150 Years at the Hospital
By James Tobin
From 20 beds in a converted house to a nationally recognized system of care.–
Chapter 1 A Beginning
In the years just after the Civil War, the University’s medical professors – all six of them – debated the dominant question in medical education: Was it enough for their students to learn medicine simply by listening to lectures? Or should they be taught at the bedsides and surgical tables of actual patients?
And if it was the latter, as the professors came to believe, shouldn’t the University have its own hospital?
Skeptics pointed out that the University trained lawyers without opening its own courts and engineers without building its own railroads. Many students had already been apprentices to doctors before entering U-M. Surely it was enough to send them out for an occasional glimpse of bone and sinew in the wards of existing hospitals.
But now, with mounting pressure from students for clinical instruction (learning by the operating tables and bedsides of patients), and medical professors overrun by local patients, the pro-hospital voices were winning out. Finally, with funds newly appropriated by the state legislature, the regents approved the idea.
But there was no money for a new building, the regents told the medical professors – just use the house on North University, one of four identical “professor’s houses” and the one nearest the Medical Building. The hospital steward, John Carrington, was allowed to move his family into the basement and was paid 75 cents per week for every patient he admitted.
The regents allotted $582.18 to convert the house into a medical facility. For medicine the doctors got $55.37. They treated their first patients in December 1869.
The house had space for 20 beds but no rooms for examinations or operations. Those were done in the Medical Building on East University, so patients had to be carted over for procedures, then carted back. The house was so cold and smelly that winter the doctors had to ask the regents for $260 more to pay for a better furnace and ventilation.
It could just barely be called a hospital. But it was the first in America owned and operated by a university, and it set the trend for ambitious universities across the country.
This little enterprise would grow so steadily for so long that in 150 years it would no longer be called a hospital at all. It would become a health system – now called simply “Michigan Medicine” – encompassing three major hospitals, several major treatment centers and scores of research centers, clinics, institutes, laboratories, helicopters, and a library spread across Ann Arbor and reaching into 25 other cities and towns, all intertwined with one of the world’s great medical schools and staffed by some 3,000 physicians, surgeons and scientists, 5,700 nurses and thousands more support staff who, together, would annually handle 2.1 million patient visits, perform 60,000 surgeries, treat 100,000 emergencies and deliver 4,600 babies.
More like a health constellation.
Chapter 2 The Pavilion Hospital
No one thought the house on North U. would suffice for long. In the 1870s Ann Arbor was growing quickly, and the citizens were keenly interested in having a real hospital. But they had to wait six years for action.
The holdup lay in Lansing, where a faction of legislators insisted that homeopathy – an alternative health system that doses disease with tiny amounts of natural substances to trigger the immune system – must be taught in Ann Arbor alongside mainstream medicine.
At last a compromise was struck. There was to be a new and separate department of homeopathic medicine. A new hospital would be built for both schools of medicine to share. The state would put in $8,000 for construction as long as Ann Arbor put in $4,000 — a deal city voters accepted by a vote of 422 to 4.
Starting from the professor’s house, which was converted from hospital beds to office space, the builders put up two long, single-story wings stretching into the Diag. Each wing held a long ward, one for men, one for women. With lessons learned from the Civil War – when two out of three soldier deaths were due to disease, not bullets – it was built entirely of wood so that it could quickly be burned in case of a sudden epidemic. It opened in 1876.
On the roof there were multiple cupolas to maximize ventilation. From a distance, the little towers made the building look like a long circus tent. The wings were called pavilions, so although the official name was “University Hospital,” it was commonly called the Pavilion Hospital.
Patients were treated for free, understanding that in exchange, their cases would be on display for the education of medical students. There were 60 beds, with 12 designated for the homeopaths’ patients. When the schism got rancorous again, the homeopaths were allowed their own hospital next door, a more or less identical twin of the original.
Cupolas or no, the smell inside was dismal. Health inspectors were said 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.”
Even as the hospital grew, addition by addition – an eye-and-ear ward, a kitchen and dining room, a surgical amphitheater – there were rising pressures for something larger, cleaner and better-equipped.
The rise of scientific medicine, especially bacteriology, was persuading progressive doctors that better sanitation in controlled hospital settings with a staff of well-trained nurses was critical to better outcomes for their patients.
