Eighty years ago if a student collapsed in his room he could lie there and die before the University took any official notice of his plight. President Eliot's benevolence towards his undergraduates in instituting the elective program did not extend to providing for their health.
But today a University-wide hygiene program cares for all the student's physical and mental ills, makes sure he doesn't succumb to food poisoning, and has embarked on extensive research into preventive medicine. Five selfless and foresighted men get partial credit for the phenomenal rise of this much-needed department. But the large part of its development was spontaneous, created by the increasing needs of the Harvard community. An enlarged student body, a new type of student, and the pressures of society which the University began to reflect brought the Hygiene Department to its present state.
Despite its numerous personnel and extensive facilities, Hygiene still has big problems. Like a growing boy bursting through the seat of too-tight trousers, Hygiene must get some new clothes to function adequately. Stillman Infirmary is ancient, outmoded and inconvenient. The Hygiene building itself is bulging with a pot-pourri of clinics, laboratories, and offices that crowd in on each other with abandon.
At one time the department's physical set-up was more than adequate. Now, according to Arlie V. Bock, Henry K. Oliver Professor of Hygiene, the only feasible solution would be to rip down Stillman and construct a combination infirmary and health center. His proposed site is between Dunster and Holyoke on the ground now taken up by Cronin's, Arthur Parker's, Cahaly's, and a parking lot.
Bock's chances of getting his building are up to a Corporation committee headed by former Corporation member and public health authority Henry F. Shattuck. The committee, however, is keeping mum on its findings and its report on the University's entire health organization will not be ready for some time.
Sensible Five
The five men who acted as society's agents in bringing Hygiene to its presets prominence were Bock, Henry K. Oliver, Marshall H. Bailey, Roger I. Lee, and Alfred Worcester.
When Oliver was an undergraduate during the 1870's he writhed at the health ignorance of both the students and the administration and vowed to someday donate funds for a professorship of Hygiene.
The Henry K. Oliver Professorship was finally established in 1920.
Bailey had become Harvard's first medical advisor, in 1897. He badgered alumni and the Administration for an infirmary and got it in 1902. For most of the next quarter century he was the school's only physician, performing hundreds of successful operations under primitive conditions and getting little thanks for his efforts.
Lee organized the Hygiene department in 1914, was the first Oliver Professor, and started a series of undergraduate courses on health information. Worcester, went him one better when he became Oliver Professor in '25, by holding small nightly classes on sex problems in student's rooms. He also began to develop a program of psychiatric aid and founded a clinic for employees.
Bock took over in 1935. He completely reorganized the department, developed an invaluable liaison with several Boston hospitals, started intensive research into preventive medicine and human development, and is now stuck with the major problem of trying to run an expanding department under continually stifling conditions.
Health Inevitable
Even though a few individuals did a lion's share of the work the changing striation of the university community was the main cause of the improvement Bock claims. A close look at the facts show him to be correct.
A century ago there was really no pressing need for a University sponsored health program. Most of the student body came from well-to do eastern fantails and had personal physicians. It is interesting to note that when the University finally appointed a "Medical Visitor" in 1823 he was instructed.
"Not to interfere with the practice of resident physicians among students. . .and to exercise no influence either in favor or against any special school of medicine."
In his first year, Dr. George Fitz, the Visitor, saw 660 students. In 1951, the Hygiene Department had 63,839 visits, including over 10,000 from employees. When Stillman opened in 1902 it admitted 223 patients; in only one year since the '20's, aside from the war, have confinements dropped below 1,000.
The tremendous increase cannot entirely be laid to a growing University population, which has only tripled since the late nineteenth century.
Neither does "mass health decline" explain the situation. Says Bock:
"It is not that men of today are less rugged than those of the past. The remarkable change in sociological outlook in the last 25 years has removed many barriers and set up others. . ." In other words, mental health problems now account for a good many of Hygiene's increases visits.
At Your Service
And, of course the majority of Harvard men are no longer self-sufficient easterners with private physicians. The more diverse student's geographic origins became, and the less their average family income, the more was the need for a University sponsored hygiene program.
Psychiatriste were unheard of at the turn of the century, but a year ago the three University psychiatrists saw 597 men in a total of 2,136 visits. Now they are booked solid for three weeks ahead.
Book attributes this to "a social revolution since the first war and the general insecurity and anxiety of the community which has become reflected in the undergraduate. The cold war has added an additional aura of anxiety and the tremendous competitions mixed with the desire for good makes to get into graduate schools have brought on all kinds of phony notions that are tough to dispel."
