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

Part V

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The Law Quadrangle

The Medical School

THE ADMINISTRATION AND CURRICULUMS

IN 1817 the governor and judges of the Territory of Michigan passed an act establishing the Catholepistemiad, or University, of Michigania. Of the thirteen didaxiim or professorships, one didaxia was designated as iatrica or the medical sciences. There is nothing to indicate that actual instruction in medicine was given at that time.

Twenty years later, in January, 1837, Michigan was formally admitted to statehood by Congress, and the legislature of the state, on March 18, passed the organic act establishing the University of Michigan. It was specified that the University was to consist of at least three departments: the Department of Literature, Science, and the Arts, the Department of Law, and the Department of Medicine.

The vastness of the educational scheme laid down by the organic act, as well as financial difficulties, made it necessary for the Regents to act slowly. The Department of Literature, Science, and the Arts opened its doors in the fall of 1841, and for some years the tenderest care and every effort were needed to keep that much of the University alive. Six years elapsed before the matter of a medical college again came up for consideration.

At a meeting of the Regents, January 7, 1847, a communication was read "from Drs. Sager, Douglass, and others, Surgeons, Physicians, etc., in reference to a Medical Department in the University," and this was referred to a committee of five, one of whom was Dr. Zina Pitcher, which reported on the following day a recommendation for the creation of such a department with four professors and a six months' course. The report was accepted, but after some discussion, on motion of Chief Justice Ransom it was recommitted. The next day the committee, for some unaccountable reason, presented a lengthy and adverse legal opinion to the effect that the Board had neither the authority nor the means to erect necessary buildings without specific action of the legislature.

At the same meeting Dr. Pitcher offered a resolution committing the Board to the organization of the Medical Department, but this was tabled. Whereupon he gave notice that he would call the resolution up again at the next annual meeting. This he did, and, in August, 1847, a committee of three was appointed to report at a further meeting "upon the expediency as well as upon the plan of organizing the Departments of Medicine and Law." Dr. Pitcher, as chairman of this committee, presented to the Board on January 19, 1848, a lengthy and masterly report on the need of a medical department, and although two of the three members of the committee were lawyers, the subject of a law department was not stressed. The adoption of this report, the appointment of Dr. Douglass and Dr. Sager as professors in the new department, and the appropriation of $3,000 for a "laboratory" make January 19, 1848, the natal day of the Medical Department. The first session of the Medical Department was to begin in the fall of 1849, but because of delay in the construction of the laboratory, or medical building, its doors were not opened until the fall of 1850. The original medical building was finally completed at a cost of $8,981.

The establishment of the Medical Department was essentially due to three

men, Zina Pitcher, Silas H. Douglass, and Abram Sager. Dr. Pitcher was one of the twelve original members of the Board of Regents appointed in 1837 and was reappointed in 1841, 1845, and 1849; he retired on the last day of 1851, at which time the appointive Board gave way to one elected by the people, as provided by the Constitution of 1850. He was the only member to serve continuously from its inception to its reorganization — a period of fifteen years. This may be taken as evidence of his intense devotion to the cause of education. The esteem in which he was held by his colleagues on the Board is to be seen in the fact that in July, 1848, a few months after the organization of the Medical Department, a committee appointed to name the University buildings, proposed to call the North Building "Mason Hall" and the South Building "Pitcher Hall." This report, although accepted, was tabled. The following day a motion to name the North Building "Mason Hall" was also tabled.

The Original Faculty. — The Organic Act of 1837, in establishing the University, provided by name for six professorships in the Medical Department, as it was officially designated until 1915. These were: (1) anatomy, (2) surgery, (3) physiology and pathology, (4) practice of physic, (5) obstetrics and the diseases of women and children, (6) materia medica and medical jurisprudence. It provided further, that in the first organization of the University the Regents should "appoint such a number only as the wants of the institution shall require; and to increase them from time to time, as the income of the fund shall warrant … Provided always, that no new professorship shall be established without the consent of the legislature."

The Organic Act of 1837, in designating the professorships in the Department of Literature, Science, and the Arts, provided for a chair of chemistry and pharmacy. Hence these subjects are listed in the title given in 1839 to Dr. Douglas Houghton. In the Statutes of 1846, replacing this act, the sixth chair mentioned above was designated as that of materia medica, pharmacy, and medical jurisprudence. It may be inferred that Dr. Silas H. Douglass and Dr. Samuel Denton, then state senator, may have effected this transfer of pharmacy to the medical faculty.

The new Constitution which went into effect in 1851 omitted the naming of specific professorships and hence the Regents, after that date, became free to create new professorships and to give to each whatever title was desirable.

The Regents, in making the first appointments in the Medical Department, endeavored to comply with the letter of the law as far as the naming of the chairs was concerned. At the same time, considering the qualifications of the men to be appointed, the duties assigned to the holder of a chair might be quite different from those implied by the title. Thus, in the report to the Regents in January, 1850, the faculty was to consist of the following:

A Professor of Materia Medica and Pharmacy and Medical Jurisprudence, who would teach only Pharmacy and Toxicology.

A Professor of Anatomy, who should do the duties of the Chair of Surgery.

A Professor of Pathology and Physiology, who should besides Physiology also do the duties in part of the Professor of Materia Medica.

A Professor of Practice of Physic (including Pathology).

A Professor of Obstetrics and the Diseases of Women and Children.

R.P.

At no time in the records of the organization of the Medical Department

was chemistry mentioned. Doubtless, it was tacitly understood that this subject was to be taught by Dr. Douglass, who, since 1846, had been Professor of Chemistry, Mineralogy, and Geology in the Department of Literature, Science, and the Arts.

The term chemistry could not be used legally in the title of Dr. Douglass as a professor in the Medical Department and hence, conforming to the law, he was designated as Professor of Materia Medica, Pharmacy, and Medical Jurisprudence, who "would teach only Pharmacy and Toxicology." A free interpretation of these two subjects might be taken to imply chemistry. At all events Dr. Douglass did teach chemistry in 1850 and thereafter, but did not teach materia medica. There being no longer any legal obstacle, in 1855 the title of Dr. Douglass was amended by substituting toxicology for medical jurisprudence.

An equally striking circumlocution was presented in the case of Dr. Jonathan Adams Allen, who in 1850 was made Professor of Pathology and Physiology, but "who should besides Physiology also do the duties in part of the Professor of Materia Medica." At the same time Dr. Samuel Denton was given the legal title of Professor of Practice of Physic, with the words "including Pathology" understood. It was perhaps deemed more logical to attach pathology, unofficially, to the duties of the professor of the practice of physic.

The removal of pathology and the addition of materia medica made Dr. Allen virtually Acting Professor of Therapeutics, Materia Medica, and Physiology, though his official title even as late as 1854 was Professor of Pathology and Physiology.

Prior to the report of 1850 the Regents had made three appointments to the medical faculty. In January, 1848, Dr. Douglass had been appointed Professor of Materia Medica; he was also to discharge the duties of Professor of Pharmacy and Medical Jurisprudence; Dr. Abram Sager was named Professor of Theory and Practice of Medicine, and was to discharge the duties of such other professorship as might be prescribed (not the professorship of physic as specified in the Act of 1837). In July, 1849, Dr. Gunn was appointed Professor of Anatomy and was to discharge such other duties as might be required of him. Denton later seems to have acquired the title to the chair of the theory and practice of medicine, and of pathology. At the same time Dr. Sager, with his consent, was transferred to the chair of obstetrics and diseases of women and children. Hence, the members of the faculty at this time held the titles prescribed by law.

Dr. Silas H. Douglass, a native of New York state, began the study of medicine in the office of Regent Zina Pitcher, who continued to be a Regent of the University until 1851. He also served as physician under Henry R. Schoolcraft, the noted Indian scholar, who was also a member of the Board of Regents. Later, he assisted Dr. Douglas Houghton in his geological survey of Michigan (see Part III: Department of Geology) .

Dr. Douglass was made Assistant in Chemistry in 1844, without salary. After the death of Houghton in 1845 he continued in charge of the work, and in 1846 he became Professor of Chemistry, Mineralogy, and Geology; no mention was made of pharmacy, probably because of the statute of 1846, which was in effect.

There is no doubt but that Dr. Douglass, with or without the approval of his former preceptor, Dr. Pitcher, formulated the communication, signed by medical men and others, which, in January, 1847, was sent to the Board of Regents asking for the establishment of the

Medical Department. The communication started the movement which, a year later, resulted in the appointment of Dr. Douglass and Dr. Sager to the faculty of the new Medical Department.

In 1846 Douglas became Superintendent of Buildings and Grounds and, as such, he had much to do with the planning and erection of buildings on the campus. The Medical and Chemistry buildings as well as the Observatory and the South Wing of the Literary Department, were built under his supervision. Dr. Douglass served as elective dean of the Medical Department for nine years. His service in the University ended in 1877.

Dr. Abram Sager, also a native of New York state, had been Professor of Botany and Zoology since 1842. He was given, in 1848, the chair of theory and practice of medicine, and this was changed, in 1850, to obstetrics and diseases of women and children. Because of ill-health he resigned in March, 1874, and Dr. Edward S. Dunster was appointed to the chair. Sager became Emeritus Professor and resigned as Dean of the medical faculty in 1875. He had served ten years as elective dean.

Dr. Moses Gunn, as a medical student, had formed a strong friendship with Dr. Corydon L. Ford, the demonstrator of anatomy. He came to Ann Arbor immediately after his graduation and brought a cadaver which had been given to him by the Geneva Medical School. Dr. Gunn dissected the body before invited guests, thus performing the first dissection in Ann Arbor, if not in Michigan. In 1849 he was appointed, as the third member of the new faculty, to the chair of anatomy, with other duties to be assigned. He was then twenty-seven years old. His interests were primarily in surgery, but the absence of clinical facilities resulted in his devoting himself during this period to work in anatomy. In 1853 he moved to Detroit, but maintained his position in Ann Arbor. The following year he became Professor of Surgery and held this title until 1867, when he resigned to accept the chair of surgery in Rush Medical College, Chicago, which position he held until his death. He acted as elective dean for only one year.

Dr. Jonathan Adams Allen, a descendant of Ethan Allen, was the fourth man to be added to the faculty. He was the youngest member, being only twenty-five years of age. His position was vacated in 1854 because of a controversy about student secret societies. Later he became president of Rush Medical College.

Dr. Samuel Denton, in 1837, was appointed a member of the first Board of Regents for a term of three years. He became the fifth member of the medical faculty. Dr. Denton served for three years as elective dean and died in Ann Arbor in 1860.

Officers. — At the meeting of the Board of Regents in January, 1849, Dr. Zina Pitcher, as chairman of a special committee, presented a report embodying regulations for the organization of the Medical Department. On July 17, 1850, the same report, somewhat amended and designated as Rules for the Government of the Medical College, was adopted.

In the report it was specified that one of the professors was to be appointed annually by the faculty as president and one as secretary of the medical faculty. This was in line with the practice of the faculty of the Department of Literature, Science, and the Arts, which, since 1845, had designated its presiding officer as president.

The minutes of the medical faculty record the election of presidents in 1850-53 inclusive, and in 1855. Apparently, following the election of Dr. Henry

Philip Tappan as President of the University, in 1852, there was a transitional period in the use of the term "president" by the faculty. It is noteworthy, however, that the Catalogue of 1852-53 lists Dr. Samuel Denton as Dean, though he was elected president. This is probably the earliest recorded usage of that title in the University. In the minutes, however, the earliest references to the dean appear in November and December, 1853; and in March, 1854, Silas H. Douglass was elected Dean.

The deans continued to be elected annually by the faculty until 1891. The rotating principle was at first adopted, but not for long, as can be seen from the following list of elective deans: Abram Sager (ten years), 1850-51, 1859-61, 1868-75; Samuel Denton (three years), 1851-53, 1857-58; Silas H. Douglass (nine years), 1853-57, 1863-68; Moses Gunn (one year), 1858-59; Corydon L. Ford (seven years), 1861-63, 1879-80, 1887-91; Alonzo B. Palmer (eleven years), 1875-79, 1880-87.

With the growth of the University, it became apparent that the election of deans by the various faculties should be centralized and, accordingly, the rules of the Board of Regents were amended on July 17, 1889, making the deans thereafter Board appointees. By this action the deans received a status which was recognized in all University publications. The elective deans had not been given this recognition in the University Calendar or Catalogue, and, at times, their names were not even in the Announcement of the Department. Dr. Ford was the last of the elective deans, and upon his resignation Dr. Victor C. Vaughan was appointed Dean by the Board of Regents.

The deans appointed are as follows: Victor C. Vaughan (thirty years), 1891-1921 (resigned); Hugh Cabot, 1921-February, 1930 (relieved); Executive Committee, 1930-33; Frederick G. Novy, 1933-February, 1935 (retired); Albert C. Furstenberg, February, 1935, to date.

In the interim following the termination of Dr. Cabot's deanship, the administration of the Medical School was entrusted to an executive committee consisting of Drs. James D. Bruce, Harley A. Haynes, Frederick G. Novy, Udo J. Wile, and Arthur C. Curtis, Secretary. The committee chose Dr. Novy as chairman, and in September, 1933, he was appointed Dean.

The executive committee, which had demonstrated its usefulness in the conduct of the affairs of the School, was continued, and similar committees were set up in the other schools and colleges of the University.

The Rules of 1850 provided that "the Faculty shall annually appoint one of their number Secretary." This rule was observed literally for a number of years, but on March 28, 1865, the Regents received a communication from the medical faculty asking the appointment of Douglass as dean and secretary with additional salary. An appropriation of $200 was made for this purpose, but no official appointment was made, since that was probably considered to be a faculty matter.

His successor, Dr. Abram Sager, likewise held the two positions from 1868 to 1875, when he resigned. It is probable that Dr. Alonzo B. Palmer, who followed as Dean, also acted as secretary, but as the faculty minutes for 1875 to 1878 are missing, this cannot be verified. These minutes were either lost or destroyed in the fire of 1911, which actually damaged the book of minutes starting in 1878.

Elective secretaries, 1850-78: M. Gunn, 1850-51; J. A. Allen, 1851-53; A. Sager, 1853-55, 1861-62, 1868-75; C. L. Ford, 1855-57; A. B. Palmer, 1857-59, 1862-64, 1875-78; S. Denton,

1859-60; S. H. Douglass, 1860-61, 1865-68; S. G. Armor, 1864-65.

A revision of the bylaws, adopted in 1880, and subsequently revised in 1883, allowed the faculty to fill the position of secretary with one of the assistants to the professors. Since they received a salary, appropriated by the Board, they became actual University appointees. Appointive secretaries, 1878-1940: L. G. North, 1878-79; G. B. Ayres, 1879-80; P. E. Nagle, 1880-81; C. F. Dight, 1881-83; C. F. Chadbourne, 1883-84; G. A. Hendricks, 1884-85; W. A. Campbell, 1885-97; G. C. Huber, 1897-1911; C. W. Edmunds, 1911-19; R. E. McCotter, 1919-29; J. L. Garvey, 1929-30; A. C. Curtis, 1931-35; H. M. Pollard, 1935-40.

Buildings. — The report of Dr. Zina Pitcher, establishing the Medical Department of the University, was presented to the Board of Regents on January 19, 1848. Among other recommendations, it proposed the "erection of a Laboratory which by the expenditure of $3,000 in addition to the material on hand can be completed so as to furnish all the room required for the Medical Department for many years to come" (R.P., 1837-64, p. 392). The Board directed the building committee to procure a plan for a laboratory to be submitted for approval to the executive committee which was to select a site for the building. The executive committee appropriated $3,000 for its erection and selected a site on the east side of the campus. When the Medical Department opened its doors to the first students the building cost was $8,981. It was not until two years later that appropriations were made to complete the exterior of the building, bringing the total cost to $9,991.84.

During the session of 1852-53, there were 167 medical students registered. The inevitable crowding of "the narrow and ill ventilated rooms" used for dissection led the faculty, in March, 1853, to recommend to the Regents that a fee of three dollars be charged for the course in practical anatomy and that the attic be fitted up for dissecting purposes. In October, 1854, a committee of the faculty appeared before the Board and presented a plan for "certain alterations in the Medical College Building for the purpose of accommodating classes in dissections, and of providing apartments for the private researches of the Professors" (R.P., 1837-64, p. 575). These alterations were probably made in the spring of 1855, since the sketch of the campus made by J. F. Cropsey in the summer or fall of that year shows the glass dome over the new dissecting room.

The original Medical Building was ninety-two feet in length, forty-two feet in width, and three stories high. The amphitheater had a seating capacity for 222 students. By 1860 the number of students had increased to 242, and by 1863 to 350. Because of the large number of students the Regents considered the question of raising the roof to provide extra space, but this was not deemed to be expedient. Another suggestion was to separate the classes into two divisions, the professors repeating their lectures. The report of the Board of Regents in September, 1863, pointed out that the Medical Building must be enlarged or its door closed to many students. In his address to the new Board, at its first meeting in January, 1864, President Erastus O. Haven stated that the "greatest immediate necessity" was a new or enlarged building for the Medical Department. The finances of the University at this time were too low to meet the expense of putting up the desired addition, but on February 17, 1864, the Board

authorized such construction as soon as $10,000 had been provided from sources other than the treasury of the University. A committee was appointed to take such steps as would be expedient to raise the sum from the citizens of Ann Arbor. Noteworthy is the fact that Dr. Douglass was appointed to this committee and that the next day he introduced to the Board a committee of the citizens of Ann Arbor, who indicated that the sum of $10,000 would be raised by subscription, with the expectation that this money would be repaid as soon as the legislature approved a general tax or a bond issue for that purpose. The money was soon subscribed, and on March 29, 1864, the Board let a contract for $20,615 for the addition to the Medical Building and appointed Dr. Douglass to superintend the work. The legislature, a year later, legalized the bond issue by the city of Ann Arbor.

The addition to the Medical Building was sixty feet square and four stories high, with two large lecture rooms or amphitheaters, each containing comfortable bench seats for about six hundred persons. The top floor provided a new and enlarged dissecting room. The addition came very opportunely, since the number of students in 1864-65 rose to 414. Dr. Moses Gunn in 1866-67 delivered his last lectures in surgery to 525 students, probably the largest medical class in this country up to that time.

As long as the method of instruction was by lectures and recitations, the enlarged old Medical Building served its purpose. But by 1886 it was apparent that new rooms and more space were required for the rapidly developing sciences. The legislature was requested to provide funds for the erection of new laboratories. It responded, in 1887, by the grant of $35,000, which obviously was insufficient to meet all the demands for space. Of this appropriation, the sum of $30,000 was allotted for the construction of a new building to house the Department of Physics and the newly created Hygienic Laboratory. This building was ready for occupancy in the fall of 1888. In the meantime, the Regents authorized the erection of an anatomical laboratory, which was occupied in 1887. This building was used as a laboratory until 1903, when it was turned over to the Buildings and Grounds service. The removal of anatomy from the old Medical Building allowed space for the Physiological Laboratory under the direction of Dr. Henry Sewall. At the same time, space was provided for histology and, a little later, for pharmacology.

All this change, however, was only temporary. The full impact of the advances in medical sciences was felt in the nineties, and enlarged and better equipped laboratories were needed. In 1901 construction was started on the West Medical Building. This was completed in 1903 at a cost of approximately $137,000 and provided space for hygiene, bacteriology, physiological chemistry, anatomy, histology, and pathology. Physiology and pharmacology were taught in the old building until, with the construction of the Chemistry Building, space was made available in the old Chemical Laboratory, which was fitted up for them in 1909.

In 1923 construction of the East Medical Building was begun, and in 1925 physiology moved into its new quarters. In 1926 anatomy, histology, bacteriology, and the Pasteur Institute occupied quarters in this building, which was erected at a cost of $858,283. The West Medical Building provided expanded space for hygiene, physiological chemistry, and pathology.

The Curriculum. — The course of study as given at the time of the opening of the Department of Medicine and

Surgery consisted of four lectures daily, or twenty lectures or recitations a week, two hours in the morning and two in the afternoon. Saturday was reserved for the reading of theses and for clinical instruction.

Each of the five professors gave four hours of instruction a week. Dr. Allen presented materia medica; Dr. Douglass, chemistry; Dr. Denton, theory and practice; Dr. Gunn, anatomy; and Dr. Sager, obstetrics. In the first report it was stated that "quite a number of clinical lectures" were also given, and that sixty-four students entered their names among the dissecting classes.

The second Announcement, for 1851-52, mentions surgical operations performed before the class and states also that "during the past term numerous patients availed themselves of this privilege." While gratified by this demand on the part of the then small population in and about Ann Arbor, the faculty could not refrain from making adverse comments on clinical teaching as a "hasty walk through the wards of a hospital" and emphasized that "Clinical Instruction … is far better imparted in the walks of private practice … than can be done even in the best regulated hospital." This view was repeated in subsequent announcements, but was eliminated in that of 1856-57, the reason doubtless being that by that time the number of medical and surgical cases presenting themselves for treatment had increased, and the desirability of a hospital was perhaps recognized.

From 1857 to 1859, Dr. Zina Pitcher conducted a summer clinical course in the hospitals of Detroit. A surgical clinic was held by Dr. Gunn, in Ann Arbor, in 1858-59, on Wednesdays and Saturdays. These two days continued to be used for medical and surgical clinics until 1884 when clinics became an everyday routine (see Part V: University Hospital) .

A striking feature of the program in 1850-51 was the requirement compelling the student to attend the same lectures again in the second year. This practice continued when the course was extended to nine months and even when it was lengthened to three years. Thus, the medical Announcement of 1889-90 stated "that attendance upon … lectures on the same subject a second time … is much more interesting … and profitable than the first; and hence they require students to attend lectures on all the leading subjects more than once." With the inauguration of the four-year course in 1890-91, this custom came to an end.

One of the requirements for graduation, as laid down in the Rules adopted by the Regents in 1850, was that the student "shall exhibit evidence of having pursued the study of Medicine and Surgery for three years, with some respectable practitioner of Medicine." This was interpreted as including two full courses of lectures. It was the accepted practice of that time for a student to serve as an apprentice with a physician, known as a preceptor. In the medical Announcement from 1877 to 1890, the preceptors' lists show that the role of the preceptor was diminishing with the passage of time, for members of the faculty were frequently named as preceptors. The formality of this requirement ceased with the organization of the four-year course.

In 1850 each candidate for graduation was required to write an original thesis which was to be read and defended before the class. These theses or essays were bound and duly deposited with the faculty. A thousand of them, more or less, now repose in the Michigan Historical Collections of the University. According to the Announcement of 1852-53 and that of 1875-76, the thesis could be written in English, German, French, or

Latin. With the nine months' course, effective October 1, 1877, and the prominence given to written examinations, the final thesis ceased to be required.

The Rules of 1850 make no mention of practical anatomy as a requirement for the M.D. degree. This may have been an omission to allay public feeling, or it may have been caused by the difficulty of securing enough subjects for dissection. In the first Announcement of the Department, 1850-51, it is stated that "arrangements have been made by which an ample supply of materiel for the department of anatomy has been secured." It was not until 1852-53 that the student, as a requirement for graduation, "must have been engaged in the study of Practical Anatomy." It thus became the first required laboratory course in the Medical Department. Two dissections were required in the first or second year, and these called for twenty to twenty-four weeks of daily laboratory work. After a few years all the work was placed in the first year. In 1941 a total of 433 hours were required in gross, applied, and topographical anatomy.

As already indicated, beginning with 1850 chemistry was a part of the didactic course. Optional laboratory work was offered early, but it was not until the Chemical Laboratory was built that the work was developed. Thus, in the medical Announcement of 1858-59, for the first time a course in Practical Chemistry was offered. This course covered qualitative analysis, urine analysis, and toxicology. When the laboratory was enlarged it became possible to instruct all medical students. Hence, in 1865-66, the requirements for graduation stated that the student "must have been engaged in the study of Practical Anatomy and Practical Chemistry." Thus, practical chemistry became the second required laboratory course.

This course as given in 1875-76 required ten to sixteen weeks of afternoon work. In 1881-82, both Qualitative Chemistry and Urine Analysis called for six weeks of afternoon work. In 1883-84 and thereafter, each course required twelve weeks. They became the second and third required laboratory courses. With the raising of the entrance requirements in 1909 to sixty hours of collegiate work, including general, organic, and qualitative chemistry, as well as physics, these subjects ceased to be a part of the medical curriculum. Chemistry had been taught in the Medical Department for fifty-nine years.

The beginning of histology may be said to go back to 1869, when Dr. Ford was given the additional title of Instructor in Microscopy. It is known that Ford gave demonstrations of histological structures. The recognition of the importance of the subject led to the establishment, in 1877, of the Physiological Laboratory, which in 1881 was renamed the Histological Laboratory. The practical course consisting of "fifteen lessons of afternoon work" was still elective in 1880-81, but became required in the following year, as a part of the new three-year schedule. It, therefore, became the fourth required laboratory course. Under the four-year curriculum, the laboratory work was extended to six weeks and in 1900-1901 to nine weeks. Subsequently, the laboratory work was greatly enlarged by the addition of embryology and neuroanatomy, so that by 1941, a total of 275 hours was required for graduation. Including lectures, the aggregate of hours amounted to 371.

With the appointment of Dr. Sewall in 1882, the lecture course in physiology became a required subject. An optional course in modern laboratory methods was offered by him in 1883. His successors also offered elective laboratory work. With increased facilities and

space, provided in 1904, laboratory instruction became required of all medical students. The course called for daily afternoon work for eight weeks, requiring twelve hours weekly in the second semester. The lectures and laboratory work, in 1941, totaled 271 hours.

Modern pathology had its beginning in the Medical Department when Dr. Heneage Gibbes entered upon his service in January, 1888. The lecture course was supplemented by an optional course, in practical pathology, open to senior students. The latter course became a required study for juniors when the four-year course went into effect in 1890.

A special course in the Pathological Laboratory, of twelve to fifteen weeks' duration, was listed from 1885-88, given, presumably, by Dr. Herdman. In addition to Practical Pathology a course in Practical Bacteriology was offered in 1889-90, at which time the department was housed in the basement of the Anatomical Building. Gibbes, as a member of the British Cholera Commission of 1885, had had some experience with the cultivation and staining of bacteria, but he had very little faith in their importance. The course was offered once again, in 1891-92, but it had no attraction owing to the extended course in bacteriology given in the Hygienic Laboratory.

In 1892 the Pathology Laboratory was moved to the recently vacated Homeopathic Hospital Building, where it remained until 1903. In 1895, the Department of Pathology was merged with the Department of Medicine. Dr. George Dock gave the lectures, and the laboratory work was assigned to Dr. A. S. Warthin, as Instructor in Pathology. With characteristic energy and enthusiasm he developed the work of the department. At the same time he himself rose rapidly in rank, becoming Professor of Pathology in 1903, which position he held until his death in 1931.

At first the laboratory work in pathology required daily afternoon work over a period of five weeks. In 1898 it was lengthened to eight weeks. In 1903 the laboratory was moved to its present quarters in the West Medical Building and the work continued to be given to the juniors until 1912, when it became a sophomore course. A total of 352 hours in lectures and laboratory was required in 1941.

The medical Announcement for three years, from 1885-87, listed a course of ten lectures on the Study of Bacteria. However, the first laboratory course in bacteriology was started in January, 1889, in the then new Hygienic Laboratory. It consisted of daily afternoon work for a twelve-week period. At first, it was optional for literary and medical students, but with the establishment of the four-year course in 1890, it became a required sophomore study. Though described in the text of the medical Announcement for 1889-91 as a course in bacteriology, in the schedule of studies it was listed first as Etiology and then for two years as Practical Hygiene. It finally appeared, in 1892-93, under its real name, Bacteriology. Actually, instruction in laboratory bacteriology began not, as sometimes stated, in 1892 but in 1889.

The lecture course in general bacteriology was given four times weekly throughout a semester from 1890 to 1938, when it ceased to be a requirement for medical students. The length of the course has varied from eight to sixteen weeks and has required from 160 to 320 hours.

The laboratory course in electrotherapeutics, which was optional under the three-year curriculum, became required when the four-year curriculum was adopted. It was taken by the second-year class, three hours daily for six weeks. In 1903 it was combined with the demonstration

course and given in the third year. For two years after the death of Dr. Herdman in 1907 it was listed as an optional course and then was eliminated. At the same time "Electrotherapeutics" was dropped from the title of the chair held by Dr. Herdman since 1899.

The appointment of Dr. J. J. Abel marked the beginning of the Pharmacology Laboratory. Unfortunately, the space allotted for his work was limited. His successor, Dr. A. R. Cushny, established the Pharmacological Laboratory in two rooms in the old Medical Building in 1894 and gave the first course in practical pharmacology. This course was open to the third-year class as an elective and required four afternoons each week for a period of six weeks. The removal of histology from the building in 1903 provided additional space so that in the following year the laboratory work in pharmacology became a required eight-week course for the second-year class. In 1910, the department obtained better quarters when it moved to the old Chemical Laboratory. This space was doubled in 1925, when the Department of Physiology was transferred to the East Medical Building. The total of hours, lectures, and laboratory required in pharmacology, materia medica, and therapeutics in 1941 amounted to 192 hours.

The four-year curriculum was characterized by the separation of the preclinical and clinical courses. The first two years were devoted to lectures and laboratory work in the scientific subjects, and the last two years were given to clinical instruction. The demonstration courses in the third year, introduced into the curriculum in 1892, have in a certain sense carried on the idea of laboratory instruction. The consideration of these courses belongs, however, under the section dealing with the development of the Hospital.

The elective system in the Department of Literature, Science, and the Arts came into full operation in 1878, when it was extended to sophomores and juniors. One result of this new departure was the opening of a large number of courses to election by the students. Moreover, the number of elective courses increased from year to year. Courses such as physics, general and organic chemistry, and qualitative analysis, which were required studies in the Medical Department, could be elected by the prospective medical student. A little later, such a student was offered courses in hygiene and physiology as well as lectures and laboratory work in bacteriology, histology, and physiological chemistry. The student electing and completing these courses received full credit upon entering the Medical Department, thereby shortening his medical course by a year or more.

With the adoption of the four-year medical course it became evident that some formal control and recognition should be given to this method of meeting the requirements for graduation in the two departments. In 1892 a combined course was established, and the student was asked to register in the Department of Medicine and Surgery at the close of his third year in the Department of Literature, Science, and the Arts. The student thus had a double registration in order to meet the time requirement of four years in the Medical Department. This combined course was the first of its kind in the University, and for that matter, the first in the country.

At first all required courses for the first two years in the Medical Department, with the exception of anatomy, were listed as electives in the Department of Literature, Science, and the Arts. Later, although anatomy also became an elective, regional and surgical anatomy, electrotherapeutics, and

pathology did not. The student taking the combined course received the bachelor of science degree in four years and the degree of doctor of medicine two years later.

The combined course was also open to the candidate for a bachelor of arts degree, and the two degrees could be earned in six years. Thus, in the medical Announcement of 1902-3, it was stated that "a student who has completed sixty hours of work in the Literary Department is permitted to enter the Medical Department, and when he has obtained sixty more hours of credit in those subjects which are accepted by the Literary Department, he can obtain the degree A.B."

This held true until 1908, when an important change was made. The bachelor of science and doctor of medicine degrees were awarded, as before, upon the completion of six years of study. But the candidate for a bachelor of arts degree was required to have ninety or more hours of credit before registering in the Medical Department. Upon completion of the first year in medicine he was recommended for the bachelor of arts degree. The combined course for the two degrees, bachelor of arts and doctor of medicine, henceforth required seven years.

Candidates for the bachelor of science and doctor of medicine degrees were eligible for double registration upon the completion of sixty hours of credit and could obtain the two degrees in six years. In 1914 the candidate for these two degrees was required to have seventy-five hours of credit before enrolling in the Medical Department. This meant that the combined course covered six years and one or two summer sessions. The degree was designated as bachelor of science in medicine.

The combined course of bachelor of science in medicine and doctor of medicine virtually ceased in 1931, when the admission requirements to the Medical School were raised from seventy to ninety hours. The student, therefore, was obliged to have ninety hours in order to enter upon the combined course. Upon the completion of the work of the freshman year he received the bachelor of arts or, at his option, the bachelor of science degree.

Those desiring to enter upon a combined course were required to have a uniform record of good scholarship. In 1921 this was expressed in terms of points. The applicant for the combined course was expected to have earned at least one and one-third times as many points as hours. In 1930 this requirement was raised to one and one-half points; and in 1937 to one and three-fourths points. In 1940, with the new grading system, this became two and three-fourths points.

A combined course in pharmacy and medicine leading to the degrees of bachelor of science in pharmacy and doctor of medicine was started in 1925, but was discontinued in 1931. The candidate was required to have ninety-six hours of credit before enrolling in the combined course. Upon completion of the first two years of the medical curriculum he was given the degree of bachelor of science in pharmacy.

The Fees. — The Organic Act of 1837 specified that "the fee of admission to the University shall never exceed ten dollars; and it shall be open to all persons resident in this state … without charge of tuition …, and to all others under such restriction and regulations as said regents shall prescribe." Acting under this provision the Regents, in the Rules of 1850, required that every student entering the Medical Department pay ten dollars as an initiation fee. In the Announcement of the first session of the department this fee was designated as a matriculation fee. No other fee was

exacted of the student and no distinction was made between Michigan residents and nonresidents.

Since the matriculation fee was paid but once, it follows that the expense to the student taking the two-year course was but five dollars a year. By contrast, the fees prevailing in other medical colleges which were essentially proprietary ranged from sixty-five dollars to one hundred twenty-five dollars a term, the income being divided among the professors. At Michigan, however, the medical professors from 1850 to 1869 received salaries of one thousand dollars each, paid by the University out of its income. The one exception to the foregoing statement was Dr. Douglass, who taught students of the Literary Department as well as those of the Medical Department, and for the double duty he received a salary of fifteen hundred dollars.

The matriculation fee for Michigan residents has always been ten dollars. In the case of nonresident students it has changed first to twenty dollars and then to twenty-five dollars. The Announcement of 1852-53 required each student to make a deposit of one dollar to cover possible damages, the balance to be returned to him at the close of the term. This practice continued until 1862. In 1852 the fee for a diploma, which at that time was printed in English, was fixed at two dollars; in 1877 it was raised to ten dollars, where it remained until 1936. In 1878, at the request of the medical students, the diploma was printed in Latin.

A moderate but new source of income was instituted in 1858 with the incidental or annual fee of five dollars. This was required of all medical students. In 1866 it was increased to ten dollars. In 1874 this fee was again increased, but this time a distinction was made between Michigan residents and nonresidents: the former paid fifteen and the latter twenty dollars. From that time the annual fee increased and a differential of ten dollars was maintained for many years.

In addition to the annual fees, the student, as the practical work developed, was called upon to pay laboratory fees, which eventually became considerable. At the same time the general expenses of the University increased. Accordingly, in 1916 the plan was developed of combining annual and all laboratory fees in one sum, which for Michigan students was set at one hundred dollars and for nonresidents at one hundred twenty dollars. In 1933 the annual fee was replaced by semester fees.

In 1936 the matriculation and diploma fees were absorbed in the semester fees, which for Michigan residents amounted to one hundred ten dollars, and for nonresidents, to one hundred seventy-five dollars, payable each semester. In 1940 the semester fees became one hundred twenty-five dollars for Michigan residents and two hundred dollars for nonresidents.

The Term. — At the time of the opening of the Medical Department in 1850, there was probably no medical college in the country which had a term exceeding four months in length. The Regents, having under consideration the question of a Medical Department, in January, 1847, recommended that the term of lectures be six months. In July, 1848, a committee was appointed to report on the prerequisites for admission to the Medical Department. This committee consisted of Dr. Zina Pitcher, as chairman, two additional Regents, Dr. Abram Sager, and Dr. Silas H. Douglass. In the committee's report of January, 1849, it was recommended among other things that "the course of Lectures and Recitations … shall occupy one entire year, to be divided into three terms, namely, one of fifteen weeks, one of fourteen weeks, and one of eleven weeks" (R.P.,

1837-64, p. 417). This would correspond to the forty-week session of the Department of Literature, Science, and the Arts.

In the meantime considerable opposition arose concerning the proposed long term, and Dr. Pitcher was obliged to yield. The Rules presented and adopted in July, 1850, provided that "the Course of Study … shall commence the first Wednesday in October and continue until the first Wednesday in April" (R.P., 1837-64, p. 469).

For some reason the Announcement of the Medical Department for the first three years gave the end of the term as the "third Wednesday in April," probably to end with the spring vacation in the Literary Department. Actually, the first two commencement exercises were held on April 21, 1852. During the first year of President Henry P. Tappan's administration the exercises were also held in April.

As early as 1857 the medical faculty asked that the term be extended to nine months, but this request was tabled, and a year later the Board decided that the change was not expedient. In 1876 the Regents' committee presented a report recommending a full nine months' course beginning in October, 1877, and this was adopted.

In the Announcement of the Medical Department for 1877-78, full prominence was given to the extension of the course to nine months. It was also stated that students entering for the term of 1877-78 would be provided with a graded course of instruction covering three college years. This three-year course was clearly optional, since the requirement for graduation was "at least two full courses."

The optional three-year course paved the way for the next step, which was taken in 1879 and which provided for a full three-year graded course to be required of all students after October 1, 1880. Improved hospital facilities were provided, and laboratory work in anatomy, qualitative and physiological chemistry, and histology was required.

The next and final step was taken in 1887, when the faculty requested that the course be extended to four years of nine months each. The Board considered the request, presented by Dr. Palmer and Dr. Herdman, but it was temporarily tabled. The death of Dr. Palmer, in December, 1887, and the subsequent agitation about the removal of the department to Detroit, delayed action on the recommendation. However, in June, 1889, the Board acted, requiring "all students who enter [the Medical] Department after July 1, 1890, … to pass four years of professional study before graduation" (R.P., 1886-91, p. 323). Ford had succeeded Palmer as Dean, but the work of reorganization devolved upon Dr. Vaughan. In June, 1890, the faculty presented a plan for a four-year graded curriculum which was adopted by the Board. In June, 1891, Dr. Ford resigned the deanship. He was the last of the deans to be elected by the medical faculty.

Admission. — The committee appointed to frame regulations for the organization of the Medical Department provided the following entrance requirements in their report in 1849:

Every candidate for admission shall present satisfactory evidence of good moral character; shall pass an examination satisfactory to the Faculty in English Grammar, Geography, Arithmetic, Algebra, Geometry, and Natural Philosophy, and be possessed of such knowledge of the Ancient Languages as will enable him to read and write prescriptions with facility.

R.P.

In the final Rules as adopted on July 17, 1850, the language follows that given in the first Announcement of the Medical

Department, for 1850-51, which evidently was published somewhat earlier. According to the Announcement:

Every candidate for admission shall present to the Faculty satisfactory evidence of good moral character, and also of such literary attainments as have been recommended by the National Medical Association, viz: — "A good English education, the knowledge of Natural Philosophy, the Elementary Mathematical Sciences, and such an acquaintance with the Latin and Greek languages as will enable the student to appreciate the technical language of medicine, and read and write prescriptions."

Primary Announcement of the Course of Lectures in the Medical Department …

In order not to frighten away prospective applicants the Rules provided that "these literary requirements shall not be insisted upon for the first two years, until the student becomes a candidate for the degree of M.D." This latter provision was stretched somewhat, for in the third to the ninth Announcement the rule regarding admission stated that "each candidate for admission … must be provided with satisfactory evidence of good moral character, and, if a candidate for graduation, also of such literary attainments as have been recommended by the National Medical Association. …" Under this requirement any person "of good moral character" could enroll in the Medical Department for at least a year, and then if he could not qualify for further study toward the degree he was free to go to another college or he could cease the study of medicine altogether. That this was actually the case for many years is seen in the great disproportion between the number of students enrolled and the number of graduates. As early as 1852, in connection with the request to have the graduation fee lowered from five to two dollars, the awareness of the faculty in this matter is indicated in its report by the statement "that the tendency will be to convert this College into a merely Preparatory School for students who wish to graduate in other Colleges." Similarly, the request of the faculty, in 1857, for an extension of the course from six to nine months may have been actuated by the fact that students upon completing the first year's work in March could enroll in some other college and even receive a medical degree a few months later.

In the Announcement of 1861-62 the admission requirements were slightly modified to read:

Every candidate for admission shall exhibit to the Faculty satisfactory evidence of a good moral and intellectual character, a good English education, including a proper knowledge of the English language, and a respectable acquaintance with its literature, and with the art of composition; a fair knowledge of the Natural Sciences, and at least, of the more elementary Mathematics, including the chief elements of Algebra and Geometry, and such a knowledge of the Latin language as will enable him to read current prescriptions, and appreciate the technical language of the Natural Sciences, and of Medicine.

This requirement did not call for an oral or written examination. As a matter of fact no medical college in the country, then nor for many years afterward, required an examination for admission. The requirement continued in force until 1874.

The question of requiring examinations of candidates for admission to the professional schools, Law and Medicine, came up in 1872, and the Regents directed "the Professor … [to] make such inquiries of the applicants …, as will enable them to report understandingly upon the actual extent of preliminary education possessed by such applicants." The result of that inquiry is unknown, but, in June, 1873, the State Medical Society, through a committee,

conferred with the Board, and the matter "was referred to the Committee on the Medical Department, together with the medical faculty."

After lengthy discussions the admission requirements were strengthened in October, 1874, and presumably included written examinations. The medical faculty in their annual report for that year reported a "considerable increase of numbers notwithstanding the rejection, for deficiency in preliminary preparation, of a number of applicants." The following year the report of the faculty indicated "more than a dozen rejections." President Angell, in his report for 1874-75, stated that "an examination for admission was held. Though the requirements were very slight, it was found necessary to reject some of the applicants, whose ignorance was profound." He went on to express his belief "that no other Medical school in the Union yet holds an examination for admission." Under the circumstances the medical faculty could justly claim this to be a "pioneer movement in Preliminary Examinations in American Medical Colleges."

The requirements for admission, as given in the medical Announcement for 1875-76, were formulated by the committee referred to, and as such were quite different from those of the preceding twenty-five years. For the first time diplomas or certificates of graduation from colleges, academies, and high schools were officially recognized. Moreover, the examinations of those not provided with such credentials were to be in writing. Thus, the requirement states that, in addition to being eighteen years of age and of good moral character, "unless already a matriculant of the University or a graduate of some respectable college, academy or high school" every candidate was to take an examination in writing, which was to "cover the ordinary branches of an English education." Until 1889 the examinations were written, but with the announcement of the four-year course in that year, although required, they no longer had to be taken "in writing." In 1875 Latin ceased to be required, but in 1892, two years after the extension of the course to four years, Latin became a required subject, and it continued to be such until 1936.

A change in the admission requirements was announced in 1878 which may have lowered the standard of 1875. Thus, "graduates or advanced members of some academy or high school" were exempted from taking the examination. Apparently, a full academy or high-school course was not considered necessary; however, in 1889, this was changed to "graduates of literary colleges of good standing, graduates of the schools approved as diploma schools in the Literary Department and of other High Schools of equal standing."

The statement concerning the written examination of 1878 was more explicit than that of 1875 as to subjects required: "Arithmetic, Geography, History, Forms of Government and current events" and the candidate was "particularly … required to correct imperfect English." These subjects were amplified in 1885 and the first science, elementary zoology, was added.

The requirements of 1892, eight in number, were more exacting than at any previous time. Emphasis was placed on subjects considered essential to the proper study of medicine rather than upon the possession of a diploma.

The minimum age limit for admission, which in 1875 had been set at eighteen years, was lowered to seventeen in 1893, doubtless to meet the twenty-one years' requirement for graduation. It ceased to be mentioned after 1900.

In 1897, instead of a classical or Latin diploma, a formal certificate was required

of the high-school principal showing that the candidate had passed in certain prescribed subjects. The applicant was exempted from examination only in those prescribed subjects covered by the certificate. He could take the examination in the uncertified subjects, or he could be accepted with a condition, which had to be removed within a year. No student was permitted to have more than two entrance conditions.

In 1903 graduation from an approved high school or its equivalent became mandatory. For unconditional acceptance, the applicant was expected to have had two years of collegiate instruction in addition to his high-school course. High-school certificates continued to be used until 1909, when the applicant for admission was required to have the equivalent of sixty hours of credit (two years of collegiate work), and also to have credentials showing "an acquaintance with Latin and a fair reading knowledge of either German or French, and a year of collegiate work in Biology (Zoology and Botany), Chemistry and Physics."

The requirements of 1909 practically called for two years of collegiate work, but it was not until 1912 that the definite announcement was made that "no student will be admitted to the school who has not completed two years of college work, in addition to graduating from an approved High School, or its equivalent." The applicant was, moreover, required to have credit for the five subjects prescribed in 1900 and also to have had organic chemistry. The subject requirements have undergone little change since 1909.

Graduation. — The Rules of 1850 prescribed the conditions required for graduation. The first was that "candidates for graduation shall announce themselves as such at the close of their first course or the commencement of their second, and shall be examined upon the subjects of Anatomy, Physiology, Materia Medica, and Chemistry." This was known as the primary examination. They were further required "to write a thesis upon some Medical or Surgical subject, once in two weeks, which thesis shall be read and defended before the class, on such Saturdays as may be appointed by the Faculty."

In the Primary Announcement of the Course of Lectures (p. 9) it was further specified:

In order that any student may be recommended for the Degree of Doctor of Medicine, he shall exhibit evidence of having pursued the study of Medicine and Surgery for the term of three years, with some respectable practitioner of Medicine; (including lecture terms;) must have attended two full courses of lectures, the last of which must have been in the Medical Department of the University of Michigan — must be twenty-one years of age — must have submitted to the Faculty an original Thesis, in his own handwriting, on some Medical subject; and have passed an examination, held at the close of the term, satisfactory to the Faculty.

It was also ruled:

An allowance of one year … may be made in favor of graduates of the Department of Science and Arts, and of other respectable Literary Colleges, and respectable practitioners, of four years' standing, may be admitted to the degree of M.D., by attendance upon one Course of Lectures — on passing the requisite examination.

Rules

The provision in the Rules granting exemption of one year to college graduates continued in force until 1858, when it was changed to "six months," and this was continued until 1880, at which time the extension of the course to three years of nine months each went into effect. Thereafter, the matriculant received credit for whatever medical courses he may have taken as a literary student.

The Rules of 1850, while stating that

"all degrees shall be conferred by the Board of Regents, upon the recommendation of the Medical Faculty," contain no mention of a diploma. However, the minutes of the faculty, November 23, 1850, show that Dr. Denton and Dr. Sager were appointed as a committee to draft a form for a diploma. This draft, in English, was adopted and sent to the Board, which, in January, 1851, entrusted to Dr. Zina Pitcher the duty of procuring the engraving of the diploma and "to make such alterations in the style and embellishment thereof as he may find proper." The cost of engraving the diploma and making twenty impressions was $250.

In 1875 Dean Sager, reporting on the complaint of the students that the old diploma plate was worn out, stated "that the vignette designed to represent the Medical College and surroundings … conveys a very imperfect and inadequate idea" of their present condition. The students asked for a new plate and new diplomas. The Board decided not to procure a new plate, but recommended that an appropriation of not more than $200 be made to represent on the plate the University buildings of that time. This recommendation was adopted, but a month later the action was rescinded, and the Board directed that the representation of the Medical Building on the plate be stricken out.

The Board, in 1878, received a petition from the medical students asking that the diplomas thereafter be printed in Latin and offering to give $150 toward procuring a new plate. This request was granted provided that the cost to the University did not exceed fifty dollars. The sum of ninety dollars was received from medical students as part payment toward a diploma plate.

In the Announcement of 1852 a new requirement for graduation was added which stated that the candidate "must have been engaged in the study of Practical Anatomy." A further slight change made at this time was that the thesis had to be "composed and written by [the candidate] himself." In 1865, as a result of the enlargement of the Chemical Laboratory, the above requirement was made to read "must have been engaged in the study of Practical Anatomy and Practical Chemistry."

With the above slight additions, the requirements were the same in 1875. It was stated, however, that the candidate was required during the course, "to submit to written examinations by each Professor." The final thesis could be written in English, German, French, or Latin.

In 1877 the transition from the old requirements began as a result of the extension of the course from six to nine months and the initiation of the optional three-year course, which went into effect in 1880. In the Announcement for that year it was stated that in addition to the examination required, the candidate "may be called upon to write upon some theme … required to be defended before the class. In consequence of the prominence given to written examinations through the Course, no graduating thesis will be required." The old phrase "of having studied medicine three years" is retained but that of "with some respectable practitioner of medicine" is deleted, although the names of the preceptors continued to be published until as late as 1890.

In 1851 the faculty decided upon a ballot system. Each professor was given five votes, making a total of twenty-five possible votes. The passing grade was fixed as sixteen votes, 64 per cent. Of the seven candidates who presented themselves, one received six votes and accordingly was rejected. The remaining six candidates received from sixteen to twenty-five votes. The one to receive the

unanimous vote was Dr. Robert C. Kedzie, who, later, as professor of chemistry in the Michigan Agricultural College, became very prominent in sanitary work.

In later years each professor was given seven votes. The full vote of six professors in 1878 was therefore forty-two, and the passing grade was twenty-six votes, 62 per cent. The candidates received from twenty to thirty-seven votes; the latter, or highest, vote was received by Dr. Victor C. Vaughan.

In 1880 the candidate who received the highest number of votes, fifty-one out of a possible fifty-six, and thus graduated at the head of his class was Dr. José Celso Barbosa of San Juan, Puerto Rico, the first student to come to the University from that island. One of the youngest graduates was Dr. William J. Mayo, who lacked one day of being twenty-two at the time of his graduation in 1883.

Probably with the object of developing the best possible relations with the physicians of the state, the Regents in 1878 decided to appoint annually two of the physicians to serve as examiners. They were to act with the medical faculty at the examination of candidates for graduation and were to report, jointly with the faculty, the names of such candidates as were deemed worthy for graduation. These examiners sat with the faculty and each had the usual seven votes. Their names were listed in the announcements of the department from 1880 to 1883.

Dr. William Brodie, of Detroit, and Dr. H. O. Hitchcock, of Kalamazoo, were the first examiners to be appointed. They were succeeded by Dr. A. F. Whelan, of Hillsdale, and Dr. E. P. Christian, of Wyandotte. The next and last to be appointed was Dr. W. Parmenter, of Vermontville.

The method of balloting upon candidates for graduation continued into the late eighties. With the increase in the number of laboratory and lecture courses, a card system for keeping records was devised by the secretary, and this procedure, greatly developed, has been followed ever since. It doubtless was responsible for the discard of the old procedure of balloting on each candidate.

The requirements for graduation under the four-year course, as set forth in the medical Announcement of 1890-91, were brief and explicit. The candidate, in addition to being "twenty-one years of age" and of "good moral character," requirements handed down from the beginning, "must have completed the required courses in laboratory work, … must have been engaged in the study of medicine for the period of four years, including time spent in attendance upon lectures. He must also have passed satisfactory examinations on all the studies included in the full course of instruction."

The reporting of examinations as "Passed," "Conditioned," or "Not Passed" had been the custom for some years, but the "Rules" were not published in the medical Announcement until 1892. The condition had to be removed within a year, otherwise it became "Not Passed." These rules were modified in 1903 by the addition of "Absent" and "Incomplete." The change to letters, still in use, came in 1915, when the results of examinations were reported as: A, excellent; B, good; C, fair; D, conditioned; E, not passed.

In 1931 the candidates for graduation, in addition to having completed all required work and having passed all course examinations, were required to take a comprehensive examination covering all subjects in the curriculum. This requirement has continued in force up to the present time.

In contrast to the five hundred hours of instruction by didactic lectures, required in 1850, the schedule of instruction in 1940 called for 4,294 hours of lectures, demonstration and laboratory work, and clinics.

Enrollment. — In his first report on the Medical Department, in 1848, Dr. Pitcher said "that in two years from the establishment of a Medical Department of the University there would at least fifty students matriculate annually, the

TABLE I

Summary of Medical School Enrollment, 1850-1940

Year	Enrollment	Graduates
Men and Women	Women	Special Students	Men and Women	Women
1850-51	91	..	5	6	..
1855-56	152	..	3	30	..
1860-61	241	..	..	44	..
1865-66	467	..	2	74	..
1870-71	315	18	..	82	1
1875-76	312	37	..	93	15
1880-81	384	43	2	101	10
1885-86	327	61	2	83	19
1890-91	371	59	4	102	16
1895-96	440	68	14	52	13
1900-1901	556	41	7	77	7
1905-6	367	26	2	67	6
1910-11	260	14	6	56	2
1915-16	324	22	2	63	7
1920-21	449	36	1	71	6
1925-26	541	36	5	112	7
1930-31	574	48	4	163	14
1935-36	481	37	8	117	7
1940-41	466	36	6	117	11

number of course constantly increasing." It must, therefore, have been a gratifying surprise to the faculty to find ninety-one matriculants when the new department began its first session. Moreover, this number was appreciably larger than that in the Department of Literature, Science, and the Arts, which had an enrollment of sixty-four.

During the first four years the enrollment in medicine exceeded that in the Department of Literature, Science, and the Arts. But, in the session of 1854-55, the latter took the lead and held it until 1863, when it was again outnumbered for another period of four years. In 1867-68 the two departments tied, each having 418 students. Table I gives a summary of the enrollment in the Medical Department. The first high peak, of 525 students, was reached in 1866-67, probably because of the post Civil War influx. At the time this was the highest enrollment in any medical school in the country. The second high peak, of 556 students, in 1900-1901, marks an adaptation to the high-school requirements for entrance. The third high peak, of 664, came in 1928-29, when, as yet, no limitation on numbers had been set. It was the next to the highest attendance in the medical schools of the country. The ninth decade, that of the "depression," marked the beginning of the limitation of enrollment with the object of securing the best possible clinical instruction. The number of students in 1940 was under 500.

The Rules of 1850 (p. 6) provided that

"clergymen, members of the legal profession, and graduates of other respectable medical institutions, may be permitted to attend the course of instruction as honorary members of the Medical Department." The enrollment under this provision is given in Table I in the column designated "special students." The custom apparently ended in 1866. Of the honorary members, eight were clergymen, twelve were medical graduates, and two were without designation. As the work in the laboratories developed, students not enrolled in the regular medical course applied for instruction in certain fields and were designated as "special students."

The students who enroll in any one year, obviously, do not all remain in school. Various causes contribute to the decrease in the number of students in any one class. A very important factor during the first three decades was the lack of clinical facilities, which caused students to migrate to other schools in large cities. This migration was lessened somewhat by the erection of the Pavilion Hospital on the campus in 1876; it decreased still more after 1892, when the then new Hospital was occupied, and soon ceased altogether. Another possible reason for the decrease recorded was that the student who had taken one year in medicine could go out and practice the art without having a medical diploma, since, at that period, there were no legal requirements.

Scholastic and financial difficulties, as well as illness and unfitness, have always been factors in decreasing the number of a graduating class. In general, it may be safely predicated that about one-third of those entering school in a given year do not graduate at the end of the four-year period, although some of these may return and graduate later.

In the first session of the department, in 1850-51, the class was made up largely of Michigan students. They constituted 78 per cent of the attendance, which is a larger percentage than that of any subsequent class. Seventy-one Michigan students were enrolled as against twenty from six other states. Evidently, the existence of the new medical college was as yet hardly known outside the state.

In 1855 students from other states, excluding foreign countries, made up 77 per cent of the total enrollment, an all-time high record. In the peak year of 1866, with an enrollment of 525, Michigan students numbered 120 or only 23 per cent of the total. It was not until 1921 that the Michigan residents regained the majority which they had lost seventeen years before. In that year they had 51 per cent, with 281 residents out of a total of 552 students. From that time the Michigan residents, with slight variation, have led in the enrollment. In 1939 they reached 75 per cent, almost the same as in 1850.

During the first twenty-five years, apart from Canada, which in 1864 had fifty-four students (13 per cent of the total), the enrollment from foreign countries was very limited. The records show only one each from England, Ireland, Scotland, France, Germany, Russia, and Jamaica, and two each from Hawaii and Liberia — a total of eleven entrants from nine countries. It may be assumed that the students from all but the last three countries were immigrants and that those from Hawaii were probably the sons of American missionaries.

A steady enrollment of foreign students began in 1876. Since that time there has not been a year without representation from some foreign country.

The missionaries began to send women for medical training as early as 1878, when Burma was represented. Later, Chinese and even some Japanese came under like auspices. The most significant

help, however, came from the Levi Barbour Oriental Girls' Scholarships, which were established in 1917; these have served to train women from many Asiatic countries. Incalculable benefits have come from this most generous foundation.

Women Students. — With the adoption of the resolution permitting the attendance of women in 1870, in October of that year eighteen women entered the Medical Department, and one of them, Miss Amanda Sanford, of Auburn, New York, was graduated in the following March. She was the first woman to graduate from the University and from the Medical Department. (It should be stated that she was followed, within a half hour, by Miss Sarah Killgore, who received the degree of bachelor of laws.) Three months later, two women, Amelia and Mary Upjohn, were given the degree of pharmaceutical chemist. Thus, four women were graduated from the University in 1871.

In view of the applications from women for admission to the Medical Department early in 1870, the medical faculty presented a memorial to the Regents. They stated that "in their judgment the medical co-education of the sexes is at best an experiment of doubtful utility, and one not calculated to increase the dignity of man, nor the modesty of women." They suggested, however, that the faculty was "willing to give a full course of medical instruction to females, at any convenient time, and for a suitable compensation" (R.P., 1870-76, pp. 36, 37).

Three months later a special meeting of the Board was called for the express purpose of considering the education of women in the Medical Department, and Dean Palmer, in a brief report, reaffirmed the views of the faculty:

Declaring their clear conviction of the inexpediency of the co-education of the sexes … having in view not only the indelicacy of such common instruction …, but also … the difficulty of restraining improprieties of deportment, and checking insubordination, in large classes of mixed students …, [the faculty recommended] a complete course of instruction separate, and in all respects apart from that given to the other class.

R.P.

They also agreed to accept a remuneration of $500 for each course. This plan was then adopted. As a result of this action two separate courses of instruction were given and hence each professor gave eight lectures a week. In 1871-72 thirty-five women were enrolled in the department, indicating "a probable final and complete success."

The first and partial break in the rigid requirement of two separate courses occurred within a year, when Dr. Douglass asked to be relieved from the duty of repeating his lectures in chemistry to the ladies. This request was granted but with the proviso that he "so arrange his lectures … as to avoid introducing the students of both sexes into a common lecture room." Just how this was done is a matter of conjecture. It may be surmised that the women students were given seats in the preparation room where they could hear, and yet could not be seen by the male students.

In March, 1874, one of the Regents offered a resolution "that hereafter there shall be no separate lectures given to women in the Medical Department, and that the extra compensation … shall be discontinued." In the report on this resolution it was pointed out that the faculty assured the committee "of the impracticability of conducting certain lectures and experiments in the presence of mixed classes, and that any further attempt in this direction would seriously damage the Department." The committee also stated that the question of a reduction in salary was equally impracticable,

and recommended that the matter be referred "to the judgment and discretion of the Medical Professors."

It was not until 1881 that the subject came up again, this time on the initiative of the faculty. They asked for discretionary power on the subject of separate lectures to the male and female students of the department. The request was granted, and from that time on the segregation of the classes practically ceased.

When it came to seating the women, then often referred to as "hen-medics," in the amphitheaters of the old Medical Building, the faculty found it desirable to bar off a section to the left of the lecturer by a broad red-painted band extending from the pit to the top row of seats. Violation of that border line by either sex was unthinkable. With the erection of the West Medical Building in 1903, the red line disappeared and the co-ed was free to take a seat wherever she wished. For many years practical anatomy was pursued by the two sexes in separate rooms.

The Announcement in 1883, regarding instruction of women, added: "And such of the lectures and demonstrations as it is thought by each member of the Faculty not desirable to be presented to the combined classes, are given separately; but in most of the lectures, in the public clinics, in the chemical laboratory, and in various other class exercises, it is found that both may with propriety be united." This statement, somewhat shortened, has been handed down through the past sixty years.

The Laboratories

Chemistry. — With the completion of the original Medical Building a limited space became available for practical instruction in chemistry. The first laboratory course in chemistry, in toxicological analysis, was given in 1854 in the Medical Building by Dr. Silas H. Douglass. The demand for this work was such that Douglass felt it desirable to provide instruction after the end of the medical term. In this he gained the support of President Tappan, who in his report in December, 1855, announced that a "summer course in Practical and Analytic Chemistry" would begin the first week in April. It may be assumed that the course was intended primarily for medical students desiring such instruction, and that it was given in 1856 and 1857. This was only a temporary expedient.

In this connection it may be well to point out that another summer course was put into effect in 1857. In that year, Dr. Zina Pitcher recommended that clinical instruction be given in one of the two hospitals in Detroit and that, in order not to conflict with the claims of analytical chemistry, it should begin in June and continue until the end of September. He was appointed Clinical Instructor and the work was given in St. Mary's Hospital, which, at that time, had an average of fifty to seventy-five patients. The course in 1857 was taken by nine students; that in 1858 had thirteen students. Dr. Pitcher resigned in the spring of 1859, and the attempt at summer instruction came to an end.

How long the summer course in chemistry continued to be given is not clear, but it probably was discontinued when the Chemical Laboratory was built. At all events these two courses were modest precursors of the summer session which came about forty years later.

The erection of a chemical laboratory had been under consideration by the Regents in the forties, but the organization of the Medical Department delayed the project. It came to the front in 1855, when President Tappan pointed out the need of a chemical laboratory. The Regents responded in May, 1856, by

appropriating $2,500 for such a building, and later four additional appropriations were made, so that up to the end of June, 1857, the sum of $6,459 had been voted. President Tappan, in his report for 1856 and 1857, referred to the new analytical laboratory as "the most complete and efficient in our country." It was situated just west of the Medical Building, probably to accommodate the large number of medical students.

The laboratory was a small building, with only twenty-six tables, but to Dr. Douglass it was the realization of the dream of a decade. It was the first chemical laboratory in a state university. Within a year after its completion, realizing the need of gas in chemical work, Dr. Douglass organized the Ann Arbor Gas Company. He was permitted in June, 1858, to lay gas pipes from the street to the laboratory at his own expense and to charge students for the use of gas. Six months later, permission to use gas in the Medical Building was granted under like conditions. The title to all gas pipes laid upon the University grounds and in its buildings was acquired by the University, in 1860, by the payment of $350 to Dr. Douglass.

With a steady increase in enrollment there came an ever-increasing demand for practical instruction in chemistry. As many as seven additions or alterations were made to the laboratory, first in 1861, and later in 1866, 1868, 1874, 1880, 1889, and 1901. For years, most of those who took practical courses in "the Laboratory," as it was generally known, were medical students. Thus, in 1871-72, of the 267 students who took lectures and laboratory in chemistry, 195 or 73 per cent, were medical students. At that time there were 135 tables. In 1878 and 1879 the Chemical Laboratory had 374 students, twenty-eight of whom were from the Department of Literature, Science, and the Arts and 346 from the Dental, Medical, and Pharmacy departments. After the last addition to the old building, in 1901, there were 362 tables available. The continued increase in students called for the construction of an entirely new building, with 634 tables, which was occupied in 1909 (see Part III: Department of Chemistry) .

With the opening of the Medical Department, in 1850, instruction was given by five professors, each of whom taught four hours a week. Chemistry was coequal with the four medical subjects. As the Chemical Laboratory developed, emphasis was placed on practical instruction in qualitative analysis, toxicology, and physiological chemistry.

General Chemistry including physics was given by Dr. Douglass until 1877. The work was then taken over by John W. Langley, who taught it until 1889 when he resigned. His successor, Dr. Paul C. Freer, greatly developed the course. Dr. Samuel Lawrence Bigelow succeeded to the chair. The subject became an entrance requirement in 1900.

After 1889 the instruction in physics was given for medical students by an instructor in general chemistry. Thus, Dr. D. M. Lichty taught the course from 1891 to 1901. It was then given by Dr. John O. Reed, of the Department of Physics, until 1906. The subject had been a prerequisite for entrance to the Medical School since 1892.

Qualitative Chemistry was at first optional, but became required for medical students in 1866 and so continued until 1900, when it became an entrance requirement. This laboratory course at first required daily afternoon work for seven weeks and later was extended to twelve weeks.

With the appointment of Dr. A. B. Prescott as Assistant Professor of Chemistry and Lecturer on Organic Chemistry, in June, 1865, the first separate course in organic chemistry was given.

He continued to lecture on this subject to medical students up to the time of his death in 1905. The course was then continued by Dr. Moses Gomberg who taught it until 1909, when it became a premedical requirement.

Physiological Chemistry. — Laboratory instruction in medical chemistry, such as urine analysis and toxicology, began very early. Such work was optional and was carried on in the old Medical Building. With the erection of the Chemical Laboratory more students availed themselves of the opportunity. The report of the Chemical Department for 1871-72 states that toxicology was taken by eighteen students and "urology" by 143 students. Thus, of the 350 students in the Medical Department, nearly one-half took the latter course, the instruction being given by Dr. P. B. Rose, a graduate of the medical class of 1862. Rose had served as an assistant in the Chemical Laboratory in 1861-63 and 1866-75.

In October, 1875, Dr. Rose was appointed Assistant Professor of Physiological Chemistry. This probably was the first use of that title in this country. Because of a laboratory defalcation Rose was suspended on December 21, 1875 (see Part I: The Douglas-Rose Controversy) .

In 1877, a joint committee of the legislature made an "investigation" and concluded that Rose was innocent and asked for his restoration. The request was repeated in February, 1879, and the Board thereupon appointed him Assistant Professor of Physiological Chemistry. In June of that year he was named Assistant Professor of Physiological Chemistry and Toxicology and Lecturer on Renal Diseases.

A decision of the Supreme Court, in January, 1881, exonerated Dr. Douglas, the Director of the Chemical Laboratory, and awarded him a judgment against the University. Thereupon, Dr. Rose resigned, as of October, 1881.

The immediate result of the suspension of Dr. Rose, in December, 1875, was the appointment of Victor C. Vaughan as temporary assistant in the Chemical Laboratory. In June, 1876, he was given the permanent appointment, which he held until 1879. At the same time, having obtained his Ph.D. degree in 1876, he enrolled in the fall of that year in the Medical Department and received his M.D. degree in 1878.

In 1879 Dr. Vaughan was made Lecturer on Medical Chemistry and Assistant in the Chemistry Laboratory. In November, 1880, he became Assistant Professor of Medical Chemistry and Assistant in the Chemical Laboratory. In 1883 he was made Professor of Physiological and Pathological Chemistry and Associate Professor of Therapeutics and Materia Medica.

On the creation of the Hygienic Laboratory in 1887, Vaughan was given the title of Professor of Hygiene and Physiological Chemistry, and he lectured on these subjects until his resignation in 1921. Dr. Vaughan was Director of the Hygienic Laboratory from 1887 to 1909. He gave the laboratory work in physiological chemistry until 1891, when it was taken over by Frederick G. Novy, who conducted it until 1921. Dr. E. B. McKinley carried on the laboratory work for the following year, when Dr. Howard B. Lewis was appointed Professor of Physiological Chemistry. In 1935 the name of the department was changed to Biological Chemistry.

When Vaughan began to teach physiological chemistry only two poor microscopes were available. In 1876 he obtained six more, and in 1879 another lot of six was added. This was at a time when microscopical work was all but unknown. The committee on microscopes reported in June, 1882, that at that time

there were 104 microscopes in the University, and forty-two of these were reported by Dr. Vaughan.

With the 1880 addition to the Chemical Laboratory, physiological chemistry acquired a large room with forty-eight tables and a room for microscopes and microscopical examinations. A room was also provided for Dr. Vaughan. In 1903 the work was transferred to the present West Medical Building, where it is still given.

The Anatomical Laboratory. — This was actually the first laboratory on the campus. In July, 1849, a year before the Medical Department opened, the Regents appointed Dr. Moses Gunn to be Professor of Anatomy and to discharge such other duties as might be prescribed. He was then twenty-seven years old and the only candidate for the position. As his real interest was in surgery, although he lectured on anatomy, the practical work was turned over to a demonstrator.

In July, 1851, Dr. Edmund Andrews was appointed Demonstrator of Anatomy and Superintendent of Grounds. Three years later he became Professor of Comparative Anatomy and Demonstrator of Human Anatomy. It may be inferred from this title that the course in practical anatomy was based to some extent on animal dissection. Andrews was capable and energetic and as Superintendent of Grounds he devised a comprehensive plan for the planting of trees on and around the campus. At that time the campus, as well as the bordering streets, was treeless. His plan called for 1,640 trees. In June, 1855, he resigned his position and went to Chicago, where he soon rose to distinction.

As early as July, 1851, the Regents had passed a resolution stating "that no anatomical subject shall be introduced into the Medical Building or brought upon the grounds of the University except through the agency of the Professor of Anatomy, and any student of the University violating this resolution shall be expelled" (R.P., 1837-64, p. 497). It may be inferred from this that during the first year medical students had attempted to act as "resurrectionists." Without doubt, during the next twenty-five years, as many stories seem to indicate, material was obtained from outside sources. It may be assumed that from the beginning an important duty of the demonstrator of anatomy was to supply material for dissection. The financial reports included in the early Regents' Proceedings, with one exception, throw no light upon the cost of such supplies. This exception perhaps entered the records inadvertently. For the session of 1861-62, the Demonstrator of Anatomy listed: "To expense of procuring 45 anatomical subjects — $1,367.46."

Students in increasing numbers elected work in practical anatomy, which, of course, they would not have done if there had been a scarcity of anatomical subjects. As a result increased space for dissection had to be provided. The anatomical law of 1875 provided relief from the difficulties of the past and assured a solution of the problem for the future. Even then the Regents, in appointing a professor of practical anatomy (1875), required that he "shall give his attention to the procuring of anatomical material." Two years later the demonstrator of anatomy was "charged with the duty of procuring the supplies of material needed for the use of the students." During the succeeding years action had to be taken frequently because of attempts to evade the law by those whose duty it was to send unclaimed bodies to the Anatomical Laboratory.

Dr. Moses Gunn, in July, 1852, was made Professor of Surgery and Lecturer on Anatomy. At the same time Dr. Alonzo B. Palmer was named Professor

of Anatomy. He never served in that capacity; in 1854, after the dismissal of Dr. Jonathan A. Allen, he was given the chair of materia medica and diseases of women and children.

In 1854 Dr. Gunn relinquished his work in anatomy, but served as Professor of Surgery until he resigned in 1867 to accept a position at Rush Medical College in Chicago. When Gunn had been a student at Geneva Medical College Dr. Corydon L. Ford was the demonstrator of anatomy. The two became intimate friends, and in discussing their futures the young Gunn dreamed of the time when they would be associated in a medical college, he as professor of surgery and Ford as professor of anatomy. The dream came true in 1854, when Dr. Ford was offered and accepted the professorship of anatomy at the University of Michigan. At the same time Dr. Edmund C. Andrews was made Professor of Comparative Anatomy.

In 1860 after the death of Dr. Samuel Denton, Professor of Theory and Practice of Medicine and Pathology, which necessitated a change in the duties of the professors, Ford became Professor of Anatomy and Physiology. This title he held until his death in 1894, which occurred two days after he had completed his fortieth course of lectures on the campus and just when he was about to retire as Professor Emeritus. He had tendered his resignation in 1892, but at the request of the Regents he had withdrawn it. Dr. Ford's whole life was devoted to the teaching of anatomy in various medical colleges. As long as the University medical course was only of six months' duration, he was able to teach in other medical schools during the spring and summer.

Dr. James Playfair McMurrich occupied the chair of anatomy from 1894 to 1907, when he was succeeded by Dr. George L. Streeter, who served as Professor of Anatomy from 1907 to 1914. After the resignation of Dr. Streeter, the chairs of anatomy and histology were combined under the direction of Dr. G. Carl Huber, who, however, retained his active interest in histology, while Dr. Rollo E. McCotter conducted the anatomical work, as Professor of Anatomy. In 1935, Dr. Bradley M. Patten (Ph.D. Harvard '14) succeeded to the position previously held by Dr. Huber. With the discarding of the title of Director, in 1938, he became Professor of Anatomy and Chairman of the Department of Anatomy.

Physiology and Histology. — Dr. Jonathan Adams Allen, one of the original faculty of five members in the Medical Department, was appointed, in January, 1850, Professor of Pathology and Physiology. But actually he served as Professor of Therapeutics, Materia Medica, and Physiology. After he left in 1854 the medical faculty was reorganized, and Dr. Abram Sager, in addition to his duties in botany and zoology, occupied the chair of obstetrics and physiology.

Upon the death of Dr. Denton, Dr. Ford succeeded to the chair of anatomy and physiology. At that time physiology was purely a didactic subject, and the experimental method was hardly available. The natural approach to physiology was through the microscopical study of the tissues. Hence it was that in April, 1869, Professor Ford was given the additional title of Instructor in Microscopy, and the students taking the course were required to pay an additional fee of ten dollars.

In June, 1872, at the earnest request of Dr. Ford, and in order to secure a more extended course of instruction in physiology, the Regents, at the request of the medical faculty, transferred this subject to Dr. Henry S. Cheever, who, from 1872 to 1876 was Professor of Therapeutics,

Materia Medica, and Physiology.

From 1873 to 1875, when Dr. Cheever was on leave of absence in Colorado, Dr. Frederic H. Gerrish was first Lecturer on Therapeutics, Materia Medica, and Physiology, and then, in 1874, Professor. He resigned his chair in 1875.

Cheever resumed his duties in 1875, but was compelled by illness to resign his position in March, 1876. Dr. Burt G. Wilder, of Cornell University, was appointed Lecturer on Physiology for the session of 1876-77.

During this year both Dr. Ford and Dean Alonzo B. Palmer pressed the need of a physiological laboratory and of a permanent professor for that subject. The Regents appealed to the legislature, which responded by an appropriation of $2,500 for 1877, and one of $1,000 for 1878.

In June, 1877, Dr. Charles H. Stowell was appointed Instructor in the Physiological Laboratory and was authorized to go to New York and examine instruments and other appliances needed. He visited Bausch and Lomb, and also Spencer at Geneva and examined their microscopes and lenses. As a result fifteen microscopes and a number of minor items were purchased at a cost of about $1,300.

In June, 1878, Dr. Ford presented a report to the Board of Regents describing the work done during the year in the Physiological Laboratory. With fifteen microscopes it was possible to give a course to six classes, each class consisting of fifteen students. A class devoted one afternoon every week for ten weeks to practical work with the microscope. It thus appears that ninety students received instruction during each ten-week period. Three courses were given, and more than 250 students received instruction during the year. Such was the beginning of actual class instruction in microscopical work in the Medical Department.

In 1880 Stowell was made Assistant Professor of Physiology and Histology. In the second semester of 1880-81, Dr. Henry Sewall began his service in physiology in the Medical School. Since Dr. Stowell was not in the new department, his title was changed to Assistant Professor of Histology and Microscopy (1881-83), Shortly thereafter, the Regents changed the name of the Physiological Laboratory to the "Histological Laboratory." In 1883 Stowell was made Professor of Histology and Microscopy, which position he held until he left the University in 1889.

