Chapter 35

• Chapter Summary
• Dean Ophüls'Administration
• Stanford Medical School during World War I
• Curriculum Changes
• Endowment Campaign
• The Hoover Presidency
• Ray Lyman Wilbur

Dean Ophüls' Administration
1916 - 1933

Dean Wilbur was elected President of Stanford University effective 1 January 1916 and on that date Dr. William Ophüls was appointed Acting Dean of the School of Medicine to replace him. Dr. Ophüls was appointed Dean on 1 August 1916.

As Acting Dean of the School of Medicine Dr. Ophüls submitted the Annual Report of the Medical School to the President of the University for the Year Ending 31 July 1916. In that Report Dr. Ophüls included the following two items: ^[1] 

Dr. Wilbur later made the following comment about his successor: ^[2] 

On 1 August 1916 Dr. Hewlett succeeded Dr. Wilbur as Professor and Executive Head of the Department of Medicine and its Subdivisions. The appointment of Dr. Hewlett, Hopkins and Pioneer Clinical Physiologist, could not have been more timely and appropriate. It served to reinforce the policy already established by Dean Wilbur of making professorial appointments to clinical departments on a geographic full-time basis and only to candidates with strong credentials in research.

Dr. Hewlett, was not only a trained physiologist but also a skillful practitioner. Throughout his career he was orderly, thorough, scientific and attentive to the needs of the patient. He was also a brilliant teacher, sound medical statesman and outstanding example of the contributions made by graduates of The Johns Hopkins School of Medicine to the growth and development of the Stanford program, and to the academic programs of numerous other medical schools nationwide. These and many of the subsequent references herein to Dr. Hewlett's career draw extensively on the definitive article on this subject published in the Johns Hopkins Medical Journal in 1979, and written by A. McGehee Harvey, Distinguished Service Professor of Medicine at Hopkins, and foremost authority on clinical research in American Medicine. ^[3] 

Albion Walter Hewlett, the son of Frederick and Cleora Melissa Whitney Hewlett, was born on 27 November 1874 in the small California town of Petaluma some 40 miles north of San Francisco. His early schooling included enrollment in the "classical" course at the San Francisco Boys High School (despite its name it was coeducational.). After two years in the High School he was admitted to the University of California at Berkeley where he graduated with a B. S. degree in 1895.

First year Student at Cooper Medical College (1895). Determined then to become a physician, he matriculated in the first year class at Cooper Medical College which met from February 1st to December 5th, 1895.

Student at Johns Hopkins Medical School (1897-1900). Upon completing the first-year class at Cooper, Hewlett applied for admission to the second-year class at Johns Hopkins. He offered his having had the highest grade average in his class at Cooper as evidence of his scholarship, and as the main justification for his admission to the second year at Hopkins. Hewlett's brash application incited considerable discussion among the Hopkins faculty with the following result: ^[4] 

Hewlett followed Dr. Welch's advice and was admitted to the second year class at Johns Hopkins University School of Medicine on October 6, 1897.

Hewlett's first real research was conducted during his second year at Hopkins in collaboration with his California boyhood friend and future Nobel Laureate, Joseph Erlanger. This project resulted in a paper entitled "A Study of the Metabolism in Dogs with Shortened Intestines," published in the American Journal of Physiology in 1901. The dogs on which the study was carried out were those used by the noted Hopkins surgeon William Stewart Halsted and his collaborator Anatomist F. P. Mall in their search for reliable intestinal sutures. Hewlett graduated from Johns Hopkins with M. D. degree in 1900. ^[5] 

Internship in New York and Postdoctoral Study in Germany (1901-1903). After graduation from Hopkins in 1900, Hewlett interned for a year on the medical service at the New York Hospital. He then studied at Tubingen, Germany in 1902 and 1903 under the auspices of Ludolf Krehl who was one of the first to emphasize abnormal function (pathological physiology) as contrasted to pathological anatomy which was at that time in the ascendancy under the influence of Rudolph Virchow. Krehl's great monograph, Fundamentals of General Clinical Pathology was published in 1893. Five years later the title was changed to Pathological Physiology. This text went through many German editions and was translated into other languages, including the third edition which was translated into English in 1905 by Hewlett under the title of Clinical Physiology. This last volume went through three American editions.

