History of the Department of Pediatrics and Communicable Diseases
By Valerie P. Castle, MacDonald Dick, and Faye Silverstein
The Early Years of Pediatrics at Michigan
In the United States, the “emergence of a class of doctors especially for children” was recognized in the late nineteenth century. The American Pediatric Society was founded in 1888 and Victor Vaughan, Medical School dean from 1891 to 1921, was a member. Yet, as Horace Davenport indicates in his history of the Medical School, at the University of Michigan “the practice of pediatrics was not separate from the practice of internal medicine until well after 1900”. Indeed, medical care of children at Michigan in the early 19th and 20th centuries was integrated into existing hospital buildings that were in place at that time. The University Hospital (Old Main) was opened in 1925 and children were cared for in open wards on specific floors. There was also an independent contagion unit where children with highly infectious diseases – diphtheria, diarrhea from various organisms, bacterial meningitis, infectious encephalitis, pertussis, sepsis, pneumonia, tetanus, tuberculosis, varicella, and acute poliomyelitis were cared for. Infectious diseases were the major cause of childhood illness and death during this time and the primary focus of pediatric medicine hence the inclusion of “Communicable Disease” as part of the department name when it was established.
Dr. David Cowie was appointed in 1905 as the University of Michigan’s first professor of pediatrics. Having earned his medical degree from Michigan in 1896, Dr. Cowie conducted the first University of Michigan Medical School course on diseases in Pediatrics in 1906. While Dr. Cowie was committed to pediatric patient care, education and research, the Medical School in 1916 had only twenty hospital beds dedicated for general pediatric patients.
Dr. Cowie rose through the academic ranks within Internal Medicine and was appointed Professor and Chairman of Pediatrics and Communicable Diseases when the specialty was recognized as a separate department at UM in 1921. Early in his career, Dr. Cowie worked on problems of infection and gastroenterology; he established a laboratory for milk analysis, housed in the basement of the Palmer Ward on Catherine Street. In 1926 Dr. Cowie wrote a report on the State of the Department for the UM Alumni Association. In that report, he highlighted service to the community, teaching of medical students, and research accomplishments of the Pediatric faculty. He indicated that specialized clinical divisions were being organized in metabolic diseases, diabetes, nephritis, and infectious diseases, and he linked growth of the Children’s Service with opening of the new hospital in 1925.
From historical and public health perspectives, Dr. Cowie’s most noteworthy accomplishments stemmed from his role in advocacy – a recurrent theme in pediatric medicine. He worked tirelessly on many fronts to eradicate endemic goiter in Michigan by adding iodine to salt (a concept initiated earlier in Switzerland). He engaged members of the Michigan State Medical Society, and worked with community and commercial leaders to gain acceptance for production of iodized salt in the 1920’s regionally and nationally, and this campaign was ultimately successful.
Poliomyelitis, one of the most feared pediatric infectious diseases in the first half of the twentieth century, received considerable attention in the UM Department of Pediatrics and Communicable Diseases. Mechanical ventilation devices were first trialed in children with acute polio 1928, at Children’s Hospital in Boston. Two of the physicians involved in this early experience, Charles McKhann and James Wilson, subsequently joined the UM faculty.
Charles McKhann was recruited to Michigan in 1941, after the death of Dr. Cowie that same year. The W.K. Kellogg Foundation provided $100,000 to assist in financing reorganization of the department. While Dr. McKhann began that effort he remained as Chairman for only three years, and in 1944 he was succeeded by Dr. Wilson.
James Wilson served as Chairman of the Department of Pediatrics and Communicable Diseases in the Medical School for twenty-three years. While in Boston, Dr. Wilson began his research focused on delineation of the pathophysiology of respiratory failure in children with acute polio, and practical refinements in the design of early artificial respirators known as the ‘Iron Lung’. During his tenure as Chairman of the Department at Michigan, his focused on a broad range of pediatric health issues. He supported the development of pediatric research activities. Acknowledgement of his academic stature included election to serve as President of the American Pediatric Society and participation as a consultant to a broad range of state, national, and international societies and agencies. He also played a pivotal role in garnering essential financial support for establishment of the C. S. Mott Children's Hospital, which ultimately opened in 1969, two years after his retirement; the research laboratories in that building were named in recognition of his important contributions to the department.