The microscope had been introduced into the University as early as October, 1854, for in an addendum to the Annual Report of President Tappan, it is stated that "several fine microscopes are also in the use of the [Medical] Department." Nothing is known of these instruments, and it may be assumed that they were not of an expensive type.

In March, 1856, Professors Sager and Winchell were made a committee to contract for the construction of a suitable microscope for the University. The committee spent $300, and in December a further sum of $150 was voted to cover the balance due. In September, 1857, the committee received an additional grant of $19 for accessories. The total cost of the instrument was $469. Since this amount was charged to the account of "Natural History" it follows that this was the first microscope in the Literary Department. Undoubtedly, it was the transfer of this microscope from the Department of Botany to the Physiological Laboratory that the Regents authorized in October, 1877, with the provision that the Laboratory should furnish a suitable one in return. At all events, the report of the committee on microscopes in 1882 lists a W. and J. Grunow microscope,

purchased in 1856 at a cost of $500, as being in the custody of Dr. Stowell of the Histological Laboratory. This would seem to explain the statement in Hinsdale's History of the University that the first course in histology was given in 1856.

The next record of the purchase of a microscope was in March, 1860, when the medical faculty was authorized to buy a "superior" microscope and certain anatomical preparations offered for sale by Dr. DeVille for $275. The actual amount was $228 as shown by the warrant paid on April 3. This instrument, also in the custody of Dr. Stowell, was listed as a Powell and Leland microscope of English make, and purchased "20 or 25 years ago" at a cost of $150.

A third instrument, listed about 1861 by the committee, as a J. Grunow inverted microscope, was probably acquired by the Chemical Laboratory, and thus came into the custody of Dr. Victor C. Vaughan. Of the remaining sixteen microscopes bought before 1877, two were acquired in 1872, twelve in 1875, and two in 1876. These were used in microscopical botany.

From January, 1877, to June, 1882, the University acquired eighty-five microscopes. The "Report on the Use of Microscopes in the University" (R.P., 1888, pp. 201-10) lists 104 microscopes, twenty-three of which were in the custody of Dr. Stowell (histology); forty-two in the care of Dr. Vaughan (physiological chemistry), making sixty-five (62 per cent) in the Medical Department. Of the remaining thirty-nine microscopes, which were in the Literary Department, thirty-three were used in botany, four in zoology, and two in geology.

In July, 1889, following the resignation of Dr. Stowell, the medical committee of the Board of Regents recommended that the chairs of pathology and histology be combined under Dr. Heneage Gibbes and that Dr. G. C. Huber be appointed Instructor in Histology. This recommendation was adopted, but two weeks later, the title of Dr. Gibbes was changed back to Professor of Pathology, and that of Dr. W. H. Howell, the newly appointed Lecturer in Physiology, was changed to include histology. The following year he became Professor of Physiology and Histology and held that title until he resigned.

Dr. Howell's successor was Dr. Warren P. Lombard, who was appointed in June, 1892, Professor of Physiology and Histology. To Dr. Lombard the connection of histology with physiology was purely formal, and in 1898 his title was changed to Professor of Physiology.

As mentioned above, Dr. G. C. Huber was made Instructor in Histology in 1889. After graduating from the Medical Department in 1887 he served two years as Assistant Demonstrator of Anatomy. His entrance into the field of histology, in 1889, marked the beginning of a long and successful career. In 1898 he became Junior Professor of Anatomy and Director of the Histological Laboratory, which position he held until 1903, when he was made Professor of Histology and Director of the Histological Laboratory. When anatomy and histology were combined in 1914, Dr. Huber became Professor of Anatomy and Director of the Anatomical Laboratories. He continued, however, to give the work in histology and embryology until his death in 1934, thus completing forty-five years of service in that field. From 1928 to 1934 he served as Dean of the Graduate School.

Dr. Bradley M. Patten became Professor of Anatomy and Director of the Anatomical Laboratories in 1935. He took direct charge of the work in histology, and in this he has been ably assisted by Dr. Elizabeth C. Crosby.

Work in histology began in 1877 in what was known at that time as the

Physiological Laboratory. The space which it then occupied in the old Medical Building continued to be used for that purpose until 1903, when new quarters were provided in the West Medical Building. In 1926 anatomy and histology were moved into the new East Medical Building.

Physiological Laboratory. — The designation Physiological Laboratory was in use as early as 1877, but the work was in histology and microscopy. By the spring of 1881 the medical faculty recognized the need of a chair in modern experimental physiology. Three names were submitted in answer to letters sent by Dr. Vaughan. H. Newell Martin, professor of biology at the newly established Johns Hopkins University, recommended his assistant, Dr. Henry Sewall. When the vote of the faculty was taken Dr. Sewall received a majority, and his name was sent to the Board of Regents. His first appointment was that of Lecturer on Physiology for the second semester of 1881-82. His ability, enthusiasm, and training were promptly recognized, and in June, 1882, at the age of twenty-seven, he was made Professor of Physiology.

The advent of Dr. Sewall marked a new era in the history of the Medical Department. The purely didactic method gave way to demonstrations and to the experimental approach. His meager laboratory, under the slanting side of the upper amphitheater, became the scene of active research. A number of scientific papers resulted, the most striking of which appeared in 1887 under the title "Experiments on the Preventive Inoculation of Rattlesnake Venom." This work was the precursor of all subsequent studies on immunity to snake venoms and to bacterial toxins. When Dr. A. Calmette, the eminent authority on venom immunity, visited Ann Arbor in 1908, he asked particularly to see the room in which Sewall had done this pioneer work.

Between Dr. Sewall and Dr. Vaughan, both young men, an intimate friendship developed which undoubtedly widened their horizons. Dr. Sewall's year abroad in 1879-80 familiarized him to some extent with the pioneer work of Pasteur and Koch, and when he returned to Johns Hopkins he already knew of the work being done by Dr. Sternberg, who was working as a guest in Dr. Martin's laboratory. As part of their Sunday afternoon stroll, Sewall and Vaughan were wont to sit on a hill overlooking the Huron River and discuss the "germ theory." The enthusiasm of Dr. Sewall found an eager listener in Dr. Vaughan, who in this way became convinced of the important relation of bacteria to disease. The immediate result of these discussions is probably reflected in the note in The Chronicle of January 31, 1885, to the effect that "Dr. Vaughan is giving to the Seniors some interesting talks on Bacteria," and again, on March 14, 1885, in the remark that Dr. Sewall gives the freshmen weekly talks on the "Bacteria Theory."

In spite of an active and vigorous constitution, Dr. Sewall developed in the spring of 1886 the first signs of illness. He spent the summer of that year in Denver and returned in October much improved in health. In November of that year he began his famous "Experiments on Preventive Inoculation of Rattlesnake Venom." The work was interrupted by another attack of illness, and Dr. Sewall was obliged to seek relief in the mountains of North Carolina. On his return, in April, he completed the investigation which marked the beginning of immunology as regards soluble toxins. During the summer of 1887 anatomy was transferred to a new building, and Sewall moved his laboratory into the renovated old dissecting room. In the

spring of 1888 Dr. Sewall asked for a year's leave of absence, and during his absence, in 1888-89, the work in physiology was given by Dr. Joseph W. Warren.

Dr. Sewall returned in April, 1889, and, although not greatly improved in health, he planned to give a course in practical physiology. At the same time he taught the second laboratory course in bacteriology offered in the University. It was there that he examined his own sputum and found the tubercle bacillus present. This was decisive for him, and, in June, he regretfully resigned his position.

Dr. Sewall's successor was Dr. W. H. Howell. He was appointed, in 1889, Lecturer on Physiology and Histology. He was Professor from 1890 to 1892, when he resigned to accept a position at Harvard. Dr. Warren P. Lombard succeeded Dr. Howell, first as Lecturer (1892) and a year later as Professor of Physiology and Histology. Largely at his request histology was dropped from his title in 1898, and he then became Professor of Physiology and held this appointment until his retirement in 1923.

Dr. Robert Gesell, the present incumbent of the chair of physiology, was appointed in 1923. He and his associates have carried on valuable researches on respiration and allied subjects.

As already stated, the modern Physiological Laboratory had its beginning under Dr. Sewall. He saw it develop from poor, makeshift rooms to commodious quarters in the old Medical Building. The laboratory was wiped out in the fire of 1907 which destroyed the western end (built in 1867) of the old Medical Building. Work, however, was carried on in the east half of the building until 1909, and thereafter transferred to the old Chemical Laboratory. Under Dr. Gesell the Physiological Laboratory acquired, in 1925, thoroughly modern quarters in the south wing of East Medical Building.

Pathology. — As stated before, one of the six professorships provided for in the Act of 1837 was that of physiology and pathology. Accordingly, in January, 1850, Dr. Jonathan Adams Allen was appointed Professor of Pathology and Physiology, but with the reservation that pathology was to be given by Dr. Samuel Denton, Professor of the Practice of Physic. Hence, Dr. Denton was in charge of pathology from 1850 until his death in 1860. The title of his chair was apparently changed after 1851, for in President Tappan's report for 1853-54 Denton is designated "Professor of the Theory and Practice of Medicine and of Pathology." No record of this change is noted in the Regents' Proceedings. Upon the death of Dr. Denton in September, 1860, Dr. Alonzo B. Palmer was appointed Professor of the Theory and Practice of Medicine, Pathology, and Materia Medica. A year later, with the appointment of Dr. Samuel G. Armor, this title was amended by leaving off "Materia Medica."

In 1863 the surgeon general of the United States Army determined to require at least one course of lectures on hygiene and military surgery from candidates for the Army medical staff. The Regents thereupon provided for a course of lectures on hygiene to be offered in the Literary Department. Dr. Palmer was appointed Lecturer for that purpose. In June, 1864, Palmer was appointed "Professor of Pathology, Practice of Medicine and Hygiene," with the stipulation that the course in hygiene was to be given in the Literary and Law departments. This course was discontinued in April, 1869, and at the same time Palmer was appointed Instructor in Auscultation. Incidentally, it may be added that a course in hygiene was not given again in the University until 1887, when Vaughan was appointed Professor

of Hygiene and Director of the Hygienic Laboratory.

The title of Dr. Palmer's chair from 1869 to 1880 was that of Professor of Pathology and Practice of Medicine. As a result of the growth of the Hospital, in 1880, "and Clinical Medicine" was added to this title, which he held until his death in 1887.

The lack of a large hospital made it difficult to secure material for gross pathology. The anatomical law of 1875 relieved the situation to some extent by supplying unclaimed bodies from state institutions. Some of these could be used for pathological demonstrations, and undoubtedly it was with this object in view that Dr. William J. Herdman was made Lecturer of Pathological Anatomy and Demonstrator of Anatomy in 1879. He held the title of Professor of Practical and Pathological Anatomy and Demonstrator of Anatomy from 1882 to 1888.

Dr. Herdman performed occasional autopsies and gave demonstrations of pathological material in the large amphitheater before hundreds of students. The medical faculty, in October, 1887, recognizing the lack of laboratory work in pathology, asked the Board to establish a chair of pathology and to appoint Dr. Heneage Gibbes, of Westminster College, London, England, as Professor of Pathology. This was done by the Board, and modern pathology thus began in the University.

The service of Dr. Gibbes as Professor of Pathology began in January, 1888. He established a laboratory in the basement of the new Anatomy Building, but the quarters were inadequate for the laboratory instruction of students. After the transfer of the Homeopathic Hospital to its new building Dr. Gibbes, in 1892, acquired ample space for his work.

Dr. Gibbes, unfortunately, had an arbitrary and intolerant disposition which brought on clashes with his colleagues. The appointment of a nonmedical man, Dr. James P. McMurrich, as Professor of Anatomy gave him an ally in the person of Dr. W. A. Campbell, Assistant Professor of Anatomy, who aspired to the chair. Together they formulated and presented to the Regents a sweeping plan for reorganizing the Medical Department. A somewhat similar plan was presented by Dean Obetz, of the Homeopathic Department. As a result, the chair of pathology was abolished, as of October 1, 1895, and the title of Dr. George Dock was amended to Professor of Theory and Practice of Medicine and Clinical Medicine and Pathology.

Dr. Aldred S. Warthin was made Assistant to the Professor of Theory and Practice of Medicine in 1891. In June, 1892, he became Demonstrator of Clinical Medicine and held this position until 1895, when he became Instructor in Pathology. In 1899 he became Assistant Professor. In 1902 he was made Professor of Pathology and in 1903 Director of the Pathological Laboratory.

Under Dr. Warthin the Department of Pathology was developed into the foremost of its kind. With the completion of the West Medical Building, in 1903, the laboratory acquired new quarters which it still occupies. Dr. Warthin died in 1931 and was succeeded by Dr. Carl V. Weller, who was Director of the Pathological Laboratories from 1931 to 1938, when he was named Chairman of the Department of Pathology.

Materia Medica and Therapeutics. — The sixth and last of the professorships prescribed for the Medical Department, as indicated under the "Original Faculty," was that of materia medica, pharmacy, and medical jurisprudence. Therapeutics was not mentioned in the legislative act and hence the term does not appear until after 1851.

Dr. Douglass was appointed, in January, 1848, Professor of Materia Medica and was also to discharge the duties of Professor of Pharmacy and Medical Jurisprudence, but, as specified in 1850, he would teach only pharmacy and toxicology. In other words he was given the title required by law, but was not to teach materia medica.

The Board in 1850 appointed Jonathan Adams Allen Professor of Pathology and Physiology. It was specified that besides physiology he should also perform in part the duties of the Professor of Materia Medica. The teaching of pathology was assigned to the chair of physics.

At the time of his dismissal in 1854, Dr. Allen though nominally Professor of Physiology and Pathology, was still "acting as Professor of Therapeutics, Materia Medica, and Physiology." In the reorganization that followed Dr. Alonzo B. Palmer was given the chair of materia medica and the diseases of women and children. At the same time Dr. Abram Sager was transferred to the chair of obstetrics and physiology.

After the death of Dr. Samuel Denton in 1860, another rearrangement of duties took place. The work in materia medica and therapeutics was divided. Dr. Palmer was appointed Professor of the Theory and Practice of Medicine, of Pathology, and of Materia Medica. At the same time Dr. Gunn was made Professor of Surgery and Therapeutics; Dr. Sager, Professor of Obstetrics and Diseases of Women and Children; and Dr. Ford, Professor of Anatomy and Physiology.

In 1861 the Regents amended the titles of Dr. Palmer and Dr. Gunn by dropping materia medica and therapeutics, respectively. At the same time a chair of the principles of medicine and materia medica was established to which Dr. Samuel G. Armor was appointed. At the next meeting of the Regents, at the request of Dr. Armor, the title was changed to "Institutes of Medicine and Materia Medica." Dr. Zina Pitcher, in 1851, had been named "Emeritus Professor of the Institutes of Medicine and Obstetrics."

Dr. Armor resigned in 1868, having served for seven years. He was succeeded by Dr. H. S. Cheever, after Dr. Robert C. Kedzie had declined the position. Dr. Cheever, made Lecturer on Therapeutics and Materia Medica in 1868, became professor of these subects in 1870. In 1872 physiology was added to the title, thus making it essentially the same as the acting title held by Dr. Allen from 1850 to 1854. Cheever held this position until 1876, interrupted by leave of absence for two years because of ill-health (1873-74). He resumed his teaching in 1875 and resigned in 1876. During his absence the work was carried on by Dr. Frederic H. Gerrish, first as Lecturer and then as Professor of Therapeutics, Materia Medica, and Physiology. Dr. Gerrish resigned in 1875.

After the resignation of Dr. Cheever the duties, in part, were passed on to Dr. George E. Frothingham, who was designated Professor of Materia Medica and Ophthalmology (1876). In 1880 "and Clinical Ophthalmology" was added to this title.

Dr. Frothingham came to Ann Arbor in 1867, as Prosector of Surgery and Assistant Demonstrator of Anatomy, with Dr. William Greene, his former preceptor, who had been appointed to the chair of surgery. From 1872 to 1875 he was Professor of Ophthalmology and Aural Surgery, and Demonstrator of Anatomy; and in 1875-76 he bore the title of Professor of Practical Anatomy and Ophthalmic and Aural Surgery. In 1876 Anatomy was replaced by Materia Medica in this title, which, with the addition of "and Clinical Ophthalmology" in 1880,

he held until his resignation in 1889.

Although materia medica was included in Dr. Frothingham's title from 1876 to 1889, it does not follow that he taught the subject for thirteen years. As a matter of fact, Dr. Victor C. Vaughan, in 1883, was appointed Professor of Physiological and Pathological Chemistry and Associate Professor of Therapeutics and Materia Medica. He taught the latter subject to pharmacy students and perhaps to medical students. His connection with materia medica and therapeutics ended in 1887, when he was appointed Professor of Hygiene and Physiological Chemistry and Director of the Hygienic Laboratory. In the fall of 1887, Dr. Conrad Georg was appointed Instructor in Materia Medica. This title he held for two years and in 1889, when Dr. Frothingham resigned as Professor of Materia Medica and Ophthalmology, Dr. Georg was appointed Instructor in Materia Medica and Therapeutics, which position he held for one year.

During the forty years that had elapsed since the opening of the Medical Department, the teaching of materia medica and therapeutics had been purely didactic and often had been combined with some other discipline. Like a poor relative it was passed around from one professor to another. Thus, during four decades the names of ten men, from Douglas to George, were associated with materia medica and therapeutics. By contrast, during the fifty years that followed, these subjects were presented by only three men.

Pharmacology. — In 1890 the Regents established a chair of materia medica and therapeutics, and Dr. John J. Abel was appointed Lecturer on these subjects, to begin his duties on January 1, 1891. In June, 1891, he was made full Professor, which post he held for the next two years, when he resigned to accept the chair of pharmacology in the new Medical School of Johns Hopkins University.

Just as the appointment of Dr. Sewall marked the beginning of a new era in physiology, so the appointment of Dr. Abel was equally significant for pharmacology. Although he did not have the title he was, in fact, the first professor of pharmacology at Michigan. He introduced the experimental, scientific approach to the subject of materia medica and therapeutics. Like Dr. Sewall he had to begin his research work in a small room under the sloping sides of the lower amphitheater in the old Medical Building. The facilities were meager, but the enthusiasm for research was uppermost.

Dr. Abel was a stimulating, prolific, and tireless investigator. He was succeeded in 1893 by Dr. Arthur R. Cushny, who resigned in 1905. Under Dr. Cushny the laboratory space was enlarged by taking over a large room in the old Medical Building. It was well equipped, and it became possible to give the practical course in pharmacology to medical students. The first course, given in 1894-95, was optional for a limited number of junior medical students. In 1909 after removal of the department to the old Chemistry Building, it became possible to make the laboratory course in pharmacology a required one for all medical students.

After Dr. Cushny's resignation, Dr. C. W. Edmunds, who had been his assistant, was given charge of the Pharmacology Department, as it was commonly designated. In 1907 he became Professor of Materia Medica and Therapeutics and Director of the Pharmacological Laboratories. Under the supervision of Dr. Edmunds the laboratory, through its research work, became recognized as the foremost of its kind. Dr. M. H. Seevers succeeded Dr. Edmunds in 1941 as Professor of Materia Medica and Therapeutics.

Electrotherapeutics. — In 1875, the Board appointed Dr. John W. Langley of Pittsburgh, Pennsylvania, as Acting Professor of General Chemistry and Physics, and a year later he was made full professor. Early in 1880 Langley offered an elective course in electrotherapeutics to the medical students, which consisted of practical laboratory work in its applications to medicine. The faculty report in 1882 recorded that the assistant in charge gave seventy-two lessons in electrotherapeutics to sections of the class and a quiz once a week during the first semester.

Incidentally, charges were preferred against this same assistant for unethical advertisement of an "electrical belt" through local dealers. The Board brought in a Scotch verdict, whereupon Dr. Frothingham and Dr. D. Maclean tendered their resignations. A month later, the Board reversed itself, and the resignation of the assistant was requested and at the same time the resignations of the professors were tabled.

In 1888 Dr. W. J. Herdman gave up his connection with pathology and was named Professor of Practical Anatomy and of Diseases of the Nervous System. In 1890 he was made Professor of Nervous Diseases and Electrotherapeutics. A practical course in the latter subject was organized and required of all medical students. It was given in the old Chemical Laboratory, but after the death of Dr. Herdman it was discontinued. In 1898 Herdman was given the title of Professor of Diseases of the Mind and Nervous System and of Electrotherapeutics.

Hospital Laboratories. — The old Hospital on the campus provided few or no facilities for diagnostic purposes, although the rules of 1891, providing for the government of the hospitals, required the resident physician to "see that all analyses and examinations of sputum, urine, etc., as required by the clinical Professors are made and properly reported to them."

When the Catherine Street Hospital was occupied in 1892, there was no provision for laboratories, and Dr. George Dock was obliged to convert a water closet into a diagnostic laboratory. Under most unfavorable conditions he organized and equipped a suitable laboratory which soon demonstrated its usefulness. The other clinical departments followed the example set by Dr. Dock.

With the erection of the new Hospital in 1925, provision was made for a central laboratory. Dr. Kenneth Fowler was in charge of it. After his resignation in 1928, Dr. Reuben L. Kahn was placed in charge and given the rank of Assistant Professor of Bacteriology. In addition to the diagnostic work in chemistry, hematology, bacteriology, and serology, some instruction was given in special methods.

The full impact of the laboratory type of instruction was soon felt by the clinical branches. In May, 1892, the Board authorized the establishment of six new courses for junior students, and the appointment of demonstrators to do the work. These courses in the clinical departments were known as demonstration courses and were required of all junior students. Later, they came to be known as junior sections. They are given in medicine, obstetrics, surgery, ophthalmology, otolaryngology, and roentgenology. Incidentally, the first work in roentgenology was done by Dr. Herdman in 1896, shortly after Roentgen's discovery, but it was not until Dr. James G. Van Zwaluwenberg became a member of the staff in 1907 that the program in roentgenology was really inaugurated.

Frederick G. Novy

SELECTED BIBLIOGRAPHY

Announcement, Department of Medicine and Surgery Calendar Catalogue … History of the University of Michigan. "Minutes of the Medical Faculty" Rules for the Government of the Medical College, 1850. President's Report Proceedings of the Board of Regents … "The Early Days of the University of Michigan." "The Early Days of the University of Michigan — II." University of Michigan Regents' Proceedings …, 1837-64. A Doctor's Memories.

THE DEPARTMENT OF ANATOMY

PROVISION for the teaching of anatomy was made with the organization of the Department of Medicine and Surgery in 1849 and the completion of the old Medical Building in 1850. One of the five professorships forming the faculty of medicine was the professorship of anatomy.

There have been five directors of the Department of Anatomy whose personalities are so closely interwoven with the achievements of the department during the period of their incumbency that it appears advisable to divide the ninety years of its development into five divisions. Dr. Moses Gunn directed the department from 1850 to 1854; Dr. Corydon L. Ford, 1854-94; Dr. James P. McMurrich, 1894-1907; Dr. George L. Streeter, 1907-14; and Dr. G. Carl Huber, 1914-34. Since that time Dr. Bradley M. Patten has been chairman.

Moses Gunn (M.D. Geneva Medical College [N. Y.] '46, A.M. ibid. '56, LL.D. Chicago '67) was the first Professor of Anatomy, and he held the chair, combined with that of surgery, for four years; he was appointed Professor in 1849 at $1,000 a year. A statement by Dean Vaughan brings out the personality of the man whose influence was outstanding:

While a student in a medical school at Geneva, New York, he read about the organization of the University of Michigan and the provision that a medical department would, sooner or later, be attached to this institution. Immediately on receiving his medical diploma he started to Ann Arbor, carrying in his grip several dissecting cases and, among his grosser impedimenta, a box of suspicious size and shape and unmarked content.

On arriving in Ann Arbor one cold February in the late forties, he hung out a shingle offering his surgical skill to the public and more discreetly he let it be known to the University students that, in his back office, after a certain hour, he was prepared to initiate any of them who might have the profession of medicine in view into the mysteries of the structure of the human body. He was soon recognized as a most desirable addition to the small group of intellectuals then constituting the faculty and student body of the University. There is no record of his surgical success as a private practitioner but his class in Anatomy was soon in a flourishing condition. His best students in his back office were Robert Kedzie, … and Edmund Andrews …

(Vaughan, pp. 187-88.)

The lectures in anatomy were given by Dr. Gunn four times a week in the morning and were attended by the two classes throughout the college year of six months.

As nearly as can be determined, the first lecture-room was on the third floor of the old Medical Building.

The first anatomical laboratory was no doubt in the northeast corner of the second floor of the same building. Dean Huber has written: "The Anatomical Laboratory is by far the oldest laboratory in the medical department … The room then used as an anatomical laboratory is the one now used by Professor McMurrich as a private laboratory" (Huber, "Medical Laboratories," pp. 259-60). This laboratory is estimated to contain about six hundred feet of floor space — or sufficient space for thirty-two students as they work now.

The staff during the formative years consisted of the professor of anatomy, who devoted part of his time to teaching surgery, and a demonstrator of anatomy. The most important duty of the demonstrator of anatomy was to obtain material for teaching practical anatomy in the laboratory. This was a most difficult task, with the two conflicting state laws; for if he obeyed one, there would be no Department of Anatomy.

Dr. Robert Clark Kedzie (Oberlin '47, Michigan '51m, LL.D. ibid. '00) was the first Demonstrator of Anatomy and one of the six graduates of the medical class of 1851. He took charge of the first anatomical laboratory while a senior. Dr. Kedzie became a distinguished professor of chemistry at Michigan State College. He has reminded us of some of the difficulties that beset the Medical School at its inception, with reference to the teaching of practical anatomy:

Many persons regarded with awe the dissecting room "where dead folks were cut up," and the question "Where do you get your subjects," had a strange fascination for many people. The reply, "We raise 'em," did not seem to satisfy the inquiring mind. There was no legalized method by which material for dissection could be secured, and the dark suspicion that graves were robbed in the vicinity took possession of many minds. The suspicion was confirmed when it was discovered that a grave a few miles away had been robbed under atrocious circumstances, fragments of the broken coffin and torn portions of the shroud being left beside the half filled grave. The outrage was charged to the Medical College. Bitter hostility against the College broke forth at once. A mob gathered in the evening with the avowed purpose of burning the medical building; the mob rapidly increased in numbers, and under the harangue of a tap-room demagogue, they announced their purpose of "burning that butcher shop of human flesh, and scattering the young crop of sawbones that would not let the dead sleep in their graves."

The medics had their spies in the mob, and when it was learned that it was planned to burn the medical building, a guard of one hundred armed medics patrolled the campus to protect the building, having signs and countersigns to exclude our enemies. The mob, learning of this determined guard, soon cooled down and dispersed. A suit at law for desecrating a grave, in which the witnesses knew little and remembered less, was the outcome of the excitement.

(Kedzie, p. 207.)

Dr. Edmund C. Andrews ('49, '52m, LL.D. '81) was appointed to the position of Demonstrator of Anatomy upon the resignation of Kedzie in 1851 by the following resolution:

Resolved, That Edmund Andrews be and is appointed Demonstrator of Anatomy in the Medical College and that he also discharge the duties lately performed by the Superintendent of Grounds. That for his services under this appointment he be allowed 10 per cent on all moneys he may collect and account for during the year ending 31st of December next, provided that such percentage shall not exceed $200.

R.P.

It appears that one of the duties of the superintendent of grounds was to collect the three-dollar anatomy laboratory fee

from each student taking the course (ibid., p. 538). Notwithstanding this dual function of his position and the method of collecting his salary, Andrews held the position until the close of college in April. In later life he became a leading surgeon of Chicago, one of the founders of Northwestern University Medical School, and a recognized authority on the geology of the Great Lakes (Vaughan, A Doctor's Memories, p. 188).

The problem of finding adequate teaching material for practical anatomy was insuperable for many years. It is observed that the Catalogue of 1853-54 carried the following indefinite statement (p. 36): "Arrangements have been made by which an ample supply of materiel for the purposes of practical anatomy has been secured …"

The second period in the development of the department began in 1854 with the change in Gunn's title to Professor of Surgery and the appointment of Dr. Corydon L. Ford (M.D. Geneva Medical College '42, A.M. hon. Middlebury '59, LL.D. Michigan '81) as the second Professor of Anatomy. He held the position for forty years:

Dr. Corydon La Ford … [was] a sensitive and earnest teacher, who had a way of "making dry bones and anatomical tissues of absorbing interest." It is said of him that in his day he probably taught more students than any other teacher of anatomy.

(Shaw, p. 124.)

Under Ford's direction lectures continued to occupy a large part of the teaching. Laboratory teaching of practical anatomy began to take a very important part in the instruction. He moved the Anatomical Laboratory from the second floor to the attic of the old Medical Building upon his arrival. This was a low room beneath the rafters, occupying the full width of the east portion of the building. The only daylight that reached the interior was through a dome-shaped skylight. The floor space of this room is estimated to have been about eight hundred square feet.

The Catalogue of 1854-55 (p. 36) announced for the first time courses in histology:

… The class is divided into sections for the examination of various tissues of the body by means of the Microscopes, so that each student has repeated opportunities for becoming familiar with the minute structure of parts, and also the practical working of the Instruments.

The teaching of anatomy at the opening of the Department of Medicine and Surgery was supplemented by the use of charts, few of which could be purchased, and by specimens preserved and placed in a room called the anatomy museum. This teaching material was prepared in the laboratory, with additions presented by friends of the school.

Ford continued to collect museum specimens largely for teaching purposes. Many of these specimens are still on exhibit, in cases especially built for them in the corridors on the fourth floor of the East Medical Building, where there is also a catalogue of the specimens in Dr. Ford's handwriting.

In 1860 the Regents decided to combine the teaching of physiology with the chair of anatomy, as follows (R.P., 1837-64, p. 918): "Resolved, That Professor Corydon L. Ford be and he is hereby appointed Professor of Anatomy and Physiology, with a salary of $1,000." And again in 1860, without a change of title, Ford was to have direction of the amount of gas to be used at the "Medical College" (ibid., p. 923).

In 1864, when the medical lecture-rooms were added to the old Medical Building, the Anatomical Laboratory was moved from the attic to the third floor. The new quarters contained an estimated sixteen hundred square feet of floor space. Dr. Lombard has stated that Ford

occupied a small room in the northeast corner of the third floor as his private laboratory.

Ford continued to broaden his teaching so that it included not only practical anatomy in the laboratory but also lectures on anatomy and physiology. There had been created an intense interest in the developing science of histology in lecture and laboratory. The importance of the teaching of histology was recognized by the following resolution of the Regents, in April, 1869: "Resolved, That Professor C. L. Ford be appointed Curator of the Medical Museum and Instructor in Microscopy" (R.P., 1864-70, p. 326). It will be observed, therefore, that at the end of the second decade of the development of the School (then the Department of Medicine and Surgery) the Department of Anatomy not only had broadened its teaching functions to include Gross Human Anatomy, lectures and laboratory, but also had developed Microscopical Anatomy and Functional Anatomy (physiology). Ford held these combined chairs as Professor of Anatomy and Physiology, Curator of the Medical Museum, and Instructor in Microscopy.

With the admission of women to all departments of the University in 1870, eighteen entered the Department of Medicine and Surgery in the autumn of that year. Acting President Frieze said of them: "Those who have entered the Medical Department, in accordance with the action of the Board prior to the opening of the year, have formed a class by themselves, both in lectures and in the dissecting rooms" (P.R., 1870-71, p. 5). Just how long this double course of lectures in anatomy continued is difficult to determine. The first anatomical laboratory for women was in the attic of the Medical Building, a room previously occupied by the men. With the completion of the Anatomical Laboratory Building in 1887 a large room on the first floor was designated as the anatomy laboratory for women, and when West Medical Building was completed early in the present century (1903) such a room was also reserved for women (Huber, "The New Medical Building"). The women and men worked in separate laboratories of anatomy until 1908, when they were assigned to the same laboratory. The latter method has worked out to the mutual advantage of all concerned and is continued at the present time.

In 1872 the teaching of physiology was split off from anatomical instruction and was combined with the chair of therapeutics and materia medica under Professor Henry Sylvester Cheever.

In 1877 the teaching of physiology was combined with that of anatomy, as follows: "The Board request Professor Ford, with the assistance of other Medical Professors, to fill the chair and discharge the duties of Professor of Physiology, aided by the instructor in the Physiological Laboratory to be appointed" (R.P., 1876-81, p. 147).

Adding to the teaching load of the department was the extension of the medical course from six months to nine months in 1877 and the increase of the medical course from two to three years in 1880.

During the year 1877 the Physiology Laboratory was equipped, and the teaching of physiology was again separated from that of anatomy — permanently this time — by the appointment of Henry Sewall (Wesleyan '76, Ph.D. Johns Hopkins '79, M.D. Denver '89, M.D. hon. Michigan '88, Sc.D. hon. ibid. '12) as Lecturer of Physiology. As he had already "engaged himself for the year to Johns Hopkins University," this appointment, though made in December, 1881, was not to become effective until October, 1882.

Apparently there has been no decade

in the development of the Medical School when the teaching of the basic medical sciences was undergoing such revolutionary changes. The teaching of physiology developed by Dr. Ford was separated for a time from that of anatomy and then again combined with it, and finally sustained as a separate department.

Histology was recognized as a separate subject in 1877 upon establishment of the Physiological Laboratory, which was also arranged for work in practical histology, and by the appointment of Charles Henry Stowell (Genesee Wesleyan '68, Michigan '72m) as Instructor in the Physiological Laboratory, where the course Microscopical Anatomy was his chief interest. That Dr. Stowell taught this subject well is evidenced by his rapid promotion, as follows:

[June, 1879.] Resolved, That Charles H. Stowell, M.D., be and is hereby appointed Lecturer of Physiology and Histology at a salary of $1200 per annum, from and after the first day of October next.

[Nov., 1880.] Resolved, That the title of Charles H. Stowell, M.D., be and hereby is changed from "Lecturer on Physiology and Histology" to "Assistant Professor of Physiology and Histology."

[June, 1883.] Resolved, That the title of Dr. Chas. H. Stowell be changed to Professor of Histology and Microscopy.

R.P.

Finally, the name of the Physiological Laboratory was changed to Histological Laboratory, in 1880.

By the creation of the chair of histology and microscopy in 1883, the complete separation of the teaching of microscopical anatomy from that of gross anatomy was recognized. The Department of Histology was maintained as a separate department until 1914, when it was again included in the Department of Anatomy. After having devoted ten important and productive years to instruction in the science of histology, and after having completed six important pieces of research, Dr. Stowell retired to private life. A copy of his large well-illustrated monograph, The Microscopic Structure of a Human Tooth, is in the departmental library. Stowell throughout his life was a loyal alumnus and was deeply interested in the development of the department. Upon the death of his widow, the following bequest was recorded in the minutes of the Board of Regents:

Regent Beal reported to the Board that the widow of the late Dr. Charles H. Stowell, who from 1881 to 1889 was Professor of Histology and Microscopy, at the time of her death, desired that the gold watch which had been presented to her husband at Christmas, 1885 by Dr. Corydon L. Ford, Professor of Anatomy, should go into the possession of the University, and particularly into the custody of the head of the Department of Anatomy and should be passed down from one succeeding holder of that chair to another. The Regents accepted the watch with thanks under these terms and conditions.

R.P.

The Stowell watch has been placed in the custody of Professor Bradley M. Patten, Chairman of the Department of Anatomy.

In the seventies the medical sciences of dentistry and homeopathic medicine were attracting much attention and discussion. Accordingly, two new colleges were added to the University, under the following provisions:

Resolve [d], … 4. Students entering the Homeopathic Medical College shall receive instruction in the now existing Medical Department in all branches not provided for by the chairs established above, (including practical anatomy); they shall be entitled to all the privileges accorded students in the Medical Department … [The two chairs established were Professor of Materia Medica and Therapeutics, and Professor of Theory and Practice of Medicine.] …

Resolved, That a College of Dental Surgery be established, which shall, in addition to the

facilities now afforded by the Medical Department and Chemical Laboratory, be constituted by the founding of two professorships.

R.P.

It is not surprising then, that, with the added teaching burden of these two groups of students, much of which fell on the Department of Anatomy, the medical faculty was striving to relieve the increasing teaching load. This was attempted in two ways: first, by separating the chairs of physiology and histology from that of anatomy, as stated above; and, second, by increasing the teaching staff of the department. The staff giving instruction in anatomy was increased by an assistant to the professor of anatomy and five demonstrators (Cal., 1877-78).

The great increase in laboratory instruction necessitated a lengthening of the medical course from two to three years in 1880.

The first formal expression by the students of their appreciation of Dr. Ford's great service as a teacher and a friend was the presentation of a large portrait of him in the thirty-third year of his service to the University, officially recorded as follows:

Resolved, That the thanks of the Regents be presented to … members of the Junior and Freshman classes of the Department of Medicine and Surgery and to members of the Dental classes for a large portrait of Professor Ford, presented by them.

R.P.

The large portrait of Professor Ford now hangs in the faculty room of the Medical School.

With the increasing popularity of the basic sciences in medicine — particularly anatomy and histology — the available laboratory space became inadequate, and a request for an anatomical building was therefore presented to the Regents in July, 1887 (p. 140):

… The Committees on Buildings and Grounds, and that of [the] Medical Department … [recommended] that a two storied building be erected at a cost not exceeding the sum of $6,000, for the uses of dissecting rooms and a dead room, and that said building be located conveniently to the Medical College, but not within 100 feet of the same.

This building was ready for use in the college year beginning October, 1889. It is said to have been the first building in this country to be used exclusively for instruction in anatomy. The floor space provided for anatomy in the Anatomical Laboratory Building has been estimated to be about 2,400 square feet. The main laboratory was on the second floor, where the men worked; it was lighted by small windows in the side walls and by several skylights built into the slant of the roof. The interior of this room was unique, in that all of the great timbers that supported the roof were plainly visible, giving the appearance of what many of us believea lodge should be. Near one end of the room from a tall, boxlike stage, about four feet square, the demonstrator might at leisure look down upon the bearded students of that day, assembled six to eight at a table. The first floor furnished a small dissecting room for women and contained the washrooms. The Anatomical Building allowed for the expansion of the laboratories of histology, physiology, and, in fact, of all of the basic sciences, and the acquisition of this extra space was a necessary readjustment for the extension of the medical course from three years to four years in 1890. The completion of the new Anatomical Building evidently relieved the crowded condition of the department for only a short time, however, for additions to the structure were authorized in 1893.

The death of Professor Ford in 1894 brought to a close a forty-year period in the development of the Department of Anatomy. Much of his time was devoted

to teaching in the department. The remainder was consumed by his development of investigative methods for creating charts, models, mannikins, and teaching specimens of all kinds. Most of the teaching aids could not be obtained in the markets of the world during Ford's career, and those few that were obtainable were prohibitive in price. As a result of Ford's foresight, the University has thousands of teaching specimens illustrative of normal and pathological anatomy, both human and comparative.

Space will not allow more than merely mentioning the names of many of the men who as demonstrators assisted Ford during the years when he had charge of the Anatomical Laboratory. Some of these — notably, Andrews, Lewit, Cheever, Frothingham, Breakey, Herdman, Campbell, and Huber — have added materially to American medicine, mostly in fields other than anatomy. There are four articles that former students of Dr. Ford frequently mentioned whenever they spoke of that great personality — a multicolored human skull, his chart of the twelve cranial nerves, a cane made from Admiral Perry's flagship, and a light stool with "Ford" carved in the seat — and these are to be found in the departmental library.

Occupying hardly a lesser place than Dr. Ford in the memories of the older medical graduates was his factotum, Gregor Nagele, better known as "Doc" Nagele. As an immigrant just landed, he helped in the construction of the old Medical Building, and remained to become for years the presiding genius of the Department, and, through his long association with Dr. Ford, an unofficial demonstrator of anatomy to the "boys."

(Shaw, p. 124.)

James Playfair McMurrich (Toronto '79, Ph.D. Johns Hopkins '85, LL.D. Michigan '12) was appointed the third Professor of Anatomy and Director of the Department of Anatomy in 1894 and served the University faithfully for thirteen years. When he came to direct the department the anatomical laboratories were in the Anatomical Laboratory Building about two hundred feet south of the present West Medical Building. His private laboratory was in the northeast corner of the second floor of the old Medical Building.

Dr. McMurrich brought to the University very definite ideas as to the function of the Department of Anatomy, which were adequately expressed in his own words:

An anatomical laboratory has a treble purpose to fulfill. A thorough knowledge of the structure of the human body and of its various parts, of the arrangement of these parts and of their physiological and topographical relations is essential to both the physician and the surgeon, and in no way can this knowledge be obtained but by actual, personal investigation. One purpose then, which may be termed the special purpose of an anatomical laboratory is to provide means whereby the student may obtain at first hand, that knowledge of the structure of the human body which will enable him later to pursue the study of medicine and surgery intelligently and successfully. It is a common, but erroneous idea that this is the only raison d'être of an anatomical laboratory. In reality, however, the study of anatomy is not a part of the study of medicine, but rather a preliminary to it, and in this connection laboratory work in anatomy has a further purpose, a general purpose, namely, to train the student to habits of observation and deduction. Whether for professional or general education this side of a laboratory's usefulness cannot be too greatly emphasized and no laboratory course offers greater opportunities for this kind of training than a practical course in anatomy. Finally the third purpose of an anatomical laboratory is to afford opportunities for increasing our knowledge of the structure of the body. It is another erroneous idea that our knowledge of the human body is complete. On the contrary there is yet very much to be learned, not only as to the actual

details of structure, but also as to the meaning of the anomalies which occur so frequently. This, which may be termed the higher purpose of an anatomical laboratory, has been too much neglected in the laboratories of this country, although from the purely scientific standpoint it is by far the most important of all the purposes of an anatomical laboratory. To fulfill these various purposes an anatomical laboratory requires an extensive equipment, a corps of specially trained instructors. In its early days the laboratory of the University of Michigan was necessarily conducted almost entirely for its special purpose, but the aim of those in charge has always been to place it in a position to fulfill all the purposes which might be demanded of it. Before this can be accomplished however, many facilities, such as a more ample building, an improved equipment and a larger corps of instructors must be provided. This being accomplished the University of Michigan will have an anatomical laboratory second to none and worthy of the great institution of which it is a part.

"Medical Laboratories,"

When McMurrich took over the direction of the department he introduced a well-organized course in the anatomy of the nervous system. This course consisted of a series of lectures followed by laboratory work. The first Neurological Laboratory was arranged by Dr. McMurrich on the first floor of the Anatomical Laboratory Building. It was impossible to provide human material for laboratory instruction at that time; therefore, a careful study was made of the sheep brain. When the West Medical Building was completed in 1903, not only was provision made for laboratory instruction in gross anatomy, but also, adequate space was provided for the practical study of the central nervous system and special sense organs. This laboratory was situated on the south side of the third floor of the West Medical Building. A very interesting commentary on the introduction of this course is the action of the Board of Regents: "That Dr. McMurrich be allowed to give a course on the anatomy of the special senses" (R.P., 1896-1901, p. 105).

In teaching the anatomy of the nervous system as a subject separate from that of gross anatomy, Dr. McMurrich laid the foundation for that division of anatomy now known as the Laboratory of Comparative Neurology.

Perhaps the first official recognition that the subject of anatomy is a part of a general education and is not restricted to those interested in the medical sciences was provided when, by the action of the Regents, McMurrich was recognized as a member of the literary faculty (R.P., 1896-1901, p. 104). The first course in anatomy for students of the Graduate School (then a department within the Department of Literature, Science, and the Arts) of the University was also provided for upon the completion of the West Medical Building (Cal., 1903-4).

The Department of Anatomy occupied the east half of the third floor, the southeast portion of the second floor, and the northeast portion of the basement of the new building. The teaching laboratories occupied 4,490 square feet of floor space, besides the space devoted to adequate private laboratories for the staff, and to such additional rooms as the storeroom and morgue. McMurrich's private office was on the third floor, adjacent to the court (Huber, "The New Medical Building," p. 203). In 1907 Dr. McMurrich resigned as Director of the Department of Anatomy, after thirteen years of service, to accept a similar position at his alma mater, the University of Toronto.

George Linius Streeter (Union '95, A.M. Columbia '99, M.D. ibid. '99), the fourth Professor of Anatomy and Director of the Department of Anatomy, came to the University in 1907. The teaching staff consisted of the professor, one demonstrator, one instructor, and four assistant demonstrators. Streeter reorganized

the department — the staff as well as the courses of instruction — and for the first time prepared teaching material according to modern methods of preservation.

Up to this time osteology, or the study of the skeleton, was taught largely by lecture. The lectures were supplemented to a very limited extent by the demonstration of five or six skeletons in the department. Streeter immediately recognized that one of the most fundamental systems of the structure and function of the body could not be properly taught without adequate material. In 1909 he was permitted to establish the loan collection of bones (R.P., 1906-10, p. 563). This collection, prepared within the department, grew rapidly under his direction. New sets have been added to it from year to year, until in 1940 the loan collection consisted of 250 complete sets. In addition, there were about two hundred sets nearly ready for use. No doubt this is the largest and most valuable collection of human skeletons for teaching purposes in this country.

In the field of investigation Streeter attracted many young men to his laboratories, where he offered full opportunity for individual investigation unhampered by European traditions. He encouraged optimism and freedom of thought and action; he expected, and obtained, results. His influence as a teacher and investigator broadened the scope of the department more than it had been broadened in any previous period. He directed the preparation of the first group of serial sections of mammalian brains prepared at the University for research purposes. These aids materially increased the interest in the study of the anatomy of the nervous system. Dr. Streeter was not only an excellent teacher and organizer, but also a trained investigator in the fields of neurology and embryology. He soon found conflict in these fields of investigation incompatible with ideals in research. In 1914 he resigned from the University to go to the Carnegie Institution of Washington, where he became Director of the Department of Embryology and Chairman of the Division of Animal Biology.

Upon the resignation of Dr. Streeter the Regents requested the medical faculty to devise a plan which would not involve an increase in the budget of the department (R.P., 1910-14, p. 960). Anatomy and histology were combined and the title of Gotthelf Carl Huber ('87m, Sc.D. hon. Northwestern '30) was changed from Professor of Histology and Director of the Histology Laboratory to Professor of Anatomy and Director of the Anatomical Laboratories. Huber was the fifth Director.

The development of the subject of histology has been traced above, from the time of the appointment of Ford (1854), who gave demonstrations on the minute structure of the human body by the use of the only microscope owned by the University, up to the recognition of a separate Department of Anatomy, with a well-equipped laboratory, by the appointment of Stowell as Professor of Histology and Microscopy (1883). The teaching of microscopic anatomy developed rapidly under Stowell. He gradually acquired the best equipment for the Histology Laboratory for teaching, demonstration, and research purposes. He encouraged original investigation among his associates by his own example. The capacity of the laboratory doubled under his guidance: only fifteen students could be dealt with in each section in 1877, but when he resigned, in 1889, there were facilities for thirty students per section.

After Stowell's resignation the chair of histology had been combined with that of pathology under Heneage Gibbes (M.B. and C.M. Aberdeen '79, M.D. ibid. '81);

and Dr. Huber at that time had been designated Instructor in Histology.

Dr. Huber, after having served as Assistant Demonstrator of Anatomy under Ford in 1887 and as Instructor in Histology under Gibbes in 1889, began the direction of histology teaching. In 1890 the chair of histology was separated from that of pathology and was combined with that of physiology under William Henry Howell (Johns Hopkins '81, Ph.D. ibid. '84, M.D. hon. Michigan '90, LL.D. ibid. '12, Sc.D. Yale '11), Professor of Physiology and Histology. Although histology was nominally combined with physiology, first under Howell and later under Lombard, Huber was privileged to guide its development along the lines of teaching and research.

When the Anatomical Laboratory Building was completed in 1889 the Department of Anatomy vacated the third floor of the old Medical Building and the Physiological Laboratory was moved into these quarters. Histology as well as physiology was taught in this laboratory until 1892, when "the histology laboratory was … moved to the second floor of the medical building" (Huber, "Medical Laboratories," p. 4). This laboratory now occupied the north half of the second floor, and Huber's private laboratory was across the hall. The floor space assigned to this department is estimated to have been 1,200 square feet.

In 1903 the Department of Histology was moved from the second floor of the original Medical Building to the second floor of the West Medical Building, where it occupied the northeast portion. The student laboratory was increased to 1,800 square feet of floor space. In addition to this laboratory there were a library, storerooms, and many rooms for members of the staff. Huber's private laboratory was on the north side. In 1898 the Regents made provisions for a separate chair of histology, as follows:

Resolved, That the title of Professor Lombard, now Professor of Physiology and Histology, be changed to Professor of Physiology. That Dr. McMurrich's title be made Professor of Anatomy and Director of the Anatomical Laboratory; and that Dr. Huber's title be made Assistant Professor of Anatomy and Director of the Histology Laboratory…

R.P.

Dr. Huber, with one assistant — Dr. Lydia Maria Adams De Witt ('99, '98m, A.M. hon. '13), continued the development of the department according to his conception of its functions, namely, the teaching of medical and dental students and of students from other departments, and original investigation.

The Histology Laboratory, as well as the laboratories of the basic sciences, became overcrowded. The completion of the West Medical Building in 1903 allowed the expansion of laboratory facilities so that students from the Graduate School and from certain departments within the Department (later the College) of Literature, Science, and the Arts were permitted to pursue studies in the Department of Histology. Dr. Huber found time, in addition to that required by his heavy teaching load, to continue research to such an extent that by 1914 he had completed sixty publications, either individually or in collaboration with others (Thompson, pp. 33-41).

The story of this era in the development of the Department of Histology would hardly be complete without mention of his only, but capable, assistant, Lydia De Witt. Dr. De Witt, during her thirteen years as assistant in the Department of Histology, by publishing six papers contributed in no small measure to the fulfillment of Huber's ideal of continuing research. After leaving the University, she spent most of the remaining sixteen years of her life with the Sprague Memorial Institute and with the University of Chicago, where she became

a prominent pathologist (Livingston, p. 31).

Many advanced students became interested in the science of histology at this time. Among them were Atwell, Guild, Curtis, Eggerth, and Clark. All have become prominent in one field of medical science or another; two have followed in the footsteps of their illustrious teacher. Wayne J. Atwell (Ph.D. '17) became professor of anatomy and director of the Anatomical Laboratories in the University of Buffalo, and Stacy R. Guild (Ph.D. '18) became director of the Department for Otological Research at Johns Hopkins Hospital.

In 1914 the Department of Anatomy and the Department of Histology were again combined as the Department of Anatomy, and Huber was placed in charge. Under his direction the Department of Anatomy rapidly developed courses that attracted students in departments of the University other than the two medical schools and the School of Dentistry. Soon the portion of the West Medical Building allocated to the Department of Anatomy became so overcrowded that even the addition of a large room in the basement brought only temporary relief. With the completion of the East Medical Building in 1925, however, this condition was relieved, and provision was made to develop courses for physical education, first announced in 1927. Courses in anatomy for nurses were announced the same year, as well as the Anatomy and Physiology of the Vocal Organs, a course for graduate students in the Department of Speech, and in 1932 a course was arranged for students in the Department of Fine Arts. In 1934 a course was arranged for students of the biological sciences. Many students from the Graduate School continued to apply for a place in the neurological division of the department. Graduate students of the School of Dentistry attended in large numbers the course in the division of gross anatomy arranged for them the second semester. Finally, courses in gross anatomy for interns were so arranged that they could work in the evenings, whereas in the similar courses for graduates in medicine the students worked throughout the day.

Not only was the teaching program for undergraduate and graduate students broadened under Dr. Huber's direction, but also many pieces of valuable equipment for teaching and original research were added. Among these were a well-equipped photographic room, including microphotographic apparatus, X-ray apparatus for teaching and research, and a well-equipped laboratory for making the Born wax-plate reconstructions.

During all of his association with the Department of Anatomy, Huber was particularly interested in neuroanatomical as well as in histological and embryological fields, as is evidenced by his research record. His interest in neuroanatomy reached fruition in the development of a Laboratory of Comparative Neurology, recognized by the Regents of the University as such in 1929 and having as its raison d'être a group of workers interested in neurological research and one of the largest collections of comparative neurological material available in this country or abroad. The collection, much of which was prepared by Huber, consisted of approximately six hundred complete series of the brains and spinal cords of various animals. These series, stained by standard methods, are one of the most valuable possessions of the Department of Anatomy.

During the twenty years that G. Carl Huber directed the Anatomical Laboratories he published thirty-two contributions to science. Most of these were in the field of comparative neurology; many were written in collaboration with others, in particular, with Elizabeth C.

Crosby. Besides the publications mentioned above there were many contributions by members of the staff and by graduate students.

In the Laboratory of Comparative Neurology Professor Elizabeth C. Crosby (B.S. Adrian '10, M.S. Chicago '12, Ph.D. ibid. '15) has had an outstanding influence. Before coming to the University in 1920, Dr. Crosby worked for several years with Professor Herrick, one of the best-known comparative neurologists. After coming to the University she was associated with Dr. Huber in the development of the laboratory. She has produced many original and important pieces of research, mostly in collaboration with Huber. Upon his death in 1934, she completed revision of that outstanding two-volume treatise, Comparative Anatomy of the Nervous System of Vertebrates. She took over the task of completing the "Huber Memorial Volume" of the Journal of Comparative Neurology. In 1936-37 Crosby brought to the University, for conferences on neurology, Dr. C. U. Ariëns Kappers, Dr. Herrick, and Dr. Larsell — three of the foremost neurologists of the world. She is an exceptionally successful teacher and is loved by all her students. We of the University were late in recognizing that in our midst is one who ranks among the leading neurologists of the world. The University is aware that with Professor Crosby directing the division of neurology in the Department of Anatomy its high standard is assured.

Bradley Merrill Patten (Dartmouth '11, Ph.D. Harvard '14) was appointed the sixth Professor of Anatomy and Director of the Anatomical Laboratories in 1935. It was decided that three divisions be made within the department, and that an adjustment of space be made for teaching and for research — the division of embryology and histology, the Laboratory of Comparative Neurology, and the division of gross anatomy. The division of embryology and histology is under the direct charge of Professor Patten. The teaching laboratory is on the second floor of the East Medical Building. The laboratory has about 180 microscopes, an excellent loan collection of microscopic slides for histology, and a good loan collection of microscopic slides for embryology. With the seating arrangement providing adequate working light, the microscopical laboratory will accommodate 144 students. Patten's private office is on the second floor, and the research laboratories are in the south part of the first floor. To the photographic laboratory has been added a motionpicture outfit for microscopic work. The general shift in the allotment of space within the department has given to the Laboratory of Comparative Neurology a group of twelve rooms on the fourth floor of the East Medical Building. Within this space have been arranged a large laboratory for technical work, a seminar room, a small but reasonably well-equipped experimental laboratory, a secretary's room together with space for housing the neurological collection, projection and chart rooms, and a series of smaller rooms for neurological research, all of which are occupied. The collection has been arranged and catalogued, and additions to it are constantly being made. A research grant from the Graduate School has made possible the development of a monkey colony having special quarters on the fifth floor. A program in normal and experimental neurological research is being carried on by members of the department and by graduate students.

The division of gross anatomy occupies portions of the first, the third, the fourth, and the fifth floors of the East Medical Building. There is working space for 472 students. The division of gross anatomy attracts students from

many of the schools and colleges of the University. The groups that receive instruction in these laboratories are: from the Medical School, first-, second-, and third-year medical students and graduates in medicine; from the School of Dentistry, both undergraduates and graduate students; and students from the School of Nursing, the School of Education, the Institute of Fine Arts, the Department of Speech, the Graduate School, the College of Architecture and Design, and the Summer Session. During 1936-37, 578 students pursued courses in gross anatomy.

The state anatomical law under which teaching material may be provided for the medical schools was passed in 1867. It has been amended many times since. The Michigan law is the best one ever enacted for scientific purposes, and it has been used as a model for similar legislation in other states.

A careful record of all the bodies sent to the University has been kept, beginning in 1881. By 1940 more than 10,000 subjects had been received. The rate of arrival of bodies is between four hundred and five hundred per year, a sufficient number at this time for the very large enrollment in the department. The subjects are cared for by a full-time embalmer and morgue director. After the bodies are used for scientific purposes they are cremated in a crematory built for this purpose. The ashes are buried once a year, with the Christian burial service, on the University lot in Fairview Cemetery.

The first morgue was built in the basement of the old Medical Building, at a cost of $185.81. In 1889 a morgue was built into the basement of the Anatomical Laboratory Building. When the West Medical Building was completed in 1903, a morgue with a capacity of fifty subjects was constructed and was furnished with refrigeration machinery. In the East Medical Building a large morgue, with a capacity of 200 subjects and with refrigeration apparatus, was provided.

It is fitting that the present members of the department should record with pride the achievements of their predecessors. But that alone is not enough. The tradition of scholarly work must continue without interruption, for we are realizing with increasing clearness that teaching soon becomes barren without the revivifying effect of original investigation.

Rollo E. McCotter

[Rollo Eugene McCotter ('10m), Professor of Anatomy in the University since 1914.]

SELECTED BIBLIOGRAPHY

Announcement, Department of Medicine and Surgery "The Department of Medicine and Surgery in the Fifties." Calendar Catalogue … Catalogue and Register Journ. Comp. Neurol. "Moses Gunn, A.M., M.D., LL.D." "The Story of a Busy Life." The Phi Rho Sigma Fraternity and the University of Michigan. "An Historical Sketch of the Department of Medicine and Surgery of the University of Michigan." "Medical Laboratories."

"The New Medical Building." "Laboratory of Comparative Neurology." "William James Herdman." Comparative Anatomy of the Nervous System of Vertebrates. "The Early Days of the Medical Department." The Tricennium President's Report Proceedings of the Board of Regents … The University of Michigan. "Bibliography of G. Carl Huber." University of Michigan Regents' Proceedings …, 1837-1864. A Doctor's Memories. Memorial Discourses on the Life and Services of Corydon L. Ford …

THE DEPARTMENT OF BACTERIOLOGY AND SEROLOGY AND THE HYGIENIC LABORATORY

THE beginning of bacteriology in the University can be traced back to 1881. In June of that year the Board of Regents established a School of Political Science, and among the courses listed was Sanitary Science, taught by Dr. Victor Clarence Vaughan (Mount Pleasant College [Mo.] '72, Ph.D. Michigan '76, '78m, LL.D. ibid. '00), then Assistant Professor of Physiological Chemistry. In the outline of the course, as given in the University Calendar for 1881-82, twelve main topics were presented, and among these the fifth is of special interest, since it concerned "Ferments and Germs; physiological ferments, and fermentation; disease germs; filth diseases; antiseptics and disinfectants and their use; quarantine, vaccination, etc." This was an elective course begun in October, 1881, in the Department of Literature, Science, and the Arts and consisted of lectures, twice weekly, in the first semester.

At that period it was quite proper to speak of the "germ theory," for bacteriology was then in its infancy. The bacteria of several human diseases, apart from those of animals, had been seen, but in the absence of suitable means of cultivation it was not possible to prove their role as causative agents. It was early in 1881 that Pasteur and, independently, a few weeks later, Major G. M. Sternberg, of the United States Army, discovered the microbe of sputum septicemia which later came to be identified as the cause of pneumonia. The bacillus of tuberculosis was not discovered until the spring of 1882. Again, it was in 1881 that Pasteur began his experimental work leading to vaccination or the preventive inoculation against anthrax and hydrophobia, thus opening up the field of immunology. At this time Dr. Sternberg, Dr. T. J. Burrill, professor of botany at the University of Illinois, and Dr. H. J. Detmers, of the federal Department of Agriculture, were

almost the only persons in this country who were engaged in the study of bacteria. Thus, it is seen that the significance of sanitary science, and incidentally of bacteria, was recognized at a very early date. Fragmentary though the treatment of the subject of bacteria must have been at this time, before a decade passed, as a result of intensive work with the newly discovered method of plate cultivation, bacteriology became a study of commanding importance.

An account of the early development of bacteriology in the University would be incomplete without the mention of Dr. Henry Sewall, who, from 1882 to 1889, was Professor of Physiology. Though only twenty-seven years of age at the time of his appointment, he had been trained under Martin at the Johns Hopkins University and had also studied abroad. Indirectly, he had acquired some knowledge of the work being done on bacteria, since he had been closely associated with G. M. Sternberg, who had worked as a guest in Martin's laboratory. Hence, he was familiar in a general way with the subject when he arrived in Ann Arbor, where he became an intimate colleague of Vaughan. Together the two young men frequently discussed the germ theory, and there is no doubt but that the convictions of the young biologically trained physiologist carried the day.

Fifty years later, in the closing paragraph of his book, Society and the Natural Law (p. 78), Sewall recalled the course in sanitary science and paid a tribute to Vaughan:

[Dr. Vaughan] was a pioneer in a Golden Age, and in virile, emphatic teaching he led his class to see with him the formation of organic compounds in plants, their metabolism in the animal. He told of the ferments and germs and their relations to health and disease. He invented a course in hygiene which was a forerunner of our noble institutions of Preventive Medicine. The largest lecture room became crowded with students who relished with zest a culture which included the motivation of their own bodies in health and disease, but stressed above all the mastery of man over his environment and his fate.

The course called Sanitary Science was given by Dr. Vaughan to students of the Department of Literature, Science, and the Arts for a decade. In 1884 he also introduced in the Department of Chemistry a practical course, Sanitary Examinations, dealing with the analysis of such materials as water, foods, and drugs. It was later transferred to the Hygienic Laboratory and in 1892 was designated Methods of Hygiene. Since 1890, separate courses in water analysis and food analysis have been given. The medical students were given a separate course of twenty lectures, Sanitary Science, from 1884 to 1891, when it was divided into two courses, Bacteriology and Hygiene. The latter was given by Vaughan until his retirement in 1921.

By 1885 the growing importance of the study of bacteria was recognized, and a special course for medical students, the Study of Bacteria (ten lectures), was listed in the University Calendar for 1885-86, and again in the next two years. Unfortunately, nothing definite is known regarding these lectures. From items in the students' publication, The Chronicle, it would appear that the lectures were given by Vaughan and Sewall. In the issue of January 31, 1885 (p. 156), Vaughan was reported as "giving the seniors some very interesting talks on Bacteria." And again on March 14 (p. 215), Sewall was said to be giving the freshman medical students weekly talks on the "bacteria theory." His assistant, Dr. Harry Lum, was mentioned (p. 237) as carrying on an original investigation on the bacterial theory. Further, on

March 12, 1887 (p. 70), the statement was made that Dr. Hugo Lupinski was requested to lecture on microorganisms. He certainly possessed at that time a copy of Hueppe's Methoden. Dr. Otto Landman ('84, '87m, A.M. hon. '12) was very much interested in the subject and remembered staining for tubercular bacilli and diphtheria bacilli and trachoma.

However scanty these lectures on bacteria may have been, it is noteworthy that in this period a significant contribution was made to the subject of immunity, then in its infancy. As indicated above, Sewall, though primarily a physiologist, was deeply interested in the rapidly developing subject of bacteriology. He was fascinated by Pasteur's studies on vaccination. At the time it was believed that the poisonous properties of bacteria were due to basic products known as ptomaines. Sewall reasoned that immunity might be produced by repeated injections of the soluble products of bacteria, and since he himself was unable to work with these organisms, he looked about for a suitable substitute. The toxicity of the venom of the rattlesnake was known to be caused by soluble poisonous proteins. He gave pigeons repeated injections of small doses of the venom and rendered them refractory against seven to ten times the fatal dose. A short paper describing his experiments was published in the spring of 1887; it antedated by six months the first work on the production of immunity with the soluble products of Vibrion septique (Roux) and by three years the immunization of animals with tetanus and diphtheria toxins (Behring and Kitasato). His was the pioneer work in antivenom serum therapy.

The recognition of Vaughan's interest in the teaching of sanitary science led to his appointment in February, 1883, to the Michigan State Board of Health. He was a member of that board continuously, except during the period 1895-1901, until 1919, when the State Board of Health was abolished and the office of State Health Commissioner was created. In January, 1884, at a time when outbreaks of cheese poisoning were claiming attention, he urged upon the Board of Health the need of a fully equipped sanitation laboratory at the University, but no action was taken at that time. The suggestion was made again in October, 1886, and then the Board of Health requested the Board of Regents to consider the advisability of establishing a laboratory of hygiene in which original investigations — chemical, microscopical, and biological — should be carried on, and in which attention should be given to the analysis of water, the adulteration of food, and the practical investigation of other problems of sanitary science. A committee appeared before the Regents on December 7, 1886, and presented in full the needs of such a laboratory. To meet this and other requests the Regents asked the legislature of 1887 for an appropriation of $75,000 for laboratories of physics, hygiene, pathology, physiology, and histology. By act of the legislature, approved June 24, 1887, $35,000 was appropriated "for the construction of a building for scientific laboratories and for the equipment of the same." It was obvious that the amount was inadequate to meet the needs of all the laboratories mentioned, and a committee of the Board of Regents on July 8, 1887, recommended the erection of a three-story brick building to accommodate at least two of the laboratories, those of hygiene and physics, at a cost not to exceed $28,000, which amount, by amendment, was increased to $30,000. Actually, when the building was completed there remained an unexpended balance of $176.93 which was used to buy apparatus for the Hygienic Laboratory.

At the same time a committee was

appointed to present a scheme for the establishment of a department of hygiene. The committee, on July 9, 1887, presented a report signed by V. C. Vaughan, A. B. Prescott, and John W. Langley recommending the establishment of a department of hygiene, the combination of the closely related subjects of hygiene and physiological chemistry in one chair, and the appointment of an instructor. The report was adopted, and Vaughan was appointed Professor of Hygiene and Physiological Chemistry and Director of the Hygienic Laboratory. At a meeting of the executive committee held the same day, Frederick George Novy ('86, Sc.D. '90, '91m, LL.D. Cincinnati '20) was appointed Instructor in Hygiene and Physiological Chemistry.

In October, 1887, the Regents accepted the architectural plans of Pond and Pond and awarded the contract for the building, which was to be completed on or before July 1, 1888. There were the usual delays in construction, and the building, the east half of the present West Physics Laboratory, was not completed until the late fall of 1888. The Department of Physics was given the basement and first floor, and the Hygienic Laboratory occupied the second floor and the attic. These quarters were soon outgrown. In 1903 the Hygienic Laboratory was moved to the present West Medical Building and in 1926 to its present location in the East Medical Building.

The Hygienic Laboratory at the University of Michigan was the first of its kind in this country; that of the United States Marine Hospital was started in New York in August, 1887, was moved to Washington in 1891, and is now the National Institute of Health; the hygienic laboratory of the University of Pennsylvania was established in 1890; and the Bender Hygienic Laboratory at Albany was founded in 1896.

Immediately after the establishment of the Hygienic Laboratory, work was carried on in rooms in the old Chemical Laboratory (the present Economics-Pharmacology Building) pending the erection of the new Medical Building. Chemical analyses of water and foods were made, but attempts to do bacteriological work were not satisfactory. It was evident that a first hand knowledge of bacteriological techniques could only be obtained by going abroad for a course of instruction in the new science. Accordingly, Vaughan and Novy went for such a course to Koch's laboratory, the Hygienic Institute of the University of Berlin, in the summer of 1888. At the same time they purchased the necessary equipment for the new laboratory. Later they visited the laboratory of Pasteur in Paris.

The first systematic lectures on the subject of bacteriology were given in the fall of 1888 by Vaughan in his course, Sanitary Science. These lectures he gave also in the following two years, when the designation of the course was changed to Hygiene. Vaughan continued to teach this course until his retirement in 1921. From 1891 to 1934, inclusive, the formal lecture course on general bacteriology was given by Novy. The course was required of all medical students, and also of students of dentistry from 1891 to 1901. In 1935 and for the next few years the lecture course was presented by Dr. Malcolm Herman Soule ('21, Sc.D. '24, LL.D. Saint Bonaventure's College '28), but because of a change in the curriculum in 1938-39 it was no longer required of the medical students, though it continued to be given to nonmedical students. Until the time of this change, the course had been taken by about 8,700 students. A full synopsis of the course is to be found in the Announcement of the Medical School (1938-39, p. 66).

In 1888 an attempt was made at giving

instruction in bacteriology in the Department of Pathology. Dr. Heneage Gibbes of London, England, appointed Professor of Pathology, began work in January, 1888, and continued in service until 1895. In the basement of the new Anatomical Laboratory Building he fitted out a small space for bacteriological work. In 1885 Dr. Gibbes had been associated with Dr. E. Klein on the British Cholera Commission and had some acquaintance with bacteriological methods, but unfortunately he did not believe in the germ theory. Hence, though he offered a course in practical bacteriology from 1888 to 1890, very few students were attracted. To Gibbes, the pathogenic germs, such as the cholera and tubercle bacilli, were merely adventitious organisms.

In the fall of 1888 the new quarters of the Hygienic Laboratory were equipped for work, and in January, 1889, the first laboratory course in bacteriology was offered in the University. It is listed in the University Calendar for 1888-89 (p. 59) as Original Research in the Causation of Disease. Some very short courses in bacteriology had been given in the East as early as 1887. Perhaps the first course given in New York in 1887 was that by Dr. John E. Weeks ('81m, Sc.D. hon. '12). The course at Michigan was the first comprehensive, experimental course to be offered in this country. It was given daily, afternoons, and on Saturday morning, twenty-four hours weekly, for three months. It was an elective open to students of the Literary and Medical departments. The first class consisted of nine students; the second, beginning in April, had fourteen. In 1889-90, three such courses were given to sixty-three students; in 1890-91, to seventy-one students.

The new four-year course in medicine went into effect in 1890-91, and at that time the three-month course in laboratory work in bacteriology, given three times each year, became a required subject for the first-year medical students, but remained optional to others. The medical curriculum was revised in 1900-1901 by the introduction of the block system, wherein all the laboratory courses were placed on an eight-week basis. At the same time the laboratory work in bacteriology was transferred to the sophomore year. As a rule, four courses of instruction in the laboratory, each for eight weeks, were given each year. The schedule continued for ten years. The faculty of the College of Dental Surgery took advantage of the shortening of the course, and in 1902-3 made it a required subject for students of dentistry, which it has continued to be ever since.

Vaughan had become Dean of the Department of Medicine and Surgery in 1891. He remained Director of the Hygienic Laboratory until 1909, when he was succeeded by Novy, who had held a full professorship of bacteriology since 1902.

In 1910-11, as a result of changes in the schedule of studies, the laboratory work in bacteriology was returned to the first-year program of the medical students, in which it has remained to the present time. Moreover, the duration of the course for the medical students was restored to three months, lasting from March to June. With this new schedule, the first period of eight weeks was reserved for the dental students, and the second period of about ten weeks was reserved for the students of other schools and colleges.

In 1923-24 the laboratory period for medical students was extended through the entire second semester, and attendance each afternoon and Saturday morning was required. In 1940 the laboratory period for medical students was cut in half — to three afternoons a week for the semester. In the first semester, two eight-week

courses were given to students in dentistry and in other schools.

The growth and development of bacteriology, or, rather, microbiology, during the past fifty years has made it necessary to alter and expand the laboratory work so as to include the study of new pathogenic bacteria, protozoa, viruses, worms, molds, yeasts, and the methods of serology. The work in bacteriology was conducted by Novy from 1889, when the first course was given, until his retirement in 1935, when it was taken over by Soule. During the fifty years from January, 1889, to January, 1939, instruction in this course was given to about 10,400 students.

Within a few years after the instruction in bacteriology began, requests came from students for further work in this subject. Accordingly, in 1896, a formal course named Special Methods in Bacteriology was given, and this in time was designated Advanced Bacteriology. The student, after acquiring some familiarity with glass blowing and the preparation of Pasteur pipets and blood pipets, worked with filters, germicidal tests, the inoculation and bleeding of animals, the preparation of vaccines, immunization procedures, and serum reactions. In 1905, the first classwork on the pathogenic protozoa in this country was introduced. In the forty years since its establishment nearly seven hundred students have availed themselves of this opportunity for advanced work. As a supplement to the advanced work, for more than twenty years a journal club, or seminar, has fostered the interest of the students.

Owing to the frequency of outbreaks of rabies in the state, the Pasteur Institute was set up as a part of the Hygienic Laboratory in 1903, with Dr. Thomas Benton Cooley ('91, '95m) in charge. He was succeeded in 1905 by Dr. James Gordon Cumming ('03m, D.P.H. Harvard '15), who in turn was followed in 1916 by Dr. Herbert William Emerson (Ph.C. '01, B.S. Pharm. '02, '15m). Emerson held the position for the remainder of the period. Between March 5, 1903, and August 23, 1941, the Institute provided Pasteur treatment to 2,815 persons with no case of paralysis or rabies following treatment. The bulk of its work has consisted in the examination of 7,772 animals for suspected rabies. Of these, 90 per cent were dogs, and the rest were chiefly cats and other domestic animals, with a few wild animals such as skunks and raccoons.

The Hygienic Laboratory, from its beginning, was called upon to render diagnostic aid to physicians and health officers, by examinations of blood, pus, sputum, and water. Scores of such examinations were made annually until the State Board of Health, through legislative action, established, in 1907, a special laboratory for that purpose at Lansing.

In addition to teaching and diagnostic service, the Hygienic Laboratory has had research as a third objective. During more than half a century since its establishment this objective has been paramount in the endeavors of its staff and is being maintained at the highest possible level. As the result of its contributions the laboratory is known far and wide and has more than justified the expectations raised at the time it was founded.

Frederick G. Novy

SELECTED BIBLIOGRAPHY

Announcement, Department of Medicine and Surgery Calendar Catalogue … Catalogue and Register

History of the University of Michigan. "Department of Chemical Laboratories, University of Michigan Hospital." "Henry Sewall and the Department of Physiology." Memorial Meeting for Victor Clarence Vaughan … [News notes.] President's Report Proceedings of the Board of Regents … Society and the Natural Law. A Doctor's Memories.

THE DEPARTMENT OF BIOLOGICAL CHEMISTRY

THE University of Michigan was one of the first American universities to recognize the importance of physiological chemistry, chemistry as applied to the living organism in health and disease, as a separate branch of chemistry. In 1883 Victor Clarence Vaughan (Mount Pleasant College [Mo.] '72, Ph.D. Michigan '76, '78m, LL.D. ibid. '00), at that time Assistant Professor of Physiological Chemistry, was appointed Professor of Physiological and Pathological Chemistry and Associate Professor of Therapeutics and Materia Medica (R.P., 1881-86, p. 360). Vaughan, later Dean of the Department of Medicine and Surgery, was the first man to hold a professorship in physiological chemistry in a medical faculty in this country. Under the able leadership of Vaughan and of his pupil, Frederick George Novy ('86, Sc.D. '90, '91m, LL.D. Cincinnati '20), the subject was developed at the University as a part of the offerings of the combined Department of Bacteriology, Physiological Chemistry, and Hygiene. (For a discussion of the developments prior to 1922, see Part V: Administration and Curriculums and Department of Bacteriology .)

