In the late nineteenth century, the American system of medical education underwent a complete transformation. Medical colleges shifted from commercial schools where instruction was based almost exclusively on classroom lectures to university-affiliated programs providing hands-on training in both laboratory and clinical work. Medical educators recognized that successfully enacting the new pedagogy required new buildings. By the 1930s, almost every medical college in the United States had rebuilt or significantly renovated its facilities. In Creating the Modern Physician: The Architecture of American Medical Schools in the Era of Medical Education Reform, Katherine L. Carroll analyzes the first wave of schools constructed to house the new medical training. She examines the three dominant types of American medical school buildings, which she argues did more than supply spaces for teaching and research—they defined specific conceptions of modern medicine and helped to shape the modern physician.

A revolution took place in American medical education in the late nineteenth century.1 Poorly regulated, commercial schools offering repetitious lectures transformed into standardized, university-affiliated departments dedicated to experiential learning and scientific medicine. This major pedagogical shift rendered obsolete even the newest and most modern medical college buildings. In the forty years between the opening of the landmark Johns Hopkins Medical School in 1893 and the sudden decrease in medical school construction brought on by the financial collapse of the 1930s, medical colleges across the country rebuilt or substantially renovated their facilities (Figure 1).

Figure 1

Coolidge and Shattuck, Vanderbilt University School of Medicine and Hospital and Nurses’ Home, Nashville, with medical school–hospital at center left and nurses’ home at far right, 1925 (“Vanderbilt University, Medical School, Nurses Home and Power House, Nashville, TN, #028, 1926” files; courtesy of Archives of Shepley Bulfinch Richardson and Abbott, Boston, Massachusetts).

Figure 1

Coolidge and Shattuck, Vanderbilt University School of Medicine and Hospital and Nurses’ Home, Nashville, with medical school–hospital at center left and nurses’ home at far right, 1925 (“Vanderbilt University, Medical School, Nurses Home and Power House, Nashville, TN, #028, 1926” files; courtesy of Archives of Shepley Bulfinch Richardson and Abbott, Boston, Massachusetts).

Medical educators recognized that a new building did more than provide the needed lecture halls and laboratories. As prominent medical educator G. Canby Robinson explained in 1923, “We have … at present a rapidly increasing number of schools in which the opportunity is afforded to construct new plants or thoroughly remodel old ones along lines which express the modern American conception of medical education.”2 Committed to creating spaces that would define medicine according to modern ideals and make possible the most progressive pedagogical aims, medical educators joined with architects, philanthropists, and state governments to construct facilities that would help place American medical training among the best in the world and that would ultimately shape American medical education to the present day.

Previous scholarship on medical architecture has focused on places for patient care, particularly hospitals, rather than on buildings for medical training. While the literature on hospitals is large, research on the architecture of medical schools is just beginning to emerge.3 My examination of the facilities at a broad cross section of medical schools in the United States between 1893 and 1940 represents the first comprehensive analysis of American medical school architecture.4 This article investigates the development of three medical school building types: the institute design; the single-building facility for preclinical studies, typically adjacent to a hospital; and the unified medical school–hospital. This is more than a typological study, however; I argue that the physical plants helped to define modern medicine. The ideas that underpinned the schools’ designs became codified and then promoted by the buildings themselves, creating a dialectical relationship between science and architecture.

American Medical Education in the Nineteenth Century

Medical historian Kenneth M. Ludmerer has described the nineteenth-century developments in American medical education. By midcentury, the typical American medical student received paltry training at best. The colonial era's apprenticeship system had largely disappeared, and the so-called proprietary school had taken its place. The faculty ran these schools, which grew significantly in number over the course of the century, primarily as commercial ventures, generating profits from student fees. Such a system encouraged large class sizes and poor educational standards. The schools offered four-month terms that students attended for two years, repeating the same classes twice. While some schools provided hands-on dissection, most included no laboratory or practical clinical work. Instead, the colleges relied almost entirely on lectures. Students earned their medical degrees by passing perfunctory oral examinations; they were not required to demonstrate their ability to read or write. Highly motivated students could pursue supplementary educational opportunities, however, either before or after completing their degrees. Some students spent time as “house pupils,” living in hospitals and gaining practical experience with patients. For those with financial means, other options included nondegree summer programs focused on clinical instruction and study in Europe.5 

After the Civil War, recently graduated physicians traveling abroad often went to Germany, the international leader in scientific medicine. In addition to providing strong clinical training, Germany offered well-funded university laboratories that encouraged new research within an invigorating academic environment. Here American doctors discovered experimental methods and the basic medical sciences, such as biochemistry, physiology, and bacteriology. While most American doctors abroad spent their time improving their clinical skills and returned home to specialize in new fields such as dermatology, ophthalmology, obstetrics, and gynecology, a subgroup of Americans devoted themselves to the laboratory and the basic medical sciences. When these physicians returned to the United States, they took faculty positions at a handful of medical schools, from which they would lead the country's revolution in medical education.6 

During the 1870s and 1880s, the medical schools at Harvard University, the University of Pennsylvania, and the University of Michigan instituted significant reforms. The new American system of medical education did not fully take shape, however, until the opening of Johns Hopkins Medical School in 1893. Students entering its four-year program faced rigorous admissions requirements. They then received two years of instruction in the basic medical sciences with significant laboratory training. Upon completion of this preclinical work, they underwent two years of hands-on clinical experience in the school's affiliated hospital. In addition to emphasizing strong teaching, the medical college actively promoted original research. The framework for the system of medical education still in use today had been established. As the new educational ideals took root around the United States, the number of proprietary schools began to decline.7 

The comprehensive change in medical education stimulated a similarly dramatic transformation in medical school architecture. Medical colleges offering little more than lectures needed only spaces for instructors to meet their students. For example, Syracuse University's fledgling College of Physicians and Surgeons rented rooms in the city's Clinton block from 1872 to 1875.8 When Howard University opened its medical school in 1868, it had similarly makeshift arrangements. During its first year, the school shared a former dance hall with other university departments, although its dissection course was relocated to a shed behind the building after the professor's family living downstairs complained.9 

Stronger schools with more financial resources, however, had long enjoyed purpose-built facilities. As early as 1816 Harvard University's medical college, for example, occupied the first building erected specifically for the school.10 Several decades later, in the 1870s, Harvard Medical School stood among the first American medical colleges to begin implementing educational reforms. In 1883, the school relocated to a new facility on Boylston Street in Boston (Figure 2). The design of the new building responded to the changes in medical education and enabled the progressive education of its occupants. The facility offered students laboratory space in five areas: anatomy, physiology, chemistry, histology, and pathology (Figure 3). These resources far eclipsed the limited accommodations for laboratory training in the school's previous home.11 Contemporary reports recognized the critical role the new building would play in the educational transformation under way at the medical school and lauded the carefully planned laboratories and lecture rooms.12 Funded by gifts totaling nearly $300,000 and erected in Boston's growing educational center around Copley Square, the five-story, Romanesque revival facility designed by Ware and Van Brunt heralded the architectural revolution that would soon sweep the nation's medical schools along with the educational reforms that the Harvard Medical School helped to promote.13 

Figure 2

Ware and Van Brunt, Harvard Medical School, Boston, 1883 (photo 1906; Record Group M-CL02, Series 00097, Image 97.242, Harvard Medical Library in the Francis A. Countway Library of Medicine, Boston, Massachusetts).

Figure 2

Ware and Van Brunt, Harvard Medical School, Boston, 1883 (photo 1906; Record Group M-CL02, Series 00097, Image 97.242, Harvard Medical Library in the Francis A. Countway Library of Medicine, Boston, Massachusetts).

Figure 3

Students in the chemistry laboratory of Harvard Medical School, ca. 1900 (Record Group M-CL02, Series 00096, Image 96.078, Harvard Medical Library in the Francis A. Countway Library of Medicine, Boston, Massachusetts).

Figure 3

Students in the chemistry laboratory of Harvard Medical School, ca. 1900 (Record Group M-CL02, Series 00096, Image 96.078, Harvard Medical Library in the Francis A. Countway Library of Medicine, Boston, Massachusetts).

The Institute Design

In 1893, the Johns Hopkins Medical School opened in Baltimore, Maryland. At its outset, the school formulated the full articulation of the modern American system of medical education. The architectural expression of the new educational approach, however, came about in a much more piecemeal fashion.

In 1873, Johns Hopkins, a Baltimore businessman and the largest shareholder in the Baltimore and Ohio Railroad, died and left funds for the creation of a university and a hospital, both of which would bear his name. Hopkins requested that the university include a medical school and that this medical school work closely with the hospital.14 The university and the hospital, however, struggled to follow his mandates. In both cases, only the income from Hopkins's gift could be used for construction, a financial challenge compounded by a reduction in income from the university's and the hospital's respective endowments during their early years. Significant proportions of both institutions’ resources came in the form of Baltimore and Ohio Railroad stock, which produced diminishing dividends between 1886 and 1891. After having to delay its intended opening for four years, in 1889 the hospital welcomed its first patients, but the university was unable to begin offering medical training at that time.15 In the end, four more years passed before medical students arrived at Hopkins in 1893, a development famously made possible by a group of women who raised the $500,000 necessary to make the Johns Hopkins Medical School a reality. The terms of the gift, however, stipulated that not more than $50,000 of the original benefaction could be spent on buildings.16 The relative lack of funds necessitated a slow construction schedule for the medical school. The gradual expansion of space was acceptable because the school added a class a year and did not need to support four classes of medical students immediately.17 

By the close of the 1898–99 academic year, the Johns Hopkins Medical School had completed its first campus. In 1893, the medical school added two floors to the existing pathology laboratory on the Johns Hopkins Hospital site. On the medical school lot diagonally behind the pathology laboratory, the medical college had subsequently constructed the Women's Fund Memorial Building (1894) and the Physiological Building (1898 or 1899) (Figures 4 and 5).18 Local architect George Archer designed all three of these new facilities.19 Reports of the Johns Hopkins Hospital's superintendent indicate that during the 1890s the hospital also augmented its buildings to accommodate medical students, specifically by adding classrooms and clinical laboratories.20 

Figure 4

Campus of Johns Hopkins Hospital and Johns Hopkins Medical School, Baltimore, showing hospital block (large box), medical school campus (small box), Monument Street (dashed line), expanded pathology laboratory with 1910 addition of a fifth floor (A), Women's Fund Memorial Building (B), Physiological Building (C), first Hunterian Laboratory (D), and second Hunterian Laboratory (E), ca. 1921 (Buildings Photograph Collection, Item 233748; courtesy of The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions, Baltimore, Maryland; modified by author).

