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Lessons to Be Learned from the History of Anatomical Teaching In RELEVANT REVIEW Lessons to be Learned From the History of Anatomical Teaching in the United States: The Example of the University of Michigan Sabine Hildebrandt* Division of Anatomical Sciences, Office of Medical Education, University of Michigan Medical School, Ann Arbor, Michigan Although traditional departments of anatomy are vanishing from medical school rosters, anatomical education still remains an important part of the professional training of physicians. It is of some interest to examine whether history can teach us anything about how to reform modern anatomy. Are there lessons to be learned from the history of ana- tomical teaching in the United States that can help in the formulation of contents and purposes of a new anatomy? This question is explored by a review of US anatomical teaching with special reference to Franklin Paine Mall and the University of Michigan Medical School. An historical perspective reveals that there is a tradition of US anatomi- cal teaching and research that is characterized by a zeal for reform and innovation, scien- tific endeavor, and active, student-driven learning. Further, there is a tradition of high standards in anatomical teaching through the teachers’ engagement in scientific anatomy and of adaptability to new requirements. These traditional strengths can inform the innovation of modern anatomy in terms of its two duties—its duty to anatomy as a science and its duty toward anatomical education. Anat Sci Educ 3:202–212, 2010 © 2010 American Association of Anatomists. Key words: history of anatomy; anatomical education; reform of modern anatomy; University of Michigan; Franklin P. Mall; ethics in anatomy; review INTRODUCTION courses that include formal anatomical training and the clas- sic learning tool of student dissection of the human body It is a curious fact that anatomy, the subject that served as a (Drake et al., 2009). Even where dissection is no longer per- leading science in the founding of medical schools, is today formed, the teaching of the structure of the human body by frequently missing from departmental rosters of medical other means is central to the education of future medical doc- teaching institutions in the United States. Classical depart- tors (McLachlan and Patten, 2006). Whether viewed as a ments of anatomy have been replaced by departments of cell research or teaching endeavor, academic anatomy has biology, subsumed into clinical departments like surgery, or changed considerably and questions must be raised concern- transformed into smaller units of medical education depart- ing the contents and purposes of a new anatomy. The aim of ments. Nevertheless, most medical schools still offer anatomy this article is to investigate this problem by reviewing the his- tory of anatomical education in the United States, with the *Correspondence to: Dr. Sabine Hildebrandt, Division of Anatomical University of Michigan as an example, to formulate sugges- Sciences, Office of Medical Education, University of Michigan tions for the future duties of anatomy. Medical School, 3767 Medical Science Building II, Catherine Street, Ann Arbor, MI 48109-0608, USA. E-mail: [email protected] Received 20 April 2010; Revised 20 May 2010; Accepted 10 June THE BEGINNINGS OF ANATOMY IN 2010. THE UNITED STATES Published online 9 July 2010 in Wiley InterScience (www. interscience.wiley.com). DOI 10.1002/ase.166 In her biography of the anatomist Franklin Paine Mall, his pupil Florence Sabin, the first woman to become a full profes- © 2010 American Association of Anatomists sor of anatomy in the United States, quotes Dixon Ryan Fox Anat Sci Educ 3:202–212 (2010) JULY/AUGUST 2010 Anatomical Sciences Education in stating that the history of medical education in the United mical and pathological specimen to the university at his States is a cultural transfer from Europe that occurred in four retirement from his position of full professor of anatomy in stages (Sabin, 1934). In the beginning, a few physicians 1847 (Warren Anatomical Museum, 2010). Likewise, Thomas trained in the old country served pioneer communities. Then Dent Mu¨tter, a surgeon at Jefferson Medical College, pre- native youth interested in the medical profession traveled to sented his collection to The College of Physicians of Philadel- the mother country for training, until medical schools were phia in 1858, thus founding the Mu¨ tter Museum (Worden, established in the new country by foreign-trained teachers. 