Throughout his career Hewlett's primary research interest was in the emerging field of Clinical Physiology. Indeed his first major scholarly contribution in this area was the translation of Krehl's book into English in 1905. In so doing Hewlett rewrote the section in Krehl's book dealing with cardiac arrhythmia's based on his own observations and graphic records which were responsible for the correct explanation of the nature of auricular fibrillation. Sir William Osler, in his introduction to this work said: "In this book, disease is studied as a perversion of physiological function. The title, Clinical Physiology, expresses well the attempt which is made in it to fill the gap between empirical and scientific medicine. Every few years the laboratories seem to run ahead of the clinics and it takes time before the facts of one are fully appreciated by the other."

Faculty at Cooper Medical College, 1904-1908. Hewlett returned from Europe in 1904 and, at the age of thirty, joined the Cooper faculty where he held the following appointments

Upon joining the Cooper faculty, Hewlett began at once to study pathophysiological problems. In this endeavor he was encouraged and assisted by Walter E. Garrey, Ph. D., Professor of Physiology at Cooper, under whom he conducted much of his early research.

Hewlett's work in Garrey's laboratory resulted in three papers based on Simon Flexner's observation that great quantities of lipase, a fat-splitting enzyme of the pancreas, occur as a result of experimental acute hemorrhagic pancreatitis. Hewlett demonstrated the presence of lipase in the urine and roughly estimated the quantity present in dogs in whom pancreatic disease had been experimentally produced. The lipase was found in the greatest amount as a result of experimental acute hemorrhagic pancreatitis. ^{[6]  [7]} 

This paper was followed by two others on gastrointestinal enzymes after which Hewlett's interest shifted to the study of cardiovascular and respiratory physiology ad pathophysiology. In the coming years he pursued these studies with a diligence and success that gained for him national recognition as a scholar, teacher and clinical investigator. This led In 1908 to his election as a charter member of the American Society for Clinical Investigation, and as one of the three members of its original council. ^[8] 

Faculty at University of Michigan Medical School. (1908-1916). Such was Hewlett's research productivity and academic promise while still an Assistant Professor at Cooper Medical College that he was called to serve as Professor of Medicine at the University of Michigan Medical School, Ann Arbor, in 1908. There he replaced Dr. George Dock who had moved to Tulane.

At Michigan Hewlett maintained an incredible schedule. In addition to his voluminous research, writing, and other activities, including a modest private practice, he scrupulously maintained his schedule of class lectures, ward rounds and personal contact with his students and house staff. The latter believed him to possess to an extraordinary degree the gift of the great teacher to make complex subjects appear simple and understandable.

While Hewlett was at Michigan acquiring further national stature as a professor and clinical investigator, Cooper Medical College completed its orderly transition from proprietary medical college to the Stanford University Department of Medicine. Throughout this period Dr. Wilbur followed Hewlett's career with interest and admiration. He remembered him from as early as 1895 when Hewlett was a promising first-year medical student at Cooper and Wilbur, serving then as an Assistant in Physiology, was doubtless one of his instructors.

Since then Wilbur and Hewlett had become friends and professional colleagues as is indicated by the following revealing letter of 19 May 1911 on the subject of faculty affairs: ^[9] 

Appointment to the Stanford Medical Faculty (1916)

After months of uncertainty, the Stanford Trustees voted in the fall of 1915 for Dr. Wilbur to become President of the University and for him to take office on 1 January 1916. At the meeting of the Medical Faculty on 15 December 1915, it was announced that Dr. Hewlett would succeed Dr. Wilbur as Professor and Executive Head of the Department of Medicine, effective 1 August 1916. The dispatch with which Hewlett was appointed to the Stanford Faculty suggests that he was an ideal and willing candidate for the position, as he proved to be.

Before leaving his post at Michigan to assume the Stanford position, Hewlett summarized in simple terms his conception of a clinical department in a medical school. He said, in essence, that the clinical department which is not adding to the sum total of medical knowledge is already falling behind; members of the department must devote a portion of their time to research; facilities for such research must be furnished by the hospital or by the university; and, finally, the problems confronting clinical medicine at the present day involve not only the usual clinical observations of patients, but also the study of these patients by the various methods that are increasingly available in biochemistry, physiology, bacteriology, immunology and other emerging scientific disciplines. ^[10] 

By this time Hewlett was at the forefront of those who had assumed leadership in enlarging medicine's scientific base through clinical investigation. And it was just as he was leaving Michigan in 1916 that the first edition of his book, The Pathological Physiology of Internal Diseases, a volume of 700 pages, appeared. This monograph was based in large part on his own clinical observations and experimental work and was the definitive medical treatise of the day dealing with the pathophysiology of disease. As such, It went through several editions. ^[11] 

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