Figure 4

Campus of Johns Hopkins Hospital and Johns Hopkins Medical School, Baltimore, showing hospital block (large box), medical school campus (small box), Monument Street (dashed line), expanded pathology laboratory with 1910 addition of a fifth floor (A), Women's Fund Memorial Building (B), Physiological Building (C), first Hunterian Laboratory (D), and second Hunterian Laboratory (E), ca. 1921 (Buildings Photograph Collection, Item 233748; courtesy of The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions, Baltimore, Maryland; modified by author).

Figure 5

Left: George Archer, Johns Hopkins Medical School Women's Fund Memorial Building, Baltimore, 1894. Right: George Archer, Johns Hopkins Medical School Physiological Building, Baltimore, 1898 or 1899 (photo ca. 1912; Buildings Photograph Collection, Item 184857; courtesy of The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions, Baltimore, Maryland).

Figure 5

Left: George Archer, Johns Hopkins Medical School Women's Fund Memorial Building, Baltimore, 1894. Right: George Archer, Johns Hopkins Medical School Physiological Building, Baltimore, 1898 or 1899 (photo ca. 1912; Buildings Photograph Collection, Item 184857; courtesy of The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions, Baltimore, Maryland).

A lack of extant buildings and architectural plans limits study of this initial campus for the Johns Hopkins Medical School. The three major spaces erected for the school—the addition to the pathology laboratory, the Women's Fund Memorial Building, and the Physiological Building—have been razed, and architectural plans currently exist only for the Women's Fund Memorial Building.21 Fortunately, descriptions of the facilities remain and allow for a general understanding of their design and use. An analysis of these early buildings indicates that the leaders of the medical school returned from their studies in Germany with an appreciation not only for that country's system of scientific inquiry and experiential learning but also for its division of universities into institutes.

When the Women's Fund Memorial Building opened in 1894, instruction in physiology remained at the separate Johns Hopkins University campus, and the medical college's leadership recognized that the new building did not fully provide for the needs of the medical school. The medical educators and architect conceived of the Women's Fund Memorial Building as the first step in the construction of a complete medical school campus. Historical documents contain references to more comprehensive visions for the medical school site that express a desire to create a square composed of a prominent building at the front of the lot, for the administration or the museum and library, flanked by a series of ancillary buildings, each devoted to a specific laboratory subject or two.22 A pre-1916 drawing of the Johns Hopkins Medical School campus shows the ultimate placement of the Physiological Building and the Women's Fund Memorial Building (labeled Anatomical Laboratory) on either side of a projected quadrangle (Figure 6).23 The location of these structures significantly away from Monument Street left room for an administration building to be erected in front of them. As often happens, however, later construction did not follow the original aim. In 1905, the first Hunterian Laboratory was built between and behind the earlier two buildings, and in 1916, the second Hunterian Laboratory was completed on the corner of the site behind the Women's Fund Memorial Building (see Figure 4). In 1929, the school erected the Welch Medical Library in the space along Monument Street that had been reserved for the campus's main building.

Figure 6

Drawing of the campus of Johns Hopkins Medical School, Baltimore, with Women's Fund Memorial Building (labeled Anatomical Laboratory), Physiological Building, and the first Hunterian Laboratory, before 1916 (untitled and unsigned drawing, Abraham Flexner Papers, Box 21, Folder “Johns Hopkins University, 1906–1911”; courtesy of the Manuscript Division, Library of Congress, Washington, D.C.).

Figure 6

Drawing of the campus of Johns Hopkins Medical School, Baltimore, with Women's Fund Memorial Building (labeled Anatomical Laboratory), Physiological Building, and the first Hunterian Laboratory, before 1916 (untitled and unsigned drawing, Abraham Flexner Papers, Box 21, Folder “Johns Hopkins University, 1906–1911”; courtesy of the Manuscript Division, Library of Congress, Washington, D.C.).

In the abstract, the leadership at Hopkins could have planned to expand the Women's Fund Memorial Building as more funds became available rather than construct separate structures. In the end, however, they envisioned a campus composed of a series of laboratory buildings dedicated to discrete subjects, drawing on the German institute design familiar to men such as William Osler and William Welch, both of whom had studied in Germany and helped found the medical school at Hopkins.24 In Germany, American medical men became familiar with universities made up of many institutes, each of which focused on a particular discipline. A separate physical and administrative unit within the university, an institute typically enjoyed its own facilities; housed expensive equipment, including scientific devices and extensive libraries; contained a large staff; and benefited from a generous budget.25 A published site plan of the University of Kiel from 1890 depicts the German university's physical division into institutes (Figure 7).

Figure 7

Site plan of the University of Kiel, Germany, showing the Chemistry Institute (A), the Anatomical Institute (B), and the Physiological Institute (C), 1890 (Moritz Pistor, Anstalten und Einrichtungen des öffentlichen Gesundheitswesens in Preussen: Festschrift zum X. internationalen medizinischen Kongress, Berlin 1890 [Berlin: Julius Springer, 1890], 325; modified by author).

Figure 7

Site plan of the University of Kiel, Germany, showing the Chemistry Institute (A), the Anatomical Institute (B), and the Physiological Institute (C), 1890 (Moritz Pistor, Anstalten und Einrichtungen des öffentlichen Gesundheitswesens in Preussen: Festschrift zum X. internationalen medizinischen Kongress, Berlin 1890 [Berlin: Julius Springer, 1890], 325; modified by author).

In the nineteenth century German universities developed into centers for original research, and with this change, institutes increased in number in both philosophical and medical faculties.26 Between 1860 and 1914, at least 173 institutes were founded in the medical faculties of German universities. Frequently, these institutes supported new fields of study, such as hygiene or otolaryngology. At the same time, however, huge sums of money went to established institutes, such as those devoted to anatomy or surgery, to erect new buildings and improve working conditions.27 German universities were the primary creators of the institute model, but it migrated to universities that drew on the German system, particularly in Scandinavia, Russia, Eastern Europe, Switzerland, and the Netherlands, and inspired significant change in university research and teaching in the United States.28 It is widely recognized that the German commitment to scientific inquiry had a lasting impact on American medical education. In this article I will argue that the American men who trained in Germany's laboratories also brought that country's architectural ideas back to the United States.

While a lack of finances forced Johns Hopkins Medical School to construct a modified version of its intended institute design, Harvard Medical School suffered from no such monetary constraints. With substantial support from a handful of private donors, in 1906 Harvard Medical School moved from its building on Boylston Street to an entirely new campus in the Longwood area of Boston.29 Shepley, Rutan, and Coolidge, an architectural firm with a well-established relationship with Harvard University, designed the five-building complex, which was constructed for the staggering sum of more than $2.6 million, nearly twenty times the combined cost of the Women's Fund Memorial Building and the Physiological Building at Hopkins (Figure 8).30 The buildings of the classical revival marble quadrangle were not only aesthetically grand but also large. Each provided as much space as the medical school's entire previous home on Boylston Street.31 The buildings also created the formally organized, comprehensive plant that had eluded the medical educators at Johns Hopkins.

Figure 8

Shepley, Rutan, and Coolidge, Harvard Medical School, Boston, 1906 (photo by Elmer Chickering; Record Group M-CL02, Series 00097, Image 97.488, Harvard Medical Library in the Francis A. Countway Library of Medicine, Boston, Massachusetts).

Figure 8

Shepley, Rutan, and Coolidge, Harvard Medical School, Boston, 1906 (photo by Elmer Chickering; Record Group M-CL02, Series 00097, Image 97.488, Harvard Medical Library in the Francis A. Countway Library of Medicine, Boston, Massachusetts).

In line with German institute design, separate structures divided the campus by academic discipline. While the building at the head of the courtyard held primarily the administration and the museum, each of the other structures provided space for two departments. The wings of these U-shaped buildings housed the laboratories, with libraries and lecture halls in the connecting sections (Figure 9).32 

Figure 9

Shepley, Rutan, and Coolidge, Harvard Medical School, plan of first floors, 1906 (“Harvard University Medical School, Original Medical School Buildings, Boston, MA, #0148, 1906” files; courtesy of Archives of Shepley Bulfinch Richardson and Abbott, Boston, Massachusetts).

Figure 9

Shepley, Rutan, and Coolidge, Harvard Medical School, plan of first floors, 1906 (“Harvard University Medical School, Original Medical School Buildings, Boston, MA, #0148, 1906” files; courtesy of Archives of Shepley Bulfinch Richardson and Abbott, Boston, Massachusetts).

Unlike at Hopkins, where the leadership never explicitly mentioned the German institute model, Harvard acknowledged the roots of the design in a medical school publication:

To Professor H. P. Bowditch belongs the credit … in association with Professor J. C. Warren, of devising a scheme along the broad lines on which the plans of the new School have been worked out. He proposed a group of buildings arranged somewhat on the plan of the modern German medical school—that the various departments should be housed in separate “Institutes”—such as the Institute of Anatomy, the Institute of Physiology.33 

Both Bowditch and Warren had studied in Germany, but Bowditch's experience in particular deserves special consideration. While the Harvard publication claimed only a general link to German institute design, Bowditch's correspondence suggests that the footprint and interior arrangement of the Harvard buildings may also have drawn on the German model.

In 1870, when Bowditch was working in the recently opened Physiological Institute at the University of Leipzig under the direction of renowned physiologist Carl Ludwig, he wrote to the Boston Medical and Surgical Journal to describe his experience. He explained to readers that few Americans traveled to Leipzig, as they preferred instead the larger cities, such as Berlin and Vienna, with better clinical opportunities. For fledgling chemists and physiologists, however, Bowditch promised that Leipzig offered the best resources in all of Germany.34 Indeed, when Ludwig joined the medical faculty at the University of Leipzig in 1865, he created a physiology institute that influenced many future doctors and universities in addition to Bowditch and Harvard. Ludwig's institute not only made a number of major discoveries, but it also became the preeminent location for investigation and training in physiology.35 In 1869, Ludwig's institute moved into a new building. In the two decades after 1870, eleven similar institutes erected at other German-speaking universities followed Ludwig's institute model.36 In his letter, Bowditch took care to describe the new building in detail and asserted that “it is universally acknowledged to be the most complete establishment of the kind in Europe.”37 

The Longwood laboratories at Harvard that Bowditch would later help to plan included several basic components found at Ludwig's institute. The Physiological Institute in Leipzig had a U-shaped plan with a lecture hall projecting from the rear of the central portion of the first floor (Figure 10). As in the Boston buildings, the wings and connecting corridor of the German institute's first floor contained various types of laboratory space in addition to storage and a small library.38 

Figure 10

Physiological Institute, University of Leipzig, Germany, first floor plan, 1869 (Henry P. Bowditch, letter to the editor, Boston Medical and Surgical Journal 82 [21 Apr. 1870], 306).

Figure 10

Physiological Institute, University of Leipzig, Germany, first floor plan, 1869 (Henry P. Bowditch, letter to the editor, Boston Medical and Surgical Journal 82 [21 Apr. 1870], 306).

