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ORGIN OF A STATE UNIVERSITYA MEDICAL BRANCH OF THE UNIVERSITY IS BORN AT KEOKUKUNIVERSITY MEDICAL DEPARTMENT CREATED AT IOWA CITY DEPARTMENT OF PATHOLOGY AND BACTERIOLOGY CREATEDBEIRRING HEADS NEW DEPARTMENTMEDICAL BUILDING DESTROYED BY FIREHENRY ALBERT BECOMES NEW HEAD OF DEPARTMENTTHE FLEXNER REPORTTHE ROCKEFELLER CONNECTIONHENRY ALBERT LEAVES DEPARTMENT, RETURNS AS COMMISSIONER OF HEALTHHYGIENE AND PREVENTIVE MEDICINE BECOMES A SEPARATE DEPARTMENT1921-1930 A HEADLESS DEPARTMENTTHE H.P. SMITH ERATHE WARNER YEARSPENICKLYNCH
The Medical Bulletin from April 6, 1940
Iowa became a separate governmental entity in 1838, when a strip of land lying west of the Mississippi River was taken from Wisconsin Territory to form Iowa Territory, with Burlington chosen as the first Capitol. It was soon decided that Burlington’s location was not central enough within the territory, and negotiations to choose a new capitol were begun. This resulted in such intense rivalry and dissension, that a plan was adopted to select a virgin site to found a new capitol city. Johnson County was selected as the general area within which the city was to be located, and a committee of three men (Chauncy Swan, John Ralston, and Robert Ronalds) was commissioned to chose the exact site.
On May 4, 1839, this committee settled upon a location overlooking the Iowa River, approximately where the Old Capitol now stands, and declared this to be the chosen spot for the "City of Iowa." Their action quickly gained the necessary approval, and with the establishment of a post office, "Iowa City" became the Capitol of the Territory of Iowa, as well as the county seat of Johnson County, although no city actually existed at the time.
Plans for a territorial capitol building were approved very quickly and construction was begun in 1840. Various problems delayed the completion of the capitol building, and temporary quarters were required for several years, but Iowa City served as the site of territorial government until Iowa became a state in 1846.
ORIGIN OF A STATE UNIVERSITY
The Constitution of the new State called for the establishment of a state university at Iowa City. The first General Assembly of the State Legislature passed an act on February 25, 1847, to implement the provisions of the Constitution. Having thus addressed the educational needs of the State, the Legislature adjourned (a familiar pattern of action for Iowa legislative bodies). The act was signed at once by Governor Ancel Briggs, and provided the guidelines for the origin and development of a state university.
The "State University of Iowa" to be established at Iowa City was to be financed by sale or rental of two townships of land granted by Congress for the exclusive support of the university and "such branches as the General Assembly shall establish." The university was to be governed by a Board of Trustees appointed and controlled by the General Assembly. The university was to be housed in the existing capitol building unless otherwise provided by law. It was assumed that governmental functions would leave the capitol facilities free for other uses much of the year, and that a new state capitol would be selected within a short time.
Several vexing problems, financial and otherwise, delayed the start of the new University. The land sales were slow in providing money; the selection of a new capitol was delayed; there was great difficulty in recruiting faculty and a President or Chancellor; and intense competition arose over formation of "branches" of the university. Although the Constitution and Legislature acts required that the university be located in Iowa City, it was argued that "branches" could and should be located elsewhere. Many were proposed and several authorized, but only the "medical branch" at Keokuk succeeded. One crucial problem was partially solved when Amos Dean of Albany, New York, accepted the position of Chancellor on a part-time basis, while still maintaining residence in Albany and continuing to hold positions in the Albany Law School and several other New York educational institutions. Under his leadership, three University "Departments" were organized. These were the Collegiate Department, or university proper; the Normal Department for teacher training; and the Preparatory Department for students with inadequate credentials for University admission. The first class entered the university in September, 1855, for a two semester course of forty weeks, with a student body of 124 (83 "gentlemen" and 41 "ladies") and a faculty of five. Only 25 qualified for the Collegiate Department, 40 enrolled in the Normal Department, and 65 took all or part of their courses in the Preparatory Department. The majority of students were from Iowa City or nearby communities, and the University soon came to be derided as the "Johnson County High School".
Until 1857 the Mechanics Academy had provided the only housing available to the University. This building, constructed in 1842 by the Mechanics Mutual Aid Association, had previously been utilized by a private "academy", and later served as Iowa City’s first public school. The building was first rented by the State, and remodeled to serve as the first home of the University of Iowa. The State later acquired ownership and the building continued to serve the University in various ways until demolished in 1898 to make way for the first University Hospital building.
Under the leadership of Chancellor Dean, the "President in absentia", the university barely managed to hold its own for the next several years, and a state of crisis became evident when a new State Constitution was adopted in 1857.
The new Constitution of 1857 designated Iowa City as the site of the State University, with no branches to be located elsewhere. Des Moines now became the Capitol, and the Old Capitol building became available as the center of University activities. The State Legislature was persuaded to provide funds for renovation and alterations, which included a fence about the Old Capital grounds to keep out hogs and other roving livestock. Funds were also granted for construction of a boarding house to encourage enrollment of students from more remote areas of the State. This building, known as South Hall, later was converted to classrooms and other uses.
The University was placed under the control of a newly created State Board of Education, which then appointed a new seven member board of trustees retaining only one of the original fifteen. Upon the recommendation of the chancellor, the Trustees temporarily closed the Collegiate and Preparatory Departments, and advocated the permanent abolition of the latter as soon as other institutions of learning became available to serve its function. All of the faculty except Professor Wells of the Normal Department were dismissed. The Trustees insisted that the chancellor reside in Iowa City, which caused Amos Dean to resign. They also voted to exclude women students from the Collegiate Department, but this unpopular rule was never enforced, and was rescinded by the Board of Education a year later, thus justifying the claim that the University has maintained its coeducational status throughout its existence.
The Board of Trustees regarded the closing of the University in 1858 as a temporary measure, and worked vigorously to enable it to reopen. The Normal Department had remained in operation, with continued success, and in 1859 the Trustees voted to reopen the Collegiate Department as of September, 1860, with a new President and faculty. Early attempts were made to eliminate the Preparatory Department, but the scarcity of adequate high schools in the State necessitated the continuance of that branch of the University until 1878. By this date high schools and academies had become generally available with educational standards in keeping with university admission requirements, and the University had established itself as a true institution of higher learning.
A MEDICAL BRANCH OF THE UNIVERSITY IS BORN AT KEOKUK
The State Constitution of 1847 made no provision for education in professional fields, as there was little public sentiment for State support in these areas. The first attempt to establish a "medical branch" of the University of Iowa became public in December of 1848 during a meeting of area physicians of Iowa City. At that time, Dr. J.M. Vaughn and Mr. Stephen Whicher, representing the group, appeared before the University Board of Trustees and obtained approval of their plan to establish a Medical Department of the University in Iowa City.
Approval of this "medical branch" was conditional upon the promoters constructing a medical building within two years. This building was to cost at least $1000, and no university funds were to be given for the support of the medical department. No building was erected, and in 1849 the same group of physicians shifted their support to a newly established medical college in Davenport, which bore the imposing title of College of Physicians and Surgeons of the Upper Mississippi.
The Davenport college was the successor to the Rock Island Medical College, a branch of the Madison Medical College. This College had begun operations in Rock Island in 1848, with a faculty of eight, and graduated its first class of 21 on February 20, 1849. The school moved across the river to Davenport in 1849, and assumed the title of College of Physicians and Surgeons of the Upper Mississippi. The move was motivated by the desire to become affiliated with the State University of Iowa, and the inducement of better physical facilities in Davenport. A course of 16 weeks of instruction was given, with eight graduates in February, 1850, and an additional seven in June, 1850.
In February, 1850, the Trustees of the State University approved the request that the Davenport college be recognized as the Medical Department of the State University of Iowa, official notification being given on March 18, 1850. This action was officially confirmed by the Iowa Legislature in the winter of 1850-51. In the meantime, the Davenport group had made another move, this time to Keokuk, and so the College of Physicians and Surgeons, now of Keokuk, became the official Medical Department of the State University of Iowa. In spite of internal dissension and external pressures, this institution persisted and remained as an official branch of the State University of Iowa until 1870.
Keokuk continued to be an important center of medical education in Iowa for several additional decades until the school closed and transferred its records and assets to Drake University in 1908.
UNIVERSITY MEDICAL DEPARTMENT CREATED AT IOWA CITY
The legislative edict that all branches of the University be located in Iowa City caused controversy over the Medical College at Keokuk, but it was allowed to continue as the official Medical Department of the University until 1870 when a newly created school at Iowa City became the official Medical Department of the State University of Iowa.