After the retirement of Dr. Vaughan in 1921, the feeling that the work in physiological chemistry, in view of its rising importance, could hardly be kept in the position of an adjunct to other subjects (P.R., 1921-22, p. 88) led to the establishment of a separate Department of Physiological Chemistry by the Regents at their meeting of May 26, 1922. Howard Bishop Lewis (Yale '08, Ph.D. ibid. '13), of the University of Illinois, was appointed Professor of Physiological Chemistry to take charge of the new department. He had received his graduate training in physiological chemistry under Professors R. H. Chittenden and L. B. Mendel in the Sheffield Laboratory of Physiological Chemistry of Yale University and had taught in the Medical School of the University of Pennsylvania. In 1935, with the approval of the executive committee of the Medical School, the name Department of Physiological Chemistry was changed to Department of Biological Chemistry. It was felt that the broader term "biological" was more in keeping with the recent developments in this branch of chemistry.

The chief responsibility of the department, aside from research, has been the conduct of the courses in biological

chemistry for students of medicine. With the reorganization of the preclinical work of the School of Nursing, the department was requested to co-operate in the development of a survey course in chemistry for nurses, to include the fundamentals of inorganic, organic, and biological chemistry as a foundation for the clinical courses in medicine, therapeutics, and dietetics. Such a course, which included laboratory exercises, lectures, and recitations, was begun in the fall of 1925.

In 1928 the faculty of the School of Dentistry requested that arrangements be made to offer lecture instruction to students in dentistry, and with the institution of the four-year curriculum in dentistry, laboratory instruction was, in 1935, also made available to the students of this group. At the request of the School of Education, a course similar to that required of students in the School of Nursing, but slightly more inclusive, was offered in 1936 to professional students in the curriculum of physical education for women. The Department of Biological Chemistry, in addition to the instruction in the required courses in the Medical School, has thus co-operated with other professional groups — in nursing, dentistry, and education. In addition, many students in the College of Pharmacy, the College of Literature, Science, and the Arts, and the Graduate School elect courses and receive their instruction in sections with students of medicine. Biological chemistry is also included in the list of courses recommended for students qualifying for positions as hospital technicians and in related work.

Advanced students have been admitted to the department as candidates for the higher degrees of master of science and doctor of philosophy in the Graduate School. Many students in this group have served, at some period in their graduate work, as assistants in the required laboratory courses for medical students. In the first fifteen years of its existence as a separate department, thirty-nine students received the degree of master of science, and thirty-two the degree of doctor of philosophy, in biological or physiological chemistry. These graduates are occupying important positions in university education or research in hospitals or research institutes, in government laboratories, and in commercial work.

In research, Associate Professor Adam Arthur Christman (Grinnell '17, Ph.D. Illinois '22) has studied various phases of purine metabolism and has published a new and simple method for the quantitative determination of carbon monoxide in blood — a method which has been employed extensively, particularly in medicolegal work. Associate Professor Henry Charles Eckstein (Illinois '15, Ph.D. Yale '23) has been an investigator in the field of lipids, and in 1925 he published the results of an exhaustive study of the composition of human fat. Along other lines, he has contributed to the knowledge of the sterols in epidermal structures, lipid metabolism in xanthoma, and the relation between the lipids of the diet and those of the tissues. Assistant Professor Herbert O. Calvery (B.S. Greenville '19, A.B. Illinois '21, Ph.D. ibid. '24), who studied in the Prague laboratories of Professor E. Waldschmidt-Leitz under the tenure of a Guggenheim fellowship, interested himself in the chemistry and enzymatic degradation of protein. His study of egg albumin was one of the first studies of the enzymatic hydrolysis of a native protein in which the newer methods of enzyme investigation were used. Miss Lila Miller (Wisconsin '26, Ph.D. Michigan '36), who worked in the Carlsberg laboratories under the direction of Professor S. P. L. Sørensen, continued these investigations.

It is to be regretted that Professor Calvery resigned in 1935 to accept an important position in the laboratories of the federal government. He became chief of the Laboratory of Pharmacology of the Food and Drug Administration of the Department of Agriculture. Professor Lewis has been interested in protein metabolism, particularly in the two sulfur-containing amino acids of the protein molecule, and has published some thirty papers on sulfur metabolism. Important among these are his contributions to our knowledge of the "inborn error" of metabolism, cystinuria.

Members of the staff have served as officers of the professional societies of biological chemistry and on the editorial boards of various important journals concerned with biological chemistry and related fields. Lewis has been a member of the National Board of Medical Examiners, serving also as a member of its examination committee. It is worthy of note that Dean Vaughan, whose work was so important to the development of instruction and research in physiological chemistry at the University of Michigan, was one of the original members of the National Board at the time of its foundation in 1915. Lewis has also been a member of the Council on Foods of the American Medical Association.

A detailed and illustrated account of the organization and of the instructional and research work of the department was published by the Rockefeller Foundation in 1930.

Howard B. Lewis

SELECTED BIBLIOGRAPHY

Announcement, Department of Medicine and Surgery Calendar Catalogue … "Department of Physiological Chemistry, University of Michigan Medical School." Memorial Meeting for Victor Clarence Vaughan … President's Report Proceedings of the Board of Regents … A Doctor's Memories.

THE DEPARTMENT OF DERMATOLOGY AND SYPHILOLOGY

COURSES in dermatology and syphilology appeared in the curriculum of the Department of Medicine and Surgery in 1890. At that time Dr. William Fleming Breakey ('59m), who had previously been Preceptor of Surgery and Associate Demonstrator of Anatomy, was appointed Lecturer on Dermatology. Dr. Breakey held the position until 1905, at which time he was made Professor of Dermatology and Syphilology. He retained this professorship until he retired in 1912. It may be assumed that previous to 1890 any cutaneous problems which presented themselves were taught in one of the other major departments, presumably in the Department of Internal Medicine.

Dr. Breakey was born in Bethel County, New York, in 1835. After his graduation from the Department of Medicine and Surgery he practiced for a short time at Whitmore Lake. He served with distinction as Assistant Surgeon with the Sixteenth Michigan Volunteer Regiment during the Civil War and while he was in service suffered a serious bullet wound in his left thigh. This wound produced a chronic infection from which he suffered throughout the rest of his life.

A lifelong member of the local medical society, Breakey was honored by being made president of the Michigan State Medical Society in 1903. He was also honored by membership in the American Dermatological Association, to which he was elected in 1902.

Dr. Breakey was a man of delightful personality, whose graciousness and lovable qualities endeared him to all of his medical colleagues. During the seven years of his professorship the department made commendable progress, and in 1912, when he retired because of ill-health, the Department of Dermatology and Syphilology at the University of Michigan was one of the few independent departments of dermatology and syphilology in medical schools in the United States.

After his retirement Breakey lived in Ann Arbor for an additional three years. He died in February, 1915, at the age of eighty. He is remembered as a loyal alumnus and a pioneer in a new field of medical practice.

In 1912, following Breakey's retirement, the professorship of dermatology and syphilology was filled by Udo Julius Wile (Columbia '04, M.D. Johns Hopkins '07).

Immediately after he had obtained his medical degree Dr. Wile had served as an intern in the Charité Hospital of Berlin for one year and had pursued graduate studies in dermatology and syphilology during the next eighteen months at the universities of Bern, Paris, and Berlin. At that time he also became a student of Professor Paul G. Unna, of Hamburg, in whose home he lived for several months. Upon his return to the United States he practiced in New York City until, at the age of thirty, he was appointed to a chair in the University. He began active service in September, 1912.

Owing to the cordial support of his colleagues and of the deans under whom he has served, Dr. Wile has been enabled to build upon Dr. Breakey's foundation one of the most active university clinics in dermatology and syphilology in the country.

Through the year 1937 twenty-seven

men had graduated from the service of dermatology of the department. Of this group several have reached national and international distinction. The first assistant of the department, Dr. John Hinchman Stokes ('08, '12m), after having established the syphilis and dermatology departments at the Mayo clinic, became Duhring professor of dermatology at the University of Pennsylvania, a position which he now holds. Dr. Stokes is an outstanding syphilologist and has achieved wide distinction, not only from the point of view of effective practice, but also from the point of view of public health. He is a member of the American Dermatological Association and in 1936 was elected its president.

Dr. Francis E. Senear ('12, '14m) has become a dermatosyphilologist of great distinction. He is professor of dermatology and syphilology at the University of Illinois Medical School and is in active practice in Chicago. Both Dr. Senear and Dr. Stokes have established schools of their own, properly trained graduates of which have already attained national reputations. Senear is a member of the American Dermatological Association and has been chairman of the Section of Dermatology and Syphilology of the American Medical Association.

Dr. Joseph Alexander Elliott (Southern University '10, Michigan '14m) was the third member of Dr. Wile's staff. He proved himself an excellent teacher, and during Wile's absence for military service during World War I, Elliott, as Acting Professor, carried the teaching and other responsibilities of the department with admirable executive ability. Dr. Elliott has been elected a member of the American Dermatological Association.

Dr. Lyle Boyle Kingery ('14, '16m), now professor of dermatology and syphilology at the University of Oregon, was the first member of the staff in the dermatology and syphilology service to remain for the full period of four years and also the first to have reached professorial rank in the University. He is an admirable teacher and, in spite of a very heavy practice, has maintained his interest in scientific investigation. He has developed a strong department at his university and is considered one of the distinguished graduates of the department.

Kingery was followed by Dr. Harther Lewis Keim ('15, '17m, M.S. '23), who was with the department nine years and who also reached professorial rank. In addition to his service in the department and his contributions to the research and literature in this subject, Keim spent a year at the Union Pekin Medical College, China, as an exchange professor. Upon his return he established himself in practice in Detroit.

Dr. Carroll Spaulding Wright ('17, '19m), the sixth graduate of the department, was fortunate in securing Professor J. F. Schamburg of Philadelphia as his associate. Wright became assistant professor and subsequently associate professor in the Graduate School of the University of Pennsylvania, and was elected professor of dermatology and syphilology at Temple University Medical School.

The next man after Dr. Wright to achieve professorial rank was Dr. George H. Belote ('23m, M.S. '27). Belote entered the department in 1923, served successively as intern, resident, and instructor, and was appointed Assistant Professor in the department in 1928. In 1930 he was promoted to Associate Professor. He died in 1941. He was an admirable teacher and an excellent administrator, and he made signal contributions to the literature.

Among the other staff members who remained during the full period of internship and graduated are many who

have university associations and from whom it is expected and hoped that more will be heard.

The Department of Dermatology and Syphilology staff had in 1940, in addition to Wile, one associate professor, two instructors, a research assistant, two assistant residents, and two interns.

In the earlier days, the department was housed in a section of the hospital, but in 1918, upon Wile's recommendation, a separate building, affording 4,166 square feet of floor space, with room for twenty-five beds, was erected at a cost of $7,445. The building was torn down in 1932, after the department was accommodated in the new hospital. Through the cordial co-operation of the University Hospital group, the department has adequate bed facilities and not infrequently has as many as sixty patients in the hospital at one time. The department maintains an active outpatient service visited by approximately nine thousand patients yearly.

Through the adequate budgets allowed the department it has been possible to keep pace with all of the newer methods of diagnosis and treatment. The department not only has been from the outset ideally equipped to perform its duties to the people of the state as a helpful integral part of University Hospital service, but also has been enabled to develop a comparatively new field and to equip young men to enter it with the scientific and practical background required of competent practitioners and teachers.

Udo J. Wile

SELECTED BIBLIOGRAPHY

Announcement, Department of Medicine and Surgery "A Banquet in Honor of Doctor Breakey." Calendar Catalogue … "William Fleming Breakey, '59." History of the University of Michigan. [News notes.] President's Report Proceedings of the Board of Regents … "The Department of Dermatology and Syphilology." "The University Hospital Department of Skin Diseases and Syphilology."

THE DEPARTMENT OF INTERNAL MEDICINE

The Period Ending in 1908

THE first step in organizing the Department of Medicine was the appointment in 1848 of Abram Sager (Rensselaer Polytechnic Institute '31, M.D. Castleton Medical College [Vt.] '35, A.M. hon. Michigan '52) as Professor of the Theory and Practice of Medicine. He had been Professor of Botany and Zoology since 1842, but apparently never conducted classes in medicine, as in January, 1850, Samuel Denton (M.D. Castleton Medical College [Vt.] '25) was appointed to the professorship in medicine as well as to that in pathology, and Sager was assigned to the professorship of obstetrics and diseases of women. In 1874 Sager was made Emeritus Professor, but he continued to act as Dean until June, 1875, when he resigned as a protest against the proposed establishment of a department of homeopathy in the Medical School.

The first active head of the Department of Medicine was Samuel Denton, who had been appointed Professor of the Theory and Practice of Medicine and Pathology in 1850. In 1837 he had been appointed one of the first Regents and he had served for three years; later, his interest in state politics led to service in the state Senate from 1845 to 1848.

According to Dr. William Fleming Breakey, Denton was very dignified in manner and always wore a high hat. He had a large general practice and was much sought in consultation, for he had an excellent reputation for sound judgment and skill in diagnosis and treatment. A great advocate of the use of alcohol in many types of illness, he especially recommended it in "consumption" and in the later stages of protracted fevers. The discrepancy between his views and those of Dr. Alonzo B. Palmer, who bitterly opposed the use of alcohol in all forms, was quickly noticed by the students, who sometimes submitted written questions in class calling attention to the opposing opinions. According to Dr. Victor C. Vaughan, Denton "possibly had something to do with the inauguration of the Medical School, but so far as I can learn he contributed but little to its reputation" (Vaughan, A Doctor's Memories, p. 195). He died in Ann Arbor, August 17, 1860. To succeed him Samuel Glasgow Armor (M.D. Missouri Medical College '44, LL.D. Franklin '72) was, in 1861, appointed Professor of the Principles of Medicine and Materia Medica, although the title was changed at once, by his request, to Professor of the Institutes of Medicine and Materia Medica. He had held teaching positions in several middle western medical colleges and was in private practice in Dayton, Ohio, when he accepted the appointment, which he retained until the close of the session of 1867-68.

Dr. Armor, a man of great personal charm, was characterized as an able teacher and lecturer, although he will not be remembered as one who contributed importantly to the advancement of medicine. He made his home in Detroit and was in practice there, for a part of the time, in professional partnership with Dr. Moses Gunn, who was then Professor of Surgery in the University.

Alonzo Benjamin Palmer (M.D. College of Physicians and Surgeons [West. Dist., N. Y.] '39, LL.D. Michigan '81) became associated with the University

in 1854, when he was appointed Professor of Materia Medica, Therapeutics, and Diseases of Women and Children. Appointed Professor of Anatomy two years before, he was listed as "not on duty," presumably because of his desire to accumulate more funds before beginning an academic life. For a time Palmer attempted to maintain a residence in Chicago, but soon gave this up and came to Ann Arbor to live. On the death of Denton in 1860 he assumed the professorship of the theory and practice of medicine and of pathology and materia medica, becoming, a year later, Professor of the Theory and Practice of Medicine and of Pathology, in 1864 Professor of Pathology, the Practice of Medicine, and Hygiene, and in 1869 Professor of Pathology and the Practice of Medicine. His title from 1880 until his death was Professor of Pathology and of the Practice of Medicine and Clinical Medicine. Thirty-three years of his life were devoted to teaching medicine in the University; the last twelve of these he served as Dean.

During the years of his residence in Ann Arbor Dr. Palmer was an active member and vestryman of Saint Andrew's Church, where as a lay reader he often conducted services and taught a students' Bible class. With Mrs. Palmer he gave a substantial sum toward the erection of the church tower. After his return from Europe in 1879 he became a warm friend of Bishop Harris of the Detroit diocese and took the deepest interest in the founding of the Hobart Guild. In 1859, when he was forty-four, he made his first European trip. His diary shows that in London he attended clinics and lectures at Guy's Hospital, Saint Bartholomew's Hospital, the London Fever Hospital, King's College Hospital, Saint Thomas Hospital, Middlesex Hospital, and the Children's Hospital. He met many prominent medical men, among them Charles Murchinson, famed for his studies on fevers and for emphasizing the importance of milk in the spread of typhoid fever. He spoke of having met Sir Benjamin C. Brodie, then seventy-six years of age, the president of the Royal College of Surgeons, and Sir Alfred B. Garrod, well known for his studies on gout.

After three months in London he spent five weeks in Paris. There he visited Charles Eduard Brown-Séquard, who succeeded Claude Bernard as the professor of experimental medicine in the Collège de France in 1878 and who is chiefly remembered for his experimental investigations of the nervous system. He also saw Auguste Nelaton, one of the surgeons to Napoleon III, and Alfred Armand Louis Marie Velpeau, surgeon at the Charité, well known for his work on surgical anatomy and his New Elements of Operative Surgery. Palmer was especially interested in the clinic of Pierre-Adolph Piorry, inventor of the pleximeter and a pioneer in mediate percussion. In his diary he recorded: "Piorry [is] famous for his percussion; pretends to tell more by percussion than anyone else, and probably can do it." This is of interest because Palmer was a master of physical diagnosis himself and drilled his students thoroughly in its methods. He also visited the clinic of Armand Trousseau, one of the leading clinicians and medical teachers of France.

In Dublin he spent a morning with William Stokes, regius professor of medicine, who, as early as 1825, had published an Introduction to the Use of the Stethoscope. He had also written on cholera, having observed the Dublin epidemic of 1832, and was well known for his description of the Stokes-Adams syndrome and for his contributions to the literature dealing with diseases of the chest, heart, and aorta.

As a delegate of the American Medical

Association, Palmer attended the meeting of the British Association for the Advancement of Science at Aberdeen, where he met and heard the most illustrious scientific men of Great Britain. Later, at Edinburgh, he called upon Sir James Young Simpson, one of the most remarkable personalities of his time, who was the first to employ chloroform as an anesthetic. He also made many contributions to obstetrics and gynecology and was greatly interested in improving the status of hospitals.

The European trip was doubtless a great inspiration to Palmer, for he came in contact with the finest type of physicians and medical teachers of Great Britain and France and visited most of the important hospitals and medical schools. Why he did not visit Germany is not known. The French, however, had contributed most of the advancements in medicine until about 1850.

On his return Palmer entered into his work with enthusiasm. Apparently he was an inspiring teacher; he sincerely enjoyed lecturing and was always ready to substitute for other lecturers in emergencies, or to add new lectures of his own if he thought there was a need for them. The memorial to him stated:

His lectures were at first fully written out but latterly he took briefer notes into the lecture room, carefully and systematically arranged. He never appeared before his class without looking over his notes and getting his subject well in hand; he was constantly rewriting and rearranging his lectures, to keep them abreast of scientific advancement.

Memorial of … Palmer

That he was thorough and meticulous in the examination of patients may be surmised by his comments on Dr. Walshe, whose clinic he visited in London:

I have been particularly interested in Dr. Walshe's clinical exercises in the hospital. I have never witnessed more searching, exact, and intelligent examination of patients, particularly in all cases of diseases of the chest. Nothing could exceed the minute care exercised in physical explorations, and, so far as I could judge from witnessing his procedures, and hearing his remarks, with occasional examinations of particular sounds, he is unusually discriminative and precise in his observations, and very just in his conclusions.

Memorial of … Palmer

Breakey says that Palmer was "energetic, ambitious, industrious, and loved teaching." To the alumni attending the Commencement of 1888, the year following Palmer's death, Dr. Elijah H. Pilcher characterized him as follows:

[He was] earnest and methodical, learned and painstaking, pure and stainless in his life, kindly and benevolent, tenacious of what he thought to be right, devoted to the interests of the University; for more than a generation of years he was one of the most conspicuous figures of the medical faculty.

Memorial of … Palmer

Vaughan commented, in A Doctor's Memories (p. 199):

He drilled his students ad nauseam in the employment of instruments of precision; auscultation and percussion were not only his favorite hobbies, but in their use he showed great skill. I remember how proudly he exhibited to me the first laryngoscope I ever saw.

Although he was an ardent Whig and abolitionist, his Civil War service was relatively brief. He resigned a commission as surgeon of the 2d Regiment of Michigan Volunteers on September 23, 1861, after a service of five months, to resume his University teaching.

In 1863 he accepted the chair of the theory and practice of medicine at the Berkshire Medical College in Pittsfield, Massachusetts, and during his first summer of service there also gave the lectures on materia medica. The plan of holding two professorships simultaneously at different medical institutions was not

unusual and apparently was sanctioned by the University. At least two other medical teachers of the University had a similar arrangement: Corydon L. Ford, Professor of Anatomy, lectured in his subject at the same institution, and Armor, Professor of the Institutes of Medicine and Materia Medica, lectured at the Long Island Hospital Medical College. This arrangement was possible because the University's term of medical instruction lasted only six months. In 1877 the annual term of the Medical Department at Ann Arbor was extended to nine months, causing a conflict with Palmer's chair of the practice of medicine in the Medical School of Maine, which he had held since 1869. During the school year 1877-78, by lecturing twice daily, he managed to give the full number of lectures at both places.

At the suggestion of many of his former pupils Palmer wrote a textbook, A Treatise on the Science and Practice of Medicine, which appeared in 1883 in two volumes of about nine hundred pages each. Although its immediate reception was flattering this work could not be regarded as a great success. According to Vaughan, "Had it been presented fifteen years earlier it would have had a wide circulation, but it came just when the new medicine was supplanting the old and is now unknown and unused" (A Doctor's Memories, p. 199).

Dr. Palmer was not a prolific writer, as there are only twelve publications recorded in his memorial book. They deal with homeopathy, the effects of alcohol and temperance teachings, the cause of typhoid fever, sulphate of quinine, epidemic cholera, the treatment of inflammation of internal organs, and medical teaching. His president's address before the Michigan State Medical Society in 1873 had the title, "Law and Intelligence in Nature, and the Improvement of the Race in Accordance with Law."

During the last decade of Palmer's life many changes occurred in the Medical School which had his support and the benefit of his influence. Two pavilions were added in 1876 to the residence which served as a hospital on the north side of the campus, and this greatly increased the bed capacity; in 1877 the sessions were extended from six to nine months; in 1880 attendance for three years was required for graduation; a more extended course in physiological chemistry was begun in 1878; and in 1879 practical work in physiology was instituted (the course in physiological chemistry had previously been limited to urinalysis).

The following items from the Calendar of 1884-85 illustrate the subjects considered as belonging to the department and the time devoted to them: Urinalysis, twelve weeks of afternoon work; Physical Diagnosis, thirty-two hours in lecture room and hospital; the Practice of Medicine, 180 hours in the general lecture room; and Clinical Medicine, 148 hours in the Hospital amphitheater.

After the death of Dr. Palmer in 1887, Dr. Henry Francis LeHunte Lyster ('58, '60m, A.M. '61) was made Professor of the Theory and Practice of Medicine and Clinical Medicine, and he served in this capacity in 1888-89 and in 1889-90. Apparently he continued his practice in Detroit while he was head of the Department of Medicine in the University. It was during Dr. Lyster's regime that the separate Department of Pathology was created.

No professor of internal medicine was appointed for the year 1890-91, but the acting head was Dr. Walter Shield Christopher (M.D. Medical College of Ohio [Cinn.] '83), who was listed as Lecturer on the Theory and Practice of Medicine and Clinical Medicine. Dr. George Dock's explanation was as follows:

All professors were elected as lecturers and only given the title of Professor if, toward the end of the year, they were recommended for full title with indefinite tenure. Christopher was a very bright fellow but more interested in pediatrics. He went to Chicago in 1891 and became a very popular consultant, but died young.

George Dock (M.D. Pennsylvania '84, A.M. hon. Harvard '95, Sc.D. hon. Pennsylvania '04) was the next appointee to the chair of the theory and practice of medicine and clinical medicine. This was an important appointment, as he probably contributed more to the development of the department than any other professor before or since. In addition to his remarkable natural ability as a physician, teacher, and investigator, he had received the advantages of the best medical education obtainable at that time. After his graduation from Pennsylvania, he served as an intern at Saint Mary's Hospital in Philadelphia and then spent two years in study at Berlin, Leipzig, Frankfort, and Vienna. Medicine at this time was developing at a rapid rate, and German medicine was conceded to be the most progressive in the world. Dock returned to Philadelphia in 1887 as an assistant in clinical pathology, under the influence of William Osler and John M. Musser, two of the most inspiring medical teachers of all time. These experiences must have had a large share in developing his scientific knowledge and his teaching ability, which endeared him to many classes of students at the University.

The status of the Department of Medicine apparently was none too satisfactory in the few years prior to Dock's arrival. At the time of his appointment, the Michigan Daily reported that the chair of the theory and practice of medicine had had a "checkered career, as more than the ordinary changes [had] caused a feeling of uncertainty in the minds of the medical students. This feeling [had] been dissipated by the appointment of Dr. Dock." He took up his work in September, 1891. In the following year Aldred Scott Warthin (Indiana '88, Michigan '91m, Ph.D. ibid. '93, LL.D. Indiana '28) was appointed Demonstrator of Clinical Medicine. According to Dock:

There were no available doctors in the city to act as volunteers and on account of my late appointment there were no senior men available to assist with the teaching. Warthin and I were literally on full time, working in the hospital or on outpatients from eight to six, and often seeing patients at night.

The condition of affairs on his arrival may be summarized by his own words:

Before my time medical patients were rarely admitted to the hospital. The space was filled with operative cases. When I arrived on the ground there were no medical patients in sight, and I gave my first clinic on a private patient of Dr. Breakey who had pleurisy with effusion. Very soon we sent out, with the consent of the faculty, letters to physicians and preachers saying that there was an outpatient service in the hospital for medical cases and that the attendants (Warthin and I) would see indigent patients or any referred by physicians at their homes. We quickly gathered up a lot of good stuff. (From a letter written on March 1, 1937, to Richard C. Boelkins, a fourth-year medical student at the University.)

During Dock's early days at the Hospital the clinical facilities of the Medical School were greatly improved by the completion of the Catherine Street Hospital in December, 1891, providing at first sixty-four beds. This was later known as the West Hospital.

Dr. Dock will be remembered for his many fine qualities and for the important innovations he introduced into medical teaching at the University. He was chiefly instrumental in organizing laboratory

methods of teaching and in reorganizing the course in auscultation and percussion. He likewise insisted that the work in medicine should not consist of the repetition of lectures in two successive years, as had previously been the custom.

His bibliography for the eighteen years he was on the staff of the Medical School contains eighty-three medical articles. They deal with many different topics and indicate his thorough knowledge and broad interest in clinical medicine. Among the subjects to which he made original contributions were chloroma, leukemia, Banti's disease, Hodgkin's disease, malaria, amoebic dysentery, osteomalacia, endocarditis, coronary thrombosis, tuberculosis, diabetes, and lobar pneumonia. In addition, he wrote the section dealing with endocrinology in Osler's Modern Medicine, published in 1909 and recognized as the leading system of medicine in the English language at that time. Dock edited and contributed additions to the volume Diseases of the Heart (1908), in Nothnagel's Encyclopedia of Practical Medicine, which was the translation of one of the outstanding systems of medicine published in Germany. Dr. Dock's interest in tuberculosis is shown by his publications on this subject, including one in 1902 on "Some Reasons Why There Should Be a Hospital for Consumptives in Connection with the University Hospital."

His wide interest in the constant advances of medicine led him, in association with Vaughan and Warthin, to devote much time and thought to the development of the Medical Library. As a result, early in the history of the Medical School a remarkably complete library was organized. His interest in this work led in 1907 to an article on "The Medical Library of the University of Michigan."

Many young medical students, stimulated by Dock's teaching, later came to occupy positions of prominence in this country. Dr. Aldred Scott Warthin, one of his first associates, became Professsor of Pathology in the University. Dr. David Murray Cowie became Instructor in Pediatrics in 1905, and in later years served as Professor of Pediatrics and Infectious Diseases and head of that department. Dr. James Rae Arneill (Lawrence '90, Michigan '94m, LL.D. Lawrence '23), of Denver, Colorado, was Instructor in Internal Medicine from 1898 to 1903, and later became professor of medicine at the University of Colorado. Dr. Roger Sylvester Morris ('00, '02m) was later associated with the Medical Department of Johns Hopkins University and finally became professor of medicine at the University of Cincinnati. Dr. James Gerrit Van Zwaluwenburg ('98, '08m) became Professor of Roentgenology in the University. In addition to the group named, many others who were his students and who in some instances were associated with him on the staff of the Department of the Theory and Practice of Medicine went to different parts of the country and became the leading consultants and practitioners in their communities.

In 1896 Dr. Dock was offered a position as professor of medicine at Jefferson Medical College in Philadelphia, but he declined it. He left in 1908 to become professor of medicine at Tulane University, and later accepted a chair in Washington University, St. Louis, which he resigned in 1922 to take up private practice in Pasadena.

Cyrus C. Sturgis

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

The Period Since 1927

The present Director of the Department of Internal Medicine and Director of the Thomas Henry Simpson Memorial Institute for Medical Research is Cyrus Cressey Sturgis (Washington '13, M.D. Johns Hopkins '17). Before coming to Michigan in 1927 as Professor of Medicine and Director of the Simpson Memorial Institute he was a member of the faculty of the Harvard Medical School and physician of the Peter Bent Brigham Hospital in Boston.

The last year that Dr. Bruce was Director of the Department of Internal Medicine, there were twenty-eight members of the staff — a director, two professors, three assistant professors, eight instructors, one instructor in dietetics, four research assistants, one assistant, and eight interns. During the following year, 1928-29, the medical staff was increased to three professors, four assistant professors, fifteen instructors, eight senior interns, and eight junior interns, a total of thirty-eight. All members of professorial rank of the original staff were retained, with the exception of John Barlow Youmans (Wisconsin '15, M.S. ibid. '16, M.D. Johns Hopkins '17), who resigned to accept an assistant professorship in internal medicine at Vanderbilt University.

Among the additions to the professorial staff of the department in 1928 was Charles Leonard Brown (Oklahoma '19,

M.D. ibid. '21), who had been an instructor in the Harvard Medical School. He came to the University as Assistant Professor of Medicine.

The Department of Internal Medicine had previously been divided into several services, consisting of a service in metabolism headed by Dr. Newburgh, a cardiology service under the directorship of Dr. Wilson, a private medical service which had been directed by Dr. Bruce, and a tuberculosis service under the directorship of George Alexander Sherman (McGill '19, M.D. ibid. '24). During the year 1928-29 Sturgis combined the cardiology, metabolism, and private medical services with those of general medicine. This allowed Newburgh, Wilson, and their staffs ample opportunity to continue with the excellent experimental work that they had done in the past and which they had found difficult to continue because of the heavy clinical load they were required to carry.

John Blair Barnwell (Trinity College '17, M.D. Pennsylvania '23) was brought to the department as Director of the Tuberculosis Unit in November, 1928. He had been research instructor in pediatrics at the University of Pennsylvania, and a fellow and acting first assistant of the Trudeau Foundation.

With the addition of the special branches of medicine to general medicine it became necessary to reorganize teaching on the various medical wards. In order to facilitate handling the large number of students at that time, the medical service was divided into four general medical services, a medical outpatient service, a private medical service, a tuberculosis service, and a diabetic outpatient service. The work of the students was divided equally among the four services. They devoted half of their time to the medical section on the wards, and each group alternated between two instructors. The other half of the time in the medical section was spent in the private medical service, the tuberculosis service, the diabetic outpatient service, and the medical outpatient service. The new arrangement allowed more individual attention for each student and more cases for the student to examine than had heretofore been possible. The general medical services were also reorganized so that each attending man who taught the senior students was a member of the permanent staff and of professorial rank. His assistant was a third- or fourth-year staff member of the rank of instructor who also taught the junior section in the afternoon. Each ward was under the direction of an assistant resident and an intern. Better care of ward patients was possible, and teaching for both the student groups and the younger staff men was more comprehensive and individual.

The department by 1940 had a staff of fifty-one members — three professors, six associate professors, five assistant professors, seventeen instructors, three research fellows, one instructor in dietetics, nine senior interns, and seven junior interns. The large staff made it possible to provide postgraduate instruction for the younger members. Interns were selected, who, if they were satisfactory, could be given a total of four years' training in internal medicine. Such an opportunity for postgraduate training greatly increased the number and quality of men who applied for internship in the department. In the early period of Dr. Sturgis' directorship of the department it was difficult to obtain men of the first rank for appointment to the intern staff. The situation changed greatly, until in 1937 sixty-five applications were received for seven internships; many of the applicants were in the first 10 per cent of their respective classes, and most of the best medical schools in the country were thus represented.

During the first thirteen years Dr.

Sturgis was Director a number of the younger men were appointed to professorial positions elsewhere. Dr. Wilson, Dr. Newburgh, Dr. Paul Shirmer Barker (Westminster '15, M.D. Washington University '20), Dr. Henry Field, Jr. (Syracuse University '16, M.D. Harvard '20), Dr. Herman H. Riecker (Marietta College '17, M.D. Johns Hopkins '23), and Dr. Arthur Covell Curtis ('23, '25m), all members of the earlier medical staff, were still active in the department as of 1940.

In addition to providing the routine teaching of medical subjects the department has doubled the length of the courses in clinical microscopy and physical diagnosis, and numerous elective courses are offered to students interested in the various special phases of general medicine. The Department of Internal Medicine teaches more hours a year than does any other department in the Medical School. That such teaching has not been burdensome to students can be seen in a statement in "A Criticism of the Teaching at the University of Michigan Medical School by the Class of 1935": "In general, we feel from the standpoint of teaching, that the Department of Internal Medicine is outstanding in the Medical School…"

Several services of the department benefited during the thirties, either by new accommodations, marked growth, or special grants. Two additional floors costing $250,000 were erected on top of the Hospital to serve as a new unit for the care of patients with pulmonary tuberculosis. The floors were first occupied by patients in July, 1931. Accommodations were provided for ninety-eight patients in six single-bed rooms, ten two-bed rooms, and seventy-two four-bed rooms. Ample teaching rooms and workrooms for examinations, treatments, laboratory work, and fluoroscopy are also available.

The allergy service has slowly grown from a part-time interest of one man in 1927 until it occupies three rooms on the second floor of the Hospital and has a permanent staff of three men and, in addition, one man part time.

The diabetic service has likewise slowly grown until now it has entire care of all diabetic patients assigned to the department and also supervises the care of all diabetic patients on services other than the medical service.

It was found possible in 1936 to rotate the senior instructors who were members of the medical service, in periods of a month each, through the electrocardiographic service, the allergy service, and the Simpson Memorial Institute. This allowed these men to spend all of their time for the period in pursuing the special work given in the three divisions and greatly added to the training that they received.

In 1937 one million dollars was appropriated from the Horace H. Rackham Fund, the interest on which was to be used for a period of not less than five years and not more than ten years, for the study of arthritis. This work was organized in the University Hospital under the directorship of Dr. Richard Harold Freyberg ('26, '30m).

Arthur C. Curtis

SELECTED BIBLIOGRAPHY

Historical Sketch of the University of Michigan. Announcement, Department of Medicine and Surgery "A Brief History of the Department of Internal Medicine in the Medical

School of the University of Michigan.""The Department of Medicine and Surgery in the Fifties.""The Department of Internal Medicine."CalendarCatalogue …"A Criticism of the Teaching at the University of Michigan Medical School by the Class of 1935,"Dock, George. Letters in MS correspondence. Univ. Mich."The Medical Library of the University of Michigan."History of the University of Michigan."Memorial Address on Alonzo Benjamin Palmer."History of the University of Michigan."An Historical Sketch of the Department of Medicine and Surgery of the University of Michigan."Memorial Meeting for Victor Clarence Vaughan …Memorial of Alonzo Benjamin Palmer.[News notes.]"Minutes of the Medical Faculty""The University of Michigan Medical School, Ann Arbor,"President's ReportProceedings of the Board of Regents …The University of Michigan.University of Michigan Regents' Proceedings …, 1837-1864.A Doctor's Memories.

THE DEPARTMENT OF MATERIA MEDICA AND THERAPEUTICS

MATERIA medica has always been considered one of the fundamental subjects to be included in the curriculum of a medical school. Accordingly, when the Department of Medicine and Surgery of the University of Michigan was organized, one of the first chairs to be established was that of materia medica.

Jonathan Adams Allen (Middlebury '45, M.D. Castleton Medical College '46) was appointed Professor of Pathology and Physiology in January, 1850, and the first medical students came in October of that year. Inasmuch as materia medica, as it was then taught, did not require a previous training in physiology but was closely allied to chemistry, it was given early in the medical course. The first class consisted of ninety-one students and five special students. The Catalogue of 1850-51 contained the statement that clergymen, lawyers, and medical graduates might enroll as "honorary" medical students. In 1852-53 the duties of Registrar of the Faculty of the Department of Medicine and Surgery were added to those of Allen's professorship, and the next year his title was changed to Professor of Therapeutics, Materia Medica, and Pathology.

In 1854 Alonzo Benjamin Palmer (M.D. College of Physicians and Surgeons [N. Y.] '39, A.M. hon. Nashville '55, LL.D. Michigan '81) was appointed Professor of Materia Medica, Therapeutics, and Diseases of Women and Children; he retained this title until 1861, when for one year he held another composite chair as Professor of Theory

and Practice of Medicine and Pathology. The University Catalogue of 1852-53 directed that students be examined in anatomy, physiology, materia medica, and chemistry.

The beginnings of the materia medica museum were indicated in the Catalogue of 1857-58, in the following statement:

Instruction in Materia Medica is greatly increased by importation from Paris of an extensive "suit" of rare and pure chemicals and of the various articles of organic materia medica put up in a beautiful and uniform style. Specimens of crude materia medica are constantly being added.

Many of these specimens are still in the department (1940), and the story connected with them, as related by Cushny, is not without interest. They were ordered in 1825 from Paris, by the University of Louisiana. When they were ready for shipment that university, having gone into bankruptcy, could not pay for them, and they were bought by the University of Michigan. The jars were each labeled with the name of the specimen, and "University of Louisiana" was permanently etched or painted on the inside of the jar, but on the outside of each is a small slip of paper, with "Michigan" printed upon it, pasted over the word "Louisiana." The specimens are of interest from the historical point of view only.

The museum was referred to in subsequent University catalogues, and it evidently was considered of some importance. The 1873-74 Calendar spoke of the "beautiful glass-covered half gallon jars, of uniform appearance, finely displayed … besides about one thousand other specimens of Simple Mineral and Vegetable Substances arranged in groups convenient for study."

In 1861 Samuel Glasgow Armor (M.D. Missouri Medical College '44, LL.D. Franklin '72) was appointed Professor of Institutes of Medicine and Materia Medica. Armor occupied the chair until 1868, when Henry Sylvester Cheever ('63, A.M. '66, '67m) was made Lecturer on Therapeutics and Materia Medica. In 1870 Dr. Cheever was appointed Professor of Therapeutics and Materia Medica, and in 1872 the words "and Physiology" were added to his title.

During these years, the textbooks of Biddle, Waring, and Ringer were recommended, and, in addition, the following were recommended for special subjects; Headland, The Action of Medicines, Anstie, Stimulants and Narcotics, and Harley, The Old Vegetable Narcotics.

Frederic Henry Gerrish (Bowdoin '66, A.M. ibid. '67, M.D. Medical School of Maine '69, LL.D. Michigan '05) was associated with Cheever in the department, in 1873-74, as Lecturer on Therapeutics, Materia Medica, and Physiology. In 1874 Gerrish was appointed Professor of Therapeutics, Materia Medica, and Physiology, in place of Cheever, who was on leave of absence from the University because of poor health. Cheever resigned in March, 1876.

In 1876 George Edward Frothingham ('64m) was appointed Professor of Materia Medica, Ophthalmology, and Aural Surgery; his title was expanded in 1880 to include clinical ophthalmology, and he continued to occupy this chair until 1889.

When an optional third year of medical study was first offered, in 1876, chemistry, anatomy, physiology, and materia medica were still being given in the first year of the three-year curriculum, but these subjects were reviewed in the second year, and examinations upon them might be passed at the end of that year. Two courses of lectures in materia medica were given, each course containing sixty lectures.

Since Frothingham's professorship was a rather comprehensive one, it is not surprising

that he had an assistant as early as 1880. Dr. Fred N. Baker (B.S. Cornell '78, Michigan '80m) acted as his assistant in 1880-81. The name of Dr. John G. Kennan (Western Reserve '79, Michigan '81m) appeared in the Calendar of 1881-82 with the title, Assistant to the Professor of Materia Medica and Ophthalmic and Aural Surgery.

In 1882 Dr. Kennan was succeeded by Dr. Harold Gifford (Cornell '79, Michigan '82m, A.M. hon. '12); in 1883 the post was occupied by Dr. Charles Marshall Frye ('82m), who was succeeded in 1884 by Dr. Arthur E. Owen.

The name of Victor Clarence Vaughan (Mt. Pleasant College [Mo.] '72, Ph.D. Michigan '76, '78m, LL.D. '00) appeared in the list of those teaching in the department in 1883-84, when to his duties as Professor of Physiology and Pathological Chemistry were added those of Associate Professor of Therapeutics and Materia Medica. Vaughan was associated with the department for three years with this title; Dr. Owen remained as his assistant for two years and then was succeeded by Dr. John Heman Andrus ('85m).

In 1887 Dr. Conrad Georg, Sr. ('72m), was appointed Instructor under Dr. Frothingham, and Dr. Thomas Charles Phillips ('85, '87m) was Assistant. The following year (1888-89) was the last in which Dr. Frothingham remained with the department. In 1889-90 Dr. Georg took entire charge of instruction in the subject. This was an important year in the history of the department, as it was the last in which the old subject of materia medica was taught as such, for in the following year the new subject of pharmacology was brought to this country, and to the University, by John Jacob Abel. In the last year under Georg, Materia Medica was a course completed in the first year, and Therapeutics was given in the second year.

Pharmacology in the modern sense in the University of Michigan may be said to date from July, 1890, when the Regents established the chair of materia medica and therapeutics in the Department of Medicine and Surgery and appointed John J. Abel to this new chair as Lecturer, at an annual salary of $2,000. In June, 1891, Abel was appointed Professor of Materia Medica and Therapeutics. The Regents chose to retain the old title of materia medica and therapeutics for the new chair rather than to adopt the name "pharmacology." In this way they linked the new science with the old historical subject which had been taught in this school since it was opened in 1850, and with the name which had been employed to designate this older subject since the days of Dioscorides.

John Jacob Abel ('83, M.D. Strassburg '88) was born in Cleveland in 1857. Before his graduation from the Literary Department of the University in 1883, he withdrew to become principal of the LaPorte High School, LaPorte, Indiana, for three years. When he returned, while finishing his senior work, he was an assistant to Victor C. Vaughan during the first semester and to Henry Sewall, Professor of Physiology, in the second. He then went abroad and studied in various European universities. While still engaged in these studies, in 1888-89, he received a cablegram from Vaughan offering him the professorship of pharmacology in the Department of Medicine and Surgery. Acting on the advice of the biochemist, von Nencki, of Bern, with whom he was working at the time, he accepted the call and arranged to begin his new duties in January, 1891. In his first lecture he told of his recent visit to Berlin, where he had spent some weeks investigating the new remedy, tuberculin, which Koch had recently introduced for the treatment of tuberculosis.

Dr. Abel's first task was to fit up a laboratory, inasmuch as there had never been any provision made for experimental work in the old Department of Materia Medica. Not only was there no room, but there was not a single piece of apparatus, not even a piece of glassware. He finally secured a small room with a sloping ceiling, situated in a corner of the rear of the old Medical Building under the lower amphitheater. The necessary glassware was borrowed from Professor Paul C. Freer of the Department of Chemistry, and the physiological apparatus was built partly by Dr. Abel, with the aid of his assistant, Archibald Muirhead, and partly by the University mechanics. For the remainder of the year he lectured for an hour daily to a class that included, besides the medical students, the students in pharmacy and in dentistry. As it was not found satisfactory to include the dental and pharmacy students in the same class with the medical students, a separation was effected, and the following year the dental and pharmacy faculties assumed responsibility for the instruction of their own students in the subject.

During the academic year 1891-92 Abel was given additional laboratory space — a fairly large room in the southeast corner of the second floor of the Old Medical Building.

In the course of the year he organized a journal club, inviting ten to fifteen of the better students to meet with him at intervals to discuss more in detail than was possible in class and laboratory the various problems and aims of pharmacology. He was interested also in bringing a knowledge of pharmacology to the attention of practicing physicians. Accordingly, he arranged a lecture and demonstration for the physicians of Ann Arbor, and, later, a similar lecture and demonstration were given to the physicians of Detroit. These lectures were published in an article in the Pharmaceutical Era in 1891. The period of Dr. Abel's service to the University of Michigan was destined not to be long, for in 1893, when the faculty of the medical school of Johns Hopkins University was being organized, he was invited to become one of its members as professor of pharmacology and professor in charge of physiological chemistry.

It is evident that, even though Abel's term was short, his service to the Medical Department of the University was of the greatest importance. He was one of the first of the remarkable group of men that Dean Vaughan gathered from far and wide to form his faculty in the closing years of the nineteenth century. In Abel, Vaughan had the founder of the first department primarily for the teaching of pharmacology in this country. In him also he had a powerful supporter of his efforts to reorganize the Department of Medicine and Surgery upon a true University basis. This support was not confined to routine teaching and research activities, but was extended outside the lecture room to the Journal Club, the Scientific Club, and to medical men engaged in active practice.

After Abel's resignation Dean Vaughan appealed again to Schmiedeberg, the professor of pharmacology at Strassburg, to send him a man to succeed Abel. Schmiedeberg recommended for the position one of his assistants, Arthur Robertson Cushny (A.M. Aberdeen '86, M. Surg. ibid. '89, M.D. ibid. '92, LL.D. Michigan '25). After his graduation from the University of Aberdeen he had been given a University fellowship to work with the physiologist Kronecker at Bern, and upon the completion of this year's work, went to Strassburg, where he spent two years studying with Schmiedeberg.

Cushny came to the University in the

fall of 1893 and remained here until, in 1905, he was called to University College, London, to organize the teaching of pharmacology in that institution.

Pharmacology at that time was a course given to the medical students in their junior year and consisted of daily lectures and demonstrations. Once a week the class was divided into two quiz sections, one being taken by Cushny and the other by his assistant. No laboratory course was required of the students, but early in his sojourn here Cushny, feeling the need of such instruction, developed a course which he offered to the students as optional work. This course was gradually developed as time went on and formed the basis of the laboratory course as it is now given. This was made a required part of the work shortly before Cushny went back to England.

The directions for the work in the optional course were given on mimeographed sheets. When the laboratory course was made a requirement for all the students these notes were given a temporary binding, each student securing his own copy. When Cushny decided to return to England the question was raised as to what would be the fate of these notes. It was possible that a new man might develop his own course; thus the outline which had been developed through the twelve years of the Cushny regime might be lost. It seemed wise, therefore, to put the material into permanent form, and this was accomplished by Cushny and his assistant. The first edition of the resulting volume, A Laboratory Guide in Experimental Pharmacology, by Edmunds and Cushny, was published by George Wahr, of Ann Arbor, in 1905. The guide has been revised and enlarged from time to time, but the name of Cushny still appears upon the title page.

The textbook problem was not confined to the laboratory course, for in 1893 there was not a single textbook on pharmacology in the English language which was suitable for medical students. The standard textbook on pharmacology in Europe was Schmiedeberg's Grundriss der Pharmakologie. Cushny felt the great need of a book of this character and accordingly set himself the task of writing one. The work had to be done mainly in the evenings, and the labor involved may be judged by the fact that it was all written in longhand, for Cushny did not use a typewriter. The first edition of A Textbook of Pharmacology and Therapeutics contains 730 pages. He took seven years to write it. The book set a high standard not only from the scientific standpoint but from the literary viewpoint as well. The first edition, appearing in 1899, was followed at intervals of about three years by revisions made necessary by the new developments in the subject, so that when Cushny died early in 1926 the book was in the eighth revision and was one of the standard works on pharmacology used by students in medical schools throughout America and Great Britain. Since Cushny's death this textbook has, as occasion demanded, undergone several revisions at the hands of J. A. Gunn, of the University of Oxford, and C. W. Edmunds, of the University of Michigan.

Cushny's devotion to research work yielded rich results during his years of residence in Ann Arbor and added greatly to his own reputation and to the prestige of the University. The scope of his studies is indicated by the bibliography of his Ann Arbor years. It is both interesting and profitable, however, to mention somewhat more in detail certain of his studies which attracted wide attention.

His monograph on the action of digitalis on the mammalian heart was a contribution of first importance. About the same time, in the late nineties, he published the results of his studies upon

the irregularities of the heart. This paper recounted the results of what was without doubt the most important special study of cardiac irregularities which had appeared in America to that time. It was very largely his experience in making the study which enabled him in 1902 to make a diagnosis of "auricular fibrillation" in the case of a hospital patient who was exhibiting marked paroxysmal irregularity. This suggestion, upon being transmitted later to Dr. Mackenzie and to Sir Thomas Lewis, led to the establishment of this cardiac disorder as a clinical entity.

Equally important was Cushny's study of kidney physiology. His work in this field was really the beginning of the modern approach to this topic and did much to bring once more into the foreground the almost neglected Ludwig theory of the mechanism of urinary secretion. The study may perhaps be said to have culminated in his monograph entitled The Secretion of the Urine (1917; 2d ed., 1926).

Another field in which Cushny made a notable contribution was that of investigation of the action of optical isomers. The study, in which the effect of the optical activity of a substance upon its action in the body was investigated, is generally considered to be one of his most important contributions to medical science, ranking with his exhaustive studies on the action of the digitalis glucosides. The results of his studies upon the action of optical isomers were incorporated in his Dohme memorial lectures, given at Johns Hopkins University. They later appeared in book form, entitled Biological Relations of Optically Isomeric Substances.

In addition to the three major studies Cushny entered upon a number of other fields during his twelve years in Ann Arbor. A word should be added as to his relation to the important subject of the biological assay of drugs, which has attained such widespread importance in the past thirty years. It was Cushny who first suggested making use of animals to test the relative activity of different preparations of the same drug. This method of testing had special application in the case of digitalis. The wide differences in the activity of various preparations of this drug were well recognized, but no way was known of avoiding them, because of the nature of the active principles of the drug. One of Cushny's assistants, Dr. Elijah M. Houghton (Ph.C. '93, '94m) was studying the problem, trying to devise some chemical method of standardization, but without success. Cushny suggested to Houghton that he might study the relative effect of different preparations of digitalis upon frogs and learn whether it might not be possible to utilize these animals for his purpose. The trial was successful, and in the late nineties the method was introduced into commercial practice. Since then the principle has been gradually extended to other drugs, so that now many drugs such as ergot, pituitary, and epinephrine preparations are assayed by biological means. The method was first introduced into the United States Pharmacopoeia in 1915 and has now been incorporated into the British Pharmacopoeia as well as into the pharmacopoeias of some other countries. It is not generally known that Cushny was the father of the idea.

An additional word should perhaps be given regarding Cushny's teaching. His daily lectures, interspersed with demonstrations, were models of a clear, concise presentation of his subject. Although he was a large, well-built man, he always spoke in a low tone so that during his lectures the amphitheater was absolutely quiet in order that none might miss what he was saying. His optional laboratory course was without doubt the first course

of its kind given in this country. First offered in 1903-4, it probably was not the first such course required in this country, for Professor Charles W. Greene claims that honor for the University of Missouri.

In 1925, after an absence of twenty years, Cushny returned to Ann Arbor at the invitation of the University to receive the honorary degree of doctor of laws. He maintained that these few weeks in Ann Arbor were the happiest of his life. Early the following year, at his new home in Edinburgh, where he had moved in 1918, he had a stroke and died a few hours later on February 25, 1926, at the age of sixty.

The Medical School and, in particular, the Department of Materia Medica and Therapeutics, owe a great debt to Abel and Cushny, and also to Dean Vaughan, who was responsible for bringing them to Ann Arbor. The wisdom of Vaughan's choice is shown by the subsequent careers of both men. During the sixteen years of their connection with the school they put the study of pharmacology upon such a firm foundation that its position in the Medical School has never been questioned. Because of the favorable beginning of the Department of Materia Medica and Therapeutics the successor to these two men has never had to fight for his academic life, as have heads of similar departments in certain other schools, where a new subject such as pharmacology has had a very strenuous fight for existence.

When Cushny left for London during the spring vacation of 1905 Charles Wallis Edmunds ('04, '01m), who was then Instructor in the department, was asked by the Dean to carry on the work of the department until the end of the year. Horace John Howk ('07m), of Rochester, New York, one of the medical students, was appointed to assist in the teaching.

At the end of the year the Regents, upon recommendation of President Angell and the medical faculty, appointed Edmunds head of the Department of Materia Medica and Therapeutics, with the title of Lecturer on Materia Medica and Therapeutics — the same title which had been given Abel in 1890. Two years later, in 1907, Edmunds was appointed Professor of Materia Medica and Therapeutics. In later years the phrase "Director of the Pharmacological Laboratories" was added to the title; this was changed in 1937 to Chairman of the Department of Materia Medica.

Following his appointment in the early summer of 1905 Edmunds left at once for Europe, and, after stopping to see Cushny in London, went on to Heidelberg, where Professors Gottlieb and Magnus were teaching pharmacology, and studied during the summer. Returning to Ann Arbor in the fall Edmunds took up the work of the department. He was assisted by Dr. William Worth Hale ('08, '04m), who remained in the department for three years. Hale went to the hygienic laboratory of the Public Health Service at Washington, as assistant pharmacologist in 1908, and in 1913 to Harvard Medical School as assistant professor of pharmacology. In Cambridge he was associated with Professor Reid Hunt, who had left the hygienic laboratory at Washington at the same time, to take the headship of the Harvard Department of Pharmacology. Hale was appointed associate professor and assistant dean of the Harvard Medical School in 1918.

During the three years of Edmunds' association with Hale (1905-8), the general plan of the teaching of pharmacology was not changed essentially from that adopted by Cushny — lectures by the head of the department and weekly quizzes to the class, in two sections. The laboratory course was also given to the sophomore students, the

class being divided into sections. The space in the old Medical Building reserved for the teaching of pharmacology remained the same during those years. The room under the amphitheater on the first floor (originally occupied by Abel and Cushny) was given to the assistant as an office, and all of the second floor of the main part of the building was devoted to pharmacology. The entire north side of this part of the building, comprised of two long, narrow rooms, was devoted to the laboratory course. On the south side of the east-west hall were three rooms, the largest of which, toward the east end of the building, was used for a private research room. The small, intermediate room was occasionally used for research, and the small room at the rear served as an office for the head of the department.

In 1910 a change in the departmental quarters was necessitated by the fear that the old Medical Building, in which the department had been housed for so many years, might not be entirely safe for class purposes. The old Chemical Building to the west of the Medical Building had been vacated recently by the chemists; the north section of it was therefore turned over to the departments of Physiology and of Materia Medica and Therapeutics, and extensive changes were made to render it fit for use. These changes included the building of an amphitheater in the east end of the old building, the construction of suitable animal quarters on the top floor, and minor alterations throughout. As soon as these were completed Dr. Lombard took the second and part of the third floor for the Department of Physiology, and the first floor and part of the basement were assigned to the teaching of pharmacology.

Immediately after World War I the classes became too large for the amphitheater, and the laboratory was greatly overcrowded. A floor was built between the two stories where the amphitheater had been, and the new space then available was appropriated for additional laboratory facilities. When the East Medical Building was finished in the mid-twenties the Department of Physiology moved out of the old Chemistry Building (Pharmacology Building) and the Department of Materia Medica and Therapeutics has since occupied the entire north wing, except for the laboratory on the east end of the second floor. A part of the rear was the first building erected by a University as a chemical laboratory in the United States. The front, or west, part of the building was erected in 1889, while Albert B. Prescott was Professor of Chemistry and Dean of the College of Pharmacy. The office occupied by the Professor of Materia Medica has served as an office for Prescott, for Professor E. D. Campbell, Director of the Chemical Laboratory, and also for Dean Julius O. Schlotterbeck and Dean A. B. Stevens of the College of Pharmacy.

Throughout these and the succeeding years, all the time of both the professor and the instructors which could be spared from teaching has been devoted to research problems, the scope of which is indicated in the bibliographies published by the University. Edmunds went abroad again in 1907, worked with Cushny in University College, London, and joined the English group of scientists who attended the International Congress of Physiologists in Heidelberg. He spent the summers of 1908 and 1909 in the hygienic laboratory at Washington, on problems concerning the biological assay of digitalis and ergot. His work on ergot, in the summer of 1909, was carried out in collaboration with William Worth Hale, who had joined the government service in the previous year. Edmunds' connection with the hygienic laboratory at Washington was very important, for it

led to a close collaboration between the laboratory at Ann Arbor and various national organizations, which has been of great value to the laboratory at Ann Arbor.

Because of his previous work on the biological assay of drugs Edmunds was asked to assume the chairmanship of a committee to make recommendations regarding the desirability of introducing such methods into the United States Pharmacopoeia, which was then undergoing revision (1910-20). As a result of these studies biological assays of certain drugs were introduced in Volume IX of the United States Pharmacopoeia, which was the first pharmacopoeia in the world to make such methods of assay obligatory. This led to a continuation of the University's connection with the Pharmacopoeia and resulted in close cooperation between the Ann Arbor pharmacological group, the National Institute of Health, and the Food and Drug Administration at Washington. The laboratory group has furnished expert advice to the Federal Government from time to time through the years, and this led to the appointment of Dr. Erwin E. Nelson (Missouri '14, Ph.D. ibid. '20, Michigan '26m) of the Department of Materia Medica and Therapeutics, first as a special expert upon certain biological problems and finally as head of the Division of Pharmacology in the Food and Drug Administration of the Department of Agriculture. This position Nelson held for nearly two years, having obtained leave from the University for that purpose. Then, too, the laboratory has maintained a valuable connection with the American Medical Association through membership in the Council of Chemistry and Pharmacy. This council, in which Edmunds has held membership since 1921, exercises a certain control over the introduction into medical practice of the newer drugs of the more effective type. This control consists in ascertaining the exact nature of the drug, in regulating its potency and purity, and in supervising the advertising literature so as to exclude false claims for curative properties. The activities of the council have exerted a tremendous influence upon medical practice, and especially upon therapeutic practice, during the thirty-five years of its existence.

Edmunds has been chairman of the committee of the Council of the American Medical Association on grants to support research on problems connected with therapeutics. He has also been chairman of the Pharmacopoeial Advisory Board on Antianemic Preparations — a committee which has control over the potency claims which are made for all official liver and stomach preparations used for the treatment of primary anemia.

These and other connections of the department have proved to be of great value to the laboratory as a means of keeping the staff in close contact with outside movements and with the newer introductions into the field of therapeutics.

Dr. Hale was followed as Instructor by Dr. George Byron Roth ('06, '09m), who remained at the University in the Department of Materia Medica and Therapeutics for four years (1909-13). Then he, too, joined the pharmacological group at the hygienic laboratory at Washington. He was made professor of pharmacology at George Washington University in 1924.

Roth was succeeded by Dr. Maurice Isadore Smith (College of the City of New York '09, M.D. Cornell '13), who served as Instructor in Pharmacology from 1914 to 1917, when he resigned in order to accept the professorship of pharmacology in the University of Nebraska. He later became the senior and principal pharmacologist in the National Institute of Health at Washington.

In 1919 Nelson was appointed Assistant Professor of Pharmacology. He became Professor of Pharmacology in 1936. During a part of his career in Ann Arbor he acted as a consultant to the Food and Drug Administration at Washington. Nelson resigned from the University in 1937 to become professor of pharmacology at Tulane University Medical School.

Ralph Grafton Smith (Toronto '21, M.D. ibid. '25, Ph.D. Chicago '28) was appointed Instructor in Pharmacology in 1928 and advanced to a full professorship in 1937. Jacob Sacks (Chicago '22, Ph.D. Illinois '26, M.D. Northwestern '31) was appointed Instructor in Pharmacology in the department in 1932 and became Assistant Professor in 1937. John Howard Ferguson (Capetown '21, A.M. Oxford '31, M.D. Harvard '28) was appointed Assistant Professor in 1937.

In addition, the following taught in the department for short periods: Dr. Allan L. Richardson ('08, '10m), Demonstrator of Anesthesia, 1912; John G. Gage ('08m), 1916-17; Alvah R. McLaughlin ('09 Lafayette, M.A. Princeton '14), 1923-25; Albert G. Young (Ph.D. Wisconsin '24, M.D. Harvard '28), 1925-28; Helen Bourquin (Colorado '15, Ph.D. Chicago '21), 1928-31; and Dr. A. R. McIntyre, 1931-32. Also, as assistants and fellows many advanced medical students have been employed in the laboratory.

In 1912 the Department of Anesthesia in the University Hospital was placed, for convenience of administration, under the Department of Materia Medica and Therapeutics. Dr. Richardson was Demonstrator of Anesthesia for the first year. After his resignation, Mrs. Laura Davis-Dunstone (R.N. '08) was placed in charge and held the position first as Demonstrator and later as Instructor. About 1930 the Department of Anesthesia was transferred to the Department of Surgery.

In 1910 the course Practical Therapeutics was instituted for the senior students. Dr. Mark Marshall (Earlham '02, Michigan '05, '08m) was appointed Instructor in Therapeutics and retained the position from 1910 to 1920. During the years, the teaching hours have been changed somewhat to make them conform to the changing requirements of the medical curriculum. The lecture course was cut from five hours a week to four, and then, in order to lighten the students' load, to three hours a week for a year. This was made possible by the placing of a greater emphasis upon the laboratory course. The position of the lecture course within the medical curriculum was also changed, in that it was moved from the two semesters of the junior year to the second semester of the sophomore year and the first semester of the junior year. In 1940 the time allotted to pharmacology was ninety-six hours of lecture and ninety-six hours of laboratory work.

Research. — In addition to studies which have been made for the trustees of the United States Pharmacopoeia, "A Study of Strophanthins" and "The Potency of the U.S.P. Standard Digitalis Powder," two problems have been attacked in a comprehensive manner. The first of these is the study of drug addiction. In 1929 the National Research Council was given a sum of money to study the opium problem. The drug-addiction committee of the council decided to make a study of morphine and allied natural and synthetic alkaloids, patterning the work somewhat after the study which has led to the introduction of novocaine (procaine) as a nonhabit-forming substitute for cocaine. In accordance with this plan, a chemical laboratory for the synthesis of the compounds was organized at the University of Virginia, and

the invitation of the University of Michigan to have the study of the action of the compounds conducted here was accepted by the committee. Accordingly, in 1930, the work was started. Edmunds was fortunate in being able to secure Dr. Nathan Browne Eddy (M.D. Cornell '11), professor of pharmacology in the University of Alberta, to conduct the work. The study extended over a period of ten years, that is, until the summer of 1940, when the Federal Government assumed responsibility for it and transferred the unit to the National Institute of Health at Washington. During this period Eddy was assisted by Hugo Martin Krueger (Denver '24, Ph.D. Michigan '30), Margaret Sumwalt (Goucher '23, B.S. Washington University '25, Ph.D. Pennsylvania '29), Charles Ingham Wright (Middle-bury '26, Ph.D. Rochester '32), Robert H. K. Foster (Ohio State '23, Ph.D. Chicago '32), and a group of assistants. The work assumed extensive proportions. Some three hundred and fifty compounds were studied, and the most desirable of these, from the standpoint of lack of toxicity and of therapeutic efficiency, were selected for trial upon the human patient. This portion of the study was sponsored largely by the United States Public Health Service, by certain hospitals under the control of some of the state health departments, and by certain general hospitals, including the University Hospital at Ann Arbor. The results of the studies which were carried out in the Department of Materia Medica and Therapeutics of the University have been published in about one hundred articles which have appeared in various medical journals, chiefly in the Journal of Pharmacology and Experimental Therapeutics. One monograph, edited largely by Eddy and entitled "Studies on Drug Addiction," was published by the Public Health Service in 1938. An extensive review of the literature of the "Pharmacology of the Opium Alkaloids," edited by Eddy, Krueger, and Sumwalt, was also prepared. The work which has been done by this group headed by Eddy has been of outstanding importance. It attracted wide attention, and, though it is unfortunate that it has been removed from Ann Arbor, it is gratifying that it has been taken over by the government.

The second extensive research problem was financed by the Kellogg Company of Battle Creek and was concerned with the relative effects of caffeine, coffee, and decaffeinated coffee. Katherine Horst (Iowa State College '17, Ph.D. Yale '31) was secured to supervise the study and she continued this work for about four years, until her unfortunate death in 1934. This work, in which Dr. Horst was assisted by medical students, was carried out upon human subjects, and the findings were published in the Journal of Pharmacology and Experimental Therapeutics.

It is hoped that the spirit of Abel and of Cushny has not departed from the department which they founded and where they carried on researches which added so much to the reputation of the Medical School and of the University.

Charles W. Edmunds [Died March 1, 1941.]

SELECTED BIBLIOGRAPHY

Announcement, Department of Medicine and Surgery Calendar Catalogue … Proceedings of the Board of Regents … University of Michigan Regents' Proceedings …, 1837-1864.

THE DEPARTMENT OF NEUROLOGY

The teaching of neurology in the Medical School began in 1888-89, when Dr. William James Herdman ('72, '75m, LL.D. Nashville '97) was named Professor of Practical Anatomy and Diseases of the Nervous System. The change of his title to Professor of Diseases of the Mind and Nervous System and of Electrotherapeutics in the following year apparently marked the removal of the subject from the Department of Anatomy and the creation of a new department.

Herdman had a large general and consultation practice. He saw patients at the Hospital, but the teaching of neurology was largely confined to the weekly clinic held each Wednesday afternoon. At this clinic and in the examination and care of the Hospital patients he was assisted by Dr. Jeanne Cady Solis ('92m), Demonstrator of Nervous Diseases. He was greatly interested in electrotherapeutics, and the medical students were taught the subject thoroughly, both by laboratory work and by the treatment of patients. His interest in electricity led to the development of the use of X rays at the Hospital, and for some time roentgenology was taught in the Department of Neurology.

In the nineties he conceived the idea of the establishment of the State Psychopathic Hospital in Ann Arbor. After some delay he persuaded the state legislature to pass the required bill and appropriation, and the building was ready for occupancy in 1906. He was then Professor of Nervous and Mental Diseases. Albert Moore Barrett (Iowa '93, M.D. ibid. '95), who had been at the Danvers State Hospital, Massachusetts, was appointed Associate Professor of Neuropathology and Director of the Psychopathic Hospital.

In December, 1906, Herdman died and Barrett was appointed Professor of Psychiatry and Diseases of the Nervous System. As Barrett was interested only in psychiatry, Carl Dudley Camp (M.D. Pennsylvania '02), who had been instructor in neurology at the University of Pennsylvania, was appointed Clinical Professor of the Diseases of the Nervous System in June, 1907. At this time the department's functions in neurology and in psychiatry were separated, both as to teaching and as to the care of patients. Dr. Solis resigned her position at this time, and Dr. Theophil Klingmann ('90p, '92m) served as Demonstrator of Diseases of the Nervous System until 1917. The Department of Diseases of the Mind and Nervous System remained one administrative unit until March, 1920, when the Board of Regents divided it into two departments and changed the title of Barrett to Professor of Psychiatry and that of Camp to Professor of Neurology.

The number of teaching hours devoted to neurology was increased in 1907. The Wednesday afternoon clinics were continued, but the clinical period was lengthened. In the second semester an introductory lecture course was given to the juniors, and ward-class instruction to groups of senior students was begun.

The junior students received a course of forty-eight lectures, which covered the subject generally and which were illustrated by case presentations and specimens. A clinic for the seniors was held once a week throughout the year. This was scheduled for only one and one-half hours, but, as all the patients were shown

it frequently lasted three or four hours. The seniors also received sixteen hours of ward-class instruction in sections of a quarter of the class. In these smaller groups they were taught the method of examining patients. Since 1929 the senior clinic has been limited to one hour and has been given in the second semester only, but the plan of teaching has remained otherwise unchanged.

At first the department had no graduate intern; a senior student lived in the Hospital and served in that capacity. In 1915 a graduate resident was appointed, and the following year, an instructor. When the new Hospital was opened the increased number of patients to be cared for called for an increase in staff, and an additional instructor was appointed. Raymond Walter Waggoner ('24m, Sc.D. Pennsylvania '30) came as Assistant Professor of Neurology in 1929, on the resignation of John Louis Garvey ('20m), who since his appointment to an instructorship in 1924 had been advanced to an associate professorship. Waggoner resigned in 1937 to take Barrett's place as Professor of Psychiatry and was succeeded by Russell DeJong ('29, '36m).

In 1940 the staff consisted of a professor, an assistant professor, three instructors, an assistant resident in neurology, and one intern. The instructors usually serve for a period of two years.

The most important activity of the department in its graduate program has been the rotation of staff members. Each year a member of the graduating class is selected as a rotating intern, to serve one year in various other departments in the Hospital. The following year, if his work is satisfactory, he becomes assistant resident in neurology. He then serves one year as junior instructor and another as senior instructor. During these two years he has time and opportunity to do work in neuroanatomy and neuropathology and may also spend three months in residence in the State Psychopathic Hospital (now Neuropsychiatric Institute). This training has been accepted as qualifying the candidate for recognition as a neuropsychiatrist.

From time to time medical graduates apply for instruction in neurology. Special courses are arranged for such men, although no certificate is given. During World War I the Surgeon General's Office assigned certain medical officers to receive instruction in neurology here.

The Department of Neurology offers courses for credit in the Department of Postgraduate Medicine. Members of the staff lecture frequently before county medical societies and participate in the program of graduate medical instruction sponsored by the Michigan State Medical Society.

Carl D. Camp

SELECTED BIBLIOGRAPHY

Announcement, Department of Medicine and Surgery Calendar "The Clinic for Nervous Diseases at the University Hospital." "The Neurological Service." Catalogue … Catalogue and Register "Albert M. Barrett." President's Report Proceedings of the Board of Regents … A Doctor's Memories. "William James Herdman."

THE DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

WHEN the Department of Med icine and Surgery was established in 1850, two outstanding scientific men were members of its faculty — Silas Hamilton Douglass (A.M. hon. Vermont '47) and Abram Sager (Rensselaer Polytechnic Institute '31, M.D. Castleton Medical College '35, A.M. hon. Michigan '52). With the aid of Regent Zina Pitcher, one of the most widely known physicians in the state, they had organized the department. In 1851, his last year as Regent, Pitcher was appointed Emeritus Professor of the Institutes of Medicine and Obstetrics. The position was purely honorary, however, and his appointment to it was apparently the University's only record of any special interest he may have had in the teaching of obstetrics.

Sager was appointed Professor of the Theory and Practice of Medicine in January, 1848, with the understanding that he would also teach pharmacy and medical jurisprudence. By his own choice, in 1854, he was transferred to be Professor of Obstetrics and Physiology. Although there were discrepancies between the titles and duties of the other four medical professors, Sager's title corresponded with his teaching responsibilities.

Jonathan Adams Allen (Middlebury '45, M.D. Castleton Medical College '46), who had previously taught physiology, left the University in 1854, and Alonzo Benjamin Palmer (M.D. College of Physicians and Surgeons [N.Y.] '39, A.M. hon. Nashville '55, LL.D. Michigan '81) was appointed Professor of Materia Medica and of the Diseases of Women and Children.

While in charge of the teaching of gynecology, Palmer was closely associated with Zina Pitcher in efforts to improve medical education. From 1854 to 1858 Palmer was an editor of the Peninsular Journal of Medicine, of which, during about one-half of that time, Pitcher was the chief editor; and in the summers of 1857 and 1858 Palmer gave clinical lectures and bedside demonstrations before the University's clinical classes in Detroit, which also were under Pitcher's direction. In these classes a few normal and abnormal obstetrical cases were presented. Both men advocated the inclusion of adequate hospital training in the work required for the medical degree, but unlike Pitcher, Palmer at that time favored a plan — advanced by Professor Moses Gunn and emphatically rejected by the Regents in 1858-to move the entire Medical Department to Detroit.

In 1860, when Palmer was placed in charge of the instruction in medicine and pathology, Sager was relieved of his work in physiology and resumed the teaching of women's and children's diseases. The six-year period which then ended was the only time in the history of the school when gynecology and obstetrics were not taught in the same department.

One student has said that Sager, in lecturing, was inclined to become absorbed in general biology rather to the neglect of obstetrics, but from all accounts he was a conscientious, if not an eloquent, lecturer. By 1871-72 throughout the six-month session he was giving

eight lectures a week, including those in obstetrics, gynecology, and pediatrics.

Though a little clinical instruction in medicine and surgery was regularly provided throughout Sager's period of service, first by means of free clinics before the students and later in the wards of the Hospital, clinical obstetrics in the University was practically nonexistent, and gynecology also was taught largely by means of lecture and recitation. Ordinarily, neither Sager nor his successor performed more than the most minor operations; major surgery in this field, such as the removal of ovarian cysts, was the province of the professor of surgery. For nearly forty years medical students at the University of Michigan were graduated without having been required to witness a case of labor or a childbirth. Some ambitious and wide-awake students witnessed a few cases in the practice of their preceptors, but such instances were exceptional, for women naturally disliked having the students present, and it is to be doubted that even these students learned much about practical obstetrics, for at that period obstetrical manipulations were conducted under the sheet.

The Hospital was opened in 1869. The financial principle on which it was established, namely, that it should be wholly self-supporting, explains why the obstetrical material did not increase much for another twenty years, for, no matter how small the charge — and at first it included only food and medicines — women would not pay to be delivered by medical students, and the Michigan state laws authorizing the use of public moneys for the maintenance and transportation of those unable to pay had not yet been enacted.

In fact, it was just as well in the days before antisepsis that the University could do so little work in clinical obstetrics, for at least one-half of the women confined in hospitals, such as Bellevue in New York City, died of puerperal sepsis. Although Semmelweiss in 1847 had proved conclusively that childbirth fever was transmitted by the contaminated hands of medical students, the medical profession as a whole either was ignorant of the fact or denied its truth. Scientific information spread slowly between 1850 and 1890.

In Sager's time surgery at the University was performed under great difficulties. In those days neglect of ordinary cleanliness before and during operations was not recognized as the cause of the many postoperative fatalities, but because of the risk, major operations were avoided whenever possible. After 1869 some operations were performed at the Hospital "upon patients that could not be brought before the class" in the presence of a few specially interested students (R.P., 1870-76, p. 207). Many of the surgical patients were carried across the campus to an upper lecture room of the Medical Building and were operated on while lying on a table upon which, perhaps the hour before, the professor of anatomy had demonstrated on a cadaver.