The U-shaped design that appeared on both sides of the Atlantic seems to have served two functions. First, laboratories required ample light. A plan composed of relatively narrow wings ensured that interior spaces did not lack for natural illumination (Figure 11).39 Similarly, the U shape allowed for uniform ventilation, another consideration for some laboratories. Second, large communal spaces, such as the library and lecture hall, could be accommodated in the central portion of the building. This location made these rooms easily accessible and divided the building into zones. The central area was most public, with all faculty and students mingling to use the library and auditorium. The wings offered more privacy as professors and students retreated to their respective laboratories segregated by discipline, research project, or course.

Figure 11

Students in a laboratory in Building D of Harvard Medical School, ca. 1906 (Record Group M-CL02, Series 00096, Image 96.172, Harvard Medical Library in the Francis A. Countway Library of Medicine, Boston, Massachusetts).

Figure 11

Students in a laboratory in Building D of Harvard Medical School, ca. 1906 (Record Group M-CL02, Series 00096, Image 96.172, Harvard Medical Library in the Francis A. Countway Library of Medicine, Boston, Massachusetts).

More than thirty years would pass between the publication of Bowditch's letter and the erection of the Longwood plant, but the Harvard facilities were still considered very much of their time. Harvard Medical School faculty member J. Collins Warren, who, like Bowditch, was instrumental in the construction of the 1906 facilities, wrote that “a plant of … a series of buildings for the School [was] similar in general plan to those which Dr. Bowditch pointed out existed in some of the most recently organized of the German medical schools.”40 More than a building form familiar to the Harvard Medical School leadership, the U-shaped institute design represented a plan that had proven successful for physicians in the world's leading medical nation.

It is difficult to determine if the U-shaped design was common in Germany. No German- or English-language scholarship provides a comprehensive overview of the architecture of German medical institutes, although the plans of a number of German institutes have been published.41 These plans indicate that Ludwig's Physiological Institute was not the only institute with a central lecture hall. For example, the first floor of the University of Berlin's Anatomical Institute, built in 1865, contained a central auditorium with laboratory and collection spaces in the wings.42 Ludwig's institute, however, appears to have been the direct point of contact between this basic plan and the faculty of the medical school at Harvard.43 

While students at Harvard might not have realized the German roots of their medical school, the design had a tremendous impact on their daily academic lives. The institute plan reinforced the curriculum inaugurated during the 1899–1900 school year. Most significantly, Harvard compressed the instruction in each of the main preclinical subjects into one semester of the first or second year. This so-called concentrated or block system required that each subject be taught for more hours each day over a shorter number of months. For example, rather than balancing anatomy, histology, physiology, and physiological chemistry during the entire academic year, a student learned only anatomy and histology from October through January of the first year and then physiology and physiological chemistry in the second half of the year.44 As Harvard Medical School faculty member W. T. Councilman explained, the new curriculum provided a carefully crafted intellectual journey for the student:

Form and structure come first in the study of objects, so in the first term in the School the time is spent on the study of anatomy. The second term is devoted to physiology or the study of function.

In the first term of the second year the student takes up pathology, in which the disorders of form and function are considered. In the second term of the second year he learns and practises the methods which are used in clinical work. This is a natural transition of subjects, and the student goes to clinical work feeling that there is no violent break of connection, but that it is merely a continuation of the kind of work he has been doing.45 

Councilman wrote this analysis in 1907, a year after the new buildings opened. An examination of the buildings indicates that they reinforced and promoted the pedagogical experience. The laboratory buildings paired the same subjects that were grouped in the new curriculum.46 For example, anatomy and histology occupied the student during the first semester of study, and Building B housed both (see Figure 9). Inside the building, the two departments shared the central lecture hall and library. The use of the latter, in particular, would have brought faculty from both disciplines in contact with each other, encouraging and reinforcing the transfer of ideas between the departments. Pedagogy and architecture together signified to students and faculty that these disciplines were closely related within modern medicine.

The new buildings carried the relationship between pedagogy and architecture a step further. As students advanced through the curriculum, they moved through the buildings progressively.47 For the first term of their first year, students learned anatomy and histology in Building B, where they spent their entire academic day, with the possible exception of excursions to the administration building (see Figure 9). They studied physiology and physiological chemistry in the second half of the year, when they moved to Building C. Their second year began with courses in bacteriology and pathology in Building D. In the second half of the second year, students did not follow a block schedule, instead balancing the remainder of the preclinical work with the beginning of their clinical training. A portion of their time, however, was spent in Building E, where they learned pharmacology and hygiene and completed their trek around the medical school's quadrangle.48 The Harvard quadrangle actively contributed to defining modern medicine and training modern physicians.

The conceptual and physical relationships established by the quadrangle also encouraged efficient movement of students and faculty. If the most closely aligned disciplines shared the same building, collaborating faculty had only short distances to travel to interact with one another. In addition, concentrating students’ courses within a single building reduced their movement around the quadrangle over the course of the day. Moreover, as Harvard Medical School faculty member and dean Henry A. Christian explained, the block schedule itself minimized students’ daily travel time: rather than moving between several rooms during the day, they spent the morning in one laboratory and the afternoon in another.49 

A Progressive Era obsession that permeated American society, efficiency remained a concern for medical educators and architects of medical schools throughout this period. The consolidation of the Johns Hopkins Medical School on one campus and its location near the hospital served to reduce the movement of students and faculty and to increase their efficiency. Once reformers of medical education affirmed the need for hands-on clinical training, medical schools and hospitals frequently located near to one another, sometimes with corridors or tunnels connecting the facilities.50 The Harvard leadership worked to ensure that a hospital soon joined its medical school in Longwood, and the Peter Bent Brigham Hospital opened in 1913 directly behind the medical school campus.

Even before the groundbreaking for Harvard's new buildings, however, one faculty member recognized the plant's relative lack of efficiency and reflected on the extraordinary cost of the campus. Writing to Harvard president Charles Eliot, Charles Minot lamented that the school wasted space by planning four laboratory buildings rather than two. He asserted that two buildings would prove more convenient for the occupants and save $200,000.51 Others likely shared such concerns, for the institute design failed to become the predominant plan for medical schools in the United States. Only a few medical colleges, such as those at Washington University in St. Louis in 1914 and Emory University in 1917, constructed facilities composed of multiple laboratory buildings. Instead, most American medical schools chose one of two single-building designs that were more economical, improved efficiency, and supported alternate conceptions of medical science, generating a different paradigm for medical education.

The Single Building for Preclinical Studies

In the early twentieth century, the overwhelming majority of American medical colleges employed single buildings for the preclinical studies covered during the first two years of medical school. Medical colleges chose the single building for preclinical sciences approximately twice as often as they selected an institute design or a medical school–hospital (discussed below).52 Schools with purpose-built facilities had long utilized the single building for preclinical work. For example, all three of the previous buildings (completed 1816, 1847, and 1883) that housed the Harvard Medical School before it opened its 1906 quadrangle followed this type. During the reform movement, both prominent medical colleges, such as the one at Western Reserve University in 1924, and struggling medical schools, such as the one at Howard University in 1927, created single buildings for preclinical studies. Syracuse University College of Medicine represents a typical medical school; it provides an example of this most common medical school type and illustrates the challenge faced by many schools of meeting the financial demands of medical education reform.

In 1910, the so-called Flexner Report scrutinized medical training in the United States and Canada.53 The Council on Medical Education of the American Medical Association initiated the study as a means of encouraging the ongoing reform of medical education. Funded and published by the Carnegie Foundation for the Advancement of Teaching and authored by American educator Abraham Flexner, the report functioned in two ways. First, it described and celebrated the system of medical education recently created at elite, university-affiliated American medical schools. Second, it enumerated unflinchingly the deficits and assets of each American and Canadian medical college. Ultimately, the report codified the reform movement already in progress and accelerated the transformation of medical education across the country.54 

Unlike many schools, Syracuse University College of Medicine fared relatively well in the report. Flexner gave the school's laboratory offerings a positive review, reserving criticism for the clinical portion of its medical training. When comparing New York State medical schools, Flexner lauded Syracuse for its university affiliation and its financial practices. Not only did the medical college use all of the profits generated from student fees for improving the school rather than padding the professors’ pockets, but it also attracted outside gifts. For these reasons, Flexner asserted that of the New York State medical schools not located in New York City, only Syracuse might survive the period of medical reform.55 Flexner did not anticipate the trouble Syracuse University would subsequently have raising money for its medical college, however.56 

While faculty, alumni, and the university had raised $40,000 toward the medical school's well-equipped 1896 building, in succeeding decades outside support on the scale necessary for a more modern medical school did not materialize.57 Adjacent to Syracuse University a constellation of clinical facilities made the first steps toward a medical center, but the medical college remained across town in its increasingly antiquated and overcrowded building.58 By 1935, the Syracuse medical school praised in the Flexner Report faced the possibility of losing its Class A rating from the American Medical Association due to its poor facilities. Fortunately, the New Deal offered the university the financial means to build its long-anticipated new medical college. The university received a loan for $825,000 from the Public Works Administration to construct the new edifice.59 Designed by Dwight James Baum and John Russell Pope, an architectural partnership with an established relationship with Syracuse University, the relatively modest building for preclinical studies finally moved the medical college to the site of the university and the growing medical center in 1937 (Figures 12 and 13).60 

Figure 12

Dwight James Baum and John Russell Pope, Syracuse University College of Medicine, Syracuse, New York, 1937 (RG 50, Box 27836, Folder “B + G/Medicine, College of/Exterior—3rd building”; courtesy of University Archives, Syracuse University Libraries, Syracuse, New York).

Figure 12

Dwight James Baum and John Russell Pope, Syracuse University College of Medicine, Syracuse, New York, 1937 (RG 50, Box 27836, Folder “B + G/Medicine, College of/Exterior—3rd building”; courtesy of University Archives, Syracuse University Libraries, Syracuse, New York).

Figure 13

Syracuse University College of Medicine (1) and area hospitals (2–6), ca. 1937 (The Syracuse University College of Medicine, Exercises of Dedication, November 14–22, 1937 [Syracuse: 1937?], following p. 28; Item 2015.0263; courtesy of The Historical Collections at the SUNY Upstate Health Sciences Library, Syracuse, New York).

Figure 13

Syracuse University College of Medicine (1) and area hospitals (2–6), ca. 1937 (The Syracuse University College of Medicine, Exercises of Dedication, November 14–22, 1937 [Syracuse: 1937?], following p. 28; Item 2015.0263; courtesy of The Historical Collections at the SUNY Upstate Health Sciences Library, Syracuse, New York).