The birth of the new Medical Department was attended by stormy labor pains, and its neonatal life was precarious. Formal efforts to establish the Medical Department were initiated in 1868, when Dr. Washington F. Peck, a Davenport surgeon, met with the University Board of Trustees and presented a complete outline of organization for a proposed Medical Department. A resolution of approval was adopted unanimously by the Board the next day, September 18th. Apparently the Board did nothing to implement the resolution until the following summer, at which time action was taken to provide housing and select faculty for the school.
The opening date for the school was to be not later than the fall of 1870. By this time bitter opposition by factions of the physicians of the State, lead by Dean Hughes of the Keokuk school, had become public. Opposition peaked at the meeting of the State Medical Society in February, 1870. Resolutions passed by the Society were presented to the Governor, and by him to the General Assembly in session, calling for the abolition of the new Medical College. A bill to abolish was passed by the Senate, but failed in the House. A substitute bill was then introduced, giving control of the University to a newly-created Board of Regents, with power to decide the fate of the Medical Department.
This five man Board met for the first time in the spring of 1870, and passed a resolution by a three to two vote, approving the establishment of the Iowa City Medical Department. The Board then made the necessary faculty appointments and gave orders for the school to open not later than the fall of 1870.
Nine faculty positions approved by the Board of Regents included Dr. W.F. Peck as Dean and Professor of Surgery. Dr. Peck was also largely instrumental in selecting the remainder of the appointees, who were to head Departments of Theory and Practice of Medicine, Materia Medica, Physiology and Microscopic Anatomy, Anatomy, Obstetrics, Gynecology, Chemistry, and Medical Jurisprudence. Dr. J.F. Kennedy of Tipton declined the Chair of Obstetrics, and so Dr. J.C. Shrader of Iowa City became Head of a combined department of Obstetrics and Gynecology which has persisted to this day. The faculty received no pay, but medical historians regard them as a competent and conscientious group who did much to enable the infant school to succeed.
The new Medical Department was housed in South Hall, for which an appropriation of $3000 was made in the summer of 1869 for alterations to meet the needs of the new department. This building, located directly south of Old Capitol, was constructed in 1861 as the first campus building designed specifically for University use. The remodeled building included an amphitheater seating over 100 and a basement dissecting room, as well as cabinets and storage facilities for medical supplies and equipment, but it did not provide hospital beds.
The University Catalogue of 1869-70 announcing the opening of the Medical Department the following term emphasized that Iowa statute decreed that the State University of Iowa should provide educational opportunities to the youth of the State on equal terms to both sexes. The Medical Department, in accord with that liberal policy, would be open on equal terms to youth of both sexes, without regard to color, "and to each will be afforded equal opportunity, and the same facilities for acquiring a complete and thorough medical education". In spite of opposition by some faculty members and others, the College of Medicine thus embarked on a nonsegregated coeducational course which it has maintained throughout its existence.
The first class met on September 20, 1870. The first course consisted of two weeks of preliminary lectures, followed by the regular course of sixteen weeks of medical lectures. There were essentially no requirements for admission, except that candidates for graduation must be twenty-one years of age and of "unexceptional moral character". Candidates for graduation must also have studied medicine for at least three years, including two courses of lectures, submit an acceptable thesis, and pass examinations in all subjects studied. A graduation fee of $25 was assessed, but was returned if the applicant failed the examinations, which may have had a negative effect on failure rates.
The first crisis threatening the new Medical School arose during the first year of operation. The University Catalogue emphasized the role of "Practical Anatomy" in the curriculum, and asserted that "our facilities for obtaining material have been perfected, so that an abundant supply will always be at hand." Evidently logistic imperfections were encountered, however, and a great public outcry arose when it was discovered that a recently interred body had disappeared from a local cemetery. Feelings were intensified when a notebook belonging to the Anatomy Department janitor was found near the desecrated grave. The missing body mysteriously reappeared a night or two later in a casket behind a local mortuary, but did show evidence of partial dissection. At this point, the janitor and the anatomy professor thought it wise to leave town. The State soon took the necessary legal steps to make available for dissection the unclaimed bodies of persons dying in Iowa prisons, and this apparently provided the "abundant supply" of "material" promised by the Medical College prospectus.
The Medical Department at first lacked any sort of hospital, but in 1873 the old Mechanics Academy was converted to hospital use, with the Sisters of Mercy from Davenport supplying housekeeping and nursing care. This building remained in use until 1898 when it was demolished to make way for the first University Hospital, later to be known as East Hall, and now known as Seashore Hall.
The first medical class graduated in the spring of 1871. It included seven women in a class of thirty-eight. Enrollment rapidly escalated, so that within little more than a decade some classes approached 200 in size, and South Hall had become grossly inadequate in size and educational facilities. In 1882 the Legislature granted an appropriation of $30,000 to construct a new medical building beside South Hall, and this building was completed in 1883. The building contained two large amphitheaters, each with capacity to seat 300 to 400 students, a library, and dissection room. A few years later, one of the amphitheaters was altered to provide a small pathology laboratory. Prior to this the only hint of any formal inclusion of pathology in the curriculum was the listing of a museum of morbid anatomy in the yearly University Catalogue.
The medical courses gradually lengthened and evolved through the early years of the Medical College. A two-year course was introduced in 1877 and a three-year course in 1878. In 1879 the catalogue listed both a graded three-year course and an ungraded two-year course. Admission required a high school diploma or successful completion of examinations in English, arithmetic, history, geography, and natural philosophy. Beginning in 1889, only a three-year graded course was offered each year to last six months, and in 1894, the four-year course was instituted.
DEPARTMENT OF PATHOLOGY AND BACTERIOLOGY CREATED
The University Catalogue of 1892-93 announced the addition of a Department of Pathology and Bacteriology to the Medical Department. The Chair was to be filled before the next term, and assurance was given that instruction would be "thorough and practical". Dr. J.M. Parker of Davenport was listed as Professor of Pathology and Bacteriology and curator of the medical museum with Water L. Beirring, a senior student, as Demonstrator of Pathology. Dr. Parker was to play a temporary role, as Walter Beirring had already been approached with the offer of Headship of the Department, conditional upon his obtaining the MD degree and completing appropriate post-graduate studies in leading European medical centers. He received his MD degree in the spring of 1892, and within a few days had embarked on his European odyssey to prepare himself for the position of Professor of Pathology and Bacteriology at the beginning of the 1893-94 session.
Dr. Beirring, in later years, gave much of the credit for the origin of the Department to Dr. Lawrence W. Littig, an Iowa graduate who returned to Iowa City in 1888 to become Professor of Anatomy. Dr. Littig held a second degree from the University of Pennsylvania and membership in the Royal College of Surgeons of London, and had spent four years studying in medical centers of London, Berlin, Vienna, and Paris. He brought the first oil immersion microscope to Iowa City, and used it to demonstrate to students the tubercle bacillus in sputum, and other microorganisms identified as causes of infectious diseases prevalent at the time. Prior to this, bacteriology had been taught by Professor Thomas H. McBride, Professor of Botany in the "Collegiate Department". McBride was expert in many botanical subjects, including mycology and bacteriology, but avoided use of organisms pathogenic to man in his laboratory courses. In 1892, Dr. Littig transferred to become Head of the Department of Theory and Practice of Medicine, and this apparently ended his direct involvement with the teaching of laboratory medicine.
Important impetus to the growth of laboratory medicine at Iowa City was also given by Elbert W. Rockwood. He became Demonstrator of Chemistry in 1888, having first attained the title of Professor of Chemistry and Toxicology in 1882. After several title changes through the years, he again held that title at his death in 1935. He came to Iowa City from the Strassburg laboratory of Hoppe-Seyler a leading physiological chemist of the time, Rockwood organized and taught one of the first courses of physiologic chemistry in this part of the country, and it soon became an important part of the medical school curriculum.
Dr. Parker gave a series of lectures on Pathology during the 1891-92 year, but did not include laboratory work. Illness prevented his finishing the course or conducting it the following year. Laboratory work in Pathology and Histology during this time was directed by Professor Samuel Calvin of the Geology Department, assisted by Drs. E.H. Williams and Frank S. Aby. The qualifications of Professor Calvin in this capacity are not recorded, and Dr. Williams had no further recorded involvement in the Department. Dr. Aby remained on the faculty for several years as Professor of Normal Histology.
BEIRRING HEADS NEW DEPARTMENT
Dr. Walter L. Beirring, having just been awarded his medical degree, departed for Europe on March 22, 1892, and arrived back in Iowa City in September of 1893. In somewhat less than 17 months he had managed to gain exposure to many of the leaders in Bacteriology and Pathology in Vienna, Heidelberg, Berlin, and Paris, although he was disappointed in not being able to study with Pasteur or Koch, both in the late stages of their careers. In an historical account of the department, published in the Iowa State Medical Society Journal in 1937, he recalled with enthusiasm and considerable detail the gratifying experiences of this scientific quest.
