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History of
Medicine at the The
history of medical education and practice in the Minnesota territory began
during the mid to late-19th century as physicians began to form groups to
educate each other and succeeding generations in the art and practice of
medicine. The national population and the number of physicians of most eastern
states and some mid-western states had grown sufficiently that practitioners
and educators were forming local and national associations for scientific
communication and to discuss common problems of practice. Formation of the
American Medical Association (AMA) in 1847 in Many
American physicians were traveling to In
the In
1851 the Meanwhile
physicians began to organize into groups with the principal goal of providing
educational opportunities for themselves and prospective future physicians. In July
1853 eleven physicians, 9 with diplomas, met in the St. Paul courthouse to form
a medical society, the forerunner of the Minnesota Medical Association (MMA).
Five others, with diplomas, soon joined. They elected Dr. Douglas Hand
president, Alfred Wharton, VP, William Banks, sec. and Charles Boardman as
treasurer. The Medical Society sent a delegation to the 1854 AMA meeting in By
1860 an electric telegraph line was completed to Following
the civil war the Minnesota State Medical Society (founded in 1853) was
reorganized and the St. Paul Society became the Ramsey County Medical Society.
That same year Dakota, Goodhue and Winona counties established their local
county medical societies. By 1872, there were six county medical societies in
the state and by 1900, 15 local and county societies were recognized. Although
the American Medical Association held their national meeting in St. Paul in
1882, the ties between state and component societies were loose until 1902 when
the American Medical Association adopted a new constitution and bylaws that
forged a strong working relationship among the county, state, and national
associations. The
below account of the history of medical education in Minnesota is from a review
by Dr. Richard Olding Beard. His speech and several others given at the January
1909 joyous celebration of the union of all medical schools into the University
of Minnesota medical school published in the J MN State Med Association and
Northwestern Lancet, 1909. Three general periods medical education took place
in all newly settled territories; the period of the preceptor, period of
private medical schools and formation of university medical schools. The
periods were progressively shorter in younger states compared to the duration
in older states. The
Preceptor Period was the first teaching method used in new territories. The
preceptor was often the only physician in the community and the answer to
purely local needs. His was a time of great distances and poor communication.
His pupil and successor apparent, was his servant, assistant and apothecary
with instruction received as opportunity offered. His dictum was unchallenged. The
Period of the
In
December 1872 a second preparatory school, the The
Another
private medical school was formed in 1883, the Minneapolis College of
Physicians and Surgeons. Twelve years later, in 1895, it became the second
medical school adopted by In
1887 Dr. Millard resigned from the faculty as a prelude to the perhaps most
important period of Minnesota medicine. That year the The
same year Drs. Parry Millard, Daniel W. Hand, Charles n. Hewitt presented a
proposal to the Regents to establish a teaching medical school to replace the
former examining faculty. They were persuasive and University President Cyrus
O. Northrup moved to carry the argument to the legislature. Dr. Hewitt argued
that the goals of medical education should be within a strong department of
public health to direct the curriculum according to public health
principles. Dr. Millard strongly
disagreed. He foresaw the treatment successes of surgery and medical
therapy. With the support of the physicians of the area Dr. Millard won
out. The department of medicine (medical school) of the U of MN was established
in 1888 with Dr. Parry Millard as dean. The Minneapolis Hospital College, St.
Paul Medical College surrendered their charters and offered use of their
buildings for 5 years to the new University medical school Two months later the
Minnesota Homeopathic Medical College did the same. At this same time (1883)
the American Neurological Association was founded. During
the 90 years following the appointment of the University medical school first
teaching facility in 1888 there were four heads of the department of nervous
and mental diseases that evolved over time into the department of Neurology. In
the succeeding years 1978 to 2004 there have been four permanent and four interim
heads. Section III of this web site on Neurology at the University of Minnesota
contains biographies of the first four heads, Drs C. Eugene Riggs, Arthur S.