With clinical training occurring in nearby hospitals, the new medical school building provided all of the facilities for the first two years of medical education under one roof.61 Although housed in one structure rather than five, Syracuse's new medical college incorporated many of the same ideas that had shaped Harvard's quadrangle thirty years earlier. First, like the Harvard laboratory buildings, Syracuse's new college formed a U shape, with an auditorium along the back of the central section on the first floor (see Figure 13). Second, like most medical schools around the country, Syracuse University's school had adopted the block plan for the schedule of the first and second years.62 A university publication devoted to the medical school explained the first two years of the program: “In these courses the various subjects are correlated, so that the relation of each subject to the others and of all to the purpose of grounding the student in the sciences essential to the practice of medicine, is ever kept in view.”63 Although Harvard would likely have described its curriculum similarly, each school chose to align the preclinical subjects somewhat differently, a fact that highlights the ways local understandings of modern science influenced both pedagogy and architecture.

Despite the varied organization of the two schools’ preclinical disciplines, Syracuse followed Harvard in physically coordinating the departments linked in the curriculum. The north corridor of Syracuse's U-shaped facility accommodated anatomy in the basement, histology (and presumably embryology) on the first floor, anatomy on the second floor, and physiological chemistry on the third floor. During the first semester of the first year, students learned anatomy concurrently with histology and embryology; during the second semester of the first year, they studied anatomy, neuroanatomy, and physiological chemistry. As a result, they spent their entire first year in the north wing. The south corridor contained bacteriology and physiology on the second and third floors, respectively. These subjects occupied students during the first semester of the second year, during which time they also began their clinical training. In addition to pharmacology and more clinical training, the next semester emphasized pathology and clinical pathology, both of which were housed along the central corridor of the second floor.64 As at Harvard, courses that the college understood as representing conceptually related disciplines were located adjacent to one another in the curriculum and in the architecture, reducing the intellectual and physical distance between the subjects.

Syracuse's compact medical school provided laboratories, rooms for research, and library facilities, as well as museum, administration, and extracurricular spaces. Medical colleges such as Syracuse that arranged their entire schools in single buildings promoted greater levels of coordination among all departments than did those with institute designs. Even if the anatomists dissecting in the north corridor of the basement rarely ventured to the Bacteriology Department in the south corridor of the second floor, all professors entered the Syracuse facility through the same doorways, moved through the same hallways, and reviewed journals together in the school's library (Figure 14). Unlike the institute design, this efficient plant encouraged the integration of the various departments celebrated by medical educators at the time.65 

Figure 14

Syracuse University College of Medicine library, ca. 1937 (Item 2015.0264; courtesy of The Historical Collections at the SUNY Upstate Health Sciences Library, Syracuse, New York).

Figure 14

Syracuse University College of Medicine library, ca. 1937 (Item 2015.0264; courtesy of The Historical Collections at the SUNY Upstate Health Sciences Library, Syracuse, New York).

As medical schools considered whether to construct institute designs or single buildings for preclinical studies, the leaders of the medical colleges weighed many factors. Beyond ideas of efficiency and departmental coordination, they discussed the lower cost of a single building, as well as their conceptualizations of modern medicine.66 Wilburt C. Davison, the dean of Duke University Medical School during its construction in the late 1920s, explained the philosophical differences between an institute design and a plan that consolidated the medical school under one roof. He asserted that those who supported a unified design wanted their students to understand the branches of medicine as parts of a whole rather than as discrete disciplines.67 A different understanding of medical science represented one component of the decision to create a single-building plant.

Finally, the vagaries of local history also affected the choice of building type. At Syracuse, hospitals arrived first in the area of the new medical center. When it came time for the school to move, there was no need to construct a new hospital simultaneously. Other localities, however, built new medical schools and hospitals at the same time. During the 1920s and 1930s, the opportunity to construct a medical school and hospital concurrently resulted in a new design that replaced the institute plan as the most progressive medical school type in the United States. The new building type coordinated medical school and hospital into one structure, taking the idea of unified medicine and consolidated buildings in a direction at once both very familiar and fundamentally different.

The Medical School–Hospital

In the early 1920s, a model collaboration took place at Vanderbilt University. G. Canby Robinson, the determined and innovative dean of Vanderbilt's medical school, joined forces with Shepley, Rutan, and Coolidge (known by this time as Coolidge and Shattuck), the premier architectural firm of American medical schools, and the General Education Board, the nation's leading philanthropic organization committed to medical education.68 Together they imagined, designed, and funded the country's first medical school–hospital, which opened in 1925 (see Figure 1).69 

Early plans for Vanderbilt's new medical school depict a conventional facility. On the South Campus, 2.5 miles by automobile from the main university campus, three buildings housed the school of medicine. Two buildings contained preclinical departments, and one accommodated laboratories for anatomy, histology, and pathology on the top floors, with the school's hospital and dispensary on the lower two floors.70 Two unsigned sketches made in fall 1919 and spring 1920 reveal the intention to keep the medical college on the South Campus and to construct a relatively typical single building for preclinical studies near the existing Galloway Memorial Hospital, with a corridor connecting the medical school with a proposed hospital extension in the later sketch (Figure 15).71 By the summer of 1920, however, Coolidge and Shattuck had drawn a plot plan for a medical campus with an entirely new design: a series of hospital buildings attached directly—with no intervening corridor—to one wing of a medical school that wrapped around an open courtyard (Figure 16).72 In its fledgling form, the unified medical school–hospital was born.

Figure 15

Sketch for proposed Vanderbilt University medical facilities, spring 1920 (unsigned sketch attached to G. Canby Robinson to James H. Kirkland, 11 May 1920, RG 300, Box 100, Folder 21; courtesy of Vanderbilt University Archives, Nashville, Tennessee; © Vanderbilt University).

Figure 15

Sketch for proposed Vanderbilt University medical facilities, spring 1920 (unsigned sketch attached to G. Canby Robinson to James H. Kirkland, 11 May 1920, RG 300, Box 100, Folder 21; courtesy of Vanderbilt University Archives, Nashville, Tennessee; © Vanderbilt University).

Figure 16

Coolidge and Shattuck, part of plot plan for proposed Vanderbilt University medical facilities, summer 1920 (Vanderbilt Training Hospital, General Plan #4, revised 8 July 1920, Dean Robinson's Files, Box 1b, Folder “Blueprints: V.U. Hospital and Medical School”; courtesy of Eskind Biomedical Library Historical Collection, Vanderbilt University Medical Center, Nashville, Tennessee).

Figure 16

Coolidge and Shattuck, part of plot plan for proposed Vanderbilt University medical facilities, summer 1920 (Vanderbilt Training Hospital, General Plan #4, revised 8 July 1920, Dean Robinson's Files, Box 1b, Folder “Blueprints: V.U. Hospital and Medical School”; courtesy of Eskind Biomedical Library Historical Collection, Vanderbilt University Medical Center, Nashville, Tennessee).

To enact this new vision for a combined medical school–hospital, however, Robinson needed funding. In September 1920, he sent a proposal to Vanderbilt chancellor James H. Kirkland and the General Education Board, where Abraham Flexner now ran the medical education program. Robinson called for a complete redesign of the Vanderbilt University School of Medicine—conceptually, pedagogically, and architecturally. Early in his report, he made a bold statement:

A guiding principle which I believe is to be an important factor in advancing medicine and medical education is coordination of departments, and this conception has been kept in mind in the planning of buildings and in the organization of departments. Although much has been accomplished by the German “Institute” method, in which each department is a defined entity, often physically removed from the other departments, much more may be accomplished by a medical school which forms one “Institute,” grouped about and participating in the study of disease, especially the study of disease in living human beings. No medical school has yet been developed with this as a fundamental conception, and the time is now at hand for the establishment of such a school.73 

Robinson imagined a medical school that would function as a single institute, including not only the various preclinical disciplines but also clinical training, what Robinson referred to as “the study of disease in living human beings.”74 To make his idea a reality, Robinson suggested the physical coordination of the preclinical laboratories with the clinical work, as well as a new continuity of staff. In his scheme, the head of a preclinical department would oversee all of the research undertaken in that department's area no matter whether that work developed in the preclinical or clinical section of the school. This new physical and administrative organization would make possible a new medical curriculum much anticipated by medical reformers. In Robinson's view, the new teaching system would “allow the integration of laboratory and clinical studies which will be mutually beneficial, and which will tend to mold a new type of medical practitioner.”75 

While the single building for preclinical studies, as at Syracuse, encouraged the coordination of the various laboratory subjects, the medical school–hospital focused on the unification of preclinical and clinical teaching and research. Certainly this was not a new idea. The importance of aligning the two phases of medical education had caused reformers to place medical schools and hospitals in close proximity for decades, as the early examples of Hopkins and Harvard indicate. The innovation of Vanderbilt's medical school–hospital came from its emphasis on this aspect of medical education, a shift that Robinson believed would create a new type of physician.

The idea resonated with major funding institutions. In spring 1921, the General Education Board augmented a previous gift to Vanderbilt's medical college, bringing its total support to $5.5 million, and the Carnegie Corporation gave $1.5 million. Together with an earlier $1 million gift from Andrew Carnegie, these funds provided the money needed to erect a completely new plant on Vanderbilt's main campus that enacted Robinson's vision.76 In the end, construction of the entire complex—comprising medical school–hospital, adjacent nurses’ home, and nearby combination power plant and laundry—cost approximately $3.35 million, with the remainder of the gifts reserved for endowment.77 

Between making his proposal in fall 1920 and receiving the funds in spring 1921, Robinson collaborated on additional architectural plans with Coolidge and Shattuck, Kirkland, and hospital consultant Winford Smith. A sketch by Coolidge and Shattuck from the winter of 1921 shows a design for the main university campus that pushed the medical school–hospital concept even further (Figure 17).78 Rather than a medical school and hospital simply abutting one another, continuous axial corridors unified the two buildings. Whether this axial format originated with the architects or Robinson cannot be determined from the historical record. In June 1921 Robinson expanded on this idea when he created a number of sketches for the new campus that presaged its final form (Figure 18).79 In this plan, medical school and hospital became a fully coordinated facility, with a series of axial corridors aligning the laboratories directly with the wards. Robinson found a way to execute physically his conception of medical education.

Figure 17

Coolidge and Shattuck, sketch for proposed Vanderbilt University medical facilities, winter 1921 (sketch attached to Winford Smith to Charles Coolidge, 7 Jan. 1921, RG 300, Box 100, Folder 12; courtesy of Vanderbilt University Archives, Nashville, Tennessee; © Vanderbilt University).

Figure 17

Coolidge and Shattuck, sketch for proposed Vanderbilt University medical facilities, winter 1921 (sketch attached to Winford Smith to Charles Coolidge, 7 Jan. 1921, RG 300, Box 100, Folder 12; courtesy of Vanderbilt University Archives, Nashville, Tennessee; © Vanderbilt University).

Figure 18

G. Canby Robinson, sketch for fourth floor of medical school–hospital at Vanderbilt University, June 1921 (G. Canby Robinson Biographical File, Folder 2; courtesy of Eskind Biomedical Library Historical Collection, Vanderbilt University Medical Center, Nashville, Tennessee).

