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

THE SCHOOL OF PUBLIC HEALTH

The early movement for the development of a teaching program in public health at the University was engendered largely by the Michigan State Board of Health, which was established by the legislature in 1873. A pioneer in preventive medicine, Dr. Henry Brooks Baker (M.D. Bellevue '66, A.M. hon. Michigan '90), the first secretary of the State Board, undertook to acquaint the people of Michigan with the new discoveries of Pasteur and Koch, which materially contributed to the prevention of disease and to the promotion of positive health. Two years before Koch discovered the tubercle bacillus in 1882, Baker introduced throughout the Michigan school system a simple textbook on physiology which explained that tuberculosis is a communicable disease, spread largely through intimate contact within the family group. Baker's views were not without scientific grounds. Some fifteen years before, in 1865, the French physician Villemin had succeeded in producing lesions of tuberculosis in healthy animals through the introduction of infected sputum from tuberculous animals and humans. Basing his action upon this evidence Baker made a pioneer contribution to the education of the native Michigander, with the result that for many years, until the advent of the automotive age which brought new increments into the population, Michigan enjoyed one of the lowest death rates of any state in the Union.

The State Board of Health, recognizing the importance of education and research as a means of controlling illness, memorialized the Board of Regents with the result that in 1887 the first full-time professorship of hygiene was established at the University with quarters in the Chemistry Building. The chair of Hygiene and Physiological Chemistry was occupied by Victor Clarence Vaughan (Mount Pleasant College [Mo.] '72, Ph.D. Michigan '76, '78m, LL.D. ibid. '00), who at the same time became Director of the Hygienic Laboratory. The appropriation for the Laboratory Building, the first of its kind in the United States, was made by the legislature in 1887, and it was opened in the fall of 1888. Until the turn of the century the Laboratory served not only as the center for training medical students and public health personnel, but also carried on the diagnostic services and research activities for the Michigan State Board of Health.

Meanwhile, largely through the interests of Dr. Vaughan and Dr. Frederick Novy ('86, Sc.D. '90, '91m, LL.D. Cincinnati '20), who, in 1902, became Professor of Bacteriology, an interest developed in the new science of immunology. With an understanding of the mechanism with which nature protects the body against the common communicable diseases, Henry Sewall (Wesleyan '76, Ph.D. Johns Hopkins '79, M.D. Denver '89, M.D.hon. Michigan '88, Sc.D.hon. ibid. '12) undertook with noteworthy success to immunize pigeons against snake venom. By gradually increasing the dosage, Sewall, who was Michigan's first Professor of Physiology, gradually increased the resistance of pigeons to this poison until lethal doses could be administered without harm. This pioneer work formed the foundation on which the European colleagues of the Pasteur and Koch schools developed diphtheria antitoxin, first announced in 1893 as the specific treatment for the dread disease.

From 1887 until 1916 the program was

under the direction of the Hygienic Laboratory and the professor of hygiene in the Medical School (see Part V: The Medical School) .

The first degree in hygiene was granted in 1897 to Edna D. Day. Until 1916 the medical degree was a fixed requirement for the master's degree in public health. The master of science in hygiene and public health was granted to three more physicians in 1911 and to one each in 1912, 1913, and 1914. In 1913 and again in 1914 a master of arts degree was given. Thus, during seventeen years of medical school supervision (1897-1916), nine master's degrees were conferred in the field of public health.

From 1916 to 1941 the graduate degree was offered through the Graduate School. This period in public health at Michigan has been admirably reviewed by Dr. John Sundwall (Chicago '03, Ph.D. ibid. '06, M.D. Johns Hopkins '12), Director of the Division of Hygiene and Public Health from 1921 to 1941 (see Part VI: The Division of Hygiene and Public Health) .

In 1941 the present phase of the public health program began. The Rockefeller Foundation, having made a survey of the need for training centers for public health personnel in the United States, joined with the W. K. Kellogg Foundation in providing funds for a new building and equipment and a contribution toward the operation of the newly authorized School of Public Health (R.P., 1939-42, pp. 705-6). The building was dedicated in the fall of 1943. At this time Professor Henry Frieze Vaughan ('12e, Dr.P.H. '16) was appointed the first Dean of the School and chairman of the Department of Public Health Practice. In establishing the School the Board of Regents in its By-laws of July 18, 1941, charged the faculty with the responsibilities of the professional education and training of persons who have chosen public health work as a career, the teaching of hygiene and preventive medicine in the units of the University which request such instruction, and the advancement of research in the field of public health and preventive medicine.

