Pediatrics and Communicable Diseases

Medical School

The University of Michigan: An Encyclopedic Survey was first published beginning in 1942. For its 2017 Bicentennial, the University undertook the most significant updating of the Encyclopedia since the original, focusing on academic units. Entries from all versions are compiled in the Bicentennial digital and print-on-demand edition. Contents

1. Pediatrics and Infectious Diseases (1942) 1 D. Murray Cowie

2. Pediatrics and Communicable Diseases (2016) 20 Valerie P. Opipari, MacDonald Dick, and Faye Silverstein

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Pediatrics and Infectious Diseases (1942)

D. Murray Cowie

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. 2 Pediatrics and Communicable Diseases

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 Pediatrics and Infectious Diseases (1942) 3 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 4 Pediatrics and Communicable Diseases

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 nitedU 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 Pediatrics and Infectious Diseases (1942) 5 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 6 Pediatrics and Communicable Diseases

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 Pediatrics and Infectious Diseases (1942) 7 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., 1910-14, p. 12.)

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 8 Pediatrics and Communicable Diseases

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 Pediatrics and Infectious Diseases (1942) 9 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. 10 Pediatrics and Communicable Diseases

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 Pediatrics and Infectious Diseases (1942) 11 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: 12 Pediatrics and Communicable Diseases

Number of Members of Total Number of Average Number of Patients Year Teaching Staff 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. Pediatrics and Infectious Diseases (1942) 13

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 14 Pediatrics and Communicable Diseases

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) Pediatrics and Infectious Diseases (1942) 15 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. 16 Pediatrics and Communicable Diseases

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 Pediatrics and Infectious Diseases (1942) 17 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 18 Pediatrics and Communicable Diseases

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 Pediatrics and Infectious Diseases (1942) 19 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 [Medical School, 1915 — ] (title varies), Univ. Mich., 1850-1940. Annual Report of the University Hospital of the University of Michigan, 1892-1911, 1918-20. Bruce, James D., and Others. “Noted Medical Faculty Member Is Dead.” Mich. Alum., 46 (1940): 294, 303. Calendar, Univ. Mich., 1871-1914. Catalogue …, Univ. Mich., 1848-71, 1914-23. Cowie, D. Murray. “University Hospital Clinic for Diseases of Children.” Mich. Alum., 23 (1917): 265-66. Cowie, D. Murray. “The Department of Pediatrics and Infectious Diseases.” Mich. Alum., 32 (1926): 521-23. Harcourt, Elizabeth. “Social Service in the University Hospital.” Mich. Alum., 23 (1917): 274-76. Ketcham, Dorothy. “The Department of Social Service.” Mich. Alum., 32 (1926): 530-31. MS, “Medical Faculty Minutes” (title varies), Univ. Mich., 1888-1940. Michigan. Compiled Laws of the State of …, 1897. Michigan. Laws [of the Session of …], 1869-73. Michigan. Public Acts [of the Session of …], 1874-1940. (P.A.) Peterson, Reuben. “The New Contagious Hospital at the University of Michigan and Its Proposed Plan of Operation.” Journ. Mich. State Med. Soc., 13 (1914): 323-35. Also in: Mich. Alum., 20 (1914): 524-34. President’s Report, Univ. Mich., 1853-1940. Proceedings of the Board of Regents …, 1864-1940. (R.P.) University of Michigan Regents’ Proceedings …, 1837-1864. Ed. by Isaac N. Demmon. Ann Arbor: Univ. Mich., 1915. (R.P., 1837-64.) [2]

Pediatrics and Communicable Diseases (2016)