It was under such circumstances that Sager performed a Caesarean section on a rachitic dwarf — one of the first, if not the first, of such operations in Michigan (Univ. Mich. Med. Journ., 2 [1871]: 385-93). It is not to be wondered at that the patient died of peritonitis soon after the operation. Sager's description of the operation, in which he was assisted by Professor Corydon L. Ford and George E. Frothingham, Demonstrator of Anatomy, is of particular interest. Because he thought it his duty, this modest little man, who probably had had very little experience as a surgeon, performed an

operation almost without parallel in this section of the country. Thirteen years earlier such a procedure was advocated by Sänger. The uterine wound was sutured to avoid spill from the interior of the uterus and subsequent infection. Dr. Sager secured the pelvis and gave exact measurements to show why birth through the natural passages was impossible. The report of the case is impressive for its demonstration of the scientific mind of that period.

Sager's teaching career ended in 1873. At that time he obtained a leave of absence because of ill-health, and in his place Dr. Edward S. Dunster was appointed Lecturer in Obstetrics and Diseases of Women and Children. In March of the following year, Sager resigned his chair and was made Professor Emeritus, but, at the request of the faculty, he retained the deanship, which he had held since 1868. The admiration with which his colleagues and the University officials regarded him was expressed in the following resolutions adopted by the Regents in March, 1874:

Resolved, That we hold Prof. Sager in the highest esteem, not only for the symmetry of his character and purity of his life, but also for the eminent services which he has rendered to this University during a period of thirty-two years.

Resolved, That the great success attending the Medical Department has been largely due to his loyalty, industry, wisdom and scholarship.

R.P.

Sager resigned the deanship in 1875 as a protest against the University policy of requiring certain of the "regular" medical professors to receive students of the new Homeopathic Medical College into their courses. He died in Ann Arbor, August 6, 1877.

Edward Swift Dunster (Harvard '56, A.M. ibid. '59, M.D. New York College of Medicine and Surgery '59, M.D. hon. Dartmouth '81), a direct descendant of Henry Dunster, the first president of Harvard College, was appointed Professor of Obstetrics and Diseases of Women and Children in 1874. He had served through the Civil War and until 1868 as assistant surgeon in the United States Army. From 1868 to 1871 he had been professor of obstetrics and of the diseases of women and children in the University of Vermont and also editor of the New York Medical Journal, and from 1869 to 1874 he served on the faculty of the Long Island College Hospital as lecturer on the subjects of obstetrics and the diseases of women and children. In 1871 he became professor of obstetrics at Dartmouth College and continued to lecture there during the summer months until his death. Holding chairs in two separate institutions at once, as he did from 1869 to 1871 and again in 1873-74, was a practice typical of the times, made possible by short annual sessions and an almost total lack of clinical teaching.

Dunster was in many ways a brilliant man and was acknowledged to be the most logical, eloquent, and interesting lecturer that the Department of Medicine and Surgery had ever had. To quote the words of his pupil, assistant, and successor, James Nelson Martin (Hillsdale '80, Ph.M. ibid. '83, Michigan '83m):

Last but facile princeps in the lecture room or editor's chair, was our scholarly Dunster. It is no disparagement to the others of that faculty to say that he was the most brilliant lecturer and writer among them all. Everyone enjoys a logical presentation of the subject, and no one left Doctor Dunster's classroom or read his articles, without a clear conception of the subject under discussion. Listening to him gave pleasure like that derived from the study of a fine painting. His language was almost perfect, his diction polished, and his argument clear and convincing … His students love to remember him in the lecture room.

Physician and Surgeon

For nearly three years the Regents had been considering plans for a large hospital, to be donated by the state and operated by the University. Such an institution, it was suggested, might have been (1) entirely an alms hospital for county patients, or (2) a treatment center where victims of diseases which were hard to treat might receive effective care, whether they were public patients or not, or (3) an alms hospital for the invalid poor which would also serve as a special treatment center for the general public (R.P., 1870-76, cf. pp. 189 and 202). Gynecological surgery was mentioned in particular in this connection, though with the indirectness customary in references to such matters at that time, as a specialty greatly needing attention and development for the relief of unnecessary suffering among all economic classes. The Regents' "committee on state hospitals" went so far as to report that very few doctors in Michigan or near-by states had the requisite skills and the costly apparatus needed for the proper treatment of certain difficult cases; moreover, that at no hospital west of the eastern seaboard could such treatment be secured; and that, in consequence, even the well-to-do delayed proper care because of the inconvenience involved, while the poor usually went without treatment altogether. Because it seemed inexpedient at the time to ask the state for such a large sum as would have been required for such a hospital as was desired, that project was temporarily abandoned in December, 1872.

In 1875-76 the original campus Hospital was remodeled, and a long annex at the rear of it, designed on the pavilion plan, was erected. This sixty-bed Hospital, mostly new, was financed largely by the state and was called a state hospital; it differed from the state hospital envisioned in the early seventies, however, not only in size, but also in other important respects, as the state made no legal provision for the transportation and living expenses of public patients.

A clinical lecture room, originally specified to be included in the new Hospital (R.P., 1870-76, p. 435), was built only after additional state funds were granted in 1879, but a lengthened course, which was intended to include much more clinical work than had been given, was introduced as an option in 1876, and by 1880 all beginning students were required to take the new three-year course, and the school year had been lengthened to nine months.

Dunster's work in the long curriculum was concentrated in the senior year. In 1881 his theoretical work in obstetrics, consisting of a one-semester course of sixty lectures, was offered both semesters of the second year. His lecture course in the diseases of women and children, consisting of forty-five lectures, also given in both semesters, remained in the third year, and the seniors also met in the amphitheater twice a week throughout the year for his course called Clinical Gynecology and Diseases of Children.

The better facilities of the Pavilion Hospital, opened in 1876, gave an impetus to the clinical work in surgery, medicine, and ophthalmology, but had practically no effect on clinical work in obstetrics, and even in gynecology the cases were pitifully meager — three in 1877, seventeen in 1878, and eleven in 1879. In spite of this, when the titles of the heads of the other clinical departments were changed in 1880, to signalize the improvement in clinical instruction expected as a result of the acquisition of the Hospital amphitheater, Dunster's title was altered to Professor of Obstetrics and of the Diseases of Women and Children and of Clinical Gynecology. The lack of any reference to clinical obstetrics in his new title was significant. In presenting a request for an obstetrical

manikin in 1879 — apparently the first one purchased in nearly thirty years of obstetrical teaching at the University — he had stated that the need of it was particularly urgent in obstetrics, because, "from our position, we are unable to have clinics" (R.P., 1876-80, p. 391).

An obstetrical clinic might have been maintained just as the physics and chemistry laboratories were maintained, or the practice of sending welfare cases at local or state expense might have been stimulated by legislation. The first law under which public patients were sent to the University Hospital was a children's hospitalization law, requested by the officials of the State Public School at Coldwater in 1878 and passed by the legislature in 1881. In his annual reports for both of those years, President Angell suggested that a similar law for adult inmates of the county almshouses be passed. It was not readily perceived, however, that the enactment and observance of special laws might be necessary to guarantee the admission of a sufficient number and variety of cases for instruction, and his suggestion met with no response (see Hospital, p. 975) .

In February, 1888, a senior petition for a lying-in ward was received by the medical faculty and was referred to Dunster. He died in Ann Arbor on May 3, 1888, without having made any formal report on the subject, but the establishment of a small obstetrical ward within the Hospital and the launching of a vigorous local campaign, in that same year, for a separate maternity hospital appear to have been results of his efforts.

One mark of the students' affection and respect for Dunster was a petition from the seniors, soon after his death, requesting the faculty to devise a way of affixing his signature to their diplomas. The faculty responded by asking the steward to have it electrotyped.

Immediately after the death of Dunster, his assistant, Dr. James Nelson Martin, was placed in temporary charge of the chair of obstetrics and diseases of women and children, in accordance with a recommendation of the medical faculty. The Regents took their time in making a more permanent appointment. In December, 1888, they appointed Martin Acting Professor of Obstetrics and Diseases of Women and Children. He was reappointed in 1889. The faculty recommended in 1890 that he be appointed Professor of Obstetrics and Diseases of Women, but the Board renewed his acting professorship of all three subjects for a single year. He was finally appointed Professor of Obstetrics and Diseases of Women in March, 1891 (R.P., 1886-91, p. 487), and thus pediatrics, previously always associated with gynecology, was formally removed from the department. A course in the diseases of children had been organized in 1889 and was continued through 1892. The transfer of instruction in that subject may have taken place about 1890, when Walter Shield Christopher (M.D. Medical College of Ohio [Cinn.] '83), a distinguished pediatrician, was in charge of the Department of the Theory and Practice of Medicine. For some years after 1892 pediatrics was taught in connection with internal medicine. In the present century, until the establishment in 1921 of a separate Department of Pediatrics and Infectious Diseases, it was given increasing attention as a specialty within the Department of Internal Medicine. In the summer of 1888, Judge Harriman, E. B. Pond, A. W. Hamilton, and Otto Eberbach, a committee representing the citizens of Ann Arbor, came before the Board of Regents to discuss the possibility of establishing a local maternity hospital (R.P., 1886-91, p. 239), and in the yearly Announcement published soon afterward (Med. Ann., 1888-89, p. 21) it was stated that local citizens had "initiated

measures looking to the erection at an early day of a well equipped lying-in hospital," to be conducted by the faculty and to be utilized for clinical instruction. In October of that year, President Angell stated that it was most desirable to have a lying-in hospital (R.P., 1886-91, p. 269). Then this particular project was dropped; it was never mentioned in the University Calendar nor in subsequent issues of the Announcement.

From the official records the reason for discontinuing the campaign is clear, even though there was no published explanation. The University was being severely criticized for the inadequacy of its hospital plant as a whole, and an organized effort was being made to have the clinical teaching done in Detroit. Ann Arbor would probably not have had a University Hospital at all, if quick action had not been taken to provide a new main building and better equipment. This was the basic clinical need, and the one with which the President was primarily concerned, even when he mentioned the special need of an obstetrical hospital. Moreover, the chance of obtaining enough money for an entirely new hospital plant depended chiefly on the size of the conditional pledge which the Regents could obtain from the townspeople before the state was asked for help. A citizens' committee estimated in December, 1888, that $25,000 might be raised for the purpose in Ann Arbor (R.P., 1886-91, p. 291), and fortified by this tentative promise the University obtained, under an act approved the following summer, a state gift of $50,000 for the new hospital plant. To enlarge the city's contribution and thus ensure the construction of new main buildings for the University and Homeopathic hospitals, the citizens interested in founding a special maternity hospital undoubtedly agreed to postpone their own plans.

Before the fall of 1888, without awaiting the outcome of the campaign for a separate maternity hospital, the faculty established a small "lying-in ward," inside the old campus Hospital; and there, according to the Announcement of 1888-89, each senior was expected to attend several confinement cases — "when available" — as the corrected explanation read during the next two years, for practically no patients came. Adopting a practice which had proved successful under similar circumstances in the Homeopathic Hospital, the faculty of the Department of Medicine and Surgery therefore obtained a Regents' order authorizing the Hospital superintendent to find obstetrical patients who would consent to be used for instruction if the University paid their maintenance costs. For this purpose the Medical Department was granted a University subsidy of $200 in each of the three years 1888, 1889, and 1890.

The first state law authorizing the care and treatment of indigent adult patients in the University and Homeopathic hospitals and the payment of their transportation and maintenance costs from public funds (Public Acts, No. 246, 1889) contained the provision:

Whenever obstetrical wards are established in said hospitals, the said [county] superintendents [of the poor] may make special contracts with the regents for the care and treatment of such obstetrical cases as are a public charge in their respective counties.

As the small obstetrical wards in the two campus hospitals were already in existence, what the writers of this part of the law had in mind was evidently the establishment of much more ample accommodations for obstetrical patients,

such as the University would have had if the plan of 1888 for a special maternity hospital had materialized. Many patients were sent to the Hospital every year under other provisions of Act No. 246 of 1889, until a new hospitalization law (No. 267) for adults was enacted in 1915, but for some reason, even after separate buildings for maternity patients were occupied in 1906 and in 1908, the above-quoted section governing obstetrical cases was almost wholly inoperative.

With the exception of the course of sixty lectures in obstetrics, taken twice in the intermediate year of the curriculum, all of the work in the department under Dunster between 1881 and 1888 had been concentrated in the third, or senior, year. In the fall of 1888, after Martin was placed in temporary charge, a two-semester lecture course in gynecology and obstetrics was begun. Originally, it was taken in the second year and was repeated in the third, but in 1889-90 it was scheduled only for seniors. A separate, one-semester course in children's diseases, for second-year students, was begun in February, 1890.

When the four-year curriculum went into effect, in 1890-91, the clinical work in gynecology, as well as that in obstetrics, was taken only by seniors, but the general lecture course in these subjects, requiring two hours a week in the first semester and four hours a week in the second, was scheduled for both juniors and seniors. Diseases of Children, a first-semester course meeting two hours a week, was also taken twice. In 1892, after this separate course in children's diseases was discontinued, the junior-senior lecture course, Obstetrics and Gynecology, was scheduled for three hours a week throughout the year, and juniors as well as seniors came to the biweekly gynecological clinics. In the same year special junior drill courses in the clinical subjects, with daily meetings for several weeks, were introduced. In the demonstration course in obstetrics and gynecology, the juniors were shown, by means of manikins and models, what to do in the various presentations and in emergencies that might occur in obstetrical practice (Med. Ann., 1893-94, pp. 21-22).

According to a statement appearing in the Announcement of 1894-95 (p. 29) and in the following years, every senior had an opportunity to attend one or more obstetrical cases, since pregnant women were admitted several weeks before delivery and were kept for several weeks afterward, and each patient was assigned to a group of a few students, who were expected to make a study of her case throughout her stay at the Hospital. Through 1898, however, only eleven or twelve confinement cases a year were available. The difficulties of obtaining even these few is indicated by the fact that in 1897-98 the Board of Regents found it expedient to grant another subsidy ($100) to "each of the hospitals … for the purpose of maintaining obstetrical cases" (R.P., 1896-1901, p. 115).

Martin stated:

Most of the work in this department of diseases of women and obstetrics is done before sections of the class, that they may come in closer contact with the patients and observe more closely the pathological changes that have taken place, while the same are being considered. Also that they may observe more closely each step in the examination and treatment of the cases, and especially each step in the operation, and thus discover the cause of the trouble and the methods of relieving the same.

Ann. Rept. Univ. Hosp.Ann. Rept. Univ. Hosp.

According to an article in the Physician and Surgeon (11 [1889]: 415-18), there had been only ten obstetrical patients in the Hospital in 1888 and 1889 and not more than seventy gynecological patients, representing about ninety examples of gynecological disorders — for often, in this branch of medicine, several such conditions are present at once, and the number of cases, therefore, usually exceeds the number of patients. In 1892-93, however, there were about five hundred gynecological cases; in 1893-94, approximately eight hundred; and throughout the remainder of Martin's administration, six hundred to eight hundred a year. After the completion of the new Catherine Street Hospital late in 1891, there had been an increase in the number of cases in gynecology, as in nearly every other clinical branch of medicine excepting obstetrics, and the work of Martin's department had been further augmented in the early nineties (Hosp. Rept., 1892-93, p. 15) by the transfer from the Department of Surgery of all surgery on the female pelvic organs. This was a great step forward, as far as the work in both obstetrics and gynecology was concerned, for previously there had been no opportunity for those who taught female pelvic and abdominal surgery to increase their knowledge of the subject. Martin was handicapped in his surgical work, however, for even the new Hospital was poorly constructed and was septic. The surgical ward was large and overcrowded, and students had free access to it. A Hospital rule in force since 1876 forbade the admission of patients known to have contagious diseases, but occasionally a patient contracted such a disease on the way to the Hospital or even after being admitted. Unfortunately, there was no separate building for these separate emergency cases until 1898-99, and con tagious-disease epidemics were common. Whenever such a disease as diphtheria, scarlet fever, or smallpox was discovered in a ward, the ward had to be quarantined and surgical work discontinued, or the lives of patients would have been seriously endangered.

The Announcement published a short time before October, 1894, contained the statement: "In the coming session … the seniors and juniors will have no didactic lectures in common, separate courses being given to each class." The lectures on obstetrics were then concentrated in the junior year, and the theoretical work in gynecology was given in the senior year. In 1894 the courses were further compressed, the theoretical work in obstetrics being given only for secondsemester juniors and the general lectures in gynecology being given only for firstsemester seniors. Throughout the early period juniors and seniors attended at least some of the clinical demonstrations in gynecology together, but the methods course preparatory to actual case work continued to be given in the junior year.

In 1894-95 each student was required to devote 382 hours to obstetrics and gynecology, in addition to the indefinite time needed for attending cases in the lying-in room (Med. Ann., 1894-95, p. 32); 192 hours were spent at classroom lectures, 128 hours at "clinical lectures," 32 hours in recitations, and 30 hours in studying methods of diagnosis and the use of instruments. The required work remained essentially the same until 1900, except for the addition of a few hours for the study of diagnosis and of the use of instruments. In 1900-1901, Martin's general lecture courses, including recitations, required only sixty-four hours in the junior year and sixty-four hours in the senior year; the junior methods course, conducted by his assistant, required thirty-six hours; and the clinical work in gynecology, again scheduled for seniors only, required 180 hours in all.

The afternoon gynecological clinics were held, as before; in addition, since 1899, there had been several short morning clinics each week in gynecology.

Word came in the spring of 1898 that the University might receive, "subject to certain charges," the bulk of the estate of Dr. Elizabeth H. Bates, of Port Chester, New York, for a professorship to be "known and called the Bates Professorship of the Diseases of Women and Children," provided the University admitted women to its Medical Department and gave them the same educational advantages as it gave male students. President Angell estimated that the legacy would yield at least $100,000. Within two years, however, the Bates property in the University's possession was worth more than $133,000, and by 1940 the principal derived from it was valued at $137,000.

President Angell wrote:

It does not appear that our benefactor ever visited the University. So far as we can learn, she was moved to remember us in this generous manner by the fact that this University was one of the first to offer medical education to women. She wished to testify her appreciation of the service thus rendered to her sex, and to enlarge our facilities for medical education.

R.P.

The Regents voted in May, 1898, to accept the gift and comply with the conditions laid down; in June they established the new professorship and gave the medical faculty the task of suggesting a suitable person to hold it. The old custom of combining the teaching of gynecology with that of children's diseases had still been widespread when the Bates will had been drawn up in 1890, but even then this custom had been falling into obsolescence at the University, and by 1898 the medical faculty apparently had no intention of permanently re-establishing it. The report of the faculty's views on the best disposition of the gift was made to the Regents orally, but the following statement in the Announcement for 1898-99 (p. 6) throws some light on faculty opinion:

In accordance with another provision of the will it is proposed that the title of Elizabeth H. Bates Professor of Diseases of Women and Children be given to Dr. James N. Martin. (The didactic and clinical work in connection with children's diseases will be in charge of the chair of Theory and Practice of Medicine, as heretofore.) It is also proposed that the income from the bequest be allowed to accumulate, and that when a sufficient fund has been acquired a ward be built for sick children, as a memorial of the donor.

During the summer the Board's main concern in connection with the bequest was a legal struggle for the property, certain relatives of Dr. Bates having contested her will. By November, 1898, a court decision affirming the validity of the will had been rendered; still, the Bates chair remained unoccupied throughout the session of 1898-99. Finally, at the Regents' meeting of September, 1899, "the Chair of Obstetrics and Diseases of Women, in the Department of Medicine and Surgery was abolished, and James N. Martin (Hillsdale '80, Ph.M. hon. ibid. '83, Michigan '83m) was appointed to the chair of the Bates Professorship of the Diseases of Women and Children at a salary of $2,000" (R.P., 1896-1901, p. 415). The Board's intentions with respect to the teaching were made clear a month later, when the following resolutions were adopted:

Resolved, That the duties of Dr. Martin, Professor of the Bates chair, Diseases of Women and Children, remain the same as before, with the addition of Diseases of Women.

Resolved, That the instruction in and the treatment of diseases of children be done by Dr. Dock, Professor of Theory and Practice.

R.P.

Thus, in spite of the apparent implications of Martin's new title, both the association of obstetrics and gynecology were continued — nor has the actual teaching of pediatrics ever been assigned to the occupant of the Bates chair. One of these resolutions brings to light a fact not mentioned elsewhere, namely, that at some previous time — possibly only a year or two before — Martin had delegated the instruction in gynecology to an assistant, concentrating his own efforts on the work in obstetrics, and that he again taught both subjects in 1899.

It was reasonable to establish the Bates chair to fulfill the terms of the bequest, but it was wholly unnecessary to exclude the word "obstetrics" from the title of the chief professorship of the department. Ever since the beginning of medical instruction at the University in 1850, obstetrics, internal medicine, and surgery had been treated as major subjects of equal importance. The occupant of the new chair was expected to be primarily an obstetrician, and this fact should have been indicated by some such official title as the one finally adopted in 1923, which was "professor of obstetrics and gynecology and Bates professor of the diseases of women and children." The actualities of the situation were recognized in the period 1899-1923, however, by the use of the unofficial title, "Bates professor of obstetrics and diseases of women," in the faculty list of the Announcement, though elsewhere in the University publications "Bates professor of the diseases of women and children" was the title ordinarily used.

The nominal "abolition" of the chair of obstetrics and gynecology was not the only strange result of accepting the Bates bequest. The amount set aside for the professor's salary was only about one-third of the income of the bequest. As has been noted, the faculty originally endorsed a plan of saving as much as possible of this income for a building fund for a children's ward. Eventually, in December, 1901, the Regents adopted a motion to make the projected Palmer Ward a children's ward, thus ending the possibility that any of the Bates money would be used for that purpose. Before this happened, however, and while Martin still held the Bates professorship, the Regents established a policy of meeting the regular expenses of the Department of Obstetrics and Gynecology, not by the customary appropriations from the general University fund, but instead, by revenue from the Bates fund. This policy was made effective with the adoption of a resolution that, after October 1, 1900, "the expense of maintaining the Chair of the Bates Professorship of the diseases of women and children be paid from the Bates fund" (R.P., 1896-1901, p. 602).

The obvious reason for the bequest was the donor's desire to enlarge the facilities for medical education, especially for women, in a university that had early admitted women to its medical school, and the greatest deficiency in the Medical Department and in the University Hospital when the bequest was received was the lack of adequate clinical instruction in obstetrics. Had this resolution not been passed the greater part of the Bates income might have been saved for the building and equipping of a maternity hospital as soon as the idea of a Bates ward for children was given up, or — though this was perhaps too much to expect in those days — it might have been used to finance a broad, intensive program of research. A small hospital laboratory equipped with apparatus for the investigation of gynecological and obstetrical cases had been set up in 1897-98, and the Regents in 1901 did appropriate $500 of the Bates income for additional equipment for this laboratory, but under the plan adopted in 1900, and

with the growth of the department and of its cost of operation, the possibility of obtaining continuous support for research or for other special projects from this source steadily declined. The result of the new policy was, therefore, that the department did not actually benefit from the money. In fact, within a few years the gift became more of a handicap than a benefit, for, while the other clinical departments expanded and were granted successively larger budgets, the Department of Obstetrics and Gynecology was retarded because the Regents refused to appropriate anything for it except the income from the Bates fund. As the principal professorship of the Department of Obstetrics and Gynecology was named in honor of Dr. Bates, her bequest should have been devoted to ways of increasing the efficiency of that department. In justice to the Regents it may be stated that they acted in good faith and thought that under the provisions of the will no action except the one which they took was feasible. It would seem that a donor should specify more definitely the purpose of a bequest and yet give the governing board the greatest possible freedom in its administration.

Martin was aided continuously after the summer of 1888 by James Gifford Lynds ('88m), who was promoted in 1892 from an assistantship to the position of Demonstrator of Obstetrics and Diseases of Women. During the year 1897-98 he was Acting Professor of Gynecology. Other assistants, each of whom served under Martin for a briefer period, were Casper K. Lahuis ('96m), Dr. Clara A. O. Dedrick, and John J. Mersen (Hope '95, A.M. ibid. '98, Michigan '99m).

Neither Martin nor Lynds had any national affiliations. Their work was confined to the state. One of the reasons, probably, for Martin's breakdown in health was his custom of operating in private houses in towns in the neighborhood of Ann Arbor, and then riding through the night in order to keep his University obligations the next day. In 1895 he was granted a leave of absence on account of blood poisoning contracted from operating on a septic case. Another year's leave of absence in 1897-98 was also granted because of ill-health. In 1900, a year before his resignation, he manifested distinct signs of mental instability and these symptoms grew worse until the time of his death in 1913. Lynds resigned with Martin, in February, 1901, and on October 1 of that year Reuben Peterson (Harvard '85, M.D. ibid. '89, Sc.D. hon. Michigan '36) became Bates Professor of the Diseases of Women and Children.

Peterson was born in Boston in 1862. After graduating from Harvard University and interning in three Boston hospitals, he came to Grand Rapids, Michigan, in 1890 and established a general practice. Because of his hospital training and inclinations, Peterson, even when engaged in general practice, devoted more and more of his attention to obstetrics and gynecology and in 1897 was elected to membership in the American Gynecological Society. In 1898 he went to the Chicago Post-Graduate Medical School as a professor of gynecology, and a year later he accepted an assistant professorship of obstetrics and gynecology at Rush Medical College.

In the early and middle nineties, instruction in gynecological diagnosis and treatment, as well as in obstetrics, had been given to small groups of students at Michigan. The effort to increase the individualization of instruction was perhaps relinquished to some extent after Martin's illness in 1897; at any rate, as late as 1900, patients were operated on before large classes, while the students sat on hard benches during long, prescribed hours and watched, seeing little and

understanding less of what was done. Clinical teaching in this manner had been an almost universal custom throughout the country in the last decade of the nineteenth century.

Peterson's first task on assuming his duties at Michigan was to increase the effectiveness of the gynecological teaching by having the technique of pelvic and abdominal diagnosis and treatment of diseases peculiar to women taught to small groups of students. At the gynecological clinic, held twice a week, emphasis was laid on differential diagnosis, demonstration of specimens, and the progress and after-treatment of patients operated on at previous clinics. There were frequent ward walks and demonstrations of postoperated patients.

Peterson's second task was to build an obstetrical clinic. Because the town was small this was no easy task, and the University authorities at that time were either opposed to, or at least unsympathetic to, the idea of making the expenditures necessary for such a clinic. It should be borne in mind that until thirteen years before Peterson's appointment, practically nothing had been done to furnish obstetrical material, and that the steady but meager supply throughout most of the period had been obtained with great difficulty. The establishment of a separate detention ward, though not ending the hazard of contagion, was no doubt partly accountable for the fact that by 1900-1901 the number of pregnancy cases observed and treated had been increased to thirty (Hosp. Rept., p. 36). Despite the difficulty of obtaining clinical material for teaching obstetrics, within the next few years the department was sometimes embarrassed by the lack of enough beds for obstetrical patients applying for admission.

As a matter of fact, the time spent in waiting for an adequate supply of obstetrical material was not wasted, however, for it was found possible to teach the principles of the mechanism of labor, at little expense, by means of the manikins with which the department was then abundantly supplied. The students, meeting in small groups, were thoroughly drilled in this way, so that even those who had had no experience in actual deliveries might have some practical knowledge of scientific obstetrics before entering medical practice. Students from Michigan interning at outside hospitals sometimes discovered that they were better grounded in the fundamental principles of normal and abnormal obstetrics than were fellow interns who had delivered, in hospitals or in outpatient services, six or more women. This method of teaching has been retained as one of the principal features of obstetrical instruction at the University.

During Peterson's first years at the University, although there were no instructors in the department, there were three or four assistants at a time, each of whom remained about two years. One of these men, Wales Melvin Signor ('05m), was advanced to an instructorship in 1906. He as well as each of the next two appointees to this position held it for only a year, but after 1909 the average tenure was lengthened. By 1917 it was customary for an instructor to remain three or four years, and the number of instructorships had been increased to four.

A co-operative interdepartmental arrangement was made in 1902, whereby one assistant appointed to the staff of the Department of Obstetrics and Gynecology was responsible for the clinical laboratory work of the department and also taught gynecological pathology in the Department of Pathology. Ralph Luther Morse ('02m) was the Assistant in Obstetrics and Diseases of Women, in charge of laboratory work from 1902 until 1904, when he was succeeded by

Samuel Reese Haythorn ('04m). Frank Clarence Witter ('06m) did the same work from 1906 until 1908, first as assistant and later as demonstrator; he was then promoted to a regular instructorship in obstetrics and gynecology, and the laboratory work was assigned to Neal Naramore Wood ('08m). In his second year on the staff, Wood was both Instructor in Obstetrics and Gynecology and Demonstrator of Obstetrics, in charge of laboratory work, but in 1910 the second half of his title was dropped and the interdepartmental staff arrangement was discontinued.

In 1902-3 the obstetrical ward was still so small that only about thirty patients received treatment. The policy of granting free maintenance during the last month of pregnancy, as well as after delivery, resulted in its being almost always full, for physicians throughout the state were glad to send certain patients who could not have afforded to come under a less liberal plan.

Eugene S. Gilmore, Superintendent of the University Hospital from 1900 until 1908, did his best to secure an increase in the obstetrical material. The new Hospital addition, Palmer Ward, had been intended primarily for children, but when it was opened, in 1903, Gilmore and Dr. George Dock, head of the department in which pediatrics was then taught, consented to the temporary use of a part of it as an obstetrical ward. When this change was made, the number of obstetrical beds was more than doubled.

The kindness of Dr. Dock in approving this arrangement was greatly appreciated, but Dr. Peterson felt that his patients were there only on sufferance. Consequently, in November, 1903, Peterson persuaded the medical faculty to make a formal request to the Regents to "rent a separate house near the hospital for the use of obstetrical cases," both in order that these cases might receive proper care and in order that Palmer Ward might be utilized to better advantage (R.P., 1901-6, p. 295); but the Regents took no action on this faculty request.

A curious incident in the continual struggle to secure more obstetrical patients should be recorded here. In those days there was little hope of obtaining anything for a department without the approval of James H. Wade, Secretary of the University and watchdog of the University treasury. Peterson, therefore, went to him with a plea that obstetrical patients be admitted free of charge. Wade was astounded and said that such a request was ridiculous, because it was sufficient that every student witnessed one delivery in the hospital amphitheater.

During Wade's illness in 1905, Peterson appealed to Regent Charles DeWitt Lawton, chairman of the medical committee of the Board, and obtained authorization to admit "certain obstetrical patients to the hospital free of cost, to remain three months" (R.P., 1901-6, p. 501). This action was taken in February. In May, as soon as Wade had recovered from his illness, he persuaded the Regents to limit the number of free obstetrical beds to three.

A frame building intended to be made into a contagious-disease ward, the Penny house, was moved from North University Avenue in 1905 to a site close to the small building then used for contagious cases, at the rear of the Medical Ward. An alternative plan of erecting a separate, modern contagious-disease hospital was under consideration at the time, however, and as the Penny house was still empty in October, 1905, it was

remodeled to serve as an obstetrical ward, at a cost of $335. Despite this decision the uncertainty continued, and the building stood unoccupied throughout the winter and early spring, but finally, in May, 1906, after its use as a detention ward had once more been seriously considered, the Regents again ordered that it be made into a maternity ward. They authorized purchases of furniture and other equipment to the amount of $1,300, this sum to be taken, if possible, from income from the Bates fund, and also authorized the employment of four additional nurses for the ward, but ruled that there should not be more than ten obstetrical cases in the hospital at a time.

Both before and after the establishment of the pediatrics clinic, it was felt that the care of the normal infant should be a part of obstetrical teaching. The students were, therefore, instructed in infant feeding throughout the six weeks during which many of the babies were retained in the clinic before being placed in institutions. Abnormal infants were referred to or transferred to the Department of Pediatrics. In 1907-8 a quarantine of the surgical wards resulting from an epidemic of scarlet fever halted the admission of new patients to the obstetrical and gynecological service. Such quarantines and the lack of an adequate number of beds had created a long waiting list, and many prospective patients had had to be turned away. Yet, in the five years, 1903-8, there had been an increase of nearly 100 per cent in the number of patients treated each year, and the increase in obstetrical work had been proportionate to the growth of the department's clinical work as a whole.

Another frame house intended as a ward for contagious diseases was moved to a site a little to the west of the Maternity Ward in 1908, but remained empty while city and University officials again discussed the possibility of building a modern contagious disease hospital. Peterson suggested that this second house be used instead as an addition to the obstetrical clinic and outlined a plan whereby the department might obtain a larger proportion of obstetrical patients in the earlier stages of pregnancy.

These suggestions were approved by the Regents, and at last the department came into possession of an obstetrical clinic worthy of the name. The newly acquired building was made into a residence for waiting patients and was called the Maternity Cottage; and the former Maternity Ward was changed into a Maternity Hospital, for patients in labor and for post partum patients. At this time the main room of the Maternity Hospital was equipped for small demonstration classes in obstetrics.

In the Maternity Cottage eighteen to twenty patients were always available for demonstrations of the various fetal presentations, normal and abnormal. These presentations were also being demonstrated by the use of manikins. In all, the department had about thirty obstetrical beds and more teaching material than was furnished by the type of teaching clinic in which there were more deliveries but few waiting patients. Success in maintaining this necessary teaching material lay in the fact that the patients were charged only while waiting, and this nominal sum, $2.50 a week, they could pay by performing certain duties for the hospital, such as the preparation of bandages and the repairing of linens, during the waiting period.

One hundred and one deliveries were reported for the year ended June, 1910. The list contained an unusually large proportion of abnormalities, which were utilized for purposes of instruction. In the next few years the department continued to grow, in spite of serious handicaps.

It should be borne in mind that since 1850, although obstetrics and gynecology had been emphasized as major subjects and taught on a par with medicine and surgery, during the first forty years almost nothing had been done to develop the clinical work of the department. Very little more had been accomplished in the nineties. Since 1900, however, the two small buildings had been secured and more liberal rules had been established, whereby, through reduced rates, obstetrical material was obtained.

Seen in this perspective, the situation of the department in the years which followed 1908 might appear to have been favorable. Actually, however, conditions were so unsatisfactory that, from the modern point of view, it seems hardly possible that they could have been endured. Both wooden structures were firetraps, and it had been intended that they be used for obstetrical cases only until suitable quarters could be secured. The proximity of the small detention ward to the Maternity Hospital constituted a serious threat to the welfare of post partum patients. Surgical patients in the gynecological service were still endangered by the septic condition of the main Hospital, which in addition to having been poorly designed had not been properly kept in repair. The situation was somewhat improved by the opening of two new buildings in the decade 1901-11 (Palmer Ward and the Eye, Ear, Nose, and Throat Ward), because this additional space provided some relief from congestion in the surgical wards.

An attempt was made in 1913 to establish an outpatient obstetrical service for poor patients referred by physicians or charitable societies, but for several reasons — principally because of the small size of the town — the effort proved a failure and was abandoned.

In June, 1914, the much-needed Contagious Disease Hospital, given by the city of Ann Arbor, was made ready for occupancy. With the new unit in operation, maternity patients with doubtful or pronounced contagious diseases could be cared for satisfactorily. The installation of this ward benefited every department of the Hospital, because it prevented epidemics and quarantines, and for the Department of Obstetrics in particular, it provided relief by doing away with the need for the two-room contagious shack, which had long menaced the welfare of obstetrical patients. Plant alterations involving a new annoyance were made, however, in the same year: the track of a trolley line for carrying coal from the Michigan Central Railroad to the new heating plant on Washington Street was laid between the Maternity Hospital and the Maternity Cottage. This greatly increased the difficulty of transporting patients in labor from one building to the other — not to mention the noise of the loaded coal trains, running between the buildings at night with clanging bells.

Peterson was Medical Director of the University Hospital and executive officer of its medical committee from 1913 until 1920, and, in addition to his arduous hospital executive duties, carried on his administrative duties in the Department of Obstetrics and Gynecology.

In 1915 Peterson was able to secure legislation whereby the benefits of Act No. 274 of 1913 for sick or crippled children were duplicated for adults, in Act No. 267. By these acts children and adults needing hospital care, but unable to pay their maintenance and travel costs, could be sent to the University Hospital by order of the county probate judges. By a provision of the adult act, pregnant women were included. Had it been possible to have the hospital expenses of adults paid out of the general state fund, as were those of the children, there would soon have been plenty of obstetrical material, but the fact that

these expenses were charged to the counties acted as a deterrent, since the county supervisors were held accountable for expenses and it was cheaper to have unmarried mothers without funds confined in unsanitary county farms. Despite this handicap, many obstetrical patients, married and unmarried, were sent to the University Hospital under the provisions of Act No. 267 of 1915.

J. B. Draper, Superintendent of the University Hospital since 1908, was accidentally killed in 1915, and the policy of the administration, which had been that of building up the obstetrical clinic by charging little or nothing for maternity service was changed.

A chance was seen to increase the hospital receipts from state patients sent by the judges of probate under Act No. 267 of 1915. Gradually, the charge for such patients was raised, with the result that the counties naturally declined to refer them to the Hospital.

The report of the business officer of the Hospital for the year 1921-22 included the following statement, which shows the failure to grasp the fundamental difference between obtaining obstetrical teaching material and obtaining material for teaching the other clinical subjects: "We might also mention the fact that if the hospital had been allowed to charge regular rates for services in the Maternity Department our receipts would have been increased by from $20,000 to $25,000" (Hosp. Rept., 1921-22, p. 19).

These figures were based upon the supposition that the same number of patients would have been admitted to the service. This was an absurdity since, as a rule, unmarried pregnant women had no money, and state patients could have been cared for at less expense.

Dr. Peterson was called into service in World War I in November, 1917, and served until January, 1919, in the Medical Corps of the United States Army. Fortunately, so far as the teaching of obstetrics and gynecology was concerned, he was stationed in Michigan and could supervise the work of the department. He also remained as medical director of the University Hospital.

When the United States entered the war, the obstetrical and gynecological staff consisted only of the head of the department and four instructors. Two of these men, Frederic Morris Loomis ('09, '12m) and Rudolph Artilles Bartholomew ('08, '12m), left permanently within the next fifteen months, and John Wesley Sherrick ('12, '15m) was absent on leave for two years. The only instructor to remain was Leslie Lee Bottsford (Williams '09, Michigan '14m), who, in 1919, received the first appointment to an assistant professorship to be made in the department. Bottsford left the position in 1920 and was succeeded by Sherrick, who left in 1922, and the position was held during the next year by Roland Spuhler Cron ('16, '17m). There was no assistant professor from 1923 until Norman Fritz Miller ('23, '20m) was advanced to the position in 1925, nor for two years after Miller left in 1926.

More time was given to gynecology than to the obstetrics division of the department, because of the exceptional increase in the number of such cases admitted and requiring operative treatment. Although the counties hesitated and often refused to send pregnant women to the clinic, they could not refuse to send those cases requiring the services of a specialist. Thus the gynecological beds from 1901 on were in great demand. Because of the amount of time consumed by the staff in nonoperative and operative care, the question often arose as to whether or not it would be wise to limit the number of gynecological cases, yet such restrictions were never adopted.

The department became, in its special field, a postgraduate school where men were thoroughly trained before entering private practice. It now seems axiomatic that staff members should be given every possible opportunity for advancement in clinical knowledge and skill; yet such was not the custom as late as 1901, when men spent years as part-time assistants, picking up what crumbs of knowledge they could but having few or no opportunities to perfect their surgical technique. Furthermore, any change was bitterly opposed by the heads of clinics, trained differently, who thought everything should center in them.

It was stated in the Announcement in 1913 that the two frame buildings were being used only "temporarily," for obstetrical patients. Inadequate and dangerous as these old buildings were, however, during the next twelve years they continued to be the only quarters available for active and waiting maternity patients.

In 1925, before the completion of the new Hospital, the Eye, Ear, Nose, and Throat Ward, a brick building erected in 1910, was remodeled at a cost of more than $20,000, into an eighty-two-bed obstetrical hospital well adapted for the care of waiting and active maternity patients. The work in clinical obstetrics has been carried on since 1925 in this brick building, renamed the Maternity Hospital.

With the transfer of obstetrical patients from the two antiquated wooden buildings to this brick structure, and with the provision for gynecological patients in the new Hospital, a new era began. Gone were the old days when entire wards were quarantined for weeks because of outbreaks of contagious disease. No longer did the surgeons have to contend with serious infections which could be ascribed only to unsanitary hospital conditions.

Between 1919 and 1927 the departmental staff was increased from five to seven, exclusive of interns and assistants below the rank of instructor. James Mortimer Pierce ('23m), who was appointed Instructor in 1925, was made Assistant Professor of Obstetrics and Gynecology in 1928, and in 1930 he became the first member of the staff of the department to be advanced to an associate professorship. Those instructors who remained during the twenties for a period of three years were: Theodore Wright Adams ('18, '20m), 1921-24; William Henry Rumpf (Minnesota '20, B.Med. ibid. '21, M.D. ibid. '22), 1923-26; Lawrence Edward McCaffrey (M.D. McGill '21, C.M. ibid. '21), 1924-27; Harold Arthur Furlong ('22, '24m) and James Valentine Campbell ('24m), 1926-29; L. Grant Baldwin ('25m) and Harold Smith Morgan ('25m), 1927-30. Lewis Ernest Daniels ('11, M.D. Harvard '20) was an instructor in the department from 1922 until 1925 and returned in 1930.

In December, 1930, after thirty years of service Dr. Peterson resigned his position as head of the Department of Obstetrics and Gynecology. He was succeeded by Dr. Norman F. Miller, one of his former assistants, who some years before had gone to the University of Iowa to become associated with Dr. Everett D. Plass, head of the Department of Obstetrics and Gynecology there.

In the nine years which followed Miller's return to the University in 1931, the staff usually consisted of eight or nine faculty members, in addition to the interns, most of whom remained as instructors for two or three years after completing the internship. By 1937 it was customary to designate a man "intern" in the first year of his internship, "assistant resident" in the second, and "resident" in the third.

Associate Professor James M. Pierce left the department in October, 1931,

and in the same year Dr. Daniels and Norman Rudolph Kretzschmar ('24, '26m, M.S. '31), instructors, were made assistant professors. Glenn Allan Carmichael ('28m) served as an instructor for three years before leaving the department, as did Woodburn Kenneth Lamb (Alma '26, '30m), David Charles Kimball (27, '30m), and Sprague Heman Gardiner ('30, '34m, M.S. '39). James T. Bradbury (Montana State College '28, Sc.D. Michigan '33) was selected to fill a special research assistantship in the department in 1933. He was transferred to an instructorship in 1938, and a year later the research position was filled by the appointment of Lore Sophie Marx (Ph.D. Heidelberg '28).

Carl Parker Huber ('24, A.M. '25, '28m) served as an instructor from 1930 until 1936, and for three years of that time, 1932-35, was Reuben Peterson Instructor and Fellow in Obstetrics and Gynecology. Kretzschmar was promoted to an associate professorship in 1938, and Clair Edwin Folsome (Albion '25, Michigan '33m, M.S. ibid. '38), after four years as an instructor, was appointed Lecturer in Obstetrics and Gynecology in 1939.

Reuben Peterson

[Died November 25, 1942.]

SELECTED BIBLIOGRAPHY

"President's Address." Announcement, Department of Medicine and Surgery Annual Report of the University Hospital of the University of Michigan Calendar Catalogue … Catalogue and Register "Abram Sager, A.M., M.D.: His Life and Services." "The Days of Auld Lang Syne — Recollections of Michigan Alumni." "Medical Faculty Minutes" "Edward Swift Dunster, A.M., M.D. A Biographical Sketch." The Peninsular and Independent Med. Journ. President's Report Proceedings of the Board of Regents … "Case of Delivery by Caesarean Section." University of Michigan Regents' Proceedings …, 1837-1864.

THE DEPARTMENT OF OPHTHALMOLOGY

THE first instruction in ophthalmology at the University of Michigan of which there is record was given in March, 1870, when George Edward Frothingham ('64m) became Lecturer in Ophthalmology. He had come to the University three years before as Prosector of Surgery and Assistant Demonstrator of Anatomy, but had become interested in ophthalmology, which had been established as a separate chair in the Miami Medical College in 1860, and in the College of Physicians and Surgeons in New York in 1869. His successor, Dr. Flemming Carrow, wrote regarding Frothingham's part in making Michigan the third medical school in America to establish a Department of Ophthalmology: "Not only did he demonstrate the necessity for this chair, but he clearly showed his ability to fill it … The clinics in ophthalmology were the most numerously attended of any … west of Philadelphia" (Carrow, p. 443).

Dr. Frothingham was born in Boston in 1836, received his early education at Phillips-Andover Academy, and for some years taught school in Massachusetts. Later, he began the study of medicine under Dr. William Warren Greene ('55m), eminent New England physician and surgeon, but came to Michigan in 1864 to complete his medical studies. After his graduation he engaged for a time in general practice in North Becket, Massachusetts, but when Greene, his old preceptor, was called to Michigan in 1867 as Professor of Surgery, he brought young Frothingham with him. It was undoubtedly Frothingham's increasing interest in ophthalmology and aural surgery that led not only to a gradual decrease of his work in anatomy but also to his appointment to the professorship of ophthalmology and aural surgery in 1872.

Evidence, however, of the minor position of ophthalmology in Frothingham's teaching and clinical duties may be gathered from a report submitted to the Regents in June, 1875, by Acting Dean Maclean:

That in addition to his present work as Professor of Ophthalmology and Otology, the incumbent of the proposed chair give his attention to daily teaching and demonstration in the dissecting room on such topics and matters as may arise in the every day work of dissecting; and that the direction of this work shall be under his personal supervision.

That he shall, on consultation and by mutual agreement with the Professor of Anatomy, give lectures on such topics as may be decided upon, for the purpose of allowing the Professor of Anatomy more time for the special instruction of the students in the Dental School in subjects not usually brought before general classes in medicine.

That he be required to hold the students to a strict examination and account for their work in the department of Practical Anatomy, giving certificates of the same on the completion of such work.

That he shall have charge of the finances of the department, and shall make a yearly report of the same to the Board of Regents.

That he shall have supervision of, and shall give attention to, the procuring of anatomical material; but on account of the labor in this work, and the extra duties required of him, he shall be allowed an assistant, who shall be styled the Demonstrator of Anatomy. The duties of the Demonstrator of Anatomy shall be defined by the Professors of Anatomy and of Practical Anatomy, and he shall be required to devote his entire

time to the practical work of this department.

R.P.

The addition to his title of the professorship of practical anatomy at this time suggests the difficulty of obtaining anatomical material. Frothingham had taken this part of his responsibility so seriously and had advanced the matter so vigorously before the legislature that a law was passed in 1876 which became a model for subsequent enactments in other states.

Frothingham continued to hold the chair of ophthalmology and aural surgery, under various titles, for nineteen years, until he withdrew from the University as a result of his advocacy, together with that of Dr. Donald Maclean, of the removal of a part of the University's medical curriculum to Detroit. Neither man felt that adequate clinical material could be obtained in Ann Arbor. One of them was said to have remarked that "one might as well undertake to raise oranges in Canada as to have a complete clinic in Ann Arbor." There ensued a bitter battle which was greatly publicized by the newspapers of the times. Largely as a result of President Angell's masterly analysis of the situation, the plan for a change was rejected. Frothingham accordingly resigned and devoted his entire time to his Detroit practice. He died in Detroit, April 24, 1900.

Dr. Frothingham's personality was pleasant and agreeable; a man of original ideas, great energy, and ability as a speaker, he took a prominent part in discussions within the Medical Department, as well as in the State Medical Society. He was active in a movement toward a general elevation of requirements for the degree of doctor of medicine, and he deplored the tendency to specialize without first having attained a proper proficiency in general medicine. He was equally emphatic in his rejection of the idea that the so-called "classical" education is the best preparation for a course in medicine. He was also one of the first members of the medical faculty in 1875 to defend the Regents' position in regard to the establishment of the Homeopathic College, contending that knowledge was the most effective antidote to false theories. His position was later sustained by the American Medical Association, in which in 1888 he was chairman of the section on ophthalmology.

Throughout Frothingham's years at the University, ophthalmology developed steadily. In 1877 President Angell reported the success of a large number of surgical operations performed on the eye and ear, and in 1878 he noted that of two hundred operations performed in the Hospital thirty-three were for cataract, and of these, thirty were successful. In 1881, an eye and ear ward was added to the University Hospital at a cost of some $2,500. At that time few men in the country were doing cataract surgery. Frothingham developed and perfected his technique as rapidly as knowledge of the times permitted. After the first use of cocaine in 1884, as a local anesthetic in eye surgery, operations for cataracts greatly increased. Dr. Frothingham became more interested in intraocular surgery. He kept accurate and complete records of his surgical cases, and he frequently reported his results in the Journal of the American Medical Association. Probably 90 to 95 per cent of the surgery done during those years was for cataracts, since glaucoma surgery of any extent was as yet unknown, and squints were treated most frequently with corrective glasses. Reports on the technique of the cataract operation were prevalent, the so-called "flap" type being the most universally accepted. Frothingham took part in the dispute among ophthalmologists regarding the kind and

extent of postoperative care to be accorded cataract patients. Then, as now, there were advocates of a long and strict confinement of the patients to bed with both eyes covered, whereas others allowed their postoperative cases to be out of bed on the first postoperative day. Dr. Frothingham pursued a middle course. He felt neither of the extreme views was justified.

The teaching of ophthalmology through the early formative days of the department was decidedly limited compared to the amount of instruction and clinic material which students now receive. In 1880 three courses in ophthalmology were given. One was entitled Eye and Ear Clinic and consisted of seventy-two lectures; another, listed in the Announcement as Ophthalmology and Otology, offered twenty-four lectures; and the third course, Clinical Ophthalmology, included 128 lectures and demonstrations. Dr. Frothingham operated before the students twice a week. In his opening lecture of the year he often told the students: "… you must know you will profit none by my operations unless you know the anatomy and physiology of the organ thoroughly. I can demonstrate the fundamental principles. The world will be your clinic" (Vaughan, A Doctor's Memories, p. 201). One may imagine the operating amphitheater in the old Pavilion Hospital crowded with students straining to see a cataract extraction. Those students in the uppermost benches must have had difficulty seeing the eye, let alone a lens being tumbled from it. Today students are allowed to stand by the surgeon's elbow to watch the operations. Many great ophthalmologists received their initial tutelage under Frothingham. Among them may be mentioned Dr. John E. Weeks, of New York, and Dr. Harold Gifford, of Omaha.

Upon Dr. Frothingham's resignation in July, 1889, Dr. Flemming Carrow (George Washington '70, M.D. ibid. '74, A.M. hon. Michigan '03) was appointed his successor, as Professor of Ophthalmic and Aural Surgery, and Clinical Ophthalmology, at a salary of $2,000. By that time both ophthalmology and otology had become of great importance in the medical curriculum, and it became necessary to devote more and more time to these subjects. Thus, when Carrow assumed his new duties, he gave up his work in anatomy. Dr. Carrow had had a varied experience. He had studied ophthalmology with Dr. C. R. Agnew in New York City, and in London, Berlin, and Vienna. In 1875 he was appointed surgeon in charge of military service for the Chinese government at Canton. During this period he was also medical officer to the British consulate (1878) and customs-medical officer in 1879. He saw active service with the Chinese army at the Gulf of Tonkin, and two years later he became American vice-consul. Later, he returned to America and practiced medicine in Bay City, Michigan, until he was appointed in 1889 to a professorship in the University.

Many of Dr. Carrow's lectures to the students have been saved and are still available. They are written in beautiful handwriting, giving the fundamentals of diagnosis and treatment of many diseases affecting the eye, ear, nose, and throat. Characteristic of these lectures are the bits of philosophy and hints to the student on the practice of the art of medicine. Dr. Carrow had a flair for the dramatic. He enjoyed telling the students how they should run their offices. He said that there should always be a neat pile of clean towels on a table in the examining room. When the patient entered one should fasten a towel about his neck and place another one over his lap and another one over the near-by table. When the patient got up to go the

towels should be nonchalantly tossed into a corner. After the patient left, however, one should pick up the towels, shake them off, and place them back in the clean pile.

The work in ophthalmology and otology flourished under Dr. Carrow's direction. Both fields were developing so rapidly that there was more work than one man and his assistant could handle. Dr. Carrow remained at Michigan until September, 1904, when he resigned to take up the practice of his specialty in Detroit. After some years he retired to Traverse City, where he died June 23, 1928.

At the time of Dr. Carrow's resignation in 1904, Walter R. Parker ('88, M.D. Pennsylvania '91, Sc.D. hon. Michigan '35) was appointed Clinical Professor of the Diseases of the Eye, becoming Professor of Ophthalmology the following year. At the same time R. Bishop Canfield ('97, '99m) was appointed Clinical Professor of the Diseases of the Ear, Nose, and Throat. After some years' experience in various hospitals in the East, Parker began the practice of ophthalmology in Detroit in 1894, interrupted in 1896 by a year's postgraduate study in Vienna. From 1899 to 1904 he was clinical assistant in ophthalmology in the Detroit College of Medicine.

During his period of twenty-eight years of service in the Medical School wide recognition came to Dr. Parker in his special field. During World War I he was colonel in charge of the Division of Head Surgery in the Surgeon General's office, under General W. C. Gorgas. His numerous contributions to ophthalmic literature, his service on the editorial staff of a number of journals, and his membership in the Council of the International Congress of Ophthalmology bear witness to the recognition accorded his work in the University.

The postgraduate training in ophthalmology developed by Dr. Parker is still followed and is considered the model for the teaching of clinical ophthalmology to undergraduates and as specialized training for postgraduate students. Today, the Department of Ophthalmic Surgery has one of the outstanding clinics in the country.

Because there were no volunteer assistants to be obtained in Ann Arbor, it became necessary to develop a large resident staff. Gradually, within the Medical School, a three-year rotation service was instituted. A graduate is actually appointed for four years of service — one year spent in a general hospital of his election and three years on the ophthalmic service at the University — one year as assistant resident, one year as resident, and one year as instructor. While this service was inaugurated primarily to assist in teaching ophthalmology to the undergraduates, it has in reality developed a postgraduate service that is well recognized and is generally known as the Michigan rotation system. Each year one or two men are graduated who are thoroughly trained in ophthalmology and who have had some experience in teaching. No degrees are given, but it is now so arranged that members of the staff holding a collegiate degree may enroll in the postgraduate school as candidates for the degree of Master of Science in Ophthalmology. That the results have been rewarding is shown by the responsible positions attained by graduates of the department.

Upon Dr. Parker's resignation in July, 1932, to become Emeritus Professor of Ophthalmology he was succeeded by George Slocum ('89m). After four years' general practice in the state of New York, Dr. Slocum spent a year in postgraduate work in the University Medical School, becoming Demonstrator in Ophthalmology in 1904, which title he held

until 1913, when he became Instructor in Ophthalmology. He continued to serve the department as Assistant Professor until 1930. At the time of his appointment as Professor of Ophthalmology in 1932 he had been Associate Professor for two years. Dr. Slocum had been in the department throughout Dr. Parker's term as chairman. As Dr. Parker practiced and lived in Detroit and came to Ann Arbor two days a week for surgery and clinic, Dr. Slocum did a large share of the student instruction and supervising of the outpatient clinic. He also had a private practice in Ann Arbor. Dr. Slocum was a member of many medical and scientific societies and the author of numerous publications in various journals, as well as of a textbook entitled Junior Ophthalmology. He died on March 24, 1933.

Dr. Slocum was succeeded by Francis Bruce Fralick ('27m, M.S. '35) as Associate Professor of Ophthalmology and acting chairman of the department. In February, 1938, he was appointed Professor of Ophthalmology and chairman of the department. Under Dr. Fralick postgraduate research and training have shown much progress. Men who are in their fourth year of training now do a large part of the clinic surgery. They are well qualified on ophthalmic surgery when they have finished their four years at the University and are as thoroughly trained as possible for the American Board Examinations in Ophthalmology.

Martha Jones

SELECTED BIBLIOGRAPHY

Announcement, Department of Medicine and Surgery Annual Report of the University Hospital of the University of Michigan Calendar Catalogue … Catalogue and Register "Minutes of the Medical Faculty" "Doctor George Edward Frothingham." President's Report Proceedings of the Board of Regents … A Doctor's Memories.

THE DEPARTMENT OF OTOLARYNGOLOGY

THE Department of Otolaryngology originated as a distinct and separate entity in the Medical School in 1904 under the direction and leadership of Roy Bishop Canfield ('97, '99m). At the age of twenty-nine he began his first year of service in the University as Clinical Professor of the Diseases of the Ear, Nose, and Throat, and one year later, in 1905, he was promoted to the rank of Professor of Otolaryngology. Although Dr. Canfield was preceded by such eminent men as Dr. George Edward Frothingham, Professor of Materia Medica and Ophthalmology, 1872-89, and Dr. Flemming Carrow (George Washington '70, M.D. ibid. '74, A.M. hon. Michigan '03), Professor of Ophthalmic and Aural Surgery, Laryngology, and Clinical Ophthalmology, 1889-1904, the functions and activities of these men were varied and pertained more significantly to ophthalmology than to the field of the ears, nose, and throat. Consequently, the appointment in 1904 of Dr. Canfield marked the separation of ophthalmology from otolaryngology and laid the foundation for the subsequent growth and development of otolaryngology in the Medical School.

Animated by a passion for the study of his specialty and familiar with the latest developments and surgical techniques, Dr. Canfield plunged vigorously into his assignment, organized a modern curriculum, and brought early recognition to the Medical School through distinguished achievements in the field of otolaryngological surgery. He was a pioneer of modern otolaryngology in the Middle West. Local anesthesia was successfully attained by his skillful methods, innovations in throat surgery were instituted, and his operations upon the nasal septum and complete procedures upon the nasal accessory sinuses were brilliantly performed. His astute knowledge of diseases of the temporal bone and his amazing dexterity in surgical approaches to this structure soon brought him wide recognition in the field of otology. It may be said of Dr. Canfield that he was the founder and one of the chief builders of modern otolaryngology in Michigan from the point of view of pedagogy and practice.

During his first five years at the University Dr. Canfield made important additions to his surgical armamentarium in spite of inadequate facilities. He established his operating room in the basement of the surgical wing of the old hospital, built in 1889-91, beneath the stairway leading to the main surgical amphitheater, and began to practice the procedures which he had learned through a rich experience in the Massachusetts Eye and Ear Infirmary in Boston and in clinics abroad. It has often been said that the operating room space allotted Dr. Canfield barely admitted the patient, the doctor, and the anesthetist, thus making it necessary for the surgical nurse to take her position in the corridor and hand instruments to Dr. Canfield through the open door. But it was under such conditions, with poor facilities and meager equipment, that the young otolaryngologist achieved an international reputation through some of the most noteworthy surgical successes of his life. When one considers what Dr. Canfield accomplished in those early years, admiration for his courage and invention is exceeded only by the widespread acknowledgment of the tremendous influence he exerted in the field of otolaryngology and in the progress of medicine.

Dr. Canfield's achievements were in keeping with the excellent training he had received in the field of otolaryngology. After his graduation from the Medical School in 1899, he was appointed assistant to Dr. Carrow, but resigned the post to become house surgeon at the Massachusetts Charitable Eye and Ear Infirmary in Boston. Later, he engaged in clinical work at the New York Eye and Ear Infirmary in New York City. During this early period he was inspired by the teaching of such eminent otolaryngologists as Dr. Clarence John Blake, of Harvard, Dr. Fred L. Jack, of Tufts Medical School, and Dr. Cornelius Godfrey Coakley, of Bellevue Medical School. Upon the completion of Dr. Canfield's services in Boston and New York, he went abroad for two and one-half years, where he devoted himself to studies under the leadership of some of the most distinguished physicians and teachers in Europe. He came under the influence of such men as Fraenkel, Jansen, Halle, Krause, and Friedlaender, of Berlin; Schwartze, of Halle; and Killian, of Freiburg. Thus, he had obtained a thorough and comprehensive training under the direction of many of the great academicians of the period. Upon his return to the United States, Canfield received the appointments of attending laryngologist to the New York City Clinic for Communicable Pulmonary Diseases and assistant aural surgeon to the Manhattan Eye and Ear Hospital. In June, 1904, he was elected to membership in the American Laryngological, Rhinological, and Otological Society, Inc., and in October of the same year, he became a fellow of the New York Academy of Medicine.

Upon assuming his professorship at Michigan in 1904, Dr. Canfield set about organizing undergraduate and graduate education in his department. Classes in applied anatomy of the ear, nose, and throat were instituted for the junior students, and clinical instruction of a genuinely practical nature was given the members of the senior class. On every occasion he emphasized the importance of paring subjects down to their essentials and presenting only those studies in the specialties that would be of subsequent value to the general physician. This point of view he retained all his life. His didactic lectures and clinical presentations always reflected most convincingly his determination to assist the student in preparing himself for the general practice of medicine.

Dr. Canfield never failed to display a keen interest in graduate medical education. As early as 1906, in co-operation with other members of the clinical faculty, he organized a plan of graduate training which has developed into one of the most adequate and creditable systems found anywhere in this country today. Under this plan the young doctor joined the hospital staff as an intern and served in this capacity for a period of one year, with maintenance in the hospital. In the second year he was appointed demonstrator at a small salary sufficient to cover the cost of a meager livelihood, and in the third year under the rotation system became an instructor with a somewhat larger stipend. At this stage in his education he was charged with important responsibilities of an academic and clinical nature. Thus, the young physician studied the basic principles of otolaryngology and progressed through a comprehensive curriculum of training until in the third and final year, he was given the title of instructor on the medical faculty and vested with the duties and responsibilities of teaching medical students and of treating the sick. The young man upon completion of such a service had acquired the fundamentals of his specialty and was thoroughly competent to practice otolaryngology in all

its medical and surgical aspects. The fact that every man now living who has finished such a training at the University of Michigan is one of the outstanding otolaryngologists in his community and a much respected member of the profession is proof of the thorough manner in which this subject was taught him during his service on the otolaryngological staff. The early services were for a period of three years, but the time was later lengthened to four and finally to five years. The four- and five-year services included a general rotation internship immediately upon graduation from the Medical School, although such a requirement was not maintained in the early years when the three-year plan was in operation. Every clinical service in the University Hospital at the present time conducts its graduate training upon this program, and the teaching and clinical services rendered by the various departments in the Hospital are made possible by this system of staff rotation.

In September, 1907, Canfield appealed to the medical faculty and thence to the Board of Regents for a special appropriation sufficient to construct "a proper building for eye, ear, nose and throat cases." No official action was taken on the matter until November 30, 1908, when De Nancrède moved "that the Faculty of the Department of Medicine and Surgery request the Honorable Board of Regents to erect a building for the accommodations of eye, ear, nose and throat cases to cost $60,000."

In March, 1909, the drawings for the new Eye, Ear, Nose, and Throat Ward were completed and submitted for bids. The building, to be erected at a cost of $25,000, was to consist of three stories and a basement; the basement was to be given over to a waiting room, offices, laboratories, staff rooms, and cubicles for the examination of patients; the first floor, to contain the operating units, several two-bed rooms, and a large ward for patients; the second floor, to be devoted entirely to patient accommodations; and the north end of the third story, to furnish quarters for the interns of the two departments, Ophthalmology and Otolaryngology. The southern extremity of the third story was to be a contagious unit to be occupied by otolaryngological patients afflicted with communicable diseases. The plans met with the approval of the Regents, and in the summer of 1909 construction of the new building was begun. It was situated on the brow of the hill north of the surgical building and connected with the latter by means of a one-story corridor. As pointed out by Dr. Canfield in one of his letters to the contractor: "The site to the north of the present hospital will present several advantages; there is plenty of room here, it is the quietest part of the hill, there will be fine light for the operating rooms, the Contagious Unit is at a distance from all other buildings and it is convenient to the administrative offices."

The new building furnished accommodations for fifty-three patients. In the spring of 1910, in addition to the regular hospital furnishings, the equipment included such modern apparatus as an S. S. White surgical engine and drills for bone surgery, material and supplies essential to the complete outfitting of a "laboratory worthy of the name," an ear operating table especially designed and built by the Scanlan Morse Company, a Rauch gastroscope purchased from Louis and H. Loewenstein, Berlin, Germany, and a balopticon used for projection purposes in the teaching of medical students.

The duties and obligations of the department were varied. Craniotomies were performed, and the Hudson drill was frequently used in making initial openings into the skull. The successful

use of the bronchoscope for the removal of foreign bodies in the bronchi brought early recognition to the department, and the gastroscope, the employment of which has undergone a recent revival and which has become a popular instrument of precision in the diagnosis of lesions of the stomach, was first used by Dr. Canfield in the University Hospital in 1910. Operations upon the throat, nose, and sinuses, and complicated procedures in the ear and mastoid had become routine experiences by this time.

Further evidence of Dr. Canfield's varied interests and his alertness in seizing upon recent scientific discoveries, is contained in a letter that he wrote to Simon Flexner, of the Rockefeller Institute, on October 3, 1910: "Have been much interested in reading of the work being done with Ehrlich's 606 and would appreciate it very much if you would send to the clinic of Otolaryngology some of this preparation. I shall be pleased to keep you informed of what success we have with it." This drug was subsequently administered in the Department of Otolaryngology for the treatment of syphilis until Dr. Udo J. Wile's appointment to the Department of Dermatology and Syphilology in 1914, when the treatment of this disease was relinquished to his supervision.

As early as 1907 Dr. Canfield was performing complete operations upon the nasal accessory sinuses and instituting those principles of sinus surgery which are now recognized as the accepted ones. The technique which he advocated called for the complete eradication of all diseased processes, the meticulous removal of the lining mucous membrane of the sinus, whether it was the maxillary, ethmoid, frontal, or sphenoidal sinuses, and the ablation or maintenance of permanent drainage of the sinus cavity. Modern surgery is making more skillful approaches to the sinuses, reducing deformities to a minimum, and embellishing the techniques in some of their minor aspects. In 1907, nevertheless, the fundamental principles of sinus surgery were as well recognized and executed by Dr. Canfield as they are by the surgeons of today.

It would appear from our records that the first successful operation for the total extirpation of the larynx for carcinoma was performed in the department in 1911. A number of unsuccessful attempts at laryngectomy followed; the operative mortality remained so high that the operation was finally considered futile and for a period of twelve years was abandoned. It was not until 1923 when the epoch-making technique of Dr. George MacKenty was put into effect at Michigan, that the laryngectomy ceased to be a hazardous operation and became the accepted procedure in the University Hospital for extensive carcinoma of the larynx. This was followed by the laryngofissure or hemilaryngectomy, a procedure now used when practicable and gaining popularity because of its splendid results in early laryngeal cancer, with the minimum cost to the voice. Laryngectomy has become less popular at Michigan because of the good results obtained by fractionated doses of X ray in far advanced carcinoma of the larynx.

The Department of Otolaryngology had only one professor for the first thirteen years of its existence. In 1917 Dr. Albert Carl Furstenberg ('14, '15m) was appointed Acting Assistant Professor and in 1919 was given the title of Assistant Professor of Otolaryngology. In March, 1927, Dr. Furstenberg was promoted to the rank of Associate Professor of Otolaryngology, which position he held for the succeeding five years.

On May 12, 1932, the tragic death of Dr. Canfield in an automobile accident brought to a close the colorful and extraordinary career of a great savant of

medical science. At the June meeting of the Board of Regents in the same year, Dr. Furstenberg was made Professor of Otolaryngology and succeeded Canfield as head of the Department of Otolaryngology, which position he still retains.

After the completion of University Hospital in 1925 the Department of Otolaryngology was transferred to the new building, and the adequate and improved facilities for the handling of patients brought a corresponding increase in the number of clinic patients seeking otolaryngological consultations. This Hospital met a very urgent departmental need. The otolaryngological service immediately acquired a larger personnel, and the physical handicaps and mechanical difficulties in the old building which had seriously impaired the growth of the department were rapidly eliminated. In 1933 James Hoyt Maxwell ('24, '27m) was appointed Assistant Professor in Otolaryngology. Dr. Maxwell had grown up in the service of the Hospital, having completed his rotation internship in 1928. He became Associate Professor in 1940. His splendid attainments in clinical medicine, his conscientious devotion to the Medical School, and his accomplishments in pedagogy and research brought him rapid promotion to the position of responsibility which he now holds in the Department of Otolaryngology.

In 1932 the University was the recipient of the Roy Bishop Canfield Memorial Fellowship in Otolaryngology, established by Mrs. Leila M. Canfield in memory of her husband. The munificent benefaction, amounting to the sum of thirty-five thousand dollars, was established as an endowment, "the interest therefrom [to] be awarded to young men, physically and mentally equipped, but perhaps financially unable, to carry on, with honor, work in this special field." It was further specified that appointees to this fellowship must be "young men, not only of ability, but of such sincerity of purpose, and of effort, that they will uphold the high standards to which Dr. Canfield pledged himself" (R.P., 1932-36, p. 34).

Since 1930 the department has actively furthered postgraduate instruction. An annual course is conducted for physicians from various parts of the country. The postgraduate curriculum is not designed for the purpose of training doctors in this special field; it merely aims to refresh the specialist by bringing to him each year some of the newer studies and techniques. This instruction, given in conjunction with the Department of Ophthalmology, has been enthusiastically received by the members of the various classes, and each year requests for registrations exceed the capacity for instruction in this feature of the academic program. In addition to a brief and rapid review of new achievements in the field, the student engages in anatomical studies and serial courses in pathology, all designed to equip him with a working knowledge of these important basic sciences and to furnish him with current clinical information.

A. C. Furstenberg

SELECTED BIBLIOGRAPHY

Announcement, Department of Medicine and Surgery Annual Report of the University Hospital of the University of Michigan Calendar "The Department of Otolaryngology." Catalogue …

"Roy Bishop Canfield, '97, '99m." "Minutes of the Medical Faculty" "The New Eye and Ear Ward." President's Report Proceedings of the Board of Regents … "Two New Deans Are Appointed,"

THE DEPARTMENT OF PATHOLOGY

THE early history of the Department of Pathology reflects the economy in personnel which existed throughout the University. Pathology was included in the plan of teaching at the birth of the Medical School, but of necessity the responsibility for this function was combined with a similar relationship to one or several other branches of medicine.

For the greater part, the history of the department can be written around the men who have borne the title of Professor of Pathology. Only three of them have not been concomitantly titular heads of other departments.

On January 10, 1850, Dr. Jonathan Adams Allen (Middlebury '45, M.D. Castleton Medical College '46) became Professor of Pathology and Physiology, but dissension developed in the faculty and Allen lost the support of his colleagues, who petitioned for his dismissal. Such action was taken by the Regents, and Allen's services to the University terminated on June 30, 1854.

Samuel Denton (M.D. Castleton Medical College '25) had been present at the first meeting of the Board of Regents, June 5, 1837, and he had served on numerous committees concerned with the establishment of the University in Ann Arbor and with the development of the physical aspects of the University. He was also a member of the first Committee on Professors and Salaries. During the winter of 1849-50, the appointment of Dr. Denton to a professorship in the Medical School had been proposed, and the physicians of Jackson submitted a petition in support of this proposal. Accordingly, in 1850 Denton was appointed Professor of Physic. Shortly thereafter came the dismissal of Allen and apparently his duties, so far as they concerned pathology, were taken over by Denton. No minute to this effect appears in the Proceedings of the Regents, but it seems to have been customary during that period for the professors in the Medical School to apportion actual teaching responsibilities among themselves without too strict regard for the implications of their academic titles. That the professorship of pathology had been assigned to Denton in fact, is made certain by an item in the Proceedings of the Regents, September 11, 1860: "The President formally announced the decease of Dr. Samuel Denton, Professor of the Theory and Practice of Medicine and of Pathology." Dr. Denton had died on August 17, 1860.

On September 12, 1860, Alonzo Benjamin Palmer (M.D. College of Physicians and Surgeons [West. Dist. N. Y.] '39, A.M. hon. Nashville '55, LL.D. Michigan '81) was transferred to the chair made vacant by the death of Dr. Denton. Dr. Palmer's services to the Medical Department in other capacities had been continuous since October 1, 1854. In fact, he had been appointed Professor of Anatomy in 1852, but could not be called

to duty at that time, apparently because of lack of funds. He had been Professor of Materia Medica, Therapeutics, and Diseases of Women and Children since 1854. His connection with the Department of Pathology is to be dated from September, 1860, but it seems probable that someone discovered that Denton's title in respect to pathology had never been established by the Regents, for on March 28, 1861, Palmer's title was amended to "Professor of Theory and Practice of Medicine and Pathology." For twenty-seven years, and until his death on December 23, 1887, Palmer served with marked success in this dual capacity.

No biographical sketch of Palmer is included here, for his history belongs much more to Internal Medicine than to Pathology. (See also C. L. Ford's scholarly account of his life and work.)

Some of the activities of the Department of Pathology during Palmer's time may be surmised from references in the announcements and catalogues (Calendar) of the School. Beginning with that of 1863, reference was made to pathological specimens in the Museum. In the catalogue for 1866, there was a list of recommended textbooks in pathology, which included Paget, Rokitansky, and Simon. Virchow was added to this list beginning with 1872-73. The examination of tissue materials and pathological analysis were mentioned in 1874-75, but under the newly established, short-lived unit which was designated "the Polytechnic School." The first reference to teaching microscopical pathology appeared in the catalogue for 1877-78, when, with the introduction of the three-year graded curriculum in medicine, "Pathology (including Pathological Anatomy and Pathological Histology)" was listed among the courses of the second year. In 1882-83 twenty to thirty microscopes were available for an advanced course in normal and pathological histology. This was an optional course, like that described in the catalogue of 1886-87: "A special course in the Pathological Laboratory, lasting from 12-15 weeks, is offered to all students who have become sufficiently familiar with normal histology and the use of the microscope."

Several assistants to Palmer in his dual capacity are listed in the catalogues of his period. In 1878-79, Lucian G. North ('77m) was included in the faculty with the title of Assistant to the Professor of Pathology and Practice of Medicine and Clerk of the Faculty. The following year Edward Wirt Lamoreaux ('79m) was Assistant to the Professor of Pathology; and in the catalogue of 1880-81, this position is listed as held by Patrick Eugene Nagle ('80m). In the next year, William J. Herdman ('72, '75m, LL.D. Nashville '97), was Assistant Professor of Pathological Anatomy and Demonstrator of Anatomy, with Charles F. Dight ('79m) Assistant to the Professor of Pathology. Dight continued as Assistant for the next year, but Herdman's title was changed to "Professor of Pathological and Surgical Anatomy, and Demonstrator of Anatomy." In 1883-84 there was further modification to "Professor of Practical and Pathological Anatomy, and Demonstrator of Anatomy." In that year, Osbourne F. Chadbourne (83m) became Assistant to the Professor of Pathology. Herdman and Chadbourne continued in these positions through 1886-87, when Joshua S. Blanchard ('81m) was made Assistant.

