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
