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The University of Michigan Medical School, 1850-2000 “An Example Worthy of Imitation”

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The University of Michigan Medical School, 1850-2000 “An Example Worthy of Imitation” SPECIAL COMMUNICATION The University of Michigan Medical School, 1850-2000 “An Example Worthy of Imitation” Howard Markel, MD, PhD The 150th anniversary of the University of Michigan Medical School af- fords occasion for both celebration and reflection, not just in Ann Arbor but THE EARLY YEARS: 1817-1847 throughout the world, as we consider its contributions to medical educa- While Michigan was still a territory of the tion, research, and health care over the past century and a half. This article Northwest Ordinance, a legislative act of explores the medical school’s origins as a frontier medical outpost and de- August 26, 1817, established the Cathol- scribes the vital reforms in medical education implemented in Ann Arbor long epistemiad, or University, of Michiga- before the landmark Flexner Report on Medical Education of 1910. It also nia in Detroit (population, 4000). The depicts how and why the medical school developed as it did and what fea- school, whose mission spanned the pri- tures are distinctive or typical about the school during this period. mary to the university levels, struggled JAMA. 2000;283:915-920 www.jama.com to exist. After the devastating cholera epi- demic of 1832, it closed and sold its prop- of the ill took place primarily in the The petition was referred for further erty for $5000, which was set aside as a home and was largely in the domain of study to a committee chaired by physi- general fund for a future University of female members of a family. Their un- cian and university regent Zina Pitcher, Michigan. It was not until March 1837, derstanding of disease was a blend of a graduate of the Castleton (Vermont) shortly after Michigan was granted state- knowledge picked up from friends, rela- Medical School and Middlebury College hood, that the legislature passed an act tives, occasional interactions with phy- (MD, 1822). After an 8-year career as a to establish the university. After heavy sicians and alternative healers, and per- US Army surgeon, Pitcher settled in De- politicking by at least 4 Michigan settle- sonal experience. The few physicians troit in 1836 to marry and practice medi- ments, the legislature approved a 40- who did practice in Ann Arbor during cine. In an attempt to spur the university acre site donated without cost to the state this period often offered commonly used into establishing a medical department by a group of citizens from Ann Arbor medicinals and humoralism-based in- of its own, he opened a proprietary medi- in which to situate the proposed univer- terventions such as bleeding.3,4 calschoolin1846,whichfailedandclosed sity. This decision was controversial, es- in 1847. In May 1847, however, Pitcher pecially for those living in Detroit, the FOUNDING THE MEDICAL attended the first annual meeting of the major entry point to Michigan because SCHOOL, 1847-1865 American Medical Association in Phila- of its deep-water port. In 1837, Ann Ar- Financial crises and administrative in- delphia, where he was a member of the bor was only 13 years old, a tiny fron- ertia made the establishment of a medi- education committee and learned about tier village with a population of only cal school at the University of Michi- the inadequate level of medical education 2000, including several German immi- gan difficult until January 1847, when across the United States. He soon became grant families and 9 physicians. Native a group of local physicians petitioned the convinced that it was the state’s obliga- Americans still came to town to trade regents. These physicians conducted a goods, and transportation between Ann survey and found that some 70 “Michi- Author Affiliation: Department of Pediatrics and Com- municable Diseases, Department of History, and His- Arbor and other points relied on stage- gan boys” had left the state to study (and torical Center for the Health Sciences, The University coach. Railroad lines to Detroit were not most likely, practice) medicine else- of Michigan Medical School, Ann Arbor. 1,2 Corresponding Author and Reprints: Howard Markel, established until 1839. where. This potential paucity of a new MD, PhD, Historical Center for the Health Sciences, Health care in Michigan during this crop of available physicians, they The University of Michigan Medical School, 100 Simpson Memorial Institute, Box 0725, 102 Ob- period was similar to that of the rest of warned, was bound to have an impact servatory, Ann Arbor, MI 48109-0725 (e-mail: the early frontier United States. The care on the health of the young state.5,6 [email protected]). ©2000 American Medical Association. All rights reserved. JAMA, February 16, 2000—Vol 283, No. 7 915 Downloaded From: http://jama.jamanetwork.com/ by a University of Michigan User on 01/05/2015 UNIVERSITY OF MICHIGAN MEDICAL SCHOOL tion to protect the health of its citizens The