, in 1928 became Director of the Department of Internal Medicine.

The second floor of the Hospital is occupied for the most part by the internal medicine service. An important offshoot of this clinic, the Heart Station, was set up in a part of the basement of the surgical wing. This clinic was inaugurated in 1921 on Dr. Newburgh's initiative, and Dr. Frank N. Wilson, a recognized authority on diseases of circulation, was appointed Associate Professor of Internal Medicine and made responsible for further research and use of the electrocardiograph. In a comparatively short time the equipment was increased, and in the new Hospital the Heart Station has become an important aid to diagnosis.

The clinic for the study of tuberculosis was also first developed under the Department of Internal Medicine. Two floors were added to the Hospital in 1931 to care for this program.

Surgery. — After the resignation of Moses Gunn, the first Professor of Surgery, in 1867 and a series of short incumbencies, Donald Maclean was obtained as Lecturer in Surgery in 1872 and in the following year was appointed Professor of Surgery. In 1880 as head of the "surgical clinique" (R.P., 1876-80, pp. 531-37), he reported to the Regents that clinics were held daily, that almost every form of "surgical affection" was presented, and that treatment was "practically illustrated." Maclean was succeeded in 1889 by Charles De Nancrède, whose skill as a surgeon gave the clinic an outstanding reputation for more than a quarter of a century. When the former University Hospital Building became the Surgical Ward in 1900, an amphitheater and three smaller operating rooms were made available. As early as 1897 emphasis had been placed upon improved methods of sterilization, and the use of X-ray apparatus, loaned to the University, proved invaluable in surgical diagnosis. Under De Nancrède, a surgical laboratory was established which increased facilities and stimulated original investigations.

Specialization within the Department of Surgery was placed upon a substantial foundation by the appointment of Ira D. Loree as Clinical Professor of Genitourinary Surgery in 1908 and by the establishment of a weekly clinic in that subject. Cyrenus G. Darling, previously Lecturer on Genitourinary and Minor Surgery, and at that time Clinical Professor of Surgery, and of Oral Surgery in the College of Dental Surgery, had charge of the cleft-lip and cleft-palate cases. A large number of cases of bone fracture in the surgical clinics led to the establishment of a clinic in orthopedics in 1911, with Charles L. Washburne as demonstrator, and a few years later Max Minor Peet took charge of a new clinic in neurological surgery.

Failing health led De Nancrède to turn more of his work over to Darling, who succeeded him and became head of the surgical clinic in 1917. Darling resigned in 1919 and was replaced by Hugh Cabot, who was shortly to become Dean of the Medical School and who remained in charge until 1930. Cabot's particular interest was genitourinary surgery, and upon Loree's resignation in 1920, he concentrated primarily in this field.

The surgical clinic, one of the oldest and most important teaching divisions Page  963of the Hospital, had occupied a separate building in the days of the Catherine Street Hospital. In the new building it was assigned, with its subdivisions, to parts of the third, fourth, and fifth floors of the Hospital. Under Cabot, who was Professor of Surgery at the time the new Hospital was occupied, the question of full-time service for the members of the Hospital staff was under serious consideration, and for a time the different surgical clinics were maintained on a full-time basis. When Cabot resigned in 1930, Reed M. Nesbit was placed in charge of the clinic in genitourinary surgery.

In orthopedic surgery LeRoy C. Abbott succeeded Dr. Washburne in 1918 and he, in turn, was followed in 1924 by Carl E. Badgley, who inaugurated the clinic in the new University Hospital. He has remained in charge, except for the three years when he was at the Ford Hospital in Detroit. During this time his place was taken by Vernon L. Hart. Perhaps no one clinic in the Hospital has experienced such fluctuations in numbers seeking diagnosis or treatment as has the bone and joint clinic, largely because of radical changes in legislation offering medical care for children, such as the withdrawal and drastic curtailment of funds.