Then there was President James Angell, who was always uncomfortable with the presence of a hospital in the midst of his students, and with good reason. One doctor reported that “all the wards are more or less infiltrated with septic material, and the hospital cannot be disinfected.”
So in the late 1880s, another funding deal was struck. Again, the state would allocate two-thirds of the cost of a bigger hospital – $50,000 – and the city would put in $25,000.
President Angell wanted it built as far from the campus as possible. The faculty wanted a closer site, to reduce the distance to the Medical Building that sat on the Diag.
They settled on 10 acres along the eastern end of Catherine Street, out by the Detroit Observatory – not exactly in the countryside, but far enough from the campus to protect students from germs as they walked from their boarding houses to class and back.
Soon enough, the new hospital would pull the Medical Department along with it.
The Pavilion Hospital straggled along for 20 more years as the College of Dental Surgery. In 1909 it was torn down, not burned, to make way for the Chemistry Building.
Chapter 3 The Catherine Street Hospitals
Grand hopes for a new building soon went a-glimmering. A planning committee toured the best hospitals on the East Coast and came back with a plan that would cost $200,000. But Lansing offered only $50,000. The people of Ann Arbor gave $25,000 more. So the planners had to settle for just two new buildings – one for the Department of Medicine and Surgery, the other for the Homeopathic College – and a long list of unmet needs. The doors of a new University Hospital opened in December 1891.
With essentially no central planning, the facility morphed into a ramshackle parade of buildings semi-connected by passageways open to the weather. “A surgeon, an internist [and] an obstetrician may be delightful gentlemen and well versed in their special lines,” wrote Dr. Reuben Peterson, a faculty obstetrician and early chronicler of the hospital’s history, “but absolutely incapable as hospital architects.”
One by one they sprouted: the Surgical Pavilion; the Palmer Ward for pediatrics; the Otolaryngology Ward; the Psychopathic Hospital; the General Office; the Maternity Hospital; the Maternity Cottage; the Dental School. Summer or winter, patients had to stare at maps and signs to plot a course to their doctors.
In 1914, a stand-alone hospital was added for the isolation of patients with contagious diseases – an acute need in an era when such germs were far less contained than they would be 50 years later. In that year alone, U-M students were treated for measles, mumps, chicken pox, whooping cough (pertussis), diphtheria, infectious gingivitis, tuberculosis, strep throat and pneumonia.
Before it was over there were 20 buildings in all with 400 beds between them.
In later years at Catherine Street, treatments were no longer offered for free, as in the Pavilion days, but fees were held to a minimum. For in-state patients, the cost of “all ordinary care and medicine” was $1.50 per day in the wards, $2.10 per day in a private room. Out-of-staters paid half a dollar more. A patient paid $35 for a “minor” operation, $80 for abdominal surgery. Pregnant women entering “confinement” paid $2.50 per week, though they were required to “assist with the housework, care for their own rooms, help with plain sewing, prepare vegetables, fruits, etc.”
Public support for the hospital ran deep, owing in part to these low costs. Even people with ample means told doctors they’d be happy to receive treatment under the gaze of medical students in exchange for the University’s reasonable fees. In any case, it was widely understood that by operating a hospital with public funding, the University was returning good to the state by training the next generation of doctors.
“The result of the social service thus rendered to the state of Michigan by its university,” wrote Dr. Aldred Warthin, a leading U-M pathologist, “has been a greatly increased appreciation of this service by the citizens, and a growing tendency toward a further development of this form of state medicine.”
By the early 1900s, University Hospital was highly regarded as a center of medical education and the largest teaching hospital in the U.S. But its reputation was chiefly due to faculty stars such as the internist George Dock and the bacteriologist Frederick Novy. The facilities were another matter.
Year by year, with more patients seeking scientific care, it became well known the buildings had lapsed into “a most shocking condition,” thanks in part to a general superintendent who was not a doctor and who measured success by pinching pennies. A lecture hall in the Palmer Ward flooded so often that students called it the Frog Pond. “Piles of dirt [were] allowed to accumulate in corridors, wards and private rooms,” Dr. Peterson wrote. There was no standard system for admitting patients. The food service was abysmal. Supplies were jammed willy-nilly in basements. Patients were prepared for surgery in bathrooms.
