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Department History (1858 - 2003)
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1858-1912 1913-1930 1931-1942 1943-1958 1959-1968 1969-1970 1971-1985 1986-2006 |
1943-1958 The University Enters Infirmary Management—and Ophthalmology All But Moves to Adams and Peoria Streets
The agreement of 1943 explicitly provided for Public Welfare and the University to cooperate in moving the Infirmary to the campus, "as soon as funds can be secured for the building of a new hospital." As departmental Annual Reports reveal, Illinois faculty seemed almost eternally hopeful that adequate funding would appear at any moment. Repairs and renovations at the Infirmary, however urgently needed, were always considered carefully, in the thought that the cost might not be justifiable "for only a few more years" at the old location. In actuality, of course, it was not until 1965 that the Infirmary moved into a new building on Taylor Street, near the other Research and Educational Hospitals. By that time there were four units at the corner of Adams and Peoria alongside the original Infirmary building (then 91 years old), the five occupying a total of 62,000 square feet.
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Hallard R. Beard, Faculty, University of Illinois College of Medicine, 1919-1960, and Acting Head of Ophthalmology, 1927-1936 |
The years of "semimerger" at the old location (1943-1965) were marked by service of a remarkably high quality, and by some investigative work as well—although both suffered because of the age of the facilities and the difficulties of rendering complete patient care at so great a distance from a full hospital. (It was especially hard to treat eye patients with diabetes under these conditions.) Thanks to a high degree of compatibility between the superintendents managing Infirmary operation and maintenance for Public Welfare and the professional "Deans of Instruction" (as they were called for a time) appointed by the University, the Infirmary continued to render an enormous amount of health care. The educational opportunities it provided for residents were nothing less than extraordinary—including a wealth of unusual eye pathology among the derelicts who tended to wander in from nearby Madison Street during the coldest months of the year.
Perhaps it was inevitable that joint operation by two state institutions operating under different calendars should give rise to occasional snags. Public Welfare, for example, had eleven annual holidays, while the University observed only six. Therefore there were five days each year when the Infirmary was open to patients as usual—even though clerical workers and those who provided "hotel services" were absent en masse. On these occasions University doctors and nurses raced about to supply food service and perform housekeeping chores—in addition to their professional work. In general, dual operation— however unsound the concept—worked satisfactorily in this period because of the will to cooperate on the part of the personalities involved. Between 1946 and 1958, the Infirmary Superintendent appointed by Public Welfare was the honest and able Lester Gerber. Representing the University as Head of Ophthalmology at the Infirmary was William F. Hughes, Professor and Head of Ophthalmology from 1947 to 1959.
Hughes was the first official Head the Department had had since E. V. L. Brown resigned in 1925. During the intervening decades, when Hallard Beard acted capably as Head, uncertainty about the University's relation to the Infirmary clearly hampered the development of Ophthalmology at Illinois. Beard first joined the Ophthalmology faculty in 1919 and first served as Acting Head between 1927 and 1936. (In 1933, during Beard's first administration, Roosevelt Brooks joined the Ophthalmology Department, reportedly the first black member of the College of Medicine faculty.) In the Annual Report Beard wrote in behalf of the Department in 1947, he explained that the few hospital beds allotted to Ophthalmology (eight) limited residency training to one or two (there was housing in the hospital for only one). (Few beds though they had, ophthalmic surgeons— who had begun using gloves—accounted for some of the rising costs of equipment in the "Operating Rooms," or so Warren Cole suggested in his Annual Report for that unit in 1947-48.) Beard believed that an expanded residency program depended on better utilization of such affiliated institutions as the Infirmary and the VA, rather than on the Hospital Addition then in the planning stages.
Beginning in 1945, a flood of letters to the department from veteran medical officers in the United States and overseas had inspired Beard to plan a three-month "Basic Science Course,'' covering the groundwork necessary for future training in ophthalmology. As Beard envisioned it, the course would be given largely by the pre-clinical departments beginning in 1947. When Hughes became Head, he expanded this scheme into a full-time post-graduate course. Incorporating aspects of a six-to-nine-month course in use at Northwestern, the Illinois course, first given from October 1948 to May 1949, included 800 hours of formal instruction. Hughes also tightened coordination of Ophthalmology's clinical, professional and teaching services, rotating Research and Educational Hospital residents in ophthalmology to the Infirmary and lengthening the residency to three years.
With the title, ''Director of the Ophthalmology Service," Hughes organized divisions of the Infirmary under corresponding departments of the University, beginning with Radiology and the Laboratories. He soon added a medical artist and social service; a pharmacy to make prescriptions averaging 84 daily (formerly done by assistant superintendent nurses); a "medical consultant" (George Brebis) for patients with medical conditions; a medical records librarian (1954); and personnel to fit contact lenses in the Infirmary Optical Department (1956).
A shortage of hospital beds plagued Hughes' entire tenure. Ophthalmology's six adult and two pediatric beds were reduced by four adult beds in 1949, and the loss was not restored until 1955, shortly before Hughes left the Headship. In the bleak interim Hughes confronted admissions backlogs of six weeks to several months at the Hospital, as ophthalmology outpatient visits rose between 1947 and 1948 from just under 8,000 to just over 9,000 at the Research and Educational Hospital, and from 48,000 to 60,000 at the Infirmary. Hughes' service was sometimes forced to refer patients seen at Research and Educational Hospital clinics to beds at the Infirmary!
