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San Francisco: Departments

Obstetrics and Gynecology
James Blake was appointed by Hugh Toland as his first professor of obstetrics and diseases of women and children when the Toland Medical College opened in 1864. Blake was an erudite scholar, but was hardly qualified for this position and was a bit too retiring to hold his own with the bombastic medical leaders of early San Francisco. The man who would have been eminently qualified for this first chair was R. Beverly Cole, but he and Toland had been bitter enemies since 1856, when Cole had accused Toland of malpractice in connection with the death of Daily Evening Bulletin editor, James King, who was shot by county supervisor James Casey. By 1870, however, Toland needed Cole's assistance, because the reactivated Cooper Medical College in San Francisco had acquired most of his faculty and all but one or two students. Furthermore, Toland was negotiating with Daniel Coit Gilman, President of the University of California, for an affiliation, and Cole was one of the most politically potent physicians in the state. Blake was therefore summarily dismissed in 1870, and Cole was appointed professor of obstetrics, and later dean of the Toland Medical College.

Against Toland's wishes (because it was so remote) Cole selected the Potrero site for the San Francisco City Hospital. It was largely through Cole's negotiations that the Toland Medical College became part of the University in 1873. It was also through his influence that Sutro Heights was selected in 1895 as the site for the new Affiliated Colleges.

Cole continued to hold the chair of obstetrics until his death in 1901. For the next 14 years, there was a succession of short-term appointments; then, in 1915, Frank W. Lynch was selected as chairman. Lynch had been a five-year resident at Johns Hopkins, and he carried on the Hopkins' traditions until his retirement in 1942. His primary interest was in pelvic neoplasms, and the department became a strong center for the treatment of gynecologic cancer.

In 1942, Herbert F. Traut, also Hopkins-trained, was selected as chairman and directed the department until 1956. Traut's orientation was primarily in pathology and in this area he was a superb teacher. He and Dr. George Papanicolaou were jointly responsible for developing the cytological diagnosis of cancer.

Since 1956, the research areas for obstetrics and gynecology quadrupled, and attention was focused more upon the physiology, biochemistry, and endocrinology of reproduction, including fetal and placental physiology. Undergraduate instruction became progressively patient-oriented, and graduate instruction was centered on a four-year parallel residency system, followed by a two-year research training program for those electing academic careers. source

Operative Dentistry
The Division of Operative Dentistry was established with the inauguration of the dental school in 1881. Originally, operative dentistry consisted of all dental procedures practiced within the oral cavity. As dentistry developed into a science and an art, the field broadened until one department could no longer adequately cover all of its original functions. This resulted in many specialties developing within the field of intraoral dentistry, such as oral surgery, periodontology, orthodontics, prosthodontics, oral medicine, pedodontics, and endodontics. As knowledge in each of these areas increased and with the consequent application of this knowledge, each of these fields became a department of its own until operative dentistry was generally recognized as that branch or specialty of dentistry which dealt primarily with the prevention, control, and treatment of diseases of the natural teeth and the restoration of tooth structure lost through disease processes or other causes.

The faculty of the Division of Operative Dentistry consisted of 32 individuals with a full-time equivalent of 12. Members of the faculty devoted time ranging from one day per week to full-time.

The division included as integral parts three sections: restorative dentistry, endodontics, and pedodontics. The alliance of these three closely related aspects of dentistry allowed an efficient teaching effort at the undergraduate level.

Early concepts of endodontic teaching consisted of the treatment of infected teeth by the removal of the infected pulp tissue and sterilization of the root canal, followed by its hermetic seal. With increased knowledge of diagnosis and treatment planning, the scope of undergraduate teaching in endodontics was expanded to include not only all phases of pulp conservation, but also the more advanced methods of surgical and chemotherapy intervention to prevent the loss of infected teeth through extraction. Root amputation, tooth hemisection, intentional and non-intentional replantation, transplantation, reverse filling technique, and bleaching of discolored teeth became part of the undergraduate curriculum.