Valerie P. Opipari, MacDonald Dick, and Faye Silverstein

The Early Years of Pediatrics at Michigan

In the United States, the “emergence of a class of doctors especially for children” was recognized in the late nineteenth century. The American Pediatric Society was founded in 1888 and Victor Vaughan, dean of the University of Michigan Medical School from 1891 to 1921, was a member. Yet as Horace Davenport reports in his history of the Medical School, at Michigan “the practice of pediatrics was not separate from the practice of internal medicine until well after 1900.” Indeed, medical care of children at Michigan in the early 19th and 20th centuries was integrated into hospital buildings that were in place at that time. At University Hospital (Old Main), which opened in 1925, children were cared for in open wards on specific floors. There was also an independent contagion unit where children with highly infectious diseases — diphtheria, diarrhea from various organisms, bacterial meningitis, Pediatrics and Communicable Diseases (2016) 21 infectious encephalitis, pertussis, sepsis, pneumonia, tetanus, tuberculosis, varicella and acute poliomyelitis — were cared for. Infectious diseases were the major cause of childhood illness and death during this time and the primary focus of pediatric medicine, hence the inclusion of “Communicable Disease” in the department’s name when it was established. David Cowie was appointed in 1905 as Michigan’s first professor of pediatrics. Having earned his medical degree from Michigan in 1886, Cowie conducted the Medical School’s first course on diseases in pediatrics in 1906. While Cowie was committed to pediatric patient care, education and research, the Medical School in 1916 had only 20 hospital beds dedicated for general pediatric patients. Cowie rose through the academic ranks within Internal Medicine and was appointed professor and chairman of Pediatrics and Communicable Diseases when the specialty was recognized as a separate department at U-M in 1921. Early in his career,.Cowie worked on problems of infection and gastroenterology; he established a laboratory for milk analysis, housed in the basement of the Palmer Ward on Catherine Street. In 1926 Cowie wrote a report on the state of the Department for the U-M Alumni Association. He highlighted service to the community, teaching of medical students, and research accomplishments of the Pediatric faculty. He reported that specialized clinical divisions were being organized in metabolic diseases, diabetes, nephritis, and infectious diseases, and he linked the growth of the Children’s Service with opening of the new hospital in 1925. From historical and public health perspectives, Cowie’s most noteworthy accomplishments stemmed from his role in advocacy – a recurrent theme in pediatric medicine. He worked tirelessly on many fronts to eradicate endemic goiter in Michigan by adding iodine to salt, a concept originated in Switzerland. He engaged members of the Michigan State Medical Society and worked with community and commercial leaders to gain acceptance for the production of iodized salt in the 1920s, regionally and nationally, and this campaign was ultimately successful. 22 Pediatrics and Communicable Diseases