Upon Dr. Beirring’s return to the University he was met at the Rock Island station by two medical students with applications for positions as laboratory assistants. When informed that the total budget for assistants was $100, they immediately agreed to share that sum, and an understanding was reached on the spot. The students were William R. Whiteis and Lee Wallace Dean. For the next three very busy years, this trio constituted the entire staff of the new Department. Whiteis and Dean received their MD degrees in due course and went on to positions of eminence in other fields of medicine. Dr. Whiteis ultimately became Professor of Obstetrics and Dr. Dean became Professor and Head of Otolaryngology as well as Dean of the Medical School and Director of University Hospital before leaving Iowa City to practice medicine in St. Louis as Head of Otolaryngology at Washington University.
Dr. Beirring, in writing of the early years of the Department, characterized his position as truly "full time". In addition to courses of didactic instruction, laboratories of Microscopic Pathology and Bacteriology were quickly organized and put into operation, aided by use of tissue specimens, blocks and bacterial cultures obtained from medical centers of Europe and the eastern United States. In the spring of 1894 Dr. Beirring was able to return to Europe to attend a course in Bacteriology at the Pasteur Institute in Paris, where his principal mentors were Rous, Metchnikoff, and Borrel. A highlight of his stay was an extended audience with Louis Pasteur, then in semiretirement, but still keenly aware of advances in Bacteriology throughout the medical world. As a result of his summertime studies, Dr. Beirring was able to undertake the production of diphtheria antitoxin upon his return to Iowa City in the fall of 1894. L.W. Dean (MD, 1896) was his principal associate in this work, and the work provided the material for Dean’s Master of Science thesis. The antitoxin produced in 1895 was the first produced in this country outside of New York City.
In all, some 300 doses of antitoxin for therapeutic or immunizing use were administered clinically without any untoward effects. In the meantime, interest in Bacteriology had become so great locally that a special one month course known as the Pasteur Course of Bacteriology was approved and first offered at the close of the school year in 1895. It was open to physicians and students and was continued yearly through 1900, after which it was replaced by courses incorporated into the regular curriculum. The Department expanded in scope in yet another direction, when the teaching of Histology and Embryology was added to the Departmental functions. The senior assistant, Dr. Whiteis, was accordingly given the title of Professor of Histology and Embryology in 1896.
Dr. Beirring made a third European trip in the spring of 1896, with visits to medical centers in Rome, Florence, Zurich, Munich, and Heidelberg, and longer stays in Vienna and Paris. His stay in Paris was saddened by the recent death of Louis Pasteur. Everywhere he went, he learned of progress in Bacteriology, and he returned to Iowa City with renewed enthusiasm for teaching and conducting studies in Applied Bacteriology. These studies included work on bacterial diseases of the eye, bacteriology of water, and the role of bacteria in the arts of sciences. In collaboration with Professor Rockwood, results of extensive investigations of the use of formaldehyde as a disinfectant were published in the Journal of The Iowa State Medical Society in 1898.
In 1894 the Medical College program was extended to four yearly sessions of six months each. Student courses in Pathology and Bacteriology included lectures and laboratory exercises extending through the sophomore, junior and senior years. These included the preparation of bacterial cultures and histologic slides of tumors, diseased organs and tissues, as well as the study of gross and microscopic materials. Instruction and practice in autopsy technique was included. Practical work was correlated with didactic lectures of the conditions studied in the laboratory. By 1900, seven courses were listed in the Catalogue, although the departmental faculty listed only Professor Beirring with John T. McClintock, MD, and Theodore W. Kemmerer, MD as demonstrators. Dr. McClintock’s name had first appeared in the departmental roster several years before, as a medical student. Several years later he transferred to Physiology and later headed the Department for many years, also serving as Associate Dean for several years. In later years Dr. McClintock was a major contributor to the history "One Hundred Years of Iowa Medicine" published by the State Medical Society in 1950.
MEDICAL BUILDING DESTROYED BY FIRE
On March 1, 1901, the general medical building was completely destroyed by fire, along with nearby South Hall, with the complete loss of Medical College laboratories and teaching equipment and materials. Dr. Beirring, in his memoirs, gave much credit to Dean Middleton of the Medical College for prompt and effective action to provide emergency quarters for the next session, and University President McLean was also cited for his leadership in a successful campaign for legislative appropriations to provide for the erection of a new medical building. Dr. Beirring was chosen to travel to European medical centers to select essential laboratory equipment, supplies and anatomical and pathological specimens for the next school year, as well as to formulate plans for modern laboratory facilities for the new building. The State Legislature authorized the construction of two new buildings to replace those destroyed by fire, but delay in construction occurred, and the new facilities first became available for use in the fall of 1904. Temporary quarters were provided in the new Hall of Liberal Arts (now Schaeffer Hall) and the Medical College was able to continue without interruption. The two new buildings were named the Hall of Anatomy and the Hall of Histology, Physiology and Pathology. They were built near the new University Hospital which had recently replaced the old Mechanics Academy that had served inadequately as the first hospital for the Medical College. These buildings were to serve as medical laboratories until a new Medical Laboratory Building was completed in 1928. The old buildings then were converted to use by the Zoology Department, and currently house the department’s successor, the Biology Department.
The college term of 1902-03 was Walter Beirring’s last as Head of Pathology and Bacteriology, before becoming Professor and Head of the Department of Theory and Practice of Medicine, which position he held until 1910. At that time he left the University to move to Des Moines, where he remained active in medicine for many years, attaining national and international prominence perhaps not equaled by any other Iowa physicians to this day.
HENRY ALBERT BECOMES NEW HEAD OF DEPARTMENT
The University Catalogue of 1903-04 listed Henry Albert, BS, MS, MD, a Acting Professor in charge of courses in the Department of Pathology and Bacteriology. The following year he held the title of Professor and Head of the Department, and he retained that position until 1921. Like his predecessor, he began preparation for this position as a junior medical student at Iowa City, and after obtaining his MD, he studied in European medical centers before assuming the role of Professor. The Catalogue lists four additional members of the departmental staff, including Charles I. Lambert, MD, as Instructor, Paul S. Krause, BS, as Fellow, Ralph L. Byrnes, BS, as Scholar, and (brother) Fred Albert, Jr., as Laboratory Assistant. This faculty of five was responsible for conducting ten listed courses, the tenth being an advanced course for students working toward a degree in the graduate college. Courses extended through the Sophomore, Junior and Senior years, which now were of 36 weeks duration, and involved classes of as many as 150 students, including those enrolled in he College of Homeopathic Medicine.
The Department moved into its third floor quarters in the new Hall of Histology, Physiology and Pathology in the fall of 1904. This building, later to become known as the Medical Laboratory Building, was the home of the Department for the next 24 years. It housed "laboratories of Pathology and Bacteriology, the Pathological Museum, and Clinical Laboratories." Also in 1904, Henry Albert became Director of the new State Bacteriological Laboratory, later known as the State Hygienic Laboratory, which supplied the Department with much material pertinent to the study of infectious diseases. The fire of 1901 had destroyed the Medical Museum, so that a call went out for specimens to stock the Pathological Museum of the new building. For several years the University Catalogue listed many donors and their contributions to this collection, which was augmented by material obtained by personal contacts with European Medical centers.
Judging by the University Catalogue, the teaching functions of the Department had become clearly defined by the 1900’s, and there was little change in listings and descriptions of courses during the next several decades. Gross and microscopic features of morbid anatomy were studied intensively, with special emphasis on infectious and neoplastic diseases. Museum specimens as well as current surgical and autopsy material were used extensively for this purpose. Bacteriological studies included practical aspects of preparation of culture media and their use in identification of organisms for diagnostic purposes. These clinically oriented exercises were balanced by thorough didactic lectures and textbook studies of the subject matter.
John T. McClintock became Professor of Physiology in 1903 after serving at various times in Pathology, Anatomy, and Surgery. To prepare for this position he took a leave of absence to study in European laboratories for a year. John W. Harriman died in January, 1904, while serving as Professor of Anatomy. He was replaced the following term by Henry J. Prentiss who headed this Department for many years. The three men (Albert, McClintock, and Prentiss) followed a new trend in medical school policy by practicing their specialties "full-time" as teachers, laboratory investigators and consultants no longer serving as primary care physicians.
During Henry Albert’s term as Department Head, his listed staff varied from three to eight, but the majority were low in rank and short on experience, with titles such as Instructor, Lecturer, Assistant, Demonstrator, or Student Assistant. Assistant Professor A. Egdahl, MD, is listed in 1907-08, the first time that rank was attained in the Department. Egdahl was gone the following year, but several others attained the rank of Assistant Professor in succeeding years. In 1911-12 the title of Hospital Pathologist was given to Mordacai Edlavitch, MD, who promptly vanished from the record at year’s end. This title was bestowed upon a member of the Department each year for some years, but the special nature of that assignment was never explained.