Figure 18

G. Canby Robinson, sketch for fourth floor of medical school–hospital at Vanderbilt University, June 1921 (G. Canby Robinson Biographical File, Folder 2; courtesy of Eskind Biomedical Library Historical Collection, Vanderbilt University Medical Center, Nashville, Tennessee).

Although growing out of established trends in medical education and medical school architecture, the building provided a completely new educational environment. Robinson explained his ideas in a number of publications, including an article in the prestigious Journal of the American Medical Association. Robinson used this prominent platform both to generalize about the direct relationship between the design of a medical school and the type of pedagogy it facilitated and to detail the new complex at Vanderbilt and the innovations it made possible in medical education.80 The Vanderbilt medical school–hospital aligned the preclinical and clinical departments more closely than they had been coordinated at any previous medical college. Laboratories for the preclinical sciences composed three sides of a court oriented toward the north and the main Vanderbilt campus, while the hospital was grouped at the other end of the building, separated from the campus and opening onto Hillsboro Road, where it was accessible to the public by streetcar line (Figure 19). The clinical laboratories stood between the two sections, with each clinical laboratory adjacent to the preclinical subject with which it was most closely related conceptually. On the main north–south axes of the second floor, the suites of rooms dedicated to the preclinical disciplines of pharmacology and anatomy led to the related disciplines of clinical chemistry and experimental surgery, respectively, and then to the wards (Figure 20). On the third floor, one could move directly from the wings that housed preclinical physiology and bacteriology to clinical physiology and bacteriology, respectively, and then to the wards (Figure 21). Robinson hoped that this design would encourage the closest possible coordination among the preclinical departments, the clinical laboratories, and the hospital and result in the continuous transfer of ideas between the preclinical laboratory and the bedside.81 

Figure 19

Vanderbilt University campus map, with projected medical school–hospital at far left, ca. 1923 (Vanderbilt Map ca. 1923 Subject File; courtesy of Eskind Biomedical Library Historical Collection, Vanderbilt University Medical Center, Nashville, Tennessee).

Figure 19

Vanderbilt University campus map, with projected medical school–hospital at far left, ca. 1923 (Vanderbilt Map ca. 1923 Subject File; courtesy of Eskind Biomedical Library Historical Collection, Vanderbilt University Medical Center, Nashville, Tennessee).

Figure 20

Coolidge and Shattuck, Vanderbilt University School of Medicine and Hospital, second-floor plan, 1925 (G. Canby Robinson, “Vanderbilt University School of Medicine: History and General Description,” Methods and Problems of Medical Education, 13th ser. [1929], 4; courtesy of Eskind Biomedical Library Historical Collection, Vanderbilt University Medical Center, Nashville, Tennessee).

Figure 20

Coolidge and Shattuck, Vanderbilt University School of Medicine and Hospital, second-floor plan, 1925 (G. Canby Robinson, “Vanderbilt University School of Medicine: History and General Description,” Methods and Problems of Medical Education, 13th ser. [1929], 4; courtesy of Eskind Biomedical Library Historical Collection, Vanderbilt University Medical Center, Nashville, Tennessee).

Figure 21

Coolidge and Shattuck, Vanderbilt University School of Medicine and Hospital, third-floor plan, 1925 (G. Canby Robinson, “Vanderbilt University School of Medicine: History and General Description,” Methods and Problems of Medical Education, 13th ser. [1929], 5; courtesy of Eskind Biomedical Library Historical Collection, Vanderbilt University Medical Center, Nashville, Tennessee).

Figure 21

Coolidge and Shattuck, Vanderbilt University School of Medicine and Hospital, third-floor plan, 1925 (G. Canby Robinson, “Vanderbilt University School of Medicine: History and General Description,” Methods and Problems of Medical Education, 13th ser. [1929], 5; courtesy of Eskind Biomedical Library Historical Collection, Vanderbilt University Medical Center, Nashville, Tennessee).

While Robinson focused on the alignment of preclinical and clinical disciplines, the facility's design also promoted other ideas important to medical educators. If merging several separate institutes into a single building for the preclinical departments, as at Syracuse, allied the medical sciences in the face of specialization, then the combined medical school–hospital at Vanderbilt extended this objective. The constant contact between the various preclinical and clinical departments made it impossible for faculty and students to ignore the interconnectedness of the disciplines. As noted earlier, Wilburt C. Davison, dean of the Duke University Medical School, wrote of the conceptual significance of a unified design in presenting medicine as an integrated whole rather than as a series of discrete parts. This idea applied to the single building for preclinical subjects, such as at Syracuse, but Davison directly referenced the medical school–hospital in comparison to the institute form.82 Robinson expanded on this point when he asserted that Vanderbilt renounced the departmental separation emphasized by the institute design in favor of “collaboration and close contact [that] would tend to carry the school forward as a whole, without isolated departments.”83 The medical school–hospital presented the various components of the human body as an indivisible network instead of highlighting their distinctiveness. The architecture played a critical role in formulating and disseminating this understanding of modern science.

Efficiency, another familiar refrain among medical educators and architects, played a major role in the medical school–hospital. While the single building for preclinical studies increased efficiency over the institute design, Vanderbilt's combined medical school–hospital economized movement even more. In just a few steps, students and faculty could go from the laboratory to the bedside and from the library to the dining room. The relatively small size of the entire Vanderbilt facility further reinforced the ease with which faculty and students could travel from one area to another.84 Although Vanderbilt adopted the block schedule before the school occupied the new plant, it did not arrange the preclinical departments in the new building according to the alignment and sequence of the courses in the curriculum.85 As a result, students did not move through the plant in conjunction with the evolution of their preclinical classes as did students at Harvard and Syracuse. The compact nature of the plant might not have warranted further consolidation of the interior of the building, or the goal of efficient movement from preclinical department to related clinical discipline may have trumped coordinating the affiliated preclinical fields.

In the end, the medical school–hospital became the new gold standard in medical school architecture. In less than a decade, seven additional medical school–hospitals were built in the United States before the Great Depression essentially halted medical school construction. The medical school–hospitals created at the University of Colorado (1924), University of Rochester (1925), Columbia-Presbyterian Medical Center (1928), Duke University (1930), Woman's Medical College of Pennsylvania (1930), Meharry Medical College (1931), and New York Hospital–Cornell Medical College (1932) prove the adaptability of the type.86 It accommodated, for example, the broad horizontal plan at Vanderbilt as well as the tall vertical design of Columbia-Presbyterian Medical Center (Figure 22). Similarly, the medical school–hospital could be expanded to include enormous square footage, seen in the Columbia-Presbyterian Medical Center, or condensed into very economical plants such as the facility at Woman's Medical College of Pennsylvania. The design also appealed to schools in a variety of geographic settings.

Figure 22

Columbia-Presbyterian Medical Center, New York, ca. 1933 (photo by 27th Div. Aviation, N.Y.N.G. 102nd Photo Section; CPMC Photograph Collection, P-001316; courtesy of Archives and Special Collections, Columbia University Health Sciences Library, New York).

Figure 22

Columbia-Presbyterian Medical Center, New York, ca. 1933 (photo by 27th Div. Aviation, N.Y.N.G. 102nd Photo Section; CPMC Photograph Collection, P-001316; courtesy of Archives and Special Collections, Columbia University Health Sciences Library, New York).

Conclusion

The development of modern American medicine could not have taken place without the complete reform of the American system of medical education and the total redesign of the American medical school. Those involved in creating the new facilities—educators, architects, and financial donors—recognized the architectural environment's direct impact on the medical school's educational mission. Writing in 1923, just a few months before the groundbreaking for Vanderbilt's medical school–hospital, Dean Robinson explained:

Medical education is conducted in different countries in various ways…. It is not always easy to determine whether the educational principles have dominated the types and arrangements of buildings, or whether the educational principles have been dominated by the facilities in which medical education is of necessity conducted….

Only in rare instances prior to twenty-five years ago did a medical faculty [in the United States] have an opportunity to express freely any true educational policy in its plant, and in this country even today the available plant dominates the educational methods of many of our medical schools.

We have, however, at present a rapidly increasing number of schools in which the opportunity is afforded to construct new plants or thoroughly remodel old ones along lines which express the modern American conception of medical education.87 

In examining the new facilities and conceptions of medical training, this article has revealed that they were hardly unidimensional; they allowed for multiple visions of modern medical education and medical science. The institute design codified and encouraged a pedagogical and scientific ideal based on classifying and separating the branches of knowledge on which medical practice was founded. In contrast, those schools that erected unified buildings—either single buildings for the preclinical departments or medical school–hospitals—endorsed an approach to modern medicine that saw the study of medicine, and by extension the human body, primarily as an indivisible whole. In the end, the medical schools did more than provide efficient space for medical instruction and research. They shaped the education formulated in their halls and nurtured a particular understanding of medicine among students, faculty, and staff.

The reform of American medical education also made it unnecessary for physicians to travel abroad to receive the best training.88 Most physicians remained in the United States, molded exclusively by this country's new pedagogical system and its buildings.89 As Robinson recognized, “The available plant dominates the educational methods of many of our medical schools.”90 With most of the buildings constructed during the reform movement still used for medical education today, the impact of these original facilities continues to be felt. The relatively swift abandonment of the institute design means that the majority of American physicians trained in the past century have been educated in one of the two unified building types and indoctrinated in the coordinated conception of modern medicine. Far from historical relics, the medical schools of the early twentieth century play an active role in creating the American physicians of today and of the foreseeable future.