Poliomyelitis, one of the most feared pediatric infectious diseases in the first half of the twentieth century, received considerable attention in the Department of Pediatrics and Communicable Diseases. Mechanical ventilation devices were first trialed in children with acute polio in 1928 at Children’s Hospital in Boston. Two of the physicians involved in this early experience, Charles McKhann and James Wilson, subsequently joined the U-M faculty. Charles McKhann was recruited to Michigan in 1941, after Cowie’s death that same year. The W.K. Kellogg Foundation provided $100,000 to assist in the financial reorganization of the Department. McKhann began that effort but remained as chair for only three years. In 1944, James Wilson succeeded him. Wilson served as chair for 23 years. While in Boston, he had begun his research on delineation of the pathophysiology of respiratory failure in children with acute polio, and practical refinements in the design of early artificial respirators known as the “Iron Lung.” As chair at Michigan, he focused on a broad range of pediatric health issues. He supported the development of pediatric research activities. Acknowledgement of his academic stature included election to the presidency of the American Pediatric Society and participation as a consultant to a broad range of state, national and international societies and agencies. He also played a pivotal role in garnering essential financial support for establishment of the C. S. Mott Children’s Hospital, which opened in 1969, two years after his retirement; the research laboratories in that building were named in recognition of his important contributions to the Department. Philanthropy played a critical role in the growth and development of the Department and the realization of the first C.S. Mott Children’s Hospital, named for one of the largest shareholders in General Motors and founder of the Charles Stewart Mott Foundation of Flint, Michigan. A major focus of this foundation was to improve children’s health; the Mott Foundation donated more than $6.5 million to U-M for the construction of the children’s hospital in 1964. The nation’s third polio respirator center, funded by the March of Dimes, opened at Michigan in 1951. Wilson was the key organizer; the first director was David Dickinson, a graduate Pediatrics and Communicable Diseases (2016) 23 of the Michigan Medical School. Dickinson articulated a vision that the patient’s care should not be limited to purely medical considerations but also to addressing “practical, personal and emotional problems.” As a result of his vision and dedication to his patients, the center at Michigan established a school and educational programs to advance both the health and academic training of his patients. Dickinson later became chief of clinical affairs at C.S. Mott Children’s Hospital, then director and chief executive office ofni U versity Hospital. A major thrust of Wilson’s efforts in the 1950s and ‘60s was the development of pediatric sub-specialists in the Department. Aaron Stern was the first pediatric cardiologist. He collaborated closely with a cardiovascular surgeon, Herbert Sloan, and advocated for early surgical repair of infants with ventricular septal defects who failed medical management. Wilson recruited Richard Allen as the first pediatric neurologist in the Department (and in Michigan) in 1957. The state of Michigan began universal neonatal screening for PKU in 1965, and Allen collaborated with the Department of Public Health to initiate treatment for all infants identified with PKU. Ruth Heyn was the first pediatrician at Michigan with expertise in the care of children with cancer. She became the first director of the Division of Pediatric Hematology Oncology and one of the first pediatric oncologists in the country to treat children with leukemia using methotrexate. Her early publications included a report on management of the erythroblastotic infant (Rh disease), published in the Medical Bulletin (Ann Arbor) in 1957, with co-author Harry Towsley (a U-M pediatrician who served as president of the American Academy of Pediatrics in 1964-65). Heyn gained prominence in pediatric oncology with her 1960 study that compared 6-mercaptopurine with the combination of 6-mercaptopurine and azaserine in the treatment of acute leukemia in children. Joseph Baublis joined the faculty in 1962 and became the first infectious disease subspecialty faculty member in 1968, following completion of his Ph.D. in virology and epidemiology. He was the founder of the national Committee for Reye’s Syndrome and director of the Pediatric Diagnostic Laboratories in Mott Hospital from 1969 until his death in 1981. 24 Pediatrics and Communicable Diseases

George Lowry joined the faculty in 1947 and became the first chief of Pediatric Endocrinology in 1957. Among his accomplishments was authorship of Growth and Development, a leading early text in his field, that was subsequently updated through eight successful editions. He served as chair of the Michigan Chapter of the American Academy of Pediatrics from 1966-1969 and for many years chaired the Ann Arbor Public Schools’ Health Services Committee. An annual lectureship acknowledges his seminal role in the development of his field. Robert Kelsch, appointed to the faculty in 1966, was considered a pioneer in the development of the subspecialty of pediatric nephrology. When the American Board of Medical Subspecialists approved pediatric nephrology as a subspecialty in the early 1970s, he was among the first cohort of successful examinees for certification, and went on to lead the development of this program at U-M. He also subsequently served as director of Pediatric General Services and participated extensively in medical student education.

1967-1979

With James Wilson’s retirement in 1967, William J. Oliver was appointed chair of the Department. It was a time of extraordinary transition in pediatric medicine, not only at Michigan but throughout the nation, fueled by the post-World War II expansion of basic science research leading to an enormous knowledge base that required deeper and fuller specialization for the treatment of human physiology and pathology. Under Oliver’s leadership and following Dr. Wilson’s important initiatives, the Department seized the opportunity to develop further the subspecialists who brought increased understanding along with advanced technology to advance patient care. Numerous subspecialties expanded during this period, including cardiology, allergy, neurology, pulmonology, neonatology and genetics and others — fields that had not existed as formal disciplines with board-certifying bodies before the 1960s. For example, the first board-certified subspecialization in pediatrics was in cardiology beginning in 1961. Pediatrics and Communicable Diseases (2016) 25