Although the oral surgical unit is in the Hospital, it is not under the immediate direction of the Department of Surgery. Chalmers J. Lyons, who was made Instructor in Oral Surgery and Consulting Dentist to the Hospital in 1919, succeeded Darling in this field and was largely responsible for the establishment of this important clinic. After his death in 1935 he was succeeded by John W. Kemper, Professor of Dentistry and Consulting Dental Surgeon to the Hospital, who is now in charge of oral surgery. In this ward hundreds of children have had opportunity for the surgical correction of mouth malformations.

Dr. Cabot was succeeded as head of the surgical clinic in 1930 by Frederick Amasa Coller, who had come to the University as Assistant Professor of Surgery in 1920. As chairman of the department, he is responsible for all subdivisions of surgery, and under his administration standards in surgery, as well as teaching methods and content of instruction and research, have been continually improved.

Obstetrics and gynecology. — The third of what may be called the original clinics was that of obstetrics and diseases of women and children, which was at first established under Abram Sager, one of the founders of the Medical School. He was succeeded in 1873 by Edward S. Dunster, who was followed by his assistant, James N. Martin, as Acting Professor in 1888. "Children's diseases" was dropped from his title when Martin was made Professor in 1891, but was nominally included in his duties when, in 1899, he became Bates Professor of Diseases of Women and Children.

Reuben Peterson became head of the department in 1901 and remained in charge until his retirement in 1931. During the first five years of his administration, the clinical material nearly doubled. Peterson was succeeded in 1931 by Norman Fritz Miller as Professor of Obstetrics and Gynecology and Bates Professor of Diseases of Women and Children. He became chairman of the department in April, 1938.

Although obstetrical clinical material had been plentiful for some time, radical changes in legislation (1933) shifted the assignment of cases from the University Hospital to local units. This and other causes contributed to a decline in the number of cases received at the Hospital and created a problem in supplying adequate clinical material for student instruction.

Page  964Ophthalmology and otolaryngology. — With the coming of George E. Frothingham to the University in 1867, a special interest arose in ophthalmology and aural surgery. When Frothingham became Lecturer in Ophthalmology in 1870, a clinic in these branches was developed under his direction. The unusual importance attached to this branch of surgery was indicated by the fact that the first University building designed for a special clinic was a small Eye and Ear Ward, added to the campus Hospital in 1881.

Apparently, no special provision was made for this clinic in the Hospital on Catherine Street until Walter R. Parker and Roy Bishop Canfield were appointed, respectively, to the professorships of ophthalmology and otolaryngology in 1904. They realized at once that efficient work in their specialties was not possible while patients were treated in a general ward where they were in contact with septic cases. They began a campaign for a new building, which was eventually built in 1910. From that time the clinics in both of these subjects expanded rapidly.

The removal of the ophthalmology clinic to the new Hospital took place under Parker, who continued as Clinical Professor of Diseases of the Eye, until his resignation in July, 1932. He was succeeded by his associate, George Slocum, upon whose death in 1933 F. Bruce Fralick became Acting Chairman of the Department of Ophthalmology and in 1938 Professor of Ophthalmology and chairman of the department.

Originally, the clinic treated diseases of the ear, nose, and throat, as well as those of the eye, but in 1904 Canfield became Professor of Otolaryngology and head of the otolaryngology clinic. Under his energetic direction and because of his extraordinary skill as a surgeon, the clinic grew rapidly. Canfield, who was killed in an automobile accident in 1932, was succeeded by Albert C. Furstenberg, who had been for many years his able assistant.

Psychiatry and neurology. — The history of the development of the Hospital clinic in neuropathology goes back to the time of William J. Herdman, who had assumed charge of the work in nervous and mental disorders in 1888. Just before his sudden death in December, 1906, he had recommended the appointment of Dr. Albert M. Barrett who in September, 1905, had taken charge of the instruction in psychiatry and diseases of the nervous system. A clinical professorship of the diseases of the nervous system was also created. In June, 1907, this was filled, on Barrett's recommendation, by Dr. Carl D. Camp.