Hamilton, John Charney McKinley and Abe Bert Baker. (Masters of medicine,1888-1966
author J. Arthur Myers), plus a list of all subsequent heads to 2007, an eulogy
of Dr. McKinley by Professor Maurice Visscher, of Dr. Baker by Dr. Sidney
Shapiro and other interesting papers. Dean
Millard organized 3 colleges in the new university medical department; medicine
and surgery, homeopathic medicine and surgery and dentistry and later (1904) a
college of pharmacy. Lecture, classes and an outpatient dispensary were at the
MN Hospital College building at 6th St. and 9th Ave. Another outpatient
dispensary was at the former St. Paul Med College Hospital. Hospitals were
urged to build amphitheaters for teaching medical students. The Board of
Regents wrote to thank Archbishop Ireland of the archdioceses of St. Paul for
his generosity in building the amphitheater at St. Joseph. Medical
school was 3 years in length, each year having one 6 month term, by1894
extended to 8 month terms for four years. Entrance examinations were either
matriculation in a college of science, literature and arts; a high school or
normal school diploma; a first-class teacher’s certificate; or the certificate
of the State High School Board. In lieu of the above an examination was given
that required an English composition of 200 words legibly written, the
translation of easy Latin, and German, French or Scandinavian prose: elementary
algebra or plane geometry or botany; and elementary physics.
The
first faculty was appointed in April 1888. The 29 members were strategically
drawn equally from physicians in St. Paul and Minneapolis. They included two
professors of nervous and mental diseases, Dr. C. Eugene Riggs in the college
of medicine and surgery and Dr. S.M. Spalding in the college of homeopathic
medicine and surgery. Foot
note: Homeopathy had strong support among the citizens, many of whom were
suspicious about the practices of regular physicians. Homeopathy was developed
by Dr. Samuel C. Hahnemann, a medical graduate of the University of Erlangen,
Germany. He proposed two general
“laws” in his book “Organ on of homeopathic medicine” published in 1810. The
first was ‘similia similibus curantur’ or likes are cured by likes. Thus a
medicine that cause symptoms like malaria might be used to cure malaria. The
second law was ‘law of infinitesimals’ based upon Hahnemann’s belief that large
doses of drugs served to aggravate illnesses and that small doses supported the
“vital spirit” of the body in its effort to overcome disease. Physician
teachers in the new medical school were in practice in the Twin Cities, they
did not have a University salary. Basic science professors (chemistry etc.)
obtained salary support, presumably from tuition. In May 1888 the Regents
appointed Charles J. Bell professor of chemistry in the department of medicine
at $1,200 yearly. He was from Massachusetts, educated at Harvard and spent 6 years
in Munich with Adolph von Baeyer and in Berlin with August Hofmann. He taught
chemistry for several years at Penn State College then as a fellow at Johns
Hopkins before arriving in MN at age 35. The same salary was probably applied
to Dr. Arthur Ritchie from Duluth (Professor of anatomy), Dr. Richard Beard
(Professor of physiology) and Professor Burnside Foster (demonstrator in
anatomy). The
University of Minnesota and Hamline University Medical School (the only other
remaining private Med School in state) adopted uniform entrance requirements in
1898-90 and a 7 year course was set up leading to the degrees B.A. and M.D. In
1892 the legislature appropriated $55,000 to build a medical building (Medical Hall)
to house the 4 departments of the medical school. The chosen site was on the
main campus on the east bank of the Mississippi. Parry Millard loaned $20,000
interest free to assure an early start. It was decided to put the dispensary in
the new medical building to replace the dispensaries in the old buildings of
the St. Paul Medical College and Minnesota Hospital College which were
subsequently destroyed. At the 1892 dedication of Medical Hall (renamed Millard
Hall in 1908) Governor Merriam presented the building and John Sargent
Pillsbury accepted for the Board of Regents. President Northrup introduced the
invited speaker, Dr. Wm Osler from Johns Hopkins University. Dr.Osler shared
(at some length) his ideas of how a medical school should be organized with
clinical and basic sciences. Dr. Osler would not work in an equivalent building
in Baltimore for another year but the location of University Hospital next to a
proposed new basic science building presented Johns Hopkins with a great
advantage. After two fires and almost 110 years of service a new Millard hall
was replaced by the Molecular and Cellular Biology building in 2002. Dean
Millard died in February 1897 and Dr. Parks Ritchie, who had come to the
University in 1895-6, was named dean. Medicine required 4 years with raised
entrance requirements. By 1903-4 an optional six year plan had been instituted
and deemed successful. The1902 entrance requirement was one year of college and
the 1st yr. students fell from 132 to 40. Soon after 1905 two yrs would be
required. During
this period a forerunner of the present day technology transfer was developing
in St. Paul where Dr. Eduardo Boeckmann was beginning to manufacture and market
a new type of surgical suture made of absorbable gut in the Ramsey County
Medical Society laboratories and later for 59 years in the Lowry building. The
profits supported the growth of a medical library, now called the Boeckmann
library housed in United Hospitals. (See articles in the St. Paul Medical
Journal 1899 & 1907, a journal that lived fromapproximately1899-1918 then
folded to support the new Minnesota Medicine 1935. (J. Coleman “Of History and
a Few Good Men”, In Appendix) In
December 1905 the University received a gift of $113,000.00 from Mrs. A. F.