Philanthropy played a critical role in the growth and development of the Department and the realization of the first C.S. Mott Children’s Hospital. Charles Stewart Mott, one of the largest shareholders in General Motors, founded the Charles Stewart Mott Foundation of Flint, Michigan. A major focus of this foundation was to improve children’s health; the Mott Foundation donated over $6.5 million to the University of Michigan for the construction of the children’s hospital in 1964.
The nation’s third polio respirator center, funded by the March of Dimes, opened at University of Michigan in 1951. Dr. Wilson was the key organizer of the center and its first director was University of Michigan Medical School graduate Dr. David Dickinson. Dr. Dickinson articulated a vision that the patient’s care should not be limited to purely medical considerations but also extent to addressing “practical, personal and emotional problems.” As a result of his vision and dedication to his patients the center at Michigan established a school and supportive educational programs to advance both the health and academic training of his patients. Dr. Dickinson later became chief of clinical affairs at C.S. Mott Children’s Hospital and then director and CEO of the University Hospital.
A major thrust of Dr. Wilson’s efforts in the 1950’s and 1960’s was the development of pediatric sub-specialists in the Department.
Dr. Aaron Stern was the first pediatric cardiologist. He collaborated closely with cardiovascular surgeon Dr. Herbert Sloan, and advocated for early surgical repair of infants with ventricular septal defects who failed medical management.
Dr. Wilson recruited Dr. Richard Allen as the first pediatric neurologist in the Department (and in Michigan) in 1957. The State of Michigan began universal neonatal screening for PKU in 1965, and Dr. Allen collaborated with the Department of Public Health to initiate treatment for all infants identified with PKU.
Dr. Ruth Heyn was the first pediatrician at Michigan with expertise in the care of children with cancer. She became the first Division Director of Pediatric Hematology Oncology and one of the first pediatric oncologists in the country to treat children with leukemia using methotrexate. Her early publications also included a report on management of the erythroblastotic infant (Rh disease), published in the Medical Bulletin (Ann Arbor) in 1957, with co-author Harry Towsley (a University of Michigan pediatrician who also served as President of the American Academy of Pediatrics in 1964-5). She gained prominence in Pediatric Oncology with her 1960 study that compared 6 mercaptopurine with the combination of 6-mercaptopurine and azaserine in the treatment of acute leukemia in children: results of a cooperative study (Blood 15: 350-9).
Dr. Joseph Baublis joined the faculty in 1962 and became the first Infectious Disease subspecialty faculty member in 1968, following completion of his PhD in virology and epidemiology. He was the founder of the national Committee for Reye’s syndrome and Director of the Pediatric Diagnostic Laboratories in Mott Hospital from 1969, until his death in 1981.
Dr. George Lowry joined the faculty in 1947, and became the first Chief of Pediatric Endocrinology in 1957. Among his accomplishments was authorship of “Growth and Development”, a leading early text in his field, that was subsequently updated through 8 successful editions. He served as Chairman of the Michigan Chapter of the American Academy of Pediatrics from 1966-1969 and for many years chaired the Ann Arbor Public School’s Health Services Committee. An annual lectureship acknowledges his seminal role in the development of his field.
Dr. Robert Kelsch was appointed to the faculty in 1966, and was considered a pioneer in the development of the subspecialty of pediatric nephrology. When the American Board of Medical Subspecialists approved pediatric nephrology as a subspecialty in the early 1970’s, he was among the first cohort of successful examinees for certification, and went on to lead the development of this program. He also subsequently served as Director of the Pediatric General Services and participated extensively in medical student education.