The number of services Hygiene supplies for the $30 medical and infirmary fee is astounding. The equivalent of 12 full-time dormers, two possible weeks a term at Stillman for every student surgical and psychiatric eliutes are only part of its continuos.
One formerly large activity is now non-extant, however. Since Rock took over in '36 there have been no major operations in Stillman's outmoded operating room. The great teaching hospitals affiliated with the Medical School, Peter Bent Brigham, Mass. General, Both Israel, the Eye and Ear, have taken care of Harvard's needs.
Bock has also worked out a deal with these hospitals where Hygiene partially subsidizes the enormous cost for postoperative care up to two weeks, almost as if the student was at Stillman.
The department maintains a laboratory with a staff of trained technicians. The Law school, Medical and Public Health school, and the Business school now have clinics. Two doctors are on call every evening. A surgical staff at Dillon Field House, supported by the H.A.A., gives over 20,000 treatments to athletes a year, and the three-man dental staff sees over 4,000 cases per annum.
One of the least known, but most important of Hygiene's services has been the sanitary inspection of all the University dining halls, swimming pools, and plumbing. This started in the late '20's when food poisoning was getting to be a common occurrence.
For instance, students no longer eat certain kinds of pies because the sanitation staff found they tended to create gastroenteritis. In '49 a rash of sickness was traced to a contaminated meat cutter. Dining hall employees now get lectures on how to handle food, and a diarrhea epidemic in Andover court was stopped a few years ago when Dr. George Moore found its source in a clogged sewage system.
Blood-Letting
Research, too, is an important function. Every man who has the ill-fortune to collapse with mononucleosis (62 in '51) gets Dr. Andrew Contratto's pamphlet on the disease as part of his Stillman reading-matter. Mono was unknown here until twenty years ago when laboratory blood tests began showing a startling breakdown of white blood corpusles, among other things.
The remarkable recovery time of mono patients (about two weeks, compared to the usual two or three months convalescence) is due to the quick action of University physicians in diagnosing and treating the disease. But speedy recovery is not restricted to mononucleosis. Recent figures show that patients spend an average of 3.7 days in the infirmary where in the 20's the average stay was 6.9 days.
When it comes to tallying up all these functions plus the compulsory physical exams, an employees' clinic, and the added load of making physical reports for graduate school and Fullbright applicants, it is easy to see why Hygiene runs a large yearly deficit.
Other major problems are apparent. There are still no medical or infirmary facilities for women students, and the number of women in the graduate schools has been increasing each year. According to Miss Reta Corbett, Stillman superintendant, two girls did manage to lodge in the infirmary for a night each, but it was only because one whole wing was empty.
The Hygiene building itself is hardly a place for an adequate medical center. It was set up in the shell of the old Spec Club that burned down in 1930. The inside is like a spider-web, with myriads of narrow hallways. Cramped offices lack of storage space, and a tiny den for testing eyes that no self-respecting optometrist would tolerate make life tough for both doctors and patients.
Some years ago the surgeons forced the employees' clinic into a little, shanty next door, but any more expansion on the present site would take out the walls.
Stillman too has its trouble. Miss Corbett and her excellent staff of 15 nurses are making the best of a bad thing. Besides its inconvenient location, the old building has not enough facilities for contagious patients. The private rooms have no running water, and there is, only one toilet a floor. The staff has no access to student's previous records which are in the Hygiene building two miles away, and doors and elevators that won't admit beds are becoming a nuisance.
The situation was worse when Bock took over. In 1935 he pulled down the outside staircase that nurses had to use to get to their apartments on the top floor, and put in an elevator. He installed running water in the wards and lockers for student's clothing, items hitherto unknown. The most important innovation was a 50-bed wing to bring the infirmary's capacity up to 115. The medical set-up now is a paradise compared to what it was at the turn of the century.
Students Dense
Bailey became the University's first full-time doctor just as the situation was beginning to get out of hand in 1897. "The students are densely ignorant not only of the manifestations of disease, but of the means of maintaining health and strength," he said.
He opened an office in Wadsworth House and immediately began to plug for an infirmary. James Stillman of New York was the first to heed Bailey's plea. He came across with $150,000, and Stillman opened in 1902.
But Bailey wanted more. His first attempt to get compulsory health insurance failed because students balked at Stillman's lack of facilities for contagious cases. During the 19th century the only place a man with measles could go was a dank "pest-house" on Soldiers Field. After this went out of business, people with communicable diseases had to pay the exhorbitant prices of local hospitals or endanger their dorm-mates by staying in their rooms.