At the time of his appointment Dr. Barrett, who thus had the distinction of carrying out and organizing the first University Hospital clinic for the treatment of mental diseases in the United States, issued a statement about the work in the two divisions, psychiatry and neurology, as follows:

The Psychopathic Ward is a hospital intended for the so-called psychopathic conditions or for mild forms of mental diseases. This means that there will always be present in this Ward, patients which might properly belong either to the neurologists or the psychiatrists… The Director of the Psychopathic Ward in his capacity of Pathologist of the State Asylums, visits these institutions from time to time and has become familiar with much of their more interesting clinical material …

(MS, "Medical Faculty Minutes," 1905-10, p. 290.)

Under Barrett, the clinic grew rapidly. It was centered in the State Psychopathic Hospital, which was connected with the old Catherine Street Hospital. An additional clinic was established in the new Hospital in 1925. Upon Dr. Barrett's death in 1936, he was succeeded Page  965by Raymond Walter Waggoner, who, as Medical Director of the State Psychopathic Hospital, was placed in charge of the neuropsychiatric unit in the University Hospital. The Neuropsychiatric Institute was built in 1939 as a separate building just to the rear of the Hospital proper. The old State Psychopathic Hospital eventually was fitted over as a nurses' home. The clinic in neurology, which was separated from that of pyschiatry in 1920 when the separate Department of Neurology was created, remained under the charge of Dr. Camp.

Roentgenology. — Although interest in X ray as an agent in diagnosis developed in the Medical School soon after Roentgen's discovery in 1895, the clinic in roentgenology was not inaugurated until December, 1903. It was first installed in a five-room laboratory in the basement of the Palmer Ward and was furnished with X-ray equipment purchased the year before. From the first the work of the laboratory, devoted to X-ray diagnosis, therapy, and photography, increased enormously.

Work in this field was at first under the charge of Vernon J. Willey, who became Director of the laboratory in 1906. X-ray therapy was conservatively practiced at first as a joint undertaking with the Department of Dermatology; little deep therapy was attempted. In 1909, Lyle Steen Hill became Director of the laboratory, which by this time had become of great value in the diagnosis of fractures, dislocations, and bone diseases, as well as in the localization of foreign bodies.

In 1913 James G. Van Zwaluwenburg became Clinical Professor and later Professor of Roentgenology. The clinic had become more than self-supporting so that the appointment of a technical assistant was authorized, and the clinic became a full-time service of the Hospital. Dr. Van Zwaluwenburg died January 5, 1922, and was succeeded by Samuel Wright Donaldson, who was acting head until the appointment of Preston Manasseh Hickey a few months later.

The design for the roentgenology clinic, in the present hospital, with its special examining rooms and photographic equipment, was the work of Dr. Hickey, who was in charge at the time of removal to the new building. The facilities of the clinic were also increased in 1928 by a purchase of 100 milligrams of radium for $7,000 under a general appropriation of $35,000 for a radium and emanation plant. Dr. Hickey died in 1930, and his place was taken temporarily by Carleton Barnhart Peirce, who was, in turn, succeeded in 1931 by Fred Jenner Hodges as Professor of Roentgenology and later chairman of the department.

Under Hodges' direction many changes have been made in the arrangement and equipment of the clinic, which is now situated on the east side of the surgical wing. In May, 1940, the W. K. Kellogg Foundation provided funds for the installation of equipment for chest X-ray examinations of patients admitted to the Hospital, for clinical investigation, for the study and prevention of tuberculosis, and for research toward the more efficient uses of X ray for diagnosis.

Dermatology and syphilology. — The dermatology clinic was the last of the major clinics to be developed in the Catherine Street Hospital. When William F. Breakey, Professor of Dermatology and Syphilology, resigned in 1912, he was succeeded by Udo J. Wile, who remained in charge of the department and of the clinic. A laboratory for dermatology was set up in the basement of the medical building of the old Hospital in 1912, but it proved inadequate. Wile almost immediately called attention to the fact that although the bed Page  966capacity for the treatment of syphilis cases was far larger than that found in any other institution of like character, there was urgent need for additional bed space. Accordingly, the construction of a special ward was authorized in 1917. It was of temporary character, however, and was used only until the new Hospital was completed, when more satisfactory quarters for the clinic became available.