With the retirement of Dr. Wilson in 1967, Dr. William J. Oliver was appointed Chairman of the Department. It was a time of extraordinary transition in pediatric medicine, not only at Michigan but throughout the nation fueled by the post-World War II expansion in basic science research leading to an enormous knowledge base that required deeper and fuller specialization for the treatment of human physiology and pathology. Under Dr. Oliver’s leadership and following Dr. Wilson’s important initiatives, the department seized the opportunity to develop further the subspecialists that brought increased understanding along with advanced technology to advance patient care. Numerous subspecialties expanded during this period including cardiology, allergy, neurology, pulmonology, neonatology and genetics and others – that did not exist as formal disciplines with board certifying bodies prior to the 1960s. As an example, the first board certified subspecialization in pediatrics was in cardiology beginning in 1961.
The Cardiology Division at Michigan was an innovative pioneer. During the 1960s, the pediatric cardiology and thoracic surgery teams worked together to improve the care of children with congenital heart disease. They were the first to show that primary repair of a ventricular septal defect in infants was as safe and effective as palliative surgery. They were the vanguard of infant cardiac surgery, which became the national gold standard later in the 1970s. Other divisions also expanded, particularly neonatology, which did not exist prior to the 1960s. This new subspecialty in pediatrics pushed the frontier of neonatal care down to the smallest and most vulnerable premature infant. At Michigan this endeavor was supported by the development of the Holden Neonatology Unit, which housed premature infants and those infants at risk for other disorders in an organized, concentrated, and focused program. The Holden Perinatal Research Laboratories were established through the Holden Fund to provide unity between maternal delivery suites and neonatal units, connecting obstetrical labor and delivery units to the radiographic, surgical, and medical care units for these newborns. The Holden Fund established biochemical laboratories within the new Mott Holden Unit, creating the James and Lynelle Holden Perinatal Research Laboratories, which were completed in 1972. This unit was the first national perinatal unit directly and intentionally built to link an obstetrical hospital with a children’s hospital. This synergism of care for these vulnerable newborns provided a unique and enormously beneficial advantage, offering the expertise and specialized features of each of the obstetrical, neonatal, pediatric, and surgical groups.
Supporting specialization that began in the 1960s, further successful recruiting yielded highly-trained specialists in critical care, neonatology, gastroenterology, endocrinology, and embryology. The department took advantage not only of expertise from other national institutions and health centers, but capitalized on current faculty members who received training at national sites throughout the country and returned to establish both strong research and clinical programs.
Clearly, as the second half of the twentieth century progressed, the demand of the influence of major developments in medical knowledge and development of understanding of the mechanisms of disease and specialized therapeutic approaches called for a pediatric dedicated facility. Finally, construction for the first Charles S. Mott Children’s Hospital began. The hospital was explicitly designed to be contiguous with the Women’s Hospital, and the obstetrical suites, eventually linking the Holden Neonatal Unit to the obstetrical, pediatric, and surgical services. In addition, diagnostic laboratories for biochemistry, hematology, oncology, microbiology, neurology, pulmonology, radiology, and cardiology were all developed within this one structure. The basement of Mott hospital housed the cardiology suite with a state-of-the-art advanced catheterization laboratory. This laboratory had the first biplane radiologic imaging system in the world, suggested by Dr. Aaron Stern, director of cardiology at the time. One x-ray beam with its image intensifier at the receiving end comprised the PA plane, whereas an additional x-ray beam and image intensifier were mounted on a C-arm which pivoted around the long axis of the patient. This was such a revolutionary design, that it had a children’s bicycle handlebar to grip and pivot the C-arm around the patient. This design is now the standard for cardiac catheterization laboratories. On the second floor were the entrances and the diagnostic laboratories. On the third floor were the radiology suites and the eight operating rooms. The fourth floor was the inpatient unit and eventually became the pediatric intensive care unit. The fifth floor became the cardiology unit and sixth and seventh floors housed the inpatient medical/surgical patients. In the early days, the seventh floor (7 East) was a unit called Constant Care, where especially vulnerable sick infants were monitored. This unit predated a more complete pediatric intensive care unit (PICU) that was eventually built. On the eighth floor was an area for inpatient children’s education. This unique unit was the first inpatient educational unit in any hospital in the country (beginning in UH, Old Main, in the 1920s), supported by local philanthropy in Ann Arbor and beyond. In addition, there was a non-denominational chapel on this floor as well as a specially provided pediatric house officer lounge, where the house officers could congregate, network, and provide the critical peer support of young medical professionals.