An additional gift finally got the infirmary a contagious ward, and in 1905 an enlightened administration levied a $4.00 yearly infirmary fee on all students. The fee provided two weeks in Stillman per man.
Having a doctor around was a good thing, and the students knew it. It was not long before the less industrious took advantage of the new set-up, and in Bailey's report of 1903 we find the first mention of a problem that has plagued Hygiene for the last fifty years.
"I wonder why it is that sign-off's in the college are twice as high as those in the graduate school." Clever undergrads were already beginning to find medical excuses a fine way to cut classes or exams.
New Organization
Appendicitis was considered a major operation in the early years of the century, and death came often during operations. It is a tribute to Bailey's skill as a surgeon that all of the 57 appendix operations during the infirmary's first ten years were successful. Another major disease, diptheria, could claim none of the 63 men struck by it during this period.
Dr. Lee's first move after he had organized a Department of Hygiene in 1914 was to require medical exams for all students in the College. Five years later the Freshman compulsory physical training program went into effect.
The influenza epidemic of 1918 hit Harvard hard. Some 258 men landed in Stillman, but the efforts of a quickly augmented staff held the deaths to six, far below the national average.
A grant from the U. S. Interdepartmental Social Hygiene Board in 1919 gave Lee an opportunity to start courses in Sex and Hygiene. Lee's successor, Dr. Worcester, didn't think the poorly-attended lectures were sufficient. Partly as an attempt to get to know students, he began a series of small nightly talks in the freshman dormitories on the problems of sex. He was amazed at how little they knew.
Soon his soirees were drawing the entire freshman class, despite the righteous indignation of puritanical proctors. Worcester also founded the employees clinic in '32 and had appointed a part-time psychiatrist eight years earlier. He built up an eye clinic and got a doctor to take care of hapless med school men, also.
Unfortunately, his proposal for a $500,- 000 health center met with little success.
A new-extinct institution of the Worcester era was Lyman House. Miss Mabel Lyman recognized the need for a place in which students could convalesce after leaving the infirmary, and donated a home that hundreds of men utilized over a period of 20 years. One of Lyman's House's main functions was to take care of mentally-disturbed students who needed the security of something more than dormitory life. It went out with the war.
With Bock's administration the infirmary fee went up to $20 a year, and a speech clinic was instituted. The depression had left its mark on Harvard.
Thusly, by 1939 the work of the psychiatrists and the late Fatigue Laboratory had become extremely important. In that year a breakdown of mental disorders by class showed that most psychopaths were freshmen. Anxiety neurosis was low in the three bottom classes but very marked among seniors and graduate students. Juniors suffered most from vocational problems.
With the war, Hygiene had fewer Harvard men to care for, but was burdened with the large numbers of service personnel who were shuttled through the University. The returning veterans got its full support, however, with special remedial exercise classes for disabled men and other benefits. When a group of married students moved into Harvard-evens village some 40 miles away the department immediately opened up an infirmary there with a staff of doctors.
Study of Normalty
One of the department's major functions in the last fifteen years has been the Grant Study. Started in 1938 with Grant Foundation Funds the study has probed the development of over 200 normal students to discover regularities in human behavior.
"The study is a departure from usual medical concepts in that we are searching primarily not for the liabilities but for the assets of the person. We have considered such factors as health, physique, heredity, physiology, socio-economics and cultural influences, and such personality factors as may be revealed by interview and psychological testing. . .No one has heretofore been in such a favorable position to observe systematically the consequences of Harvard undergraduate decisions."
Hygiene's widespread precautionary system has prevented the spread of any major epidemic since the great flu rage of 1918. The only recent flare-up was another rash of influenza that was quickly scotched two years ago. In '48 a state-subsidized chest x-ray program found only 3 cases of active tuberculosis out of 7.563 pictures, well below the national average.
The common cold, however, is still the bugaboo. It is twice as prevalent as any other disease, and even the men at Hygiene don't know what to do about it.
Such has been the development of one of the largest University-run health programs in the country. It has many weaknesses and needs, but has been of unparalleled service to the Harvard community. It needs much improvement, but whatever happens the many Corporation-appointed doctors and the rest of Hygiene's large and capable staff will continue to fulfill what Bock calls the department's two main objectives.
"1. The care of the sick, advice, and teaching of common sense principles in regard to health.
"2. Investigation into the problems of man."
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