Obstetrics and Gynecology Obstetrics and Gynecology Medical School The University of Michigan: An Encyclopedic Survey Copyright © 2015 by the Regents of the University of Michigan 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. Obstetrics and Gynecology (1942) 1 Reuben Peterson 2. Obstetrics and Gynecology (1975) 30 Fred J. Hodges 3. Obstetrics and Gynecology (2016) 32 Alexandra Minna Stern [1] Obstetrics and Gynecology (1942) Reuben Peterson WHEN the Department of Med icine and Surgery was established in 1850, two outstanding scientific men were members of its faculty — Silas Hamilton Douglass (A.M. hon. Vermont ’47) and Abram Sager (Rensselaer Polytechnic Institute ’31, M.D. Castleton Medical College ’35, A.M. hon. Michigan ’52). With the aid of Regent Zina Pitcher, one of the most widely known physicians in the state, they had organized the department. In 1851, his last year as Regent, Pitcher was appointed Emeritus Professor of the Institutes of Medicine and Obstetrics. The position was purely honorary, however, and his appointment to it was apparently the University’s only record of any special interest he may have had in the teaching of obstetrics. Sager was appointed Professor of the Theory and Practice of Medicine in January, 1848, with the understanding that he would also teach pharmacy and medical jurisprudence. By his own choice, in 1854, he was transferred to be Professor of Obstetrics and Physiology. Although there were discrepancies between the 2 Obstetrics and Gynecology titles and duties of the other four medical professors, Sager’s title corresponded with his teaching responsibilities. Jonathan Adams Allen (Middlebury ’45, M.D. Castleton Medical College ’46), who had previously taught physiology, left the University in 1854, and Alonzo Benjamin Palmer (M.D. College of Physicians and Surgeons [N.Y.] ’39, A.M. hon. Nashville ’55, LL.D. Michigan ’81) was appointed Professor of Materia Medica and of the Diseases of Women and Children. While in charge of the teaching of gynecology, Palmer was closely associated with Zina Pitcher in efforts to improve medical education. From 1854 to 1858 Palmer was an editor of the Peninsular Journal of Medicine, of which, during about one-half of that time, Pitcher was the chief editor; and in the summers of 1857 and 1858 Palmer gave clinical lectures and bedside demonstrations before the University’s clinical classes in Detroit, which also were under Pitcher’s direction. In these classes a few normal and abnormal obstetrical cases were presented. Both men advocated the inclusion of adequate hospital training in the work required for the medical degree, but unlike Pitcher, Palmer at that time favored a plan — advanced by Professor Moses Gunn and emphatically rejected by the Regents in 1858-to move the entire Medical Department to Detroit. In 1860, when Palmer was placed in charge of the instruction in medicine and pathology, Sager was relieved of his work in physiology and resumed the teaching of women’s and children’s diseases. The six-year period which then ended was the only time in the history of the school when gynecology and obstetrics were not taught in the same department. One student has said that Sager, in lecturing, was inclined to become absorbed in general biology rather to the neglect of obstetrics, but from all accounts he was a conscientious, if not an eloquent, lecturer. By 1871-72 throughout the six-month session he was giving eight lectures a week, including those in obstetrics, gynecology, and pediatrics. Though a little clinical instruction in medicine and surgery was regularly provided throughout Sager’s period of service, first by means of free clinics before the students and later in the wards of the Hospital, clinical obstetrics in the University was Obstetrics and Gynecology (1942) 3 practically nonexistent, and gynecology also was taught largely by means of lecture and recitation. Ordinarily, neither Sager nor his successor performed more than the most minor operations; major surgery in this field, such as the removal of ovarian cysts, was the province of the professor of surgery. For nearly forty years medical students at the University of Michigan were graduated without having been required to witness a case of labor or a childbirth. Some ambitious and wide-awake students witnessed a few cases in the practice of their preceptors, but such instances were exceptional, for women naturally disliked having the students present, and it is to be doubted that even these students learned much about practical obstetrics, for at that period obstetrical manipulations were conducted under the sheet. The Hospital was opened in 1869. The financial principle on which it was established, namely, that