Heneage Gibbes. — In 1888, shortly after the death of Alonzo B. Palmer, who had held the joint title of Professor of Pathology and of Practice of Medicine, Heneage Gibbes (M.B. and C.M. Aberdeen '79, M.D. ibid. '81) became the first to fill an independent chair of

pathology in this University. The medical faculty, in a resolution of October, 1887, had urged the establishment of such a chair and had requested that instruction in the subject "should be largely given as laboratory work." Dr. Gibbes was born in Berrow, Somerset, England. His father, a minister, was the grandson of Sir G. S. Gibbes, M.D., F.R.S., who had been physician to Queen Charlotte. It is said that the Reverend Gibbes had intended that his son should prepare for the ministry, but the boy rebelled and at fourteen sailed for the East Indies instead. A period of adventurous living followed, which furnished the material for many tales of the Opium War, of combats with pirates, of shipwreck, and of commanding his own ship at twenty-one.

He then returned home, resumed his studies under private tutors, and completed his education at the University of Aberdeen. In 1879 he became a licentiate of the Royal College of Physicians. In England and in governmental service in India, Gibbes had a varied and interesting career. He was curator of the Anatomical Museum of King's College and lecturer in physiology and normal and morbid histology in Westminister Medical School, both of London, and in 1884 he was sent to India as cholera commissioner for the British government. As a student of Klein and as a well-established histologist, it was natural that he should be chosen to accompany Klein on this mission.

When Gibbes came to Ann Arbor he brought with him very definite views as to the nature of bacteria and their significance in the production of disease. These views he did not hesitate to express forcefully even after it was evident that they were unwelcome to his colleagues and were not in harmony with current advances in the field of bacteriology. In 1888 he told the Michigan State Medical Society that phthisis and tuberculosis were distinct diseases and that the tubercle bacillus had not yet been proved to have any causal relation to either, but "would seem to be a concomitant of the process of caseation." He recognized the presence of bacteria in tissues and devised and taught methods for staining them, but he thought that such organisms were present because tissues altered by disease were suitable soil for their growth and that no specific etiological relationship existed. This was a period of rapid progress in bacteriology, and his colleagues were keenly sympathetic to the changing order. Some of them were having a very important share in the demonstration of living organisms as specific causes of disease. Thus, the gap widened, and differences in point of view became more obvious. In defense of Gibbes it should be remembered that he had written freely while yet in England. His views could have been easily ascertained and probably were already well known to some members of the faculty before he was offered a chair in this University.

The discord which characterized Gibbes's tenure and the great success which Warthin achieved when, after a short interlude, he became head of the Department of Pathology have combined to belittle the work of Heneage Gibbes. While in England he had written many papers on histology, most of which appeared in the Quarterly Journal of Microscopical Science. He had also published a textbook, Practical Histology and Pathology, which ran through several editions both there and in America. While he retained his professorship in this University, he contributed more than twenty additional articles to medical journals. Although the topics on which he wrote were widely scattered in the general field of pathology, those selected for special study were so well

chosen that in regard to most of them there has been well-sustained interest even to the present time. Tuberculosis, cancer, pneumonia, the hemolymph nodes, and actinomycosis appear most frequently among the titles of his papers.

It is difficult to appraise the teaching of pathology during Gibbes's professorship. The microscope was still a comparatively new aid in uncovering the processes of disease. It has been said that there was no course in microscopical pathology worthy of the name until Dr. Warthin organized one in 1895-96. As has been stated, however, an elective course of this nature was offered before Gibbes came and was continued during the earlier years when he headed the department. Moreover, beginning with 1891-92 it became a required course for all students. It is scarcely credible that one who wrote as extensively and as accurately on many phases of histology and histopathology as did Gibbes and who had had such interesting experiences in distant lands could not have given a worth-while course. Memories of success in teaching were clouded by the controversies of the period and finally by the scientifically unsound position of the teacher. Only recently, however, one who was a student of Gibbes in Detroit, Dr. William Fowler, has written appreciatively of the teaching he received from him:

I had the fortune to take a special course in Pathology from him [Gibbes] and he was a fine teacher. Pathology was a comparatively new subject and here was a man who claimed much for it … Shortly before the death of Doctor Gibbes, I spent a very pleasant afternoon with him in his home at McAllister [McAlester], Oklahoma, and it was only then that I learned that beneath a Scottish-Cockney exterior was a charming character, subdued, cultured, sympathetic, companionable and inspiring.

Journ. Mich. State Med. Soc.

Heneage Gibbes continued as Professor of Pathology until 1895. Shortly thereafter he removed to Detroit, where he became professor of the theory and practice of medicine and of pathology in the Michigan College of Medicine, and also city health officer. He died on July 18, 1912.

In the catalogue of 1887-88, the year in which Heneage Gibbes was chosen to fill the vacancy in the chair of pathology due to the death of Dr. Palmer, William J. Herdman was continued as Professor of Pathological and Surgical Anatomy, and Demonstrator of Anatomy; and Joshua S. Blanchard appeared as Assistant to the Professor of Pathology and the Practice of Medicine and Clinical Medicine. In the following year no assistants to Gibbes were listed. It is evident that the first Professor of Pathology to be unhampered by duties in other departments was expected to do alone everything needed in pathology. Provision for this independent professorship may have left no funds with which to pay assistants. In 1889-90, Vida A. Latham ('92d, M.D. Northwestern '95) was Assistant in Pathology, Arthur S. Rogers ('85p, '90m), in 1890-91, and Martin L. Belser ('91m), in 1891-92. Belser was Instructor in Pathology from 1892 to 1895.

Changes in methods of teaching and expansion of departmental activities are indicated by brief references in the annual catalogues. The first description of the Pathological Laboratory appeared in 1888-89. The microscopes were made by R. and J. Beck of London. The staining and detection of bacteria were included in the procedures taught. Zeigler's General Pathology and, in the following year, Gibbes's Practical Histology and Pathology were added to the list of recommended textbooks. The elementary laboratory course was required of all students in 1891-92, and autopsies were done before

the senior class with selected students assisting. A graduate course in pathology, including microscopical technical methods, was described in 1892-93. In the following year two hours per week were devoted to pathological histology. The detailed program for 1894-95 assigned sixty-four hours of lectures in General Pathology to Gibbes; Gibbes and Belser together gave sixteen hours of lectures, fifty hours of laboratory work, and twenty-eight hours of microscopical demonstrations in Pathological Histology, and each student received three hours of Autopsy Demonstrations.

Aldred Scott Warthin. — With the departure of Heneage Gibbes in 1895, George Dock (M.D. Pennsylvania '84, A.M. hon. Harvard '95, Sc.D. hon. Pennsylvania '04) was placed in charge of pathology, and his title was expanded to read "Professor of Theory and Practice of Medicine and Clinical Medicine and Pathology." Dr. Dock had been at the head of the Department of the Theory and Practice of Medicine since 1891, and the addition of pathology to his responsibilities was a restoration of the arrangement which existed before Gibbes was appointed. Dock was well fitted for this assignment for he had been professor of pathology at Texas Medical College and Hospital before coming to Michigan, but he was much too busy to carry this added work alone. Fortunately, he had on his staff a young man whose personal attributes and professional training made him peculiarly fitted for transfer to pathology.

Aldred Scott Warthin (Indiana '88, Michigan '91m, Ph.D. ibid. '93, LL.D. Indiana '28) was born at Greensburg, Indiana, October 21, 1866, and died at Ann Arbor, May 23, 1931. He received a Teacher's Diploma in Music from the Cincinnati Conservatory in 1887. The subject of his doctoral thesis was "The Value of Music as a Dramatic Element." He had been assistant to Dock in 1891-92 and Demonstrator of Clinical Medicine from 1892 to 1895. He had given special attention to microscopy in medical diagnosis, and each summer found him in Europe acquiring the rapidly increasing knowledge of tissue diagnosis as it was then being developed in Germany and Austria. It was natural, therefore, for Dock to place Warthin in immediate charge of his newly acquired responsibility. Thus, in 1895 Warthin became Instructor in Pathology. Dock delivered the lectures on general pathology until 1899, when Warthin was advanced to the assistant professorship, and nominally held the professorship for four years more. In 1900 the basic laboratory course was lengthened to nine weeks, with 135 hours of work. On request of the medical faculty Warthin was, in 1903, made Professor of Pathology and Director of the Pathological Laboratory.

Warthin was extremely productive in research and was a frequent contributor to medical journals. Even a partial list of the topics on which he wrote reveals the breadth of his interests. Only the more important works can be mentioned here. While yet a demonstrator in the Department of Internal Medicine, he described the accentuation of the pulmonary second sound in pericarditis and assigned diagnostic significance to this clinical manifestation, which has since been known as "Warthin's sign." Tuberculosis of the placenta, the histology and pathology of the hemolymph nodes, the generic relationship of the leukemias, Hodgkin's disease, and lymphosarcoma, the pathology of irradiation, traumatic lipemia, the lesions produced by dichlorethylsulfide (mustard gas), and the constitutional pathology of hyperthyroidism are some of the subjects to which he made important contributions. It is for his work on the pathology of latent

syphilis, however, that Warthin is best known. Interested first in the lesions of congenital syphilis, he early recognized that the histopathological manifestations of syphilis exhibit an essential unity in various organs and at various stages of the disease. In a series of some forty papers he established a new conception of the pathology of late, and of latent, syphilis, particularly in the heart, aorta, pancreas, adrenals, and testes. Making use of new techniques in staining, developed in association with Allen C. Starry, Richard E. Olsen, and Robert Farrier, he was able to support his views of this disease process by the demonstration of Treponema pallidum in lesions in which it had never before been seen.

For many years medical students used Dr. Warthin's translations and revisions of the tenth and eleventh editions of Ziegler's General Pathology as well as his own Practical Pathology and Autopsy Protocols. In the later years of his life his writings reflected to a greater extent his interest in the cultural and philosophical aspects of medicine. During this period he brought out three books: Old Age (1929), The Creed of a Biologist (1930), and The Physician of the Dance of Death (1931).

Warthin held office in many of the societies in the fields of medical biology, pathology, and internal medicine of which he was a member. He was president of the American Association of Pathologists and Bacteriologists in 1908, of the International Association of Medical Museums from 1910 to 1913, of the American Society for Experimental Pathology in 1924, of the American Association for Cancer Research and of the Association of American Physicians in 1928, and of the American Association of the History of Medicine in 1930-31.

Warthin, in collaboration with Dr. M. E. Abbott and others, edited the Bulletin of the International Association of Medical Museums (1911-31), the Annals of Clinical Medicine (1924-27), and the Annals of Internal Medicine (1927-31).

Untiring energy, broad cultural attainments, personal fastidiousness, and unswerving loyalty to his chosen interests were Warthin's prominent traits. He was a vigorous and outspoken proponent of that which he believed to be right. Thus, he made many enemies as well as many friends. Students considered him a hard taskmaster, and those who had little personal contact with him generally disliked him. To the individual student, however, he was always ready to give sympathetic encouragement, and his friendly and understanding attitude toward the individual was in sharp contrast to the pedagogical pressure which he put upon his students en masse. He was fully aware of the feeling of the average student toward him and frequently reacted with the statement that he was quite willing that the students should swear at him while here, if they would swear by him after they were out in the practice of medicine. This hope was amply realized, and many who had been outspoken in adverse criticism as students, returned to voice their appreciation and to assert that from pathology, more than from any other one department, they had gained the knowledge which enabled them to succeed in practice.

Between 1903 and 1931 all junior work in general pathology was transferred to the preclinical years, the required autopsy work was greatly increased, specialized undergraduate courses were introduced, an expanded summer program was established, and an ambitious program of research and of extramural service was carried out.

Activities in connection with world war I. — The teaching load of the Department of Pathology was practically

doubled during the period of American participation in World War I. Classes were greatly increased in size, and the curriculum was compressed in order to prepare young medical men for military service as rapidly as possible. Physical changes in the department also were required, and the old arrangement of tables in the main teaching laboratory (West Medical Building, Room 104) gave way, during the year 1917-18, to a more practical, if less interesting, floor plan, which doubled the number of working places. (This seemingly minor point would scarcely deserve mention were it not for the fact that as the older alumni return, they are puzzled by the unfamiliar appearance of the room which had impressed upon many their most vivid recollections of the Medical Building.) A special course, "Pathology in Relation to Military Medicine," was offered during this period and proved both popular and useful.

The War Retrospect Section of Bulletin VII of the International Association of Medical Museums, edited by A. S. Warthin and C. V. Weller during the year 1917-18, contained twenty-four articles on the special pathology of morbid conditions of military importance. Eight of these were written by Warthin; Weller was responsible for a comprehensive survey of the "Pathology of Gassing," with a complete bibliography of the medical aspects of military gassing up to that time.

This was also a period of intense research activity. Through the kindness and skill of Dr. Moses Gomberg, of the Department of Organic Chemistry of the University, a supply of pure liquid mustard gas (dichlorethylsulfide) was made available long before this potent war gas was under factory production in this country. With this pure product, and, later, with commercial mustard gas provided by the Dow Chemical Company of Midland, Michigan, every possible phase of the pathological effects of mustard gassing was investigated. Dr. George Herrmann assisted Warthin and Weller in this work and was primarily responsible for the clinical investigation of human cases of mustard gassing which became available. The results appeared in six papers published in the Journal of Laboratory and Clinical Medicine in 1918. The first study was published independently, but shortly thereafter the Pathological Laboratory became allied, through its director, with the Medical Advisory Board of the Chemical Warfare Service and had the status of a branch laboratory. The remaining investigations were given that board, appeared in abstract in its bulletins, and were later released by the board for publication in full. To meet the demand for this material for medical officers of the Army and others, it was brought out in book form. It also was utilized in The Medical Department of the United States Army in the World War, Vol. XIV, Chap. XV. This chapter, prepared by Warthin, is entitled "Pathologic Action of Mustard Gas (Dichlorethylsulfide)."

The Aldred Scott Warthin Anniversary Volume. In recognition of his thirty-five years of teaching in the Medical School of the University, and of his international reputation in pathology, a Festschrift was planned in honor of Dr. Warthin's sixtieth birthday, October 21, 1927. This book included scientific contributions from sixty-four authors, among whom Vaughan, Dock, Novy, Huber, and Rous represented his early colleagues, while each of the thirty-five classes taught by Warthin was represented by articles written by one or more of its members. The editorial work on this volume was done by Willard J. Stone, of Pasadena, and Carl V. Weller, of Ann Arbor. Formal presentation of this volume was made December 13, 1927, in the

West Amphitheater of the West Medical Building. After a short address by Dean Hugh Cabot, the presentation was made by Frederick Novy.

On June 15, 1935, the Aldred Scott Warthin Memorial Plaque, a bronze bas-relief of Warthin, was unveiled in the east lobby of the West Medical Building. This was presented to the University by those who had served under Warthin as undergraduate or graduate members of the Department of Pathology staff. Of this group, seventy-eight contributed to the fund which made this plaque possible. It was modeled by Fredrika Godwin Mallette, of Ypsilanti. At the presentation exercises Dr. Howard H. Cummings represented the department staff, Dean Albert C. Furstenberg accepted on behalf of the Medical School, and President Ruthven on behalf of the Regents of the University.

In 1935-36 the executive staff of the University Hospital directed that the space for museum purposes in the Department of Pathology of the University Hospital be designated the Aldred Scott Warthin Museum of Pathology. Through Dr. Harley A. Haynes, Director of the University Hospital, a bronze tablet, carrying this designation, was provided and installed.

Until 1899-1900, Warthin had no aid in the teaching of pathology. In that year Frederick Amos Baldwin ('98m, '02, Sc.D. '04) was appointed Assistant in Pathology. He continued at this rank until he was made Instructor in Pathology in 1903-4. This position was unfilled in the faculty list for 1904-5. Elmore Ernest Butterfield (M.D. Columbian '03) was Instructor in 1905-6; Francis Peyton Rous (Johns Hopkins '00, M.D. ibid. '05, Sc.D. hon. Michigan '38, Sc.D. hon. Cambridge '38), from 1906-8; Robert Livingston Dixon (Tri-State '96, Michigan '10m), in 1908-9 and also in 1910-11, and Plinn Frederick Morse ('07, '09m, A.M. '10), in 1909-10. For a time, members of the staff of the Department of Gynecology and Obstetrics assisted in the diagnosis and teaching of gynecologic pathology. Those assisting in this way were Ralph L. Morse, 1902-4; Samuel R. Haythorn, 1904-5; Frank Clarence Witter, 1906-8; Neal Naramore Wood, 1908-9.

Carl Vernon Weller (Albion '08, Michigan '13m, M.S. ibid. '16) joined the staff as Instructor in Pathology in 1911, was made an Assistant Professor in 1916, Associate Professor in 1921, Professor of Pathology and Assistant Director of the Pathological Laboratories in 1924.

For many years much of the routine histological work was done by student volunteers of the junior staff. The first salaried technician was Ellery Adolph Schmidt, who was appointed in 1908.

Prior to 1922, the departmental janitor assisted in the autopsy room and in the general work of the laboratory. This arrangement was heartily disapproved by the Buildings and Grounds Department, and in 1922 a laboratory attendant, known still as a "Diener," was engaged in the person of John Henry Robinson. With his abundant snow-white hair and dignified bearing, Robinson added significantly to the atmosphere of the department during his fourteen years of loyal service.

With the growth of the department, the number of research and teaching assistants, of technicians, and of clerical workers rapidly increased. To name each of them is beyond the scope of this article. Their names are in the announcements of the Medical School. Only those who served as instructors or in the professorial ranks can be mentioned specifically for the later years. This is unfortunate, for among the lower staff were many who here, or elsewhere, have attained distinction in pathology or in

one of the clinical branches of medicine.

Harriet Shourds Taylor (M.D. Hering Medical College '97) joined the staff of the Department of Pathology as Research Assistant in 1918-19. She returned in 1921-22 as Assistant Professor in Dental Pathology and held the title of Assistant Professor of Pathology for three years thereafter. Walter M. Simpson (B.S. Med. '22, M.S., '24, '24m), a student teaching assistant in 1923-24, became Instructor the following year and was succeeded in 1927 by Carl Hale Fortune (Transylvania '22, Michigan '26m), who remained until 1930.

From 1922 to 1924 Ruth C. Wanstrom ('14, '18m, A.M. '24) was Research Assistant in Pathology under a special grant for the investigation of syphilis. She continued in this work during the following year, when she was advanced to Assistant Professor. In 1931 she returned to the department and in 1937 was made Associate Professor in Pathology.

John C. Bugher ('21, '29m, M.S. '32) was made Instructor in 1930 and was advanced to Assistant Professor in 1933. He resigned in 1937 to accept a position with the International Health Division of the Rockefeller Foundation, in which position he directed a research laboratory and field work for the control of yellow fever in Colombia, with headquarters in Bogota.

Carl V. Weller. — In June, 1931, Weller was made Director of the Pathological Laboratories and was placed in charge of the department. In a standardization of the titles of similar faculty positions seven years later, his title was changed to Professor of Pathology and Chairman of the Department of Pathology.

Harold Gordon (M.D. Toronto '33, M.S. Michigan '34) had been associated with the department for two years as a teaching assistant when he was appointed Instructor in 1932. He continued in this capacity for three years, when he resigned to become associate professor of pathology in the University of Louisville.

Lloyd Fullenwider Catron (B.S. Med. '29, M.D. Rush Medical College '32) was appointed Instructor in Pathology in 1935 and Assistant Professor in 1937. His service was continuous from his first appointment until his resignation in 1941 to assume directorship of the laboratories of the Akron City Hospital.

Robert J. Parsons (Syracuse '28, M.D. ibid. '32) joined the staff of the department as Instructor in 1938, and was advanced to Assistant Professor in 1941. Before coming to Michigan he had been for three years assistant in the Department of Pathology and Bacteriology at the Rockefeller Institute for Medical Research.

Junior Staff and Journal Club. — About 1896 Dr. Warthin began to select groups of eight to ten junior medical students on the basis of scholarship as members of the Junior Staff and Journal Club. This group met twice a month, usually at Warthin's home. Papers on the history of medicine and sometimes on simple research problems were presented by members of the club. Membership in the club was greatly appreciated by students, but it also entailed much hard work, for to these students was assigned the preparation of microscopic sections from the material from the clinics of the University Hospital. Eventually, the clinical material became so extensive that students no longer had time to do the work. During the accelerated activities of World War I, the junior staff had to be abandoned and was never re-established.

Physical growth. — When Heneage Gibbes came to Ann Arbor as the first Professor of Pathology (as an entirely independent chair) he was given working space in the basement of the small new

Anatomical Laboratory Building. This was soon outgrown and the laboratory of pathology was established in the central part of the long, low building on the north side of the campus which was largely occupied by the Homeopathic Medical School and Hospital and which was known for years as the "old" Hospital. It was here that Warthin began his laboratory teaching of pathology. The interior of this laboratory is shown in a picture of the Pathology Staff and Journal Club of 1898-99 in the Aldred Scott Warthin Anniversary Volume (p. 116). Pathology was never taught in the original Medical Building which faced East University Avenue where the Randall Laboratory of Physics now stands.

In the new building (1903) now designated the West Medical Building, comparatively generous provision was made for pathology. The more easterly of the two amphitheaters was equipped for the performance of necropsies, and a large room in the southeast corner was arranged as the Pathology Museum. Offices, laboratories, animal rooms, and storerooms occupied the remainder of the east half of the first floor and a part of the east half of the basement.

In 1926 the completion of the East Medical Building made possible the removal of three departments from the older building and the Department of Pathology acquired the basement space and the east half of the second floor, which had been used for work in anatomy and histology. Half of the one-story addition, which had been built in the central court as an overflow anatomical laboratory during World War I, became a satisfactory animal room. This expansion relieved the crowded condition created by the necessity of adding both lectures and laboratory instruction for dental students in separate classes, and by the great increase in graduate students.

Prior to 1926, bodies upon which necropsies were to be performed were transported from the Hospital to the Medical Building on the campus. All surgical specimens, also, were carried to the Medical Building. Under this plan the essential services of the Department of Pathology to the clinical units at the Hospital were rendered with great difficulty and with many opportunities for confusion and delay. Immediate frozen section diagnoses, while the patient was under anesthesia, were almost impossible. With the completion of the Hospital in 1925, the department moved into space well arranged for its needs on the subbasement floor of the surgical wing. In spite of the "subbasement" designation, these new laboratories were above the ground level. A large museum room, staff offices, a necropsy amphitheater, and numerous laboratories for technicians were provided. Most of the corresponding area of the sub-subbasement floor was equipped for storage of prepared microscopical sections and of paraffin blocks. The first necropsy in the Hospital amphitheater was performed by Dr. Warthin on February 9, 1926. This was No. 2045, A-147-AD.

At the Hospital no provision had been made for teaching sophomore medical students, dental students, or graduate students. Accordingly, space on the old campus was retained and gradually remodeled in order to meet special needs as they arose. Technical staffs were maintained both on the campus and at the Hospital. Between them the work of the department was divided on the principle that all material originating in the Hospital (necropsies and surgical specimens) was to be examined there, while all other material (surgical specimens from the Health Service and College of Dentistry, specimens from outside hospitals and physicians, and all research material) was to be prepared and

examined in the West Medical laboratory.

In 1938-39 the Neuropsychiatric Institute was constructed. To secure physical continuity with the main Hospital, it was necessary to cover the skylight which provided the only natural lighting for the necropsy amphitheater. Although retained as a lecture room, with its table left for the teaching of autopsy technique, the amphitheater could no longer be used for routine necropsies and was replaced by a more convenient room with two tables, providing more intimate instruction for smaller groups.

Consultation service in tissue diagnosis. — Physicians of Michigan, and, to a lesser extent, those of neighboring states, have looked to the Department of Pathology for diagnostic aid and for consultation service in tissue pathology. This was a natural and legitimate demand, since the services of pathologists have not been locally available. During the period in which Warthin was Director the demand for tissue diagnosis grew rapidly. From an occasional case in the early years, by 1928-29 the volume of this material had increased until it exceeded ten thousand cases per year, and more than six hundred physicians were making use of the consultation service.

In May, 1932, the Regents recognized this diagnostic service as a University function and adopted regulations for its operation. A Pathology Diagnostic Revolving Fund was established to facilitate the handling of financial matters in connection with this work. In June, 1937, the Regents authorized the transfer of the accumulated balance in the Pathology Diagnostic Revolving Fund to the Pathology Endowment Fund and provided that similar transfers could be made from time to time as circumstances might warrant. This has been done, and thus, through the use of the facilities of the laboratory for an essential public service, a permanent endowment for the department is being established.

To the nonmedical reader, the significance of this work may not immediately appear. Many of the tissues examined in the laboratory are "surgical biopsies," which have been removed by a minor procedure in order to obtain a more accurate diagnosis and thus gain information upon which further treatment may be undertaken and the ultimate prognosis gauged. Frequently, the clinical question is that of the presence or absence of cancer. For many years, it has been a departmental aim to make such tissue diagnoses available to every citizen of Michigan at a nominal cost. This has been accomplished without prejudice to private endeavor in the field of professional pathology. In fact, most of the pathologists in the state owe their positions to the fact that the Department of Pathology had taught the value of routine tissue examinations to the local physicians. Whenever a local hospital reaches a size which justifies the employment of a resident pathologist, the University assists in making the necessary arrangements and frequently sees one of its own graduate students installed. As the larger hospitals advance to this level, smaller institutions are added to the list of those which the University serves. Thus, the Department of Pathology continues to influence the practice of medicine over the state and to serve the citizens of the state.

Research activities. — As a matter of departmental policy each member of the professional staff has been expected to maintain a continuous program of research, with emphasis upon study and investigation rather than upon publication. Under this plan, and in spite of the routine service responsibilities of the department, there has been a fairly constant stream of contributions to medical periodical literature and to various

handbooks. Those investigations which have been concerned with morphological pathology have very largely had origin in the routine diagnostic material, and this has been partly true of research in experimental pathology.

Grants from extramural sources have supported some of the more ambitious research programs. Among the more important grants have been those from the Pease Laboratories, Inc., for investigation of the toxicity of aluminum compounds, from the Committee on Research in Syphilis, Inc., in support of studies on the lesions of latent syphilis and on the demonstration of spirochetes in tissues, from the American Medical Association for a study of the fish tapeworm (Diphyllobothrium latum) in the Great Lakes region, and from the A. C. Barnes Company, Inc., for an investigation of argyria.

Three doctoral dissertations had been presented from the Department of Pathology by the end of June, 1940:

George R. Herrmann, "Electrocardiography and Cardiac Pathology with Especial Reference to Ventricular Preponderance," 1921-22.

Richard E. Olsen, "A Study of the Granular and Atypical Forms of Spirochaeta Pallida in Tissues," 1930-31.

Frank P. Mathews, "An Experimental Investigation of Lechuguilla (Agave lecheguilla) Poisoning," 1936-37.

Twenty-nine students had also received master's degrees in pathology from this department by 1940.

In 1902 reprints of all papers which had been published from the Department of Pathology since Warthin had joined the staff were bound as Volume I of a series entitled Contributions from the Pathological Laboratory. Subsequent volumes have appeared at irregular intervals as material has been available. Volume XIX contains the papers which were published in the period 1937 to 1940. Copies are distributed to the more important medical libraries over the world and also to other pathological institutes in exchange for their own contributions.

Institute for law-enforcement officers. — As might well be expected, those public officials who are charged with responsibility for the investigation and prosecution of criminal acts have frequently sought the aid of the staff of the Department of Pathology and have called on them to perform necropsies, to secure materials for submission to toxicologists, and to make microscopical examinations and photomicrographs of human tissue, and of objects thought to have possible evidential value. In addition, the staff has almost constantly acted in an advisory capacity, in medical matters, with the State Police and other official agencies. Thus, the staff of the Pathological Laboratories has been concerned in the investigation of many notorious homicides in this state.

As the value of scientific technology in the study of crime became more apparent to public officials, there developed a demand for instruction in this field with requests from individual judiciary and police officers reinforced by formal resolutions of various organizations. In March and April, 1934, the first Institute for Law-Enforcement Officers, organized under the auspices of the Extension Service of the University, was held in the East Amphitheater of the West Medical Building. A program of sixteen lectures and four discussion periods was provided. Professor O. W. Stephenson, of the Department of Education, and Dr. Herbert W. Emerson, of the Hygienic Laboratory, aided in the organization of this and the succeeding institutes, which were held in 1935 and 1936. Detailed programs with the personnel of the committees in charge were printed. With the development of increased

facilities for instruction in East Lansing by the State Police and with the growth of the school organized by the Federal Bureau of Investigation, it was decided in 1937 to discontinue the institutes.

Carl V. Weller

SELECTED BIBLIOGRAPHY

Announcement, Department of Medicine and Surgery Calendar Catalogue… "Aldred Scott Warthin." "Memorial Address on Alonzo Benjamin Palmer." "A Short Sketch of Heneage Gibbes." "The Pathology of Acute Miliary Tuberculosis." Practical Histology and Pathology. Institute for Law-Enforcement Officers, Programs. "Medical Faculty Minutes" Memorial of Alonzo Benjamin Palmer. President's Report Proceedings of the Board of Regents … Contributions to Medical Science. University of Michigan Regents' Proceedings …, 1837-1864. A Doctor's Memories. "Medical Aspects of Gas Warfare." The Medical Aspects of Mustard Gas Poisoning. "Special War Retrospect Section," "The Pathological Laboratory."

THE DEPARTMENT OF PEDIATRICS AND INFECTIOUS DISEASES

THE first regular course in pediatrics in the Medical School was given in the year 1905-6 by Dr. David Murray Cowie ('96m), who had been appointed Instructor in Pediatrics in the Department of Internal Medicine. Prior to this time, however, the subject of children's diseases had not been neglected. It was included in the course on the Theory and Practice of Medicine. The title of Dr. Alonzo Benjamin Palmer (M.D. College of Physicians and Surgeons [West. Dist., N. Y.] '39, A.M. hon. Nashville '55, LL.D. Michigan '81) in 1854 was Professor of Materia Medica, Therapeutics, and Diseases of Women and Children. This was later changed, on the death of Dr. Samuel Denton (M.D. Castleton Medical College [Vt.] '25) in 1860, to Professor of Pathology, of Materia Medica, and of the Theory and Practice of Medicine. His successor, Dr. Henry Francis LeHunte Lyster ('58, '60m, A.M. '61) was Professor of Theory and Practice of Medicine and Clinical Medicine from 1888 to 1890; but up to this time no emphasis had been placed on diseases of children. There is no mention of children or infancy in the index of the two 900-page volumes of Palmer's excellent and then very popular text, The Science and Practice of Medicine. It is noteworthy that Dr. Walter Shield Christopher, who followed Dr. Lyster, was a pediatrician, and in his courses on internal medicine, he must have more or less continuously pointed out the differences between childhood and adult types of disease. It was his interest in pediatrics that led Dr. Christopher to resign his chair at the University in 1891 and to take up the practice of that specialty in Chicago, where he became professor of diseases of children at the Chicago Polyclinic.

After graduating from the Medical College of Ohio in 1883, Dr. Christopher was elected Demonstrator of Chemistry at his alma mater, and consulting chemist to the Rookwood Pottery, where he perfected some of the glazes which have since given world-wide fame to Rookwood ware. Soon after his graduation he was made clinician to the children's clinic of the Medical College of Ohio, in Cincinnati.

Dr. Christopher was elected to membership in the American Pediatric Society in 1889 and served as its president in 1902. He was greatly interested in "the perversions of the chemism of the body," and was one of the first to see the importance of such studies in diseases of infancy: "It is in these conditions of perverted chemism of infancy," he said, "that we find many of the difficulties of infant feeding." Dr. Christopher died in Chicago, March 2, 1905, "one of the best known and best beloved physicians of this country."

In 1891 Dr. George Dock (M.D. Pennsylvania '84, A.M. hon. Harvard '95, Sc.D. hon. Pennsylvania '04) was appointed Professor of Theory and Practice of Medicine. He had been an associate of Osler, and he continued to be an ardent follower and exponent of this great teacher and clinician. Osler was particularly interested in pediatrics and was a member of the American Pediatric Society, being its president in 1896. Medical men of that time were particularly interested in the childhood types of disease, and it should be pointed out that

Dock did not neglect pediatric training while he was abroad. He made every effort to encourage doctors to send sick children to the University Hospital. He taught a simple milk dilution method of infant feeding, which soon went out of vogue, overshadowed as it was by the newly developed "percentage method," but since reinstated with a better understanding and appreciation of its merits. Sterilized and pasteurized milk dilutions, cereal and vegetable additions, yolks of hard-boiled eggs, milk and cane sugar, were all that were needed then as now, if intelligently employed, to carry the infant successfully through the then more perilous period of infancy.

Because of the alarming increase in the infant mortality rate about this time, general interest was aroused in the conservation of infant life. Few medical schools had instituted required courses in the diseases of infancy and childhood, and pressure was being brought to bear on their faculties to establish such courses.

Dr. Cowie was particularly interested in the field of gastroenterology and infectious diseases. When, in 1905, it became advisable to develop the subject of pediatrics as a permanent course in the Medical School, because of the frequency of these two types of disturbance in infancy and childhood, he was selected to teach this branch in addition to his other work. The staff had been trying for several years, without much success, to increase the admission of children to the University Hospital. Parents who could afford to pay for their children's medical attention would, of course, not send them to a charity hospital which possessed no special equipment for their care. There was no state children's fund and no way whereby the indigent medically sick child could enter the hospital unless a cash deposit was made or the child's expense in some way guaranteed. This was done insofar as possible by the organization of King's Daughters, the Palmer fund, and by private donations. The interest on the Palmer fund amounted to $750 a year and was used for surgical as well as medical child patients and for some time for the defraying of the expense of glasses for children.

The opportunity to develop a clinic under these conditions was discouraging. A bill had been passed by the legislature some years previously providing hospital care for children with congenital deformities, but the medically or acutely sick child was discriminated against. Only children with certain states of mental deficiency could be admitted to the clinic under this provision. This helped to increase the number of children at the Hospital. Where children are gathered the disturbances to which they are heir sooner or later show themselves, and, developing under the eyes of the staff, they were sooner recognized and more properly handled. The staff, however, began to think that these children, in spite of popular belief to the contrary, were more resistant to the vicissitudes of childhood than those not so afflicted. Medical material for teaching purposes did not perceptibly increase with their attendance, but they proved excellent cases for the study of this ever-increasing and important form of juvenile disturbance. Children with "epilepsy" could also be admitted under the provisions of this act. They are always of great interest and importance as medical problems, and much could be done for them.

There was some technical difficulty in bringing about the establishment of this separate division of internal medicine, since there was already a chair of diseases of women and children, the Bates professorship, first given to Dr. James N. Martin. An adjustment was soon made, and the subject of pediatrics was permanently

established as a required course for graduation — one of the first in the United States.

As early as 1902-3 in the description of the Department of Medicine in the yearly Calendar there appeared a statement of the teaching of diseases of children: "The peculiarities of medical diseases in childhood are discussed in the lectures and recitations. Clinical instruction is given in the various hours mentioned above. Most of the infants born in the Obstetric Clinic are artificially fed, and furnish abundant material for instruction in this important branch … Contagious Diseases are demonstrated in an Isolation Ward." This latter statement was perfectly correct.

In 1901 Mrs. Love M. Palmer, widow of the late Alonzo B. Palmer, made a bequest of $20,000 to the University for the building of a memorial ward, to be known as the Alonzo B. Palmer Ward. She also established an endowment fund of $15,000 to be used for the medical care of patients brought there. The building was completed in 1903. It was decided by the Board of Regents to dedicate the ward to the service of children. The urgent need for quarters for obstetrical patients, however, persuaded the Hospital staff, with the permission of the Regents, to use the first floor of the building for that purpose. Another pressing need determined them to use the second and third floor for a nurses' home. Accordingly, there was no special place in which to house the patients of the children's division of clinical medical study.

The children's clinic grew very slowly. The greatest number of yearly registrations during the first eight years was 228 (1912). Much pressure was being brought to bear on the Regents to transfer the clinical years of medical study to Detroit, and the need for more adequate teaching material in pediatrics was being stressed. Dr. Cowie decided to organize a campaign for a revision of the congenital deformity act (No. 42) of 1897 or for the passing of a new act by the legislature that would permit any indigent sick child in the state who needed medical care to be sent to the University Hospital as a so-called free case. Dr. Peterson, hearing of this, informed Dr. Cowie that he had been thinking of a similar plan for the admittance of pregnant women to the Hospital and requested that he be allowed priority for his plan. Cowie agreed that his was the greater need. The babies born at the Maternity Ward were turned over to the Department of Pediatrics for feeding and medical care (see Hospital, p. 975) .

In due time the proposal for the new children's act was revived and pressed with vigor. It was not difficult to secure favorable legislation when the legislators saw the needs. Accordingly, in 1913 the now well-known children's act (No. 274) was established. In Michigan the legislature has always acted wisely in matters pertaining to public health. Michigan stands second to none in devising ways and means for the care of its unfortunate and underprivileged children.

Since the establishment of this law the children's medical clinic has had a phenomenal development. It progressed from twenty-two patients for teaching purposes in the first year, to a yearly registration of 6,346 in 1932 and a monthly attendance of 2,580 in August, 1935.

The new law stipulated that a place should be provided for all children brought to the Hospital by properly authorized agents. The space that could be used for them was soon exhausted, and more beds had to be provided. The Palmer Ward originally had been set aside for the care of children. As arranged, the space assigned to obstetrics became inadequate, and buildings were moved to the hospital grounds to provide better accommodations for the patients of that

clinic. The first floor of Palmer Ward was turned over to the Department of Pediatrics in 1911. This served the need, however, for only a short time. The increasing number of children made it necessary to crowd the wards and the sun porch beyond their capacity.

Finally, the glass-enclosed corridor between the old Surgical Building and Palmer Ward and the one between Palmer Ward and the Medical Ward (destroyed by fire, 1927) had to be filled with beds for children. Their smiles and cries made a great appeal to the passerby. They were a daily reminder that more space had to be provided; in 1913 the nurses' quarters were removed from the second and third floors of the building to attractive cottages near the Hospital, and the entire Palmer Ward was devoted to the use of children, with the exception of space in the basement for the Department of Roentgenology. Soon space was again inadequate, and again the nurses had to be disturbed. An orthopedic ward was opened in the building occupied by them adjoining Palmer Ward, leaving more space for children in Palmer Ward.

It was largely the appeal of the children that finally resulted in the passing of the bill for the erection of the new University Hospital and in the establishment of the present modern clinics in all branches of practice that have brought widespread fame to the University of Michigan Hospital and Medical School.

In planning the new Hospital, space for the care of two hundred children was allotted on the sixth floor, to be designated as the Palmer Ward. It was decided to use the Palmer Building as an overflow or convalescent ward. It has always been hoped that a complete children's unit, connected with the main hospital building, ultimately would be provided. Because of this possibility and because of a belief that the new Hospital would become inadequate for the needs of the other clinics, little if any architectural change for the special care of children was made on this floor.

Although there is need for better arrangement of wards, the children are in no way neglected. They are provided with well-equipped roof-garden service, manual training rooms, recreation and class rooms, occupational therapy rooms, and teachers. The Galens, a medical students' society, supports a shop in woodcraft, known as the Galens Shop for the training of convalescents. Physiotherapy in all its forms is provided, including a swimming pool for paralytic cases and the most modern X-ray facilities. But these advantages are scattered, and many of them could be brought together in a special children's unit where the special methods of juvenile care could be better stressed and carried out, thus, in many instances, making the situation for children and adults equally advantageous. There are no quiet wards for children — these are very necessary for the care of children with rheumatism, chorea, and heart disease. Nowhere has the state provided a place for the care of very young children with tuberculosis. Much can be done to benefit or cure these patients.

The specific infectious diseases. — In 1910 a resolution for the construction of a contagious hospital was passed by the Board of Regents:

On condition that the City of Ann Arbor will furnish $25,000 for the purpose of building a contagious disease hospital, the University of Michigan will furnish the site for the same and agrees to equip and maintain it after completion. Such hospital shall be for the sole use of patients taken sick of contagious diseases in the City of Ann Arbor, and such hospital shall be conducted under such conditions as shall be arranged between the City of Ann Arbor and the Board of Regents.

R.P.

Four years later, in June, 1914, the Contagious Hospital was opened to the public for inspection. The new building with its new aseptic method for the care of contagious diseases, the second in America to adopt this plan, became the show place of the University Hospital group. Very pleasant quarters for nurses were fitted up on the second floor of the building, but as in all divisions of the departmental work, it was not long before more space was needed, and the second floor had to be used for patients. Again the nurses had to be moved. The size of this clinic, like that of all the others, rapidly increased after the opening of the new Hospital, and the building soon became, as it is today, entirely too small for requirements. In times of epidemic, which are not infrequent, auxiliary wards have to be opened, the working of the Hospital is greatly handicapped, and the time of the staff is greatly encroached upon.

In the winter of 1909 the demands of a contagious epidemic were met by boarding up the two summer houses, heating them with stoves, and using them as three-bed scarlet fever wards. It is hard to realize that not so many years ago it was necessary, because of Board of Health regulations and lack of isolation space, to have large wards in the general Hospital under quarantine for long periods of time. Three times during the college year of 1909-10 strict quarantine had to be observed, totaling an inactivity of over three months. In 1911 Palmer Ward was under quarantine for five months, and the surgical wards were rendered inactive, except for the most urgent cases, for as long as a month at a time. The effect this had on teaching in general and on the patience of teachers and clinicians in particular can well be imagined.

Since the opening of the contagious unit (1914), the introduction of the aseptic technique plan of caring for contagious patients, and the inauguration of the present method of handling contagious cases, a general quarantine has not been necessary, and partial quarantines have been of comparatively few days' duration.

For some years the work of an infectious disease institute has been carried on. Immunizations of all kinds are made in this division of the clinic, not only for the patients but for the entire personnel of the University Hospital. These immunizations consist of vaccinations against smallpox, typhoid fever, diphtheria, and whooping cough, the giving of antitoxins, of immune serums, and of immune blood transfusions, and the carrying out of desensitizations of various kinds for those who are allergic. The Contagious Hospital laboratories employ a full-time chemist and a full-time bacteriologist.

By 1922-23 ultraviolet light had become a popular therapeutic measure. The knowledge that this modality was being used indiscriminately caused members of the profession to guard its use very carefully. Other hospitals had reported favorably on its use. More than $400 had accumulated in the Mary J. Furnum fund, and with this and an addition from the current budget a lamp was bought for the department. A technician was necessary, and finally a full-time nurse was engaged. The baggage room in Palmer Ward was released for use, better lighting was provided by a new window, and a quartz light division of the clinic was organized. Very soon the lamp was in constant use.

Sensitization clinic. — In 1910-11 Dr. Cowie became very much interested in the work von Pirquet was doing in Vienna on allergy, and he conducted observations on cowpox disease and serum disease from that point of view. Oscar Schloss in New York had demonstrated

food sensitization in children and had prepared an egg allergen, ovo mucoid, for use in testing the skin for sensitivity to that substance. With Dr. Albert By-field, Cowie immediately began work with this substance and carried on with all allergens as they became obtainable on the market. Up to this time the allergic therapy and testing had been limited to the use of pollen and horse serum antigens and eliminations. Hay fever had been treated by the use of commercial pollen extracts for some years.

General interest in sensitization developed rapidly because of the ease with which testing materials could be obtained and testing could be carried out by the simple scratch method. In 1921-22 John P. Parsons ('14, '19m) became interested in this work. Appreciation of his quick understanding, versatility, and dependability resulted in a happy association continuing many years. Because of rapidly developing enthusiasm concerning allergy at that time it was very necessary to make conservatism the watchword. The examinations soon became time-consuming, and the teaching and administrative duties were already very heavy. Extra help became necessary. In 1924 Buenaventura Jiménez ('05m, M.S.P.H. '27) applied for graduate work. He became interested in the sensitization clinic, then carried on in the basement of the Contagious Hospital. Cowie assigned "Studies on Allergy" to him as the subject of his thesis. Dr. Jiménez soon became proficient in the technique of testing and in following and recording the clinical course of the increasing numbers of patients sent to the clinic for examination and advice. To him more than to anyone else is due the development of the large clientele that finally came to the clinic. His enthusiasm, devotion, honesty, and personal appeal were all that was necessary. The daily attendance at the clinic became so large that a few years later it was necessary to work out a plan to decrease it and yet at the same time to increase the number of new patients. This was accomplished by devising treatment schedules, diagrams, and instruction sheets so that the bulk of the treatments could be turned over to the referring physician, with whom the staff co-operates in every way possible. In order to compass the work two more assistants were necessary.

Clinic classes. — In 1920 a hay fever and asthma class was organized to bring the patients together to be instructed as a group and to ask questions and relate experiences. In this way they learned much from each other and gained a better idea of what the staff was trying to do for them. Diabetes, infant feeding, and cardiac classes were conducted in the same way.

Work in allergy had its beginnings in 1912, as publications from the department attest; it passed through the first few years of general interest and the succeeding years of doubt and ridicule; it now stands as one of the most important special divisions of medicine in all medical schools and in medical practice. There has never been a pause or diminution in the work of this clinic since its beginning. The clinic of the department continued to be known as the sensitization clinic; the one in the Department of Internal Medicine is the allergy service, which has been under the competent directorship of Dr. John Sheldon. Many clinical and scientific reports were published from the sensitization clinic. All of this work is now carried on in the allergy service.

Teaching. — In the early days of the department teaching material was so meager and the demand for it was so great that removal to Detroit seemed to be the only answer. The clinical material has now become so rich as to

be unexcelled in variety and importance from the standpoint of teaching. This record is one of which the Medical School and the University Hospital may well be proud.

A subject as large as internal medicine and infantile and child nutrition had to be covered in some way with an almost insignificant budget and a part-time staff. One part-time clinical professor, one instructor, and a half-time intern constituted the entire staff. An assistant and a full-time intern were added. Later, an extra stenographer was provided. The registration list had reached 3,251. The working staff gradually was increased to one professor, two assistant professors (one at Children's Center, Marquette, Michigan), four instructors, one chemist, one bacteriologist, one instructor and two assistants in sensitization, one child psychologist, one teaching fellow, three rotating interns, eight assistant residents, a secretary, a clinic nurse, a clinic clerk, and a clinic ward helper.

With the increase in the size of the staff came the phenomenal increase in the size of the clinic, as stated before, to 6,346 patients a year (1932), and the outpatient attendance reached a monthly peak of 2,580 in August, 1935. The teaching load of 768 clock hours had to be divided between five instructors. The other members of the staff were necessary to help care for the patients.

The teaching in 1939 consisted of forty-eight hours for the entire junior class; sixteen hours for the entire senior class; sixty-four hours for the senior morning bedside section work, repeated four times during the year by each of four instructors; eighty hours of afternoon bedside instruction, repeated four times a year by each instructor; and 320 hours elective courses for junior students. The junior elective bedside section met twice a week for a two-hour period. There were from fifteen to twenty students in these sections, which lasted eight weeks, thirty-two hours, and were repeated four times during the year.

The regular bedside section work consisted of rotation through the four divisions of the clinic: outpatient and sensitization, nursery and metabolism wards, boys' and girls' medical wards, and contagious hospital.

The teaching load included familiarization with all patients coming to the clinic. The average number of patients per instructor over a period of years is shown in the following table:

Year	Number of Members of Teaching Staff	Total Number of Patients	Average Number of Patients per Instructor
1928-29	5	4,100	820
1929-30	5	5,000	1,000
1930-31	6	5,686	947
1931-32	6	6,141	1,023
1932-33	6	6,346	1,057
1933-34	6	5,404	900
1934-35	6	5,398	899

City clinics. — In the beginning of the work of the department it was almost impossible to induce parents in the city to bring their children to the outpatient clinic at the Hospital. Dr. Cowie decided to move the afternoon outpatient clinic to the business section of the city. The Hospital Circle of King's Daughters (later, the Public Health Nursing Association) gave its co-operation, and patients became so numerous that in 1920 a second clinic had to be opened in "lower town." One instructor and an intern were assigned to each clinic. The nursing and the general management were attended to by the public health nurse. When the new Hospital was opened the clinic was moved there, where it is known as the Well Baby Clinic; it still co-operates with the Public Health Nursing Association.

County clinics. — In 1919, clinics, under the auspices of the Washtenaw

County Public Health Nursing Association of the Red Cross, were begun in many villages of the county. The medical work of these clinics was carried on by members of the staff of the Department of Pediatrics and Infectious Diseases. These clinics, in addition to rendering valuable service to the children of the county, furnished excellent experience for the graduate group in child welfare work. Unfortunately, because of lack of funds, they were discontinued in 1922.

Child psychology. — For many years the importance of giving the students instruction in child psychology and in child psychiatry had been recognized — particularly with regard to behavioristic problems and personality changes. Helen Bradford Thompson Woolley (Chicago '97, Ph.D. ibid. '00) came to the department when the Merrill Palmer School was opened. Appreciating her ability as a teacher and lecturer, Dr. Cowie encouraged her to volunteer several lectures each year (1924-26) to the senior class. An effort was being made to have her given a regular appointment in the department when Columbia University called her to head its Child Development Institute. Janet Stetson Barnes (Buffalo '24, Michigan '28m) was appointed to the position of Pediatrician in the Elementary School and Instructor in Pediatrics. She was well trained in child psychology and psychiatry. Her teaching and clinical care of this group of children, very much handicapped as it was, was greatly appreciated. Lavinia MacBride MacKaye ('17, A.M. '20, '31m), who worked with and succeeded Dr. Barnes, was unable to continue because of increased duties on the campus, and the work finally had to be abandoned at the end of the 1936-37 session. Since the reorganization of the Department of Psychiatry as the Neuropsychiatric Institute, a division of child psychology and psychiatry has functioned under Paul H. Jordan (M.D. Iowa '29), who was trained as a pediatrician and as a psychiatrist. The members of the staff gain much stimulation and knowledge from the close association that has been established with that department. Children enter the Neuropsychiatric Institute through the Department of Pediatrics and Infectious Diseases. About thirty beds were provided for their care in the institute.

Michigan State School for Children, Coldwater. — Through an arrangement with the Superintendent of the State School for Children in 1930, a pediatrician was appointed to look after the medical needs of the children there. Dr. W. W. Redfern (M.D. Chicago '30), the first appointee, was particularly interested in immunology and continued his studies. Harold B. Rothbart (M.D. Toronto '30) was appointed to fill the place made vacant by Dr. Redfern's untimely death in February, 1932. Dr. Rothbart completed observations on basal metabolism in children, which were published the following year. Unfortunately, just as Coldwater was becoming known as an active center for pediatric investigation, it was decided to close the school, the oldest of its kind in the state, and to devote the buildings to other state purposes. The work of the school has been continued by the Michigan Children's Institute, situated in Ann Arbor in a new building near the Hospital grounds.

Service to the Institute for Human Adjustment. — All children applying for study and care in this institute receive through the Department of Pediatrics and Infectious Diseases a complete physical examination and record of laboratory tests. If medical conditions are found other than those for which the patient was previously admitted, they are cared for by the department. The institute has been of special service to the

department, particularly in the management of speech defects of various kinds.

The Couzens Children's Center at Marquette. — Through the generosity of the late Senator James Couzens, funds were provided for the building of a children's center in connection with St. Luke's Hospital at Marquette. In 1931 Moses Cooperstock (Yale '23, M.D. ibid. '26), an instructor, was put in charge with the rank of assistant professor in this department. Four assistant residents serve in Marquette for a period of three months each. The opening of this clinic made it unnecessary for a large percentage of children in the Upper Peninsula to continue to come to the University Hospital, although many selected and unusual cases are referred to the department from this clinic. The center is rich in clinical material and furnishes another link in the chain of services designed to round out the special training of young physicians in pediatrics and infectious diseases.

The Couzens Children's Center at Traverse City. — Also known as the Central Michigan Children's Center, this clinic was opened in 1936 with Mark Frederick Osterlin (Capital University [Ohio] '25, Michigan '29m) in charge, with the rank of teaching fellow. The organization is the same as at Marquette and the same rotation of an assistant resident is carried out. Here, again, while this clinic made it easier for children in the western part of Michigan to secure special medical care, it has had a distinct influence in decreasing registrations at the University Hospital.

To show the position of the clinic in the medical group of specialties the figures for 1929-36, of the "clinic classification percentage of patients," from the Hospital reports (P.R., 1929-36) are given in the accompanying table, and, by way of contrast, percentage figures for larger surgical specialties are added.

Clinic Classification Percentage of Patients Admitted

Year	Pediatrics	Internal Medicine	Neurology	Dermatology	General Surgery
1929-30	15.30	12.77	3.66	13.00	15.99
1930-31	16.22	13.14	3.77	13.99	13.98
1931-32	14.88	12.65	4.26	13.10	14.31
1932-33	15.34	12.75	3.45	11.52	14.73
1933-34	13.53	13.43	4.02	8.54	15.17
1934-35	12.79	15.23	4.00	7.29	14.75
1935-36	8.31	17.05	4.56	6.25	15.64

The chief reason for the decreasing number of children coming to the University Hospital has been legislative Act No. 248 (P.A., 1933). The act dealt a serious blow to the long and successful effort to develop a children's clinic entirely adequate for the needs of teaching medical students.

Because of the nature of the Hospital monthly statistical reports, the work of the clinic has not appeared to full advantage, and the needs of the department accordingly have not been very apparent. The guarding of the entire group of hospitals against epidemic disease, for example, is in itself a difficult task. The clinic, however, receives credit only for the three hundred or four hundred cases that enter Contagious Hospital each year. The admitting of a smallpox patient means vaccination of the members of the entire working staff of the Hospital who have not been successfully vaccinated within two years. In one year three smallpox patients made it necessary to vaccinate sixteen hundred people. In 1938 the bacteriological division examined and reported on 7,138 cultures. If a measles case develops on a ward a prophylactic serum, prepared in the department laboratories, from blood taken from suitable donors, has to be given intramuscularly to all who have been in contact with the patient. In 1935-36, 95,040 cc. of blood were collected, from which 38,040 cc. of serum were prepared and 2,460 children were immunized.

Bequests. — Among the bequests for the care of sick children and research in diseases of children and infectious diseases may be mentioned the Palmer bequest of $20,000, to be expended in the erection of "an appropriate and handsome ward of the University Hospital, to be known as the 'Dr. A. B. Palmer Memorial Ward,' and $15,000 in trust, the income … to be devoted to the support and maintenance of free beds, in said building or ward …" (R.P., 1901-6, p. 222).

The income from the Mary J. Furnum fund of $1,000 is used for the purchase of apparatus for the study of children's diseases. This small fund has been of remarkable assistance.

When the Merrill Palmer School of Detroit opened its extension project in Ann Arbor in connection with the University for the purpose of affiliation with various departments for further investigation, particularly in child psychology, the Department of Pediatrics and Infectious Diseases was asked to undertake the medical aspects of the project. Accordingly, an instructor from the department was assigned to this duty. Physical and laboratory examinations were made for each pupil, and all pupils were inspected daily. At the end of the first year the Merrill Palmer School authorities offered a grant of $3,000, which paid the salary of one instructor, for the purpose of carrying on the work of the school in conjunction with the Medical School, and furnished necessary equipment. Dr. John P. Parsons was relieved of all teaching responsibility for the year in order that he might study the protein requirement of children. A creditable investigation was carried on and published in the American Journal of Diseases of Children.

The University of Michigan Elementary School may be said to be the outgrowth of the Merrill Palmer School. With its completion and its administration in the hands of Professor Willard C. Olson, the Merrill Palmer authorities felt that their work in Ann Arbor had been accomplished. The department carried on the same type of work as was done in the Merrill Palmer School. The salary of one instructor was provided, whose duties required that half time be spent at the school and half time at the clinic.

In 1932, because of an unused balance in the salary account of the department, the Regents authorized the use of $500 for the purpose of bringing distinguished lecturers and teachers to the Medical School. Professor Armand de Lille of Paris and Professor Franz von Groer of Lemberg each delivered a series of very enlightening lectures and carried on bedside clinics and conferences. A few years previously Professor Heinrich Finkelstein of Berlin had come on a similar visit.

In 1929 Parke, Davis and Company made a substantial grant for the purpose of studying the comparative antirachitic effect of irradiated ergosterol made from ergot and from yeast. The investigation entailed the co-operation of the Department of Roentgenology and of the Department of Pathology. The work was carried on jointly by Katharine Mabone Jarvis (New Brunswick '21, Ph.D. Michigan '28), A. D. Emmett, and Dr. Cowie. The results of this investigation were published in the Transactions of the University of Michigan Pediatric and Infectious Disease Society (1929-30). In 1931 Parke, Davis and Company made a grant for the observation of the effect of certain carbohydrates on the growth and development of infants. The work was satisfactorily carried on by John Lealis Law (M.B. Edinburgh '29, Ch.B. ibid. '29, M.D. ibid. '34).

In 1930 Mead Johnson Company of

Evansville, Indiana, gave $1,600 for investigations in diseases of infancy and childhood. As a result a study was made of the action of the various sugars used in infant feeding on the blood sugar curve; information was sought on the comparative assimilation and utilization of these sugars. Investigations with indirect relation to infant feeding were conducted, and three papers were published.

Postgraduate teaching. — After Dr. Cowie's death in 1940, the W. K. Kellogg Foundation gave a grant of $100,000 to effect a reorganization of the Department of Pediatrics in the Medical School. The plan of postgraduate work consists of a year's rotating internship here or in some other accredited hospital, a year as assistant resident in this clinic, a year abroad or in some other clinic, and an additional two years at the University as instructor — in all, five years of special training after graduation.

Professors Morse, Talbot, and Blackfan of Boston, Schloss, Schick, Holt, and Wilcox, of New York, Gerstenberg of Cleveland, Mitchell of Cincinnati, Brenneman, Hess, and Poncher, of Chicago, Marriott and Hartman, of St. Louis, Finkelstein, of Berlin, Armand de Lille, of Paris, and Franz von Groer, of Lemberg, co-operated with Dr. Cowie in giving young men and women sent to them every possible advantage.

The University of Michigan Pediatric and Infectious Disease Society. — This society was organized in 1921 to bring the men in the field of actual practice back to the clinic at least once a year for an exchange of views. It has proved an unquestioned success.

In 1938 two amendments to the bylaws of the society were adopted, whereby all individuals completing one year's residency in the Department of Pediatrics and Infectious Diseases become eligible for membership, and all those completing a rotating junior internship in the University Hospital and who, at the time of the meeting of the society, are assistant residents in the department become eligible for membership. This greatly stimulated interest in research.

Previous to this time journal club work was carried on by a selected group of students in the senior class. Assigned subjects were carefully reviewed by them, and the results of their studies were presented to the entire senior class. The reviews presented in 1913 were of such importance that they were published in the Archives of Pediatrics, and the reprints were bound in booklet form.

Social service. — Long before the designation "social service" was in vogue, much of this type of work was admirably carried on by the society of King's Daughters. The members of this society had provided books and amusement for children and for years had done many things to meet their needs.

Dr. Cowie finally prepared a report detailing the scope of social service as carried on at the Massachusetts General Hospital and at other large hospitals and presented it at one of the meetings of the University Hospital Clinical Society as a means of bringing about a general discussion on the subject. The members of all the clinical staffs favored the idea, and before long, with the co-operation of the Public Health Nursing Association, Miss Sarah Burrows was brought to Ann Arbor to begin social service work. Out of this work has grown the present organization. Without this service the Hospital could not function effectively.

D. Murray Cowie

[Dr. Cowie died January 27, 1940. He was succeeded by Dr. Charles F. McKhann.]

SELECTED BIBLIOGRAPHY

Announcement, Department of Medicine and Surgery Annual Report of the University Hospital of the University of Michigan "Noted Medical Faculty Member Is Dead." Calendar Catalogue … "University Hospital Clinic for Diseases of Children." "The Department of Pediatrics and Infectious Diseases." "Social Service in the University Hospital." "The Department of Social Service." "Medical Faculty Minutes" Compiled Laws of the State of …, 1897. Laws [of the Session of …] Public Acts [of the Session of …] "The New Contagious Hospital at the University of Michigan and Its Proposed Plan of Operation." President's Report Proceedings of the Board of Regents … University of Michigan Regents' Proceedings …, 1837-1864.

THE DEPARTMENT OF PHYSIOLOGY

THE following sketch of the Department of Physiology covers eighty-nine years, and during much of this time the lectures and laboratory courses were required of students of the Medical School, the Homeopathic Medical College, and the College of Dental Surgery, and were also available to students of other departments who desired to elect them.

Physiology is the science which treats of the normal activities of living organisms. The vital processes of plants and animals are fundamentally the same, and the science of physiology is built up of a vast number of facts which have been ascertained by the study of many forms of life. With the growth of our knowledge of physiology the subject has come to be subdivided into a number of specialties — physiological chemistry (or biochemistry, as it is now called), physiological botany, physiological psychology, and others — many of which are now taught on the campus. Physiology in the Medical School deals with the chemicophysical activities of the fluids, tissues, and organs of animals (especially man), their interdependence, and the way in which they react on the body as a whole in its response to the influence of its environment.

The importance of physiology in the training of the physician has always been recognized, and the subject was one of the four required for graduation of the first class of the Department of Medicine and Surgery.

Teaching and research. — The first to teach physiology was Jonathan Adams Allen (Middlebury '45, M.D. Castleton Medical College '46), who was appointed Professor of Pathology and Physiology in 1850, but who later acted as Professor of Therapeutics, Materia Medica, and Physiology. New England born, a direct descendant of Ethan Allen of Revolutionary fame, he settled in Kalamazoo in 1846. Two years later, at the age of twenty-three, he became a professor in

the Medical College at La Porte, Indiana, whence he was called to the University of Michigan. According to Dr. W. F. Breakey, he had a striking personality and was a popular lecturer (Breakey, p. 274; Lombard, pp. 240-43). While at the University of Michigan he gave the introductory addresses to the classes of 1852 and 1853, addresses which were published by the classes. Besides the many addresses he delivered, he published a book on Medical Examinations for Life Insurance, which ran through no fewer than five editions. He had a keen sense of humor and could be decidedly sarcastic when he chose. For example, referring to epidemics, he said:

We need a careful chronicle of their visits and peculiarities from every part of the state. Isolated reports are comparatively valueless. What Doctor So-and-So saw or thought he saw; what wonder-working charms he carried in his dilapidated saddlebags; how many he cured or dismissed to the Superior or nether regions, although facts very interesting to Doctor So-and-So and his committee of old ladies, are, in a scientific point of view, hardly worth the paper on which he communicates them to the popular medical or secular paper, according as he believes or disbelieves in the code of ethics.

"President's Address,"

Allen was in many respects ahead of his time. He urged the accurate registration of births, deaths, and the causes of deaths, and the collection of statistics and observations upon epidemics and endemics. He pointed out the apathy of the public and the need for physicians who would educate the public to demand better trained doctors; and he called attention to the desirability of a high grade of preliminary attainment before matriculation in a medical school.

He argued in favor of a state hospital, and said:

By rendering this hospital subservient to the clinical department of the State Medical College, the patients would while helpless themselves, be made to contribute to the general welfare, proving that "there is a soul of goodness even in things evil," and "from the nettle, danger, can be plucked the flower, safety."

"President's Address,"

He had been trained as a physician and probably taught physiology from the point of view of the clinician. Although he is not known to have made any original contributions to the subject, he had a good knowledge of physiological literature. Dr. Huber, in his article on the history of this school, wrote:

… The whole subject of reflex nervous influence, of which excito-motor and excitosecretory action are but constituent parts, was taught as early as 1850 in the University of Michigan [by J. Adams Allen], and in his teachings and writings are to be found the only explicit and comprehensive exposition of the whole subject of reflex nervous action that has ever fallen under my observation.

"Historical Sketch,"

Something of the man is revealed in the following extracts from an address:

Here is the standpoint of view. Medicine is to be looked upon and studied, precisely as all other arts and sciences are to be looked upon and studied. The truths upon which it is assumed to be based, are to be tested as all other truths are tested; and when they cannot abide the same, let them be mercilessly discarded.

"Observations on the Medical Platform,"

Condemning books which are merely compilations of old dogmatic teachings, he said: "We want a living, breathing, productive literature, not a barren, dead, marshalling of old errors" (ibid., p. 27).

Unfortunately, Allen became involved in some difficulty, and in 1854 was asked to resign. The Proceedings of the Regents contain merely a resolution, signed by twelve of Allen's colleagues, headed by Tappan, asserting that "the prosperity

of the Medical College and the general welfare and harmony of the University are seriously affected by the connection of Dr. J. Adams Allen with the institution as a Professor" (R.P., 1837-64, p. 565).

When Allen left the University he apparently returned to Kalamazoo, where he became a prominent and respected physician, as is shown by the fact that he was the president of the Michigan State Medical Society in 1859. That same year he was called to be professor at Rush Medical College, Chicago, and later he became its president.

The next to teach physiology was Abram Sager (Rensselaer Polytechnic Institute '31, M.D. Castleton Medical College '35, A.M. hon. Michigan '52). During his nearly thirty-three years of service beginning October 1, 1850, when as the first President of the Faculty of the Department of Medicine and Surgery, he gave the opening address, he played many important roles in the University (Huber, Sager). He became Professor of Obstetrics, Physiology, Botany, and Zoology in 1854, but the next year was called merely Professor of Obstetrics and Physiology, which title he kept until 1860, when he again taught, instead of physiology, the diseases of women and children. Dr. William F. Breakey, who was a student during Sager's time, said of him: "It is no disparagement to other members of the faculty of his time to say that he was one of the most profound and versatile in literary and scientific scholarship" (Breakey, p. 270). In the journals of the period are translations by him of foreign physiological papers, and there is an article by him in the Michigan University Medical Journal (1: 265-67) giving the result of experiments upon the respiration of cold-and warm-blooded animals, when caused to inhale exciting, indifferent, and directly noxious gases. He collected a valuable herbarium (see Part VIII: University Herbarium) and made considerable additions to the medical museum, then considered an important teaching adjunct (see Part V: Department of Materia Medica and Therapeutics) . Of his ability as a practitioner, "a few of the older residents of Ann Arbor speak reverently and lovingly" (Shaw, p. 123). Because of failing health he resigned in 1873, and was made Professor Emeritus in 1874.

Corydon L. Ford (M.D. Geneva Medical College '42, A.M. hon. Middlebury '59, LL.D. Michigan '81) was appointed Professor of Anatomy in 1854, and Professor of Anatomy and Physiology in 1860. He held this title until he resigned a short time before his death, April 14, 1894. From 1887 to 1891 he was Dean of the Department of Medicine and Surgery. Dr. Charles B. Johnson, one of his old students, said of him:

Dr. Corydon L. Ford, who taught us our Anatomy and Physiology, was in a class by himself. He could pick up a dry bone and in three minutes have hundreds of wide-eyed, open-mouthed hearers intently attentive lest they should miss a word, such was his power over an audience.

(Johnson, p. 18.)

When Ford at the age of eighty-one delivered his last lecture, Dr. Lombard had the good fortune to be present and was greatly impressed by his distinguished bearing, his method of presentation of his subject, his grace in the demonstration of the dissection (in spite of his handicap of one shortened leg), and his remarkable hold on the attention of the student audience (Lombard, p. 244). Unquestionably he was the best lecturer on anatomy this country had seen. Ford was not a trained physiologist, but he deduced the functions of the human body from the structure of its dead organs; his demonstration of the action of the valves of the heart and the cause of the heart sounds, for example, was convincing. He

had little to do with the teaching of physiology in the Department of Medicine and Surgery after 1872. He gave lectures on anatomy, physiology, and hygiene to the students of the Department of Literature, Science, and the Arts, however, as late as 1877, having begun these lectures to nonmedical students in 1869.

Henry S. Cheever ('63, A.M. '66, '67m) was appointed Demonstrator of Anatomy and Curator of the Medical Museum in 1867. He was appointed Lecturer on Materia Medica and Therapeutics in 1868 and was advanced to the professorship the following year. In 1872-73 he was made Professor of Therapeutics, Materia Medica, and Physiology, and during the same period he filled the chair of physiology in the Long Island College Hospital.

Throughout this time he was also engaged in general practice, and it is not strange that under the accumulated strain of these combined labors his health broke down (Breakey, "Cheever," p. 152). In 1873 he obtained a leave of absence, and his work was carried on by Frederic Henry Gerrish (Bowdoin '66, A.M. ibid., '67, M.D. Medical School of Maine '69, LL.D. Michigan '05) as Lecturer on Therapeutics, Material Medica, and Physiology. That year the Calendar stated (p. 62):

It is absolutely necessary before taking up these advanced studies in Surgery [Ophthalmology and Otology] that the student should be fully acquainted with the Anatomy, Physiology, and Physics of the special senses seeing and hearing.

In 1874 Gerrish became Professor of Therapeutics, Materia Medica, and Physiology. Cheever returned in 1875 and tried to lecture, but his voice failed him and he was obliged to abandon the work. He had made a brave fight and died much respected by his fellow practitioners. Something of his character is suggested by the closing sentence of his letter of resignation to the Board of Regents, March 27, 1876: "Trusting that the time is close at hand when the Department of Medicine and Surgery shall have its course lengthened and graded, I sever my connection with it with profound regret" (R.P., 1876-81, p. 5).

Upon Cheever's resignation, the Regents requested Ford, who still retained the title of Professor of Anatomy and Physiology, to fill the chair and discharge the duties of the professor of physiology, aided by an instructor in the Physiological Laboratory whom they would appoint (R.P., 1876-81, p. 147). The result was that Burt Green Wilder (Lawrence Scientific School '62, M.D. Harvard '66), of Cornell University, was appointed Lecturer in Physiology, to give one course of lectures in 1876-77. Charles Henry Stowell (Genesee Wesleyan '68, Michigan '72m) was made Instructor in the Physiological Laboratory, under the direction of Professor Ford. Stowell retained this title until 1879, when he became Lecturer in Physiology and Histology, and in 1880 he was appointed Assistant Professor of Physiology and Histology. The next year he was made Assistant Professor of Histology and Microscopy.

In 1881 Henry Sewall (Wesleyan '76, Ph.D. Johns Hopkins '79, M.D. Denver '89, M.D. hon. Michigan '88, Sc.D. hon. ibid. '12) was appointed Lecturer in Physiology (Lombard, p. 297). He had received training in biology under Newell Martin, who in turn had been trained under Huxley and Michael Foster. After receiving the doctor's degree, he worked with the celebrated German physiologist, Kühne, in Heidelberg, and on his return to Baltimore was appointed associate in biology at Johns Hopkins.

Victor Clarence Vaughan (Mt. Pleasant College [Mo.] '72, Ph.D. Michigan '76, '78m, LL.D. '00) was at this time (in 1880) Assistant Professor of

Medical (physiological) Chemistry. To quote from Novy's address at the memorial meeting for Dr. Vaughan:

Through his work in physiological chemistry he was in touch with the progress in physiology, which was then looming strong on the horizon as a result of the work of men such as Claude Bernard, Ludwig, and Foster. And when there arose in 1881 the question of an independent chair in that subject, young as he was, he strongly urged and secured the appointment of Henry Sewall, who proved to be an inspiring teacher and an investigator of the first rank.

Vaughan Memorial

The fact that a man who did not have a medical degree, but who had been trained as a biologist, was called to do this work showed that the medical faculty recognized the value of pure science as a foundation for medical education. In 1882 Sewall was made Professor of Physiology, and given an assistant, Willis Elmer Hallowell ('82m).

From the first Sewall had devoted himself to research work. During the eight years that he was connected with the department he published twelve articles, in which he gave full credit to those who worked with him (Lombard, pp. 298-99). The most remarkable of these researches was the one on immunity. To Sewall belongs the credit of being the first to give incontestable proof that it is possible artificially to establish immunity to a purely chemical poison which is the product of a living cell, by injecting the poison into an animal frequently, in small increasing doses. Sewall saw the importance of his discovery. He wrote: "We may suspect that the same sort of resistance against germ-disease might follow the inoculation of the appropriate ptomaine, provided it is through the products of their metabolism that the bacteria produce their fatal effects" (Sewall, p. 203).

The year following the publication of his discovery, Sewall, attacked by tuberculosis, was given a leave of absence, and in 1888 resigned and went to Denver. He later became one of Denver's most prominent physicians and wrote many excellent medical articles in which the application of physiology to clinical medicine was given prominence. There are at least fifty papers carrying his name (Lombard, pp. 297-301).

The year 1888-89 was unfortunate for the Department of Physiology, not only because of Sewall's illness, but also because Elmer Sanford ('87), who had been his assistant, and who had been appointed Instructor in Physiology, died. Gustave A. Deutcher, Assistant, carried the work for a time, and then Joseph Weatherhead Warren (Harvard '71, M.D. Bonn '81) was called from Harvard to complete the course of lectures.

In 1889 William Henry Howell (Johns Hopkins '81, Ph.D. ibid. '84, M.D. hon. Michigan '90, LL.D. Trinity '01, Sc.D. Yale '11, LL.D. Michigan '12), who was associate professor of physiology at Johns Hopkins in 1888-89, was appointed Lecturer in Physiology and Histology. He had been trained in physiology, as Sewall had been, by Martin at Johns Hopkins. Howell was made Professor of Physiology and Histology the next year. It was not easy to lecture to a class of women and men, consisting of students from the medical, homeopathic, dental, and liberal arts departments, some of whom, at least, had the reputation of being unruly. Howell concealed beneath a quiet, mild manner great strength of character, which came to the fore when certain students tried to take advantage of him. Howell decided that either they or he would leave the University. The students left, and he had no further trouble with his classes.

In addition to his work in the Medical Department, Howell was listed in 1890 and in 1891 on the staff of the Department of Law, as Lecturer on Microscopy

in its Medico-Legal Relations.

After Stowell left the department, Howell was given charge not only of the teaching of physiology, but also of the instruction in histology. To help him, in 1889 Gotthelf Carl Huber ('87m, Sc.D. hon. Northwestern '30) was appointed Instructor in Histology, and the work in physiology and histology was carried on in the Physiological Laboratory. In 1891-92, when Huber had a leave of absence, Frank A. Waples ('89, '93m), who had previously acted as an assistant, served as Instructor in Histology. Howell and Huber were thoroughly congenial, and together did research work which resulted in two excellent papers bearing their names. Howell published four other papers as a result of his research work at the University of Michigan. The name of Elizabeth Cooke appeared on one of these, and that of Sidney Budgett and E. Leonard on another (Lombard, p. 302). Howell left the University in 1892 to go to Harvard, where he took charge of the new laboratory course in physiology. Soon afterward he was called to Johns Hopkins, where he later filled many important positions.

Warren Plimpton Lombard (Harvard '78, M.D. ibid. '81, Sc.D. hon. Hobart College '09) was appointed Professor of Physiology and Histology in 1892, the appointment being confirmed the next year, and he was made Professor of Physiology in 1898.

Lombard had received his original training under Ludwig in Leipzig; had served under Curtis, as assistant in physiology, at the College of Physicians and Surgeons, New York; had done research work at Harvard, Johns Hopkins, and in New York; and had been assistant professor of physiology at Clark University for three years, until he resigned in 1892. He was a physiologist, not a histologist, although he was called Professor of Physiology and Histology.

