Medicine at Michigan: A History of the University of Michigan Medical School at the Bicentennial by Dea H. Boster and Joel D. Howell (review)

Institutional histories are by their nature bound to be inward looking; too often they are largely celebratory. Boster and Howell have a great deal that is positive to say about the Medical School at the University of Michigan, but they successfully avoid relying on a drumbeat of constant praise, straightforwardly discussing periods in the school’s history when tensions arose or a change in direction or focus was deemed necessary. The ups and downs are treated matter-of-factly—and instructively.

The tone of the book is set in the introduction, which heralds the challenges and putative advantages of having what would become a major medical school established in a genuinely small town at the founding: “The university and its medical school have always had a deep and complex relationship with the town of Ann Arbor and the people of Michigan” (p. 1). Readers will have to decide for themselves whether the authors have made their case for this being, as they go on to say in that same sentence, a “remarkable institution” (p. 1).

They delay providing evidence for that claim by starting chapter 1 in a confusing manner (which does little to set the stage for their actual subject), reviewing the fact that it is not the medical school but the University of Michigan itself that marked its bicentennial last year. In 1817, the forerunner of the university was an institution whose task was “to offer a coordinated system of education spread throughout the Territory of Michigan” (p. 8); the medical sciences composed one of the thirteen subject-matter areas to be taught (there’s the connecting thread that makes this background relevant). When Michigan actually became a state in 1837, one of the first acts passed by the new legislature formally established the University of Michigan, specifying there would be three departments—one of which “was to be a ‘Department of Medicine,’” evidence that “medical education [was being made] a clear priority” (p. 8). This chronology and the early signs of interest in having medicine taught in Michigan are more confusing than helpful. The University of Michigan School of Medicine finally came into being in 1850.

One way to assess the claim quoted above that this institution is remarkable is to note the numerous times throughout the book that the authors attribute a leading role to Michigan’s medical school in establishing new approaches to medical education (often being the first). The frequency of such claims might make readers wonder whether the authors are exaggerating: “the first major American medical school to become coeducational” (p. 29); a decision “to establish a university hospital . . . made the University of Michigan the first university in the United States to own and operate its own hospital in connection with its medical school” (p. 40); “Michigan was one of the nation’s first medical schools to prioritize subscriptions to international medical journals” (p. 61); “the new Department of Postgraduate Medicine . . . was the first of its kind in the United States” (p. 117); “the first university-owned and -operated hospital in the United States” (p. 149). If the authors had provided a general assessment of how they thought such a remarkable series of innovations was to be explained, rather than simply documenting the sources on which they relied in the footnotes, perhaps any mild skepticism at the claim of so many “firsts” might be reduced.

If Boster and Howell are correct in identifying the University of Michigan Medical School as one “historically poised on the leading edge of medical innovation” (p. 152), they also acknowledge that the trajectory of change had not always been positive—or easy. Their last chapter, especially, addresses some of the shifts in thinking about what medical schools should be teaching—and to whom—as the twentieth century moved...