Special clinics and research programs. — From time to time there have been additions to the facilities of the Hospital in the way of special clinics and research programs developed in co-operation with different members of the medical faculty. Among these are to be noted new clinics in allergy, arthritis, cancer, and the Clara Ward Seabury clinic in infantile paralysis.

A sensitization clinic organized in the basement of the old Contagious Hospital grew into a much larger clinic after it was moved to the new Hospital. General interest in allergy, at first a subject of doubt and ridicule, was increasing, and an allergy clinic was developed within the Department of Internal Medicine under the direction of Dr. John Sheldon.

In 1936 a teaching clinic for the study of malignant growths was created through the combined efforts of all the professional departments of the Medical School. The work has been correlated with nuclear research carried on with the physics and the roentgenology departments, with financial support from the Rackham Fund.

The arthritis clinic was organized in 1935 at the suggestion of Dr. Sturgis and Dr. Badgley to co-ordinate various methods used in the Hospital for treatment of arthritis. Three years later a trust fund of $1,000,000 was established by the Rackham Fund for the furtherance of research in this field. This support resulted in the development of an arthritis unit in the basement of the Hospital, with Richard Freyberg in charge.

A gift of $8,000 from anonymous donors in 1937 made possible the establishment of a memorial clinic to Mrs. Clara Ward Seabury for the study of infantile paralysis. This research clinic was placed under charge of Malcolm H. Soule, Professor of Bacteriology and Chairman of the Hygienic Laboratory.

Several services directly related to the clinics, and functioning in co-ordination with them, are the pathological diagnostic service, the clinical laboratories, the Department of Anesthesia, the Hospital Pharmacy, and the dietetic, physical therapy, and blood bank services.

Pathology. — The pathological service was first organized in 1900 under Aldred Scott Warthin, at that time Chairman of the Department of Pathology. Under his administrative direction it was enlarged, and offices and laboratories were provided for it in the basement of the new Hospital. This service gave ample proof of Dr. Warthin's assertion that in a single year the Hospital's clinical material covers almost the entire range of practical diagnostic pathology and gives the Hospital a unique teaching and research value quite different from that of the ordinary city hospital. When Warthin died in 1931, he was succeeded by Carl Vernon Weller.

The growth of the clinical laboratory and of the consultation services coincided with the emergence of the Hospital as one of the outstanding medical centers of the country. In March, 1928, Dr. R. L. Kahn was made Director of Laboratories and Assistant Professor of Clinical Bacteriology and Serology. His researches and clinical tests have been internationally recognized.

Anesthesia. — In 1919 Miss Laura M. Davis, the anesthetist of the Hospital, organized a course for graduate training in anesthesia. She continued as director Page  967of the course until 1938, when Fenimore E. Davis was placed in charge of a newly organized Department of Anesthesia established in the Department of Surgery.

The first appointment of a Hospital dietitian was apparently made in 1901, and from that time increasing emphasis was placed on adequate and proper diet for patients. A more scientific approach to the subject, however, was not undertaken until the establishment of the diet therapy clinic under S. Margaret Gillam, who, as Director of Dietetics, worked closely with Dr. Newburgh and others in the study of diet and metabolism. Miss Gillam resigned in 1932 to be succeeded by Mrs. Dorothy Stewart Waller, who was also Instructor in Internal Medicine. Upon her death in 1934, Miss Mable M. MacLachlan was appointed Director of Dietetics and Housekeeping.

A metabolism unit with twelve beds was opened in 1922 under the direction of Phil Lewis Marsh. This included a well-equipped kitchen and a small laboratory for the treatment of diabetics and the intensive study of patients presenting disturbances of metabolism. With removal to the new Hospital, this unit was greatly expanded.

A gift from the Rackham Fund in 1934 for the construction of a therapeutic pool greatly strengthened the facilities of the Department of Physical Therapy. It now occupies an entire wing of the basement floor and is one of the best equipped and most modern units in the country.

In 1938-39, the establishment of a blood bank in the Hospital was announced, and a member of the Internal Medicine Department was charged with developing the service. The bank is situated on the ground floor of the Hospital, and each service has a separate account for credit and withdrawal of blood from the bank.