board of regents unanimously eningofthemedicalschool,andthemedi- and the best way to reach this goal would adopted Dr Pitcher’s recommenda- calbuilding,modeledafteraGreektemple be to establish a first-rate medical school. tions to establish a medical school and withcolumnsandaportico,wasnotready Such thought was remarkably advanced appropriated $3000 to construct a until the fall of 1850 (FIGURE 2). The fi- for a post-Jacksonian era American and medical building to be opened by the nalcostofthebuildingwasapproximately presages much public health and medi- following autumn. Five professors were $9000, but it boasted several lecture cal education policy making of the late appointed over the next 2 years: Silas rooms, offices for the professors, a chem- 20thcentury.OnJanuary9,1848,Pitcher Douglass (pharmacy and medical ju- istry laboratory, and a room under a submitted the blueprint for the medical risprudence, 1848), Abram Sager domed roof designed for anatomical dis- school to the regents: (physic or medicine, 1848, and obstet- sectionswheneverahumancadavercould rics and the diseases of women and chil- be procured.9,10 The first class consisted If it can be conceded that it is the duty of this Board when circumstances favor that dren, 1850, and the first dean), Moses of 90 matriculants and 5 physicians seek- end, to establish a Medical Department of Gunn (anatomy and surgery, 1849), ing additional training. Unlike many US the university, it may also be seen that we Jonathan Adams Allen, Jr (pathology medical schools at that time, Michigan who have the administration of a splendid and physiology, 1850), and Samuel could claim its own building on a univer- trust are charged with the execution of a Denton (physic, 1850)8 (FIGURE 1). sity campus—as opposed to another lo- high and responsible duty in setting be- fore such Institutions in our organization, Underestimates of construction costs cation or no affiliation at all with a an example worthy of imitation.7 and inclement weather plagued the op- university—and, unlike all other medi- cal colleges in the nation, in having pro- fessors whose salaries were entirely paid Figure 1. The University of Michigan Medical School Founding Faculty by the university. The latter meant that students were not required to buy admis- sion tickets directly from professors for the lectures and demonstrations that made up the curriculum.11 Many other schools were owned by busy practition- ers and operated on a for-profit basis, hence the term “proprietary medical school.” Few medical schools were at- tached to a hospital nor did many have aspecificbuildingforlaboratoryexercises or lectures. At most of these institutions during the early- to mid-19th century, medical instruction was deemed by con- temporary observers to be inadequate. At Michigan, admission required evi- dence of “good moral character” and knowledge of Greek and Latin. Few stu- dents went to college, but many were graduates of provincial high schools, as was typical for the good medical schools in the nation such as Harvard Medical School in Boston and the College of Phy- sicians and Surgeons in New York. Once in medical school, students attended 4 lectures per day, Monday through Fri- day,withaclinicaldemonstrationonSat- urday mornings, from October to April. Studentswererequiredtorepeatthesame 6-month regimen the following year and to present a thesis on a topic of their choice, which was essentially a review of the literature on a specific topic. University of Michigan medical stu- dents, like their peers at other medical 916 JAMA, February 16, 2000—Vol 283, No. 7 ©2000 American Medical Association. All rights reserved. Downloaded From: http://jama.jamanetwork.com/ by a University of Michigan User on 01/05/2015 UNIVERSITY OF MICHIGAN MEDICAL SCHOOL schools across the nation, were also re- Figure 2. The 1850 University of Michigan Medical School Building quired to serve as apprentice to a “re- spectable physician” for 3 years before or during the periods between the di- dactic terms in Ann Arbor. This re- quirement served as the principal means of teaching clinical medicine at Michi- gan until 1880. While an apprentice, the student took on a variety of duties rang- ing from hitching the physician’s horse to his buggy and compounding pre- scriptions to holding down a patient un- dergoing an operation without anes- thesia.5(pp1-7) The term “respectable,” as used by the Michigan medical faculty, meant that the precepting physician subscribed to the methods and theo- ries of the “regular” profession as op- posed to other popular medical phi- losophies such as homeopathy or eclecticism. Indeed, there existed much Americans and other minority stu- sibilities” of women students. Others rancor and competition between allo- dents long before this was a common protested based on notions of a wom- pathic and homeopathic physicians in practice at other US medical schools. an’s “physical incapacity” to practice the state of Michigan during this pe- During the late 19th century, the aver- medicine.
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