Pedodontics had, from its inception, stressed the relationship of diet to dental caries and the importance of maintaining the primary dentition until its replacement by the succedaneous teeth. After the mid-1950's, increasing emphasis was placed on preventive dentistry, tooth guidance, space maintenance, and the use of stainless steel in restoring badly broken down primary teeth.

In 1960, the section on pedodontics instituted a hospital and outpatient service, providing dental care for children who were mentally or emotionally crippled or had severe physical disabilities necessitating treatment while under a general anesthetic.

The educational objectives of the division were continually advanced on the basis of an active research program. Significant contributions to the advancement of dental science in the areas of understanding the nature of disease within vital teeth and improved restorative technics for the hard and soft tooth structure evolved through investigative efforts. source

Opthamology
One hundred years ago ophthalmology was not practiced or taught at the University as a separate specialty. It was part of an "Eye, Ear, Nose and Throat" division. Early instructors were general practitioners who were somewhat skilled in eye, ear, nose, and throat procedures. Elsewhere in the world, and in the eastern United States, ophthalmology was developing into a well-recognized specialty. California ophthalmology developed in stature through immigration of European specialists, and by postgraduate study of California physicians in Europe.

Up to 1900, there was little change in the teaching or practice of ophthalmology, but the invention of the opthalmoscope, development of specialized techniques in ophthalmic surgery, advances in perimetry (and the testing of visual fields), and development of the slit lamp microscope, caused such an increase in the understanding of the eye and its diseases that it became impossible for a physician to be skilled in the eye, in addition to the ear, nose, and throat. In fact, ophthalmology became the most advanced specialty in medicine.

William F. Smith was the first professor of eye, ear, nose, and throat in the Toland Medical College, assisted by Dr. Frank H. Howard, who was lecturer on optics and the diseases of the ear. They were succeeded by Narcesse J. Martinache, who was professor between 1875 and 1881. Instruction in combined eye, ear, nose, and throat was carried out by these men and their successors. Dr. Walter Scott Franklin became instructor of ophthalmology in 1912. He was named assistant professor in 1915 and clinical professor in 1921, serving until 1929. Although eye, ear, nose, and throat still were combined, he and Dr. Albert Houston, who limited himself to otolaryngology, had a tacit agreement on the division of instruction methods in the Medical School.

Dr. Franklin was the instructor of Dr. Frederick C. Cordes who graduated from the University's Medical School in 1918 and became clinical professor of ophthalmology in 1936, serving until 1959. Dr. Cordes, with his great vision, tremendous ambition, and determination, was responsible for almost all the developments in the teaching and research programs in ophthalmology. He developed specialities in neuro-ophthalmology and perimetry, glaucoma, pathology, neuro-muscular diseases, and medical ophthalmology. Ophthalmology was designated as a separate department in 1952.

In 1940, the first laboratory (pathology) for research was established by Dr. Michael J. Hogan, who had the first salaried appointment in the department, through the generosity of Mrs. Clara Heller, for whom all the departmental research laboratories later were named.

Teaching under Dr. Franklin was largely clinical, with instruction and lectures given in the Eye Clinic. During Dr. Cordes' chairmanship, instruction was extended to include basic science fields of anatomy and physiology of the eye. By the 1960's, under the chairmanship of Dr. Hogan, it included teaching in the first three years of medical school training by three full-time and eight part-time instructors at the Medical Center and San Francisco General Hospital. They were assisted by approximately 42 part-time clinical teachers from the community.

Residency training in the department commenced in 1930 with one appointee responsible for two in-patient beds. During Dr. Cordes' regime the program increased to six residents. By the mid-1960's, the program included 21 residents rotating their services at the University, San Francisco General Hospital, Southern Pacific Hospital, Veterans Administration Hospital, and Sacramento County Hospital. source

Oral Biology
The concept of oral biology was first introduced into dentistry and into the dental school of the University in 1928 when Dr. Hermann Becks was made a professor of dental medicine and received an appointment in the George Williams Hooper Foundation for Medical Research. The first work in this field was that of correlating various nutritional and hormonal deficiencies with changes in bone and teeth in laboratory animals.