Notes

Notes
1.
For careful readings of the dissertation on which this article is based, I thank Keith N. Morgan, who also commented on a draft of this article, and Jessica Ellen Sewell. Additionally, I am grateful for the helpful comments of the editor and anonymous reviewer and for the funding provided by a Henry Luce Foundation /ACLS Dissertation Fellowship in American Art, a Francis A. Countway Library Fellowship in the History of Medicine, a Grant-in-Aid from the Rockefeller Archive Center, and a Walter Read Hovey Memorial Fund Scholarship from the Pittsburgh Foundation.
2.
G. Canby Robinson, “The Relation of Medical Education to the Medical Plant,” Journal of the American Medical Association 81, no. 4 (28 July 1923), 321. Robert Collins, late professor of pathology at Vanderbilt University, introduced me to this article.
3.
Examples of scholarship on hospitals include John D. Thompson and Grace Goldin, The Hospital: A Social and Architectural History (New Haven, Conn.: Yale University Press, 1975); Adrian Forty, “The Modern Hospital in England and France: The Social and Medical Uses of Architecture,” in Buildings and Society: Essays on the Social Development of the Built Environment, ed. Anthony D. King (London: Routledge & Kegan Paul, 1980), 61–93; Allan M. Brandt and David Charles Sloane, “Of Beds and Benches: Building the Modern American Hospital,” in The Architecture of Science, ed. Peter Galison and Emily Thompson (Cambridge, Mass.: MIT Press, 1999), 281–305; Stephen Verderber and David J. Fine, Healthcare Architecture in an Era of Radical Transformation (New Haven, Conn.: Yale University Press, 2000); David Charles Sloane and Beverlie Conant Sloane, Medicine Moves to the Mall (Baltimore: Johns Hopkins University Press, 2003); Annmarie Adams, Medicine by Design: The Architect and the Modern Hospital, 1893–1943 (Minneapolis: University of Minnesota Press, 2008). Other spaces for the care of patients, such as insane asylums, have also received consideration. See Carla Yanni, The Architecture of Madness: Insane Asylums in the United States (Minneapolis: University of Minnesota Press, 2007). Despite the long-standing interest in places for clinical care, scholars are only just beginning to examine spaces for medical education. One article analyzes a specific medical school: Steven J. Peitzman, “Style and Space: Designing a Medical School Building for Women in the 1870s,” Medical Humanities Review 13, no. 2 (Fall 1999), 28–43. A more recent article explores a professional and educational space for practicing physicians: Matthew Walker, “Architecture, Anatomy, and the New Science in Early Modern London: Robert Hooke's College of Physicians,” JSAH 72, no. 4 (Dec. 2013), 475–502.
4.
The larger study of which this article forms a part considers four-year schools that offered the MD degree, embraced the new scientific medicine, and located their entire programs in the same city. For additional discussion of the parameters of the research, see Katherine L. Carroll, “Modernizing the American Medical School, 1893–1940: Architecture, Pedagogy, Professionalization, and Philanthropy” (PhD diss., Boston University, 2012), 21–23.
5.
Kenneth M. Ludmerer, Learning to Heal: The Development of American Medical Education (New York: Basic Books, 1985), 11–20.
6.
Ibid., 18, 30–33. The phrases basic medical sciences and preclinical sciences are used interchangeably, along with laboratory training, to denote fields that study the human body, physical processes, and other related topics separate from the actual patient. Conversely, the term clinical training refers to experience with patients, either inpatients (those in hospitals) or outpatients (those who visit doctors).
7.
Ibid., 47–63, 72–73.
8.
J. Howard Ferguson, “A Chronological Calendar of Events of the College of Medicine at Syracuse 1872–1968 with Some Later Additions,” vol. 1, 1968, http://library.upstate.edu/collections/history/institution/ferg.php (accessed 8 Oct. 2010; site discontinued), Historical Collections at the SUNY Upstate Health Sciences Library, Syracuse, New York (hereafter SUNY Upstate). Ludmerer also mentions the limited physical environments of proprietary schools. See Kenneth M. Ludmerer, Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care (Oxford: Oxford University Press, 1999), 4.
9.
For descriptions of Howard's earliest medical school facilities, see Walter Dyson, Founding the School of Medicine of Howard University, 1868–1873 (Washington, D.C.: Howard University Press, 1929), 6; Walter Dyson, Howard University: The Capstone of Negro Education—A History, 1867–1940 (Washington, D.C.: Graduate School Howard University, 1941), 45.
10.
Harvard Medical School, The Harvard Medical School: 1782–1906 ([Boston?], [1906?]), xi.
11.
Explaining the need for the expanded laboratory spaces in the Boylston Street building, Harvard University president Charles Eliot compared the 1883 facility with its predecessor in “Exercises in Huntington Hall, Massachusetts Institute of Technology: Remarks of President Eliot,” in The New Century and the New Building of the Harvard Medical School, 1783–1883: Addresses and Exercises … (Cambridge, Mass.: John Wilson and Son/University Press, 1884), 38. While Eliot described a single anatomical laboratory in the previous building, other sources mention some additional laboratory accommodations. See J. Collins Warren, To Work in the Vineyard of Surgery: The Reminiscences of J. Collins Warren (1842–1927), ed. Edward D. Churchill (Cambridge, Mass.: Harvard University Press, 1958), 66–67; Moses King, Harvard and Its Surroundings, 3rd ed. (Cambridge, Mass.: Charles W. Sever, 1880), 59–60.
12.
“A Description of the New Building Erected for the Medical School of Harvard University,” Boston Medical and Surgical Journal 108, no. 15 (12 Apr. 1883), 339–43.
13.
On the city's development in the area around the new building, see ibid., 340.
14.
For a discussion of Hopkins's intentions for the medical school and hospital, see Alan M. Chesney, The Johns Hopkins Hospital and the Johns Hopkins University School of Medicine: A Chronicle, vol. 1, Early Years: 1867–1893 (Baltimore: Johns Hopkins Press, 1943), 12–17.
15.
Ibid., 68–69, 95–97; A. McGehee Harvey et al., A Model of Its Kind, vol. 1, A Centennial History of Medicine at Johns Hopkins (Baltimore: Johns Hopkins University Press, 1989), 16–17; Kathleen Waters Sander, Mary Elizabeth Garrett: Society and Philanthropy in the Gilded Age (Baltimore: Johns Hopkins University Press, 2008), 155–57.
16.
For a discussion of the conditions related to the gift, see Alan M. Chesney, The Johns Hopkins Hospital and the Johns Hopkins University School of Medicine: A Chronicle, vol. 2, 1893–1905 (Baltimore: Johns Hopkins Press, 1958), 42.
17.
The school's annual announcements described the slow expansion of the student body. For example, the 1893 announcement stated that only freshmen would be admitted at that time. Johns Hopkins Medical School, The Johns Hopkins Medical School Announcement for 1893–1894 (Baltimore: Johns Hopkins Press, 1893), 10, located in the Alan Mason Chesney Medical Archives of the Johns Hopkins Medical Institutions, Baltimore.
18.
The opening of the Physiological Building completed the first medical school campus; medical education had been bifurcated between the medical school site and the university campus until the Physiological Building enabled the Department of Physiology to relocate to the medical school block, uniting the medical school in a single location for the first time. See Chesney, The Johns Hopkins Hospital, vol. 2, 208–9. All dates for buildings indicate the year the structure was finished.
19.
Before being hired by the Johns Hopkins Medical School, George Archer (1848–1920) was one of a number of local architects who worked on the construction of the Johns Hopkins Hospital. Archer went on to design other buildings for the hospital and medical school in addition to those discussed in this article. For biographical information, see Irma Walker and James T. Wollon Jr., “George Archer,” Baltimore Architecture Foundation, http://baltimorearchitecture.org/biographies/george-archer (accessed 19 June 2014).
20.
Johns Hopkins Hospital, Seventh Report of the Superintendent of the Johns Hopkins Hospital (Baltimore: Johns Hopkins Press, 1896), 7; Johns Hopkins Hospital, Eighth Report of the Superintendent of the Johns Hopkins Hospital (Baltimore: Johns Hopkins Press, 1897), 7; both reports are located in the Alan Mason Chesney Medical Archives of the Johns Hopkins Medical Institutions, Baltimore.
21.
The pathology laboratory suffered a serious fire on 10 January 1920 and subsequently was razed in 1922, the Women's Fund Memorial Building was razed in August 1979, and the Physiological Building was razed in 1959. Similarly, neither the first nor the second Hunterian Laboratory (discussed shortly) survives. Plans for the Women's Fund Memorial Building published in Franklin P. Mall, “The Anatomical Course and Laboratory of the Johns Hopkins University,” Johns Hopkins Hospital Bulletin 7, nos. 62–63 (May–June 1896), 85–100.
22.
William Osler, one of the founding physicians of the Johns Hopkins Medical School, later described the ideal campus plan he had sketched when the medical school was being organized. Had money not been an object, he would have preferred four principal buildings, one centered on each side of a square outlined by cloisters ornamented by busts and statues of luminaries in the medical profession. The campus's focal point, “a beautiful structure in stone devoted to the library and museum,” would face the hospital and Monument Street (see Figure 4). See William Osler, “On the Library of a Medical School,” Johns Hopkins Hospital Bulletin 18, no. 193 (Apr. 1907), 111. In fact, at the time of the construction of the Women's Fund Memorial Building, the medical school had publicly adopted Osler's vision. Two descriptions of the projected campus, one of which was published in the local newspaper, generally followed Osler's ideas, although the Sun reported that the main building would house the school's administration rather than solely the library and museum. See “Woman's Fund Building [sic]: The First of the Johns Hopkins Medical School Group,” Sun, 16 Apr. 1894; George Archer to Daniel Coit Gilman, 12 Nov. 1894, Ms. 1, Series 1, Box 1.2, Folder 31, Ferdinand Hamburger University Archives, Johns Hopkins University, Baltimore.
23.
In contrast to the description in the Sun (“Woman's Fund Building”), which envisioned the Women's Fund Memorial Building on the side of the imagined quadrangle and another building behind it marking the back of the square, the L shape of the Physiological Building suggests that plans later in the decade did not foresee a quadrangle that extended to the very back (northern) edge of the lot. This interpretation is supported by the pre-1916 drawing, which includes a dotted outline that might indicate a proposed addition to the Women's Fund Memorial Building that would make the building into an L shape, mirroring the Physiological Building and further demarcating the back of the quadrangle (see Figure 6).
24.
American physicians in this period applied the word institute to a range of characteristics of a medical school. One use of the term denoted a separate building housing one or two subjects. See Harvard Medical School, The Harvard Medical School, 177. In the present article, I follow this definition.
25.
William Coleman and Frederic L. Holmes, “Introduction,” in The Investigative Enterprise: Experimental Physiology in Nineteenth-Century Medicine, ed. William Coleman and Frederic L. Holmes (Berkeley: University of California Press, 1988), 6.
26.
Ibid., 8.
27.
Charles E. McClelland, State, Society, and University in Germany, 1700–1914 (Cambridge: Cambridge University Press, 1980), 280–81.
28.
Coleman and Holmes, “Introduction,” 9. This discussion concerns only institutes founded at German universities, not research institutes founded outside academia.
29.