In order to discharge these obligations and at the same time maintain relative simplicity in organization, the School was divided into three major departments: Public Health Practice, including public health administration, public health economics, health education, public health dentistry, public health nursing, physiologic hygiene, mental health, and nutrition; Epidemiology, including public health laboratory practice, with special reference to the newer knowledge concerning the various communicable diseases and public health statistics; and Environmental Health, including public health engineering and industrial health. Soon thereafter the Department of Tropical Diseases was authorized, and at a later date the Department of Public Health Statistics was established; both of these had largely functioned in the beginning under the Department of Epidemiology.

Since 1941 the School has offered as its major degree the master of public health for graduates in medicine, dentistry, and engineering, and for those with a bachelor's degree and either graduate work or a satisfactory experiential background in fields which lead to career work in public health, such as public health nursing, public health statistics, health education, sanitary science, nutrition, and laboratory services. All candidates for the degree of master of public health must possess satisfactory backgrounds in the natural, physical, and social sciences.

Authorization of the degree of doctor of public health as well as of the master's degree was transferred by action of the

Regents to the School of Public Health in 1941. For the doctor of public health, candidates must be graduates of an approved medical school, have completed courses leading to the degree of master of public health or its equivalent, and have completed one or more years of distinctive field experience in public health work.

Since the doctor of public health degree is reserved for candidates with a previous doctorate, beginning with the school year 1947-48 programs of study leading to the doctor of philosophy and doctor of science degrees for those with other professional backgrounds were established in the Graduate School. The areas provided for include epidemiology, public health laboratory practice, tropical diseases, public health statistics, public health economics, and sanitary science.

The bachelor's degree in public health nursing and the certificate for public health nurses which previously had been granted by the School of Education were transferred to the School of Public Health. Shortly thereafter, in keeping with practice in other educational institutions, the granting of the certificate was discontinued.

In February, 1950, the Regents approved the establishment of an undergraduate program leading to the degree of bachelor of science in public health. Provision was made for training in the fields of nonmedical administration and sanitary science. The purpose of these programs of study has been to meet the increasing demand for personnel to serve the federal, state, and local health departments as administrative associates and as sanitarians. With due regard for the limitations imposed by lack of a degree in medicine, the trained nonmedical health administrator functions as an administrative associate in public health agencies. The new emphasis upon heart disease, cancer, mental illness, hospital construction and maintenance, adult health, and medical care programs poses new problems of an administrative character, and trained personnel is needed for their solution. In addition, the voluntary health agencies of industry, labor unions, and other nongovernmental associations, such as the Blue Cross and Blue Shield medical care plans, need trained technical assistants, individuals who have a broad background, including a minimum of what is essential and basic in public health work. A curriculum in sanitary science has been provided by the School at both the graduate and undergraduate level. There has been an acute need for qualified people trained at the latter level. Local and state health departments, as well as the United States Public Health Service, employ persons with this educational preparation as general sanitarians or for specific tasks, such as milk and food sanitation, housing, industrial hygiene, or insect and rodent control; as technical assistants for stream pollution or industrial waste investigations; as laboratory analysts; or as assistants in other phases of environmental work.

Admission requirements for the undergraduate degree include (a) satisfactory completion of a minimum of sixty credit hours of work in required and elective courses, (b) an honor-point-hour ratio of at least 2.5, that is, a scholastic average at least halfway between C and B, and (c) a satisfactory total record of achievement. The two years of preparatory work may be obtained in the College of Literature, Science, and the Arts of this University or in another college of equal standing. The work in the third and fourth years is divided almost equally between the basic courses in public health and additional courses in the sciences, sociology, and government. The public health

courses include health administration, vital statistics, epidemiology, environmental health, public health economics, and a few elective courses. Between the third and fourth years there is a required period of supervised field work. The W. K. Kellogg Foundation, in 1950, made a grant of $200,000 with which to support this undergraduate program over a period of five years.