The Division of Oral Biology was formed in 1960 as a merger of the sections of oral histology, oral pathology and oral medicine. The purpose was to improve the correlation of overlapping subject matter and student orientation and to improve the teaching approach.

The objective of this division was to develop in students an understanding of oral health and disease and their interrelationships with a patient's entire well-being. This entailed study and correlations between normal oral structure and oral biology, pathology, basic sciences, medicine, and dentistry. Signs and symptoms, history taking, differential diagnosis, diagnostic techniques and fundamentals of treatment were emphasized to develop the ability in a student to evaluate and manage patients with lesions of the oral cavity and to comprehend systemic implications. The important relationship of basic and applied research to this field was stressed to support clinical approaches and methods.

The faculty complement was seven and one-half full-time equivalent staff members made up of persons with either dental or medical degrees, most of whom also held master of dental science or Ph.D. degrees. Most of the staff were full-time and were devoted mainly to research and teaching; some also carried on general or specialized practices. More than ten additional appointees were supported by research grants or contributed their time. This formed a group with a wide background and depth to enable the division to function adequately and to correlate the broad array of material for the students.

Course work in the Division of Oral Biology commenced in the sophomore year of dental school and continued through graduation. Elective and graduate courses were available.

Research interests within the division dealt with a broad range of biologic phenomena ranging from basic chemical and physical characteristics of dental and oral structures to clinical studies of disease. The division also served actively in postgraduate teaching and consultation services for the Medical Center and outside agencies relative to problems of oral disease and biology. source

Oral Roentgenology, Section of
Oral Roentgenology, Section of, was created in January, 1938, by Dr. Guy S. Millberry, dean of the School of Dentistry. Previous to this date, dental students were given three lectures covering x-ray physics and senior students were allowed to watch a technician x-ray a patient two times in the senior year. The dental hygienists were given no lectures or instruction.

Dean Millberry appointed a chairman and an assistant and allocated funds for a dental x-ray building and furnishings. With five operating cubicles, two darkrooms, a waiting room and an office, it was possible to start a teaching program and increase the service work. The dental students and hygienists were given lectures for one semester covering roentgenologic techniques and interpretation, and both groups were offered clinical practice.

After World War II, the faculty decided that all patients coming to the dental clinic for treatment would have a complete x-ray examination. In addition, it was found desirable to have separate courses for the dental students and the hygienists; to make the clinical practice required for the dental students; and to conduct a separate course for roeotgenologic interpretation. In the early 1960's, two more elective courses were offered to qualified senior dental students and hygienists, in which the students developed technical skills and increased interpretive abilities.

The quality of the x-ray work was continually improved and refined since section the started. Research resulted in greatly improved x-ray equipment, films, darkroom procedures, film mounts, and radiation hygiene. In combination with the above, publications, numerous lectures, and courses given in other dental schools and for dental societies, resulted in the section becoming known as a leader in this dental specialty. By the mid-1960's, somewhat more than half of the dental schools in this country, some of the dental schools in other countries, and the U.S. Navy Dental Corps, followed and taught the principles developed at this school. source

Oral Surgery
In the first dental department announcement (1882), the course in surgery consisted of two lectures a week on the art and science of surgery. These were given by a faculty member of the medical school and consisted of "illustrated drawings and models and demonstrations on the cadaver, with particular attention to surgical diseases and injuries of the had, face, jaw, and mouth."

In 1905, the oral surgery department added a course in surgical dissections upon the cadaver and operations upon animals. The 1915 Announcement listed a staff of three and emphasized clinical and didactic teaching comprising "all surgical operations about the mouth and contiguous parts."