Henry Albert found time to publish a reasonable number of papers during his academic career. Like his mentor, Walter Beirring, his strongest interest appeared to be Bacteriology (infectious diseases) and related public health matters. His publications included case reports and epidemiological observations of such major diseases of the times as typhoid fever, diphtheria, smallpox, gonorrhea, tuberculosis, influenza, trichinosis, and less familiar diseases including rabies, actinomycosis and amoebiasis. His familiarity with this wide range of infectious diseases was enhanced by his experience as Director of the State Hygienic Laboratory, and this knowledge stood him in good stead in his later work in public health.
THE FLEXNER REPORT
The year 1910 marked the beginning of an era of great changes in medical education in North America. Abraham Flexner, a 42-year-old former schoolmaster and Johns Hopkins graduate from Lexington, Kentucky, was the chief catalyst of what amounted to genuine educational revolution. He was the author of the book The American College, which so impressed Dr. Henry S. Pritchett, President of the Carnegie Foundation for the Advancement of medical education in the United States and Canada. Although he had never set foot in a medical school before accepting the assignment, Flexner set out in December, 1908, to visit and evaluate all of the 155 "medical schools" in the United States. He finished this Herculean task in a little over a year and one-half, and the results were summarized as Carnegie Foundation Bulletin #4, published in 1910.
In Abraham Flexner’s autobiography, he relates in some detail how he prepared for his seemingly impossible task by reading everything he could find about medical education in Europe and North America and by consulting with medical educators at home and abroad. He relied on the leaders of the Johns Hopkins school, especially William H. Welch, unquestionably the most distinguished and influential American pathologist of his generation. Having thus prepared himself, he promptly devised a system that enabled him to obtain the basic information concerning finances, admission standards, teaching methods, laboratory facilities, hospital and clinic capacity and quality, and general operating standards in the course of a visit lasting a day or so at any school.
The four medical schools then existing in Iowa were visited in April, 1909, and the combined report occupies somewhat less than a page in Carnegie Bulletin #4. None of the four schools received a clean bill of health. To quote from the "General Considerations" portion of the report:
Of the four medical schools in the state, none is ... satisfactory. The osteopathic school ... is a disgrace to the state, and should be summarily suppressed. ... the medical department of Drake University and the homeopathic department of the State University are well intentioned but feeble institutions ... (and) it would be the better part of wisdom to retire from a contest to which the institution is so clearly unequal .... The homeopathic department of the State University has now a small attendance ... (which is) ... destined still further to shrink ... wisdom would therefore counsel (that ... the two medical departments of the State University should be consolidated with special teaching ... for those who desire the homeopathic diploma.
Of the four medical schools in the state, none is ... satisfactory. The osteopathic school ... is a disgrace to the state, and should be summarily suppressed. ... the medical department of Drake University and the homeopathic department of the State University are well intentioned but feeble institutions ... (and) it would be the better part of wisdom to retire from a contest to which the institution is so clearly unequal .... The homeopathic department of the State University has now a small attendance ... (which is) ... destined still further to shrink ... wisdom would therefore counsel (that ... the two medical departments of the State University should be consolidated with special teaching ... for those who desire the homeopathic diploma.
The Medical College of the State University of Iowa received a mixed review, with generally favorable comments concerning the basic sciences. Flexner judged their equipment and instruction to be generally good, with particular praise for the Anatomy Department. He noted a lack of a "sufficient number of skilled assistants" in Pathology and Bacteriology.
The clinical facilities were thought by Flexner to be seriously inadequate. He found the hospital to be too small to provide adequate "teaching material" in medicine, obstetrics, and infectious diseases, but did note that the state had appropriated money for expansion of the hospital. The clinical teaching was found wanting "mainly for lack of proper organization and material."
Flexner noted that "laboratory instructors devote full-time to their work; the clinical teachers are practitioners, some of them non-resident." He noted with disapproval that the Professor of Surgery resided in Sioux City, and the Professor of Gynecology, who was also the Dean of the Medical School, lived in Dubuque. These two men each spent two days per week in Iowa City during the school year.
When Abraham Flexner made his tour of the medical facilities at Iowa City, he was accompanied by University President George E. MacLean and William R. Boyd of Cedar Rapids, Chairman of the finance committee of the University Board of Regents. In a private conversation after completion of the tour, Boyd acknowledged the validity of Flexner’s critical evaluation and responded thoughtfully to suggestions for change. Boyd refused to accept Flexner’s conclusion that the school faced dismal prospects for the future, and expressed his resolve to bring the medical school up to approved standards. This meeting was the beginning of a long association between Boyd and Flexner, marked by mutual respect, trust, and admiration.
The next six years were characterized by considerable dissension in University administration at Iowa City. President MacLean, although judged by history to have been a fine scholar and accomplished leader, acquired opponents who forced his resignation in 1911. His successor, John G. Bowman had no better success, and resigned in 1914. Thomas H. MacBride, the highly respected and eminently qualified head of the Botany Department succeeded Bowman, but retired because of age in 1916.
Throughout the years of unstable University administration, W.R. Boyd retained his position as Finance Chief of the newly formed State Board of Education, and continued his effective efforts to improve medical education in Iowa. The Flexner report had aroused such a storm of protest and denial in medical circles of the state that a return visit was requested. This resulted in an even more critical evaluation given privately to the University President which stimulated the University administration and Board of Education to action. Early efforts were made to improve clinical practice and teaching. Following the resignation of Walter Beirring, Campbell P. Howard was recruited from Johns Hopkins to become full-time Head of Medicine, and C.J. Rowan was brought in from Rush in Chicago as Head of Surgery. He brought with him Howard Beye as Chief Assistant and Nathan G. Alcock as specialist in Urology. Frederick H. Falls from Chicago became Head of Obstetrics and Gynecology. Lee Wallace Dean became Dean of the school, while retaining his position as Head of Otorhinolaryngology. All of these men were to be full-time medical school faculty, with offices within the hospital complex, and were to limit outside practice to consultation. With the closing of the Drake Medical School, Dr. Arthur Steindler joined the Iowa City faculty as Head of the Orthopaedic Service, which later became a separate department. Dr. Philip C. Jeans of St. Louis joined the faculty as Head of Pediatrics.
Walter A. Jessup became the eleventh President of the University in 1916, and retained that position until 1934. He was a strong and successful leader and administrator who worked harmoniously with W.R. Boyd and George Baker, Head of the Board of Education. Abraham Flexner had continuing contact with these three men for many years, and continued to have the utmost respect for their ideals, competence, and accomplishments.
The Perkins Law, enacted by the State Legislature in 1916, had a most important influence on medical care in Iowa by mandating a State Crippled Children’s Service to be established in Iowa City. To meet the requirements for this, the Children’s Hospital was authorized, funded, and built, and opened for service in 1919. This did much to alleviate the deficiency in patients for teaching in Pediatrics, although the emphasis was on chronic diseases. A second legislative measure, the Haskell-Klaus Law, enacted in 1919, was designed to promote statewide care for indigent adults at the University Hospital in Iowa City.
The Children’s Hospital was the first medical building to be located on the west side of the Iowa River, and in 1921 it was joined by a new Psychopathic Hospital.
THE ROCKEFELLER CONNECTION
In 1920 the University needed help in solving another funding problem. Dr. Oscar H. Plant of the University of Pennsylvania had accepted the position of Professor and Head of a new Department of Pharmacology with the understanding that a new building to provide space for a modern laboratory of Pharmacology was to be provided. When no funding for this was forthcoming from the State, W.R. Boyd (still Finance Chairman of the State Board of Regents) sought out Abraham Flexner for aid and advice. Flexner was now a member of the General Education Board, sponsored by Carnegie, the Rockefellers, and other prominent individuals working for the betterment of education, and which had close connections to the Carnegie and Rockefeller Foundations.
Flexner had continued to be highly influential and keenly interested in medical education, and was much impressed with the progress made by Iowa since 1910. He gave most of the credit for this to the leadership of W.R. Boyd, President Jessup and George Baker, Chairman of the Iowa Board of Education. After listening to Boyd’s proposal for funding of a new laboratory building, Flexner countered with the concept of a new hospital and laboratory building to complete the new westside complex with Children’s and Psychopathic Hospitals. To finance this scheme, he undertook to raise one-half the necessary funds, if the State of Iowa would supply the other half. After prolonged discussion, an agreement was reached and in December of 1922 Flexner was able to announce the gift of two and one quarter million by the Rockefeller Foundation and the General Education Board. The following spring the Iowa General Assembly passed a bill providing for Iowa’s share of the building cost. On June 17, 1924, Governor N.E. Kendall turned the first spadeful of sod, and in the fall of 1928 the new buildings were formally dedicated.
Abraham Flexner, almost single handedly, was able to persuade his associates of the wisdom of this generous and disproportionate gift to a single educational institution. First, he convinced them of the great value of establishing a truly first-rate medical school in a section of the country where none existed. He pointed out that this would stimulate neighboring states to emulate Iowa by generating superior schools of their own. Secondly, he was able to convince his colleagues that the Iowa leaders - Boyd, Jessup, and Baker - possessed such high qualities of dedication, integrity, and capability that full confidence could be accorded them to accomplish their goal.