The Cardiology Division at Michigan was an innovative pioneer. During the 1960s, the pediatric cardiology and thoracic surgery teams worked together to improve the care of children with congenital heart disease. They were the first to show that primary repair of a ventricular septal defect in infants was as safe and effective as palliative surgery. They were the vanguard of infant cardiac surgery, which became the national gold standard later in the 1970s. Other divisions also expanded, particularly neonatology, which had not existed before the 1960s. This new subspecialty in pediatrics pushed the frontier of neonatal care down to the smallest and most vulnerable premature infants. At Michigan the endeavor was supported by the development of the Holden Neonatology Unit, which housed premature infants and those infants at risk for other disorders in an organized, concentrated, and focused program. The Holden Perinatal Research Laboratories were established through the Holden Fund to unify maternal delivery suites and neonatal units, connecting obstetrical labor and delivery units to the radiographic, surgical and medical care units for these newborns. The Holden Fund established biochemical laboratories within the new Mott Holden Unit, creating the James and Lynelle Holden Perinatal Research Laboratories, which were completed in 1972. This was the first national perinatal unit directly and intentionally built to link an obstetrical hospital with a children’s hospital. This synergism of care for these vulnerable newborns provided a unique and enormously beneficial advantage, offering the expertise and specialized features of each of the obstetrical, neonatal, pediatric, and surgical groups. Supporting specialization that began in the 1960s, further successful recruiting yielded highly-trained specialists in critical care, neonatology, gastroenterology, endocrinology, and embryology. The Department took advantage not only of expertise from other national institutions and health centers, but capitalized on current faculty members who received training at national sites throughout the country and returned to establish both strong research and clinical programs. As the postwar era went on, it became increasingly clear that major developments in medical knowledge, greater 26 Pediatrics and Communicable Diseases

understanding of the mechanisms of disease and specialized therapeutic approaches were pointing to the need for a dedicated pediatric facility. Finally, construction for the first Charles S. Mott Children’s Hospital began. The hospital was explicitly designed to be contiguous with the Women’s Hospital, with links between the obstetrical suites, the Holden Neonatal Unit, and the the obstetrical, pediatric and surgical services. In addition, diagnostic laboratories for biochemistry, hematology, oncology, microbiology, neurology, pulmonology, radiology and cardiology were all developed within this one structure. The basement of Mott Hospital housed the cardiology suite with a state-of-the-art advanced catheterization laboratory. This laboratory had the first biplane radiologic imaging system in the world, proposed by Aaron Stern, then director of cardiology. One x-ray beam with its image intensifier at the receiving end comprised the PA plane, whereas an additional x-ray beam and image intensifier were mounted on a Carm which pivoted around the long axis of the patient. This was such a revolutionary design that it had a children’s bicycle handlebar to grip and pivot the C-arm around the patient. The design is now the standard for cardiac catheterization laboratories. On the second floor were the entrances and the diagnostic laboratories. On the third floor were the radiology suites and the eight operating rooms. The fourth floor was the inpatient unit; it later became the pediatric intensive care unit. The fifth floor became the cardiology unit and sixth and seventh floors housed the inpatient medical/surgical patients. In the early days, the seventh floor (7 East) was a unit called Constant Care, where especially vulnerable sick infants were monitored. This unit predated the more complete pediatric intensive care unit (PICU) that was built later. On the eighth floor was an area for inpatient children’s education. This unique unit was the first inpatient educational unit in any hospital in the country. It had begun in Old Main in the 1920s, supported by philanthropists in Ann Arbor and beyond. In addition, there was a nondenominational chapel on this floor and a lounge where house officers could congregate, network and provide each other with peer support. The Department in this period was fortunate to have senior Pediatrics and Communicable Diseases (2016) 27 faculty members who provided critical support to Oliver’s chairmanship. Harry A. Towsley, founder of the Center for Continuing Medical Education, advocated for the development of the old Mott Hospital and made significant contributions to graduate medical education as well. David Dickinson assumed leadership roles in the medical center as vaccination programs virtually eliminated polio in the U.S. Oliver stepped down from the chair in 1979. Interim chairs for the next two years were Robert P. Kelsch (1980-1981) and Robert C. Kelch (1981-1991).

