Then and Now: Always Healing
1869 - 1950s
U-M opens the first university-owned medical facility in the United States. The 20-bed hospital is located in the residence of a former professor. It has no wards or operating rooms.
U-M adds two wooden pavilions to the hospital. From a distance it resembled a pair of long, white circus tents with cupolas and spires like the minarets of a castle. On a campus composed chiefly of stolid brick blocks, it drew the eye.
If the Pavilion Hospital’s exterior design was “tasteful,” as President James Angell allowed, the same could not be said of the interior, at least after a couple years of hard service. According to Reuben Peterson, a U-M obstetrician who wrote an early history of the hospital, health inspectors were reported to be “deeply impressed by the insufficiency of the ventilation system the moment they entered the main wards. Indeed, it was such as to remind one very forcibly of the condition of the military hospitals in the early years of the late war.”
A new hospital on Catherine Street replaces the old Campus Pavilion Hospital. It consists of two structures, one for the medical department and one for the homeopathic medical college.
The U.S. medical community recognizes the Catherine Street Hospital as the largest teaching hospital in the country.
University Hospital gains 50 more patient beds, laboratory space and a surgical amphitheater when it takes over the vacated Homeopathic Hospital on Catherine Street. A new homeopathic hospital opens on North University.
Albion Walter Hewlett, a member of U-M’s internal medicine faculty and one of the world’s first physiologic cardiologists, advocates for laboratory tests to supplement clinical evaluation and for the value of the electrocardiogram as a diagnostic tool. In 1913, U-M researchers will introduce the electrocardiogram to American physicians.
Construction begins on a new hospital. The original appropriation is only enough to pay for the shell of the building, and it stands gaunt and boarded from 1921 to 1923, when Governor Alexander Groesbeck obtains an additional $2.3 million in appropriations to complete it.
Frank Wilson (CVM) establishes the first heart station, the precursor to the modern coronary care unit, where patient beds are connected to electrocardiograms in a central room. Before this, no one had ever connected beds to a central monitoring station for rhythm. In the 1940s, his work will play a major role in transforming clinical cardiology by expanding the value of the electrocardiogram for something other than arrhythmias and especially for the diagnosis of coronary artery disease. The designation of “V” for vector to describe the leads that are attached to the body during an EKG is derived from Wilson’s research.
A new 700-bed University Hospital (also known as the Main Hospital) replaces the Catherine Street Hospital and is designed by renowned architect Albert Kahn. With the completion of the building Michigan had a Hospital worthy of the state and of the University, adequate for the needs of the people and for the training of medical students and nurses. The Hospital, built on the system of regularly spaced piers, is of fireproof construction throughout and contains two miles of corridors and ten acres of floor space. At the present time it provides 744 beds.
The Pulmonary and Critical Care Division begins at U-M as the tuberculosis ward on the 7th floor of the University Hospital under the leadership of John Blair Barnwell. In 1946, he will become director of the Tuberculosis Division of the Veterans Administration in Washington, D.C. The division’s leadership in the care of TB patients continues to this day. Dana Kissler (PCCM) currently oversees the Washtenaw County TB program. It was estimated that of the total cost of the building, more than $400,000 was spent for equipment.
The Human Heredity Clinic is established to collect data and provide genetic counseling regarding hereditary disease, one of the first human genetics programs in the country connected to a university hospital.
Sibley W. Hoobler (CVM) forms a special unit whose main thrust is research and patient care in hypertension. This is the second unit of its kind in the nation. He will direct the hypertension unit from 1947 to 1974.
John Sheldon starts an allergy clinic at U-M that was instrumental in creating the early foundation for the Allergy Division.
The Veterans Administration Hospital is dedicated. An important source of expanded clinical experience for students in the U-M Medical School, the 500-bed VA Hospital’s affiliation with U-M, as with other such affiliations around the country, also helps improve medical care for the nation’s veterans. More than 65,000 veterans living in a 15-county area of Michigan and northwest Ohio will utilize the VA Ann Arbor Health¬care System in 2015.
The U-M Hepatology Program is founded by Keith Henley (GI). Henley was the first to describe alanine aminotransferase in serum, which is used throughout the world as a diagnostic tool for liver injury. Along with Jeremiah Turcotte from the Department of Surgery, he will establish the Liver Transplant Program in 1985. Today, the Hepatology Program is led by Anna Lok (GI). It is one the oldest liver programs in the country and has trained the majority of transplant hepatologists practicing in Michigan.