Special attention was given in 1950 to the need for personnel in the field of industrial health. With the General Motors Corporation providing fellowships for trainees, two programs of study were adopted. The first offers a two-year fellowship in co-operation with the Medical School and a hospital in Michigan which is serving as one of the decentralized units for continued medical education. The student spends the equivalent of one year in the hospital on a rotating residency, nine months at the School of Public Health, and three months in field work in General Motors plants and with the State Health Department. The trainee is admitted to candidacy for the master of public health degree. The second plan, which does not as yet contemplate offering a degree, extends for twelve months, during which time the trainee attends the School of Public Health for four months, taking the basic courses during the first semester, and then spends eight months in selected General Motors plants, receiving field training under direction and in co-operation with the School of Public Health.

The field of industrial health is an extremely important one. The program of study embraces several of the functional activities of the School, with special emphasis on human biology and physiology and on environmental health. While interest in industrial health developed in this country largely because of the surgical and medical care required under compensation laws, during the past twenty or thirty years the field has broadened to include a generalized health program for the employed, both in the place of business and in the home. The expansion of interest makes it necessary that all the disciplines of public health practice and preventive medicine be offered in an adequate training program. It is to this end that the courses, as they have been established in the Medical School and in the School of Public Health, have been brought together in a co-ordinated teaching program.

By 1953 the University had granted 63 doctorates, 1,263 master's degrees, 344 bachelor's degrees, and 313 certificates in public health, a total of 1,983 degrees and certificates.

In accordance with an agreement approved by the Regents in September, 1941, the Kellogg Foundation appropriated $25,000 a year for five years for postgraduate courses. At the close of this period University funds were provided for their continuation. The courses which are designed to acquaint professional public health workers with the current expansion of knowledge and the development of new techniques in their several fields, serve the needs of many other groups whose interests and occupations border closely upon health conservation. This project has definitely set a pattern for national and international health programs, as for example, the furtherance of local health units, the control of dental caries, the application of public health statistics to new fields, such as home accident prevention and population studies, the furtherance of the new approach to sanitation as a way of life, and consideration of air pollution, noise, and other industrial and community hazards of the environment.

Since the first noncredit course was given in May, 1942, fifty-four courses

with a registration of 6,000 have been offered.

With the opening of the new building of the School the First Inter-American Conference on Professional Education was held in November, 1943. The meeting took place under the auspices of the Pan-American Sanitary Bureau in cooperation with the newly established Association of Schools of Public Health, the W. K. Kellogg Foundation, and the Office of the Co-ordinator of Inter-American Affairs. There were in attendance about forty delegates from schools which provide professional education in public health at graduate level (in contradistinction to the teaching of hygiene and preventive medicine to medical students, dentists, and the like). The United States and Canadian schools represented included Harvard, Yale, Columbia, Johns Hopkins, North Carolina, Minnesota, Toronto, Vanderbilt, and Michigan. Guests were also present from Brazil, Chile, Cuba, Mexico, Peru, and Uruguay. The conference dealt with interrelated problems of public health education in the various countries, the teaching of preventive medicine, the pooling of inter-American resources, exchange of professorships, study tours, the publication of an outline of training facilities, the promotion of research facilities, the need for special vocabulary, and the distribution of literature.

In general, the teaching programs emphasize instruction for students whose major interest is in the field of public health, whether enrolled in the School of Public Health, the Graduate School, or some other unit of the University; instruction for students whose interest in public health is secondary to their major interest, for instance medical and dental students and those in the fields of education, nursing, and pharmacy; and instruction in the field of continued education or postgraduate studies for individuals whose training and interest in public health varies but for whom organized courses, usually on a short-term basis, are desirable.

Grave public health problems existed just before the entry of the United States into World War II: the necessity of finding a substitute for quinine, the supply of which had been almost eliminated owing to the occupation of Malaya and the Philippines by the enemy; the need of an effective vaccine for influenza to prevent the repetition of the catastrophe of World War I, with its high mortality from this disease; and the training of physicians, engineers, and others to serve in the protection of health in occupied countries so that it would be possible for industry to secure such basic materials as rubber and tin from Central and South America. The School participated in all these programs. Thomas Francis, Jr. (Alleghany College '21, Sc.D.hon. ibid. '41, M.D. Yale '25, M.S.hon. ibid. '41), who became Professor of Epidemiology and chairman of the Department of Epidemiology in 1941 and Henry Sewall Professor of Epidemiology in 1947, has served continuously since 1941 as chairman of the Influenza Commission of the Armed Forces. It is through the activities of this commission, the Virus Laboratories of the School serving as pilot station, that a successful vaccine was prepared with which the armed forces of the United States and England were protected against influenza. The vaccine, with certain modifications, is now used for the civilian population.