2002). Indeed, a well-stocked museum was frequently seen as Finally, the schools in the new country became adequate. an ‘‘indispensable supplement to the dissection of cadavers’’ While all these stages can be observed in the history of US and used as a selling point in circular advertisements for med- medical schools, they did not occur strictly chronologically ical educational institutions (Sappol, 2002). but coexisted over long stretches of time. The three different systems of medical education existed In the 17th and early 18th century, foreign-trained physi- concurrently throughout the 19th century and the develop- cians served their communities in the new North American ment of adequate medical schools that trained competent colonies (Sabin, 1934). William Shippen Jr. of Philadelphia physicians in the new country only began in the 1890s. What was among the young men who went to London to study were the reasons for this delay? First, quality standards for anatomy with John and William Hunter. In 1746, William medical schools were lacking. By the middle of the 19th cen- Hunter had newly introduced the ‘‘Paris manner of dissec- tury, a general decline of the quality of medical education tion,’’ which was anatomical dissection by students them- was noted (Bardeen, 1905). Hartwell traced this development selves as opposed to teaching anatomy by demonstrations back to the lack of influence of the state on the many (mostly only (Gelfand, 1972). After his return from Europe, Shippen privately owned) medical schools, thus making quality con- started the first North American medical school at the Col- trol impossible (Hartwell, 1881b). Second, Hartwell criticized lege of Philadelphia in 1765 and made anatomy the founda- the insufficient legislation concerning the provision of human tion of his medical teaching. He offered courses in anatomical bodies for anatomical dissection. In his opinion, US legisla- dissection accompanied by didactic lectures (Blake, 1955). So, tion compared unfavorably to European legislation, where from the beginning of systematic medical education in the individual states made liberal provision for anatomical insti- United States, the most modern European method of anatom- tutions by allowing them the use of unclaimed bodies of per- ical teaching, dissection by medical students, was employed sons who had died in public institutions such as hospitals and in some North American medical schools, thus promoting prisons. Third, anatomy remained the main subject of most active learning by students. Many other private physicians medical schools, but the teaching was often focused on lec- and educational institutions adopted Shippen’s example in the tures instead of dissections by students. The teachers were following decades and founded their own medical schools, physicians who taught anatomy exclusively as a clinically among them Harvard, Dartmouth, New York, and William applied discipline and they had little time for their students and Mary College by1800 (Hartwell, 1881b). and less time for innovations in the field of scientific anat- Throughout the 19th century, there existed three different omy. A fourth reason may have been the continued expansion basic systems of medical education: first, the apprenticeship of the United States into the Western territories and the with a physician; second, the proprietary school providing accompanying pioneer mentality. Fox stated: ‘‘civilization theoretical and clinical training by the physician-owner; third, [...] declines when it strikes the frontier’’ (Fox, 1927) and the university associated medical school (Halperin et al., observed a relaxation of legal standards for the practice of 2010). At the beginning of the Civil War, 85 mostly proprie- medicine and of medical standards in general far into the tary medical schools existed (Bardeen, 1905), by 1905 there 19th century. Medical educators were not unaware of these were 160 (Michels, 1987). By 1830, nearly half of all medical problems and early attempts at reform were made. In 1859, schools were located in small towns of rural America, an the Medical Department of Lind University in Chicago, a arrangement that had no equivalent in Europe but served the forerunner of Northwestern University Medical School intro- education of a significant number of physicians in the new duced a graded curriculum, and in 1857, New Orleans country (Bonner, 1995). In all the three types of medical School of Medicine decided on a thorough reform of clinical education, the teachers were practicing physicians and teaching that included active participation of students in care surgeons, who trained their students clinically in their private for patients (Ludmerer, 1985). However, these reforms were practices. Their teaching was accompanied by short courses isolated and other endeavors failed due to a lack of insight of formal lectures, mostly on clinically relevant anatomy. into the importance of experimental medicine by many clini- During this early period of US medical education, teaching cians (Bonner, 1995) and the fact that a ‘‘modern philosophy
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