A number of Lombard's original investigations were made with others — two with Professor Walter B. Pillsbury, one with Sidney P. Budgett, two with Fred M. Abbott, and five with Dr. Otis M. Cope. The physiology of man especially interested him, and this interest resulted in three papers dealing with the influences which affect endurance in voluntary muscular work. He invented a balance capable of supporting a man and of recording the changes of weight occurring during short intervals of time; devised a piston recorder with the aid of which the effect of respiration and vasomotor action to produce rhythmic changes of the human heart were studied; and, working in Professor Max von Frey's laboratory in Würzburg, discovered a method of observing the capillaries of the human skin and measured the blood pressure in the arterioles and capillaries. He gave much time to studying the influences which determine the duration of the systole and diastole of the human heart.

The physiology of nerve muscle in general was another of Lombard's major interests. He wrote papers on the mechanical effects of the contraction of individual muscles and on the action of two joint muscles, as demonstrated by a model. He also wrote an article on electrotonus, and a section in the American Textbook of Physiology on nerve muscle.

In addition brief reports were published on special apparatus devised in the laboratory, as well as addresses, including "The Life and Work of Carl Ludwig."

In December, 1922, he presented his resignation, to take effect in June, 1923, on the completion of thirty years of service. He was made Professor Emeritus in January, 1923, and in August of that year he presented his library to the University for the use of the Department of Physiology.

In 1892-93 the staff consisted of the professor and a student assistant. There was no laboratory mechanic, and, since appropriations for the laboratory were small, the staff had to make and repair the smaller apparatus used in the laboratory course. The assistant was Sidney Payne Budgett ('95m), who had worked with Howell and who continued in the department until 1896, when he became professor of physiology in the Medical School of Washington University, St. Louis.

It was in 1901-2 that the largest number of students (282) attended the lecture course. That year fifty-three students took the laboratory course. The assistant, Wilbur Pardon Bowen ('00, M.S. '01), was made Instructor in 1902. He left the following year to become professor of physical education at the Michigan State Normal School, Ypsilanti. While in the University he published five articles, two of which dealt with the effects of bicycling on the heart rate, blood pressure, and duration of systole.

Only one student assistant had been allowed until 1903-4, when there were two; in 1905-6 there were three. In 1906 Carl John Wiggers ('06m), who had been an assistant from 1903 to 1905, was made Instructor in Physiology, a position which he held for seven years. He was given charge of the department in 1910-11, while Dr. Lombard was in Europe on leave. During this year, Wiggers gave the regular lecture courses, except those for the dental students. The latter were taught by Otis Merriam Cope ('02, '04m), who was appointed Instructor in Physiology in 1910. Wiggers and Cope, with the aid of two student assistants, both of whom had served the preceding year, supervised the laboratory work. Wiggers resigned in 1912 to take a position at Cornell Medical School and became professor of physiology at Western Reserve University in 1918. While in Ann Arbor he did excellent research work, publishing fourteen papers from the University.

For many years a few students of the College of Literature, Science, and the Arts had elected the lectures and laboratory courses in physiology, usually with the idea of teaching the subject. As students planning to study medicine were urged more and more by the medical faculty to extend their premedical preparation, the number from the liberal arts college increased; these students elected courses in physiology as their science subjects.

The number of students enrolled in the laboratory course gradually increased until by 1923 the work was being given to two sections of about eighty students each. This necessitated an increase in the staff, and six student assistants were employed in addition to the professor and the instructor.

From 1910 to 1926, Otis Cope, as Instructor and later as Assistant Professor, helped teach the dental students. Eventually he had full charge of their work in physiology. The course of lectures that he gave them was less detailed than that offered to medical students and was elected by some students from the College of Literature, Science, and the Arts who wanted a less extensive course — such as those preparing to teach physiology or physical training in high schools, or to be supervisors of school hygiene. Cope played a significant role in physiology. A good organizer as well as a good teacher, he was of great service during the sixteen years that he was connected with the Department of Physiology. He resigned to accept a professorship in physiology in the New York Homeopathic Medical College in 1926. His name appeared on seven published researches, five of which were made with Dr. Lombard on the influences controlling

the duration of the systole and diastole of the human heart.

John Henry Muyskens ('13, Sc.D. '25), who had been Instructor in French and through his work with Professor Meader had become interested in the mechanics of phonetics, did some research work in the Physiological Laboratory on the movements of the mouth, especially of the soft palate. In 1922-23 he became Instructor in Physiology and helped with the laboratory work. In the summer of 1923 he and Dr. Cope conducted an optional laboratory course in physiology. Later, he continued his studies of the mechanics of phonetics in relation to abnormalities of speech.

Other pieces of research in the Physiological Laboratory which were published during the years 1892-1923 were papers by David P. Mayhew and A. E. Guenther; two by George O. Higley, Instructor in Chemistry, who undertook some investigations on the rate of excretion of carbon dioxide; and two by Thomas A. Storey, later Professor of Physical Education at Leland Stanford Junior University.

In 1923 Robert Gesell (Wisconsin '10, M.D. Washington University '14) succeeded Lombard as Professor of Physiology. He had already gained a name for himself in research when he came to the University of Michigan, and this, together with his wide experience as a teacher, made him a welcome addition to the faculty of the Medical School.

At first Gesell had to occupy the quarters in the old Chemical Building (Pharmacology Building), which had been the home of the Department of Physiology since 1910. He wrote in his account of the department:

When I came to Michigan I found a well-organized department but with the growth of physiology and of the classes the University quarters were again in a crowded condition. Fortunately new space [approximately 32,000 square feet gross] in a building to be completed within two years was allotted to the department along with funds for added equipment. With these augmented facilities the possibility of extending substantial opportunities for undergraduate and graduate students and for staff research was at hand.

(Gesell, p. 43.)

Method and curriculum. — The history of the Department of Physiology shows an appreciation of the clinical method of instruction from the earliest days, but the conception of a physiological laboratory came much later and was of slow development. With the growth of the laboratory occurred an increasing emphasis on research.

Laboratory instruction. — The first teacher of physiology at the University, Professor Allen, in his president's address in 1859 before the Michigan State Medical Society said:

It is about as difficult to convey to a student by oral instruction any definite ideas of particular diseases, as it is to explain colors to a blind man or sounds to the deaf … It is the clinic only which is the truly substantial part.

(P. 27.)

He did not refer to laboratory work, for at that time there were no physiological laboratories in the country.

In his introductory address to the third session of the College of Medicine and Surgery Professor Allen argued the importance of the writing of theses by students. Probably it was due to him that in the first years emphasis was laid on the writing and defending of an original thesis on some medical subject, as a requirement for graduation.

Although a histological and physiological laboratory was organized in 1876 and $3,500 was appropriated by the legislature in the next year for its equipment, the teaching of physiology could not have advanced greatly because the professor at that time, Stowell, was not a trained physiologist, but a histologist. In short,

for the first thirty years of the existence of the Department of Medicine and Surgery physiology was taught at the University of Michigan as in the other medical schools of the country in those years, almost wholly by lectures and recitations and by the use of textbooks.

From the time when Sewall came (1882) the teaching of physiology changed. Of course he gave lectures — forty hours each semester the first year, and in 1883 seventy-two hours each semester. The completeness of his lecture course is indicated by the synopsis that he published for the use of the students (Sewall, Topical Synopsis). But his chief interest was in the laboratory, which he developed as rapidly as he could. At first, the small amount of equipment and inadequate facilities permitted opportunities for research work to advanced students only. We read in the University Calendar for 1882-83 (p. 93): "Students willing to devote time to original work in Physiology, Physiological Chemistry or other branches, after due preparation, are given the fullest encouragement and cooperation." This statement was undoubtedly inspired by Dr. Vaughan, who ardently advocated research work, not only by the teachers, but also by the more competent students.

In 1883 the legislature appropriated $2,000 for apparatus, and the Announcement of the Department of Medicine and Surgery stated that a special course of practical demonstration in physiology would be offered the second-year class. The laboratory was to be open daily for purposes of physiological experimentation and research. The list of apparatus was, however, limited to those instruments which were the most essential and, in general, to one piece only of each type. In those days almost all physiological apparatus had to be imported from England, France, or Germany.

By 1885 the number of instruments had been increased so that there were some duplicates, sufficient for a small number of students, and that year the demonstration course became an optional laboratory course in which the student made the experiments himself. This course, which was later extended, Sewall continued to give as long as he was with the department. The course was very complete, as is indicated by the notes still preserved in the physiological library. This was the first laboratory course in physiology offered in any medical school of the country, although earlier Newell Martin had supplied one for students of biology. It had been an uphill fight. One notices in the account of the apparatus in the Announcement that there was a foot-power lathe, which means that the professor and his assistant had to take off their coats and make some of the simpler instruments. No laboratory instrumentmaker could be thought of in those days.

The Calendar of 1887-88 noted the unsurpassed facilities for practical work in physiology (p. 26):

A large and well-lighted room is appropriated chiefly to the use of undergraduate students who perform under the direction of instructors most of the fundamental physiological experiments … A smaller room is devoted to advanced work and original investigation. Conveniently situated are an apparatus-room, a dark chamber for optical experiments, an incubation closet, and a large work shop containing machinists' and carpenters' appliances. The instrumental equipment of the Laboratory is unusually complete.

With the completion of the new Anatomical Laboratory Building the Department of Physiology had inherited the former quarters of the Department of Anatomy, that is, all of the third floor (except the northeast corner room, which Dr. Ford continued to retain for himself) and the attic in the old

Medical Building. Both the large room on the third floor and the loft were well lighted by skylights. Of course they were somewhat odorous — to put it mildly — after the many years during which they had been used as dissecting rooms, but they gave ample space for the work.

Howell carried on the work of the department on the lines which Sewall had established. The first year he lectured and continued the optional laboratory course inaugurated by his predecessor. Later, he extended the work, as shown by the little book of Laboratory Directions which he had printed for the use of his students in 1891. In 1890 the medical curriculum was lengthened from three to four years (of nine months each). In the schedule of courses for medical students given in the Calendar of 1890-91, lectures in physiology were listed for three hours in the second year and for two hours in the third year. At the same time, a practical laboratory course was provided, to last throughout the second semester, 1 to 5 P.M. daily, for students of the third year, and this course was required, except for the students who were to be only three years in the Department of Medicine and Surgery. The next year this laboratory course in physiology was a requirement for all students, the first laboratory course in physiology to be required in any medical school of the country.

Professor Howell was one of the speakers at President Hutchins' luncheon at the celebration of the seventy-fifth anniversary of the founding of the University of Michigan (1912). In his address he said:

It has been some twenty years since I had the pleasure and the privilege of being a member of the Faculty of this University. Although this connection lasted but a brief three years, it formed an eventful period of my life, for I made here some friendships which I prize highly and I acquired for the University a respect and an affection that have been intensified by every succeeding contact … When the methods of the experimental sciences began to penetrate into the field of medicine some of the older and more influential schools failed to adjust themselves to the new conditions and thereby lost gradually their prestige. The Medical Department of this University on the contrary was among the first to adopt the newer methods of instruction and early enrolled itself among the progressive schools in this country.

The Seventy-fifth Anniversary … University of Michigan

He paid respect "to the determined spirit, clear vision, and devoted loyalty of him who for so many years has acted as its Dean [Dr. Vaughan]," and added: "The record made by it for important and scholarly contributions to medical science and medical practice is equal, I believe, to that of any other medical school in this country."

In the medical Announcement of 1892-93 the following statement, reminding one of Allen's introductory address of 1852, appears:

Knowledge is gained from one's personal observation or experience or is communicated from one to another. The former is positive knowledge, while the latter may be designated as hear-say. The medical student acquires this positive knowledge in the laboratory, in the ward and autopsy room, while he must depend for much of his information upon lectures and textbooks. It is the aim of this school to give its students all the positive knowledge possible and with this in view, great stress is laid upon the laboratory instruction in … [Various sciences were mentioned, but unfortunately physiology was omitted from the list].

The members of the medical faculty have always vied with one another for time for their laboratory courses, each of them honestly believing that the course which he was giving was the most important in the development of a doctor. When Howell left in 1892, and a new

man was to come, the opportunity was too good to lose; consequently, the new man, Lombard, found that he was to give five lectures a week each semester, and that the laboratory course in physiology was to be no longer required, that in its place an optional one of six weeks had been substituted, and that there was no time left when the regular medical student could take such a course.

The lectures and recitations of 1891-92 were attended by 235 students — medical freshmen and sophomores, homeopathic medical students, dental, graduate, and pharmacy students, and those from the Department of Literature, Science, and the Arts. In addition, there were three sections of optional laboratory work, for medical, homeopathic, dental, liberal arts, and graduate students.

From 1892 to 1904 there were only minor changes in the work of the Department of Physiology. The medical, homeopathic, and dental students were required to attend the lectures and recitations, and there were always a few graduate students and students from the School of Pharmacy and the Department of Literature, Science, and the Arts who elected the courses. Usually there was a special quiz section for dental students. The practical laboratory course, which was optional for all students, continued to be given to small sections, the number totaling from twenty-one to fifty-four. The laboratory was at all times open to students sufficiently advanced to do research work, and courses were offered for students proposing to teach physiology.

In 1904-5 the practical laboratory course in physiology became a required course for medical and homeopathic students, although it was elective for students in other departments. That year the course was given in three sections to seventy-six students, and in 1905-6, 103 took the required course in laboratory work, which was given five afternoons a week for nine weeks.

With the coming of Gesell (1923) there was a change in the teaching of physiology. At that time the old methods of lectures, recitations, and frequent written quizzes, in which the student was made to feel that his work was definitely assigned and under constant supervision, was altered. The student was given greater freedom to do his work in his own way, this being especially true of the laboratory work.

In 1930 Professor Gesell described the methods of instruction:

Formal instruction is offered to three groups of students in medicine, dentistry and physical education. An introductory course of eighty lectures on human physiology with demonstrations is given jointly to the students of dentistry and physical education during the second semester. In the following semester another set of forty-eight lectures on the physiology of muscular exercise is given to the students of physical education. The course in physiology offered for the students of medicine begins the second semester of the first year of the medical curriculum with a series of lectures, demonstrations, and conferences. These lectures and demonstrations include an introduction to general physiology followed by a systematic discussion of the physiology of muscle, nerve, circulation, and respiration. The remaining subjects are concluded during the first semester of the sophomore year, the class meeting three times a week. The laboratory course, which consists of eight weeks of five three-hour periods and one laboratory conference each week, may be taken during the summer session between the two lecture courses or in the fall along with the second set of lectures. All courses offered by the department are open to undergraduate and graduate students of any school who have adequate training in physics, chemistry, and biology.

In the combined course for dental and physical education students, the enrollment is about one hundred and twenty-five; in the course in the physiology of muscular exercise about twenty-five. The enrollment in the course for medical students is about one hundred

and eighty, of whom approximately one hundred and fifty are medical students…

In our lectures we attempt to cover the subject in a fairly systematic way emphasizing the principles of physiology, the methods of research, and the means of arriving at conclusions. Demonstrations are freely used. Clinical data are frequently employed and found valuable not only in establishing fundamental principles but in gaining the interest of the students as well. Reference to original literature and to monographs are given but there is no assigned reading. It is left to the student to determine whether he reads or not. Three standard text-books are recommended but no specific one required. The class is divided into three sections for weekly conference…

The laboratory course is in the process of development. At present there are thirty-seven experiments each requiring on the average one complete laboratory period. One experiment (respiration of man) runs the entire week. The physiology of muscle, nerve, central nervous system, special senses, circulation, respiration, secretion, and metabolism [is] represented in varying degrees. Our aim is to develop careful technic, accurate observation, clear thinking, and sound deductions. With that in mind as much reliable standard research equipment is provided as the funds will permit. Detailed laboratory instructions are kept at a minimum. Quantitative analysis of results with the use of graphs is encouraged. Brief descriptions bearing only on the essentials are submitted by the student for weekly inspection. So that inspection may be critical, only a small proportion is graded. The student does not know which experiment is graded, neither are the grades reported. It is for the student to determine whether or not he is satisfied with his work. He has an opportunity to find his weak points at laboratory conference and through the instructors in the laboratory.

Twenty-three of the experiments the student does in the large general laboratory with equipment issued to him for the course. These experiments he is free to carry out when he pleases. The laboratory is open day and night throughout the week. The remaining experiments which are performed in the outlying rooms require special equipment and more guidance. These are assigned on posted schedules to the students in rotation.

Gesell

From the beginning of 1935-36, laboratory work has been offered as a special course to the students of the School of Dentistry during the second semester.

Combined curriculum. — Dr. Novy, in his address at the memorial meeting for Dr. Vaughan, said:

[A] significant step due to the initiative of Dr. Vaughan was the early establishment of the combined curriculum. By arrangement with the Literary Faculty in 1892, students were permitted to register in the Medical School at the close of the third year and were given their bachelor's degree upon the completion of the first year in medicine. Eventually this arrangement was modified so that a student desirous of obtaining the two degrees could shorten the time from eight to seven years for the A.B. degree and to six and a half years for the B.S. degree. By this arrangement the Medical School sacrificed nothing since the Literary College merely gave credit to which any student would be entitled if he elected such medical courses.

Vaughan Memorial

Summer instruction. — No one was enthusiastic about teaching in the summer, but, because of the low salaries, it was done to help pay living expenses. Wiggers, Cope, and Muyskens all taught summer laboratory courses in physiology at various times, and sometimes to rather large numbers, the work being carried on in the same manner as during the regular sessions. The complete advanced course of lectures and laboratory instruction is offered during the summer. This opportunity of meeting all of the requirements in physiology has attracted many out-of-state medical students.

Buildings used. — Originally the lectures were given in one of the two lecture rooms in the old Medical Building. After the addition had been completed in 1864, the amphitheater (the upper

lecture room) was undoubtedly used by Professor Ford. Sewall, Howell, and Lombard lectured there until 1906, when it was declared unsafe, and then Lombard was assigned the amphitheater of the old Homeopathic Building on the north side of the campus. After 1910 Lombard lectured in a small amphitheater which had been built at the east end of what was known as the old Chemical Building (Pharmacology Building), except when the classes were too large and he had to use the west lecture room of the West Medical Building. Professor Gesell gave his lectures there until the East Medical Building was constructed in 1925; after that he used the lecture room in the east wing. The laboratory work also was shifted from place to place as time went on.

When the new Anatomical Laboratory Building was completed in 1889, Howell took over the former anatomical quarters — all of the third floor and the attic. Howell's private room was in the southeast corner. Lombard occupied these rooms, using the large room as a general laboratory, and the attic for a shop and for research. It was not until 1910 that the Physiological Laboratory was moved to the third- and fourth-floor rooms of the Pharmacology Building, near the center of the campus. Lombard used the large room on the northwest corner for his private office and for much of the research work of the staff. Special experiments of the students took place in small rooms on this floor or on the floor above. Other rooms on the fourth floor were used for the shop, for research work, and for storing instruments, one room being devoted to a balance for recording the loss of weight. The animals were housed in the east end of this floor.

Gesell found quarters crowded. Fortunately, new space, approximately 32,000 square feet gross, consisting of the second, third, fourth, and fifth floors of the south wing of the East Medical Building was allotted to the department in 1925.

Warren P. Lombard

[Died July 13, 1939.]

SELECTED BIBLIOGRAPHY

Introductory Address to the Third Session … College of Medicine and Surgery … Observations on the Medical Platform … "President's Address." Announcement, Department of Medicine and Surgery "The Department of Medicine and Surgery in the Fifties." "Mortuary of Henry S. Cheever, A.M., M.D." Calendar Catalogue … Catalogue and Register "Department of Physiology, University of Michigan." "Abram Sager, A.M., M.D.: His Life and Services." "An Historical Sketch of the Department of Medicine and Surgery of the University of Michigan." "Medical Laboratories." Sixty Years in Medical Harness … "Henry Sewall and the Department of Physiology." Memorial Meeting for Victor Clarence Vaughan … "The President's Luncheon." President's Report

Proceedings of the Board of Regents … "Experiments on the Preventive Inoculation of Rattlesnake Venom." A Topical Synopsis of Lectures on Animal Physiology. The University of Michigan. University of Michigan Regents' Proceedings …, 1837-1864. The Seventy-fifth Anniversary of the Founding of the University of Michigan.

THE DEPARTMENT OF POSTGRADUATE MEDICINE

THE Board of Regents of the University of Michigan in 1892 gave support to a program of postgraduate education when it authorized the faculty of the Department of Medicine and Surgery to admit medical graduates to undergraduate classes. This provision of the Regents was made in recognition of the rapid increase of medical knowledge. The discoveries of Pasteur were bringing about great changes in the practice of medicine and offering renewed hope in many of the most baffling problems in both medical and surgical fields. The medical graduate in search of further educational opportunities was being forced to look to the Old World medical centers. In extending the teaching facilities of the undergraduate Medical Department, the Regents, in a forward-looking policy, provided an opportunity in this country for the medical graduate to keep abreast of modern advances in practice.

The Department of Medicine and Surgery, in addition to admitting graduates to already established courses, the subject matter of which had been greatly increased since their graduation, offered special graduate courses in hygiene, bacteriology, electrotherapeutics, microscopic and gross pathology, physiology, histology, chemistry, and therapeutics. These were given once a year, in the summer, and were usually six weeks in length. This program continued with some interruption until 1920. As a substitute, one day of teaching each month was offered in the form of a composite program for practitioners. This plan, too, was finally discontinued, and various medical organizations, notably the Michigan State Medical Society, established postgraduate conferences throughout the state to which members of the University teaching staff frequently contributed. These conferences were well received by the medical profession, but there was a growing demand for greater continuity and more academic direction of the program.

In January, 1926, representatives of the University of Michigan Medical School and the Detroit College of Medicine and Surgery were invited to meet with the council of the Michigan State Medical Society to consider ways and means of meeting the rapidly growing needs for postgraduate study in Michigan. The meeting was held in Ann Arbor, and the officials of the council presented a résumé of their efforts in this field, of the difficulties experienced, and of the growing demands. Dr. Clarence C. Little, President of the University, and the faculties of both schools responded sympathetically and a committee of three, representing the two medical

schools and the Michigan State Medical Society, was assigned to study the problem for a year and report at a similar joint conference at the next annual meeting of the council. The committee was composed of Dr. Carl D. Camp, Dr. Douglas Donald, and Dr. James D. Bruce, chairman.

The committee presented its report in February, 1927. It expressed the opinion that the obligation to inaugurate and maintain a program of postgraduate education should be assumed by the University because of its state support. It was further stated in the report:

This does not mean that all postgraduate medical study should be conducted at the University Medical School and Hospital. There are many centers in this state and nation distinguished for special attainments in the various departments of medicine which should be made accessible for postgraduate study, and to which physicians should be recommended and sent for advanced and special work. The University Medical School, in which postgraduate study in medicine is offered and administered, should seek and maintain the closest co-operation with those extramural centers with a view of utilizing their facilities. Physicians in these centers who have distinguished themselves might be invited to become extramural members of the faculty of postgraduate medical instruction.

Journ. Mich. Med. Soc.

The committee recommended that a Department of Postgraduate Medicine in the Medical School of the University of Michigan be established to direct these activities. A tentative schedule of study periods was suggested.

The council and the two medical schools were in complete accord with the recommendations. Dean W. H. MacCraken and Dr. A. P. Biddle, representing the Detroit College of Medicine and Surgery, stated that the Detroit College could assume neither direction nor financial support, but promised the co-operation of its faculty, together with the use of laboratories and buildings, if and when any part of the program should be developed in Detroit. Dr. Little, on the part of the University, promised to place the matter before the Board of Regents with his approval. This he did in a communication to the Board on June 17, 1927, proposing the establishment of a Division of Postgraduate Medicine. In the absence of Regent Sawyer the matter was laid upon the table for consideration at the next meeting of the Board, June 24, at which time the following action was recorded:

The subject of post-graduate medical courses was taken from the table… The Board approved the establishment, within the Medical School, of a Department of Post-Graduate Medicine and named Dr. James D. Bruce as the head thereof, without additional salary, with the provision that during the year 1927-28 a beginning would be made toward placing the work of this department in operation. The organization of the Department of Post-Graduate Medicine is to proceed, under the charge of Dr. Bruce and under the usual conditions governing a department of the Medical School …

R.P.

The direction of the program has been shared since its beginning by committees representing the profession, the Council of the Michigan State Medical Society and the Wayne County Medical Society.

The first postgraduate courses were given May 27 to June 24, 1929, at the Receiving Hospital, Hermann Kiefer Hospital, and Children's Hospital in Detroit. Twenty-four doctors registered for the course in internal medicine and twenty for the surgery course. In 1938-39, the tenth year of this program, fifteen short, intensive courses in various fields of medical practice were given in Detroit and Ann Arbor. Extramural teaching programs of eight days each were given in various centers: Saginaw, Battle

Creek-Kalamazoo jointly, Flint, Grand Rapids, Jackson-Lansing jointly, Traverse City-Cadillac-Manistee-Petoskey jointly, and Ann Arbor. Summer session courses were available to medical practitioners, and during the school year composite courses were arranged upon special request. Doctors were enrolled from approximately one-half of all the cities and towns in the state, as well as from a considerable number of other states. The total registration in courses increased from forty-four in the first year to 2,392 in the tenth year.

Since the inauguration of the postgraduate medical program all the professional schools in the University have engaged in meeting the educational needs of graduates in their respective fields. As a further evidence of the acceptance of this general policy the following is quoted from the recommendations of the University Council to the Regents, which the latter acted upon favorably in August, 1939:

In view of the rapid growth of continuing professional training afforded by various units of the University, as described in the report submitted at the April meeting of the University Council, and in view of the likelihood that there will be pressure for further development of educational opportunities along these lines, it is recommended that a University Committee on Continuing Professional Education be appointed by the President with the approval of the Board of Regents. The Committee is to consist of representatives of the Schools of Medicine, Law, Dentistry, Education, Business Administration, Forestry and Conservation, Nursing, and Music, of the Colleges of Engineering, Architecture, and Pharmacy, and of the Division of Hygiene and Public Health. In addition, the Dean of the College of Literature, Science, and the Arts, and the Dean of the Horace H. Rackham School of Graduate Studies, or their designated representatives, shall be ex-officio members of the Committee to represent such professional fields as may be embraced within the jurisdiction of their respective units.

The Committee shall be authorized to act through an Executive Committee of not less than five members under such procedure as it may itself establish. The functions of the Committee shall be twofold: (1) to keep itself informed of the experience of the various units, with a view to harmonizing and improving established activities for continuing professional education; and (2) to advise the President, on the basis of this knowledge, concerning the desirability and character of new projects for continuing professional education. This University Committee on Continuing Professional Education is to replace the University Committee on Postgraduate Education authorized by the Board of Regents at its meeting of December, 1933.

R.P.

James D. Bruce

[Died September 5, 1946.]

SELECTED BIBLIOGRAPHY

Announcement, Department of Medicine and Surgery "Aspects of Medical Education," "Developments in Postgraduate Medicine." Calendar "Post-Graduate Medical School." Catalogue … Catalogue and Register President's Report Proceedings of the Board of Regents …

THE DEPARTMENT OF PSYCHIATRY

THE teaching of psychiatry in the Medical School dates from the time of William James Herdman ('72, '75m, LL.D. Nashville '97). He was born in Concord, Ohio, on September 7, 1848. In 1875 he became Demonstrator of Anatomy, a position he held for fifteen years. In 1879 he received an additional appointment as Lecturer on Pathological Anatomy, and in 1880 he became Assistant Professor of Pathological Anatomy. Two years later he was made Professor of Practical and Pathological Anatomy. His growing interest in the new field was indicated in 1888 by his change of title to Professor of Practical Anatomy and Diseases of the Nervous System, and Demonstrator of Anatomy. With the change to a four-year course in the Medical Department in 1890, Herdman was assigned to the new chair of nervous diseases and electrotherapeutics, and in 1898, he became Professor of Diseases of the Mind and Nervous System and Electrotherapeutics.

At the time that Herdman was becoming especially interested in this field, Oscar Russell Long (M.D. Detroit Homeopathic Medical College '73, M.D. hon. Michigan '98), of Ionia State Hospital (then termed the Asylum for Insane Criminals), by request, gave a course of lectures on mental diseases before the students of the Homeopathic Medical College, but without expense to the University. The course was repeated in subsequent years.

In 1892 Dr. Jeanne Cady Solis ('92m) was made Clinical Assistant to Herdman upon her graduation from the Medical Department and was offered an assistantship in the Department of Nervous Diseases and Electrotherapeutics. There was evidence of some misgiving regarding the development of the new program. One comment from a qualified observer was that the "Department of Nervous Diseases and Mental Diseases" was well received by other departments, but "with a chip on the shoulder." Nevertheless, the study of both nervous and mental diseases, as well as electrotherapeutics, was included in the departmental program, the actual instruction consisting of a one-hour lecture on Tuesday and Friday and a one-hour quiz on Wednesday, conducted by the assistant. Herdman also held a clinic, from two to five on Wednesdays, when the patients were examined and then presented to the class. The students made no examinations.

Although the course ran throughout the senior year, the lectures covered mental diseases only at the end of the year; in May, interested students were allowed to accompany Herdman and the staff to a state hospital, either Pontiac or Kalamazoo, where they were presented with an afternoon clinic by the hospital superintendent. This activity constituted all of the clinical psychiatric material presented to the class in the early days of the department.

The Regents showed their interest in Herdman's work by requesting him to appear before them in June, 1893, when he "explained the nature of his work, …" (R.P., 1891-96, p. 160). During this period, Herdman, who realized from the first the great importance of psychiatry, was active in his advocacy before the legislature of the establishment of a psychopathic hospital at the University. Largely as a result of his efforts, the University obtained, in 1901, an appropriation of $50,000 for the

construction of a psychopathic hospital in Ann Arbor, to be administered in connection with the University Hospital.

In 1894 Long had been appointed Lecturer on Mental Diseases, without salary, in the Homeopathic Medical College. In the following year he refused an appointment to the professorship of therapeutics and the deanship of the Homeopathic College, but accepted a lectureship of mental and nervous diseases in that college. He held this position until 1914, except for the period 1903-8, when he was Nonresident Lecturer on Mental Diseases. Dr. Solis became Demonstrator of Nervous Diseases in 1897, a position which she held until 1907.

These developments indicate the increasing interest of the University and of the Medical Department in the scientific study of nervous and mental diseases. Dean Vaughan reported to the Regents in 1897 that the asylum boards of the state were proposing to consider the appointment of a pathologist at the University to carry on the pathological work of all the state asylums; and he asked the University on behalf of the boards to send a representative to confer with them on the feasibility of such a project. Vaughan and Regent Hermann Kiefer were appointed as representatives of the University to meet the asylum boards in conference (R.P. 1896-1901, p. 128). Consequently, Dr. Theophil Klingmann ('90p, '92m), appointed Assistant to the chair of nervous diseases in 1897, became "Assistant in Pathology for the State Asylums" in January, 1898, with permission to use the microtomes in the Pathological Laboratory when necessary for his work with the state asylums. At this time the Regents also authorized the secretary of the University to have a room in the Pathological Laboratory made ready for Klingmann's use and to supply him with whatever might be necessary to carry on his work. The position was supported financially by the asylums for the insane, and in 1898 Klingmann was given the title of special pathologist for the asylums. Three years later, he was reappointed to the University staff as Assistant in Diseases of the Mind and Nervous System, but he continued to hold his position with the asylums until 1906.

The Regents approved, in 1898, a recommendation "that the Superintendents of the Asylums of the State, Dr. William Edwards of the Michigan Asylum, Dr. Edward Christian of the Eastern Michigan Asylum, Dr. James Munson of the Northern Asylum, and Dr. Bell of the Northern Peninsula Asylum, be appointed Special Lecturers upon Mental Diseases, provided these gentlemen consent to give one or more special lectures each, the University paying their actual expenses while giving these lectures" (R.P., 1896-1901, pp. 224-25).

The efforts in the development of a program in nervous and mental diseases under Herdman's leadership through the years subsequent to 1890 resulted in a gradual extension of the time given to the subject, although the chief emphasis was on electrotherapeutics and neurological disorders. Electrotherapy as then practiced was primarily suggestive, a type of psychotherapy which could thus well be considered in the field of psychiatry as defined today, but the specific type of treatment employed during the formative years of the department has given way to other methods.

In 1900 electrotherapeutics, included as part of the regular medical curriculum, was given daily for nine weeks of the junior year. Clinical demonstrations were given four times weekly during this period. In addition, supplementary weekly clinics were offered in the senior year. Optional courses, such as one in

physiological psychology given by Professor Walter B. Pillsbury, of the Department of Literature, Science, and the Arts, were also listed. As early as 1893 the seniors attended annual clinics in each of the two state hospitals, and small sections of seniors were assigned to psychiatric wards for special study of individual cases, which were presented for discussion by the class and staff. Each of these smaller sections lasted five weeks.

Agitation for a state psychopathic hospital in Ann Arbor developed rapidly, and in May, 1901, the Regents passed a resolution declaring that they were "willing to accept the administration and control of the Psychopathic Hospital provided for by a recent act of the Legislature, in case it involves no expense to the University" (R.P., 1896-1901, p. 638). A month later, Regents George Alexander Farr and Hermann Kiefer met with the medical faculty to consider the design of the building and the management of the hospital. President Angell, in his report for 1900-1901, stated: "In this ward opportunity will be furnished to our medical students to study some of the problems of alienism. This is a consideration of much importance…" The building was started in October, 1902, and in June, 1905, Regents Lawton, Carey, and Knappen "were appointed a committee to meet the Asylum Boards and devise a plan for operating and managing the Psychopathic Ward in conformity with the State law [of 1905]" (R.P., 1901-6, p. 561).

In September, 1905, the asylum trustees and the committee of the Board of Regents were empowered to employ Albert Moore Barrett (Iowa '93, M.D. ibid. '95) as "Pathologist of the State Asylums for the Insane and Associate Professor of Neural Pathology in the Psychopathic Ward upon the hospital grounds of the State University" (R.P. 1901-6, p. 606). Barrett had been physician and pathologist of the Danvers Insane Hospital in Massachusetts from 1902 to 1905, and from 1905 until he came to Michigan, in January, 1906, had been an assistant in neurological pathology in the Harvard Medical School.

The new hospital was opened on February 7, 1906 (Hosp. Rept., 1903-8, p. 61), and Barrett's first report was received six months later. In December, 1906, Dr. Herdman died in Maryland while on leave of absence from the University. In February, 1907, on recommendation of the hospital committee of the medical faculty, Barrett became "Professor of Psychiatry and Diseases of the Nervous System, and [was] charged with the immediate care of the clinic of Nervous Diseases, without salary from the University …" (R.P., 1906-10, p. 68). At the same time it was voted that a clinical professor of nervous diseases be appointed, and the following June, upon Barrett's recommendation, Carl Dudley Camp (M.D. Pennsylvania '02) was appointed to this position. Klingmann was made Demonstrator of Nervous Diseases, and Vernon Justin Willey (Michigan Agricultural College '93, A.M. Michigan '02, ibid. '09m) became Instructor in Electrotherapeutics and Director of the X-ray Laboratory. In 1908 Albert Barlow Hale ('82, M.D. Northwestern '86, M.D. Strassburg '87) was appointed Assistant in the Roentgen Laboratory. George Milton Kline ('01m, A.M. hon. '31), later commissioner of the Department of Mental Diseases in Massachusetts, and Melvin John Rowe ('03m) were appointed as assistants in psychiatry; Donald Dinnie Johnston ('08m) was made Intern in the Neurological Service of the Hospital.

In March, 1920, the Department of Diseases of the Mind and Nervous System was divided into the Department of Psychiatry and the Department of Neurology.

Barrett's title was changed to Professor of Psychiatry, and Camp became Professor of Neurology (R.P., 1917-20, p. 896).

It is interesting to note that the Announcement of the Medical Department lists electrotherapeutics for a period of more than thirty years as a compulsory and time-consuming course. In the University Calendar and in the Announcement of the Medical Department it was repeatedly stated: "For the treatment of diseases of the nervous system, the hospital is furnished with apparatus for generating all kinds of electric current. Attendants especially skilled in the application of electricity and massage are put in charge of these cases."

In the years since the introduction of neurology and psychiatry into the program of the Department of Medicine and Surgery there has been a gradual increase in the amount of teaching time allotted to these subjects, an indication of the increasing importance of psychiatry in medical education. In addition to a sophomore course in psychopathology and a junior course in psychiatry, a freshman course in medical psychology was given in the period 1930-38. In 1938 this course was increased from eight to sixteen hours and became a required subject. The senior students were taught psychiatry in sections.

From 1907 to 1936 Dr. Barrett continued in charge of the department and as head of the Psychopathic Hospital. During this period many important contributions to the development of the science of psychiatry were made by him and by those associated with him (see Part II: Neuropsychiatric Institute) , and many advances were made in the teaching of the subject. A laboratory of neuropathology had been in use for a number of years, and the subject was taught in the Medical Department by Barrett. Under his supervision the laboratory became an important part of the Psychopathic Hospital. According to Michigan statutes, it was designated the Central Laboratory of Neuropathology for the State Hospitals. Konstantin Scharenberg (M.D. Hamburg '22) has been in charge of the laboratory since 1930, and during this time many important publications have been issued. The state hospital groups have provided an important source of material, particularly the institutions at Caro and Lapeer, and the superintendents of the state hospitals have been very co-operative in making material available.

In 1936 Raymond Walter Waggoner ('24m, Sc.D. Pennsylvania '30) was appointed Professor of Psychiatry and chairman of the department. He assumed office on January 1, 1937, and has continued in that position. The completion of the Neuropsychiatric Institute building in 1939, situated directly at the rear of the University Hospital and connected with it by a corridor, has permitted a much greater co-ordination of psychiatric teaching than was possible when the psychiatric unit was a separate building and has enabled students to have a much closer association with the patients.

The appointment of a psychiatrist as a consultant on a par with the internist and surgeon in the office of the surgeon general in Washington was evidence of the increasing recognition of the importance of psychiatry in military medicine. This trend is borne out by the manifestation of greater interest in the subject of psychiatry by Medical School students.

As a result of the close relationship between the Neuropsychiatric Institute and the various state hospitals, a program of clinics conducted by members of the staff of the Neuropsychiatric Institute was begun in the state institutions in 1937. At these clinics patients selected by the state hospital staffs were examined

and discussed by members of both the institute and hospital staffs. The neuropathologist from the institute discussed the pathology of cases, the material of which had been received from the state hospital where the clinic was being held. The practice has been described by state hospital superintendents as a valuable addition to the teaching activities of the state hospital group.

From time to time members of the state hospital staffs come to the Neuropsychiatric Institute for a period of intensive postgraduate study; an opportunity is afforded them for graduate work in neuroanatomy and neuropathology, as well as for clinical work in psychiatry and neurology. As a part of the graduate teaching program, short postgraduate courses are held to prepare applicants for their examinations for the diplomate in the American Board of Psychiatry and Neurology. Some of the courses in the Medical School are also utilized by the Graduate School of the University for students qualified to register for the courses. This applies particularly to those students who have a significant background of psychological or sociological training.

Since 1937 some reorganization of the department has taken place, and the graduate program as it applies to interns, assistant residents, residents, and instructors is the same as it is for other departments. During the training period opportunity is afforded those who are properly qualified to do extra work necessary to obtain the degree of master of science in psychiatry or in psychiatry and neurology. Thus, there has been established an excellent postgraduate training program for those who desire to specialize in this field.

Raymond W. Waggoner

SELECTED BIBLIOGRAPHY

Announcement, Department of Medicine and Surgery "The State Psychopathic Hospital." Calendar Catalogue … "Albert M. Barrett." "The Present Campaign Against Insanity." "The Psychopathic Ward." "Hospital Facilities Are Increased." "The Neuropsychiatric Institute." The Neuropsychiatric Institute. President's Report Proceedings of the Board of Regents … "William James Herdman."

THE DEPARTMENT OF ROENTGENOLOGY

THE Department of Roentgenology was officially created by the Regents in July, 1913, when a budget of $1,000 for current expenses was allocated to it and an additional $360 was appropriated for repairs in the X-ray quarters in the Hospital. Long before, however, the medical application of Roentgen rays at the University had been begun, and it was the importance which activities in this field eventually assumed that culminated in the establishment of a separate department.

On April 26, 1896, only five months after the announcement of Roentgen's discovery, occurred the first recorded medical use of the newly described "X rays" at the University. Mr. Stanislas M. Keenan, of Eloise Hospital, who had become interested in Professor Henry S. Carhart's work with X rays, brought to Ann Arbor a patient with a bullet in his foot. Using X rays produced in the Physics Laboratory, Professor Carhart and Dr. William James Herdman ('72, '75m, LL.D. Nashville '97), Professor of Diseases of the Mind and Nervous System and of Electrotherapeutics, photographed the foot and demonstrated the presence of an opaque foreign body.

At that time there was no X-ray equipment at the University Hospital, but Herdman, who for some years had conducted a course in electrotherapeutics begun by Professor John W. Langley in 1880, was in the habit of demonstrating to his students with the static machine in his office the production of X rays and their medical uses. Sometime about 1900 the first piece of equipment for the production of X rays in the Hospital was purchased personally by Dr. Charles B. G. De Nancrède and Dr. Cyrenus G. Darling. This original induction coil was preserved by Dr. D. Murray Cowie and sometime before his death was presented to the Department of Roentgenology. X rays were first mentioned in the University Calendar in 1901-2, in a revised description of the electrotherapeutical laboratory. The late C. Perry Briggs, for many years Pharmacist of the University Hospital, is credited with having developed the technique employed during the early years when the original equipment was in use, having first familiarized himself with the subject in the laboratory of Professor Carhart.

The first X-ray equipment purchased with University funds was acquired in 1903 with $1,000 appropriated by the Regents (R.P., 1901-6, p. 65). This apparatus was placed in the custody of the Department of the Diseases of the Mind and Nervous System and Electrotherapeutics, then directed by Herdman, and a small X-ray laboratory was set up in the basement of the Palmer Ward building. Additional small appropriations were authorized by the Regents from time to time, the "Treasurer's Report" of June 30, 1907, listing an expenditure of $514.63 for the Roentgen Laboratory during that fiscal year.

Vernon Justin Willey (Michigan Agricultural College '93, A.M. Michigan '02, ibid. '09m), appointed Instructor in Electrotherapeutics in 1901, was given the additional title of Director of the Roentgen Laboratory in 1906, and in the same year Almus A. Hale was appointed his assistant in the laboratory and clinical photographer. Willey continued in charge of the laboratory, after attaining considerable prominence in the field of roentgenology, until 1909, when he resigned to join the staff of the Mayo clinic.

In 1907 Carl Dudley Camp (M.D. Pennsylvania '02) was appointed Clinical Professor of Diseases of the Nervous System and assumed immediate supervision of electrotherapeutics and consequently of the Roentgen Laboratory, and Dr. James Gerrit Van Zwaluwenburg ('98, '08m), later identified with the work in roentgenology at the University, was appointed second assistant in internal medicine. Through close association with Almus Hale, Van Zwaluwenburg became deeply interested in the clinical use of Roentgen rays.

During the two years after the resignation of Willey in June, 1909, Lyle Steen Hill ('08e, M.D. Detroit College of Medicine and Surgery '14), previously an assistant in the electrotherapeutics laboratory, was Director of the Roentgen Laboratory. Van Zwaluwenburg, who was made Instructor in Internal Medicine and Demonstrator of Clinical Medicine upon the resignation of Dr. Frank Smithies in 1908, took a special interest in the use of X rays in examinations of the heart and of the stomach. His interest, combined with the desire of De Nancrède, of the surgical service, to make greater use of the possibilities of Roentgen apparatus, resulted, early in 1910, in the transfer of the supervision of the laboratory to the departments of Internal Medicine and Surgery, acting jointly. Van Zwaluwenburg took over direct charge of activities, and De Nancrède represented the laboratory in meetings of the faculty. Under the new arrangement, X-ray examinations were becoming so numerous that the Regents established an X-ray fee schedule in September, 1912.

When the full-fledged Department of Roentgenology was established in July, 1913, Van Zwaluwenburg was chosen as the first Clinical Professor of Roentgenology. He brought to this newly developed clinical specialty of the University a rare combination of background and point of view admirably suited to the work in hand. His preliminary training in engineering, his sound grasp of internal medicine, and his inquisitive attitude all came into play in the development and firm establishment of roentgenological methods in the clinical activities of the Hospital. "Van," as he is affectionately remembered by colleagues, assistants, and students, rapidly attained a national reputation in his field through his energetic and untiring efforts as a Roentgen diagnostician, a teacher, and an investigator; and, in recognition of his accomplishments, the Regents appointed him Professor of Roentgenology in July, 1917. During the war the new department, in conjunction with the United States Army and the Michigan Antituberculosis Society, took an active part in the examination of men discharged from Camp Custer because of suspected tuberculosis.

From correspondence and reports of the period, the need for additional equipment to meet increasing clinical demands appears to have been ever present. There was but a single generator, a ten-kilowatt high-tension transformer, one radiological table with a tube stand, and a Groedel fluoroscope with orthodiagraphic attachment. Gas-filled X-ray tubes were costly and unreliable. The number of examinations conducted each year had risen from less than 600 in 1911 to 4,203 in 1917-18, by which time the activities of the department had far outgrown the quarters which it occupied in the basement of the old Palmer Ward. Late in 1918 a separate machine was acquired for the production of medium-voltage X rays to be used therapeutically. A new scale of charges adjusted to the financial status of patients, the adoption of which had been advocated by Van Zwaluwenburg to avoid unfair competition by the University with

private practitioners, was approved by the Regents in 1920.

Heedless of his own personal welfare, unsparingly devoted to medicine, Van Zwaluwenburg died of pneumonia on January 5, 1922, after a very brief illness, and thus the formative period of the department came to an abrupt and untimely end. More than ten thousand X-ray examinations were made by the department in the year of his death. His boundless energy, his wholehearted devotion to clinical roentgenology, his great human kindliness, his important contributions to the examination of the heart, of the great vessels, and of the organs of the abdomen by Roentgen methods, and his insistence that Roentgen diagnosis of disease must be primarily objective led American roentgenologists to regard him as one of this country's outstanding pioneers in his field.

After Van Zwaluwenburg's death the Regents placed Samuel Wright Donaldson (Tennessee '12, Michigan '16m), a senior assistant, in temporary charge of the department. Donaldson was assisted by Elmer Forrest Merrill ('20m) and later by Clyde Knapp Hasley ('15, '18m), formerly an instructor in dermatology.

Preston Manasseh Hickey ('88, M.D. Detroit College of Medicine '92) was appointed Professor of Roentgenology in the fall of 1922. An outstanding clinician of Detroit, Hickey had previously been a professor of pathology and otolaryngology in the Detroit College of Medicine and Surgery and had won international acclaim as a roentgenologist. His interest in the subject had developed from his hobby — photography. Together with Dr. Augustus Warren Crane, of Kalamazoo, Dr. Henry Hulst, of Grand Rapids, Dr. James Case, of Battle Creek, and Dr. J. G. Van Zwaluwenburg, Hickey had already achieved recognition as one of the five great Michigan radiologists who had distinguished themselves in the early years of roentgenology.

During the war years Hickey had rendered unusual service to the Army Medical Corps by participating in the organization of specialty schools for roentgenologists and by serving as chief consulting roentgenologist to the American Expeditionary Forces. Outstanding pioneers in roentgenology in England, France, Sweden, Germany, Italy, Austria, and Canada were his personal friends. He founded the American Quarterly of Roentgenology in 1906 and for ten years was editor of this publication, which in the meantime (1913) became the American Journal of Roentgenology. With this rich background he was ideally equipped to be a teacher of roentgenology, and as such he is remembered and revered.

Under Hickey's forceful guidance the department expanded rapidly. From his appointment in 1922 until the new University Hospital was occupied in August, 1925, he devoted much time and attention to planning the new quarters for the department. High-voltage therapy equipment was installed temporarily in the basement of the Palmer Ward. The professorial staff of the department was enlarged in April, 1925, when Ernst Albert Pohle (M.D. Frankfurt [Germany] '20, Ph.D. Michigan '28) took up his duties as Assistant Professor of Roentgenology and was placed in charge of the work in radiation therapy. In August, 1925, the Department of Roentgenology was moved into spacious new quarters in the present Hospital building (Hickey, pp. 113-25).

Clinical photography, a hospital activity of constantly growing importance, had been fostered first by Van Zwaluwenburg and then by Hickey as a part of the Department of Roentgenology.

When the new Hospital was opened, Harry Franklin Minkley, a former commercial photographer, was placed in direct charge of this work in the new studio provided for the purpose. Burr Anderson, technician for many years, resigned in 1925, and the technical work was distributed among assistant residents assigned to the department — an important feature of the training program instituted by Dr. Hickey.

Instructional and research activities were materially accelerated during Hickey's incumbency; interdepartmental clinical conferences were established, and formalized teaching of roentgenology to undergraduates was further developed and extended. There was an increase in the number of graduate students, most of whom remained for two years of postgraduate instruction after their internship. Other physicians holding fellowships from various national foundations were attracted to the department.

The first radium owned by the department was purchased in 1928. Previously, the only stocks available had been owned privately by members of the faculty, or had been rented.

In 1927 Pohle had been promoted to an associate professorship in recognition of his experimentation with ultraviolet light, high-frequency currents, X rays, and the radiations of radium. Before Pohle's departure in 1928 these activities led to the formation of a subdepartment of physical therapy, later combined with the physiotherapy section of the Department of Surgery. Closely adjacent to the Department of Roentgenology was the work in hydrotherapy and in electrotherapy, supervised by Dr. Hickey and conducted by Willis Seamans Peck (Syracuse '22, M.D. ibid. '24), who in July, 1928, had become Instructor in Physical Therapy, Assistant Director of the Department of Physical Therapy of the University Hospital, and part-time physiotherapist in the Health Service. In March, 1929, all physical therapy activities were amalgamated to form a new department of the Medical School (R.P., 1926-29, pp. 939, 1020), administered by Dr. Hickey and an advisory committee consisting of Dr. Warthin and Dr. Huber. Courses for medical students and technicians served as models for similar work in other institutions.

Hickey's intensely active and valuable service to the University came to a close with his death on October 30, 1930. Because of his gentle kindliness, he will long be referred to by former assistants, students, and colleagues as "Pop" Hickey — a form of endearment accurately expressing the character of his relationship to a large band of physicians. Hickey's influence upon American roentgenology was nation-wide, and he earned recognition for the University as an outstanding teaching center in this subject. On the wall of what once was his private office hangs a memorial bronze bas-relief presented by his associates in the name of the American Roentgen Ray Society as a testimonial to his eminence in American medicine.

Carleton Barnhart Peirce ('20, '24m, M.S. '27) was appointed Acting Director of the Department of Roentgenology immediately after the death of Dr. Hickey, under whom he had begun his specialized training in 1926 as an instructor. He had resigned to take a position at the University of Nebraska, but returned early in 1929 as Assistant Professor of Roentgenology, relieving Carl Lewis Gillies ('26m), who left to become an associate professor of roentgenology at the University of Iowa. In 1928 Dr. Pohle resigned to accept a professorship of roentgenology at the University of Wisconsin, and until 1930 the work in radiation therapy was supervised by John McGregor Barnes (B.S. Med. '24, '24m), Instructor and later Assistant Professor,

whose colleague and successor, William Macauley Gilmore (M.D. University of Western Ontario '27), was in charge of this work at the time of Hickey's death. Dr. Gilmore was in turn succeeded by Daniel Maurice Clark (M.D. Minnesota '27), who supervised the work in radiation therapy during the first three months of 1931.

On January 23, 1931, the Regents appointed Fred Jenner Hodges (Wisconsin '17, M.D. Washington University [St. Louis] '19) Professor of Roentgenology, effective April 1. Hodges had been a lecturer in roentgenology at the University of Wisconsin and roentgenologist to Saint Mary's Hospital and to the Wisconsin Memorial Hospital in Madison. Vincent Clifton Johnson (M.D. Wisconsin '27), who was Associate Professor in 1940, was appointed Instructor in Roentgenology July 1, 1931. Peirce became Associate Professor in 1933 and continued in that capacity until, in 1938, he resigned to succeed Dr. Howard Pirie at the Montreal General Hospital.

Harold William Jacox (B.S. Med. '26, '28m), just completing his specialized training, was placed in charge of the work in radiation therapy in 1931. He resigned as Assistant Professor of Roentgenology in December, 1935, to become radiation therapist to the Western Pennsylvania Hospital, Pittsburgh, and Willis Peck, who had been Assistant Professor of Physical Therapy since 1931, succeeded him. In September, 1937, Dr. Peck was transferred to an assistant professorship of roentgenology, and he continued in diagnostic and later in therapeutic roentgenology until September, 1939, when he entered practice in Toledo.

At the time of Hickey's death the splendid plant conceived and developed under his direction had been outgrown because of increasing departmental activities, and in the next year, 1931, it was extensively repaired and altered. An additional four hundred square feet of floor space was acquired by the transfer of the medical illustrator's quarters to another part of the Hospital. The highly specialized departmental activities were provided for by the careful subdivision of floor space and by the acquisition of new equipment. Dental roentgenology was transferred to the oral surgery service, a fluoroscope was installed in the newly opened Tuberculosis Unit of the Hospital, and filming for urological diagnosis was provided for in the urology outpatient quarters. On April 4, 1932, about fourteen months after the appointment of Professor Hodges, the redesigned departmental quarters became available. In the interim the varied activities had been conducted under most trying conditions in temporary quarters on the ground and basement floors. For the first time there were well-arranged facilities for patients needing radiation therapy. These activities had been constantly increasing until patient visits had reached the total of 9,446 annually. In July, 1935, the medium- and high-voltage machines which had been transferred from the old Hospital ten years before were replaced with shockproofed 200-kilovolt instruments, and in the following year, because of the constantly increasing number of cancer patients, equipment limited to the treatment of superficial skin lesions was provided in the dermatology outpatient quarters.

In the 1932 reorganization the work in clinical photography ceased to be a subsection of the Department of Roentgenology, and all hydrotherapeutic and electrotherapeutic activities were united to constitute a subdepartment of physical therapy, which was later, in 1937, transferred to the Department of Surgery. In the meantime, many somewhat disconnected activities in this field had been brought together in quarters specially developed for them on the basement

floor of the southeast wing of the main Hospital. An exercise pool for poliomyelitis patients, contributed by the Rackham Foundation, was built. After the remodeling of 1935, when the adjoining Hospital stores addition was erected, the department was better able not only to carry its ever-increasing clinical load efficiently, but also to provide greater opportunities for its graduate and undergraduate students. An entirely new method of case reporting, film filing, and cross indexing was established, and the departmental business office, film-processing facilities, film storage, and viewing rooms for the staff were brought into close proximity to conserve effort and permit rapid service. Dressing rooms for the specialized technical branches in therapy and diagnosis were installed close to the exposure rooms, and transformers were housed in closed lofts to conserve floor space. A student laboratory for the demonstration of X-ray physics was built and equipped, and one room was utilized for a departmental library designated as the Hickey Memorial Library and maintained largely by Dr. Hickey's bequest of $1,000.

The teaching of roentgenology has also been changed since 1932. Previous efforts to train nonmedical technicians were discontinued in order that undergraduate and graduate medical students might be more thoroughly trained in roentgenology. In a typical year, 1939-40, thirty-two hours of lectures for juniors were offered in the first semester, augmented by thirty-two hours of required clinical instruction conducted on the block system throughout the year. Several courses were discontinued as electives and were replaced by a six-week summer course of intensive laboratory, lecture, and clinical instruction open to students and practitioners alike.

The plan of interdepartmental clinical conferences already instituted was materially expanded. In 1933 the program for postgraduate students in roentgenology was revised and was placed upon a three-year-training basis. Carefully selected medical graduates who had completed a year of internship were accepted as assistant residents in roentgenology, eligible for reappointment for a second year as residents and for a third year as instructors. Modest stipends provided by the Hospital and the University made it possible for more than forty young men of limited means to obtain this training in the next ten years. The plan previously in vogue, of delegating trainees in rotation to a month's service at Detroit Receiving Hospital, outgrew its usefulness and was discontinued in 1933.

Some ten nonprofessional workers brought together under Hickey's direction before 1931 readjusted themselves to the rapidly changing conditions and, with but few exceptions, remained in the employ of the department. They have contributed greatly to the successful provision of roentgenological service to the University Hospital, as have the less numerous veteran workers in physical therapy.

The Department of Roentgenology has assisted in the extensive reorganization of the general Hospital records since 1932 by actively participating in the development of a mechanical tabulation system.

The department has made important contributions to the establishment and maintenance of the concerted program of the University's cancer committee, having taken an active part in the two tumor conferences conducted by the Department of Obstetrics and Gynecology and in the two general tumor conferences held each week in conjunction with the departments of Pathology and Surgery. In succession, Dr. Jacox, Dr. Peck, and

Dr. Isadore Lampe (Western Reserve '27, M.D. ibid. '31, Ph.D. Michigan '38), who became Assistant Professor of Roentgenology in 1938, have served energetically and efficiently in this field. In association with the Department of Physics, the Department of Roentgenology began to participate in 1935 in the University's nuclear physics program centered about the construction of the University's cyclotron and its subsequent employment in research. As an outgrowth of this venture, which was supported by the National Cancer Institute and the Rackham Foundation, both Lampe and Hodges have been associated with Professor E. O. Lawrence and the radiation laboratory at the University of California, where Hodges served as a research associate while on sabbatical leave for one semester.

Interested in the broad-scale investigation of the incidence of pulmonary disease in general, the departments of Roentgenology and Internal Medicine have since 1931 been actively concerned with various mass surveys. As a result, a periodic X-ray chest examination has become a routine practice for all Hospital employees as well as for all students entering the University. In June, 1935, chest filming of all patients registering at the University clinics during a two-week trial period proved convincingly that this procedure should be instituted, but it was not until July, 1941, that, through the financial assistance of the Kellogg Foundation, a plan of chest survey based upon the use of photofluorography was put into effect. Facilities were installed in the Hospital admission office, and during the first twelve months nearly 23,000 patients were so examined, of which 10 per cent showed sufficient evidence of intrathoracic abnormality to warrant more extensive X-ray examination.

Charged with the supervision of the X-ray activities at the University Health Service, the Department of Roentgenology took an active part in the planning of the X-ray Laboratory in the new Health Service Building, completed in 1939, and has provided medical supervision of the work of this laboratory.

The Neuropsychiatric Institute building, long under contemplation, was finally opened for patients in April, 1939. Direct communication with the main Hospital building made it necessary to alter the central section of the X-ray quarters materially to provide a corridor thoroughfare. As a by-product of this remodeling, the business office of the department was enlarged, and space for the stenographic staff and for film-interpretation facilities was added.

The amount of work in the Department of Roentgenology has steadily increased, the annual number of patient visits having risen from 33,803 in 1932-33 to 54,750 in 1938-39.

Since the private purchase of primitive X-ray equipment by De Nancrède and Darling in 1900, the medical use of X rays at the University has undergone a phenomenal and constantly accelerated development, naturally divisible into four major periods — the formative period before 1913 and the three administrations of Van Zwaluwenburg, Hickey, and Hodges as professors of roentgenology and heads of the department. New and immature as a full-fledged clinical department of the Medical School, the Department of Roentgenology has risen to a position of unquestioned importance in a relatively short period.

Fred J. Hodges

Carleton B. Peirce

SELECTED BIBLIOGRAPHY

Announcement, Department of Medicine and Surgery Annual Report of the University Hospital of the University of Michigan "Noted Alumnus-Teacher Passes Away — An Appreciation of Preston M. Hickey." Calendar Catalogue … "In Memoriam, Preston M. Hickey, 1865-1930." "The X-ray Department of the Hospital of the University of Michigan, Ann Arbor, Michigan." "James Gerrit Van Zwaluwenburg, 1874-1922." President's Report Proceedings of the Board of Regents … "X-ray Department of the University Hospital."

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

surgery 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

have 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

other 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

This description of his teacher by one of the eminent surgeons of the century indicates Maclean's great worth.

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

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

a 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 [1921]: 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

scientific 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

to 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

he 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

features 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

gave 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

further 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

which 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

for 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.

Frederick A. Coller

SELECTED BIBLIOGRAPHY

Annual Report of the University Hospital of the University of Michigan Announcement, Department of Medicine and Surgery "The Department of Medicine and Surgery in the Fifties." Calendar "Dr. Donald Maclean, Detroit." Catalogue … Catalogue and Register "Moses Gunn, A.M., M.D., LL.D." From Vermont to Michigan; Correspondence of James Burrill Angell: 1869-1871. Memorial Sketches of Doctor Moses Gunn. The Medical Independent Peninsular and Independent Med. Journ. "An Historical Sketch of the Department of Medicine and Surgery of the University of Michigan." letter to Frederick A. Coller "The History of the University of Michigan Hospital." President's Report Proceedings of the Board of Regents … "Donald Maclean, 1839-1903." University of Michigan Regents' Proceedings …, 1837-1864. A Doctor's Memories. "Charles B. G. de Nancrède, 1847-1921." "Cyrenus Garrett Darling."

The University Hospital

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The University of Michigan Hospital

THE UNIVERSITY HOSPITAL

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

American 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.

The 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

more 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

for 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

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

and 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

which 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

didactic 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.

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

carried 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

Henry 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

of 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.

Ophthalmology 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 …

"Medical Faculty Minutes,"

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

by 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

capacity 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

of 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.

Administration and Policies

In the memorandum outlining the functions of the Hospital drawn up by Dr. Abram Sager in 1869, certain fundamental principles were set forth, although it required time for some of them to be realized effectively. Dr. Sager assumed that the University "did not on the one hand design to offer [the Hospital] as a public charity, nor on the other, intend rigidly to restrict its benefits to those who were competent to meet the necessary charge for maintenance." He suggested that "the main object of a hospital … is to utilize for practical instruction all the clinical material that may present itself." With these objectives in view Sager suggested that the Hospital should be kept open throughout the entire year. This was twenty-four years before the University summer session was opened, and thirty-three years before the summer session in medicine was begun in 1902.

No person was to be admitted for treatment except upon his willingness to contribute directly or indirectly to the "main object of the institution." No patients should be admitted who were not willing to be utilized for class instruction.

The general management of the Hospital was to be under the control of the medical faculty, with the patients under the charge of the Hospital staff "consisting of the Professors of the Practical branches of the University." It was also suggested that "the charge for maintenance should be placed at the lowest rates consistent with the avoidance of actual loss." This last provision was for many years a bone of contention between the Regents and the clinical faculty, especially in later years when the cost of hospital care was largely augmented. The Regents insisted that the Hospital be self-supporting; the clinical faculty always maintained that low charges were

necessary to furnish the maximum amount of teaching material. Thus, for many years, the Regents maintained financial control of the Hospital's operations, and the medical faculty exercised immediate supervision over admission of patients and educational policies.

Whether a medical school should own its own hospital or utilize affiliated institutions has been much discussed during the past fifty years. Naturally, every school has defended its own system. To many, the use of a hospital by a medical school without the problems incident to its control appears advantageous. In reality, there always have been difficulties. President Charles W. Eliot observed in his report for the year 1888:

The School [Harvard Medical School] labors under some disadvantage because it has no official influence over the appointments in any hospital. It receives indispensable aid and furtherance from all the principal hospitals and Infirmaries in and about Boston, and it has always been in especially intimate relations with the Massachusetts General Hospital; nevertheless, there is not a single hospital, infirmary, or dispensary over the appointments in which it has the least control. Yet no clinical teacher in a medical school can do his work properly unless he has rightful access to a large hospital or infirmary. When, therefore, a vacancy occurs in some clinical department of teaching in the Medical School, the question before the Governing Board of the University is — not who is the most available man for the place in Boston or elsewhere — but who is the most available man as a teacher among the Boston practitioners already holding cognate hospital appointments given by other Boards of Trustees. (Harrington, p. 1079.)

The principle that the Hospital ought to be self-supporting had much to do with the remarkable success of the Medical School. Charges were to be so fixed that the Hospital was to pay its own way and was to be no financial burden upon the University. It was not possible to carry out this program completely, and after the first few years state appropriations for maintenance supplemented the income from patients for board, medicine, unusual appliances, and special nursing. This state support, first provided in 1877 to enable the Hospital to keep open during the summer term, was continued through the summer of 1918. In 1892 the superintendent stated that his current report included only running expenses, not maintenance or permanent expenses (R.P., 1891-96, p. 104), though just what the difference was between maintenance and running expenses is not clear. Since 1918 the principle of self-support has been followed with a fair degree of consistency, with deficits in one year balanced by increased income in others. Without the rigid adherence to this rule in recent years one can imagine the mounting expense of the present Hospital of some 1,350 beds, with an annual budget, in 1940, of more than two million dollars.

During the period while the new Hospital was in the course of construction and immediately after it was occupied, the question of full-time service on the part of the clinical members of the Hospital staff was under serious — and sometimes heated — discussion. The faculty had voted in June, 1919, that the chairs of surgery and internal medicine should be filled by teachers giving full-time service to the University, with a salary from University funds supplemented by a further amount from the income of the Hospital. The appointment of Dr. Hugh Cabot as Professor of Surgery in 1919, an active advocate of the plan, made certain its adoption at Michigan, even though many members of the medical faculty were doubtful about its desirability or practicability.

In a statement made to the Regents by Dr. Cabot in January, 1920, he defined

full time as "the requirement on the part of members of the Department of Surgery to give their whole time to teaching and to the care of patients at the University Hospital." By this plan, he maintained, teachers would devote their entire time and thought to the work of the Hospital, and the resulting conflict between duty to the University and the support and education of a family would be avoided. He pointed out that the income of a teacher in a clinical service arose from two sources, his work as an instructor and his "market value" as a practitioner of medicine. This fact must be recognized in assessing a proper income for such teachers, or the best men would be unwilling to limit their incomes to the ordinary University professorial salaries. He proposed that while his salary as a teacher should be equivalent to salaries in other departments of instruction, the clinical instructor should also be paid an additional amount from patients' fees, to be collected by the University and allocated in accordance with the importance of his medical and surgical services. The amount of the whole compensation should be fixed so that it would bear some relation to the income he would receive as a practitioner.

A few months later, in December, 1920, the Regents adopted a resolution establishing full-time chairs "as soon as the new Hospital building is prepared." In the final event, the plan proved only partly successful. The salaries in the Medical School were criticized by members of the other faculties of the University, while the medical profession in the state was equally critical because of what they felt was a threat to the practice of doctors in local communities throughout the state.

With the opening of the new Hospital, the question was again brought up for consideration, and in February, 1927, the Regents declared full-time service in the Medical School to "comprehend the policy of using the surplus earnings of the full-time departments … for increasing and supplementing expenditures for salaries, supplies, and equipment." Nevertheless, the whole question continued to be a vexing one, and in May, 1929, a committee composed of Regents, members of the medical faculty, and University officers was set up to study and report on the problem. This committee reported informally from time to time, and their consideration eventually led to a resolution on the part of the Regents that on and after July 1, 1932, full time should "cease to be mandatory in the clinical departments" (R.P., 1929-32, p. 868). Within a few years after the passage of this measure, the status of some members who had been serving on a full-time basis had been changed to part time.

The question of part-time service had been affected also by the fact that throughout the early years of the Hospital little or no accommodation was given to private patients. After 1881 patients were those referred to the Hospital from the local communities or by the state. This restriction upon the patients admitted to the Hospital gave rise to the establishment of other hospitals in Ann Arbor. These included a number of private hospitals maintained by members of the University's medical staff. With the coming of Dr. Cabot a few private surgical patients were admitted to the Hospital, and the situation was finally clearly defined in December, 1932, when the Regents approved special provisions on two floors of the surgical wing for the private patients of part-time members of the faculty. In 1939-40, a little more than 41 per cent of the patients were referred by physicians or were University students. A relatively small number (about 3 per cent) were

employees of the Hospital; the remainder were admitted to the Hospital under the various state laws for indigent adults and children.

Hospital superintendents. — When the first little hospital was established on the campus in 1869, John Carrington became janitor or steward (the terms appeared interchangeably), and his wife was matron. He was to prepare the dietary for the hospital patients, keep the fires, and care for the rooms and beds, in return for which he and his family were to "have residence" in the Hospital and receive seventy-five cents per week for each patient. Another couple continued this arrangement for a year or so. After that for a period of some fifteen years, there is no record of a hospital steward, but in 1874 the position of hospital physician was created. It was first held by Dr. Robert J. Peare, denominated by Dr. Sager as "the physician in immediate charge of the inmates." Dr. Alexander C. Maclean was appointed Hospital Surgeon in 1877 and was also designated Hospital Superintendent, with the understanding "that he shall be furnished a room in the building … and also contingent upon his assuming the general control of the work of the matron" (R.P., 1876-81, p. 125).

The increasing number of patients and the difficulties of satisfactory administration under this system led eventually to a series of recommendations by the medical faculty submitted to the Regents in June, 1888. Among other measures, it was suggested: "That the price of board be raised to four dollars per week, … That a competent matron and steward be engaged to conduct the culinary department, … and that the present system of boarding patients … be abolished." In December, 1888, the auditing committee reported that they had selected Joseph Clark as steward of the hospitals at a salary of $1,000. Two and one-half years later he was given the title of Superintendent of the Hospitals, including the Homeopathic Hospital.

On completion of the Catherine Street Hospital group in 1891, a series of new rules and regulations provided that the superintendent should have charge of admitting and discharging patients and should also keep records of patients as well as a property inventory, provide for the patients' diet, hire all servants, collect all moneys from patients, and have oversight of each department of the Hospital (R.P., 1886-91, p. 532).

This was the beginning of a more systematic administrative policy. Clark continued to serve until his death in 1897, when he was succeeded by his son, Harry W. Clark, upon whose resignation in 1900, E. S. Gilmore became superintendent. Gilmore, in turn, was followed in 1908 by Jay B. Draper, who had previously been superintendent of the Pontiac Asylum. Draper was hardworking and conscientious, but apparently had little administrative ability. A rigid policy of making the Hospital "pay its own way," although it resulted in a surplus, gave rise to many complaints and was responsible for a general decline in efficiency and morale.

This condition led to an investigation by a committee of the medical faculty, which reported that in all medical affairs the Hospital should be under the direction of the medical faculty. There had been hospital committees of the medical faculty before the Catherine Street Hospital was built, but their powers were limited, particularly in the matter of finances. As a result, with the approval of the Regents, a new Hospital committee, with extended powers, was created in January, 1912. Dr. Reuben Peterson was made Medical Director, with Dean V. C. Vaughan and Dr. De

Nancrède, Dr. Hewlett, Dr. Canfield, and Dr. Barrett as the other members.

This committee, eager to improve conditions, found that their efforts were still limited by the fact that they had no direct control of Hospital finances, which were administered by the Regents. Although friction was bound to result, this system of control worked with fair success until it was given up in 1918. That it worked at all was probably due to the support of Dr. Walter H. Sawyer, chairman of the Regents' Hospital Committee, to whom the Board naturally turned for advice. Then too, any plan of management would have been strained to the breaking point by World War I and the confusion resulting from the enlistment of a great part of the Hospital staff.

A summary of a report made to President Hutchins by the Medical Director in 1915, outlines the general situation of the Hospital at that time. In this report it was pointed out that the reorganization of the Hospital along modern lines was no easy task, since, under nonmedical management, the unsanitary condition of the old building had resulted in many cases of erysipelas, tonsilitis, and bronchial infections among both patients and nurses. This condition had been remedied and the Hospital had been made clean and sanitary, reducing these avoidable diseases to a minimum. One of the best general kitchens in the state had been installed, as well as a bakery, ward serving-rooms, and a nurses' diet kitchen.

The report also stated that the new Interns' Home had obviated the humiliation of losing the best senior students as interns to other hospitals. A Hospital usher who received patients as they entered and saw that they were escorted to the proper departments, also ended many complaints. An increase in the teaching and supervisory staff of the Training School for Nurses made unnecessary the use of outside nurses unless they were employed by the patients. A trained social service worker, first appointed in 1912, also gradually changed the general tone of the Hospital, bringing the patients to feel that the authorities were interested in them as well as in their bodily ills. Moreover, the twenty-four bed Contagious Disease Hospital brought relief from financial loss caused by quarantines arising from the presence of contagious diseases in the wards. Compulsory Wassermann examinations were given free of charge to all Hospital patients.

As a result of these progressive measures, a deficit incurred in the years 1911-14, because of the increased number of patients, became a surplus in 1914-15. The report mentioned many inadequacies in the plant and emphasized the impossibility of making it over into a modern hospital. It also called attention to the need for a new nurses' home. Despite these deficiencies and handicaps, the report concluded that the institution was as good a teaching hospital as existed anywhere in the country. One great advantage in the increase of control on the part of the Hospital committee lay in the knowledge thus acquired by the faculty members of the committee of the difficulties of hospital management.

Superintendent Draper was killed in a streetcar accident on November 13, 1915, and Robert G. Greve, then in the office of the Secretary of the University, was appointed temporary Superintendent of the Hospital. He held the position until 1918. This was a period of peculiar difficulty because of the problems arising from World War I and from the limited number of nurses, especially during the influenza epidemic of 1918. Moreover, the war also placed those connected with the Hospital in a peculiarly embarrassing position, because the faculty, as teachers, were urged to remain at their posts in

order that the Army would be assured an adequate supply of doctors, whereas the War Department naturally welcomed enlistment of highly trained doctors and surgeons in the Army Medical Corps.

When it was evident that war was imminent, this situation was discussed at a meeting of hospital clinicians held in March, 1917. A statement was drawn up by this group pointing out that the Medical School, in its clinical program, differed from other schools, since its staff was never more than sufficient to ensure good medical and surgical care. The staff at that time included forty-one physicians, all of whom were members of the medical faculty, and their teaching duties were necessarily closely interrelated with the care of their patients. A loss of eight men (20 per cent of the staff) was the maximum depletion that could be allowed if the clinical teaching program were still to be maintained. Reduction of the faculty beyond a certain point would either limit the number of admissions to the Hospital, with a corresponding lessening of service to citizens of the state, or else result in inadequate instruction and the lowering of standards in the treatment of patients.

The members of the staff expressed their willingness to do what was best for the country and signified their readiness to serve in the Medical Officers' Reserve Corps, although it was suggested that a plan be devised which would prevent too serious a reduction of the teaching staff. But, as the war progressed, conditions in the Hospital became worse, and eventually the personnel was depleted by nearly 50 per cent.

When the new and greatly enlarged University Hospital became a certainty in 1917, it was evident that the old system, under which a member of the medical faculty served as medical director, was inadequate and that a medical superintendent and director should be secured who could give his whole time to the administration of the Hospital. Dr. Peterson, then absent under an Army commission, accordingly resigned, and Dr. Christopher G. Parnall, of Jackson, Michigan, a graduate of the Department of Medicine and Surgery in 1904, and experienced in hospital executive work and instruction, was made Medical Superintendent and Director in April, 1918, with the expectation that he would give his whole time to the affairs of the Hospital. Somewhat later he was also made Professor of Administrative Medicine.