To cover the approximately $5 million required for the land, construction, equipment, and endowment of the new facilities, the school needed to raise about $3 million. Almost 90 percent of this amount came from four donors: J. P. Morgan ($1,135,000); John D. Rockefeller Sr. ($1 million); Arabella Huntington ($250,000), widow of railroad mogul Collis P. Huntington; and prominent Bostonian and Harvard alumnus David Sears ($250,000). For details of these gifts, see Warren, To Work in the Vineyard of Surgery, 214–17.
30.
The Women's Fund Memorial Building cost $63,331.14 to complete, and construction of the Physiological Building cost a total of $76,869.44. Chesney, The Johns Hopkins Hospital, vol. 2, 47, 209. As the comparison of Hopkins and Harvard indicates, the institute model could be constructed on both large and relatively small budgets and scales. The same is true for the other two medical school building types discussed shortly. Given this fact, an analysis of construction costs within each of the three types reveals little.
31.
Warren, To Work in the Vineyard of Surgery, 204.
32.
For a description of the buildings, see “The New Harvard Medical School: The Architects’ Work,” Harvard Graduates’ Magazine 14, no. 56 (June 1906): 616–17, nrs.harvard.edu/urn-3:HUL.FIG.GITEM:32044107292575 (accessed 19 Oct. 2014). The architectural plans reveal one variation on this general layout for laboratory buildings. The library in Building E did not sit above the lecture hall in the building's central section. Instead it resided in one of the wings, while the space usually reserved for the library remained empty for future use as a hygiene laboratory. Plans for Harvard Medical School are available at the archives of Shepley Bulfinch Richardson and Abbott, Boston, Massachusetts.
33.
Harvard Medical School, The Harvard Medical School, 177.
34.
Henry P. Bowditch, letter to the editor, Boston Medical and Surgical Journal 82 (21 Apr. 1870), 305. Jack Eckert, public services librarian at the Center for the History of Medicine at the Francis A. Countway Library of Medicine, introduced me to this letter.
35.
W. Bruce Fye, “Carl Ludwig and the Leipzig Physiological Institute: ‘A Factory of New Knowledge,’” Circulation 74, no. 5 (Nov. 1986), 920; Coleman and Holmes, “Introduction,” 5. For a critical discussion of the formation of this institute, see Timothy Lenoir, “Science for the Clinic: Science Policy and the Formation of Carl Ludwig's Institute in Leipzig,” in Coleman and Holmes, The Investigative Enterprise, 139–78.
36.
Richard L. Kremer, “Building Institutes for Physiology in Prussia, 1836–1846: Contexts, Interests and Rhetoric,” in The Laboratory Revolution in Medicine, ed. Andrew Cunningham and Perry Williams (Cambridge: Cambridge University Press, 1992), 73.
37.
Bowditch, letter to the editor, 306.
38.
Ibid. In other ways, the Harvard Medical School structures diverged from their German prototypes. For example, at least some German institutes provided housing for faculty and other personnel. As Bowditch reported, the Physiological Institute at Leipzig accommodated Ludwig and his family along with other laboratory personnel on the second floor. Ibid. In contrast, Wilhelm His's Anatomical Institute in Leipzig, which opened in 1875, contained housing for staff and assistants but does not appear to have included living quarters for His. Wilhelm His, “Bericht über die anatomische Anstalt in Leipzig,” Zeitschrift für Anatomie und Entwickelungsgeschichte, Separatabdruck 26 ([1877?]), 423–24, located in the U.S. National Library of Medicine, National Institutes of Health, Bethesda, Maryland.
39.
A contemporary description of the new Harvard Medical School quadrangle notes that the distance between the wings and the buildings was calculated using on-site experiments to ensure that the buildings were separated enough to enable sunlight to reach the basement windows even in the winter. Harvard Medical School, The Harvard Medical School, 189. These ideas are also discussed in “The New Harvard Medical School Buildings, Boston, Mass,” American Architect 92, no. 1669 (21 Dec. 1907), 204. This article is reprinted from Harvard Medical School, The Harvard Medical School, 185–93. According to the American Architect article (203), the architects of the quadrangle, Shepley, Rutan, and Coolidge, prepared this section of the Harvard Medical School volume.
40.
John Collins Warren, “Memoir #4,” 217, emphasis added, John Collins Warren Additions, box untitled, Folder “Memoir #4,” Massachusetts Historical Society, Boston.
41.
For published plans, see Moritz Pistor, Anstalten und Einrichtungen des öffentlichen Gesundheitswesens in Preussen: Festschrift zum X. internationalen medizinischen Kongress, Berlin 1890 (Berlin: Julius Springer, 1890). See also His, “Bericht über die anatomische Anstalt in Leipzig,” 411–41. The American journal Methods and Problems in Medical Education included a number of illustrated articles dedicated to specific institutes. For examples, see H. Braus, “Die anatomische Anstalt der Universität Würzburg,” Methods and Problems of Medical Education, 1st ser. (1924), 55–68; and André Forster, “L'Institut d'Anatomie de l'Université de Strasbourg,” Methods and Problems of Medical Education, 3rd ser. (1925), 129–35.
42.
For the plans for this institute, see Pistor, Anstalten und Einrichtungen des öffentlichen Gesundheitswesens, 95.
43.
It remains to future scholarship to determine where the plan originated in Germany and the frequency of its occurrence in German medical institutes and other building types. Another potentially fruitful project would look at other American scientific disciplines that may have used the central auditorium model. P. Thomas Carroll and Stewart W. Leslie's paper “Buildings and Bildung: Science's Place in Academic America,” presented at the annual meeting of the Society of Architectural Historians in 2009, suggests the richness of this area of research.
44.
Charles W. Eliot, “President's Report for 1898–99,” Annual Reports of the President and the Treasurer of Harvard College, 1898–99 (Cambridge, Mass.: Harvard University, 1900), 25–26, http://nrs.harvard.edu/urn-3:hul.arch:15002 (accessed 20 Oct. 2014); Charles W. Eliot, “President's Report for 1899–1900,” Annual Reports of the President and the Treasurer of Harvard College, 1899–1900 (Cambridge, Mass.: Harvard University, 1901), 19, http://nrs.harvard.edu/urn-3:hul.arch:15002 (accessed 20 Oct. 2014).
45.
W. T. Councilman, “Ideals and Methods of New Medical School,” Harvard Graduates’ Magazine 15, no. 55 (June 1907), 586, located in the Francis A. Countway Library of Medicine, Boston, Massachusetts.
46.
Despite what Councilman would insist, these relationships were not fixed or, to use his word, “natural.” Ibid. The medical school at Syracuse University, discussed shortly, provides one example of a school that correlated the preclinical disciplines differently.
47.
Ralph Bergengren hinted at this situation when he wrote, “Each department building thus bring[s] together the subjects most closely allied in the school curriculum and [is], to all intents and purposes, the home of the individual student while he is mastering them.” Ralph Bergengren, “The New Harvard Medical School: The Most Perfectly Equipped Institution of Its Kind in the World Begins Its Activities with the Opening of the Present College Year,” Indoors and Out 3, no. 2 (Nov. 1906), 54.
48.
For a summary of the schedule and the courses for the first and second years, see Harvard University, Official Register of Harvard University 3, no. 39 (1906–7), 17–36, located in Harvard University Archives, Cambridge, Massachusetts. For a discussion of how Harvard Medical School organized its block system, see Henry A. Christian, “The Concentration Plan of Teaching Medicine,” paper read at a meeting of the Association of American Medical Colleges, 21 and 22 [Mar.?] 1910, 1–4, Abraham Flexner Papers, Box 20, Folder “Harvard University, 1904–1910,” Manuscript Division, Library of Congress, Washington, D.C. For a description of the division of space within the buildings, see Harvard Medical School, The Harvard Medical School, 189–91.
49.
Christian, “The Concentration Plan of Teaching Medicine,” 7–8.
50.
For an examination of the growth of the teaching hospital as part of the reform of medical education, see the chapter titled “The Rise of the Teaching Hospital” in Ludmerer, Learning to Heal, 219–33. Ludmerer also mentions the physical association of the medical school and hospital. Ibid., 231.
51.
Charles S. Minot to Charles W. Eliot, 24 Sept. 1902, Records of the President of Harvard University, Charles W. Eliot, 1869–1930, UAI 5.150, General Correspondence Group 2, Box 54, Folder “Charles S. Minot, 1893–1903,” Harvard University Archives, Cambridge, Massachusetts.
52.
In 1933, there were seventy-seven medical schools in the United States. Ludmerer, Time to Heal, 51. To date, I have identified the medical school building types constructed between 1893 and 1940 at nearly forty of these medical colleges, specifically, twenty-six single buildings for preclinical studies, four institute designs, and eight medical school–hospitals.
53.
Abraham Flexner, Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching (1910; repr., n.p.: Wm. F. Fell, 1972), http://archive.carnegiefoundation.org/publications/medical-education-united-states-and-canada-bulletin-number-four-flexner-report-0 (accessed 5 Sept. 2015).
54.
For a thorough discussion of the Flexner Report, see Ludmerer, Learning to Heal, 166–90.
55.
Flexner, Medical Education, 272–73, 276.
56.
After his work at the Carnegie Foundation, Flexner became the leader of the medical education program of John D. Rockefeller's General Education Board, where he worked from 1912 to 1928. In this role, Flexner helped to enact the system of medical education outlined in his 1910 report and focused the board's financial resources on the medical college at the University of Rochester rather than on the medical school at Syracuse University. For a larger analysis of Syracuse's efforts to obtain funding through the General Education Board, including Flexner's role in channeling money to Rochester rather than to Syracuse, see Carroll, “Modernizing the American Medical School,” 202–6. For a thorough study of Flexner's development of a national program for medical education and his implementation of this program through his work at the General Education Board, see Steven C. Wheatley, The Politics of Philanthropy: Abraham Flexner and Medical Education (Madison: University of Wisconsin Press, 1989), esp. chaps. 3–5, on the rise and fall of Flexner's management system.
57.
For floor plans and discussion of the 1896 building, see Eric v. d. Luft, SUNY Upstate Medical University: A Pictorial History (North Syracuse, N.Y.: Gegensatz Press, 2005), 72–73.
58.
By 1930, five hospitals stood in the vicinity of the proposed site for Syracuse's college of medicine. See Kenneth W. Wright, Foundations Well and Truly Laid: A History Leading to the Formation of the State University of New York Health Science Center at Syracuse (Syracuse, N.Y.: Alumni Association of the SUNY Health Science Center at Syracuse, 1994), 58–59, 113. For a description of the inadequacies of the 1896 building by the 1930s, see ibid., 53–54.
59.
F. Gordon Smith to William Graham and the Executive Committee of the Board of Trustees, 10 Oct. 1940, Chancellors Charles Flint and William Graham Papers, RG 01/Flint and Graham, Box 13626, Folder “Smith, F. Gordon, 1937–41,” University Archives, Syracuse University Libraries, Syracuse, New York (hereafter Syracuse University). This document traces Smith's efforts to procure financial support for the new medical college building, including the ultimate loan from the Public Works Administration. In describing his task, Smith mentions that in 1935 the school's Class A rating was in jeopardy. While Smith implies that the poor physical plant undermined the school's Class A rating, a direct connection between the facilities and the rating is established in “Syracuse University College of Medicine; Copy of Outline to Mr. Straus,” 19 Sept. 1936, 3, Papers of Herman G. Weiskotten, Box 13, Folder “Historical—College of Medicine,” SUNY Upstate. Finally, it was much more common for a medical school to receive state support than to obtain funds from the federal government.