The department during this period was very fortunate to have senior faculty members who provided support to Dr. Oliver. Dr. Harry A. Towsley, the founder of the Towsley Center for Continuing Medical Education, advocated for the development of the old Mott Hospital and he made significant contributions to graduate medical education as well. Dr. David Dickinson assumed leadership roles in the medical center as vaccination programs virtually eliminated polio in the United States. Dr. Oliver stepped down from the chairmanship in 1979. The interim chairs for the next two years were Dr. Robert P. Kelsch (1980-1981) and Dr. Robert C. Kelch (1981-1991), in succession. They provided able leadership during this transition.
In 1981, Dr. Robert P. Kelch was appointed Chairman of the Department of Pediatrics and Communicable Diseases. For the next 13 years, the department expanded its clinical operations by a growth in faculty members and expertise. Many faculty members in multiple disciplines reached national prominence under Dr. Kelch’s leadership. The faculty expanded to provide clinical services in Ann Arbor as well as adjacent communities and across the state with a number of field clinics. Dr. Kelch led the department to national prominence. Residency and educational programs expanded. Basic science activities and extramural funding vastly improved. Particularly important during this period was expansion of educational activities including growth in the house staff cohort as well as the development of a number of fellowship subspecialty training programs designed to train future pediatric academicians. The emphasis was to focus on hypothesis-driven research, training, and mentorship by leading scientists, both basic and clinical. Important recruitments by Dr. Kelch were in the Division of Hematology/Oncology as Dr. Larry Boxer brought national prominence to this important field, and in the Division of Pediatric Neurology with recruitment of Dr. Gary Goldstein. Additionally, Dr. Joseph Custer was recruited to establish Pediatric Critical Care Services and Dr. Arnold Coran became Mott Hospitals first Chief of Pediatric Surgery. Dr Kelch established the first endowed professorships in the department dedicated to pediatric medicine and research including: the David G. Dickinson Collegiate Professorship in 1990 designated for a pediatrician whose efforts focus on optimizing care for children with chronic disease; the Amnon Rosenthal Collegiate Professorship in Cardiology in 1993, and the Robert C. Kelsch Collegiate Professorship in Nephrology 1994. Recognition of the department’s rising stature and promise led to the election of Dr. Kelch as President for the Society of Pediatric Research.
Although the existing C.S. Mott Children’s Hospital was serving the department well in the 1990’s, there were several clinical areas of deficiency. In 1991, a 91 million dollar wing to Mott Hospital was opened, expanding the cardiology division on the first level (basement) and enlarging the radiology and anesthesiology group on the third level. The fourth level provided an opportunity to create “birthing rooms” on the fourth floor of the existing Mott with the wing including an updated expanded Holden neonatology unit and obstetrical /surgical suites enhancing the direct communication in the maternal-neonate relationship, particularly those at high risk. In concert with the Department of Obstetrics, a perinatology unit involving the identification and care of at-risk newborns before birth was established. The fifth floor housed a 15 bed cardiac ICU (Pediatric Cardiothoracic Unit) and a 16 bed pediatric intensive care unit (PICU); all were rapidly filled at the moment of opening. The sixth floor of the wing contained the pediatric psychiatric unit which had transferred from the old Children’s Psychiatric Hospital on the medical campus. Again, the C.S. Mott Foundation supported components of these capital renovations with a $2 million grant to the University in 1984.