In 1927, a course of graduate instruction leading to a master's degree was offered in oral surgery. This consisted of a full-time one-year course or a part-time registration for a period of more than one year.

The undergraduate program consisted of lectures on local anesthesia and exodontia of the junior year. Juniors also assisted in the Oral Surgery Clinic. During the senior year lectures in principles of surgery and anesthesiology were given. The senior students operated in the Oral Surgery Clinic. Demonstrations on the administration of nitrous oxide anesthesia were also presented.

A three-year graduate course was first offered in 1947. The purpose of this course was to fit the student as thoroughly as possible for the practice of oral surgery as a specialty in dentistry. Particular emphasis was placed upon the basic sciences and hospital practice.

By the mid-1960's, the undergraduate program consisted of lectures and clinical assignments throughout the junior and senior years.

The oral surgery division staff increased from one lecturer in 1882 to 15 staff members. In addition to the Oral Surgery Clinic and the oral surgery service at Moffitt and University Hospitals, it maintained a teaching service at San Francisco General Hospital and San Quentin State Prison. source

Orthodontics
Originally, the teaching of orthodontics comprised but a small part of the dental school curriculum. The 1882 Announcement of Courses for the first class in dentistry indicated that "various mechanical means employed in correcting irregularities of the teeth were explained and illustrated, etc.," as part of the subject matter in the Department of Mechanical Dentistry.

In 1889, this department was divided and dental metallurgy and orthodontics were made a separate department. Orthodontics was allowed more time in the curriculum for instruction and demonstration of treatment.

In 1894, a separate Department of Orthodontia was set up after the need for special instruction in this area was noted. There was greater interest in orthodontics on the part of the profession and there was a greater recognition of the services that orthodontics could provide.

The department expanded and grew as this area of dentistry became aware of the biologic and physiologic considerations which regulated the mechanical response of appliances.

While Dr. Guy S. Millberry was dean of the School of Dentistry, he became acutely aware of the need for better and more complete dental care of children. Accordingly, he set up a special curriculum to care for this problem. In 1930, he introduced an undergraduate orthodontic major. This program formally recognized orthodontic training as a major field of instruction and placed it in a curriculum where the major emphasis was on preventive dentistry rather than on restorative dentistry.

This change was made possible by substituting, in the regular study program, orthodontics for clinical experience in denture prosthetics and crown and bridge. It was anticipated that students who selected this curriculum would limit their practice to children, so the substitution was a reasonable one.

Shortly after World War II, the number of students admitted into this curriculum was increased from six to nine. By elimination of the clinical courses mentioned above, it was possible to offer over a three-year period essentially the same material as was presented in graduate or postgraduate courses in 18 months. This program, then, had the basic advantage of preparing a student for practice in a specialty at the undergraduate level.

The School of Dentistry was the only dental school in the United States which offered such a program. Its graduates were eligible to become members of the American Association of Orthodontists and to take the examination for certification by the specialty board in orthodontics. More graduates of this curriculum successfully passed the examination certification by the American Board of than have the students from any other school at either the graduate or postgraduate level; no graduate of this program who completed the examination for certification ever failed to pass. Over 80 per cent of those passing received special commendation by being asked to display part of their presentation at subsequent professional meetings.

There was a period when postgraduate studies were offered, but because of the advantages offered in the special curriculum program, the postgraduate course was not offered after 1951. source

Orthopaedic Surgery
The Department of Orthopaedic Surgery was first established as a service under the guidance of a number of outstanding orthopaedic surgeons who contributed to its development by their association with the teaching program; among them may be listed Drs. Harry M. Sherman, Samuel J. Hunkin, James T. Watkins, Walter I. Baldwin, Howard H. Markel, and Edward C. Bull. The department achieved autonomous status in July, 1949, under the leadership of Dr. LeRoy C. Abbott, who had been its chairman since 1930. Dr. Verne T. Inman succeeded him as chairman in 1957. In the same year, physical medicine and rehabilitation, which, by the mid-1960's had a full-time faculty of three and a part-time clinical staff of seven, was established as a section of the department.