60.
Final plans for the 1937 Syracuse medical school (from 20 Mar. 1936) are located in the Physical Plant–Technical Support Department of the SUNY Upstate Medical University, Syracuse, New York. Earlier sets of plans dated 3 July 1935 and 10 October 1935 showing the building with different footprints, in addition to a set of the final plans, are available at Syracuse University; the 3 July 1935 set is located in College of Medicine, RG 44, Box 15410, Folder “Medical College,” and the 10 October 1935 and 20 March 1936 plans are located in drawer “MC 4-4; SU Buildings ME-Mi.”
61.
Outpatient care initially took place in several locations around the city before being consolidated in one of the hospitals. See Wright, Foundations Well and Truly Laid, 60–61. Training took place not only at the hospitals around the medical school but also at those outside the immediate area of the medical college. See Syracuse University Bulletin: College of Medicine, 1938–1939 (Syracuse: [Syracuse University?], [1938?]), 20–21, located in SUNY Upstate.
62.
Ludmerer describes the widespread adoption of the block system. Ludmerer, Time to Heal, 66.
63.
Syracuse University Bulletin, 22.
64.
For an outline of the school's curriculum, see ibid., 23–30. The final architectural plans do not label the various departments in the medical college, but the departments are labeled on the earlier plans dated 10 October 1935. By correlating the physical needs (e.g., types of laboratories) in the two plans, I was able to determine which departments occupied which spaces on the later plans. The space for the Department of Pharmacology was not definitively concluded, but it may also have been located along the central corridor of the second floor. Regardless, it is clear that the layout of the departments in the building aligned closely with the curriculum. The plans dated 10 October 1935, along with a set of the final plans, are available at Syracuse University.
65.
At the dedication of the 1906 Harvard Medical School plant, William Welch asserted that “in the singular harmony of the architecture of the group of buildings devoted to the various medical sciences is typified the unity of purpose of these sciences and their combination into the one great science of medicine.” “The Dedication of the New Medical School,” Harvard Graduates’ Magazine 15, no. 58 (Dec. 1906), 246, nrs.harvard.edu/urn-3:HUL.FIG.GITEM:32044107292526 (accessed 16 Sept. 2015). While he recognized the need for specialization, breaking down medical science into subsections of study, Welch affirmed that “the further division of labor is carried, the more necessary does it become to emphasize essential unity of purpose and to secure coördination and cordial coöperation of allied sciences.” Ibid., 250. Welch looked at the Harvard Medical School quadrangle and saw an integrated plant. Its institute design, however, promoted affiliation primarily between the related disciplines aligned in each of the four laboratory buildings. The single building for preclinical studies and the medical school–hospital, described next, took this unification even further.
66.
Syracuse constructed its single-building medical college with an $825,000 loan, and Harvard spent more than $2.6 million to erect its institute design, but these numbers are somewhat misleading, since an institute design could be constructed for much less money than Harvard used. More significant than the raw numbers was the understanding that the more buildings a school erected, the greater the overall cost of the project. See the earlier discussion of Minot's letter to Eliot, 24 Sept. 1902.
67.
Wilburt C. Davison, The Duke University Medical Center (1892–1960): Reminiscences of W. C. Davison, Dean of the Duke University Medical School, 1927–1960 ([Durham, N.C.?]: [Duke University?], [1967?]), 17. Davison compared the institute design with the medical school–hospital, but his point is relevant with regard to both the medical school–hospital and the single building for preclinical sciences. Historian Charles E. McClelland notes that the institute design in German universities also reflected intellectual barriers between departments, concluding that “the walls of the institute … buildings … were mute representatives of the walls between disciplines, even within the same faculty.” McClelland, State, Society, and University, 279.
68.
Between 1906 and 1932, Shepley, Rutan, and Coolidge designed eight medical schools, more than any other architectural firm in the country. In addition, the firm created two of the nation's most progressive medical schools of the early twentieth century, Harvard Medical School in 1906 and Vanderbilt University School of Medicine in 1925. The firm and its members also published on the topic of medical school architecture. See Coolidge and Shattuck, Winford H. Smith, and G. Canby Robinson, “The New Plant of the Vanderbilt University Medical School and Hospital,” Modern Hospital 20, no. 2 (Feb. 1923), 109–18; Henry R. Shepley, “Considerations in Planning a Teaching Hospital,” in Modern Hospital Year Book, 6th ed. (Chicago: Modern Hospital Publishing, 1926), 91–96. Shepley's article includes a discussion of how to design a medical school–hospital. For consistency's sake, in this essay I generally refer to the firm as Shepley, Rutan, and Coolidge, but the firm's name changed several times. The various iterations are as follows: the Office of H. H. Richardson (1874–86); Shepley, Rutan, and Coolidge (1886–1915); Coolidge and Shattuck (1915–24); Coolidge, Shepley, Bulfinch, and Abbott (1924–52); and Shepley, Bulfinch, Richardson, and Abbott (1952–present), the last often branded Shepley Bulfinch. I use the chronologically appropriate name when discussing specific projects. For contextualization of the firm's medical school buildings within its broader work, see Julia Heskel, Shepley Bulfinch Richardson and Abbott: Past to Present (Boston: SBRA, 1999). For additional information on the firm, see J. D. Forbes, “Shepley, Bulfinch, Richardson & Abbott, Architects; An Introduction,” JSAH 17, no. 3 (Autumn 1958), 19–31. On the dominant role of the General Education Board in medical education philanthropy, see Ludmerer, Learning to Heal, 192–93. John D. Rockefeller founded the General Education Board, and from 1919 to 1921 he provided it with $45 million for American medical colleges. By the time the organization closed its doors in 1960, it had given the nation's medical schools just over $94 million. General Education Board gifts were often conditional on the recipient acquiring an even greater amount of money from other sources. When combined, the conditional gifts and the funds received directly from the General Education Board resulted in approximately $600 million directed to medical education. Raymond B. Fosdick, Adventure in Giving: The Story of the General Education Board, a Foundation Established by John D. Rockefeller, based on an unfinished manuscript prepared by the late Henry F. Pringle and Katharine Douglas Pringle (New York: Harper & Row, 1962), 161, 172–73.
69.
Timothy C. Jacobson provides a thorough description of the funding and final design for the 1925 Vanderbilt medical school and hospital in Making Medical Doctors: Science and Medicine at Vanderbilt since Flexner (Tuscaloosa: University of Alabama Press, 1987), esp. 79–140. In particular, Jacobson recognizes the landmark nature of the facility as the first single-building medical school to combine preclinical and clinical teaching and research. Ibid., 121. The term I use here, medical school–hospital, has no historical precedent; it is my phrase.
70.
For descriptions of this campus, see Rudolph H. Kampmeier, Vanderbilt University School of Medicine: The Story in Pictures from Its Beginning to 1963 (Nashville: Vanderbilt University Medical Center, 1990), 26–28; James H. Kirkland to Abraham Flexner, 27 June 1921, General Education Board Archives, Series 1, Subseries 1, Box 152, Folder 1408, Rockefeller Archive Center, Sleepy Hollow, New York (hereafter RAC).
71.
Unsigned sketch attached to James H. Kirkland to Wallace Buttrick, 13 Oct. 1919, General Education Board Archives, Series 1, Subseries 1, Box 152, Folder 1406, RAC; unsigned sketch attached to G. Canby Robinson to James H. Kirkland, 11 May 1920, RG 300, Box 100, Folder 21, Vanderbilt University Archives, Nashville (hereafter Vanderbilt University).
72.
Coolidge and Shattuck, Vanderbilt Training Hospital, General Plan #4, revised 8 July 1920, Dean Robinson's Files, Box 1b, Folder “Blueprints: V.U. Hospital and Medical School,” Eskind Biomedical Library Historical Collection, Vanderbilt University Medical Center, Nashville (hereafter Eskind Library).
73.
G. Canby Robinson, “Plan for the Proposed Reorganization of the Vanderbilt University Medical School,” received 25 Sept. 1920, 1–2, General Education Board Archives, Series 1, Subseries 1, Box 152, Folder 1407, RAC.
74.
Ibid., 2.
75.
Ibid., 3.
76.
G. Canby Robinson, “Vanderbilt University School of Medicine: History and General Description,” Methods and Problems of Medical Education, 13th ser. (1929), 1, 8.
77.
For an overview of the facility, including finances, see ibid., 1–14. As with the other two medical school types, the cost of medical school–hospitals varied tremendously. Woman's Medical College of Pennsylvania built a modest medical school–hospital in 1930 for just under $900,000, while the $3 million raised by Columbia University's College of Physicians and Surgeons covered only the medical school section of the 1928 Columbia-Presbyterian Medical Center.
78.
Coolidge and Shattuck, Proposed Hospital on South End of West Campus, Vanderbilt University, attached to Winford Smith to Charles Coolidge, 7 Jan. 1921, RG 300, Box 100, Folder 12, Vanderbilt University.
79.
G. Canby Robinson, sketches for Vanderbilt University School of Medicine and Hospital, June 1921, G. Canby Robinson Biographical File, Folder 2, Eskind Library.
80.
Robinson, “The Relation of Medical Education,” 321–23. The article also included the architectural plans of the first and third floors of the new Vanderbilt facility.
81.
Ibid., 321; Robinson, “Vanderbilt University School of Medicine,” 8; “Comments on Suggested Plan of Medical Buildings Vanderbilt University, West Campus,” RG 300, Box 98, Folder 21, Vanderbilt University.
82.
Davison, The Duke University Medical Center, 17.
83.
Robinson, “Vanderbilt University School of Medicine,” 11.
84.
A history of the school mentions how quickly one could visit a colleague in his laboratory in the small building. Rudolph H. Kampmeier, Recollections: The Department of Medicine, Vanderbilt University School of Medicine, 1925–1959 (Nashville: Vanderbilt University Press, 1980), 179–80, located in Eskind Library.
85.
For the schedule before the move, see Bulletin of Vanderbilt University, School of Medicine of Vanderbilt University, 1924–1925 (Nashville: [Vanderbilt University?], 1924), 57–59, located in Eskind Library.
86.
While the University of Colorado's new medical school–hospital opened before Vanderbilt's, Robinson completed the June 1921 sketches that formulated the final layout of the Vanderbilt complex before architect Maurice Biscoe began designing the University of Colorado facility. The medical school–hospital scheme originated at Vanderbilt. See Carroll, “Modernizing the American Medical School,” 124n313.
87.
Robinson, “The Relation of Medical Education,” 321. Medical educators throughout the country recognized the significance of medical school design to medical education. Robinson's voice is frequently heard in this article, however, due to his connection with Vanderbilt and his promotion of the medical school–hospital.
88.
Ludmerer, Learning to Heal, 32.
89.
The indoctrination of medical students that took place in the lounges, laboratories, and clinics of the new facilities also resulted in the earliest formation of their nascent sense of professional identity, one that privileged white men. For discussion of this topic, see the chapter titled “Making People: Creating Professional Identities,” in Carroll, “Modernizing the American Medical School,” 211–73.
90.
Robinson, “The Relation of Medical Education,” 321.