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A complex but enduring partnership

Yale Medicine Magazine, 2019 - Autumn


After two centuries of shared history, the School of Medicine and the city of New Haven continue to shape each other.

Yale School of Medicine (YSM) in the 21st century is rightly considered a world-class institution, while the city that surrounds it is equally renowned for the excellence of its hospitals and biotechnology companies. Today, the relationship between YSM and New Haven is strong, but it wasn’t always that way: the pair has weathered setbacks in their growth and their relationship.

YSM was founded during a period in which professional schools in law, medicine, and theology separated from undergraduate colleges. The Medical Institution of Yale College, as it was then known, was not chartered until 1810. Its beginnings in a building on Prospect Street soon brought it into conflict with the townsfolk, then numbering fewer than 7,000 souls. A riot broke out in 1824 when the body of a young woman taken from the cemetery was discovered in the cellar of the Medical Institution. While New Haveners held general medical practice in high regard, dissection associated with grave robbing was taboo.

The Industrial Revolution brought many changes to city and school alike, not all of them positive. New Haven’s 1830s investment in building a canal northward to Northampton squandered capital that could have been used to build a railroad. On the other hand, Eli Whitney’s cotton gin and gun factory brought prosperity to the city and turned it into a manufacturing center for military equipment. As a result, New Haven’s population grew from 20,000 in 1850 to 40,000 only 10 years later. The medical school made its own history in this period by graduating its first African American student in 1857 and by moving to York Street in 1860. It became the official medical school of the university in 1887.

YSM’s stature declined after the 1890s, however. Abraham Flexner noted in his famous 1910 report on American medical education that although Yale compared favorably to medical schools that were not university-affiliated, its departments of anatomy, bacteriology, and pathology were deficient; its professors had to do routine work rather than research because they lacked assistants; and the study of obstetrics and gynecology was limited to the outpatient clinic in the hospital. World War I brought two important innovations: the establishment of the Department of Public Health (later to become a separate school) in 1915, and the admission of the first women students in 1916. But the school’s four buildings were scattered across downtown New Haven, and it had to rely on the university to cover its debts.

It was Milton Winternitz, MD, who transformed YSM from the university’s stepchild to a national leader in medical education. Winternitz, dean from 1920 to 1935, not only raised money to give the school financial stability, but also supervised its move to its present location next to what is now Yale New Haven Hospital. He added the Department of Psychiatry and the School of Nursing as well as recruited a stellar faculty that brought YSM into the front rank of American medical schools. Most importantly, he introduced the Yale system, an approach unique to YSM that deemphasizes grades and class ranking, and encourages medical students to become flexible and independent thinkers (as their varied postgraduate careers demonstrate). Winternitz’s requirement of a thesis for the MD degree is one reason why a high number of YSM graduates still enter academic medicine.

The 1950s witnessed the impact of the automobile and the construction of interstate highways on both the city and its medical school. As the city’s population grew to a postwar high of 160,000 and its medical center attracted increasing traffic, Mayor Richard C. Lee decided in 1957 to tear down a Jewish, Irish, and Italian immigrant neighborhood near the hospital to make room for an expressway and two frontage roads. In addition to destroying one of New Haven’s most distinctive areas, the Oak Street Connector severed the medical center from the rest of the university and introduced numerous hazards for drivers and pedestrians alike. Downtown Crossing, a three-phase project to redesign the expressway is currently in Phase 2. Completion is scheduled in 2021. Planners hope it makes New Haven friendlier to people commuting by foot—after all, the city has a higher percentage of residents who walk to work than any other city in New England.

YSM contributes to the revitalization of downtown New Haven in several ways—first, by ensuring that all its new buildings meet Leadership in Energy and Environmental Design (LEED) certification standards. Second, the school is working with the city to make the medical campus more pedestrian-friendly. Most importantly, however, YSM is deeply involved with the surrounding community to meet its most pressing health care needs. Faculty and students provide care for people in a wide range of settings, from YSM’s refugee clinic for adults and the student-run HAVEN Free Clinic in Fair Haven to the Neighborhood Health Project (which provides free diabetes and blood pressure screenings) and an expanded addiction medicine program. While many challenges remain in regard to human need as well as urban infrastructure, YSM and New Haven are committed to meet them as partners.