1981-1993

In 1981, Robert P. Kelch was appointed chair. For the next 13 years, the Department expanded its clinical operations with a growing faculty and increasing expertise. Many faculty members in multiple disciplines reached national prominence under Kelch’s leadership. The faculty expanded to provide clinical services in Ann Arbor, adjacent communities and across the state with a number of field clinics. Kelch led the Department to national prominence. Residency and educational programs expanded. Basic science activities and extramural funding vastly improved. Particularly important during this period was the expansion of educational activities including growth in the house staff cohort as well as the development of a number of fellowship subspecialty training programs designed to train future pediatric academicians. The emphasis was on hypothesis-driven research, training and mentorship by leading scientists, both basic and clinical. Among Kelch’s most important recruits were Larry Boxer in the Division of Hematology/Oncology; Gary Goldstein in the Division of Pediatric Neurology; Joseph Custer in Pediatric Critical Care Services; and Arnold Coran who became Mott Hospital’s first chief of pediatric surgery. Kelch established the first endowed professorships in the Department dedicated to pediatric medicine and research including the David G. Dickinson Collegiate Professorship in 1990, designated for a pediatrician specialized in the optimization ofcare for children with chronic diseases; the Amnon Rosenthal Collegiate Professorship in Cardiology in 28 Pediatrics and Communicable Diseases

1993; and the Robert C. Kelsch Collegiate Professorship in Nephrology, in 1994. Recognition of the Department’s rising stature and promise led to Kelch’s election as president for the Society of Pediatric Research. Although the existing C.S. Mott Children’s Hospital was serving the Department well in the 1990s, several clinical areas were deficient. In 1991, a $91-million new wing was opened, expanding the cardiology division on the first level (basement) and enlarging the radiology and anesthesiology group on the third level. The fourth level provided an opportunity to create “birthing rooms” on the fourth floor of the existing Mott with the wing including an updated expanded Holden neonatology unit and obstetrical /surgical suites enhancing communication in the maternal-neonate relationship, particularly those at high risk. In concert with the Department of Obstetrics, a perinatology unit involving the identification and care of at-risk newborns before birth was established. The fifth floor housed a 15-bed cardiac ICU (Pediatric Cardiothoracic Unit) and a 16-bed pediatric intensive care unit (PICU); all were rapidly filled at the moment of opening. The sixth floor of the wing contained the pediatric psychiatric unit which had transferred from the old Children’s Psychiatric Hospital on the medical campus. Again, the C.S. Mott Foundation supported components of these capital renovations with a $2 million grant in 1984. Kelch’s years were characterized by further expansion of clinical services, basic and clinical research and the faculty and facility growth that had begun in the 1960s. In 1993, Kelch was appointed dean of the College of Medicine at the University of Iowa. Janet Gilsdorf (Pediatric Infectious Disease) was named interim chair. She served ably in this role from 1994-1996.

1996-2003

In 1996, Jean Robillard (Pediatric Nephrology), associate chair for research in the Department of Pediatrics at the University of Iowa, was recruited to become chair of the Department of Pediatrics and Communicable Diseases at Michigan. He was a leading authority in the development of the structure and function of the kidney from the fetus to adulthood. Robillard Pediatrics and Communicable Diseases (2016) 29 continued the strong tradition of recruitment of outstanding leaders in pediatric medicine. Friedhelm Hildebrant was recruited from Germany to lead a basic science research program in diseases of the kidney. Hildebrant, a member of the Howard Hughes Medical Research Institute, became a leading authority in the genetics of kidney disease. Robillard also recruited Gary Freed, who established one of the nation’s first health-services research groups focused on childhood disease. The Child Health Evaluation and Research Unit recruited and developed social scientists and national leaders in children’s health, establishing Michigan as the premier institution researching health service issues for children and advising the public and policymakers, on children’s health issues and needs. Freed’s clinical program expanded the general pediatric program at Michigan during his tenure as division director (1998-2013), both for service to children in Ann Arbor and Washtenaw County and surrounding areas as well as expanding the primary care training opportunities for house officers. This enterprise now encompasses more than 50 practitioners, both delivering expert primary care and instructing medical students and house officers in the practice of primary care for children. In 2003 Robillard began the recruitment process for a new director of Pediatric Pulmonology. Marc Hershenson (University of Chicago), a leading investigator in the pathophysiology of lung disease in children, joined the faculty that same year. In 2003, Dr. Robillard returned to the University of Iowa as dean of the Medical School. Thomas Kulik (Pediatric Cardiology) ably served as interim chair.