Every sort of facility and equipment was in short supply – even bathtubs. To take a single example: In the 1890s the pathology lab at the Catherine Street Hospitals handled perhaps 300 tissue studies a year. By 1915 the number had reached several thousand. Every day, orderlies hand-carried baskets containing excised toes, tumors, tonsils and appendixes through wards, along corridors, across streets and between buildings, delivering them from far-flung surgical wards to the overburdened path lab, leaking formalin all the way. It was a hygienic and logistical nightmare, with many specimens lost, delayed, mixed up, and misidentified.
A faculty revolt overthrew the non-medical administrators and a general clean-up ensued. But there was no cleaning up the built-in mess of the buildings themselves. The First World War merely delayed the inevitable. When the war was over, planning for yet another new hospital, this one on a spectacular scale, began in earnest.
Chapter 4 The Glory of Old Main
When the first hospital opened to patients in 1869, the state of Michigan had only one city of significant size and a sprinkling of small towns in an ocean of farms. Half a century later the state was a rising industrial giant with a true metropolis right next door to Ann Arbor. The state’s population had risen by 50 percent since the Catherine Street Hospital had opened. With patients referred from across the state, the hospital simply could not meet the rising demand for its services.
For a great hospital of the industrial age, U-M chose a great architect of the industrial age, Albert Kahn of Detroit. Renowned for his design of the Ford Motor Company’s massive River Rouge complex, Kahn and his associates already had designed several of the campus’s most important new buildings, including Hill Auditorium and the William Clements Library. Now they went to work on the largest construction project in the University’s history.
If the Catherine Street Hospitals had been a sloppy improvisation, the new hospital would be their opposite. The designers paid scrupulous attention to efficiency, looking for every way in which the building could serve the practice of medicine.
On their drawing boards they sketched “a double Y intersected by a double T,” as one administrator put it, to be built on the hill overlooking the Huron River at the corner of Ann and Observatory streets. The T at the front would be for admitting and administration, the T at the back mostly for the Medical School. The structure would be sunk into the hillside, with nine stories facing the river and six facing the campus. (Two more stories would be added in 1931.)
The arms of the double-Y mimicked the long wings of pavilion hospitals like U-M’s, allowing maximum light and air, but these pavilions would be stacked one upon another.
The general contractor was the Thompson-Starrett Company, which had built New York’s Woolworth Building, the world’s tallest at the time, and Detroit’s General Motors Building that Kahn designed. Construction began in 1920. A stall in state funding left a skeletal shell standing empty for three years. Then building resumed, and in 1925 the building was complete at a total cost of $3.85 million.
Denizens of the old hospitals on Catherine Street toured the new building in amazement. On the first floor they found a diagnostic and outpatient unit of 56,000 square feet and a centralized records department with pneumatic tubes shooting out like the arms of an octopus to carry records throughout the building.
There were more than two miles of main corridors, 10 acres of floor space, 2,799 windows, and 280,000 square feet of floor space in all. In the old buildings, a person moving from one unit to another had often been forced to hurry through Michigan’s elements. No more – in the new building people moved from unit to unit via 10 large elevators.
In the basement there was a sprawling X-ray lab as well as cafeterias and kitchens, including three ovens capable of baking 180 loaves of bread at a time, a giant electric dishwasher, an ice plant, and a water distillery.
The clanging and clattering of Catherine Street were stilled. In the new building, noise was muffled by heavy linoleum tile on the floors, felt liners on many of the walls and ceilings to dampen reverberations, metal crooks replacing doorknobs on patients’ rooms, and electric-light signals to replace bells.
Laboratories were designed and equipped to serve the needs of multiple departments, thus eliminating duplicate spaces. Wards were standardized for the use of any service as necessary.
Decoration was state-of-the-art for modern health care. In the operating rooms, for example, the light green color of the walls – later a defining trait of institutional drabness – was chosen as a pleasant contrast to the stark white then associated with hospital interiors. (“Green has been found to be far more restful to the eye and therefore peculiarly favorable for the surgeon’s work,” confided Harley A. Haynes, director of the Hospital.)
Then there was the new pathology lab. No more orderlies leaking formalin from ill-smelling baskets. In the new hospital, specimens were carried promptly by electric dumbwaiters that ran from surgical suites to the new path lab in the basement. There, at a rate of 30,000 specimens per year, they went into water-jacketed paraffin ovens or ventilated drying ovens; then to the diagnostic rooms; and finally into a permanent collection of diagnostic slides. Surgeons typically received the pathologist’s diagnosis within 24 hours of an operation.