Elliott to build a badly needed clinical facility for clinical practice to be
called Elliott memorial hospital. The purpose was to allow focus on the
clinical as well as laboratory studies on the new University campus. In 1906
Dr. Parks Ritchie resigned (read L. Wilson’s book for details of unrest) and
Dr. Frank Fairchild Wesbrook was made dean. Dean Wesbrook reorganized the
medical school faculty into Executive and General faculties. There were 12
departments, 6 basic and 6 clinical (including nervous and mental diseases).
With C. Eugene Riggs (top center of picture) the head of Nervous and Mental
diseases? The same year citizens from Minneapolis gave the University $44,000
to purchase land for the Elliott memorial building (see plaque 1st floor
Elliott) and the legislature appropriated $23,000/yr for maintenance. The
merger of the Hamline University and the University of Minnesota medical
colleges and faculties in 1908 marked the end of formal private medical
education in Minnesota. The event was celebrated in January of 1909 in the
University Chapel by speeches that reviewed the histories of the several
private medical schools and medical journals (J MN State Med Association and
Northwestern Lancet, 1909). The era of the private medical school was fast waning.
Of the 526 medical schools formed between 1800 and 1908, 396 were extinct. Of
the 150 that remained, 67 were already affiliated with Universities. 1908
was the twentieth anniversary of medical teaching at the University and also
the termination of the college of homeopathic medicine for lack of student
interest. In the first 20 years of University medical school existence there
were 1468 entering students and 934 doctors graduated (63.8%). Most non-graduates
left for a more suitable calling or for financial reasons; failures were rare.
Medical school was now 4 years with two years college required for admission.
The Minnesota State Board examinations were difficult. The failure rate was
16.8% for Minnesota graduates and 28.5% for those educated elsewhere. Only 5%
of Minnesota graduates examined in other states failed. The high quality of
education and difficult examinations discouraged unqualified practitioners but
may have been the reason for the low ratio of physicians to population (1:943)
compared to the average for all other states (1:636). A main concern in 1909
was the distance students traveled to see patients in several hospitals
throughout the Twin Cities. None of the hospitals were obliged to allow
students to examine patients. The U of MN still did not have its own hospital.
Elliott would not be built until 1911-12.