2003 to 2017

In 2003, Valerie Castle (Pediatric Hematology-Oncology) was appointed by Dean Allen Lichter as chair of Pediatrics and Communicable Diseases. Castle had built a successful academic career studying the childhood cancer neuroblastoma. She had served as the Department’s associate chair for research and associate provost for faculty affairs during Paul Courant’s tenure 30 Pediatrics and Communicable Diseases

as interim Vice President and Provost of the University under President Mary Sue Coleman. Castle was the first woman to become a department chair in the Medical School. During her tenure as chair she was a member of the American Pediatric Society Council and elected to serve as president of the American Society of Academic Medical School Department Chairs (AMSPDC). During this decade, the faculty and staff continued their efforts to expand clinical service lines and basic, clinical and health-services research programs. As examples, the Department established and launched more than 50 multi- and interdisciplinary clinical services and translational research programs including the Michigan Fetal and Diagnostic Treatment Center, the Michigan Molecular Medicine and Genetics Laboratory, Pediatric Palliative Care, the Michigan Center for Disorders of Sex Development, Pediatric Multidisciplinary Sleep Disorders Program, Neonatal B.R.A.I.N program, Congenital Cardiac MRI, Mott Hospital Palliative Care Service and Rapid Response Team, the Charles Woodson Clinical Research Unit, the Michigan Congenital Heart Outcomes Research and Discovery (MCHORD) program and the Michigan Congenital Heart Innovations Collaborative (M- CHIC), a unique group of U-M Congenital Heart Center investigators, physicians, engineers, and other scientists across the University focused on the development of innovative devices and therapies for congenital heart and critical-care medicine. The Department under the leadership of the chair increased its outreach to philanthropy, greatly expanding the cohort of endowed chairs as summarized in Table 1. Importantly, six of these chairs were self-funded by the Department to honor past and current members of the faculty who through their research, clinical and administrative roles had made major contributions to the Department’s accomplishments since its inception in 1921. These chairs are denoted with an asterisk (*).

Table 1. Endowed Chairs Established 2003-present Pediatrics and Communicable Diseases (2016) 31

Inception First Endowed Chair Date Recipient

Henry and Mala Dorfman Laurence Family Professorship in 17‐Jul‐03 A. Boxer, Pediatric Hematology/ M.D. Oncology

Ravitz Foundation Endowed Professorship Valerie P. in Pediatrics 18‐Mar‐04 Castle, and Communicable M.D. Diseases

James L. Ruth Heyn Professorship 17‐Jun‐04 Ferrara, in Pediatric Oncology M.D.

Aaron Stern Mark W. Professorship 17‐Jun‐04 Russell, in Pediatric Cardiology M.D.

Elizabeth Russell G. Adderley R. Lawlor, Professorship in 19‐May‐05 M.D., Pediatric Oncology Ph.D.

Janette Thomas P. Ferrantino Professorship 19‐May‐05 Shanley, in Pediatrics M.D.

Leland and Elaine Blatt Gregory Family Professorship in 16‐Jun‐05 A. Yanik, Pediatric Hematology/ M.D. Oncology

Laurence A. Boxer, M.D., Research Professorship Steven W. in Pediatrics and 18‐Jun‐09 Pipe, M.D. Communicable Diseases*

David Murray Cowie, M.D., Research Ram K. Professorship 18‐Jun‐09 Menon, in Pediatrics and M.D. Communicable Diseases*

Macdonald Dick II, M.D., Research Albert P. Professorship 18‐Jun‐09 Rocchini, in Pediatrics and M.D. Communicable Diseases*

Robert P. Kelch, M.D., Research Janet R. Professorship 18‐Jun‐09 Gilsdorf, in Pediatrics and M.D. Communicable Diseases* 32 Pediatrics and Communicable Diseases

Donita B. Sullivan, M.D., Research Donna M. Professorship Martin, 18‐Jun‐09 in Pediatrics and M.D., Communicable Ph.D. Diseases*

James L. Wilson, M.D., Research John J. Professorship 18‐Jun‐09 LiPuma, in Pediatrics and M.D. Communicable Diseases*

Frederick G.L. Vivian Huetwell Professorship 21‐Feb‐13 Cheung, in Pediatric Research+ M.D.