HENRY ALBERT LEAVES DEPARTMENT, RETURNS AS
COMMISSIONER OF HEALTH
Henry Albert left Iowa City in 1921, and for the next nine years the Department was directed by a series of Acting Heads. Albert suffered from a chronic throat infection for some time. In early 1921 this progressed to paralysis of the left vocal cord. He was granted a leave of absence, and moved to southern California to seek a cure, with the goal of returning to Iowa by academic year 1922. His health did improve rapidly due either to the California climate or voice rest, but he resigned his University of Iowa position to remain in the West indefinitely. In 1922 he accepted appointment as director of the State Hygienic Laboratory and Professor of Bacteriology at the University of Nevada at Reno.
Henry Albert left Reno in 1926 to return to Iowa as Commissioner of Health, the head of a newly reorganized Iowa State Department of Health. In his acceptance statement published in the "Journal of the Iowa State Medical Society", December, 1926, he expressed his resolve to make the Department of Health a strong one dedicated to serve the State and medical profession of Iowa. He called attention to the fact that the per capita appropriation to the Department was only three cents, making Iowa next to the bottom of the 48 States. The average of all States was not very impressive: 10 1/4 cents per capita. Dr. Albert concluded his inaugural message by explaining the Department’s current project to eliminate diphtheria from the State with the use of toxin-antitoxin (TAT).
Henry Albert’s introductory message to the Iowa medical profession was followed by monthly reports in the state medical journal, often dealing with the leading infectious diseases of the times. These included influenza, measles, smallpox, typhoid fever, tuberculosis, syphilis, whooping cough, scarlet fever, and pneumonia’s of several types. It was an era of increasing knowledge and therapeutic resources in combating many of these diseases. At times, strong opposition arose against the acceptance of new public health measures or clinical therapies. This was especially true of smallpox vaccination and tuberculin testing of cattle. Henry Albert sustained a theme of sound medical knowledge and calm reason in his weekly "Health Bulletin" and monthly reports in the "Iowa State Medical Journal" over a four-year period. This service was brought to an abrupt and untimely end by his death from appendicitis on April 6, 1930, at the age of 52.
Henry Albert was eulogized by his mentor, colleague and longtime friend Walter Beirring who noted a long list of accomplishments as Commissioner of Health. He especially praised Albert’s "rare tact and understanding" in maintaining harmony and cooperation among all Public Health agencies in Iowa.
HYGIENE AND PREVENTIVE MEDICINE BECOMES A SEPARATE DEPARTMENT
In the 1920-21 catalogue, Hygiene and Preventive Medicine is listed as a division within the Department of Pathology and Bacteriology for the last time. The following year, a separate Department of Hygiene and Preventive Medicine is listed with Associate Professor Donald Morse Griswold, MS, MD, as Acting Head. Griswold retained this position until 1927, at which time he was replaced by Albert Victor Hardy, MS, MD. At that time, the Department of Hygiene and Preventive Medicine moved into new quarters in the new Medical Laboratory building, as did the Department of Pathology and Bacteriology.
Dr. Hardy remained the Acting Head until 1929, at which time he was replaced by Milford E. Barnes, MD, DPH, as Professor and Head. Dr. Barnes was a career public health professional, with far-ranging experience, eminently qualified for the position. He retained the Headship until his retirement. In 1933, Bacteriology was added to his directorial charge, and he now headed the Department of Hygiene, Preventive Medicine and Bacteriology. This arrangement lasted until 1938 when Bacteriology became a separate department.
A HEADLESS DEPARTMENT
Edgar Mathias Medlar was named Acting Head of the Department of Pathology and Bacteriology to fill the vacancy caused by Albert’s leave of absence in 1921. Medlar was a 1913 graduate of Harvard Medical College. He became Hospital Pathologist in Iowa City after leaving a position in Pathology at the University of Tennessee. He held that position for two years. He remained only one year as Acting Head, and resigned to accept a position with the Metropolitan Life Insurance Company where he spent the next 25 years. Among other accomplishments, he attained international recognition for his research in tuberculosis. At the time of his death in 1956, at the age of 69, he held the rank of Associate Professor of Pathology at Columbia University.
Frederick W. Mulsow, MD, PhD succeeded Medlar as Acting Head of the Department of Pathology and Bacteriology in 1922. Mulsow was a 1919 graduate of Rush Medical School, who previously had served in the Department of Hygiene and Bacteriology at the University of Chicago. He held the rank of Assistant Professor in the Department during 1921-22 and was promoted to Associate Professor when he became Acting Head. He remained in this position until 1926, but was never confirmed as Department Head, and resigned to enter private practice of Pathology in Cedar Rapids in 1925. He died October 24, 1974, at the age of 81, some years after retiring from practice.
George Henry (Gus) Hansmann, MD replaced Mulsow as Acting Head of the Department in 1925, and retained that position until 1930 without promotion in rank or confirmation as Head. Hansmann was a native Iowan and 1918 medical graduate of the University of Iowa. After graduation he had spent three years in the Department at Iowa City before accepting a pathology position at Peter Bent Brigham Hospital in Boston. After two years in Boston he returned to Iowa City. He was listed as Assistant in Pathology in 1923-24 and as Hospital Pathologist in 1924-25.
As the new Acting Head, Hansmann began his tour of duty with the rank of Assistant Professor. His staff was comprised of six associates, none of whom had rank higher than Instructor. The 1926-27 University Catalogue listed the staff members as "Instructor and Demonstrator," and one, Dr. Baldridge, had his major affiliation in Internal Medicine. Only one, Richard Palmer, Instructor in Bacteriology, later attained prominence in Pathology and within the American Medical Association after leaving Iowa City. One new member, Granville A. Bennett, MD, an Iowa Graduate, is listed as Assistant. Granville Bennett was gone the following year, but continued his career in Pathology to later become Head of the Department at the University of Illinois and ultimately Dean of the University of Illinois Medical College.
The process of staff depletion continued for Hansmann, and by 1928-29 his original staff had all left. Only three assistants were listed as supporting staff in the Department. This was to be Hansmann’s last year as Acting Head of the Department. He stayed on as a member for several years after Harry Pratt (H.P.) Smith was brought in from Rochester, New York in 1930 as Professor and Head of the Department of Pathology and Bacteriology.
"Gus" Hansmann left Iowa City in 1933 to join the faculty of Georgetown University School of Medicine in Washington, D.C., where he attained the rank of Associate Professor of Pathology. He later left Georgetown to become a Staff Pathologist at Milwaukee Children’s Hospital, and died in January, 1949, aged 58. Hansmann was regarded as an excellent Anatomic Pathologist and diagnostician, according to Dr. Warner and others who knew him, and was also said to be an effective teacher. He apparently made enemies among the clinical staff because of his caustic personality, and was not an experimentalist or publisher of papers.
When Hansmann left Iowa City to accept a position at Georgetown, he was accompanied by John Rudolph (Rudy) Schenken, MD, who had been an Instructor in the Iowa City Department. "Rudy" Schenken later joined the faculty of Louisiana State University, where he became Head of the Pathology Department. His next move was to the University of Nebraska, where he again attained Department Head. He became one of the most widely known Pathologists in the country, and was especially influential in Pathology organizations such as the American Society of Clinical Pathologists and the College of American Pathologists, as well as the American Medical Association, and other medical organizations. He died in Omaha, March 6, 1982, at the age of 77.
THE H.P. SMITH ERA
Harry Pratt (H.P.) Smith became Professor and Head of the Department of Pathology and Bacteriology at Iowa in 1930 and remained for 15 years before accepting a similar position at Columbia University in 1945. He was a native Iowan, born near West Branch, who had spent most of his youthful years in Oklahoma, on land homesteaded by his parents. From there he had gone farther West to attend the University of California at Berkeley. There he received a BA degree in 1916 and an M.D. degree in 1921. As a medical student he had come under the influence of Dr. George H. Whipple, and had completed his first experimental projects as a student fellow under Dr. Whipple’s’ tutelage. Following graduation from Berkeley, he spent several years in the Johns Hopkins Department of Pathology, where he continued his experimental studies. Following this he spent a year as a National Research Fellow in Chemistry. In the meantime, Dr. Whipple had become Dean and Head of Pathology at the new medical college at Rochester, New York. Whipple chose H.P. Smith as his first associate professor and he remained as Whipple’s senior staff associate in Pathology until his move to Iowa City.
H.P. Smith came to his new position resolved to establish within the Department a strong center of experimental pathology such as he had known at Berkeley, Baltimore, and Rochester. He had come to know Emory Warner at Rochester, and brought him back to Iowa City as his senior associate. From the beginning, Dr. Warner was given major responsibility in departmental research, teaching, and patient care. Dr. Kenneth Brinkhous, an Iowa graduate who spent one year with Whipple at Rochester, joined the staff in 1932.