Click the picture to see a full size version In
1909 Dr. Abraham Flexner visited the University of Minnesota. Dr. Flexner had
been appointed by the Carnegie foundation to survey U.S. medical schools and
propose improvements to medical education. These appeared in the famous Flexner
report, perhaps the most important influence on US medicine. The Flexner survey
of the University of Minnesota’s basic education was favorable. The lack of
convenient clinical facilities was a negative feature that was counter balanced
by the proposed Elliott hospital (built in 1911). The report of Dr. Flexner’s
second visit in 1923 cited the lack of progress during the 12 years elapsed
since 1909 (L. Wilson reference p. 262). The
Minnesota Neurological Society, the first neurological organization in
Minnesota, was formed in 1909 by a group of physicians who had interest in the
nervous system with Dr. C. Eugene Riggs as president and Dr. Arthur S. Hamilton
as recording secretary. Meetings were held regularly at the Town and Country
Club of St. Paul, which was equidistant between the two cities, or occasionally
at the Mayo Clinic. The hand written minutes of the society from 1909 to 1940 were
deposited in the Minnesota History museum (a copy is in appendix) when the name
was changed to Minnesota Society of Neurology and Psychiatry. Minutes from 1940
to 1962 are missing. Minutes from 1962 to present are in the offices of the
successor organization, Minnesota Society of Neuroscience that houses with the Minnesota
Medical Association.. The
chapter of Leonard Wilson’s book that describes the reorganization of the
medical school by Dr. George Edgar Vincent, the new University president, and
the loss of Dean Wesbrook is extremely interesting, especially the ignored
conflict of interest position held by Regent Dr. William W. Mayo. The minutes
of the College of Medicine and Surgery Executive Faculty meeting Jan 11, 1913
(vol. 19) provides a picture of the needs of the school and the frustration of
the faculty. President Vincent’s term was a disaster. It resulted in rifts
between the University and physician-teachers in the Twin Cities, with
substantial loss of growth momentum for clinical care and research of the
medical school. Dean Wesbrook, whose education had been in several European
centers, was bypassed in the reorganization and resigned to accept the position
as first president of the new University of British Columbia in Vancouver.
Several other physician leaders resigned, including Dr. C. Eugene Riggs first
head of nervous and mental diseases, Dr. A. Jones editor of The Lancet and many
clinical faculty. At this time the only salaried clinical positions were those
of heads of medicine and surgery. Others who contributed considerable time for
teaching or patient care were promised a stipend but this was made impossible
during the Vincent times. No expansion occurred and Elliott remained the sole
clinical care building, nurses remained in housing that had poor sanitation.
These events benefited the Mayo Clinic where, by caring for many indigent
patients, physicians grew skilled and in demand for those who could afford to
pay for medical services. Dean Lyon was appointed in 1913. The
chapter about the proposed affiliation with the Mayo Clinic, which was being
discussed during 1913-1915, is enlightening and distressing (for myself as a
former Mayo trainee) but I suspect correct. The medical school faculty and
former faculty were embittered by the arbitrary and unjust treatment that they
had received in the reorganization of 1913. They distrusted President Vincent
and suspected that Dr. Mayo was using his position as University Regent to
retard the development of the clinical departments of the medical school and of
the university hospital. The faculty and alumni were against an affiliation
with the Mayo Clinic because it favored a private entity to the disadvantage of
all others in the state. One reason for distrust stems from a meeting of
faculty members and Dr. William Mayo where he told them that he supported their
request for $400,000 for a contagious disease infirmary, nurse’s quarters and
enlargement of Elliott. When the Regents approved only $100,000 solely for the
contagious disease infirmary the faculty were angry because they could not
believe that the Regents would not approve the request if Dr. Mayo had back
edit strongly. Several surgeons in the country, who were asked their opinion of
the proposed affiliation agreed that it was a logical step, but all had worked
closely with Dr. Mayo on formation of the American College of Surgeons. As part
of the affiliation the Mayo Clinic was to place $1,000,000 in an endowment fund
to help support the education of clinical fellows who benefited from the union.
It was later learned that the money was to be spent in Rochester and would not
directly benefit the medical school. A petition to drop the proposed merger
signed by over 200 leading physicians of the Twin Cities, the negative stance
by the alumni association, Hennepin and Ramsey county and the state medical
societies were all ignored. The Regents approved the affiliation and issued the
statement that the affiliation should not be opposed by any member of the
faculty. This action with the associated suppression of free speech was
followed by several resignations. The conflict of interest of Dr. William Mayo
as Regent of the University and control of the Mayo clinic was never resolved.