Edith Schlafer Pediatric In Open Oncology Professorship progress.

*Endowed Professorships established by the faculty and staff in the department; +Chair established following Regental approval that split the endowment of an existing Huetwell Professorship whose endowment had grown to financially support a second chair. To encourage additional scholarly and research activity, community support for the work of the faculty and staff also led to named endowment funds in the Office of the Associate Chair for Education (T.G Brown Endowment in Education and Bruce Fund); named endowed lectureships distributed in the Divisions (the MacDonald Dick Lectureship in Cardiology; the Aileen Sedman Lectureship in Medical Informatics; the David Rosen Lectureship in Adolescent Medicine); and junior scholar awards (the Jeanette Ferrantino Young Investigator Award; the Jones Family Foundation Research Scholar Award; the Gorman Family Scholar Award; the Charles Woodson Research Awards) and the Charles Woodson Clinical Research Fund in the Office of the Associate Chair for Research, which provides support for departmental research infrastructure, biostatistics support, the Charles Woodson Laboratory for clinical research specimen processing and 10 annual named intramural competitive research awards. Concurrently, the Department grew its research portfolio and sources of funding. As examples, the work of the faculty and staff improved the Department’s rank in National Institutes of Health funding among academic pediatric departments, from Pediatrics and Communicable Diseases (2016) 33

15th to 17th in the years before 2003 to ninth in 2005 and fifth in 2010. The Department was in the top 10 for funding in 6 of the last 11 years. This period was also associated with an expansion in clinical outreach to communities across Michigan and into Ohio, providing subspecialty pediatric care at a distance in cardiology, neurology, child protective services, genetics, nephrology, gastroenterology and pulmonary medicine. Additionally, the Department established its first U-M-owned and operated multispecialty pediatric clinics in 2014 at the University’s new Northville ambulatory site. Most significant was the planning, approval and construction of the new C.S. Mott Children’s and Von Voightlander Women’s Hospitals, completed in 2011. At that time the project was the largest capital investment ever made by the University of Michigan ($750 million), and the new hospitals were completed a year ahead of schedule and roughly $50 million under budget. The facility included a 12-story inpatient tower and a nine-story ambulatory outpatient facility totaling 1.1 million square feet of clinical space and capacity for 285 inpatient beds. Importantly, more than $75 million in philanthropy was secured in support of the construction costs with many donors having named rooms and spaces within the facility. While it was decided the new facility would continue to be bear C.S. Mott’s name, the Mott Foundation again supported the University with a $25-million grant in sup of the project. The new C. S. Mott Children’s Hospital had many important features for patients and staff, including an extensive art collection purchased and curated by the U-M Museum of Art; an inpatient Ronald MacDonald House to serve the families of children admitted to the three intensive-care units (the Pediatric Intensive Care Unit, the Neonatal Intensive Care Unit, and the Pediatric Cardiology Intensive Care Unit); state-of-the-art patient care rooms and technology including an OR-MRI unit for the care of patients with complex brain tumors. The tradition of housing mothers and babies continued with the construction of a newly named Women’s Hospital, the Von Voightlander Women’s Hospital, which was housed on the ninth floor within the C.S. ottM Children’s Hospital. 34 Pediatrics and Communicable Diseases

To support the expansion of clinical services and research programs, the faculty grew from 130 in 2003 to more than 240 in 2014 in 15 general and subspecialty divisions. The quality of services and care provided at Mott Hospital led to many national awards, near-perfect patient satisfaction scores, faculty and staff recognitions and appointments to national academic and society leadership positions. Collectively the Mott community of providers received consistent recognition by Parents’ Magazine and U.S. News and World Report as one of the nation’s leading comprehensive children’s hospitals and Departments of Pediatrics. This decade was a period of substantial growth and accomplishment. By 2014 the Department of Pediatrics had become the second largestin the Medical School and University of Michigan Health System.