Dr. Smith had decisive views concerning attitudes and qualifications necessary for a successful career in basic medical research, and a firm belief in the value of taking direct action to correct perceived deficiencies in these attributes. Since the German literature was the most important repository of knowledge about blood coagulation at the time, he believed that he and his staff must acquire proficiency in that language if they hoped to succeed as researchers in that field. Consequently, tutoring service was arranged with a senior member of the University German Department, and many evening and weekend hours were given over to the quest of mastery of scientific German. Knowledge of principles of advanced mathematics was also deemed essential by Dr. Smith, so his new associates were persuaded to audit courses in calculus and statistics. These extracurricular studies were continued for most of the years of Dr. Smith’s tenure at Iowa, and sometimes included rotating surgery residents and student fellows.
The trio of Smith, Warner and Brinkhous formed an exceptional team, with complementary personalities and skills which enabled them to work together in harmony and with great productivity. Walter Seegers, PhD was an early addition to the group whose expertise in Biochemistry added much to the group efforts in the identification, purification, and quantification of blood coagulation factors. The group pioneered studies in the role of Vitamin K in blood coagulation, and added materially to knowledge concerning the role of liver function and bile excretion in the coagulation process. Their pioneer work enabled them to publish (1938) the first report of successful treatment with Vitamin K of life-threatening hemorrhage in a jaundiced patient with prothrombin deficiency.
The successful efforts by the Iowa group to purify and concentrate coagulation components lead to development of mass-production methods for thrombin and other products. Patents were obtained, and Parke Davis was awarded rights to process and market these products. A non-profit corporation was formed to receive funds resulting from this enterprise, which continued to be profitable for the duration of the patents. Funds accruing to the corporation were used solely for education and research. At the final dissolution of the corporation, each member was given the option of designating the disposition of his share of remaining funds. Dr. Warner chose to donate his share to the Department for the establishment of a research fellowship which is in operation to this day.
The Department under went a major change in 1933, when the Division of Bacteriology was placed in the Department of Hygiene and Preventive Medicine. In 1938 Bacteriology was given departmental status, with Dr. William Hale as Professor and Head. Years later it became known as the Department of Microbiology.
The change in departmental structure in 1933 was accompanied by major changes in personnel. The names of Drs. George Herman Hansmann, John Rudolph Schenken, and John J. Clemmer all disappeared from the roster that year. Dr. John Wesley Budd and others had departed somewhat earlier, so that now the Hansmann era was truly at an end at Iowa.
With the deletion of Bacteriology from the Department, the remaining staff had decreased responsibilities, and could now concentrate more efficiently on teaching and service in Anatomical Pathology, in addition to continuing emphasis on experimental pathology. The work load was still heavy, since the Department covered Mercy Hospital’s pathology needs in addition to those of University Hospital. Pathology had become the major course of the sophomore year of the Medical College, and all members of the Department were obliged to contribute to its completion.
Surgery residents constituted an important component of the Pathology work force. It had long been customary to include a year of Pathology in the Surgery residency programs and that practice continued until World War II. Most Surgery residents worked mainly on the Autopsy and Surgical Pathology services, with variable amounts of time allotted to medical student teaching. In addition, several contributed materially to departmental research. This was especially true of Robert Tidrick and Sidney Ziffren who both later served terms as Surgery Department Heads at Iowa.
The department did not have a structured residency program, as now known, during the Smith era, but customarily had several young staff members who planned a career in Pathology, either in academics or private practice. These included Drs. Roland S. Aronson (1933-47), Harvey S. Smith (1938-39), Joseph E. Glynn (1939-49), Eugene J. Boyd (1940-41, 1945-52), Willard S. Pheteplace (1942-45) and John R. Carter (1944-46, 1948-60).
Early in his tenure at Iowa, Dr. Smith introduced a program for Student Fellows, similar to ones which Dr. Whipple had offered at Berkeley and later at Rochester. Each year a post-sophomore medical student was selected to work within the department for one year. Research activity was stressed, but fellows were expected to do a fair share of student teaching, as well as routine autopsy and surgical pathology duty. Student fellows of early years included George Hoffman, Lester Hoyt, Charles Owen, Sheldon Walker, Fred Stamler, and George Chambers. This program was interrupted by World War II, but was later resumed under the headship of Dr. Emory Warner. Of the first six fellows, three remained in Pathology; one chose Dermatology; one Orthopaedics, and one Urology.
As World War II threatened, and manpower demands increased, Dr. Smith became greatly concerned about efficiency of performance in all areas. Technicians were required to schedule their work in detail, and were accountable for each 15-minute increment. All personnel were encouraged to account for each minute of their time. Secretarial help became so scarce during the war years, that at times surgical pathology reports were not typed, but returned to the patient’s charts in abbreviated handwritten form. By the spring of 1945 the departmental roster, including one secretary, four technicians, and a morgue attendant, had dwindled to thirteen, to be further depleted by Dr. Smith’s departure July 1.
Dr. Smith left Iowa City in 1945 to become Head of Pathology at Columbia University, and held that position until retirement fifteen years later. During his later academic years his emphasis shifted to the rapidly developing practice of Clinical Pathology. He was acutely aware of the problems this presented to most academic departments, which were designed principally to meet the demands of teaching and service in Anatomic pathology. He was a staunch supporter of the American Society of Clinical Pathologists and the College of American Pathologists. He became an authority on medical politics and policies, and after retirement at Columbia he created a new position for himself as "librarian" for the ASCP. The society honored him with its Ward Burdick Award and Distinguished Service Award. After a second "retirement" he became active in the Pathology Department at Columbia, Missouri, until his death at age 75 on April 12, 1972.
Among Dr. Smith’s associates at Columbia University several later attained prominence. Those becoming department heads included Joseph Flynn (University of Missouri), Wellington B. Stewart (University of Kentucky), Robert Coon (University of Vermont), Richard Naeye (Hershey, Pennsylvania) and Fred Lucas, who succeeded Flynn at Missouri. Donald West King held successive headships at Colorado and Columbia University before becoming Dean and Vice President of the Division of Medical Science at the University of Chicago.
THE WARNER YEARS
Emory Warner was a native of rural Williamsburg, Iowa, who received his medical degree in Iowa City in 1929. His interest in Pathology was stimulated in his senior year by Dr. George Whipple’s visit to Iowa City as a guest lecturer. Dr. Whipple expressed a desire to interview a student who might be interested in a career in Pathology, and Emory Warner was selected by the Dean as a likely candidate. Dr. Whipple was favorably impressed, and offered an internship appointment for the following year. Dr. Warner promptly accepted, although this necessitated his resignation from a rotating internship already arranged elsewhere.
When Emory Warner became head of the critically depleted war time department in 1945, he was the only remaining member of the original group which had put Iowa in the forefront of research in blood coagulation. Walter Seegers had departed in 1944 to head the Department of Physiology and Pharmacology at Wayne State University in Detroit, where he continued to compile a distinguished record in coagulation research until and beyond retirement. Kenneth Brinkhous was called to army duty in 1941. He attained the rank of Lt. Colonel in the medical corps before returning briefly to the Department in 1945. In 1947 he left to become Head of Pathology at the University of North Carolina where he gained worldwide recognition for his continuing studies of hemophilia and other aspects of coagulation research.
Staff replacements were difficult to recruit at war’s end. John R. (Jack) Carter, a University of Rochester graduate (1943) and former Whipple student fellow joined the Iowa staff in 1944, but his stay was interrupted by two years of military service in 1946. Eugene Boyd came to the Department as an assistant in 1940, only to leave for army service in 1942. He returned to the department in 1945, and resigned in 1952 to accept the newly created position of Chief of Pathology at Mercy Hospital in Iowa City. Willard Pheteplace began residency training in 1942, and left to enter private practice of Pathology in Davenport in 1945. George Chambers, a wartime student fellow, graduated from the medical college and departed from Iowa City in 1946. Jack Layton and Fred Stamler returned from military service in 1948 to join the Department with the goal of pursuing academic careers in Pathology.
Prior to World War II much of the routine surgical and autopsy pathology service had been done by surgery residents on one-year assignments as Assistants in Pathology. During the war residency programs in Surgery were drastically curtailed and time spent in Pathology was reduced, never to be restored to the one-year allotment. Other departments augmented the Pathology work force to variable degrees. Residents in Orthopaedics, Urology, Otolaryngology, and Neurosurgery at various times were assigned to Pathology for periods of from three to six months. Prospective Radiology residents were encouraged by Radiology Head, Dr. Dabney Kerr, to work as Pathology Assistants for a year. Their eventual acceptance by Radiology was conditional upon satisfactory performance in Pathology. John Sulzbach (1946-47), Mansfield Lagen (1946-47), Gwilyn Lodwick (1947-48) and William Gladstone (1949-50) were notable examples of this system who all went on to successful careers in Radiology. George Bedell (1947-48, Malcolm Campbell (1948-49) and Roy Phillips (1948-49) utilized a year in Pathology as prelude to residency in Internal Medicine.