The result of the affair was deterioration of the University medical school and
its faculty, delayed advancement of the University and increased strength and
wealth of the Mayo Clinic. The
ill feeling between town physicians (many former faculty) and the University
created by the faculty reorganization and Mayo affiliation was increased by the
proposal that University hospital would benefit by admission of paying
patients. Dr. W.A. Jones, editor of the Journal Lancet, and former faculty
member in the division of nervous and mental diseases, and most twin city
physicians in practice, were opposed to admission of paying patients. Recovery
of the medical school was further delayed by World War I. Numerous faculty members
were lost because of low income and poor outlook for the school. Dr. George
Edgar Vincent’s replacement, President Burton, left almost immediately for the
University of Michigan. Several faculty who spent part time at the Mayo clinic
as part of the new affiliation, were offered more money by the Mayo clinic and
resigned from the University and moved to Rochester full time. at Several
attempts were made by the University to obtain money from the Rochefeller
foundation to increase the clinical facilities were unsuccessful. Former
President Vincent was now at the Rochefeller Foundation. University attempts to
obtain matching money for the possible Rockefeller Foundation grant are
distressful, particularly the Mayo clinic refusal to help. The attempts by University
Dean Lyon and the new President Coffman were ineffectual. The saving of medical
education at the University came about mainly through monetary gifts by the
widow of Dr. Todd, the George Chase Christian family for a cancer hospital (one
son died of cancer) and especially the generosity of Flour industrialist,
William Henry Eustis, who gave $1,000,000, later added $500,000, and still
later more. The Todd cornerstone reads 1923, but apparently construction began
the following year and the building opened in 1925. The Eustis cornerstone
reads 1928, Elliott reads 1911, Jackson (anatomy building, 19). The Owre dental
school building, Lyon hall and the New Millard Hall were destroyed to make room
for the new Molecular Biology building. In
April,1933, Dr. Owen Wagnensteen, the rising surgical star at the University,
was accused by Dr. Halbert Dunn, the new director of University hospitals who
replaced the remarkable Mr. Paul Fesler who went to Northwestern U in Chicago,
of poor patient care. He apparently had the agreement of Dean Scammon. Dr. J.
Charnley McKinley, professor of Neurology and acting chief of the department of
Medicine, defended Dr. Wangensteen at a meeting with Dr. Scammon. Dr.
Wagensteen was cleared but the records are sparse. This may have been one of
the underlying reasons for the history of strong department heads at the U of
MN. It is interesting that succeeding hospital administrators have not been
physicians. Sister
Elizabeth Kenny began to work at General hospital in 1940. In 1942 the
Lymanhurst School-hospital (a branch of General hospital) became the first
Sister Kenny institute building. The Mayo Building Following
the death of Drs Charles and William Mayo in 1939, Dean Howard Diehl proposed
that a memorial devoted to education and research be created on the campus of the
medical school to which the brothers had given millions of dollars and years of
unselfish service, Dr. Will as Regent and Dr. Charley as Professor of surgery.
He argued that it would be superfluous to place a memorial in Rochester where
the several Mayo buildings already constituted a memorial. The building was
placed in the central quadrangle between basic science (Jackson and Millard)
and the hospital buildings. (Dean Diehl’s argument was ironic, but pragmatic;
because he was well aware that the Mayo brothers had done their utmost to
prevent the development of the University as a leading research and clinical
center and that the “millions of dollars” were spent in Rochester and did not
benefit the medical school). Diehl hall Dean
Diehl also spearheaded construction of the medical library. After his
retirement in1958 it was decided to name the future library, Diehl hall. The
construction was planned to include underground surgical research laboratories.
Drs Wangensteen, Baker and Hastings of Neurology and Psychiatry resp. and many
others struggled to raise private money to match federal funds and complete the
building. The 5th floor houses the Wangensteen history of medicine library and
the 6th floor contains research laboratories for neurology, psychiatry and
pediatrics. The Mayo
Clinic The
history of the Mayo clinic has been well documented and will not be attempted
here. The first Mayo neurologist, Dr. Shelton arrived from the University of
Minnesota and practice in Minneapolis in 1913. Drs. Henry Woltman and Herman
Moersch were students of Dr. Arthur Hamilton. (Mentioned in the appendix in
“History of the first four heads of Neurology”. Dr. John Doyle and Harry Lee
Parker of Dublin (author of “Clinical Studies in Neurology”) were among the
first trainees. |
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