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From the days of the 'Wild West' to world renown: Medical historian describes the U-M Medical School's first 150 years

ANN ARBOR - Today's world-renowned University of Michigan Medical School seems a long way off from the place one early medical student excitedly wrote his mother about - saying a classmate had gone 'out west' and brought back two dead gunmen for dissection.

Such is the case, however, for a medical school born in the days of the stagecoach and this year celebrating its 150th anniversary, says medical historian Howard Markel, M.D., Ph.D., in a paper in the current issue of the Journal of the American Medical Association.

Markel highlights the U-M Medical School's rich and groundbreaking history in an article, "An Example Worthy of Imitation: The University of Michigan Medical School, 1850-2000", that is included in a special issue of JAMA devoted to the U-M in recognition of its sesquicentennial. Markel, director of U-M's Historical Center for the Health Sciences, is now on sabbatical in The Center for Scholars and Writers in the New York Public Library.

The seemingly bizarre acquisition of cadavers for medical students to dissect wasn't really that strange for a 19th century medical school, Markel writes, quoting historian Thomas N. Bonner: "No school of this era was without its 'horror stories' of nightly raids on cemeteries, a provoked and outraged citizenry and violent attacks on the offending parties."

Yet there are also many examples of distinction in the U-M's 150-year history, especially its scientific approach to training, says Markel, who is also an associate professor of pediatrics and communicable diseases at the U-M.

Indeed, he writes, even as early as the 1870s, "Instead of requiring regurgitation of dusty textbooks and antiquated prescriptions, Michigan medical students were challenged to be active participants in their medical education."

He continues, "They were required to understand the biological basis of disease and to reason through puzzling clinical presentations. Scientific thought was now the monarch of modern medical practice, and the University of Michigan was making fundamental changes to its medical curriculum decades before the landmark Flexner Report on Medical Education of 1910 mandated the reform of American medical training."

The article details other notable moments in the school's colorful history. For instance:

• The first class of 95 students (90 medical students and five physicians or clergymen seeking additional training) were the only ones in the United States taught by professors whose salaries were paid entirely by the University. This way, students didn't have to buy admission tickets from their professors for lectures and demonstrations, as did their counterparts at for-profit schools.
• U-M students had access to their own hospital and laboratory for training, unlike those at most other schools. U-M, in fact, established the country's first university-owned hospital in 1869. As early as 1878, all U-M students were required to complete lab instruction in every scientific subject offered, including physiology, anatomy and chemistry. This became, says Markel, the "gold standard of medical education in the United States." Likewise, the U-M was one of the first institutions to require a medical clerkship in which students were responsible for direct patient care under faculty supervision.
• The U-M began routinely accepting women, Asians, Jews and African Americans into its student body long before most other medical schools. Still, women were taught such courses as anatomy and gynecology separately from male students, in deference to the women's "sensibilities," and the first woman graduate received hoots from some male students as she accepted her diploma.
• Sinclair Lewis, in his Pulitzer Prize-winning novel Arrowsmith, modeled his medical school after the University of Michigan's after enlisting the help of a bacteriologist who graduated from the U-M.
• The U-M again made history when in 1925 it opened the Albert Kahn-designed 893-bed University Hospital, the largest and most modern facility of its kind in the nation.
• U-M researchers and physicians have made numerous medical breakthroughs, including the discovery of the gene that codes for cystic fibrosis and the refinement of the electrocardiogram as a clinical tool for diagnosing heart disease.

Markel is a recipient of a Robert Wood Johnson Foundation Physician Faculty Scholars Award, the James Shannon Director's Award of the National Institutes of Health and the Burroughs-Wellcome Fund 40th Anniversary History of Medicine Award.

He is the author of several critically acclaimed books, including Quarantine! East European Jewish Immigrants and the New York City Epidemics of 1892 (Johns Hopkins Press), and The Practical Pediatrician: The A to Z Guide to Your Child's Health, Safety and Behavior (Scientific American Books/W.H. Freeman). His works has appeared in scholarly journals and the popular press, including the New York Times, Wall Street Journal and Washington Post.

On sabbatical, he is one of 15 inaugural fellows at the Center for Scholars and Writers of the New York Public Library. There, he is writing a book on the history of immigration and public health in the United States during the 20th century, from Ellis Island to today's migration of people from developing nations and Eastern Europe.

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