William Beierwaltes (MEND & Nuclear Med) is among the first to use radioiodine (131-I) for the diagnosis and treatment of thyroid cancer and becomes a national authority for this technique. Following the 1957 publication of “Clinical Use of Radioisotopes,” the first book on clinical nuclear medicine practice, co-authored by Beierwaltes, the treatment of thyroid cancer with 131-I will become widely adopted. It remains the standard of care worldwide.
1960s - 1980s
Josef Smith (PCCM) is hired to develop the pulmonary function laboratory. The first “modern” pulmonary function lab will be established in the early ’80s, and considered state-of-the-art at the time. Today, the division operates PFT labs at five sites, and performs more than 100 pulmonary function studies daily.
U-M establishes the first transplant center in Michigan. The Multi-Organ Transplant Program will come to include kidney, heart, liver, pancreas, heart-lung, artificial heart, bone marrow and cornea grafting for infants, children and adults, becoming one of the most comprehensive and longest-running transplant programs in the country.
The Division of Nephrology is established at U-M and is part of the care team involved in the first organ transplant (kidney) in the state of Michigan.
Cardiologist Bertram Pitt (CVM), one of the best-known designers of large-scale clinical trials in cardiovascular medicine, jointly develops the first nitroglycerin patch to be approved by the Food and Drug Administration. These patches are used to prevent episodes of angina (chest pain) in people who have coronary artery disease.
William Ensminger (Hem/Onc) oversees the first implantation of an Infusaid pump for the targeted delivery of chemotherapy drugs. Pump devices will be used increasingly for administering drugs to specific areas, sparing healthy tissue.
U-M’s Heart Rhythm Center (Arrhythmia Program), first led by Fred Morady (CVM) and now Hakan Oral (CVM), develops new catheter technology to terminate irregular heartbeats by electrically isolating tiny fiber strands of muscle that go up the sleeve of the pulmonary veins. The center will become an international leader in the treatment of arrhythmias.
Timothy Nostrant (GI) is the first person at U-M to emphasize the importance of endoscopy, and is instrumental in establishing one of the world’s most sophisticated and well-equipped medical procedure units. The MPU will become one of the most successful clinical units in UMHS. There are now more than 35,000 procedures performed each year.
The GI Division performs the first endoscopic sphincterotomy in Michigan. This diagnostic tool first used for biopsies will quickly evolve into a therapeutic tool that is used to remove gallstones from the bile duct.
The Interstitial Lung Disease Program is started by Joseph P. Lynch III (PCCM) with an emphasis on sarcoidosis and idiopathic pulmonary fibrosis. The program participates in multiple NIH- and industry-sponsored trials, providing new therapeutic options for many patients and becomes designated as one of only nine Pulmonary Fibrosis Foundation Care Center Network sites nationwide. It is now directed by Kevin Flaherty.
The first Geriatric Clinic is created at U-M to provide comprehensive interdisciplinary geriatric assessment and ongoing primary care for elderly patients.
Richard Swartz (Neph) establishes one of the nation’s first, large academic peritoneal dialysis treatment centers at U-M.
After 10 years of planning and at a cost of $285 million, a new 11-story, 848-bed University Hospital replaces 61-year-old Old Main. The adjacent A. Alfred Taubman Health Care Center, with 120 outpatient clinics, also opens, reflecting the increasing trend of outpatient care.
The U-M Cancer Center is established under the leadership of Max Wicha (Hem/Onc); its collaborative approach will lead to an array of significant breakthroughs, garnering a reputation over the next decade as one of the top cancer centers in the U.S. In 1988, it received official designation as a Comprehensive Cancer Center from the National Cancer Institute.
In response to the need to contain medical costs, the University of Michigan establishes M-CARE, only the second university in the U.S. to design its own managed care program. The non-profit corporation will grow to become one of the state’s leading health care companies, serving 180,000 members in 19 counties.
Advances in the diagnosis and treatment of cystic fibrosis result in extended life expectancy of patients beyond childhood and teens. The Pulmonary Division starts an Adult Cystic Fibrosis Program at Michigan. Richard Simon was named director in 1994, a position he holds to this day. The program now cares for more than 250 patients and has emerged as one of the top CF centers regionally and nationally.
The Geriatrics Center is founded. Under the directorship of Jeffrey Halter (GPM), the center is an effort among 14 schools and institutes and 244 faculty from 27 medical school departments. The center is one of the first in the country to be organized with a collaborative multidisciplinary clinic model involving many specialties and an emphasis on social work programs for the older population.
1990s - 2000s
Clinical programs focused on chronic obstructive pulmonary disease are developed by Fernando Martinez and Galen Toews (PCCM) as a component of the dyspnea program. In addition to providing state-of-the-art clinical care, the COPD clinical program will become closely integrated into the lung transplantation and pulmonary rehabilitation programs.