A formal residency program such as that currently in operation did not exist in the Department in the early post World War II years. Those individuals professing an interest in Pathology as a career usually began with the title of Assistant, and rose through the ranks as Instructor and Associate before attaining rank as Assistant Professor. The emphasis was mainly in the area of Anatomic Pathology and teaching, since the subspecialty of Clinical Pathology was still in a formative stage.
The impetus for recognition and certification of specialists in Clinical Pathology came from private practice and hospital pathologists rather than academicians. The American Society of Clinical Pathologists (ASCP) was conceived at a small gathering of practicing pathologists in St. Louis in 1922. The American Journal of Clinical Pathology (AJCP) began publication in 1931 as the official organ of the ASCP. The presidential address at the ASCP meeting, published as the lead article of the first issue of the AJCP lamented the lowly position of the hospital pathologist, financially and otherwise, with suggestions for remedial action. Four years later (1935) the then current president of ASCP, Dr. Arthur H. Sanford, advocated the formation of Specialty Boards in Pathology. The Society concurred, and by 1936 had taken steps to gain approval from the AMA Advisory Board of Medical Specialists. The Directory of Medical Specialties of 1940 published full information about requirements for admission to the specialties of Anatomical and Clinical Pathology. These subspecialties were defined much as now accepted, and applicants could apply for admission to either or both categories. Admission standards were gradually refined and standardized, and in 1947 the Board announced that after January 1, 1948, all applicants must take an examination given by the Board. In 1950 the Board announced that after July 1, all AP-CP applicants must have two years supervised training in CP. This deadline was apparently later extended to July 1, 1953. In the meantime, more comprehensive criteria were being developed for approval of training facilities and practices, in conjunction with the Council on Medical Education and Hospitals of the AMA. By the middle 1950’s the summation of these criteria required several pages of close print in the Board Directory. Since that time, further refinements have been added, and the number and diversity of subspecialties within the two main subdivisions of AP and CP continue to increase impressively.
The academic structure of the Iowa College of Medicine and University Hospitals, like most academic medical centers, was poorly designed to enable the Pathology Department to cope with the demands put upon it by the post World War II burgeoning of Clinical Pathology. Since the beginning of the Department it had performed a major role in undergraduate teaching and autopsy and surgical pathology. With the advent of H.P. Smith in 1930, it had become first class in experimental Pathology. In contrast to its recognized status in basic anatomical and experimental pathology, it had little to offer in clinical pathology. Bacteriology had become a separate department, and clinical chemistry, serology, immunology, blood banking, and hematology facilities were scattered about the hospital complex under control of several different departments, including Internal Medicine, Biochemistry, and the State Hygienic Laboratory. These departments were understandably reluctant to relinquish control of laboratories which they had developed and continued to staff. They usually were equally reluctant to accept arrangements whereby their facilities could be utilized in the operation of a workable Clinical Pathology residency program.
In spite of all obstacles, the Pathology department did gain approval for both AP and CP residency training programs. Approval for CP training was gained by forming working agreements with other departments for residency involvement in clinical chemistry, hematology, serology, and microbiology. Although this situation was not very attractive to CP residents, a limited number of AP-CP residents qualified and became board certified during the 1960’s. These included Arnold Tammes (1958-67), Herbert Miller (1964), Barry Knapp (1964), James Smith (1965), James Robertson (1967), Daniel Till (1969), Paula Arnell (196), John Lyday (1969), Wayne Phillips (1969) and Robert Cardelli (1969). During those years, a number of recruits elected to follow the anatomic course only, some with academic goals in mind. These included William Smith (1949-53), Albert Hilberg (1949-51), George Zimmerman (1951-71), James J. Butler (1953-57), Franz Enzinger (1954-58), Carleton Nordschow (1954-70), Fernando Aleu (1957-62), Robert Givler (1957-61), John Davis (1960-67), Daniel Longnecker (1959-69), Thomas Kent (1961-95), Dale Huff (1963-65), Michael Korns (1963-70), Cooley Butler (1966-68) and Steven Bauserman (1969-73). A majority of these residents filled academic positions at Iowa or elsewhere after completion of their residency.
During the 1960’s the clinical laboratory facilities gradually came more under the direction of the Pathology Department. This made possible better coordination of all phases of the residency program, although serious space and staffing problems still existed, and continued to exist well into the next decade.
The problems faced by Pathology in the post-war years were by no means unique to the department, but tended to be shared by all units of the medical college and University Hospitals. Greatly increased demands on clinical and laboratory medicine made academic budgets woefully inadequate. Faculty and staff were depleted by the war and the hospital had undergone no expansion and very niggardly maintenance since its opening in 1928. State funds for capitol improvements and increased salary budgets were not forthcoming. University President Hancher recognized the gravity of the situation and instructed Dean MacEwen to provide a solution. A plan to augment salaries was given highest priority, and Dean MacEwen’s initial response to the charge was rather prompt. It met strong opposition from some medical faculty, especially clinical department heads who would no longer be allowed to monopolize private practice fees in their departments. The solution to this state of conflict was complicated by Dean MacEwen’s failing health and eventual death from a heart attack on September 2, 1947.
Dr. Warner was a member of a committee involved in the planning and implementation of the Compensation Plan at the time of Dean MacEwen’s death. This committee of five members then became an Executive Committee to administer the affairs of the medical college until a new dean could take office. In spite of all opposition, a plan was approved by President Hancher and the Board of Regents and was put into operation on a trail basis on July 1, 1947. This Medical Service Plan, with frequent reviews, and continuing modifications, remains in effect, and has been a major factor in the tremendous growth and development of the University Hospitals. Many of those involved in this origin and early operation would agree with Dean Robert Hardin’s later expressed opinion that "the plan saved the Medical College."
Dr. Mayo Soley became medical dean in 1948. He had become sufficiently impressed with the work of the Executive Committee that he requested that the members continue as his advisory committee. After Dean Soley’s death on June 21, 1949, this group again became an Executive Committee. Their management of medical college problems impressed the medical faculty sufficiently that many of the faculty favored indefinite or permanent continuance of this form of administration. The appointment of Norman Nelson as Dean in 1953 again placed the committee in an advisory role, and some form of "Executive Committee" has continued to be an integral part of medical college administration at Iowa since that time.
The critical shortage of space and associated physical facilities of the entire university was a continuing frustration during the first and second post-war decades. The new Veterans Administration Hospital, completed in 1952, provided additional facilities accompanied by increased demands. The federally subsidized Medical Research Center, constructed in 1957, alleviated but did not eliminate the critical shortage of research space. The Basic Science Building in 1972 finally provided the space for development of modern departments of pre-clinical medicine. The passage of the Medicare Act put enormous pressure on the hospital, because governmental regulations now decreed most of the hospital beds to be inadequate to meet requirements for patient care reimbursement. A state policy of bonded indebtedness was instituted to finance hospital revisions and additions to bring it into conformity with regulations and this policy has continued to date. Pathology has been a rather late beneficiary of that policy. One important result of this process over the years has been a shift in cost of patient care from the state to federal government and the patient.
Departmental research activities continued during the post-war years, with gradually diminishing emphasis on blood coagulation, Warner and Carter continued to be very active in that field until Carter left in 1960. Warner’s interest later turned to the interdepartmental research center for atherosclerosis and thrombosis which had been developed at Iowa, and he contributed materially to the success of that group effort. Jack Layton developed interest in viral and Rickettsial diseases, and basic electron microscopy. Stamler studied animal models of pregnancy diseases, and reported original observations of fatal disseminated intravascular coagulation (toxemia of pregnancy) in pregnant rats subjected to Vitamin E deficient diets. A wide range of interests were favored by other departmental members, including physical chemistry of connective tissues (Nordschow), cardiac pathology (Korns), gastrointestinal diseases (Kent), pancreatic diseases (Longnecker), gynecological malignancies (Levine), wound healing and lathyrism (Enzinger). Kent later made valuable contributions to medical education practices by innovative approaches to methodology and assessment of teaching effectiveness.
Emory Warner had continuously heavy demands upon his time and energy, both within and beyond departmental confines. He was always an active teacher at all levels, popular with students, and appreciated by house staff and colleagues, as well as those outside the academic fold. The Iowa Association of Pathologists had received his support from its origin in the early 1930’s , and had shown its appreciation by later electing him to life membership. He continued to serve on important collegiate committees, including the Deans Committee for the Veterans Administration Hospitals in Iowa City and Des Moines. He served conscientiously on Review Committees for the National Institute of Health, and was elected to a term as president of the American Society of Experimental Pathologists in 1957. The Gold Headed Cane of the American Society of Pathologists was awarded him in 1980. This award is generally considered to be the highest award given by organized Pathology to a member.