Dr. Kelch’s years were characterized by further expansion of clinical services, basic and clinical research, and the faculty and facility growth that had begun in the 1960s. In 1993, Dr. Kelch was recruited to be Dean of the College of Medicine at the University of Iowa. Dr. Janet Gilsdorf (Pediatric Infectious Disease) was named as Interim Chair and she served ably in this role for 2 years (1994-1996).
In 1996, Dr. Jean Robillard (Pediatric Nephrology) Associate Chair for Research in the Department of Pediatrics at the University of Iowa was recruited to be the chairman of the Department of Pediatrics and Communicable Diseases at Michigan. He was a leading authority in the development of the structure and function of the kidney from the fetus to adulthood. Dr. Robillard continued the strong tradition of recruitment of outstanding leaders in pediatric medicine. Dr. Friedhelm Hildebrant was recruited from Germany to lead a basic science research program in diseases of the kidney. Dr. Hildebrant, a member of the Howard Hughes Medical Research Institute (HHMI) and while at Michigan, became a leading authority in the genetics of kidney disease. Dr. Robillard also recruited Dr. Gary Freed who established one of the nation’s first health services research group focused on childhood disease. The Child Health Evaluation and Research (CHEAR) Unit, recruited and developed social scientists and national leaders in children’s health, establishing Michigan as the premier institution researching health service issues for children and advising the public and policymakers, and the government on children’s health issues and needs. Dr. Freed’s clinical program expanded the general pediatric program at Michigan during his tenure as Division Director (1998-2013), both for service to children in Ann Arbor and Washtenaw County and surrounding areas as well as expanding the primary care training opportunities for house officers. This enterprise now encompasses over 50 practitioners, both delivering expert primary care and instructing medical students and house officers in the practice of primary care for children. In 2003 Dr. Robillard began the recruitment process for a new Director of Pediatric Pulmonology. Dr. Marc Hershenson (University of Chicago), a leading investigator in the pathophysiology of lung disease in children joined the faculty that same year. Dr. Robillard successfully secured two medical school endowed chairs in support of Dr.’s Hildebrandt and Hershenson’s recruitments that had been provided by the estate of Frederick G.L. Huetwell to the University (1995).
In 2003, Dr. Robillard returned to the University of Iowa as Dean of the Medical School. Dr. Thomas Kulik (Pediatric Cardiology) ably served as interim chairman.
2003 to Present
In 2003, Dr. Valerie Castle (Pediatric Hematology-Oncology) was appointed by Dean Allen Lichter as the Chair of Pediatrics and Communicable Diseases. Dr. Castle had built a successful academic career studying the childhood cancer neuroblastoma. Preceding her appointment as Chair she served as the Department’s Associate Chair for Research and the Associate Provost for Faculty Affairs during Dr. Paul Courant’s tenure as the Interim Vice President and Provost of the University under President Mary Sue Coleman. Dr. Castle is the first woman to be appointed in the University of Michigan Medical School as a Department Chair. During Dr. Castle’s tenure as Chair she was a member of the American Pediatric Society Council and elected to serve as President of the American Society of Academic Medical School Department Chairs (AMSPDC).
During this decade the faculty and staff continued their work to expand clinical service lines and basic, clinical and health services research programs. As examples, the Department established and launched more than 50 new multi- and interdisciplinary clinical services and translational research programs including the Michigan Fetal and Diagnostic Treatment Center, the Michigan Molecular Medicine and Genetics Laboratory, Pediatric Palliative Care, the Michigan Center for Disorders of Sex Development, Pediatric Multidisciplinary Sleep Disorders Program, Neonatal B.R.A.I.N program, Congenital Cardiac MRI, Mott Hospital Palliative Care Service and Rapid Response Team, the Charles Woodson Clinical Research Unit, the Michigan Congenital Heart Outcomes Research and Discovery (MCHORD) program and the Michigan Congenital Heart Innovations Collaborative (M-CHIC) a unique group of U-M Congenital Heart Center investigators, physicians, engineers, and other scientists across the University of Michigan focused on the development of innovative devices and therapies for congenital heart and critical care medicine. The Department under the leadership of the chair successfully increased its outreach to philanthropy greatly expanding the cohort of endowed chairs as summarized in the below document. Importantly, six of these chairs were self-funded by the Department to honor past and current members of the faculty who through their research, clinical and administrative roles had made major contributions to the Departments accomplishments since its inception in 1921. These chairs are denoted with an asterisk (*).
