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San Francisco: Departments
Obstetrics and
Gynecology
Operative Dentistry
Opthamology
Oral Biology
Oral Roentgenology, Section of
Oral Surgery
Orthodontics
Orthopaedic Surgery
Otolaryngology
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
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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
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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
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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
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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
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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
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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
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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
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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
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