In Dr. Parnall's first annual report, which covered the year ending June 30, 1919, it was pointed out that the University Hospital had become one of the great teaching hospitals of the country. Despite yearly admissions numbering nine thousand and an equally large number of outpatients, there was a long waiting list, especially in the surgical service. The Hospital served, in effect, as an infirmary for the entire state, with patients referred to it from every county — particularly from those without adequate hospital facilities. Dr. Parnall served as Superintendent until 1924. During his term of office he promoted many new ideas in organization and administration and was responsible for the planning and designing of the present Hospital building.

After Dr. Parnall's resignation Mr. Greve again served for a short time as Acting Director prior to the appointment of Dr. Harley A. Haynes, who came to the Hospital after many years' experience as director of the State Hospital at Lapeer. In the course of his tenure many radical changes took place in the policies and administration of the Hospital and in its organization in relationship to the University. Dr. Haynes's institutional experience helped him to keep the Hospital doors open during legislative and financial difficulties, during panics and

war, and aided him in the solution of multiple problems ever present in such an institution.

Shortly after Dr. Haynes was appointed, Dr. Albert C. Kerlikowske ('24m) became Chief Resident Physician and, in 1928, Assistant Medical Director of the Hospital.

Development of intern system. — Throughout the early years of the Hospital, the problem of interns, or house physicians, was never satisfactorily settled. Although essential to the proper conduct of a hospital, for many years they occupied an inferior position and were more or less looked down upon by the hospital chiefs. By 1890, however, it came to be recognized in medical schools that experience was a valuable asset for young doctors before they went into practice.

Thus, although the beginnings were very modest, a system of internship gradually developed. A Hospital physician, later called resident physician, was first appointed in 1874 and doubtless performed many of the functions of an intern. In 1895 both a house physician and a house surgeon were listed in the Announcement. The first interns under that designation, four in number, were listed in the Calendar for 1899-1900 and were given a salary of $125 a year with room and board.

For some years after those first appointments the intern system was far from satisfactorily organized. Some ambitious students in applying for positions as interns secured recommendations to more than one hospital, leaving to their faculty sponsors the duty of explaining their failure to accept appointments in other hospitals to which they had applied. This led, of course, to great confusion.

To meet this situation the medical faculty in 1911 appointed a committee to systematize the entire program. To this committee, composed of Dean Vaughan, Dr. Hewlett, and Dr. Peterson, all requests and recommendations for internships were to be referred. Dr. Peterson in laying the matter before the Council on Medical Education of the American Medical Association reported that the committee felt that a firsthand knowledge of the best hospitals throughout the country should be obtained and that appointments to positions in these hospitals, as well as certification of the students' fitness, should be made. A plan for a fifth clinical year in the medical curriculum at Michigan was considered, but was never put into practice.

The admission of students to internship in the Hospital was thus gradually systematized. The situation was strengthened in 1922 by the passage of a law requiring all medical graduates to serve one year in an accredited hospital before beginning to practice. In 1940 thirty-five interns were on the Hospital staff. They rotated among the various clinical services. There were also approximately forty assistant residents, who served for a second year, and thirty resident physicians, who stayed for a third year.

As the University Hospital expanded and more and more interns were required the question of adequate quarters for them, as well as for the house physicians, became pressing. An old residence, moved to the Hospital site, was made over into an interns' home in 1914 at a cost of $2,500, and three years later an enlargement was authorized, so that the building accommodated fourteen men. The third floor of the Hospital Administration Building was also used, as well as a near-by residence taken over for the purpose. These makeshifts were so unsatisfactory, however, that in 1939, a new building for interns, housing some seventy-five men, was erected at the rear of the main Hospital building.

Medical museums and memorials. — In 1935, largely at the suggestion of Dr. Peterson, it was decided to start a collection of medical and surgical apparatus which had been in use in the Hospital. Cases containing items of interest were placed in the teaching amphitheater and in a small room off the Hospital library. The material thus exhibited includes instruments, splints, stethoscopes, and old X-ray equipment.

To preserve the memory of some of the men whose lives were an inspiration in the organization and development of services within the Hospital, from time to time memorial tablets have been placed on walls within the Hospital. These memorial tablets have thus commemorated the services of Regent Walter H. Sawyer, Albion W. Hewlett, James G. Van Zwaluwenburg, George E. Frothingham, Aldred S. Warthin, A. B. Palmer, and Reuben Peterson.

It would be impossible to enumerate the many generous gifts which the Hospital has received over the years, all expressing the particular interests and desires of the donors. They comprise buildings, research and teaching funds, scholarships and fellowships, as well as small individual gifts, all of which have contributed to the development and growth of the Hospital and its services to thousands of patients.

Reuben Peterson[Died November 25, 1942.]

Wilfred B. Shaw

SELECTED BIBLIOGRAPHY

Announcement, Department of Medicine and Surgery Annual Report of the University Hospital of the University of Michigan "The University Hospital." "Conference Meeting Ann Arbor." "Out-Patient Teaching in the Departments of Medicine, Surgery, and Ophthalmology at the University of Michigan Hospital." "Dean Cabot on the Medical School." "The University Hospital: Its Past, Present, and Future." The Harvard Medical School: A History, Narrative and Documentary. "The University Hospital, University of Michigan." "Hospital Facilities Are Increased." "Department of Chemical Laboratories, University of Michigan Hospital." "Medical Faculty Minutes" Compiled Laws of the State of … Public Acts [of the Session of] "Minutes … Executive Committee of the Council.…" "New University Hospital Completed." "Official Minutes of the … Annual Meeting … 1926…" "Report of the Committee on Medical Education." "The History of the University of Michigan Hospital." "The New Contagious Hospital at the University of Michigan and Its Proposed Plan of Operation." "University Hospital Report, 1914-15." "The Relation

of the Medical School to the Hospital or Intern Year" "The University Hospitals." President's Report Proceedings of the Board of Regents … "Report … Committee … to Survey … Hospital Charity in Michigan Hospitals." University Hospital Bulletin University Hospital Number. University of Michigan Regents' Proceedings …, 1837-1864. A Doctor's Memories.

The Relationship of the Hospital to the State

In the year 1939-40 the University of Michigan Hospital received 26,728 patients. Of these, 6,619 were to some extent dependent on the counties or on the state, and the expenses of 715 other patients were guaranteed by public officers and payable from public funds (P.R., 1939-40, pp. 308-9).

Although the University Hospital opened in 1869, it received no state support until 1875, and only since the 1880's have there been laws governing the care and maintenance of public patients. Nevertheless, as early as 1859 the concept of a state almshouse to be maintained by the University for clinical as well as charitable purposes was presented to the Michigan State Medical Society.

Ten years later, when the Regents were planning a hospital, the medical faculty set forth the scope and purposes of the institution, stating that its main object should be "to utilize for practical instruction all the clinical material that may present itself" and adding that they believed the Regents neither designed it to be a "public charity" nor meant to restrict its benefits only "to those who were competent to meet the necessary charge" (R.P., 1864-70, p. 366). A maintenance charge sufficient to cover food and medical and surgical supplies was recommended, and all patients were to be utilized for clinical instruction. The medical faculty was to have general control.

Summer operation of the Hospital was postponed until 1878, although at that time there was no instruction during the summer. Until 1872 charges to patients covered only their food. After that date all except "paupers" paid for medical supplies.

References to "paupers" and "charity patients" seem to indicate ability of the patients in some cases to pay for food and supplies, but the scanty records are not clear. Indigent patients must often have found even nominal fees impossible, especially in cases of long or chronic illness. Since medical service was free, fees from the well-to-do could not have provided for the poorer patients, and yet the Hospital was attempting to maintain itself from fees adjusted to the actual cost level. How this difficulty was solved, the records do not state. Possibly, charitable agencies maintained some patients.

The year in which the Hospital was established, Henry P. Baldwin, a Detroit philanthropist, became governor of the state. He had visited jails and county almshouses and had been shocked by the unsanitary conditions, lack of medical care, and nonsegregation of criminals. He was aroused over the conditions of children forced to remain in these places of ignorance, disease, and crime. Illnesses which might have been temporary often

went untreated, eventually became incurable, and made patients permanently dependent on public funds.

Governor Baldwin secured the appointment of a state investigating commission, the adoption of children into normal homes, and the authorization of a central school to care for them before adoption, thus avoiding the county almshouse. He also demanded a remodeling of the state's charitable and penal systems. The state public school thus established in 1871 was opened at Coldwater in 1874, the first institution of its kind in the United States. In 1879 the investigating commission became the State Board of Corrections and Charities and so remained until 1921, when it was replaced by the Department of Social Welfare.

While this commission was examining the county almshouses, a committee of the University medical faculty reported, in 1870, on the first year of operation of the Hospital. Although additional beds had been secured during the year the Hospital had been filled to capacity, and the committee recommended a large state hospital in connection with the Department of Medicine and Surgery. While there were no immediate results of the proposal, discussion of the plan undoubtedly had some bearing on later developments.

A "state almshouse hospital," on the general plan of such institutions in Massachusetts, was proposed. Free medical service and medicines prepared inexpensively by the pharmacy were offered the state for its invalid poor in return for the benefit of clinical material. The commission believed that with help from the legislature such a plan would be feasible.

The Regents, however, were slow to act on this recommendation, although a committee conferred with Governor Baldwin's commissioners. Then a new Regent, Dr. Charles Rynd, serving as head of the committee on the Medical Department, reported unfavorably on the value of large hospitals for instruction, preferring the old preceptor system.

Later, however, the committee changed its view, for in the spring of 1872 (R.P., 1870-76, pp. 189-91) it strongly urged the establishment of a large state hospital at the University, the best place "in the West" for pursuing the "higher clinical field of thought." It requested a large and modern hospital:

Not only are our alms-houses the repositories of many persons who are thus incarcerated to languish, suffer on and die without that aid to which the suffering poor are justly entitled, but many persons of wealth and refinement labor from diseases which if treated at all by the private practitioner, are treated but poorly, and with indifferent and unsatisfactory results.

R.P.

President Angell, in 1872, made a vigorous plea for a state hospital for almshouse patients or a large hospital for special diseases, the funds to come either from private or from public benefactions. At the same time Dr. Alonzo Palmer reported the medical faculty's views to the Regents and promised to have a hospital plan ready for consideration at the next meeting.

A joint committee of Regents and faculty members was then appointed to confer with the governor's committee on state charities. This joint committee discussed the necessity for such a hospital and favorably considered a proposal to build it at Ann Arbor, but it was not deemed "judicious to ask for an appropriation" (R.P., 1870-76, p. 251). Possibly some new difficulty in the controversy over the proposed homeopathic school made the University reticent in pressing any demands for state funds. When the Homeopathic Medical College

was established three years later, the legislature contributed several thousand dollars toward the construction and equipment of a larger and more modern University Hospital, provided a stated amount could be raised in Ann Arbor.

Act No. 207 of 1875, granting funds for the old Pavilion Hospital, was the first specific appropriation for the University Hospital, henceforth called a "state hospital." Though no funds were provided for running expenses, it did set a precedent for a series of future appropriations separate from grants for buildings and equipment. These were also distinct from somewhat later state disbursements made under public-patient laws.

No sooner was the new building completed in 1876 than the faculty requested, as it had in 1869, that the Hospital remain open throughout the year and that the medical session be extended from six to nine months. These requests were approved by the legislature in May, 1877.

During the vacations of 1878, 1879, and 1880, the Hospital remained open, but for the following eleven years it was closed in the summer, although the appropriations by the legislature continued, averaging until 1891, about $4,000 a year. Throughout this period these grants were used for Hospital running expenses. In the year 1891-92 the Hospital received $10,000 from the state in addition to funds for the new Hospital on Catherine Street, then in the course of construction. The following year an additional $8,000 was received for salaries and general expenses, but no direct grants for expenses were made during the next four years.

The opening of the Catherine Street Hospital in 1891 brought a marked increase in receipts, but, nevertheless, over the four-year period, 1893-97, there were regular deficits to be made up from the University's general fund. Despite financial difficulties, however, the Regents directed that the Hospital be kept open in summer, although the effects of the nationwide financial crisis in 1893 forced its closure during the summers of 1895 and 1896.

Relief came in 1897, when Act No. 203 provided $3,000 a year regularly "for the use and maintenance" of the University Hospital and the Homeopathic Hospital, provided the hospitals were operated during the summers. Though this law has never been repealed, it remained in practical effect only until July, 1919. After that date the payments were refunded to the state, and whatever annual deficits have been incurred have been offset by the surpluses of other years.

First public-patient laws, 1881-97. — The metamorphosis of the University Hospital into a state hospital accommodating many public patients has been slow. There have been three types of public-patient laws: those for children, those for adults, and those for either adults or children suffering from certain specified disorders. Of these, only the first two types came before 1900.

The board in control of the State Public School at Coldwater first advocated state laws for hospitalizing public patients in the University Hospital. The secretary of this board wrote to President Angell in 1878, suggesting that it would afford great relief to the Cold-water school if the state would provide for dependent children afflicted with chronic diseases requiring surgical operations, since they were not admissible to the school and had of necessity to be returned to the poorhouses, where they could receive no proper treatment. He

suggested that the Regents might recommend appropriate action to the legislature and that the "State Hospital at Ann Arbor" was the proper place for such patients.

This letter was printed in full in the Regents' Proceedings, but the committee on the Medical Department reported that they had no funds for such a program. They promised, however, to join in a request that such children be provided for, and eventually the two boards secured the passage of Michigan's first law for the treatment of the invalid poor in the University Hospital, the children's act (No. 138) of 1881.

This act provided not only for sick and diseased children from the State School at Coldwater, but for all children suffering from conditions preventing eventual self-support. Transportation, board, nursing, and other expenses were to be paid by the state upon recommendation by the proper authorities, but admission depended upon the decision of the resident physician at the University Hospital as to whether or not the child could be benefited.

Thirteen children were treated under the provisions of this law during the first year, but many were turned away because of the Hospital's crowded condition. Transportation and maintenance for these thirteen children amounted to $634.68; the following year the corresponding payment was $434.84.

President Angell made it clear in his report for 1878 that he did not consider the Pavilion Hospital adequate and insisted on aid for adults, as well as for children, pointing out that the University's hospitals had already returned more than their cost to the state.

The Hospital's congested condition was relieved to a certain extent by a legislative grant for an eye and ear ward in 1879, but once more no provision for adult invalids was made. The subject was not mentioned again until 1888, when certain groups endeavored to have at least part of the clinical work transferred to Detroit. President Angell in opposing such a step emphasized once more the need of a larger and more modern hospital:

It would doubtless be a real economy for the counties, which may now be burdened with the cost of maintaining through life persons who have curable maladies, to send such patients here. To some extent they do this now. But with ampler accommodations more patients could be cared for, and the interests of the counties, of the patients, and of our medical school would at once be subserved.

(P.R., 1888-1902, p. 22.)

In 1889 the legislature made a grant of $50,000 for the new Hospital, to be supplemented by a contribution from the city of Ann Arbor. A note of disappointment tempered President Angell's expression of gratitude. The appropriation would not permit the erection of a large hospital such as had been projected in earlier years, but it was his belief that the clinical facilities might be made "reasonably satisfactory."

At the same session the legislature passed the first state law (Act No. 246 of 1889) for the admission of three classes of adult public patients: those who had become county charges because of severe injury and were in need of special treatment to prevent their becoming permanently dependent; those dependent upon the counties because of acute disease or physical injuries and requiring major operations to preserve life; and such obstetrical cases as were a public charge upon the counties for care and treatment.

Unlike the preceding children's law, this act charged the transportation and maintenance of these patients to the counties and left local enforcement to local officers and physicians. While such medical service to adult county poor to

some extent already was provided, the new law afforded a statutory basis for the procedure and undoubtedly encouraged further use of the Hospital.

Two laws enacted in 1897 authorized further medical aid, primarily for children. Act No. 42 required that the physician attending at the birth of a child of "any indigent poor person" should report, under penalty, any deformity or malady curable by surgical operation. On certification by the proper local officers, the child was to be brought at state expense to one of the University hospitals for treatment.

Under the first children's hospitalization act of 1881, only those enrolled in the State Public School at Coldwater or those who, if restored to health, could enter that school had been admissible for treatment. By an amending act (No. 233 of 1897) the same benefits were extended to any dependent persons in the state schools for the blind, deaf, and feebleminded, as well as to anyone entitled to enter one of these institutions. Actually, for two years the Hospital had been caring for the children from the School for the Blind at Lansing, at a charge of $2.50 a week.

This substitution of "dependent persons" for "dependent children" might seem to indicate that a large number of adults would be admitted under the new law, but this was not true, since the state charitable institutions existed chiefly for the benefit of defective children. Nevertheless, this oldest public-patient law is still in effect, and today patients recommended by the Michigan Children's Institute, which took the place of the State Public School in 1935, are treated under its provisions.

First special-disease laws, 1901-7. — In 1899 President Angell reported that the University had established an informal but valuable relationship with the state institutions for the insane, in each of which University graduates had been installed as resident pathologists, acting as assistants to the state's head neuropathologist at the University.

There had previously been grants to particular clinics, but until the present century no state provision had been made for the maintenance in the University Hospital of persons suffering from any specified diseases. The first such law was Act No. 161 of 1901, under which the construction of the Psychopathic Ward was begun. It was passed not upon the request nor with the consent of the Regents but in response to the efforts of friends of Professor William J. Herdman, head of the Department of Psychiatry. The Regents, however, accepted the gift, provided the unit be maintained at no cost to the University, and actual construction began in 1902.

The first special-disease law put into full effect was the rabies law of 1903 (Act No. 116), approved a few weeks after the Regents established the Pasteur Institute for the treatment of Michigan residents. It undertook to defray the expenses of indigent persons infected with the virus and assigned to the local boards of health the responsibility of sending them to the University, with transportation and other expenses to be paid by the township, village, or city.

Although the new Psychopathic Ward was practically completed and plans for its administration were under discussion in the spring of 1904, it was not occupied until Act No. 140 of 1905 shifted the payment of the director's salary to the state and introduced partial state control. It specified that a joint board composed of the Regents and the trustees of the state asylums should select a clinical psychiatrist to manage the institution and to oversee the clinical and pathological research in the state asylums and that this same psychiatrist, as a member of the medical faculty, should give instruction

in nervous and mental diseases. The same act also appropriated $14,000 for equipment and $5,000 a year for running expenses for each of the following two years, out of which the new appointee's salary was to be paid.

The following year by Act No. 278 the State Psychopathic Hospital ceased to be a department of the University Hospital and became an almost autonomous state institution. For many years thereafter, under an unusual arrangement, it was conducted in a non-University building on the University Hospital grounds. Its control was vested in a board of eight trustees, four Regents and four asylum trustees appointed annually by the four asylum boards.

Under the two acts of 1901 and 1907 expenses of all public patients except wards of the state were paid by the counties, although whenever possible these costs were to be reimbursed by relatives or guardians. Some public patients were sent by probate judges for curative, preventive, or diagnostic purposes and others came from the asylums. Private patients were also received and cared for at fixed rates.

Legislation for children, 1900-1913. — Between 1880 and 1910 the population of Michigan almost doubled. During this period measures for the relief of persons only partly dependent became more numerous. An 1889 law for veterans and their dependents gained popularity, and the children's law of 1881 was supplemented by amendment, by legislation for veterans' families, by the juvenile court act of 1903, and by other legislation relative to desertion and broken homes. A 1907 act for dependent, neglected, and delinquent children reflected the growing number of local hospitals, since under it county probate courts were authorized to place any child requiring special medical attention "in a public hospital or in an institution."

This measure might seem to have encouraged local treatment, but the University Hospital was gaining special recognition for its work in pediatrics, and after 1906 the Palmer Ward clinic supplied the impetus for modernizing and amplifying the hospitalization statutes affecting the University. Previous laws were considered inadequate since they provided only for certain classes of persons and "discriminated against the normal child who developed an illness requiring hospital care, in favor of the imbecile who never could be made into a good citizen" (Hosp. Rept., 1918-19, pp. 113-14).

The result was a new children's law (Act No. 274, 1913) which became the model for similar measures in other states. Under its terms deformed or afflicted children whose conditions could be remedied and whose parents could not provide proper treatment were to be reported to the probate judges and cared for at state expense at one of the University hospitals. County agents and superintendents of the poor not on fixed salaries were to be compensated for their time and expense in making the necessary investigations, and the examining physicians were guaranteed a standard fee.

While this 1913 law did not affect the Coldwater State School hospitalization act of 1881, in effect it replaced and led to the repeal in 1915 of the infants' hospitalization act of 1897. Unfortunately, the provision for compulsory report and treatment of deformities present at birth was not included in the new law. The Afflicted Children's Act was in force until the new Crippled Children's Act was passed in 1927.

The adult public-patient law of 1915. — Free treatment for adult residents of any Michigan county who would be benefited by medical and surgical treatment but who were financially

unable to obtain it was provided in 1915 by Act No. 267, which also provided obstetrical service for mothers unable to pay for it and for the care of children born of women hospitalized under the statute. As in the children's law, the prospective patient was committed to treatment by a probate judge only after he had obtained a satisfactory financial and medical report, and the expense of the necessary investigation had been guaranteed.

This act for the adult poor specified that transportation and maintenance were to be paid by the counties, which were to reimburse the state for any funds advanced to the Hospital for these expenses. Although University authorities felt that this was a defect, since the county officers might be inclined to send patients to county houses, where they could be treated at less expense, rather than to the University, between July 1, 1915, and June 30, 1940, more than 70,000 patients were registered in the Hospital.

The effect of the laws of 1913 and 1915. — These new laws for adults and children extended the benefits of hospitalization. In fact, the only important restriction other than that pertaining to medical and financial needs was that the maladies and deformities to be treated could be remedied. The broader scope of these laws and also, possibly, the guarantee of payment of the agents' fees and expenses resulted in a notable increase in public patients. In 1913-14, 255 children were treated under the 1913 children's law; the next year there were 615. In 1915-16, 604 children were treated under this act, and under the 1915 adult law 411 patients were treated; during the following year 707 children and 647 adults were treated. Two years later more adult patients than children were being received under these laws.

Psychopathic hospital law of 1917. — Under Act No. 310 of 1917 the trustees of the State Psychopathic Hospital were given the right to establish centers for the treatment, care, and maintenance of patients at places other than the Psychopathic Hospital and to provide for the preservation of mental health in former patients. A $3,000 increase in the state's annual appropriation to the institution took care of the additional expense for these new services.

The children's law of 1921. — A new children's law in 1921 (Act No. 137), primarily affecting local hospitals, empowered the counties to contract with agencies and institutions licensed by the State Board of Corrections and Charities for the care, maintenance, and medical treatment of children, all expenses to be paid from county funds.

Special-disease laws, 1921-25. — A general reorganization of all the public charitable, corrective, and penal institutions was effected in 1921 (Act No. 163), when the State Welfare Department was created to take the place of the old Board of Corrections and Charities. The State Psychopathic Hospital was particularly affected, since the old separate asylum boards were abolished and their powers transferred to the State Hospital Commission, one of four set up within the new department. All non-Regent trustees of the State Psychopathic Hospital were to be appointed by the governor, and while the medical director's functions of visiting and inspecting the other state hospitals were now a part of the activities of the new State Welfare Department, that department was to have no part in the management of the Psychopathic Hospital nor control of its board of trustees.

A new general insanity law (Act No. 151) superseded in 1923 the old Act No. 217 of 1903. It not only defined the functions of the new State Hospital

Commission and of the institutions under its control, but also affected the mode of dealing with State Psychopathic Hospital patients. The same year authorization was given for sterilization operations at the University Hospital (Act No. 258, amended by Act No. 71 of 1925).

The University's Pasteur Institute ceased to be the only clinic in the state for treatment at public expense of persons infected with rabies when, in 1925, Act No. 321 was passed authorizing local health boards to make the necessary arrangements at the Institute or at some other treatment center for Pasteur treatment at an expense to the counties not to exceed $200 in any one case. It was held by the attorney general in 1929 that this act by implication repealed the old rabies law of 1903 and in effect shifted the costs from cities and townships to the counties. At the same time everyone in need of treatment became entitled to receive it regardless of economic status.

The adult-patient law of 1925. — A new general poor law in 1925 (Act No. 146) repealed the old law of 1869, which had made it "the duty" of county poor superintendents to send to the University county charges who would remain indigent because of severe injury unless specially treated, as well as those who needed major operations to save their lives. While the new law still provided that superintendents of the poor might arrange for the hospital care of such persons, they were no longer compelled to do so. Furthermore, patients might be committed either to the University Hospital or to any other hospital the superintendents of the poor might select — an "alternative" provision later inserted in the three laws under which the University Hospital now receives most of its public patients, the adult-patient act of 1915 and the two general laws for crippled and afflicted children (1881 and 1913).

The 1925 version of the poor law providing for medical aid was in most respects, however, identical with that of 1889, except that the terms "poor person" and "infirmary" were used in place of "pauper" and "poor-house." The retention of the terms "obstetrical wards" and "hospitals of the University" revealed a certain obsolescence in the statute, since for nearly twenty years there had been separate buildings for obstetrical patients and the Homeopathic Hospital had been merged with the University Hospital in 1922.

The years following the opening of the present Hospital building in 1925 witnessed significant developments in all three types of public-patient laws. The major law for the hospitalization of indigent adults (Act No. 267 of 1915) was materially altered by four amendatory acts. In 1927 Act No. 317 directed the University Hospital superintendent to send reports on persons hospitalized under the 1915 law to the probate judges and to release the counties from liability for hospitalization periods longer than six months, unless an extension order was obtained. In 1929 the boards of county auditors were made responsible by Act No. 293 for investigating the financial condition of prospective patients seeking aid under the 1915 adult-patient act and were permitted to arrange with patients to repay the counties for benefits received.

Under the earlier poor law and under certain other statutes, adults were treated in local hospitals, but those hospitalized under the adult-patient law of 1915 had to be committed to the University Hospital. This was changed in 1933 by Act No. 222, giving the probate judges the privilege of selecting other hospitals if they saw fit.

Act No. 304 of 1939 denied officials

any authority to compel a patient to undergo an operation or treatment as provided under the terms of the 1915 adult-patient law. Only with the consent of the guardian or of the nearest relative could such treatment be undertaken for patients not in condition to decide for themselves. The same held true for children.

Since physicians not at the University were permitted to charge fees, the title of Act No. 267 of 1915 was altered in the 1939 law to omit the word "free" from the phrase "to provide free hospital service and medical and surgical treatment." Stricter financial controls were also prescribed, and any falsification regarding financial need was punishable by fine or imprisonment. Also, the optional repayment agreements were made compulsory. Where there were county boards of auditors, the Department of Social Welfare might conduct financial investigations and become responsible for obtaining repayment pledges.

Upon the enactment of this 1939 law the attorney general distinguished between the hospitalized group of special patients in the amended Act No. 267 of 1915 and the group given medical aid outside of hospitals under a 1939 welfare act (No. 280).

In certain instances county costs for administering the poor law of 1925 (No. 146) might be recharged to the smaller governmental units, which the afflicted adult act of 1915 did not permit. This led the attorney general to rule in March, 1939, that supervisors might not charge back expenses incurred under the 1915 act to the townships or cities.

Special-disease laws, 1925-40. — The Psychopathic Hospital act of 1927 (No. 207) was the first special-disease law affecting the clinical work of the Medical School after the opening of the new University Hospital. It repealed the amended law of 1907 and embodied the changes brought about by the abolition of the several asylum boards and the creation of the State Hospital Commission and the augmented State Administrative Board in 1931. In all matters not prescribed, the trustees of the State Psychopathic Hospital retained sole control. Non-Regent members were appointed by the governor for four-year terms, whereas the four Regent members continued to be selected annually by the Regents. The new law required that medical officers of the state mental hospitals receive University instruction, at the expense of the respective institutions.

A new law for sterilization (No. 281), repealing the amended act of 1923, was passed in 1929. The largest number of cases registered under it in a year was sixty-three in 1930-31; there were none in 1939-40.

The first tuberculosis legislation affecting the University Hospital was passed in 1929, when Act No. 115 abolished the board of trustees of the Howell State Sanatorium and created the state Tuberculosis Sanatorium Commission. The commission was given control of any sanatoriums to be established and the power to transfer patients from state tuberculosis sanatoriums to the University Hospital for special treatment, with the usual costs chargeable to the counties for all indigent patients except state wards. A fund for a one-hundred-bed University Hospital addition for tubercular patients, equipped for diagnosis and special surgical treatment rather than for prolonged care, was granted in 1929 by Act No. 324.

In 1935 the legislature, by Public Act No. 173, abolished the State Psychopathic Hospital board and transferred its functions to the Board of Regents. Since the Psychopathic Hospital still remained, nominally, a semi-independent state institution and not a part of the

University Hospital, the Regents, in acting upon Psychopathic Hospital affairs, assumed that they were serving as a state board succeeding the old board of trustees (R.P., 1932-36, pp. 718 and 810). This act under which rules were to be formulated by the Regents, replaced, in general, all references to the regulations of the State Administrative Board as set forth in the Psychopathic Hospital law of 1927. The governing board retained the power to provide aftertreatment, but the provision for city or community dispensaries and mental hygiene departments was omitted.

The laws concerning institutions for mental diseases, feeble-mindedness, and epilepsy were revised in 1937, when, under Act No. 104, the State Hospital Commission within the State Welfare Department was replaced by a new, separate commission of the same name. Also, Acts No. 85 and 243 providing for the new five-story Neuropsychiatric Institute addition to the University Hospital, superseded and repealed the Psychopathic Hospital act of 1927 and abolished the State Psychopathic Hospital as an organization, but stipulated that the Regents should keep the property (see Part II: The Neuropsychiatric Institute and the State Psychopathic Hospital) .

The main purposes of the Institute as outlined are: (1) to emphasize early diagnosis and treatment, (2) to establish a clinic for study of the prevention of mental illness, and (3) to conduct training and research in all phases of mental disease. The Institute, as part of the University Hospital, is controlled by the Regents. It does, however, receive state aid. In the three years ending June 30, 1940, this annual grant averaged about $105,000.

The provision that the medical director of the Psychopathic Hospital was also to be ex officio neuropathologist of all the state mental hospitals was discontinued by Act No. 85, as were the regulations regarding the visits by the outstate hospital staff members to the neuropathological laboratory at Ann Arbor. It also provided that all patients in the old Psychopathic Hospital should either be discharged as normal or declared insane, feeble-minded, or epileptic and committed to a suitable institution. State hospital patients might be transferred to the new Institute for treatment or for purposes of research, at the expense of the Institute. The law also permitted the temporary referral to the Institute of all persons suspected of mental disorder. Though not definitely committed, their detention periods could be extended to provide time to determine whether commitment to a state hospital was desirable.

While the only voluntary patients in the old Psychopathic Hospital were private patients, under the regulations of the Institute an indigent person might apply for admission under a private court order. The Institute was also organized to make special provision for the care of children. Up to June, 1940, patients were received under several different laws. Thus, transfer patients were admitted under Act No. 85 of 1937; adults came under Act No. 267 of 1915; and children entered under Act No. 138 of 1881, as well as under the two general laws for afflicted children, Act No. 174 of 1913 and Act No. 283 of 1939, and also under the crippled children's law, Act No. 158 of 1937.

Children's hospitalization laws, 1925-40. — More than half the laws affecting the University Hospital passed between 1925 and 1940 concerned children, and the changes were far-reaching. After Act No. 236 created the Michigan Crippled Children Commission in 1927, any crippled child could be treated either at the University Hospital or at any

other hospital having an orthopedic surgeon, the commission to approve both surgeons and hospitals. Surgeons' fees in all hospitals except the University Hospital as well as transportation and hospital expenses were to be paid by the state. The commission was to locate as many as possible of the state's crippled children and report what was being done for them. It was to conduct diagnostic clinics and, in general, to secure the best possible surgical and medical treatment for the children, as well as to take charge of their convalescent care and education. By a further act (No. 317), in 1929, the commission was given the additional responsibility of follow-up supervision.

In the same session in which the Crippled Children's Act was passed, Act No. 274 of 1913, known since 1927 as the Afflicted Children's Act, was amended to provide for the treatment of obstetrical cases.

Although the 1927 Crippled Children's Act was supposed to end hospitalization of crippled children as provided under the old 1913 law, there is evidence that the law was sometimes used for the local hospitalization of "afflicted" but not crippled children. In fact, many probate judges continued to send crippled children to the University Hospital under the 1913 act.

In 1926-27, 2,614 patients were registered in the University Hospital under the children's act of 1913; the following year there were 2,760, and in 1928-29, 3,356. Apparently, no statistics are available on the corresponding numbers of patients registered under the Crippled Children's Act of 1927 until 1929-30, when there were fifty-three children under the Crippled Children's Act as against 4,244 under the Afflicted Children's Act, with seventeen children registered from state institutions under the amended Act No. 138 of 1881.

In June, 1931, the Crippled Children Commission obtained authority to pass upon hospital bills incurred under the Crippled Children's Act, but since the hospitals and courts were not obliged to report on children committed under the Afflicted Children's Act, it still had no way of estimating the total hospitalization of crippled children. Two years later an amendatory act (No. 248) sought to improve the situation, but conflicting provisions made the law difficult to administer. It introduced the use of local hospitals for "afflicted" children, gave the Crippled Children Commission charge of the administration of the Afflicted Children's Act, and forced a sharper separation of "crippled" and "afflicted" cases by making it illegal to hospitalize a crippled child under the Afflicted Children's Act.

Since under the adult acts only patients more than twenty-one years old were entitled to aid and under Act No. 248 of 1933 only persons under eighteen could be treated under the Afflicted Children's Act, there was no legal way to hospitalize "afflicted" persons between seventeen and twenty-one years of age. Act No. 5 of 1934 removed this difficulty.

Contradictory provisions in Act No. 248 regarding fee schedules and modes of payment as between the counties and state brought some confusion. The first difficulty was temporarily solved by the adoption of a satisfactory fee schedule. The commission also decided in 1933 to approve no hospital bills under the Afflicted Children's Act except those for fifteen-day treatment periods for which advance permission had been obtained, thus preventing state payment for children not hospitalized under proper probate court orders.

Hurley Hospital at Flint, Fairmount Hospital at Kalamazoo, and the Northern Michigan Children's Clinic at Marquette had been regarded as "branches"

of the University Hospital, but when Act No. 248 went into effect the two former hospitals were made approved hospitals for afflicted children, the Marquette clinic remaining as a branch of the University Hospital.

In a 1935 ruling the commission provided reimbursement to the state by the counties for expenses incurred in cases of children suffering from adult types of tuberculosis, venereal diseases, or other communicable diseases and committed to hospitals under the Afflicted Children's Act. This became law in 1939.

The sweeping change of policy involved in Act No. 248 of 1933 caught most local officials unaware, and thousands of court orders under the old children's law of 1913 had to be returned for correction. But despite flaws, mostly corrected later, the act had a more pronounced effect on the over-all administration of children's hospital relief than did the special legislation and establishment of the Crippled Children Commission in 1927. The University, in June, 1933, was the only institution approved under the Afflicted Children's Act. A year later, in 1933-34, there were more than one hundred approved institutions with a resultant decrease in the University Hospital of nearly twelve hundred patients committed under the Afflicted Children's Act. Registrations under the Crippled Children's Act rose from 190 to 1,049, and the commission reported that the University Hospital increase accounted for more than three-fourths of the year's increase in cases for all hospitals under the Crippled Children's Act.

As a result of continuing dissatisfaction with the allocation of fees between state and counties, the old children's law of 1913 was once more amended. In 1935 Act No. 94 made transportation expenses of afflicted children rechargeable to the counties, but left treatment fees payable by the state. But then a new difficulty arose; the state appropriation for children's medical care was not adequate to cover physicians' fees. The commission estimated in 1936 that about one million dollars should have been added to the fund to cover these fees. The physicians, however, agreed to accept a nominal fee of one dollar a case during the 1934-36 biennium, and within a year a more liberal schedule was tentatively adopted.

The Afflicted Children's Act was further amended in 1935 by Act No. 208, which required that before a child could be hospitalized an agreement to reimburse the state for expenses was necessary between the auditor-general and the child's parents or guardian. Within two years such repayments rose from $841.92 to $11,723.88.

Three amendatory statutes in 1935 also changed the Crippled Children's Act of 1927. One (No. 169) shifted transportation costs to the counties, directed hospitals to report on the admittance and discharge of patients, and specified that no person should be considered a recipient of pauper aid because of inability to pay for a child's treatment. Another act (No. 182) prescribed that all collections from parents and school districts, as well as gifts to the commission, should be deposited to the commission's credit in the state's general fund. A third (No. 207) made repayment pledges by parents or guardians mandatory and fixed the amount per day payable by the state and local school districts for hospital schools. In 1937 these amendments were consolidated in Act No. 158, which replaced Act No. 236 of 1927.

This new law included the needed definition of "crippled child" and gave the commission additional responsibility, financial backing, and greater authority to enforce its decisions. It became responsible for handling each case committed

by a probate judge. Collections, legislative appropriations, and gifts were to be held, as before, distinct from other state funds, but the new law omitted the provision that such funds be disbursed "as appropriated by the legislature." The commission and the auditor-general had the right to check all disbursements.

The new law emphasized preventive measures. Aid to children suffering from conditions that lead to crippling was authorized, and facilities for finding and serving such children, and those already crippled, especially in rural areas, were improved. In addition to diagnostic clinics, an expanded outstate service provided preventive treatment, minor orthopedic operations, follow-up supervision, and outpatient and convalescent service. In special cases transportation to clinics and treatment centers was furnished.

The commission was authorized to approve homes or hospital outpatient departments where adequate care and prevocational training could be provided those crippled children who would benefit very little from treatment. Rates for medical and hospital service were fixed for the first time: $4.50 a day for hospital service, doctors' fees at $75 for a major operation, and $200 for any one patient in a single year. One-half the costs of custodial cases was to be recharged to the counties; local school districts continued to furnish some support for the hospital schools, but under the new Crippled Children's Act all other expenses were paid by the state.

The desired definition of "afflicted child" was furnished by Act No. 217 of 1937, which also effected certain other changes in the Afflicted Children's Act, but two years later the old much-amended children's act of 1913 was replaced by Act No. 283. It extended the commission's jurisdiction in "afflicted" cases, established further financial controls, and systematized provisions added to the old act by the various amendments. It also limited the state's liability, allocating to the counties according to population three-fourths of the fund available each year, with the remaining one-fourth to be distributed according to need. The rate at which counties could consume their quota was also limited, and they were not allowed to reimburse themselves from later allotments. The commission was thus relieved from approving more services than could be paid for from available funds, and the state from the necessity of making supplementary appropriations.

In 1932-33, the year before the local hospitals were permitted to receive afflicted children under Act No. 274 of 1913, the number of patients in the University Hospital under the Afflicted Children's Act was nearly twice the number under the Afflicted Adult Act of 1915. By 1935-36 more patients were registered under the adult act of 1915 (No. 267) than under all three children's laws. In 1939-40, by far the greatest number of patients received under any one law was registered under the Afflicted Adult Act of 1915.

Helen Travis

SELECTED BIBLIOGRAPHY

Annual Report of the University Hospital of the University of Michigan Compiled Laws of the State of …, 1897. Public Acts [of the Session of] President's Report Proceedings of the Board of Regents …

The Heart Station

During the period when Dr. A. W. Hewlett held the chair of medicine at the University (1908-16) there was widespread interest in the irregularities and other abnormalities of the heartbeat, and knowledge in this field was expanding very rapidly. Dr. Hewlett himself had made important contributions to this subject, and Dr. J. G. Van Zwaluwenburg was also deeply interested in it. As soon as the necessary funds could be obtained Dr. Hewlett purchased a string galvanometer, and electrocardiograms were taken for the first time at the University Hospital in the spring of 1914.

Dr. Frank N. Wilson, who was appointed Assistant in the Department of Internal Medicine upon his graduation with the class of 1913, was assigned the task of installing and operating this instrument. Since no other space was available it was placed in Dr. Hewlett's private office, a small room separated by a thin wooden partition extending half way to the ceiling from the general office of the department, which was on the second floor of the Medical Wing of the Old University Hospital. The electrocardiographic tracings were carried downstairs, where a tiny darkroom was available for their development. In spite of these meager and inconvenient facilities, many interesting observations were made and a number of papers were published. With Dr. Hewlett's help arrangements were made for recording the venous pulse, taken with a Frank capsule, simultaneously with the electrocardiogram, and this added greatly to the value of the tracings. One of the most important studies carried out dealt with the production of atrioventricular rhythm in normal subjects after the administration of atropin.

In 1916 both Dr. Hewlett and Dr. Wilson left Michigan and during the next four years relatively few tracings were taken. When Dr. Wilson returned to Ann Arbor in 1920 the equipment had been removed from its old location. It was not in good working order, and there was no available space where it could be installed. Nothing further was done until 1922 when Dr. George Herrmann, a Michigan graduate, joined the staff. At that time, with the help of Dean Vaughan, a special appropriation was obtained which made it possible to purchase new equipment and to construct a small laboratory where it could be set up. This laboratory included a small passageway and some space beneath the stairs leading to the medical amphitheater. As a result many of the waves on the tracings obtained were produced, not by the patient's heartbeat, but by the students rushing to and from their classes. In the early summer of 1922, when this new laboratory was completed, Sir Thomas Lewis of London visited the University, and this visit did a great deal to stimulate interest in electrocardiography.

In order to defray the expense of operating the new laboratory, the Hospital made a charge for each clinical electrocardiogram taken. A technician, Miss Evelyn Turner, was secured, and she soon became expert at operating the galvanometer. During the next three years about 4,500 electrocardiograms were taken and several research projects were carried out, among which may be mentioned Dr. Herrmann's studies on ventricular hypertrophy.

When the new University Hospital was under construction, arrangements were made for a wiring system whereby it became possible to take an electrocardiogram on any patient in the Hospital without making it necessary for the patient to leave his bed. In 1924 Professor Willem Einthoven visited Ann Arbor, and negotiations were begun with him at that time for the construction in Holland

of a new galvanometer which would make it possible to take two electrocardiographic leads simultaneously. After much delay this galvanometer, which was actually constructed in Einthoven's laboratory, was obtained in the summer of 1927. It proved to be a wonderfully fine piece of apparatus, and much of the research work carried out in the Heart Station since that time could not have been done without it.

The Heart Station was moved to the new Hospital in the autumn of 1925. Dr. Herrmann was succeeded by Dr. Paul S. Barker. The additional help, space, and equipment made it possible not only to serve the Hospital more adequately, but also to do research which has been of the utmost importance. Studies of the distribution of the electrical currents produced by the heartbeat within the body, of the electrocardiograms produced by human bundle branch block, of precordial leads, of the areas of the electrocardiographic deflections, and of experimental and clinical coronary occlusion may be mentioned.

In 1932 Dr. Franklin D. Johnston joined the staff. He not only has taken an active part in many of the studies already mentioned, but also has done a great deal of work on the registration of heart sounds and on the adaptation of the cathode-ray oscillograph to the study of the electrocardiogram.

Frank N. Wilson

SELECTED BIBLIOGRAPHY

"The Department of Internal Medicine." Calendar Catalogue … "Medical Faculty Minutes" Proceedings of the Board of Regents … "The Heart Station of the University of Michigan Hospital."

The Tuberculosis Unit

On January 25, 1926, under the direction of Dr. George Sherman, a fifty-bed unit was opened on the second floor of the Convalescent Hospital for the medical treatment of tuberculosis. This was the first time in the history of the University Hospital that separate beds had been set aside for this specific purpose, although in 1902 George Dock, who was then Professor of Medicine, had written an article urging that a special hospital for this purpose be constructed. While this arrangement served its purpose well as a beginning, it was soon appreciated that the space for beds, offices, X-ray facilities, and laboratories, was inadequate. In order to remedy this situation the legislature of Michigan appropriated $250,000 to add two floors to the University Hospital for the care of patients with pulmonary tuberculosis. They were first occupied by patients on July 21, 1931. Accommodations are provided for ninety-eight patients in six single rooms, ten two-bed rooms, and eighteen four-bed rooms. There are ample workrooms for examinations, treatments, laboratory examinations, including fluoroscopy, and a room for the demonstration of patients and X rays to students.

The unit is a part of the University Hospital and Medical School. A medical staff is maintained by the Department of Internal Medicine, through which are rotated all of the instructors and interns.

Dr. John B. Barnwell has headed the medical staff since 1928. In this way the Hospital is sending out into practice in the state of Michigan, year after year, physicians who are especially trained in all of the modern phases of the treatment of tuberculosis. The Department of Surgery maintains a division of chest surgery under the leadership of Dr. John Alexander, who is directly responsible for the tuberculosis patients who are admitted primarily for surgical measures.

Instruction of medical students in regard to tuberculosis is carried out in the last three years of their course. In the second year, one or more groups are giving instruction in physical diagnosis. In the third year, groups may elect work in tuberculosis. All fourth-year students pass through the unit in small groups for discussion of diagnosis and treatment.

Cyrus C. Sturgis

SELECTED BIBLIOGRAPHY

"Enlarged Tuberculosis Unit in Operation." "Some Reasons Why There Should Be a Hospital for Consumptives in Connection with the University Hospital." "Hospital Facilities Are Increased."

Social Service Department

The Social Service Department of the University Hospital began with the passage of the Michigan Medical Care Acts, the first of which (Act No. 274), passed by the legislature in 1913, permitted judges of probate to send to the University Hospital children suffering from congenital defects or diseased conditions. Shortly afterward, a similar measure (Act No. 267) authorizing the care and hospitalization of adults, was passed by the legislature. These acts determined in large part the designation, number, and type of patients received for clinical teaching purposes. They came particularly from indigent or marginal groups for which such care was otherwise not available: children who were wards of the state, congenital cripples, psychopathic cases needing medical care or surgical treatment, children with curable maladies or deformities whose parents were unable to provide proper treatment, crippled children, sterilization cases, and tuberculosis cases.

These measures brought many new patients needing special services to the hospital. Efforts to provide some sort of social service for hospital patients had, as a matter of fact, begun almost with the opening of the old University Hospital. The University Hospital Circle of the King's Daughters was formed in 1892 to give assistance to patients. These efforts, however, were voluntary and not always continuous. Within the Hospital, moreover, the nurses' service in 1912 had designated a particular nurse to act as a part-time social worker.

Mary C. Merriweather was Supervisor of Social Service in 1918 and Imogene Poole in the years 1919-21. Offices were assigned the Social Service Department in 1919, and in 1920 Dr. Christopher Parnall, then Director of the Hospital, reported that the Rotary Clubs were interested in maintaining in the Hospital a social service worker who would care particularly for the welfare of children sent to the Hospital under Public Act 274. In 1921 Mrs. Elmie W. Mallory (Ph.B. Buchtel '97, A.M. Michigan '20) was made Supervisor of Social Service in the Homeopathic Hospital. When the

University Hospital and the Homeopathic Hospital were combined in 1922, Miss Dorothy Ketcham was appointed Social Service Director to integrate the Social Service Division of the University Hospital. Mrs. Mallory became Director of Social Service in the State Psychopathic Hospital.

In his report for 1920-21, Dr. Parnall said: "The role of a University Hospital in a broad program of education is to teach people the means of protecting and restoring health and preventing disease, both directly and through those who by their preparation and calling are fitted to serve in this field." With a social service program thus recognized, the first few years were spent in defining objectives, in improving methods so as to increase the satisfaction of the patients, in selecting personnel, and in establishing an improved system of records.

The Hospital School. — Among the important objectives of the service was the Hospital School. The King's Daughters of Ann Arbor supported the first teacher and have continued to help the program. Through the Michigan Crippled Children Commission the state also made funds available for the instruction of crippled children. New activities directed toward constructive programs were introduced in 1918 by Claudia Wanamaker. Since 1925 the Ann Arbor Kiwanis Club has given financial support to the program. In 1928 Galens, a senior medical society, undertook the support of a hospital workshop. The hospitalized child has been able to continue his schooling in this way, advancing with others of his age and in some cases graduating from school at the proper time. Although state funds make no provision for teaching preschool children, who at times make up almost half the total enrollment, a definite program has been set up for them as funds have become available.

Occupational therapy. — At first, occupational therapy for adults was carried on through voluntary service. Miss Helen James was appointed in July, 1920, to take charge of social work among dermatological cases being treated by Dr. Udo J. Wile. The work was financed through the Michigan Department of Health. Miss James introduced basketry, sewing, and similar activities, and an early exhibit revealed the value of such employment.

The facilities for occupational therapy include a large central shop and supplementary ward units. Some work can be carried to the patient's bedside. The central shop, largely equipped through the Galens' support, is a large, pleasant room for wheelchair or bed patients. The shop is equipped with looms, sewing machines, a jigsaw, carpenter's benches and tools, leather and reed tools, rug frames, a knitting machine, hoops, hooks, needles, as well as art and craft magazines and instruction books. It is open all day and has an average attendance of one hundred. The type of work varies according to the patient's individual interests and the length of his stay in the hospital. Some accept the idea of occupation eagerly and engage in comparatively vigorous activity; others require a limited or graduated program.

An important part of the social program is the library service. In 1935 a regular library service was set up on a full-time basis, and books were distributed on schedule. This service covers every unit in the Hospital. Reading lists are provided, and awards in the form of reading certificates are made on the basis of achievement.

Social service in the Hospital grew up as a result of case work with the individual patient. The work concerns itself particularly with the patient and with his reinstatement, if possible, as an effective member of society. The program

in the University Hospital has adhered closely to lines laid down by the American Association of Medical Social Workers, the American Hospital Association, and the American College of Surgeons. As standards for personnel have improved new methods have been adopted for handling the work of the department. These improvements include a system of case recording, staff and group discussions, statistical sheets developed for the use of the case workers and the consultant, plans for better student instruction, and better and more accurate medical data. A further function of social service has been the matter of follow-up, which often concerns physician, judge, patient, and family.

Dorothy Ketcham

SELECTED BIBLIOGRAPHY

"The Crippled Child's Education at the University Hospital.""The Department of Social Service, University Hospital.""The Medical Aspects of the Depression."Michigan Hospital Handbook.100,000 Days of Illness. A Study of 276 Children Hospitalized at Intervals over a Fifteen-year Period.Public Acts.Morse, Harriet. Crafts in a General Hospital. Occupational Therapy, October, 1936.President's ReportProceedings of the Board of Regents …

Metabolism Research

The first deliberate attempt by a member of the Department of Internal Medicine to advance the knowledge of metabolic processes in patients was begun by Dr. L. H. Newburgh when he came to the University as an Assistant Professor in the fall of 1916. He suspected that the kidneys could be impaired by food very rich in protein. The first experiments were carried out in the Hygienic Laboratory because the department was without an experimental laboratory in the University Hospital. Shortly thereafter, the old laundry behind the hospital was renovated and in part given over to the members of the department for their investigations. Dr. Newburgh was assisted in the study of nephritis produced by diets rich in protein and its products by Dr. Theodore L. Squier, Dr. Phil L. Marsh, Dr. Arthur C. Curtis, and Miss

Sarah Clarkson (d. 1931). More recently the work has been conducted by Dr. Margaret W. Johnston; and Dr. Richard H. Freyberg has been concerned with the question of the recoverability from the injury produced by the diets.

As late as 1918, the treatment of diabetes mellitus was still very unsatisfactory. Dr. Newburgh and Dr. Marsh began at that time to try to improve the dietary control of the disease, and by 1922 they were able to report that the disease could be adequately controlled in most adult patients by the plan they had developed. Dr. Floyd H. Lashmet and Dr. Newburgh undertook a study of the edema that occurs with one form of chronic nephritis. They were able to work out a plan that usually succeeds in eliminating the edema and preventing its recurrence.

Obesity is one of the most important causes of chronic illness in middle life. Earlier students had thought that the condition was often hereditary and unavoidable. This conception seemed highly unlikely. In order to study the question adequately, methods for measuring the exchange of energy and of water first had to be devised. Dr. Frank H. Wiley was of the greatest help in developing these two techniques. Dr. Newburgh and Dr. Margaret Johnston, using these new methods, then demonstrated that obesity is always caused by an inflow of energy greater than the outflow and that it can always be overcome by appropriate dietary methods.

Dr. Newburgh, Dr. Johnston, Dr. Jerome Conn, Dr. Florence White, and Dr. Elisabeth B. Stern engaged in an elaborate investigation of the normal and abnormal metabolism of carbohydrate. Dr. Coral A. Lilly for some years investigated the nature of dental caries as related to diet.

Since the opening of the University Hospital the group has had adequate laboratory space and a sufficient appropriation for current supplies. Salaries for fellow workers have always had to be obtained from sources outside of the regular budget. The work has been seriously hampered by inadequate financial support.

L. H. Newburgh

SELECTED BIBLIOGRAPHY

"Professor of Medicine Augments Teaching with Research."

University Hospital Pharmacy

During the years (1869-90) forming the initial period in the history of the University Hospital, there was no obvious need for a separate pharmaceutical service.

In 1892, when the University Hospital was moved to new quarters on Catherine Street, the rules and regulations adopted for the conduct of the newly created post of Apothecary were as follows:

The Apothecary shall be subordinate and responsible to the Resident Physician. He shall have the immediate care and custody of all drugs, medicines and other articles belonging to the department and be responsible for the same. He shall compound and make up all medicines which may be prescribed with exactness and promptitude. He shall deliver no medicines or other articles unless the same shall be duly entered upon the prescription or order books, or ordered in writing. He shall put up the medicines intended for each ward separately and shall annex to them labels containing the names of the patients for whom they are respectively prescribed, with written or printed directions for their use. He shall deliver them promptly to the nurses of each ward to be by them administered

to the patients. He shall be responsible for the correct preparation of all prescriptions. He shall have charge of all the instruments belonging to the Hospital and shall be responsible for them and their good order. He shall keep an account of them and shall never allow them to leave his possession without taking a proper receipt or ticket from the person so taking them. He shall make an inventory of all instruments belonging to the hospital, when he enters upon his duties; and, on giving up his charge, he shall furnish the Superintendent a like inventory countersigned by the Resident Physician. He shall keep the dispensary and everything pertaining to it clean and in perfect order, and the same shall remain open from 8:30 a.m. to 8:00 p.m., in his charge. He shall observe economy in everything relating to his department, be particularly careful in the preparation and delivery of medicines, and permit no noise, confusion or disorder in his premises.

R.P.

Having thus outlined his duties, the Regents authorized that an apothecary be appointed in the University Hospital for one year at a salary of $200. In carrying out the intent of the Regents the executive committee appointed James Perry Briggs ('91p) to the position.

Mr. Briggs's duties covered a very wide field. He prepared all the sutures used in the operating rooms, and, after the initial pictures taken by Carhart and Herdman, he was assigned the task of taking the first X rays used here, continuing all work of this nature until the Department of Roentgenology was established.

Mr. Briggs's association with the institution cannot be passed without mention of his wide acquaintanceship, especially in the "old Hospital," and his kindness to those with whom he worked. He was particularly happy to help the nurses. He removed stains from uniforms or best dresses and provided remedies for headache, a cold, or a cold sore. His "favorite prescriptions" were never disclosed, and no record of them has ever been found.

A bronze tablet now placed at the location of the present Hospital Pharmacy befittingly states: "In Memory of James Perry Briggs, Ph.C., Pharmacist to the University Hospital, 1891-1927. Universally Respected and Beloved by Those Connected with This Hospital During His Long and Faithful Term of Service."

Mention of Perry Briggs, despite the fact that a written record of the Hospital Pharmacy is his biography, would be quite incomplete without coincident mention of "Pat Scully." The bronze tablet opposite that of Mr. Briggs tells its story. This continuing association of these two names is very satisfying to their friends: "In Memory of Patrick Henry Scully Who Devotedly Served This Hospital In Many Capacities For More Than Half A Century. 1875-1929."

In 1920 Amos Ludwig Kroupa (Ph.C. '22) became Assistant to the Pharmacist. He retained this post until 1936, when he accepted an appointment as Chief Pharmacist at the Evangelical Deaconess Hospital at Evansville, Indiana.

In 1925 Harvey A. K. Whitney (Ph.C. '23) joined the staff, and he became Chief Pharmacist upon the death of Mr. Briggs in 1927.

The department has gradually grown in range of activities and in personnel. During a changing materia medica the Hospital Pharmacy has been allowed to engage in many manufacturing activities that were previously prohibited. The staff in 1940 consisted of eleven registered graduate pharmacists and five unlicensed assistants. The products of the department are obtained from the three kingdoms and are prepared to be administered by all natural bodily orifices, as well as some man-made, as when access is to the circulatory system.

One interesting development in the growth of the department has been the

establishment of a pharmacy internship plan, adapted from present medical practices. Six pharmacy interns are quartered with the medical interns and enjoy the same privileges. The plan calls for the selection of a candidate from among the recent graduates of one of the member schools of the American Association of Colleges of Pharmacy. Such an applicant when accepted receives an appointment as junior grade pharmacist for one year. He may be reappointed for a second year as senior grade pharmacist.

H. A. K. Whitney

Hospital Records and Statistics

The very first record available on any patient in the University Hospital is dated October 5, 1881. This is Case No. 1, which is listed in a leatherbound book and is the first of a series of records maintained by the Department of Gynecology, at that time under the direction of Dr. Edward Dunster. This book is entitled "Gynecological Clinic Record, Medical Department" and contains the records on patients seen in that department from October 5, 1881, to December 5, 1882.

The history sheets in this record book were outlined forms calling for routine statistical information about the patient, such as age, marital status, number of children, age of oldest, and age of youngest. Ten lines were reserved for enumeration of the symptoms and three lines for the physical examination. Space was also left for a rather detailed gynecological history. At the bottom of the sheet was a space for diagnosis. Opposite this page was a ruled sheet for recording treatment.

The diagnosis noted on this first patient was menorrhagia, and on the treatment sheet under date of October 26 is a note, "No abnormal condition of the interior of the womb. Mucous lining removed with curette." Under date of November 8 appears another note — "Uterine mucous lining again removed." Patient No. 3 was diagnosed "vesico-vaginal fistula traumatic." On the treatment sheet under date of October 28 is noted: "Fistula closed; eight sutures (silver) (one horse hair)"; November 4: "Stitches removed; operation incomplete due to neglect after operation (anesthesia, ether). Patient left Hospital." January 17: "Returned; second operation successful. Patient dismissed." These examples are typical of the extent to which examinations were written up and operations described at that time.

Record systems were apparently established about the same time in other departments, each one maintaining its own separate case number for the patient and retaining in the department all available information learned.

It was interesting to find a sheet in this original book entitled "Examination of the Urine." This contained statements as to the physical characteristics including reaction, color, and specific gravity. After this, was chemical examination, which called for urea, phosphates, bile, albumen, urates, and sugar. The microscopical examination called for crystals, anatomical elements, casts, and, finally, other morphological elements. At the end were reserved a few lines for pathological indications.

It is difficult to determine just when indexing of diagnoses was actually begun; however, shortly after the history forms were established, these various clinical departments formulated their own individual systems of recording diagnoses and operations. No uniform system was used, some preferring to list the diagnoses alphabetically, and some

by numbers. Operations were recorded in a similar manner.

Shortly after the University Hospital was opened in 1925, Dr. Harley A. Haynes, the Director, obtained the services of Miss Florence G. Babcock, at that time record librarian of the Peter Bent Brigham Hospital in Boston, who assumed charge as Record Librarian. At the same time the various departments were persuaded to submit all information pertaining to a given patient to a central record room, where it could be included in a unit patient record. In addition to including the various examinations made by different departments on any one patient, the record thenceforth was to include all X-ray reports, pathology reports, bacteriology reports, and other special laboratory procedures. On admission to the Hospital, each patient was to be given a registration number, and this was to be employed uniformly by all the departments in which the patient was seen. Coincident with the formation of the unit system, the Hospital staff adopted the Massachusetts General Nomenclature of Disease as the standard nomenclature to be used in the Hospital.

The staff doctors were then requested to list the various diagnoses and operations on the front sheet of each patient's unit-record, and these in turn were recorded on special cards in the central record room by trained record librarians. For reference purposes the diagnosis, secondary diagnosis, name, operated or not operated, registration numbers, service, sex, age, registration date, date of death, date of previous registration, and classification were recorded.

With this new system it became possible for the doctors to obtain for study all cases of any one diagnosis seen in the University Hospital, regardless of who made the diagnosis. In addition, all information pertaining to a patient could be obtained in one record.

In 1933 the executive staff of the Hospital entertained the advisability of establishing a large cancer clinic. In the course of developing this clinic various methods of recording routine statistical information were studied, and the so-called Hollerith punch card system was adopted. Dr. H. M. Pollard, at that time Instructor in the Department of Internal Medicine, was appointed to take charge of establishing this unit for hospital statistics. He was succeeded July 1, 1937, by Dr. Isadore Lampe, Instructor in the Department of Roentgenology.

Space was made available for this new unit on the ground floor of the University Hospital, and adequate tabulation machinery was obtained. From July 1, 1934, all routine statistical information relating to patients, and all their diagnoses and operations, have been recorded on punch cards. This includes the patient's registration number, age, race, status, classification, service, residence, all diagnoses and operations, Kahn report, death, autopsy, X-ray report, pathology report, and condition on discharge.

The nomenclature employed beginning July 1, 1934, was still the Massachusetts General System, but diagnoses were given numbers which could be utilized in the punch card system, and in so doing, space was made available for the addition of new diagnoses.

A doctors' study room was built in connection with the Statistical Unit and furnished with comfortable chairs convenient for studying records. All doctors studying cases utilize this room, so that records are not distributed to various offices.

This whole method of tabulation for hospital records is proving highly satisfactory and serves as a great stimulus to the staff physicians making careful and accurate statistical analysis of various diseases, forms of treatment, and results.

The records themselves have been improved by typing all inpatient histories and physical examinations. Outpatient notes are still made in longhand; case summaries, and in some instances progress notes, are typed. An effort is made to have all statements relating to types and results of treatment as specific as possible so that the information may be made available for study at any future date.

H. M. Pollard

SELECTED BIBLIOGRAPHY

"The Records of the Hospital." "Gynecological Clinic Record, Medical Department," "Minutes of the Executive Staff of the University Hospital,"

THE SCHOOL OF NURSING

THERE is no reference to nurses in the official records of the first campus Hospital of 1869. When the Hospital was enlarged in 1876, it was recommended that two nurses be employed, "one male and one female," though the position was still apparently such a menial one that nurses are not mentioned by name in the Regents' Proceedings until 1881, when Dr. E. O. Bennett put in a claim for $130 for thirteen weeks' nursing services during the summer of 1880. The following year two young doctors and one woman were appointed at a salary of $300 each. In 1883 the position of wardmaster was recorded in the Regents' Proceedings; it was abolished in 1891. Apropos of this unusual title, the late Dr. W. J. Mayo wrote to Dr. Peterson in 1937:

In my student days … there were comparatively few nurses, in the modern sense, and a good deal of the work was done by practical nurses, the students, and helpers generally. There was attached to each ward, a wardmaster and wardmistress who were responsible for the care of the patients, and gave the students their orders.

Peterson

After 1891 there was a steady growth in the number of nurses; by 1896 there were sixteen. This was probably the result of the authorization in 1891 of a training school for nurses and of a two years' nursing course.

The enrollment in the first year of the School was eight. Seven were graduated in December, 1893. Mrs. Jane Pettigrew, a trained nurse then pursuing medical studies in the University, directed the training. The next year President James B. Angell observed that the course was "attracting a large number of intelligent and devoted women, who render a serv-vice to the sick, hardly inferior to that of the physician."

Graduates of the School, a head clinic nurse and two head nurses, were permanently employed by the Hospital for the first time in 1899. It is also worthy of note that graduates of the School served in the Spanish American War. By 1900 the School had developed a sufficient sense of solidarity to organize an alumnae association, with eighteen charter members. By the year 1924-25, 190 nurses were in training. The administrative nursing staff included, in addition to a matron and a dietitian, a principal of the training school, a superintendent and an assistant superintendent, a director of the Hospital education department, and two instructors.

This rapid increase in the nursing staff

necessitated successive adjustments in the living quarters provided for nurses, which in the early years were inadequate. At first the nurses were quartered in the basement of the Hospital and in adjacent houses, but the completion both of the Nurses' Home in 1898 and of Palmer Ward in 1903, for a time provided some relief. The continual increase in the number of children admitted to Palmer Ward, however, necessitated the removal of the nurses housed in the upper floors of that building to private houses near the campus. Six such houses were taken over by the University for the nurses after the year 1909. The erection of the Pemberton-Welsh Nurses' Residence in 1921 provided space for seventy-five more nurses. This method of housing a continually growing staff became increasingly unsatisfactory. Couzens Hall, erected in 1925, with 285 separate sleeping rooms, finally provided adequately for both nursing staff and student nurses.

At the time the new Hospital was opened, the program of teaching in the Training School for Nurses was reorganized. The instruction in basic sciences was given by regularly appointed members of the faculties, the instruction in practical medical work by the professors in the Medical School, and the instruction in therapy and practical nursing suggestions by the nursing staff. A reorganization five years later provided for one semester's work on the University campus. In 1940 there were 177 students in the School of Nursing and 198 graduate nurses on the Hospital staff. There were also, on the average, 146 enrolled in the courses in public health nursing.

Wilfred B. Shaw

SELECTED BIBLIOGRAPHY

Announcement, School of Nursing Annual Report of the University Hospital of the University of Michigan President's Report Proceedings of the Board of Regents …

THE THOMAS HENRY SIMPSON MEMORIAL INSTITUTE FOR MEDICAL RESEARCH

THE Simpson Memorial Institute was presented to the University of Michigan by Mrs. Christine McDonald Simpson, of Detroit, as a memorial to her husband, Thomas Henry Simpson, who died of pernicious anemia in 1923. Mr. Simpson was born in McConnelsville, Ohio, and as a young man entered the business of manufacturing malleable iron in Detroit, in which city he resided until his death. After the death of her husband, Mrs. Simpson decided to erect and endow an institution for the study and care of patients with pernicious anemia and to present this to the University of Michigan.

Mrs. Simpson offered $150,000 for a building and $250,000 as an endowment. It was stipulated that the activities of the Institute should be devoted, primarily, "to the study of pernicious anemia, the alleviation of the suffering of persons afflicted with that disease, and the discovery of a cure for the same." The offer was promptly accepted by the Regents.

Albert Kahn, the architect selected by Mrs. Simpson, completed the plans by

May 22, 1925, and on May 28 the contract was let to the firm of Henry L. Vanderhorst, of Kalamazoo, Michigan. Ground was broken for the building by Mrs. Simpson on June 3, 1925, and thereafter construction progressed at a rapid rate.

By January, 1926, the Institute building was nearing completion, and as the Board of Regents was not yet ready to select a permanent director and staff, on June 21 it appointed Dr. James D. Bruce, who then occupied the position of Director of the Department of Internal Medicine, as Acting Director of the Institute. At the same time a permanent advisory committee was appointed, to confer and advise concerning the research work of the organization. The personnel of this committee was as follows: Dr. Hugh Cabot, Dean of the Medical School; Dr. James D. Bruce, Director of the Department of Internal Medicine; Dr. Aldred S. Warthin, Professor of Pathology; Dr. Frederick G. Novy, Professor of Bacteriology; Dr. Howard B. Lewis, Professor of Physiological Chemistry; and Dr. Preston M. Hickey, Professor of Roentgenology.

By June 29, 1926, the building was completed. The committee of the faculty appointed Cyrus Cressey Sturgis (Washington '13, M.D. Johns Hopkins '17) as Director on January 6, 1927. He reported for duty on July 15 of the same year. Raphael Isaacs (Cincinnati '11, A.M. ibid. '12, M.D. ibid. '18), of Harvard University, was appointed Assistant Director and also Assistant Professor of Medicine in the Medical School, in February, 1927, and was asked to report for duty on April 1.

Dr. Isaacs, a native of Cincinnati, was thirty-five years of age at the time of his appointment. He had had a broad training in the field of hematology and was already well known for his contributions to the literature bearing on the subject. He had taught various subjects, including anatomy, physiology, medicine, and clinical pathology. He had served as intern, resident physician, and chief resident physician at the Cincinnati General Hospital; then, after one year as instructor in medicine at the University of Cincinnati, and another as voluntary graduate assistant in medicine at the Peter Bent Brigham Hospital, Boston, he had been appointed instructor in medicine and assistant physician at the Collis P. Huntington Memorial Hospital of Harvard University. During his last year in Boston, 1926-27, he was consulting hematologist at the Beth Israel Hospital and assistant physician at the Boston Dispensary. He entered the Department of Internal Medicine as Assistant Professor in 1927, and was promoted to an associate professorship in 1930.

Dr. Isaacs was the first member of the staff to arrive in Ann Arbor. Much of the credit for the efficiency of the Institute rightfully belongs to his skill and judgment in formulating the early plans for its organization.

In the first thirteen years of the Institute's existence, approximately one thousand patients with pernicious anemia were seen, as well as many patients with other types of anemia. A large majority of these patients were observed over a period of one to thirteen years, and an excellent opportunity was afforded to appraise the effects of various types of treatment. In 1929 the investigators at the Institute introduced a new and effective form of treatment for the disease, which is derived from hog stomach (ventriculin). It is now widely used.

The knowledge which has been accumulated by various investigators has been made available to the medical profession by means of numerous publications which have appeared in various medical journals. Each member of the staff has collaborated in the teaching of undergraduate and graduate students.

Cyrus C. Sturgis

SELECTED BIBLIOGRAPHY

"The Simpson Memorial Institute Dedicated." "Thomas Henry Simpson, University Benefactor." "The Work of the Simpson Institute for University." "Gift Marks Epoch in Medical Education." Catalogue and Register "Institute Scientists Scan Triumph." [News notes.] "Plans Well Under Way for Construction of Simpson Memorial Hospital." President's Report Proceedings of the Board of Regents …

The Homeopathic Medical College

THE HOMEOPATHIC MEDICAL COLLEGE

BURKE A. HINSDALE stated that homeopathy was first recorded in University history in 1851 (Hinsdale, p. 106). However, as early as 1848 the practioners and patrons of homeopathy in Michigan were petitioning the legislature and the University, setting forth their rights and claims, to the end that homeopathic instruction be included in the curriculum of their state institution. The abstract of the minutes of the Michigan Institute of Homeopathy in 1849, printed in the Michigan Journal of Homoeopathy, mentioned the appointment of a committee of three to "address the Regents of the University of Michigan, praying them to establish a Professorship of Homeopathy in the Medical Department of that college" (I: 105). Even earlier, committees were appointed by various lay groups to formulate petitions of a similar nature. The first meeting of the Michigan Institute of Homeopathy in 1845 devoted a portion of the single session of June 12 to the question.

Previous legislation regarding medical practice in the state included a law passed in 1846 (Mich. Rev. Stat., 1846, pp. 168-73), giving to the state and county medical societies power to issue and revoke licenses to practice, and making all persons who practiced as physicians or surgeons without obtaining such license subject to fine or imprisonment. The result of the activity on the part of groups of physicians to pass laws favorable to themselves was an action by the legislature to place the question of medical practice and its control in the hands of the committee on the judiciary for investigation. In 1851 the Honorable Thomas B. Church, chairman, reported that "sundry petitions praying for … the establishment of a professorship of homoeopathy in the University of this State" were referred to his committee. He discussed the general medical situation in regard to its legal control and advised that Chapter XXXVI of the Revised Statutes of 1846 be repealed. This was done. Further, he recommended that the homeopathic question be referred to the newly appointed Board of Regents, "fresh from the people," who had been elected under the Constitution of 1850. The several petitions were referred to the committee on education of the legislature.

In the memoir prepared by Dr. Zina Pitcher at the request of the Regents, embracing an epitome of the transactions of that body from 1837 to 1851 (J. Doc., 1851, pp. 312-28), several pages were devoted to this question. Pitcher took a militant stand against any favorable recognition of the petitions or of the petitioners. One gathers that the author was expressing his personal views rather than the considered opinion of the entire Board. Petitions, both to abolish the Department of Medicine and Surgery, founded in 1850, and to establish homeopathic instruction in that department, constituted the immediate occasion for this part of the memoir. It must be remembered that Dr. Pitcher was the sole author of this review. However, a perusal of the document will explain the feeling that any discussion of the subject must have caused.

Several problems were satisfactorily solved with the election of the new Board of Regents in 1851, but the exact delineation of its powers was still to be determined. For forty years the homeopathic controversy furnished the trial material which at last made hard and fast the position of the Board in relation to the lawmaking and judicial bodies in

Michigan (see Part I: Constitutional Status).

An interesting episode developed regarding the selection of a president by the new Board. In June, 1852, Tappan was favorably considered, and during the investigation of his abilities and background, Dr. Pitcher, using the name of D. B. Minor, wrote Dr. Vanderburgh of New York — Tappan's medical adviser and a homeopathic physician. According to Vanderburgh (Mich. Journ. Homoeop., 2: 126-27) the letter expressed a sympathetic attitude toward homeopathy and asked whether or not Tappan's inclination was in that direction. An affirmative reply resulted in Tappan's temporary defeat, if we may believe the letter from Vanderburgh which shows his chagrin at being tricked. In July of the same year, the Board elected to the presidency the Reverend William Adams, much to the amusement of Vanderburgh, who had been his physician for twenty years (ibid., p. 124), but Adams declined. As a consequence, the lesser of the two evils, as viewed by some of the Board, was the reconsideration and election of Tappan. From fragments of reports and contemporary correspondence one gathers that Dr. Pitcher was disappointed but continued to be the constructive worker he always had been.

From 1851 to 1855 the legislature and the new Board of Regents were continually being bombarded with petitions and various other legal procedures to induce them to include homeopathy in the University curriculum. Most of these instruments, at least those addressed to the legislature, were referred either to the committee on the judiciary or to the committee on education. The committee on education was responsible for the examination of the organization of the University. As a result of these activities the legislature of Michigan in 1855 passed an act providing for the appointment of at least one professor of homeopathy in the Department of Medicine and Surgery (Laws, 1855, No. 100). For the next twelve years, an almost constant legal battle was waged to compel the Regents to comply with the act. They refused to do so, and since the act of 1855 provided no enabling funds they resisted all efforts against them. However, the real reason for the refusal is apparent from contemporary correspondence between the Regents and various state officers. While there was very real opposition to teaching homeopathy in the University, the main objection arose from the effort to establish chairs of homeopathy in the Medical Department. Until this effort was abandoned the partisans of homeopathy were doomed to failure.

About the time of the passage of the 1855 law, Dr. A. I. Sawyer, a graduate of the Western College of Homeopathic Medicine in 1854, took up his residence in Monroe, Michigan. Intensely partisan, gifted with intelligence and sound political judgment, he hurled himself into the fight. It was said that for twenty-five years he attended nearly every session of the Board of Regents and of the legislature as well. Very promptly dissension developed in the homeopathic ranks and a demarcation appeared, based, first, on the championship of Ann Arbor as the proper location for the homeopathic teaching as against Detroit; and, second, on the belief that it would be wise to add homeopathic chairs to the Medical Department rather than to establish a separate college within the University. As a consequence, the attack lost momentum and, on occasion, lost its force entirely.