Lowell Thelwell Coggeshall (Indiana '22, A.M. ibid. '23, M.D. ibid. '28, LL.D. ibid. '48), who became Professor of Epidemiology in 1941, conducted the studies in malaria control. More than 3,000 drugs were tested at the University for prophylactic and therapeutic

activity as possible substitutes for quinine. Dr. Coggeshall was granted a leave of absence in 1942 in order to organize malaria control for Pan American Airways, and he played a major role in the air transport service which extended to South America, Africa, and the Near East. In addition, and at the request of the War Department, the School provided instruction for personnel who served the civilian populations in North Africa, Italy, France, Germany, and Japan, and thus, as the war progressed, materially contributed to the rehabilitation of the health facilities in these countries.

Again, beginning in 1941, the National Foundation for Infantile Paralysis made a major contribution to the Virology Laboratory for the study of the mode or modes of transmission of poliomyelitis and the means whereby this disease might be controlled and ultimately eradicated. This work was also under the direction of Dr. Francis. With the assistance of others, including Harold E. Pearson (Stanford '33, M.D. ibid. '38), Gordon Campbell Brown (Ohio State '34, Sc.D. Johns Hopkins '42), and Jonas Edward Salk (College of the City of New York '34, M.D. New York University '39, Sc.D.hon. Michigan '55), much new data with which to approach the problem of poliomyelitis has been provided. The laboratory studies have been continuous and intensive; field studies which have been made during epidemic periods have extended, geographically, from Michigan to Texas and North Carolina. Assistant Professor Salk resigned from the University in 1947 and subsequently pursued this work at the University of Pittsburgh Medical School. The successful poliomyelitis vaccine which he developed was evaluated under the direction of Dr. Francis, in the greatest mass experiment in the field of medicine ever undertaken.

In November, 1945, the Regents authorized the establishment of a Bureau of Public Health Economics under the direction of Nathan Sinai (D.V.M. San Francisco College '15, M.S.P.H. Michigan '24, Dr. P. H. ibid. '26), who came to the University as Instructor in Hygiene and Public Health in 1924 and became Professor of Hygiene and Public Health in 1932. While primarily a teaching unit providing instruction for those who are concerned with problems of medical care, this Bureau has carried on extensive studies in widely separated areas. Noteworthy are the research activities centered in the voluntary health insurance plan which provides comprehensive physicians' services in Essex County and Windsor, Ontario. This plan is sponsored by the local medical society which furnishes care for 130,000 subscribers. Principal interest has centered in a study of the utilization of services by subscribers in a situation in which the unique barrier to the receipt of physicians' care has been removed. Administrative and statistical control of techniques as applied to this fee-for-service plan has been objectively studied, together with other details of this distinctive voluntary health insurance service. The Bureau has also conducted extensive surveys of the program for senior citizens of the state of Washington, of medical care programs employed by industry in Hawaii, and of many medical and hospital programs in Michigan and nearby states. Dr. Sinai has designed a health audit or evaluation schedule for the health services conducted by the World Health Organization, applicable to all projects of this organization throughout the world. The Bureau, since 1944, has published a digest which serves as a teaching medium and which through its wide circulation keeps public health and medical and allied personnel acquainted with programs

dealing with health economics as they develop. Solomon Jacob Axelrod (Dartmouth '34, M.D. Jefferson Medical College '38, M.P.H., Michigan '49), Associate Professor in Public Health Economics, who joined the faculty in 1950, has contributed materially to the teaching and research programs. As an indication of the importance given to the synthesis of the health and social sciences, the staff includes members who represent the fields of social psychology and sociology.