it should be wholly self- supporting, explains why the obstetrical material did not increase much for another twenty years, for, no matter how small the charge — and at first it included only food and medicines — women would not pay to be delivered by medical students, and the Michigan state laws authorizing the use of public moneys for the maintenance and transportation of those unable to pay had not yet been enacted. In fact, it was just as well in the days before antisepsis that the University could do so little work in clinical obstetrics, for at least one-half of the women confined in hospitals, such as Bellevue in New York City, died of puerperal sepsis. Although Semmelweiss in 1847 had proved conclusively that childbirth fever was transmitted by the contaminated hands of medical students, the medical profession as a whole either was ignorant of the fact or denied its truth. Scientific information spread slowly between 1850 and 1890. In Sager’s time surgery at the University was performed under great difficulties. In those days neglect of ordinary cleanliness before and during operations was not recognized as the cause of the many postoperative fatalities, but because of the risk, major operations were avoided whenever possible. After 1869 some operations were performed at the Hospital “upon patients that could not be brought before the class” in the presence of 4 Obstetrics and Gynecology a few specially interested students (R.P., 1870-76, p. 207). Many of the surgical patients were carried across the campus to an upper lecture room of the Medical Building and were operated on while lying on a table upon which, perhaps the hour before, the professor of anatomy had demonstrated on a cadaver. It was under such circumstances that Sager performed a Caesarean section on a rachitic dwarf — one of the first, if not the first, of such operations in Michigan (Univ. Mich. Med. Journ., 2 [1871]: 385-93). It is not to be wondered at that the patient died of peritonitis soon after the operation. Sager’s description of the operation, in which he was assisted by Professor Corydon L. Ford and George E. Frothingham, Demonstrator of Anatomy, is of particular interest. Because he thought it his duty, this modest little man, who probably had had very little experience as a surgeon, performed an operation almost without parallel in this section of the country. Thirteen years earlier such a procedure was advocated by Sänger. The uterine wound was sutured to avoid spill from the interior of the uterus and subsequent infection. Dr. Sager secured the pelvis and gave exact measurements to show why birth through the natural passages was impossible. The report of the case is impressive for its demonstration of the scientific mind of that period. Sager’s teaching career ended in 1873. At that time he obtained a leave of absence because of ill-health, and in his place Dr. Edward S. Dunster was appointed Lecturer in Obstetrics and Diseases of Women and Children. In March of the following year, Sager resigned his chair and was made Professor Emeritus, but, at the request of the faculty, he retained the deanship, which he had held since 1868. The admiration with which his colleagues and the University officials regarded him was expressed in the following resolutions adopted by the Regents in March, 1874: Resolved, That we hold Prof. Sager in the highest esteem, not only for the symmetry of his character and purity of his life, but also for the eminent services which he has rendered to this University during a period of thirty-two years. Resolved, That the great success attending the Medical Department has been largely due to his loyalty, industry, wisdom and scholarship. (R.P., 1870-76, p. 334.) Obstetrics and Gynecology (1942) 5 Sager resigned the deanship in 1875 as a protest against the University policy of requiring certain of the “regular” medical professors to receive students of the new Homeopathic Medical College into their courses. He died in Ann Arbor, August 6, 1877. Edward Swift Dunster (Harvard ’56, A.M. ibid. ’59, M.D. New York College of Medicine and Surgery ’59, M.D. hon. Dartmouth ’81), a direct descendant of Henry Dunster, the first president of Harvard College, was appointed Professor of Obstetrics and Diseases of Women and Children in 1874. He had served through the Civil War and until 1868 as assistant surgeon in the United States Army. From 1868 to 1871 he had been professor of obstetrics and of the diseases of women and children in the University of Vermont and also editor of the New York Medical Journal, and from 1869 to 1874 he served on the faculty of the Long Island College Hospital as lecturer on the subjects of obstetrics and the diseases of women and children.