At the annual meeting of the Michigan Institute of Homeopathy in 1866 a committee was appointed to employ counsel to apply to the Supreme Court of the state to force the Regents to comply with

the law of 1855 (Proc. Mich. Homoep. Instit., p. 3). To this end the members of the Institute were assessed to defray the costs of such a step. Possibly it was as a result of this move that the rider was added to the law of 1867 (see Part I: Constitutional Status) .

It must be remembered that the growth of the University during the fifties and sixties had exceeded its resources, and had the legislature not come to its relief in 1867 serious consequences must have followed. In that year a law was passed giving to the University one-twentieth of a mill from each dollar of taxes collected (Laws, 1867, No. 59). To this bill a rider was attached rendering void the mill tax assessment unless at least one professor of homeopathy were appointed in the Medical Department. Much excitement followed, and many resignations were offered. The department most affected succeeded in delaying the action for one year, and at the end of that time the Regents endeavored to establish a school of homeopathy outside Ann Arbor but under University auspices (see Part I: Constitutional Status) .

In 1869 an act was passed amending the law of 1867 and appropriating $15,000 to the University directly instead of continuing the tax rate of one-twentieth of a mill (Laws, 1869, No. 14). In this act homeopathy was not mentioned. Petitions and injunctions were again the order of the day, and dissension in the ranks of the petitioners served only to heighten the controversy. The Michigan Institute of Homeopathy, founded in 1847, had taken the leadership in the attack on the Regents and the legislature. Legal steps begun by laymen and taken eventually to the Supreme Court were instigated by the Institute. In 1870 the Homeopathic Medical Society of the state of Michigan was organized, however, and at the second meeting, in May, 1871, all the books and papers of the old Institute of Homeopathy were taken over (Trans. Homoeop. Med. Soc., 1871, p. 3).

At this meeting a committee was appointed to "institute legal proceedings against the Board of Regents of the University of Michigan" to enforce the law of 1855. The continued efforts of this committee were being felt in both Uni versity and state circles — so much so, in fact, that the meeting of the Regents in September, 1871, brought forth the following resolution:

Resolved, That we approve the efforts that are being made to establish a Homoeopathic Medical College at Detroit, to be eventually connected with the University, and when we are authorized to make it a part of the University by law, with proper provisions for its support, we will administer its affairs to the best of our ability.

R.P.

Prior to this a memorial had been presented, signed by citizens of Detroit (R.P., 1870-76, p. 104), offering land for the site and money for the erection and conduct of such a school in Detroit, to be connected with the University. Just what was intended by this resolution is not clear, but it served to hearten the group interested in establishing such a school in Detroit. And the direct result may have been the launching of the Michigan Homeopathic Medical College at Lansing in November, 1871, though the first announcement of this college makes no attempt to claim a University connection.

The result of the legal steps taken by the Homeopathic State Society was a Supreme Court decision against forcing the University to establish a chair of homeopathy in the Department of Medicine and Surgery. A second college to be organized in Detroit with the backing of the Regents was discussed at a meeting of the state society. At this meeting the president's address stressed the fact

that dissension in the ranks caused the failure to force the Regents to recognize homeopathy in the University. Three points of view were put forward: one group wanted a teaching unit outside Ann Arbor; the second faction urged enforcement of the law of 1855; and a third group insisted on abandoning the fight because it was prejudicial to the good name of the University. The two sessions of the society in 1871 (May and November) served to crystallize the sentiment of that body into a set of resolutions insisting on the teaching of homeopathy in the Department of Medicine and Surgery.

On March 20, 1873, the House of Representatives appointed a committee with instructions to proceed to Ann Arbor to study the question whether homeopathy could be successfully taught in the Department of Medicine and Surgery. To this end nineteen responsible witnesses, all faculty members, were questioned, and testimony covering 110 closely written pages was obtained. Included among the witnesses were such men as President Angell, Judge Cooley, Professors Douglass, Cocker, Williams, and Olney, and, finally, Dr. Corydon L. Ford, Professor of Anatomy. All these men testified that to teach homeopathy in the Medical Department would be a great mistake and would ultimately kill the department itself. One must remember that in the year before the Department of Medicine and Surgery was opened, 1850, there were only sixty students in the University, and that in the fall ninety students began the study of medicine. In the early seventies there were 575 registered in the Department of Medicine and Surgery alone. Any legislation unfavorable to this important unit of the University was considered seriously. The testimony reveals that both President Angell and Judge Cooley employed homeopathic physicians at the time of the interview by the committee.

The legislative committee of the State Homeopathic Society, due to the "unwearied industry … and Spartan courage of Dr. S. B. Thayer" (Mich. Journ. Homoeop., 1 [1873]: 89), its chairman, succeeded with the legislators, and as a result a law was passed in 1873 appointing two professors of homeopathy in the Department of Medicine and Surgery and repealing all other laws of related content (Laws, 1873, No. 63). That same year the 1869 law — or, rather, amendment (see Part I: Angell Administration) — granting a lump sum to the University was repealed and again one-twentieth of a mill was assessed against all taxable property for the benefit of the University (Laws, 1873, No. 32). This bill had no rider attached, since special legislation had solved the situation relative to the teaching of homeopathy.

The Regents again refused to comply with the law, urging that, because of the existing state of feeling, it was impossible to combine the teaching of two schools of medicine in one department. Since no special funds had been appropriated, nothing was done. As has been said, the Regents were consistent and had been so from the first. From 1851 to 1875 the controversy was constantly in evidence, a controversy developed in part for the general public welfare, but in no small part for the play of personal ambition and desire for partisan advantage. The enemies of the University displayed great zeal in creating strife and used homeopathy as a shield.

The gradual trend toward the establishment of a separate school was very noticeable after 1871. Early in 1875 the Regents restated resolutions adopted two years before, declaring their willingness to assume direction of a separate School of Homeopathy when funds should be provided for its support. This action was predicated on the knowledge

that the legislature then in session would act favorably on a bill which was to be presented, establishing such a school. As expected, in April, 1875, the law was passed establishing a Homeopathic Medical College as part of the University in Ann Arbor.

For almost twenty-five years (since 1851) the Regents had been in a position of opposing the legislature, and they had always denied that this position was the result of "factious opposition to … that body," as Hinsdale put it. Rather, they had insisted that the true and best interests of the University were being served by their attitude. In the state generally, a large group felt that the wishes of the commonwealth were being ignored.

The year 1875 proved a busy one for the administration of the institution in Ann Arbor. Both the College of Dental Surgery and the Homeopathic Medical College were organized. On May 11 the Regents passed resolutions that seemed wise and far-reaching in their effects. In brief, they accomplished the following: The Homeopathic Medical College was established, with two professors appointed to it, one, a professor of materia medica and therapeutics, and the other, a professor of the theory and practice of medicine. (The students paid the same fees as those in the Medical Department and received instruction in that department in all work except that included under the two homeopathic chairs.) The same conditions as to curriculum and graduation were observed in both schools and it became the duty of the president to see that all rules were enforced. The homeopathic medical graduates received diplomas designating the college in which they were enrolled.

The new college grew rapidly for some time. President Angell, in his report for 1877, observed that it had fully twice as many students as in the preceding year, and "the number this year promises to be at least half larger than it was last year" (p. 159), in spite of the fact that it was "the only Homeopathic School which has courses of nine months, and it must attract the students, who desire a thorough training" (p. 159).

Both President Angell and the Board of Regents were sincere in hoping that this experiment would prove successful, because it removed at least one obstacle from the path of much-needed legislation for steady financial support of the University. The friends of homeopathy, and those partisans aligned with them from other motives, were silenced. The plan was to keep them so.

The State Homeopathic Society wisely recommended for the two chairs men widely removed from the bickerings and discussions of the local groups. Samuel Arthur Jones (M.D. Missouri Homeopathic Medical College '60, M.D. Homeopathic Medical College of Pennsylvania '61), of Englewood, New Jersey, was chosen to teach materia medica and therapeutics, and John Coleman Morgan (M.D. Pennsylvania Medical College '52) of the Hahnemann College of Philadelphia, was selected for theory and practice. The correspondence of these two appointees with the President prior to their acceptance of the positions is most interesting. Though Dr. Angell's letters have not been available, the other half of the communications of the two men has been preserved, and shows an earnest desire by both the administration and the prospective faculty members not to overstate or understate the situation. The prejudices on the part of members of the medical faculty were fairly stated and were as fairly considered, if one may judge from the responses of the two men appointed. Dr. Jones, particularly, became an important figure in the life of Ann Arbor. In addition to his professional ability, he

was a scholar recognized for his knowledge of the literature of Thoreau and Carlyle. The greater part of his book collection is now in the University Library. He became the first Dean of the Homeopathic Medical College.

The long controversy that had begun before the founding of the Department of Medicine and Surgery was quieted with the founding of the Homeopathic Medical College in 1875, but flared periodically, as in the attempt to amalgamate the two schools in 1893, and in the legislative action of 1895 directing that the College be moved to Detroit. In both instances the Regents refused to comply.

The right of the Regents to act independently of the legislature was finally established on a firm and unquestioned basis largely through this controversy. In the decision anent the 1895 removal, the court said, in effect, that the Board of Regents was empowered by the state constitution to have direct and exclusive control of the University as direct representative of the commonwealth (see Part I: Constitutional Status) .

The legislature, however, exerted pressure through its control of appropriations. The act founding the Homeopathic Medical College provided for additional funds — a device which had not been utilized in any previous legislation on this question. The fear of harm to the Medical Department, which had activated the Regents up to this time, was quieted, and a sincere effort was made to organize the new College in such a way as to ensure scientific soundness in its teaching.

From the founding of the College to its termination very little of a major controversial nature developed between the two medical schools in Ann Arbor. Difficulties involving personalities were of frequent occurrence, but nothing that approached the problems of the previous twenty-five years gave cause for official action. As much cannot be said for the cause of homeopathy itself. The internal dissension among the practitioners in the state erupted often and vigorously. Resignations and new appointments were frequently made, in an effort to soothe the various elements.

During the years following 1875, the need for funds grew more and more acute and jeopardized the entire program of the University, which was receiving the one-twentieth of a mill from the total state tax collection granted in 1873. The mill-tax rate was changed in 1893 to one-sixth of a mill; and the act (P.A., 1893, No. 19) included the proviso: "The Board of Regents … shall maintain at all times a sufficient corps of instructors in all departments … as at present constituted, … said departments being known as [listed with other units] the Homeopathic Medical College…" Failure to observe this clause carried a penalty of reduction of the funds to one-twentieth of a mill. So was brought into existence the homeopathic rider which was guarded so jealously by its partisans.

In 1899 the rate was raised from one-sixth to one-fourth of a mill, but the rider was retained. No further change was made until 1921, when, under the regime of President Burton, the rider was dropped from the appropriations bill. As an immediate consequence the legislature passed a resolution requesting the Board of Regents to effect a consolidation between the two medical schools and their respective hospitals (see Part I: Constitutional Status and Burton Administration ).

In the early days of the new College, feeling ran so high that the position of medical men in both schools was difficult. But as the new unit grew the situation eventually resolved itself, though the anomaly of two medical schools within one university was never without its critics. This growth was such that when the legislature in 1895 reversed itself and ordered

the Homeopathic Medical College moved to Detroit, the Regents battled successfully to retain it in Ann Arbor.

All medical faculty groups before the turn of the century were torn with dissension that arose largely from the individual jealousies so prone to develop among men who devote a part of their time to private professional activity. All men teaching clinical subjects were so occupied. The Homeopathic Medical College presented a typical picture of such a group. The later eighties saw the development of a long and bitter personal quarrel which culminated in the sending of a letter signed by four faculty members to the Board of Regents requesting the removal of the Dean. Dean Henry L. Obetz, as a defense measure against his colleagues and as a means of settling their differences, had suggested a scheme for amalgamating the two medical departments. This was not formally presented to the Board, but individual Regents knew that such an idea was being considered by certain members of both medical faculties. The American Institute of Homeopathy addressed a communication to the Board arguing against such a merger. The reply to this letter shows conclusively that no such plan had been formally considered, nor would be, unless presented as the expressed desire of both faculties. In part, the answer stated: "It has been and will be the pleasure of this Board to advance to the utmost of its power, within the means at its disposal, the interests of the School of Homeopathy" (R.P., 1891-96, p. 370).

The Dean was vindicated completely of any harmful intent and resigned voluntarily in November, 1894. At the meeting at which the resignation was acted upon, the Board called for the resignation of the remaining members of the homeopathic medical faculty, to take effect in October, 1895. These were forthcoming as requested. An entirely new faculty, headed by Wilbert B. Hinsdale (Hiram '75, M.D. Homeopathic Hospital College of Cleveland '87, A.M. hon. Hiram '00, A.M. hon. Michigan '34) as Dean, was appointed. Dean Hinsdale, an able administrator, a scholar, and a competent physician, occupied his position till the merger of the two medical schools took place in 1922.

Soon after the appointment of the new faculty the legislature in 1895 enacted a law which in effect directed the Regents to move the College to Detroit (P.A., 1895, No. 257). At their meeting in December, 1895, the Board drew up a resolution refusing to comply with the law. The proponents of "removal" carried the matter to the Supreme Court of the state, where it was decided that the law was constitutional. But the Board still refused to obey, thus completely reversing its position of the sixties and early seventies, when it wished to aid in organizing a school outside Ann Arbor. Then a mandamus was asked in order to compel the Board to obey the law. The court in replying to the request ruled that inasmuch as the Board had full control of all matters appertaining to the University, it might obey the law or not, as it chose.

The decision regarding the mandamus proceeding was more momentous for the University than it was for the Homeopathic Medical College. It reaffirmed the decision of 1859 by the same court, as clarified at that time by Judge C. B. Grant. A joint committee of members of the law and homeopathic committees of the Regents reported to the Board in January, 1897 (R.P., 1896-1901, pp. 21-29). This report explains the refusal to obey the law. It was maintained that although land in Detroit for the College had been promised, none had been deeded to the University; further, that Grace Hospital, which was to be

used by the College, had been deeply in debt for years, and that no guarantee was forthcoming that it could be maintained without expense to the state. In obeying the law, the Board would be in the position of assuming the burdens without receiving the benefits contemplated by the act. These reasons rather than a desire to keep the school accounted for the action taken.

The new faculty appointees took part in the "removal" fight as their initial activity in the University. The struggle moved through the legislative halls to the Supreme Court, and at last back to the Regents, where the decision was final.

Strangely enough, the final years of the School were comparatively free from controversy. Periodically, as new appropriations were being considered, the proponents of homeopathy saw to it that the rider was included in the act as finally passed. In 1921 the legislature passed a resolution requesting the Regents to consolidate the two medical schools for reasons of economy. The Board complied promptly, in 1922 (R.P., 1920-23, pp. 373-74), with the result that the teaching of homeopathy became University history.

From 1875 to 1922 the deanship of the College was conferred upon five men: Samuel A. Jones, 1875-78, Edward Carroll Franklin (M.D. University of New York '46), 1878-83, Thomas Pardon Wilson (M.D. Western Homeopathic College [Cleveland] '57), 1883-85, Henry Lorenz Obetz (M.D. Homeopathic Hospital College of Cleveland '74), 1885-95, and Wilbert B. Hinsdale, 1895-1922. Beginning with two departments — that of the theory and practice of medicine and that of materia medica — the institution gradually expanded, until, in 1909, all the branches of clinical medicine were taught in separate departments.

The Department of Surgery, organized in 1876, was headed by John C. Morgan. He was followed by Dr. James G. Gilchrist, 1876-78; Edward C. Franklin, 1880-83; Henry L. Obetz, 1883-95; Oscar Le Seure ('73m, M.D. Bellevue Hospital Medical College '74), 1895-1900; Dean Tyler Smith (Nebraska '87, M.D. Chicago Homeopathic Medical College '89, M.S. hon. Michigan '14), 1901-14; and Hugh McDowell Beebe ('07h), 1914-22. The separate Department of Gynecology and Obstetrics was also organized in 1876, with Dr. Frank Augustus Rockwith (M.D. College of Physicians and Surgeons [N. Y.]) as head. He held this position for one year. Newton Baldwin ('75m) was appointed in 1883 and served two years; James Craven Wood ('79h, A.M. Ohio Wesleyan '91) served in the years 1885-93; Maurice Patterson Hunt (M.D. Homeopathic Hospital College of Cleveland '79), 1893-95; Myron Holly Parmalee (M.D. Hahnemann Medical College [Chicago] '70), 1895-97; Claudius Bligh Kinyon (Illinois State Normal University '76, M.D. Chicago Homeopathic Medical College '78), 1897-1918; Theron Grover Yeomans ('09h), 1918-20; and Scott Clark Runnels (M.D. Indiana '07, '08h), 1920-22.

The Department of Materia Medica, organized by Samuel Jones, maintained a high degree of excellence. This department was served in turn by Jones, in the period 1875-80, by Henry C. Allen (M.D. Western Homeopathic College [Cleveland] '61), 1880-84; by Allen Corson Cowperthwaite (M.D. Hahnemann Medical College '69, Ph.D. Central University of Iowa '76, LL.D. Shurtleff '88), 1884-85; by Hugo Emil Rudolph Arndt (M.D. Western Homeopathic College [Cleveland] '69), 1885-89; by Charles Samuel Mack (Harvard '79, M.D. College of Physicians and Surgeons [N. Y.]

'83), 1889-95; and by Willis Alonzo Dewey (M.D. New York Homeopathic Medical College '80), 1896-1922. Instruction in the theory and practice of medicine, with Morgan as the first Professor, developed rapidly. After Morgan, in 1879, was Charles Gatchell (M.D. Pulte Medical College [Cincinnati] '74), who served for one year and later returned and occupied the chair from 1883 to 1893. Eugene Ransom Eggleston (M.D. Homeopathic Hospital College [Cleveland] '75) served during the years 1893-95, and Wilbert B. Hinsdale, 1895-1922. Dr. Hinsdale carried on work on American Indian archaeology for many years thereafter as a member of the staff of the University's Museum of Anthropology.

The separate Department of Pharmacology was started in 1882 and until 1919 was administered by the professor of materia medica. During the last three years of the School's existence Linn John Boyd ('18h) was in complete charge, and during his regime some excellent work was done. Boyd later became head of the Department of Internal Medicine in the New York Medical College.

The teaching of ophthalmology, otology, laryngology, and rhinology was all done within a single department in 1880, under Thomas P. Wilson. Charles Frederick Sterling (M.D. Pulte Medical College [Cincinnati] '77), appointed in 1887, served until 1889; he was followed by Daniel A. MacLachlan ('79h), 1889-95. Royal Samuel Copeland ('79h, LL.D. Syracuse '23), later United States Senator from New York, held the position in the years 1895-1908, and Dean Wentworth Myers ('99h) during the period 1908-22.

Some clinical subjects were taught by nonresident instructors. Rollin Howard Stevens ('89h), Professor of Dermatology (1904-9), made an outstanding contribution in his field. O. R. Long headed the Department of Nervous and Mental Diseases from 1890 until 1914. Both of these men were nonresident.

The necessity for enlarging the scope of instruction, which by 1909 resulted in so many separate departments, led to unforeseen difficulties. The duplication of departments in the Homeopathic Medical College and the Medical School resulted in a great deal of unfavorable comment among both the friends and the enemies of homeopathy. In the original plan no duplication had been intended, and the trend was most unfortunate. Then, too, the number of students in the Homeopathic College fluctuated within very wide limits, never exceeding 125 and often less than fifty. The steadily increasing budget of the school was offset largely by income from the University Homeopathic Hospital, which was showing a steady growth. Here, as well as in the school proper, the duplication was apparent. The Hospital rendered a great service to both the University and the state, and this service was recognized widely.

For a time after the Homeopathic Medical College was organized, a part of the hospital of the regular Medical School on the campus was used by the department (P.R., 1877, p. 13). This arrangement, however, proved unsatisfactory, and in 1879 an appropriation of $6,500 was made by the Regents for the erection of a Homeopathic Hospital and amphitheater, as an extension of the west professorial residence on the north side of the campus, together with $1,250 for hospital expenses. This building served the department until, as part of the Hospital group on Catherine Street, a new hospital was built in 1891. This was occupied until the erection of a third hospital in 1900, when it was taken over by the regular Medical Department and

became the Medical Ward. It was destroyed by fire in 1927.

The Homeopathic Hospital, providing for one hundred patients, erected in 1900 on the northeast corner of the campus, served until the department was discontinued in 1922. It is now known as North Hall. As an addition to this building a children's ward was erected in 1918 just to the south, which was later the Health Service; since 1940 it has been the Annex to the University Museums. For many years the old residence of Judge William A. Fletcher, at one time Regent of the University, stood near this hospital and was used first as a nurses' home and later as an administration building. Subsequently, quarters for nurses were provided in the hospital building and in near-by residences taken over by the University.

As the institution increased its patronage, however, the legislature became more and more cognizant of two medical schools in one University, each with an associated hospital. The natural result was a move to consolidate by a merger of the two schools. This was resisted by the members of the homeopathic medical faculty, and the resultant merger never received their co-operation. The subsequent history of the merger was much as had been predicted by the enemies of such a move prior to 1875 (see Part I: Burton Administration, p. 85 ).

Hugh M. Beebe

SELECTED BIBLIOGRAPHY

"Abstract of the Minutes of the 3rd Anniversary of the Michigan Institute of Homeopathy, held at Detroit, June 27th, 1849."Announcement, Homeopathic Medical CollegeCalendarCatalogue …First Term of the Michigan Homeopathic Medical College of the City of Lansing (Session of 1871-72).History of the University of Michigan."Homeopathy in the University of Michigan."Jones, Samuel A. MS correspondence. In: James B. Angell Papers. Mich. Hist. Coll., Univ. Mich.Constitution [of] 1850.Joint DocumentsJournal of the House of Representatives …Laws [of the Session of …]Public Acts [of the Session of …]The Revised Statutes of the State of …, 1846."Michigan Homeopathic Institute, Seventh Annual Meeting."Morgan, John C. MS correspondence. In: James B. Angell Papers. Mich. Hist. Coll., Univ. Mich.President's ReportProceedings of the Board of Regents …"Proceedings … First Semi-Annual Meeting; Held at Ann Arbor, Nov. 21, 22, 1871."Proceedings of the Michigan Homeopathic Institute … Seventh Annual Meeting … [1866] …"Proceedings … Second Annual Meeting at Marshall, May 16, 1871."System of Public Instruction and Primary School Law of Michigan …University of Michigan Regents' Proceedings …, 1837-1864."Who Is D. B. Minor?"

The Law School

THE LAW SCHOOL

THE establishment of the department. — It has now been officially decreed that the birthday of the University of Michigan is August 16, 1817, and that the birth certificate is "an act to establish the Catholepistemiad, or University, of Michigania." The author of this act was a lawyer, Judge Augustus Woodward. He provided for thirteen didaxiim, or professorships, including a didaxia of medical sciences but no didaxia of the law. Although in Judge Woodward's fantastic analysis of the field of knowledge, in his book A System of Universal Science, he included the law as a department called themistia under the division of ethica, yet there is no evidence that in his Catholepistemiad he planned for a didaxia, or professorship, of law, much less of a department of law, in the University of Michigania.

This is not strange, for in 1817 law schools in the modern sense were unknown. At that date it was the universal practice to prepare for admission to the bar by private study, usually under the tutelage of a lawyer and in his office. Professorships of law there had been. One was held by Wythe at William and Mary, one by Wilson at Philadelphia, still another by Kent at King's College (later Columbia), and a few others, but the first law school, if the so-called Litchfield School of Judge Reeve, which flourished from 1784 to 1833 in Connecticut, be excepted, was Harvard, established in 1817, at Cambridge. There, two professors and three students in two small rooms constituted the beginning of the first separate law school connected with a university. By 1837 the brilliant work and strong personality of Story had built up the school's enrollment to sixty-three.

Twenty years later, on March 18, 1837, the organic act of the University of Michigan, under which the present-day University in Ann Arbor came into existence, was approved. Section 8 provided that "the university shall consist of three departments. 1st. The department of literature, science, and the arts. 2d. The department of law. 3d. The department of medicine." It was also provided that professorships should be established in the Department of Law: "one of natural, international and constitutional law; one of common and statute law and equity; one of commercial and maritime law" (Laws, p. 102).

If before 1817 there had been no law school as part of a university, by 1837 it was quite otherwise. Of such schools still surviving there were then Harvard (1817), Yale (1824), University of Virginia (1826), University of Cincinnati (1833), and New York University (1835). But enrollments were small; nearly all lawyers still came to the bar by the office route, though here and there it began to be sensed that this was not adequate preparation. Men learned to be lawyers at the expense of their clients, law tended to be an art and not a science, lawyers to be artisans skilled in narrow and mechanical technique — pettifoggers and not scholarly lawyers and judges with broad views of their science. There were, however, many exceptions.

The very slender resources of the University delayed realization of the plans of the act of 1837. The medical profession urged vigorously the establishment of a school of medicine, but the great body of lawyers was indifferent or even hostile to the idea of a law school. And so medicine, though named third and after

the law in the organic act, preceded the law by ten years in the establishment of a school.

The University Catalogue of 1852-53 differs strikingly from its predecessors. Michigan's first president, the Reverend Henry P. Tappan, had arrived. In the Catalogue he laid down in broad outline his celebrated plan for a system of public instruction. He called for the education of teachers, preachers — by theological faculties which he hoped would be established outside the University by the different denominations — doctors of medicine, engineers, agriculturalists, followers of the mechanic and industrial arts, and, of course, those taking the traditional college course in science, literature, and the arts. He looked beyond these to the proper development of a university, as distinguished from a college — to the development of graduate and professional work, or, as he called it, a "university course," to which the Medical Department already established properly belonged.

Strangely enough, neither in the Catalogue of 1852-53 nor in those of the succeeding years to and including that of 1859, is there any word about instruction in law, much less about a department of law. That he was not unaware of the requirement of the act of 1837 that there be a department of law we know, because in his report to the superintendent of public instruction for 1853 (J. Doc., 1854, No. 6, pp. 51, 53) he included as suggested subjects for the university course: "The Law of Nature — the Law of Nations — Constitutional Law." He further said:

For the completion of the University thus successfully commenced, the following particulars may be mentioned as necessary:

.....

3. The establishment of a Department of Law. This has been prescribed by statute, and ought not to be delayed any longer. Applications are frequent on the part of law students. Unquestionably a very considerable number would resort here immediately.

In his report to the Regents in 1856, President Tappan envisaged a university that, with provision "to complete its buildings, to enlarge its Library and apparatus, and to establish its Law Department … would very soon be surpassed by none." There was, however, in the yearly University Catalogue no reference to instruction in law or to a law department until, suddenly, in 1860, the Department of Law was announced as already existing, with three professors and ninety-two students. From the Regents' Proceedings and other sources it is learned that petitions had been presented and that a Regents' committee had been appointed, which had made a study of existing law schools and had recommended the establishment of a law department. On March 29, 1859, the Regents acted on this report and voted that the Department of Law be opened on October 1 of that year. The next day they chose as law professors in the University of Michigan, at a salary of $1,000 each, the Honorable James V. Campbell, Charles I. Walker, and Thomas M. Cooley. These were to designate one of their number to deliver the opening address. This faculty chose Professor Campbell and elected him Dean. Cooley was chosen Secretary.

The advance announcement of the opening of the Law Department was made, not in the University Catalogue — the plans were not completed in time — but by advertisement in the papers in Detroit, Chicago, New York, Cincinnati, St. Louis, and Washington, D. C. This was a notice to a national constituency, and it met with a national response which has continued to the present day. In the first year nine different states and England were represented, and by the third year students had been admitted from every New England state as well

as from a number of other Eastern states, most of the Middle Western states, Kentucky in the South, and California on the Pacific coast.

By special action of the Regents twenty-four students were granted the degree of bachelor of laws (LL.B.) at the end of the first year. Attendance grew rapidly. In 1865-66, 385 were enrolled in the Department of Law, whereas there were only 335 in the Department of Literature, Science, and the Arts. The Department of Law had become the largest law school in the country, and such it remained for many years. Incidentally, so far from being a financial burden on the University, as had been feared, it became a source of net income. The President and Judge Cooley, in their reports to the Regents, often pointed out that the fees of nonresident students more than paid the current expenses of the department.

If one considers the meager attendance at other law schools in those early days it is not strange that the Regents allowed their financial straits to delay the opening of the Department of Law. In their report they pointed out that it was predicted that the professors would lecture to empty benches. But in the light of the results it would seem that an earlier establishment of the Department of Law would have helped the general exchequer of the University. In the Catalogue of 1860 it was stated that "its success thus far has exceeded expectation," and in 1862 that "the success of this Department has more than equaled the highest expectations at the time it was first opened."

History and development. — An immediate need of the department was a home. At first the lectures were given in the old chapel in Mason Hall. The books of the library were placed on shelves in one end of a room in this "South College" (see Part VIII: First Buildings) . The principal task of the student librarian was to feed wood to the box stove and to sweep the floor. In the week of the opening of the Department of Law in 1859 a committee of the Regents was appointed to devise ways and means for the erection of a suitable building. The surprisingly large enrollment made the quarters in the chapel very inadequate. An attempt was made at once to raise by subscription the sums of $10,000 in Ann Arbor and $5,000 in Detroit, to which the Regents were to add $5,000, but the people of Ann Arbor and Detroit failed to appreciate their privilege. The building was ordered in 1861 and was completed in 1863, but the Regents had to pay the entire cost.

The new building, erected to the north of Mason Hall, gave the Law Department a lecture room, a small room for the Law Library, and some office room — all on the second floor (see Part VIII: Haven Hall) . There were a few third-floor rooms. But the whole of the first floor was occupied by the General Library of the University until a new library building was erected in 1882-83. Thereafter for the next ten years, the department was the exclusive tenant of the building, which it had already outgrown. A considerable addition on the north was made in 1893, but immediate changes in methods of instruction and rapid growth in attendance made this inadequate almost before it was occupied. In 1898-99 the addition was wrecked. The original building was given a new addition on the north with offices and classrooms, and a larger addition on the south with classrooms on the first floor and much enlarged quarters for the library above. Here the department, which since 1915 has been officially designated the Law School, remained till 1933, when Hutchins Hall, the recitation and administration building named in honor of the late President Hutchins, was erected.

The buildings of the Quadrangle were made possible by the munificent gift of William W. Cook ('80, '82l), of New York City. The plans had been carefully formulated by Mr. Cook, advised and assisted by Dean Bates of the Law School and by President Hutchins. The first section of the Quadrangle, completed in 1924, is known as the Lawyers Club. This strikingly beautiful group provides sleeping rooms and studies for 160 students, a great dining hall with capacity for 300 men, a spacious lounge, and, beneath, a recreation room of the same size — these two being a social center for the members of the club. Above the lounge are guest rooms for the accommodation of visiting lawyers and distinguished guests of the University.

In 1930 a large addition was opened, named for the donor's father, the late John P. Cook. It accommodates 117 students. In the following year the most conspicuous building, the beautiful William W. Cook Legal Research Library, was occupied. During his life Mr. Cook would not agree to have any of the buildings named for him. He died before the library was completed, and the Regents felt that his name should be recognized in this building. The library includes the main reading room, numerous research offices and conference rooms, alcoves, carrells, and book stacks with capacity for 275,000 volumes.

The final building of the Quadrangle was Hutchins Hall, the recitation and administration building for the Law School. Classrooms occupy the first and second stories. The third and fourth floors contain the faculty library and numerous offices.

Splendid as are the buildings of the William W. Cook Quadrangle, they are not so significant as is the purpose behind them. The donor caused to be carved in stone over the entrance to the Lawyers Club: "The Character of the legal profession depends on the Character of the Law Schools. The Character of the Law Schools forecasts the future of America." He intended to create a home in which teachers, lawyers, judges, and students preparing for practice should mingle, and where in a more or less cloistered life for the period of his law study the student should live and breathe in a legal atmosphere. He also intended to establish a center for legal research and for activities designed to improve the law.

The faculty of the Law School has in many respects been a remarkable one. From 1859 until 1865 it consisted of James Valentine Campbell (LL.D. '66), Marshall Professor of Law, Charles Irish Walker (LL.D. '74), Kent Professor of Law, and Thomas McIntyre Cooley (LL.D. '73), Jay Professor of Law. They began to lecture in 1859, and twenty-five years later they were still teaching. Professor Charles Walker, because of ill health, had to retire from 1876 to 1879, but he lectured again from 1879 to 1881 and again in 1886-87. Professor Cooley retired from the law faculty in 1884, and Professor Campbell in 1885. The original three were joined by Ashley Pond ('54), a practicing lawyer from Detroit, in 1865. Because of the demands of his practice he resigned in 1868 and was succeeded by Charles Artemas Kent (Vermont '56, LL.D. Michigan '99), who had been a student in the office of Professor Walker. This new professorship was named the Fletcher professorship in honor of Judge Fletcher of Massachusetts, who had made a valuable contribution to the Law Library. Professor Kent served until 1886. In 1874 another Detroit lawyer, William Palmer Wells (Vermont '51, A.M. ibid. '54, Harvard '54l), joined the faculty, taking Professor Walker's place as Kent Professor of Law. He remained until 1885, and returned for the years 1887-91. In 1879 Alpheus

Felch (Bowdoin '27, LL.D. ibid. '77) was made Tappan Professor of Law.

Professor Felch was succeeded in 1883 by Henry Wade Rogers, the first full-time member of the faculty. With him began a new era, though part-time nonresident professors whose main occupation was in practice or on the bench continued as members of the faculty for many years, the last one, Otto Kirchner (A.M. hon. '94, LL.D. '19), retiring in 1906. After 1894 most of the work of instruction was given by full-time resident professors.

During most of this first twenty-five-year period the department had been the largest law school in the country. The attendance grew from ninety-two to 437 immediately after the close of the Civil War. It fluctuated between three hundred and four hundred for the rest of the first period, falling to 305 in 1883-84. Changes in the entrance requirements and in the curriculum were largely responsible for a sharp decline in enrollment, to 262, in 1884-85, but this decline was quickly checked and was followed by a continuous growth to 649 in 1894-95.

In the Catalogue for the years 1860 to 1871 and in the Calendar for 1871-72 through 1877-78 it was stated in each issue: "The sole requisites for admission are that the candidate shall be eighteen years of age, and be furnished with certificates giving satisfactory evidence of good moral character." In 1877-78 it was expected that all students would be well grounded in at least a good English education. This was an expectation rather than a requirement. No examination or test was announced. In the original manuscript "Record Book," still preserved, each student wrote his name, residence, place of nativity, and (after 1862) his age. The word of the student seems to have been all the evidence required. Of the class entering in 1862 five were eighteen years of age, but in that and in the ensuing year many were over twenty-five, and not a few were past thirty. The average age for some time was more than twenty-three, and it was a requirement for receiving the degree of bachelor of laws that the candidate must be twenty-one. Not until 1910 were entrants to the first-year class required to be nineteen years old. That there were practically no entrance requirements in 1859 is not strange. No other law school asked more; relatively few students took a course in a law school; and in the entire Middle West at that time there were scarcely any high schools and only a few colleges where preparation might be secured (see Part I: Branches) . But these conditions changed, and it would seem that the University of Michigan might well have enforced advancing entrance requirements to its Department of Law long before this was done. Experience shows that undue delay in adopting higher standards when they are warranted causes the more desirable students to go where the requirements are more exacting. Moreover, if there is a temporary drop in enrollment when changes are made, this is speedily followed by an increase. President Angell in his reports to the Regents more than once called attention to the need of higher requirements and written examinations to test the prelegal training. Although there was a large attendance of able men, such requirements would have decreased the number of the "persons who do us no credit." In 1897 he noted with satisfaction that the requirements for admission had been materially raised, and, surprisingly, without a diminution in the number of applicants.

The Calendar for 1881-82 was the first to announce an examination of an applicant as to general education in order to determine his fitness to practice law as soon as his legal studies should be

completed. No subjects were specified until 1883, and a diploma was accepted as evidence of fitness. After 1883, with the coming of full-time professors, the faculty had more time to give to administrative matters, and could know the students and their progress better. Thus, under the deanships of Henry Wade Rogers (1886-91) and Jerome C. Knowlton (1891-95) entrance requirements were gradually increased.

With the coming of Dean Hutchins in 1895 further advances were announced for 1897, and later came the announcement that in 1900 and thereafter all candidates, except those admitted on certificate or diploma, must pass examinations equivalent to those required for admission to the Department of Literature, Science, and the Arts, that is, the equivalent of a four-year high-school course. Examinations were given, however, not by professors in the various branches of the Department of Literature, Science, and the Arts, but by members of the law faculty, and records show that the examiners were generous in grading papers. Still, this would have reduced materially the entrance of weak students but for the fact that those who feared to try these examinations or who failed to pass them might still be enrolled as special students. There were twelve special students in 1893 before the severer tests were applied, and the number of such students increased to eighty-three in 1903 — more than 10 per cent of the enrollment. Since that date students under twenty-one, later under twenty-five, have not been admitted as special students, with the result that they have almost disappeared.

It was no doubt wise to increase entrance requirements gradually, but these advances were delayed so long that the school suffered severely — not quantitatively, for enrollment increased till the classes were too large, but qualitatively, as is shown by the fact that in 1903-4 only 207 of the total 883 enrolled had college degrees. College graduates were drawn to law schools with higher entrance requirements. A college degree is not a sure hallmark of ability, but, as a whole, college graduates are far more promising as law students than those without such previous training.

The faculty was not blind to this situation and soon after 1903 urged a forward move. Some of the Regents objected, and it was not until 1912 that admission required one year of college work. In this year there were only 203 college-degree men out of a total enrollment of 856. In 1915 two years of college work were required, in 1926 three years, and in 1928 a college degree was made a prerequisite to admission to the Law School. A combined curriculum was offered whereby a student who had attained a high standing in three full years of college work at Michigan might receive his bachelor of arts degree upon completion of his first year in law, and his law degree upon meeting the requirements for that degree two years later. The Law School had become a graduate school.

The effect of these changes upon attendance was only to bring about a desirable drop from a high enrollment of 930 in 1909 to a steady enrollment, except during the war years and the first three years of the depression, of six to seven hundred students. The amount and quality of the work required of these students would have been quite impossible with the student body in the early nineteen hundreds. The present enrollment would be much larger if all applicants with college degrees were accepted. Diplomas are no longer accepted as evidence of fitness. A detailed certificate is required, and candidates are refused if their college record does not promise well for success in law study. The Law

School considers that the public needs are best served by quality and not by quantity.

The law faculties. — Of the great triumvirate — James Valentine Campbell, Charles Irish Walker, and Thomas McIntyre Cooley — which for so many years guided the destinies of the Department of Law, Professor Campbell must have been best known when the faculty elected him Dean and designated him to give the address on the occasion of the opening of the department. He was a distinguished member of the Supreme Court of the state. His position as Dean must have been largely nominal. He was never so designated in the University Catalogue, and from the beginning Professor Cooley seems to have been the active executive officer. He was elected Secretary, and the Regents in June, 1860, voted to give him $500 additional salary on condition that he would move to Ann Arbor and be resident professor. He was also to give an additional course of lectures outside the Department of Law. It was considered undesirable that he "should very much enter into a course of professional business at or about this University" (R.P., 1837-64, p. 907).

It has often been said that it was the renown of Judge Cooley's name that drew the larger proportion of students present from other states. In later years that may well have been the case, for his decisions on the state Supreme Court, to which he was elected in 1865, his numerous treatises on legal subjects, and more especially his classical works on Constitutional Law and Constitutional Limitations made his name familiar wherever the American or English law was known. But in 1859 he had been a country lawyer in what was then the small town of Adrian, had edited Michigan Compiled Laws, 1857, the Michigan Digest, revised in 1866, and was reporter for the Michigan Reports, volumes V to XII. (Only volume V had been published prior to 1859.) This was enough to make him known to the Regents, notably to Regent Baxter, from near-by Tecumseh, who was a member of the Regents' committee on opening a law department, but hardly to possible students looking for a law school.

But if his fame was local at the beginning, his works growing out of his law lectures and his decisions on the Michigan Supreme Court have given him a place among the immortals with lawyers here and abroad. Justice William R. Day of the United States Supreme Court, formerly one of Judge Cooley's students, and who for a time lived in the Cooley home, said of him:

Here was a man of world-wide fame as a jurist — the author of a book which is at once the greatest authority upon the subject of constitutional limitations upon our government and a classic in legal literature — whose recreations seemed to consist in change of occupation, and whose energies seemed never to tire.

Shaw

But if Cooley became best known, his colleagues were cultured and scholarly men of great ability, and they made a deep impression on the students who, in increasing numbers, sought here the fountain of their legal learning and never found it dry. As President Angell once wrote: "Never was a law school so fortunate as this was in beginning its work and continuing it for so many years under such gifted instructors" (Angell, Reminiscences, p. 233).

In 1871 Cooley succeeded Campbell as Dean, and he in turn was succeeded by Charles Artemas Kent, who had joined the faculty in 1868, and who continued as lecturer and Dean until 1886. This first twenty-five years covers an era in the Department of Law, the era of lectures by men active in practice and on the bench, who out of their busy lives gave a part of their time to the teaching

of law. With 1886 came in new men and new methods.

In the second twenty-five years Henry Wade Rogers ('74, A.M. '77, LL.D. Wesleyan '90) was Dean from 1886 to 1890, Jerome Cyril Knowlton ('75, '78l), Acting Dean and then Dean from 1890 to 1895, and Harry Burns Hutchins ('71, LL.D. Michigan '21), Dean until 1910. From 1910 to 1939 Henry Moore Bates ('90, LL.B. Northwestern '92) was Dean. In 1939 Edwin Blythe Stason (Wisconsin '13, B.S. Massachusetts Institute of Technology '16, J.D. Michigan '22) succeeded to the position upon the retirement of Dean Bates.

Roughly speaking, the history of the Law School may be divided into three eras, 1859 to 1884, 1884 to 1910, and 1910 to 1940. In the first era the organization of the faculty was very loose. All three of the original members worked together to formulate policies and methods of instruction, and these were carried out with very slight change for the whole period. Toward the close changes were evidently being considered, so that when the three original members retired, almost together, plans were being laid for the changed work and methods of the second period. On the whole, Professor Cooley must be regarded as the leader in the first period.

The second era was one of gradual transition from instruction by lectures, with oral and not very rigid examinations of seniors only, the instructors being men primarily active in practice or on the bench, to instruction largely by recitations and classroom discussions based on textbooks and collections of cases and with predominantly resident, full-time professors. Examinations were written and were increasingly rigorous. At the beginning of this second period Henry Wade Rogers was the leader. He was the first full-time professor, the first who had had any training as a student in a law school, the first to come to law teaching with almost no previous law practice. In 1890 he was called to the presidency of Northwestern University and was succeeded by another full-time professor, Jerome C. Knowlton. Harry B. Hutchins was appointed Dean to head the faculty for the last fifteen years of the period. Dean Knowlton in 1895 became again Professor Knowlton and so continued until his death in 1917. Dean Hutchins had been a professor in the department from 1884 to 1886, when he had gone to the newly organized Cornell Law School. In 1895 he returned to devote the rest of his life to the University of Michigan — as Dean of the Law Department till 1910, then as President till 1920, and as President Emeritus from that date till his death in 1930.

Dean Hutchins was admirably fitted by his past experience as teacher, practicing lawyer, and college professor to carry the Law School through the transitional period from 1895 to 1910. His law lectures were prepared with care, and were characterized by sound scholarship, crystal clearness, and a phrasing and wealth of illustration that made them intensely interesting. His dignified presence and his very speech are still vivid in the minds of students who sat in his classroom. He was equally effective in the courses conducted by the use of textbooks and in the so-called case method of teaching law. He made the fields of the law of real property and of equity peculiarly his own. He edited an American edition of the classical work, Williams on Real Property, and prepared a useful casebook on equity to accompany his lectures in that subject. He was a prime mover in the establishment of the Michigan Law Review.

Under the leadership of Dean Hutchins there was built up a faculty composed almost exclusively of men who devoted all of their time to the Law School.

The entire faculty undertook a study of policies and methods of instruction, a procedure never before possible. Entrance requirements were gradually increased, the course was lengthened to three years, and the lecture system almost disappeared. Standards for graduation were made much higher, and the student body became one of the busiest on the campus.

Under the leadership of Dean Bates, in the third era, all these movements went on with accelerated pace. The basis of study in nearly all the work became collections of cases in the various subjects. Scholarship took on a new content, and independent research was fostered on the part of students and faculty. Some of the faculty were released from part of their teaching duties to devote time to special research projects, and graduate students were engaged in intensive studies in various lines.

Among those who served on the faculty for extended periods in the later years were Victor Hugo Lane (C.E. '74, '78l), Robert Emmet Bunker ('72, A.M. '75, '80l), Grover Cleveland Grismore ('12, J.D. '14, S.J.D. Harvard '21), Edwin Charles Goddard (Ph.B. '89, '99l), Joseph Horace Drake ('85, '02l, Ph.D. '00), Evans Holbrook (Stanford '97, Michigan '00l), Ralph William Aigler ('07l), John Barker Waite (Yale '05, Michigan '07l), Edgar Noble Durfee (Harvard '04, J.D. Chicago '08), and Burke Shartel ('11, J.D. '13, S.J.D. Harvard '19).

Program of studies. — The act of March 18, 1837, section 8, provided three professorships. In 1858 it seems to have been assumed that one professor might hold all these professorships. But the Regents' committee, in its report of March 29, 1859, recommended three — one of common and statute law; one of pleading, practice, and evidence; and one of equity, jurisprudence, pleading, and practice. To these three professors were to be assigned the general subjects of international, maritime, civil, commercial, and criminal law, medical jurisprudence, the jurisprudence of the United States, and other branches of law. The system of lectures, study, practice, and examinations was to extend through a period of two terms, the length of each term being from the first of October to the last Wednesday of the ensuing March. Moot courts were to be organized and other measures were to be taken to promote the practical knowledge and application of the principles taught. The course was to be so arranged that a student might begin with either term. The plan was adopted by the Regents. The extension of the term to nine months was proposed the second year, but a committee of the Regents reported adversely, and the six-month term continued until 1883, when, Judge Cooley favoring but other members of the faculty undecided, the term was made, like that in other departments of the University, nine months.

For almost forty years each professor was accustomed to enter in the "Record of Law Department," in his handwriting, the lectures he was to give on each day and their subjects. This "Record" shows the following item for October 3, 1859: "Law Department Inaugurated by an address from Professor Campbell on the 'Study of the law.'" Under date of October 5, in Professor Walker's hand, appears: "1st Lecture. Personal Property — What? 2nd Lecture. Contracts — Definition and Classification." The Catalogue of 1860 (p. 61) announced that the work was apportioned as follows:

first year

Professor Campbell — the Origin and History of Equity Jurisdiction; the General Heads of Equity Procedure, and Nature and Forms of Equitable Remedies; Criminal Law; the Laws of Evidence, and their Application in Legal Proceedings.

Professor Walker — Contracts; Title to Personal Property by Gift, Inheritance, Sale, Mortgage Assignment, and by Operation of Law; Bills of Exchange and Promissory Notes, and Commercial Law generally.

Professor Cooley — Estates in Real Property; Title to Real Property; Easements; the Domestic Relations; Wills, their Execution, Revocation and Construction.

second year

Professor Campbell — Some Special Heads of Evidence, and Equity Jurisprudence; Equity Pleading and Practice; Jurisprudence of the United States; Shipping and Admiralty.

Professor Walker — Agency; Bailments; the Law of Corporations; Common Law Pleading and Practice.

Professor Cooley — Constitutional Law; Partnership; Uses and Trusts; the Administration and Distribution of Estates of Deceased Persons.

A moot court presided over by the lecturer for the day was to be held at least once a week, and club courts were to be organized among the students.

Such was the course of instruction, followed with slight differences for a quarter of a century. After 1865 the assignments to individual professors were omitted from the Catalogue, and in 1882-83 appeared for the first time Actionable Wrongs, which in 1884-85 became Torts. This is curious, for the "Record" of the Department of Law shows that lectures had been delivered on this subject since January, 1869, and, strangely enough, by Kent, and not by Cooley, who in 1879 published his standard treatise on torts.

The Calendar of 1883-84 makes notable announcements. Change is in the air. The old faculty has lectured ably and has given the school a high standing. As it leaves it announces an "Improved and Extended Course of Instruction." The course has been extended to two years of nine months each. There is a "sincere conviction that the standard of legal education should be raised." New subjects are added, recitations and examinations will be held, textbook work in the Commentaries of Blackstone and Kent is prescribed for juniors, with satisfactory written examinations thereon. Previously only seniors had been examined, and examinations had been oral. A record is to be kept, and seniors must pass satisfactory oral and written examinations on the lectures. Additional requirements are announced for admission to the department. A revolution is under way. The lecture system and the professor who is first of all an active practitioner or a judge are on the way out. Henry Wade Rogers, the first resident full-time professor, has arrived and has charge of the textbook work. It begins to be suggested that law students shall have textbooks at their rooms and shall use them. There has been no rule against a law student's working, but henceforth the faculty will check up on him to see what he is accomplishing.

In 1885-86 Harry B. Hutchins and in 1886-87 Jerome C. Knowlton were added as full-time professors, and another innovation appeared. Previously, part of the lectures had been given in odd years, the rest in even years, and seniors and juniors listened together. Thereafter, the course was graded, all the subjects were given each year, and juniors were not allowed to attend senior lectures. More subjects were added, both to the lecture and to the textbook courses. Students were to be examined on a "Study of Leading Cases."

In the next decade ten new men were added to the faculty, and they were resident, full-time men. There were fewer lectures and more recitation and textbook work, and there was a gradual appearance of collections of "Illustrative Cases" in various subjects. In 1895 the course was extended to three years, there

were more additions to the curriculum, and the completion of all the subjects was required for graduation. Even before this date all examinations were in writing.

At the time the Department of Law opened, law schools were criticized by lawyers as being too theoretical. The three professors who opened the Law Department were themselves office trained and were in a position to know. In their first announcement in the Catalogue of 1860 (p. 63) they pointed out:

The active practitioner, engrossed with the cares of business, cannot — or, at least, as proved by experience, does not — give to the students who place themselves in his charge, that attention and assistance essential to give a correct direction to their reading … The effort here will be to make, not theoretical merely, but practical lawyers: not to teach principles merely, but how to apply them.

To this end they announced that they would conduct a moot court in which all students might participate, and that the faculty would assist the students in their club courts.

The moot courts were directed by the faculty, and from the first entry in the "Record of Law Department," October 13, 1859, Professor Cooley presiding, to June 7, 1893, moot courts were as regularly provided for as were lectures. But on September 25, 1893, it was recorded: "The Practice Court is to be under the charge of Professor Mechem." The moot court, which had existed so long without interruption, was displaced by the highly organized and faculty-directed practice court. This was intended to require of every senior participation in a jury case involving questions of fact and a case to be argued and disposed of as a question of law upon an agreed statement of facts. Papers and briefs were to be prepared and filed, and arguments were to be made as in an actual case in court. The following year Thomas Ashford Bogle ('88l) was added to the faculty to have entire charge of the practice court. He was assisted by the other members of the faculty, who sat as judges to hear the cases. Under his masterly direction the practice court was vigorously developed.

As further practical training for the actual work of the law office, a course in Conveyancing was arranged. In this course such papers were drafted by the students as would be expected to be called for in actual practice. James Henry Brewster (Sheffield Scientific School '77, LL.B. Yale '79) was called to devote his entire time to this work. By these and other means the Department of Law endeavored to keep good that early promise to make the work not theoretical merely, but practical as well.

The idea long persisted that the instruction could be made more practical by having a faculty of practicing lawyers and sitting judges. As previously noted, in 1882 a change began. The first full-time professor had had very little experience in practice. For another dozen years the full-time professors were in a minority, and the advantage of having lecturers engaged in practice was stressed in the departmental Announcement. Some objected to the practice court on the ground that the practical work could be done only in a law office. Professor Bogle's answer was: "We are doing it in the Law School."

On account of the rapidly expanding law, the effort to give instruction in all the subjects to all the students was breaking of its own weight. No student could profitably pursue so many studies, and in 1897 election courses were established, and each student was required to elect and complete three. These electives were given as courses of lectures, for the most part by practicing lawyers who were specialists in the various fields. Ten years later most of these special courses

were open to second- and third-year classes, but not required of them, and certain courses given by resident professors were made elective, each third-year student being required to complete one each semester.

With the induction in 1910 of Henry M. Bates ('90, LL.B. Northwestern '92, LL.D. Kalamazoo '25) as Dean, a change was made. Law had become so complex that a lawyer in a lifetime could not master every subject, and it was agreed that the student could be much better prepared for practice by the requirement of certain subjects as fundamentals and by more thorough courses in fewer subjects, which he might elect. The question became, not how much law he could learn but how well he could be trained to know how to find and to apply the law as he might need it in practice. Accordingly, in time most of the second- and third-year subjects were made elective. Coincident with these changes the number of class-hours was decreased and the work was made more intensive and extensive in each subject. First-year men, just entering a strange field, spent more hours in recitation so as to have greater aid from the instructor in becoming oriented. In the next two years students were thrown more on their own. It would require six years or more for a student to complete all the courses in the curriculum, but in the three-year course in law school it was believed that he would be better grounded in the law and its practice by doing better work in fewer subjects.

The summer session. — In 1895 a summer school of law was announced, with three courses given for six weeks by three instructors. The next year short review courses were offered in nearly all the principal subjects of the first and second years in law. The term was eight weeks. These courses were commended to students who wished to review as preparation for examinations for admission to the bar or for advanced standing in the Department of Law. They also appealed to students who had been conditioned. The courses were announced as not in any sense equivalent to the corresponding courses given in the regular session.

Until 1904 the summer school was a privateventure. The University furnished the building, collected fees, and paid the expenses. The balance was to pay the faculty. At first the attendance was small, the compensation slender. In 1904 the Board of Regents voted that the various summer schools should be operated under its direction and control as the Summer Session of the University of Michigan (see Part IV: Summer Session) . The selection and salaries of the faculty were determined by the Regents as in the regular session. The attendance ranged from 25 in 1895 to 149 in 1909.

In 1910 the law summer session was extended to ten weeks, later to eleven, and the work offered in each subject was the same in character and amount as that given in the regular session. The effect of this was that three summers were equivalent to one year, and that by entering in a summer session it was possible for a student to graduate two years from the following September, saving practically a year of time. Many have done this, and in 1940 more than half of those enrolled were also students in the regular session. The summer session is really an extension of the regular session.

Methods of instruction. — During the first twenty-five years the method of instruction in the Department of Law was simplicity itself. The professor lectured; the student listened. Late in the term there were occasional oral quizzes of the seniors, usually in part of the lecture hour. Juniors were not quizzed or examined. Each week there were ten lectures. At the end of the term there were

final examinations, oral only, of the seniors. A student of that day, who was afterward a member of the faculty, said that each senior was supposed to be asked a few questions, but the examination was largely a matter of form. No one was rejected. The men sat at the feet of great lawyers, learned men, and could learn much or little as they might elect. Graduation entitled them to admission to the bar. Other law schools of that date required no more, some less, and admission to the bar by the office route was easier still. There were few requirements. In the Department of Law there were the moot courts, and a written dissertation, or thesis, of not less than forty folios was required for graduation, "but no great stress was laid upon it."

With the second twenty-five years the textbook appeared. Instruction by lecture continued, but some courses were given by textbook, or by lectures and cases or textbook and cases, and toward the end of this second period sometimes by the study and discussion of cases alone, with running comment by the professor. In the third quarter-century of the Department of Law, since 1915 called the Law School, instruction by lecture or textbook rapidly disappeared and was largely, but not entirely, displaced by the so-called case method of instruction. To receive credit in the second and third periods of the School the student was required to pass written examinations in each subject pursued. These examinations at first were largely memory tests, but later became tests in legal reasoning on hypothetical cases involving principles of law in the subject. Cases form the basic material in developing the principles of law, and ability to apply legal principles to the ordinary controversies of life is the test by which preparation to enter the practice of the law is measured. Thus the Law School is "practical" by teaching the law student how to use in practice the knowledge he has acquired in school.

Recently, there has been much discussion in the law schools about relating the law more closely to the present conditions of living, particularly in their social and economic aspects. Some schools have announced new approaches to the law and revised curriculums making specific provision for instruction in the law school by economists and sociologists who are not lawyers. The University of Michigan faculty has long recognized the problem of relating present-day law to the increasingly complex and ever-changing social and economic life. It has been felt, however, that the law student should secure the foundations of his economic and social background in his prelegal college work under the guidance of trained economists and sociologists. Then, when he enters upon the study of law, he will be prepared to study and understand the economic and sociological implications of every case. It is felt that this approach can best be directed by those who are primarily trained as law teachers, but who are fully awake to and informed as to the problems of society to which the law is to be applied, and in which it finds its reason for existence, rather than by instructors primarily trained in other branches who give separate courses in the Law School. The aim in the Law School is to treat the law and the life in which it operates, not as things separate and distinct, but as one, the law existing solely for the contribution it makes to the life to which it is applied. Every recitation hour, therefore, is devoted to the law, not as an isolated thing, but as part and parcel of the conditions for which alone its existence and form are justified. Every professor in every course is an instructor not only in law but also in such subjects as economics and sociology as well.

Graduate instruction. — The student was

formerly prepared to enter the practice of the law by work and observation of the law in action in a law office. He still does most of his graduate work, if any, in that manner. Today the school has almost entirely supplanted the office as a preparatory institution, but it has made slight inroads on the office for work following graduation. After eighteen or nineteen years at school the student is ready for a change, and once he is in successful practice he is not likely to leave it to return to school. Thus far, completion of a graduate course does not bring more attractive offers to enter practice.

The immense increase in enrollment in law schools, however, has brought the need for many more lawyers fitted to become teachers of law, and for that purpose legal scholarship is very important. Success at the bar has proved no criterion of promise as a law teacher. Successful practice is financially so much more remunerative than teaching that active practitioners are rarely willing to change, and very successful practitioners have often proved ill suited to the teaching of law, particularly so if they enter upon teaching after many years of practice. More and more, law faculties are recruited from lawyers with short experience at the bar, often with none at all, but with scholarly instincts and achievement. For the training of these there is a limited but growing demand for superior graduate work in law.

The first enrollments for graduate work were in the days of the two-year law course. In 1889 the Regents approved a study of one year after graduation leading to the degree of master of laws (LL.M.). Between 1890 and 1897 (the year in which the course was increased to three years) there were from six to twenty-one enrolled in this graduate year. Since that time enrollments have been few. This shows that several years before it was offered there was a substantial demand for a three-year course. When three years of study were required for the bachelor of laws degree, the degree of master of laws almost disappeared. The course was little more than an added year of law study, though some specialization was required.

In 1924 a new fourth-year course (for the degree of master of laws or juris doctor, J.D.) was announced which was not merely an added year after graduation, but called for specialization and a different kind of work. For this, new courses were offered which were open only to fourth-year students. The next year this was modified so as to provide for two fourth-year curriculums (LL.M. and doctor of juridical science, S.J.D.). These two curriculums are still in force. To enter the former the student must have secured a law degree with high rank and must thereafter pursue a fourth-year program of study in this Law School approved by the committee on graduate law instruction. This program must provide for a substantial measure of specialization in some selected subject.

More worthy still of being dignified as graduate study is the course leading to the degree of doctor of juridical science (S.J.D.). The candidate must not only have the previous record required for the course leading to the degree of master of laws and pursue an approved program of graduate study for at least a year, but he must also demonstrate capacity for independent research in law by completing and preparing for publication an approved original study upon some selected subject. This study may be submitted at any time within five years after completion of the graduate year. This year must be devoted to pursuit of seminar courses open by special permission to a limited number of exceptionally qualified third-year and fourth-year students. This is graduate work calling for independent research which requires scholarly

attainment. A considerable number, many of whom are graduates of other law schools, have elected this work every year since it was first offered.

The law students. — The student body of the Department of Law from the first was cosmopolitan. In the first year nine states and England were represented. Twenty-six of the ninety-two students were nonresidents of Michigan in that year; fifty-three of 134 the second year, representing thirteen states. There were large numbers from Ohio and Illinois, and some from most of the other Midwestern states. In 1861-62 fifty-eight of 129 students came from beyond the borders of Michigan, and ten years later only 115 of the 307 students enrolled in law were residents of Michigan. Some objections to providing training for non-Michigan men were met by the President and Dean Cooley with the statement that it cost no more to lecture to a larger group and that the fees of these nonresidents paid all the current expenses of the Law Department.

During the following years two-thirds of the students, sometimes slightly less, sometimes more, came from outside the state. In 1880-81 there were 112 students from Michigan, 259 from outside; in 1890-91, 165 and 416. In recent years Michigan students have constituted about half the total number. In 1934-35 270 students were from Michigan and 268 were from thirty-six states and four foreign countries. This situation serves as both cause and effect. Because the student body is cosmopolitan, instruction must be on broad lines and not confined to narrow local law. Because the law is broadly presented, this cosmopolitan body of students is attracted here. This condition is altogether favorable at once for the study of the law and for the best preparation for practice. Once through school the lawyer has a lifetime of study and practice of local law. He is fortunate in his student days to be presented with the broader view taking in jurisdictions other than his own. Moreover, this association with such a student body, men from every state and from many foreign countries, in itself is part of a liberal education.

Student societies. — From the very beginning the students of the School have had voluntary organizations to promote activities which were of special interest or value to students of the law. The Webster Society dates almost from the opening of the department. It is said to have been founded early in October, 1859, with the co-operation of the faculty. The Jeffersonian Society followed soon after. These were literary and debating societies which held weekly meetings in rooms provided for them in the Law Building. For almost sixty years these societies flourished. When in 1887 a professor of elocution was appointed for the Department of Literature, Science, and the Arts (see Part IV: Department of Speech) , these law societies participated in the debating and oratorical contests held under his guidance. So keen was the interest that other societies — the Clay, Benton, Griffin, and Mechem — were formed to provide more active participation by a larger number.

As requirements for admission to the Law School were advanced to include preliminary college work, and especially after the Law School became a graduate department, the part these societies had played tended to be relegated to the college years, and in 1919 or 1920 the law societies died.

The case clubs. — To some extent, the place of the literary societies and the oratorical and debating contests has been taken by the case clubs, which were first organized in 1925. In the first year students may join one of four clubs. In each club teams of four are assigned a hypothetical case on which the students draw

papers and briefs as in an actual case in court. The work is supervised by members chosen from the third-year class who act as advisers and sit as judges to hear the arguments of each team and to decide the cases, each case being argued by two men on each side. In the second year, professors sit with third-year students to hear arguments in an elimination contest to select the four students who shall appear as attorneys in the finals. These are held on Founder's Day.

Honors and prizes. — The first prizes offered in the Law School were in the form of honors to those students standing highest in each third-year class. They were selected as student editors of the Michigan Law Review. They received not only this recognition, but also the valuable opportunity to prepare for publication studies of recent cases. Incidentally, they greatly improved their chances of finding positions in desirable offices on graduation. Law Review men are at a premium.

In 1912 the University of Michigan Department of Law joined with several other law schools in establishing the Order of the Coif, an honor society for law schools, whose members are chosen principally on the basis of scholarship (see Part IX: Coif) .

The first monetary prize offered in the Law School was an award of the Howard B. Coblentz prize, paid from the income of a fund given by the parents of a member of the class of 1918 who lost his life in World War I. In 1925 a class of 1908 memorial scholarship was provided for by Guy B. Findlay of that class for the second-year student who in the previous year had attained the highest rank in his class.

The Henry M. Campbell case club award was established by the Detroit law firm of which Mr. Campbell, of the class of 1878, had been a member. It is awarded to the four men of the case clubs who win through the preliminary contests and are chosen for the final argument on Founder's Day. Two-thirds of the prize goes to the two who win the final contest, the other third to the losers.

In 1928 the Regents established three fellowships with substantial stipends to assist graduates of outstanding ability to do graduate work and independent research. Other funds have been made available by the great gifts of William W. Cook to the Law School.

Publications. — The law class of 1894 began an "annual publication" called To-Wit. The classes of 1895 and 1896 continued it, but changed the name to Res Gestae. This contains considerable matter of historical interest. Judge Cooley contributed to To-Wit a very valuable article on "Founding of the Law Department of the University of Michigan," with fine appreciations of Professors Campbell and Walker. An appreciation of Judge Cooley was written by President Angell. Res Gestae of 1895 contains important addresses made at the unveiling of a bust of Judge Cooley, which had been given by the class. The principal speaker was a distinguished member of the New York bar, Mr. William B. Hornblower. One feature of the publication was an article by Judge Cooley on the Webster-Hayne debate in Congress, in which Judge Cooley proceeded to present his views of the nature of the Constitution. The Res Gestae of 1896 contains a tribute to Judge Campbell, then just deceased, by Judge Cooley, the last survivor of that great triumvirate, and an article by the new Dean, Harry B. Hutchins, on "The Law School of To-Day, Its Work and Functions." Such contributions are indeed res gestae.

Other publications deserving mention are The Brief, issued in 1925 by the first students who lived in the new Lawyers Club; Addresses, issued in 1925, at the dedication of the Lawyers Club; The

Lawyers' Quadrangle, published in 1931 when the William W. Cook Legal Research Library was completed; Dedicatory Exercises, Law Quadrangle at the University of Michigan, a book of illustrations published in 1934; and Law Quadrangle, 1934, containing the notable addresses at the dedicatory exercises after Hutchins Hall was finished.

The Michigan Law Review. — Increasingly in recent years the most valuable contributions to the law and its procedure have been made by scholarly studies which have been published as articles in legal journals. The demand for suitable vehicles for bringing such studies to public attention has been met to a large extent by law journals supported by the law schools. The Harvard Law Review appeared in 1887, the Yale Law Journal in 1891, the Columbia Law Review in 1901, and the Michigan Law Review in 1902. The last-named was under the editorship of the late Floyd Russell Mechem (A.M. hon. '94, LL.D. '12), Professor of Law, and the author of notable standard texts on various subjects of the law. He was assisted by the members of the law faculty and by ten students from the third-year class who acted as editorial assistants. The purpose was to give expression to the legal scholarship of the University and to serve the profession and the public by timely discussion of legal problems and by noting important developments in the field of jurisprudence.

The Review was made up of leading articles, comment on important cases and interesting legal subjects, notes on recent cases, and reviews of books and legal literature. The aim was to be practical and scholarly, and not so academic as to be out of touch with the legal profession. The Law Review has been edited, in turn, by Professors Mechem, Brewster, Holbrook, Drake, Stoner, Aigler, Waite, and Shartel. Student editors chosen from the third-year classes on the basis of scholarship and proved aptitude for the work have written the comments and notes. The leading articles have been furnished not only by members of the faculty but also by law teachers from other schools and by scholars who are practicing lawyers, judges, and experts in various legal fields. Student editors have not infrequently produced work of such value as to be published as leading articles. More and more the contributions to the Review have been studied by lawyers and cited by judges. They have done much to lend impetus to the widespread present-day movements for the improvement of the law and of its practice and procedure.

Founder's Day. — Each year since the completion of the first unit of the William W. Cook Quadrangle, the Law School (in Mr. Cook's honor) has set aside a day in April as Founder's Day. To the exercises of this day members of the bar are invited as guests. In the afternoon the final argument in the case club contest for the Henry M. Campbell case club award is the chief feature. In the evening a dinner in the dining hall of the Lawyers Club is attended by students and large numbers of lawyers, most of whom are alumni of the Law School. The dinner is followed by an address on some legal subject by a distinguished member of the bench or bar.

Legal research. — Although research in law has always been an important field of work for members of the Law School faculty, the first definite and formal proposal to provide means for the systematic development of legal research was made in a letter to the Board of Regents, dated April 25, 1922, by a then anonymous donor who later was revealed as William W. Cook.

In that letter Mr. Cook stated that he proposed to erect a building to be known as the Lawyers Club. He said, further:

All dues and all profit from the operation of the building shall be used exclusively for legal research work, to be expended from time to time as the Governors may deem best. This legal research work will render possible the study of comparative jurisprudence and legislation, national and state, and also of foreign countries, ancient and modern. Such work should be of use in proposed legislation, and, besides leading to the production of reliable law treatises and studies, would help to systematize the law as a science. The European plan of giving leisure time to professors to pursue their studies and produce original works may well be applied in America to professors of law, who at present are absorbed too exclusively in class-room work. A legal research fund could be used to pay part of their salaries, thus giving them time for original research.

R.P.

Research work on the Lawyers Club foundation began in 1927, when Edson Read Sunderland ('97, '01l, LL.D. Northwestern '33) was appointed Professor of Law and Legal Research. Later, William Wirt Blume (Texas '20, Michigan '27l, S.J.D. '28) was given a continuing research appointment. Others have received temporary appointments from time to time for the purpose of working out specific problems.

The first task undertaken with Lawyers Club funds was the revision of the legal procedure of the courts of Michigan. Soon after Professor Sunderland's appointment as Professor of Legal Research, he was made a member of the newly created Procedure Commission of the state, and became secretary and draftsman of the commission. A completely modernized system of procedure was prepared as a result of about two years of work, presented to the profession for criticism and suggestions, and finally put into operation by order of the Supreme Court under the title, "Michigan Court Rules, 1931."

As a result of this work Professor Sunderland was asked by the Chicago Bar Association to prepare a new and simplified system of procedure for the state of Illinois, and the Law School was in a position to enable him to devote a large part of his time for two years to this work. The new Practice Act was adopted in 1933 by the legislature of Illinois.

When the Supreme Court of the United States appointed an Advisory Committee in 1934 to draft new rules of practice for the federal courts, Professor Sunderland was made a member, and he was actively engaged in that work for nearly three years.

In 1929 the legislature of Michigan created the Judicial Council, to make a continuous study of the administration of justice in the state and to suggest to the legislature and to the Supreme Court, from time to time, such changes as might be deemed advisable. No appropriation was made for the council, and it was understood that responsibility for making the necessary studies and publishing the reports would be assumed by the Law School as a part of its research program. Professor Sunderland has been secretary of the Judicial Council from the beginning, and has published six annual reports, each containing a statistical presentation of the work of the courts of the state during the year, together with some special legal study, all financed out of Law School research funds. Among these special studies have been Condemnation Procedure, by Roy R. Ray (1931), Discovery Procedure, by George Ragland (1932), Organization and Operation of Courts of Review, by Edward O. Curran and Edson R. Sunderland (1933), Declaratory Judgments — Their Availability in Different Types of Controversies, by Edson R. Sunderland (1934), The Office of the Friend of the Court in Wayne County, by Frank E. Cooper and John P. Dawson (1935), and Pre-trial Procedure in Wayne County, by Frank E.

Cooper (1936). These studies have attracted wide attention. Discovery Procedure, in an enlarged and revised form, was published as a book by the Law School, and has become recognized as the leading American treatise on the practical use of discovery before trial.

Historical studies have taken an important place in the research program of the Law School. An extraordinarily valuable mass of documents was discovered in Lansing consisting of records and files of the Supreme Court of the Territory of Michigan and of the early state Supreme Court. They cover the period from 1805 to 1860. Professor Blume devoted several years to examining and classifying this material, which includes some three thousand original files, and he selected and edited the documents which are of special historical value for the light they throw upon the character of the judicial business transacted by those courts and the manner in which it was done. Four large volumes prepared by Professor Blume have been published by the Law School under the title Transactions of the Supreme Court of the Territory of Michigan, 1805 to 1814.

A study of English chancery decrees of the sixteenth century was made by Professor John P. Dawson ('22, J.D. '24, D. Phil. Oxford '30). During the second semester of 1936-37, Professor Dawson was engaged, while on sabbatical leave in England, in completing this study.

Research funds have also been made available for a number of other projects of more or less extended scope. Paul Gerhart Kauper (Earlham '29, J.D. Michigan '32), now a member of the Law School faculty, spent the year following his graduation in a research study of the regulation and taxation of motor carriers, under the direction of Professor E. Blythe Stason. Seven extensive papers giving the results of this study have been published in the Michigan Law Review. William Warner Bishop, Jr. ('28, J.D. '31), devoted a year to research work in international law under the direction of Professor Edwin DeWitt Dickinson (Carleton '19, Ph.D. Harvard '18, J.D. Michigan '19), which consisted in editing the Spanish-American cases for the International Law Digest published by the University of London.

The text of the American Law Institute's restatement of the law of contracts has been annotated with Michigan citations, in order to make it more useful to the courts and lawyers of Michigan. Professor Grismore has had charge of this work.

Invaluable work in collecting and editing materials for the use of students in a number of branches of the law has been made possible by allocations of research funds to various members of the Law School faculty. Nothing is more essential to effective teaching of modern law than the constant revision of materials for study, in order that work in the classroom may be closely correlated with the continuous changes in the body of the law and its application to new problems. The labor involved in this process of continual modernizing of teaching material is enormous, and the success of the Law School in maintaining its high standing for legal scholarship is due in no small degree to the availability of funds for this purpose.

Edwin C. Goddard

[Died August 14, 1942.]

SELECTED BIBLIOGRAPHY

Addresses Delivered at the Dedication of the Lawyers' Club … June 13, 1925. The Reminiscences of … Announcement of the Department of Law

School, 1915-] (title varies), Univ. Mich., 1859-1940.A Book of the Law Quadrangle at the University of Michigan.A Book of the Lawyers Quadrangle at the University of Michigan.CalendarCatalogue …Catalogue and RegisterDedicatory Exercises of the Law Quadrangle, the Gift of William Wilson Cook …, 1934.History of the University of Michigan.The Lawyers Club.Joint DocumentsLaws [of the Session of …]The Michigan Law ReviewPresident's ReportProceedings of the Board of Regents …Res GestaeThe University of Michigan.To-WitUniversity of Michigan Regents' Proceedings …, 1837-1864.

Notes

• The name was spelled "Douglas" after 1873.
• C. W. Edmunds held the official title of Assistant Dean and Secretary from 1919 to 1924, but Rollo E. McCotter was designated Acting Secretary for this period.
• Spelled "Douglas" after 1873.
• This term (in the rather unrecognizable form of "Paediotrics") appeared for perhaps the first time in University records in the 1871-72 report of the medical faculty (R.P., 1870-76, p. 206). The term was not in ordinary usage until about twenty-five years later.
• This law was similar to Act No. 267, 1915, in that it called for payment of such expenses from county, not state, funds.
• An appropriation of $375 for manikins — presumably obstetrical manikins — had been granted by the Board of Regents in 1889 (R.P., 1886-91, p. 376).
• The Medical Ward, the westernmost of the three main buildings on Catherine Street, had been the Homeopathic Hospital between 1891 and 1900. It was destroyed by fire in 1927, when it was known as the Convalescent Ward.
• Died in 1943.
• See footnote 2, page 859.
• Died March 25, 1949.
• The grants for the running expenses of the Neuropsychiatric Institute in recent years constitute another exception to the rule of self-support.