While it is impossible to outline all of the interesting research and study programs which have been developed at the School, it is appropriate to mention a few. In 1949 fundamental research in stream analysis, sponsored by the National Council for Stream Improvement of the Pulp, Paper and Paperboard, Industries, Inc., was transferred to the University, under the direction of Clarence Joseph Velz (Minnesota '24e, M.S.P.H. Columbia '33), who in that year became chairman of the Department of Public Health Statistics. The purpose of this project is to define the natural purification characteristics of streams to serve as a basis for pollution abatement. These studies are developed usually as a co-operative effort of the industry and the regulatory agencies. Research carried on under this project has led to new statistical techniques for evaluation of hydrologic and biologic characteristics leading to fuller utilization of water resources. These investigations have taken place in widely spread areas of the United States.

With a research grant from the United States Public Health Service and with subsequent assistance from the W. K. Kellogg Foundation, a study of the causes of home accidents was begun in 1951. Injuries and accidents are becoming one of the most important causes of disability and death. While preventive programs are under way dealing with accidents on public carrier and other means of transportation, including the family automobile, little has been done to determine the conditions which surround the serious injuries and accidents which occur in the home and its environment. The study in Washtenaw County has provided a base line, and through the co-operation of the United States Public Health Service and the W. K. Kellogg Foundation, a program including at least eight of the major state health departments is under way. It is believed that accident prevention can be furthered by the same basic control procedures that have been applied so effectively in the struggle against tuberculosis and in the eradication of diphtheria and typhoid fever.

Increasingly, since 1900, we have learned to survive through the sanitary control of our environment. Research and teaching in this aspect of public health work have been a joint undertaking of the School and the National Sanitation Foundation, the latter incorporated in Michigan, in 1944, as a nonprofit foundation with headquarters at the School of Public Health. The work of the Foundation was begun through a mutual understanding on the part of national leaders of industry and business and leaders in the field of public health. The basic research in sanitary science which is keeping pace with American invention and production, the development of uniform sanitation standards available to manufacturers and to health authorities, and the educational program to promote sanitation are all discussed in the publications of the National Sanitation Foundation.

Public health practices vary in time as well as place, and the new products of research must be tested, evaluated, and reconciled. The administrator of a successful public health program must

utilize the varied contributions of biology, medicine, dentistry, sanitary science, and nursing together with those of the social sciences, business administration, and general education. Public health is essentially concerned with the manner in which conditions harmful to health arise, decline, or recur in a population. It aims to establish the factors which govern these occurrences and directs efforts toward their control. Basically, therefore, the scope and influence of public health depend upon the successful synthesis of the biological and social sciences. Thus, the work of the School of Public Health has been continuously enriched by association with other units of the University. Many of the courses in the School are provided for public health students by faculty members from other units. Although designed and staffed to accommodate from 180 to 200 students of its own, the School provides service for 1,200 to 1,500 students in the University. The teaching of preventive medicine in the Medical School, of community health and personal hygiene in the College of Literature, Science, and the Arts, and of courses in the School of Education and the Graduate School, offers an example of the inter-relationship and mutual interest which have been developed in the University.

Public health practice can no longer be considered as limited to the prevention of communicable disease, laboratory studies, and like activities. Public health embraces the total health of all people in society, individually and collectively, and is concerned primarily with community organization for self-protection against controllable or preventable causes of illness and accidents. The public health student must be trained to exercise leadership in health programs; he must have a broad understanding of the physical, biological, and social forces which influence man's relations to his fellow men and to his environment.

The School has enjoyed co-operation with local, state, and federal health agencies, especially the Michigan Department of Health, the Detroit Department of Health, and the several teaching centers in Michigan and Ohio. In addition, assistance has been rendered by such agencies as the W. K. Kellogg Foundation, the Rockefeller Foundation, the National Foundation for Infantile Paralysis, and the several units of the federal government — the Public Health Service of the Department of Health, Education, and Welfare and the Medical departments of the Army, the Navy, and the Air Force.

Among members of the faculty who served the School subsequent to July, 1941, and who have since severed their connection with the University, the following deserve special mention: Marguerite Franklyn Hall, G. Howard Gowen, Raymond Lee Laird, Charles F. McKhann, George H. Ramsey, John J. Hanlon, Marion Isabel Murphy, Odin W. Anderson, Mary P. Connolly, William J. Morrow, Herbert R. Morgan, and John D. Morley.

Henry F. Vaughan

SELECTED BIBLIOGRAPHY

Announcement, School of Public Health President's Report Proceedings of the Board of Regents …