In all, the University now offered the public 1,100 to 1,200 beds, depending on how you counted, including 300 in the old Catherine Street hospitals (now to be known as the Convalescent Hospital), and 100 in the building on North University later named North Hall. This was roughly triple the old number of beds.
“To the members of the teaching staff and the medical alumni who had to put up with the inconveniences of the old Catherine Street Hospital,” Dr. Peterson wrote, “the new hospital is still hardly believable.”
Chapter 5 The Replacements
For half a century, University Hospital stood like a rugged fortress on its hill, extending new fortifications to the south and west, back toward the Central Campus.
The Medical School shifted to new buildings adjacent. In 1969 the C.S. Mott Children’s Hospital rose next door, soon to be followed by construction or renovation for more affiliated health units. The School of Nursing colonized the old St. Joseph’s Mercy Hospital on Ingalls Street. The School of Public Health built a new headquarters on Observatory Street. The W.K. Kellogg Eye Center was planned for a site on nearby Wall Street.
Meanwhile, as medical specialties multiplied and Michigan’s population grew, Albert Kahn’s fortress in the center of it all was asked to house more units, more services, more patients.
By the 1970s, its overburdened and aging electrical system was sputtering. Old elevators groaned up and down, still operated by men in uniforms. The stairwells – called “ureters” by nurses and doctors – were crowded. A design that had once been the height of efficiency was growing archaic.
So, after a long and contentious battle over the size and cost of the project, the state legislature in 1981 appropriated some $285 million to build a new hospital just to the east of the building that people had come to call “Old Main.”
There was no such affectionate title for the newcomer. It was simply called “RHP” — the Replacement Hospital Project.
As big a project as Old Main had been in its day, RHP dwarfed it. The new building would house services and centers unimagined in the 1800s, with science-fiction names like Nuclear Medicine, Neurointerventional Radiology, and the Nanotechnology Institute for Medicine and Biological Sciences.
And the hospital itself was only part of the project. The adjoining A. Alfred Taubman Health Center would come to contain 31 clinics and centers, from the Arthritis Cooperative Clinic to X-Ray. Multiple Pavilion Hospitals could have been comfortably enclosed in just one of the new complex’s several parking structures.
On Valentine’s Day 1986, months of planning culminated in an extraordinary cavalcade between Old Main and the new University Hospital. All day long, patients were escorted through the old corridors into gleaming new ones.
“It was a very proud moment when the move in our ward ended and everyone was fine, as our patients were among the most frail,” recalled Dr. Sofia Merajver, then a medical student, now a U-M professor of medical oncology. “They understood they were part of history and it was very emotional to see how they rallied and how excited they were to be such pioneers.
“I will never forget that day,” she said. “It helped make me a proud Wolverine.”
And on it went, on the medical campus and beyond. The new Rogel Cancer Center opened in 1997. The new Frankel Cardiovascular Center opened in 2007. The biggest of U-M’s many satellite health facilities, the East Ann Arbor Health and Geriatrics Center, opened in 2006.
In 2011, two entirely new hospital buildings welcomed their first patients – the C.S. Mott Children’s Hospital and the Von Voigtlander Women’s Hospital.
And in 2018, on the eve of the hospital’s 150th anniversary, regents gave the go-ahead to begin planning a new inpatient facility, with 264 beds and 23 surgical and radiology suites. The additional space, if plans move forward, will be used for University Hospital’s most highly specialized care.
* * *
Deserted by staff and patients, the empty structure of Old Main cost $1 million a year just to maintain. It stood vacant for a couple of years. Then, in 1989, after months devoted to removing asbestos from floors, doors, ceilings and pipes, an eight-ton wrecking ball took down the building that once had represented the state of the medical arts.
In its place: More space for parking.
Key sources included Dea H. Boster and Joel D. Howell, Medicine at Michigan: A History of the University of Michigan Medical School at the Bicentennial; Victor C. Vaughan, A Doctor’s Memories; Reuben Peterson, The New Contagious Hospital at the University of Michigan and Its Proposed Plan of Operation; Peterson’s unpublished history of the hospital’s first 50 years; the Michigan Daily; and Stories of the Staff. Portions of this article appeared in the writer’s accounts of the original hospital on North University, the Pavilion Hospital, and “Old Main,” first published in Medicine at Michigan.