The GI Division is the first in the state of Michigan and among only a handful in the country to offer endoscopic ultrasound, a procedure where ultrasound pictures are taken on the end of the endoscope to examine the internal lining of the gut and through its wall. Fine needle aspiration can also be done during this procedure to conduct sampling of adjacent structures. This new tool allows for definitive early diagnosis of pancreatic cancer.
Nationally recognized genetics expert Wendy Uhlmann (MMG) is recruited to become the genetic counselor/clinic coordinator of the Medical Genetics Clinic. She is also an executive faculty member of the Genetic Counseling Training Program. A past president of the National Society of Genetic Counselors, Uhlmann will play a major role in national genetics policy.
Eduardo Schteingart (MEND) founds the Millie Schembechler Adrenal Cancer Program. It will grow to be the top adrenal cancer program in the world and is now led by Gary Hammer (MEND). Part of the U-M Destination Center for Endocrine Oncology, people now come to Michigan from all over the world for adrenal cancer treatment.
The Dyspnea Program is introduced by the Pulmonary and Critical Care Division to care for patients with breathing disorders such as end-stage lung disease including interstitial lung disease and chronic obstructive pulmonary disease.
William Chey (GI) joins the faculty at U-M and becomes co-director of the Michigan Bowel Control Program, one of the first multidisciplinary programs that specializes in the diagnosis and treatment of defecation, posterior pelvic floor and neurogenic bowel disorders.
Kim Eagle and Mauro Moscucci (CVM) create the Blue Cross Blue Shield of Michigan Cardiovascular Consortium-Percutaneous Coronary Intervention (BMC2-PCI), one of the very first Collaborative Quality Initiatives to assess outcomes following angioplasty procedures.
The University of Michigan Faculty Group Practice is established to combine the practice plans of 15 U-M clinical departments into a single, integrated, multi-specialty U-M physicians’ group. It is led by David Spahlinger (Gen). In 2008, FGP will take on responsibility for outpatient care as part of an ongoing effort to integrate the medical school with the hospitals and health centers. In 2012, it will play an important role in two newly formed accountable care organizations, the U-M Pioneer ACO and POM ACO, putting UMHS at the forefront of health care reform. Today, FGP is called the U-M Medical Group and includes more than 1,800 physicians (plus other health care professionals) in 20 clinical departments.
U-M moves its cancer and geriatrics clinical and research programs into the new $88 million Cancer Center and Geriatrics Center Building.
Given the key role health systems now play in America’s academic research institutions, the regents create the position of executive vice president for medical affairs, forming - with the positions of provost and vice president for financial operations - a triumvirate of leadership to support the president. Gilbert S. Omenn (MMG) is chosen to fill the position. The medical school dean, the hospitals’ executive director and the president of M-CARE report to him. He will serve in this position until 2002.
Ariel Barkan (MEND) begins efforts to improve the treatment of patients with acromegaly, or gigantism, a condition of chronic, excessive growth hormone secretion by a benign pituitary tumor. He will go on to study gene expression and hormone secretion patterns, test important drugs and issue patient communication guidelines to improve the care experience and health outcomes.
Steven Gruber (MMG) is recruited to build U-M’s Cancer Genetics Program, which will become one of the top programs in the country. It includes the Cancer Genetics Clinic, which works with patients to determine if their families are at a higher-than-average risk of developing cancer. Today, the clinic is run by Elena Stoffel (GI).
U-M becomes one of the first GI Divisions in the country to use capsule and deep enteroscopy, a procedure involving patients swallowing a capsule that takes pictures as it travels through the small bowel, an internal area doctors had previously not been able to access or view.
The Adult Diabetes Education Program is established. Currently run by Jennifer Wyckoff (MEND), this program will continue to expand in response to the growing population of adults facing a diagnosis of type 1, type 2 or gestational diabetes. It is one of a select number of programs certified by the American Diabetes Association, and offers more programs and services for adults with type 1 diabetes than anywhere else in Michigan and the surrounding region.
The Division of Cardiovascular Medicine establishes the Pulmonary Hypertension Program for patients with high blood pressure in the pulmonary arteries of the lungs. It will quickly become the largest and most experienced program in the country.
The work of Bill Armstrong (CVM) helps U-M become a leader in contrast echocardiography, a technique for improving echocardiographic resolution and providing real-time assessment of intracardiac blood flow.
Sources: Bentley Historical Library; and The University of Michigan: An Encyclopedic Survey.