Medicine in the University

MEDICINE IN THE UNIVERSITY DAVID S. GREER* Culture L· activity of thought, and receptiveness to beauty and humane feeling. Scraps ofinformation have nothing to do with it. A merely wellinformed man L· tL· most useless bore on God's earth. What we should aim at producing L· men who possess both culture and expert knowledge in some special direction. Their expert knowledge will give them tL· ground to startfrom, and their culture will lead them as deep as philosophy and as high as art."—Alfred North Whitehead [1] Medicine has long been a part ofthe university. In medieval European universities medicine frequently was a basic discipline, along with philosophy and theology. In the United States medical education developed as a vocationally oriented enterprise apart from the university. The Flexner Report of 1910 [2] is generally acknowledged to have accelerated the incorporation of medical education into the higher education mainstream. This marriage of medical education and universities occurred at a time of rapid development in the natural sciences. Flexner's objectives were to use the university to provide the science base, which he correctly perceived would be of increasing importance to medicine, and to establish quality control in medical education. Flexner's focus was on what the university could do for medical education rather than what medical education could do for the university. Medicine, however, had been a valued participant in the intellectual life of European universities long before the natural sciences developed as university disciplines. Indeed, medical practitioners were highly esteemed human service professionals long before the development of a scientific basis for their therapeutic ministrations. Medicine thus preceded science in the university as well as in the broader society. What did medicine offer the intellectual community of the university during the *Dean of Medicine, Division of Biology and Medicine, Brown University, Providence, Rhode Island 02912.© 1988 by The University of Chicago. All rights reserved. 0031-5982/89/3201-0609J01.00 Perspectives in Biology and Medicine, 32, 1 ¦ Autumn 1988 \ Io prescientific period and what can we learn about the place ofmedicine in the modern university from an examination of the prescientific era? The University It was during the late Middle Ages that institutions recognizable as universities arose. Initially, they were communities of scholars who addressed the nature ofman and God through study ofthe classics and the scriptures. The classical disciplines were those we would now group primarily as the "humanities," defined as those focused on the study ofman and utilizing primarily retrospective methods. Students were expected, through exposure to classical texts inherited from a glorious past, to gain insights applicable to man in the present. The approach was primarily deductive. The origin of the scientific culture is often traced to Francis Bacon (1561-1626). Bacon focused attention on the contemporary natural world and the importance of knowledge that is discoverable using man's senses. The methods Bacon espoused were essentially reductive; the ultimate value of his approach depended on its generalizability and predictive capacity. In contrast to the classical humanities, Bacon's science examined the present and looked to the future, rather than using the past to understand the present; it was also implicitly antiauthoritarian. Bacon was a prophet without a following in his own time. It was to take more than 200 years for the principles he promoted to become established in the scholarly communities ofthe Western world and almost 300 years for the scientists who emerged from Baconian philosophy to become dominant participants in university faculties.1 The initiatives that ultimately brought the natural sciences to the fore can be traced to Continental, particularly German, universities at the time of the Reformation. These universities emerged from the Renaissance steeped in the humanist2 tradition, with a core faculty in philosophy and faculties in theology, law, and medicine whose purpose was to train practitioners. In the latter half of the eighteenth century there was slow growth in the amount of instruction in pure and applied science and mathematics in German universities, but it was not research oriented and remained at an introductory level. Institutional commitment to the research imperative (the Baconian ideal) did not arise until the early decades of the nineteenth century. Concurrent with the establishment of the...