A History of Yale's School of Medicine: Passing Torches to Others, and: Making the Modern Medical School: The Wisconsin Stories (review)

The two volumes considered here present the history of two very different medical schools. Yale's history goes back to the colonial period, while Wisconsin's medical school dates from 1907. The two schools resembled one another in quality and aspiration in the early twentieth century, in spite of very different antecedents. Yale would go on to become one of the nation's best medical schools, and Wisconsin would settle into the middle ranks. Yale attracted grants from foundations such as the Rockefeller General Education Board; Wisconsin had to rely on a state legislature not inclined to be generous to the medical school before federal dollars started to flow in the 1950s. Both schools would be transformed by the expanding NIH budget and the passage of Medicare and Medicaid in the 1950s and 60s.

The story of Yale is told by one of its own. Gerard Burrow trained at Yale in the 1950s and early 1960s, going on to a distinguished career in academic medicine capped by his return to Yale as dean in 1992. Wisconsin's story is told by a young historian who completed much of his work during a postdoctoral stint at the School of Medicine's Department of Medical History. Burrow starts from Yale's beginning but focuses on the twentieth century, taking his story through the 1970s; Oliver brings us from 1907 through a difficult time at Wisconsin in the 1990s. Burrow appears to have benefited from the propensity of tradition-conscious schools such as Yale to preserve their records; Oliver ekes out his story from what one must presume are scanty primary sources, supplementing with interviews that he has conducted with many of the important figures in Wisconsin's recent history. The two schools offer many contrasts to the perceptive observer of academic medicine.

Yale began as a respectable colonial foundation and did its best to keep standards up during the heyday of proprietary medical education in the middle to late nineteenth century. fiith other reforming schools in the 1870s, Yale improved its curriculum and suffered financial losses as a result, but was supported by the university's president, as was Harvard Medical School at the same time. Yale entered the twentieth century on an improving trend, aiming at the model established at Johns Hopkins, which was to gain its most important adherent in Abraham Flexner at the time of his 1910 report. William H. Welch was consulted in the hiring of George Blumer to be Yale's professor of medicine in 1906. A strong effort was made to lure Harvey Cushing to be professor of surgery, but it foundered on the medical school's lack of control over New Haven Hospital.

In spite of its aspirations Yale was not markedly superior to Wisconsin in Flexner's eyes in 1910. New Haven Hospital was not controlled by the university, and the medical school was viewed with suspicion by the Yale Corporation, which had to subsidize its annual deficits. Yale's early success owed much to Flexner's decision that it would be a suitable school in which to encourage the "full-time" plan, according to which salaries of leading clinical faculty members would come wholly from university funds and not from the proceeds of clinical practice. That decision led to favorable attention from the Rockefeller General Education Board (GEB), and the school secured a grant from the GEB in 1914. By the fall of 1919, full-time heads in the major clinical specialties controlled the respective public wards of the hospital. The relations between the medical school and the hospital were to be...