Beds were scarce at the Infirmary too, despite Lester Gerber's valiant efforts to increase their number without sacrificing critical functions; but the Infirmary far surpassed the University, where Ophthalmology had effectively become an outpatient function by 1954. As Hughes pointed out at a General Faculty Meeting in 1956, the allotment of resources, and the mere eleven hours Ophthalmology had in the undergraduate curriculum, scarcely did justice to the facts: Ophthalmology was then responsible for 70,000 out-patient visits yearly, compared to only 133,000 in all other branches of medicine and surgery combined.
Administrative shuffling within the University during this period was at least partly responsible for the difficulties Hughes encountered. World War II, with its staff shortages and accelerated curriculum, was under way when the Infirmary first came under joint University operation in 1943. In that same year Dean Davis retired, and the Board of Trustees named as his successor for the duration Raymond B. Allen, who had served since 1938 as the first chief executive officer of the Chicago Professional Colleges (under the title of "Executive Dean"). When Allen left Illinois in 1946, the University (under its new President, George D. Stoddard) put Andrew C. Ivy at the head of Medicine, Dentistry and Pharmacy as a floating CEO with the title of "Vice-President of the University of Illinois in Charge of the Chicago Professional Colleges." Against the recommendations of President Stoddard, who wanted the Dean of Medicine to be in charge of the entire professional campus, the Trustees named a separate individual (John B. Youmans) as Dean of the College of Medicine.
The first three years of joint Infirmary operation, between 1943 and 1946, coincided with these numerous, closely spaced changes in important administrative positions. University officials were shifting so rapidly that no one seems to have thought out a judicious plan for integrating the Infirmary with existing University apparatus. In 1946-47 Dean Youmans served as "Medical Director of the Illinois Eye and Ear Infirmary"; in the next year's reorganization the Medical Director of the Research and Educational Hospitals was designated also as Infirmary Medical Director, while the Heads of Ophthalmology and Otolaryngology became chiefs of those services at the Infirmary: in 1950, the year in which Stanley Olson succeeded Youmans, the Dean of Medicine was again made Medical Director of the Infirmary - and of the Research and Educational Hospitals as well! In March 1951 Vice President Andrew Ivy publicly introduced Krebiozen as a treatment for cancer, unleashing a chain of administrative upheavals that made the war years look placid.
Despite material shortages which curtailed both teaching and clinical research, and the equally persistent problem of transferring patient records between the Hospital and the Infirmary, the Hughes years saw a surprising number of noteworthy advances. During this period Ophthalmology inaugurated a special Beta Irradiation Clinic under the management of Albert Biegel; a Motility Clinic under Martin Urist; a Uveitis Clinic under Maurice Pearlman; and an electroretinography laboratory, which Alex Krill started while a resident. The Glaucoma Clinic, which had been founded by H. Saul Sugar, flourished under Peter Kronfeld and Joseph Haas, while Kronfeld, in an "ivory tower" penthouse laboratory improvised on the top floor of the old Infirmary hospital, began work on the physiology of the aqueous. As Hughes recalls it, it was Henry Mundt, Jr., who "came up with the new idea of using ultrasound" for diagnosing posterior ocular lesions when opaque media blocked visual techniques of examination. In 1956 Mundt and Hughes coauthored the first publication describing this important advance in methods of delineating posterior ocular pathology.
With ten adult beds in the Hospital Addition beginning in 1955, the faculty began to have more interesting cases and more complicated surgery, notably retinal detachments and corneal transplants. Given greater proximity to the Infirmary and a few more resources, the University could have made even better use of a facility which, as it approached 100,000 out-patient visits yearly, had become one of the largest eye, ear, nose and throat hospitals in the nation. As Hughes has summed it up: "Although all Residents were encouraged to pursue a research project, lack of facilities and stimulation prevented most of them from producing much more than clinical surveys.'' To alleviate this situation, Hughes obtained a Graduate Training Grant in Ophthalmology from the National Institutes of Health. Shortly before leaving the Headship, he inaugurated a research-oriented training program for residents.
As the years passed without sign of real intent to move the Infirmary into the campus, Hughes' Annual Reports began to smolder with stultified research instincts. He made repeated requests for the laboratory facilities and personnel necessary for research into the biochemical and physiological problems of the eye, but the only response forthcoming was from George Wakerlin, the Head of Physiology. In a thoughtful, constructive letter to Dean Bennett at the time of Hughes' resignation in February 1958, he urged that eye faculty be put on geographic full-time, allowing them to have some private patients at the Research and Educational Hospitals. He also suggested mandatory vacations of two to three months (including time at professional meetings), because "There is no fundamental reason why a professor at the Chicago Professional College should have greater mental and physical stamina than a professor at Urbana"—indeed, the stress of patient care might even predispose to "battle fatigue. "
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William F. Hughes, Professor and Head of Ophthalmology, University of Illinois College of Medicine, 1947-1958; |
Among other suggestions concerning use of the Infirmary at its old location, Hughes urged converting the top nursing floor into space for clinics, laboratories and offices. He questioned whether the University, with its small eye faculty, should continue to attempt care for the huge patient loads that resulted from Public Welfare's policy of universal admissions. It might be better, he thought, to reduce the number of University beds at the Infirmary, admitting only for teaching and research purposes, while cutting the resident staff by half and greatly increasing research facilities and the number of salaried teaching staff.
Hughes strongly urged that some way be found to maintain the Infirmary's identity when it eventually moved to campus, for it had earned a great reputation "not only in Illinois but throughout the world."
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