Since 1930, the full-time faculty of the department increased from one to six members and the part-time faculty from seven to 71. Participation in undergraduate instruction grew to meet increasing enrollment in the School of Medicine. Instruction in examination and treatment of disorders of the musculoskeletal system was provided for students in their second, third, and fourth years.

One hundred and eighteen orthopaedic surgeons were trained in the postdoctoral education program since its establishment in 1931. The program, in which 11 hospitals participate, offered positions to 31 residents. The department conducted basic science seminars which were attended by its own residents and were open to residents from other training programs as well.

Of great influence in the development of the department was the generosity of Mr. and Mrs. Sidney Ehrman. Among their contributions were the establishment of a hospital service for crippled children in 1934; the support of several members of the nonacademic staff; the founding, in 1939, of the Anatomico-Pathologic Laboratory (later the Orthopaedic Surgical Research Laboratory); and support of faculty research such as the studies on the spine begun in 1950 by Dr. Donald B. Lucas, vice-chairman of the department.

Members of the department conducted basic research as well as clinical and experimental investigations. Significant early work included studies on bone grafting and on the operative lengthening of the lower extremity. In 1940, organized research on the anatomy and physiology of skeletal movements was begun. This area of research was of major interest to various members of the department since that time; its increasing importance led to the establishment, in 1957, of the Biomechanics Laboratory for interdisciplinary research on the mechanics of the human body. Since 1957, nearly 60 research studies had been conducted that dealt with 25 different fields and involved over 42 investigators. source

Otolaryngology
The eye, ear, nose, and throat division at the San Francisco Medical Center began with the opening of the Medical School Building, in which space was allotted for its clinic. The first chairman was Dr. William Arthur Martin, who came to San Francisco in 1890 after 12 years of study in Europe. He was succeeded In 1907 by Dr. Albert J. Houston, who organized the first postgraduate training program in otolaryngology at the medical center. The first trainee under this program was the late Dr. Robert Carson Martin.

Early in the century in Vienna, the medical specialty concerned with the eye became separated from that concerned with the ear, nose, and throat. This division reached San Francisco in 1915, when Dr. Houston limited his practice to the ear, nose, and throat and his associate, Dr. Walter Franklin, was named chairman of the new Division of Ophthalmology.

Dr. Wallace Bruce Smith assumed the chairmanship of the Division of Otolaryngology in 1924 and held the post for 21 years. He practiced otolaryngology exclusively and introduced for the first time the skill of broncho-esophagoscopy and the motor-driven suction for tonsillectomy.

In 1933 the Ear, Nose, and Throat Clinic was moved to a location in the new clinic building and the training program for residents was increased from one to two years.

The chairmanship was offered to Dr. Martin in 1944, but he felt that he would be unable to give the division adequate time and Dr. Lewis Francis Morrison accepted the position. He obtained autonomy of hospital beds for the division and enlarged the training program to include supervised training in affiliated hospitals. Under his direction, the Ear, Nose, and Throat Research Laboratory and Audiology and Speech Clinic were organized.

In 1950, the first division office was established by Dr. Morrison in space made available in the Ear, Nose, and Throat Clinic; an increasing workload dictated two expansion moves by the mid-1960's.

Dr. Francis Adrian Sooy succeeded Dr. Morrison as chairman of the division. He was named director of the Audiology and Speech Clinic in 1953, acting chairman of the division in 1956, and chairman in 1958. His clinical interest centered around the growing field of microscopic otological surgery.

Under the direction of Dr. Sooy and Dr. Meyer Schindler, vice-chairman, the division grew to include three full-time staff members as well as 33 part-time clinical staff members, most of whom were trained in the division's program. There are 12 residents in the training program. source