View a table of Endowed Chairs Established 2003-Present Endowed Chairs.pdf
To encourage additional scholarly and research activity, community support for the work of the faculty and staff also led to named endowment funds in the Office of the Associate Chair for Education (T.G Brown Endowment in Education and Bruce Fund), named endowed lectureships distributed in the Divisions (MacDonald Dick Lectureship in Cardiology, the Aileen Sedman Lectureship in Medical Informatics;, the David Rosen Lectureship in Adolescent Medicine); and junior scholar awards (Jeanette Ferrantino Young Investigator Award; the Jones Family Foundation Research Scholar Award; the Gorman Family Scholar Award; the Charles Woodson Research Awards) and the Charles Woodson Clinical Research Fund in the Office of the Associate Chair for Research that provides support for departmental research infrastructure, biostatistics support, the Charles Woodson Laboratory for clinical research specimen processing and 10 annual named intramural competitive research awards.
Concurrently, the Department grew its research portfolio and sources of funding. As examples, the work of the faculty and staff improved the Department’s rank in NIH funding among academic pediatric departments from 15-17 in the years preceding 2003 to 9th in 2005 and 5th in 2010 maintaining top 10 funding status for 6 out of the last 11 years.
This decade was also associated with an expansion in clinical outreach to communities across the state of Michigan and into Ohio providing subspecialty pediatric care at a distance in cardiology, neurology, child protective services, genetics, nephrology, gastroenterology and pulmonary medicine. Additionally, the Department established its first UM owned and operated multispecialty pediatric clinics in 2014 at the University’s new Northville Ambulatory site. Most significant, however was the planning, approval and construction of a new C.S. Mott Children’s and Von Voightlander Women’s Hospitals that was completed in 2011. The project, at that time, was the largest capital investment ever made by the University of Michigan ($750 Million) and was completed a year ahead of schedule and ~$50 Million under budget. The facility includes a 12 story inpatient tower and a 9 story ambulatory outpatient facility totaling 1.1 million square feet of clinical space and capacity for 285 inpatient beds. Importantly, more than $75 Million in philanthropy was secured in support of the construction costs with many donors having named rooms and spaces within this facility. Importantly, while a decision was made that the new facility would continue to be named the C.S. Mott name, the Mott Foundation again support the University with a $25,000,000 grant in support of this capital project.
The new C. S. Mott Children’s Hospital had many important features for the patients and staff including an extensive art collection purchased and curated by the University of Michigan Museum of Art, an inpatient Ronald MacDonald House services families of children admitted to the 3 intensive care units (Pediatric Intensive Care Unit, Neonatal Intensive Care Unit and the Pediatric Cardiology Intensive Care Unit); state of the art patient care rooms and technology including an OR-MRI unit for the care of patients with complex brain tumors. Importantly, the tradition of housing mothers and babies continued with the construction of a newly named Women’s Hospital, the Von Voightlander Women’s Hospital housed on the 9th floor within the C.S. Mott Children’s Hospital facility.
To support the expansion in clinical services and research programs the faculty grew from 130 in 2003 to more than 240 in 2014 in 15 general and subspecialty divisions. The quality of services and care provided at Mott Hospital led to many national awards, near perfect patient satisfaction scores, faculty and staff recognitions and appointments to national academic and society leadership positions. Collectively the Mott community of providers received consistent recognition by Parent’s Magazine and US News and World Reports as one of the nation’s leading comprehensive children’s hospitals and Departments of Pediatrics. This decade was a period of substantial growth and accomplishment. By 2014 the Department of Pediatrics had become the second largest and one of significant prominence within the Medical School and University of Michigan Health System.