Science, Practice, and the Reform of American Medical Education

180 p.Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 1988.Tension has been often felt between science and practice in practical occupations undergirded by science. The reform of medical education in America provided an occasion for the working out of this tension in medicine. In early nineteenth century American medicine the two sides of this divide were represented by followers of the Paris Clinical School and by advocates of the doctrine of specificity. The influence of these two opposite approaches to medical thinking and practice were reflected in the early debates between the Harvard medical faculty and the AMA over educational reform in the 1840s and 50s; and in the debates at Harvard over the Eliot reforms of 1871. The actual measures taken in the 70s and 80s at Harvard and elsewhere, however, did not constitute victory for either side of the controversy. Reform measures that palpably followed from a reductionist viewpoint were propounded only in the 1890s and after by militant basic scientists influenced by German laboratory research. The objections made to such measures by clinicians representing various shades of anti-reductionist opinion bore many similarities to those raised by earlier opponents of less tendentious reforms at midcentury. The eventual outcome of reform battles at Harvard and other medical schools in the late teens and 1920s cannot fairly be characterized as a straight forward victory for the reductionist scientists over practitioners. The basic scientists were able to transform medicine's fundamental branches according to their distinctive view of medical practice as the unproblematic application of their own disciplines. In the clinical branches and in other matters of medical school policy they were forced to compromise with their clinician opponents. Still less can reform be seen as a simple triumph of "science" over obscurantism. Most of those on either side of the debate favored the high standards, active teaching and larger role for research that were increasingly realized in elite medical schools by 1920.U of I OnlyRestricted to the U of I community idenfinitely during batch ingest of legacy ETD