Dr. Warner was always supportive of his staff, and took much satisfaction from the fact that significant numbers became departmental heads or attained other positions of prominence. Those becoming heads of academic departments include John R. Carter (Kansas) later Case Western Reserve at Cleveland, Jack M. Layton (Arizona), Jon V. Straumfjord (Wisconsin at Milwaukee), and Carlton D. Nordschow (Indiana), followed by James Smith after Nordschow’s retirement. Others of note include Franz Enzinger, whose work at the AFIP made him a world famous authority on soft tissue tumors, and James J. Butler of M.D. Anderson Hospital in Houston, a leader in hematopathology.
Dr. Warner retired as department head in 1970, and left Iowa City in order that he might not appear to exert undue influence upon departmental activities. He later returned to part-time duty in the department, at the cordial invitation of Dr. George Penick and the entire staff of the department. For several years he divided his time between part-time assignments at Arizona and Iowa City, until a few months before his death from cancer (hypernephroma) in November, 1982, at the age of 77. His death negated plans to entertain him as the guest of honor at the dedication of the newly completed Emory Dean Warner Clinical Laboratories of the University Hospital, a fitting tribute to his long years of service to the institution.
The College of Medicine and University Hospitals recognized the need for considerable expansion of the pathology staff and activities and made the institutional decision that this department should assume and carry out the major responsibilities for diagnostic laboratory services to this medical center. On the strength of this commitment and the opportunities and challenges that it presented for the development of a superior department, a new chairman was recruited and the long, slow process of rebuilding the department was begun. This new chairman was George Dial Penick, a graduate of Harvard Medical School and a colleague of Kenneth Brinkhous at the University of North Carolina.
As frequently occurs with a change in department headship and a redirection of policies, considerable turnover in personnel took place. Key people were recruited into subspecialty areas where strong clinical programs required appropriate laboratory backing, especially in the field popularly termed "clinical pathology." And yet, in so doing, a special effort was made to keep the department a unified one in order to bring a total approach to our laboratory services and teaching programs. The decision was made to incorporate the laboratories at the Veterans Administration Hospital into the department in order to avoid unnecessary and costly duplication of laboratory facilities and equipment and to coordinate with the successfully consolidated programs in some of the clinical departments. Through negotiation of a contract with the Veterans Administration and rotation of our staff through the VA Hospital, this was accomplished.
In 1969, the department was housed in areas that were widely separated throughout the Medical Laboratories Building, University Hospitals and Oakdale Hospital. At that time, the Medical Chemistry and Hematology Laboratories, the Blood Bank and some faculty occupied space in University Hospitals; the Medical Technology Teaching Laboratories, Special Chemistry and faculty utilized 3,820 square feet at Oakdale Hospital. The remainder of the department functions, including faculty and house staff offices, administrative office, research laboratories and teaching programs were housed in 15,298 square feet of space on the basement and first floors of the Medical Laboratories Building.
Certain improvements were made in the physical plant that facilitated consolidation of the department and improvement in laboratory efficiency, basically the Basic Science Building was built, releasing space to Pathology. New administrative offices were constructed that enabled the Department Head and Vice-Chairman to coordinate their efforts and to have the immediate support of personnel concerned with fiscal matters, personnel, supplies, and equipment, and general administration. New laboratories were designed and built to house medical chemistry, hematology, immunopathology and histopathology. An effective word-processing center was developed to handle centrally the large demands for typing involved in rendering pathology reports, preparation of teaching materials, manuscript typing and general correspondence.
Extensive effort was invested in revamping the teaching programs. This involved enthusiastic effort on the part of the faculty under the guidance of Dr. Thomas Kent, acting in the capacity of Departmental Course Director. The main thrusts of the changes adopted in our courses for medical students was to create self-paced courses through the development and introduction of much new self-instructional material, to make the student laboratory experience more meaningful by adopting a case study approach, to expand the material taught to reintroduce clinical pathology into the curriculum, and to utilize the computer for course monitoring and student performance evaluation. A graduate program leading to the granting of an MS in Pathology was created. The department also reassumed responsibility for instruction of the College of Dentistry students that had previously been carried out by the Department of Oral Pathology. It also provided courses for the Physician’s Assistant program and other paramedical personnel. There was a steady progressive expansion in the size of the house staff, from four in 1970 to 20 in 1980.
Very successful studies were carried out in conjunction with the Department of Medicine in relation to the transfusion of blood platelets under the support of an NIH contract. There was continued participation in the Specialty Center of Research in Atherosclerosis and thrombosis of particular interest to Dr. Penick.
Researched and Written by
Dr. Fred Dee
In 1980 the with the retirement of George Penick the institution began a search for a new chair who would maintain the excellence in education and service developed over the previous decade, while at the same time markedly expanding the research activities of the department. This search culminated in the appointment of Richard G. Lynch, MD, a graduate of the University of Rochester with postgraduate training at Washington University in St. Louis. Dr. Lynch came to Iowa as a very well established investigator with national and international recognition in immunology research.
To facilitate the desired expansion in research in the department considerable new space was needed. Along with the appointment of Dr. Lynch a plan was instituted to relocate the majority of the clinical laboratories to 40,000 square feet of newly constructed space in the Roy J. Carver Pavilion. This freed up much needed research space in the Medical Laboratories and MRC. During the early years the department developed the Critical Care Lab and later negotiated with UIHC to acquire space for the Surgical Pathology Gross Room/Frozen Section Lab, the Cytology and Hematology Space in the Cancer Center, and the Stem Cell /Bone Marrow Transplant/Transfusion Medicine Lab that will go on the 2nd floor of General Hospital in the old Ophthalmology space.
After his arrival, Dr. Lynch immediately began recruiting faculty, adding four new faculty in Immunology. Other areas of research growth were identified including neuropathology and viral oncogenesis. Excellence in these areas was developed, and in the late 1990’s a focus on the biology of stem cells and cancer research, was also added. With the financial support of Mr. John Colloton, the Department purchased its first FACS instrument and renovated space in MRC to house the facility. Initially the facility was used for basic and clinical research, and to pilot the development of clinical tests; it was later used only for research activities. A few years ago a new FACS analyzer and cell sorter was obtained for the flow core lab. In addition, to the flow core lab, another important core lab was developed and was initially used by anatomic pathology faculty to develop clinically focused projects. The laboratory evolved to its present configuration and expanded menu of procedures, including molecular biology.
Recruiting was also dramatically increased during the Lynch years with expansion of the scope of the disciplines of Transfusion Medicine, Hematopathology, Microbiology and Cytopathology, and new faculty were also added in Surgical Pathology. This recruiting resulted in an increase in faculty numbers from ~20 in 1980 to ~40 when he stepped down. These critical additions resulted in a markedly increased level of scholarly activity including publication, grants, and national visibility for the department.
Under the leadership of Dr. Lynch the quality of the residency program was maintained. Also with financial support from the department in the 1980’s, clinical fellowships flourished in Surgical Pathology, Hematopathology, Neuropathology, and Transfusion Medicine; and in the 1990’s in Cytopathology and Microbiology. These programs have trained numerous pathologists for the state of Iowa and the nation. Approximately one third currently hold positions in academic institutions.
The excellence in undergraduate education developed by Tom Kent was maintained and expanded under the leadership of Dr. Lynch, and is currently spear-headed by Fred Dee. In the 1990’s the space of the Pathology Learning Center was consolidated and remodeled with matching funds from the College of Medicine and the University. Dual headed microscopes were upgraded with multi-headed microscopes, and microscopes with monitors were added to small group rooms. Computerized assisted instruction was supported and an instructional designer was added to the staff. A computer classroom was added in the late 1990’s. Continued modernization of the resources of the PLC for students has markedly expanded the capabilities of the PLC, and has maintained the department's visibility as a leader in education in the College of Medicine.
The acquisition of space and new clinical laboratories in the hospital at the time of Dr. Lynch's arrival set the stage for continued expansion of cooperation and financial support from the hospital. Multiple small satellite laboratories previously controlled by clinical departments were incorporated into the Pathology laboratories. In the mid 1990’s, understanding that the cost containment, forced by the emerging paradigm of managed care, would be of major importance, the department took a proactive stance and undertook a major reorganization of the clinical laboratories, including a decrease in middle management positions and consolidation of existing laboratories. In the late 1990’s, new outreach initiatives were undertaken to maintain the economic viability of the laboratories. These initiatives have set the stage for continued financial viability of the laboratories, and support of the mission of the department into the next decade.
Sometime in 1982 Emory Warner came to see Dr. Lynch, and with financial support from him, his family and friends and some of his long-term research collaborators, the Warner Fellowship was initiated. It was geared towards medical students taking a year out to do research. Finally, Dr. Lynch, with the help of Kent Bottles, then the Interim Head, was also instrumental in establishing the Department’s first endowed Professorship in honor of Dr. Fred Stamler. The Professorship is currently held by Frank Mitros.
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