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Considers the increasingly popular, so‐called ‘No‐Miracles’ argument that we do have a valid inductive argument for supposing that our current theories, at any rate in physics, are substantially, if not wholly, true: it would be incredibly improbable that theories very far from the truth could make such extremely precise predictions, verified experimentally up to one part in a billion. Such ‘miracles’ of chance agreement can clearly be ruled out as themselves too improbable to be true. This apparently plausible argument is examined carefully and shown to consist in a number of separate steps, all of which are fallacious.

Some say that no challenge is more difficult than trying to change a traditional curriculum into a problem-based one. Maastricht University has been lucky in that it was able to start with problem-based learning (PBL) curricula right from its foundation. However, most universities that wish to adopt a PBL curriculum have to take a more difficult path. Some universities have walked this path successfully and it is worthwhile learning from their experiences. This chapter is based on involvement over the past twenty-five years in different models of PBL curricula, at Harvard Medical School, the University of Heidelberg, the Charité Medical Center in Berlin, and Maastricht University. It presents practical advice on the transition from a traditional to a PBL curriculum.

This chapter presents an ethnographic account with a recollection of the early debates about the New Pathway, thereby setting the stage for student experience. The ethnographic text grew out of a study of curricular innovation at Harvard Medical School, initially known as the New Pathway. The discussion begins with the study in the second year of the experimental curriculum, when 38 of 160 students in the incoming class of 1990 were selected to pursue the New Pathway, noting that discourses on medical competence characterize moments of educational innovation. The New Pathway was promoted as committed to the ideals of improving relationships between patients and physicians, and experimental tutorials led by clinicians exposed students to early patient contact, training in clinical skills and psychosocial assessment, and discussions of critical issues in the patient-doctor relationship.

In the waning years of the nineteenth century, despite (or perhaps because of) the inroads of laboratory science, uncertainty still hung heavy over the future shape of the medical curriculum. Although currents of change now flowed freely through the medical schools and conditions of study were shifting in every country, agreement was far from universal on such primary questions as the place of science and the laboratory in medical study, how clinical medicine should best be taught, the best way to prepare for medical study, the order of studies, minimal requirements for practice, and the importance of postgraduate study. “Perturbations and violent readjustments,” an American professor told his audience in 1897, marked the life of every medical school in this “remarkable epoch in the history of medicine.” Similar to the era of change a century before, students were again confronted with bewildering choices. Old questions long thought settled rose in new form. Did the practical study of medicine belong in a university at all? Was bedside instruction still needed by every student in training, or was the superbly conducted clinical demonstration not as good or even better? Should students perform experiments themselves in laboratories so as to understand the real meaning of science and its promise for medicine, or was it a waste of valuable time for the vast majority? And what about the university—now the home of advanced science, original research work, and the scientific laboratory—was it to be the only site to learn the medicine of the future? What about the still numerous hospital and independent schools, the mainstay of teaching in Anglo- America in 1890—did they still have a place in the teaching of medicine? Amidst the often clamorous debates on these and other questions, the teaching enterprise was still shaped by strong national cultural differences. In the final years of the century, the Western world was experiencing a new sense of national identity and pride that ran through developments in science and medicine as well as politics. The strident nationalism and industrial-scientific strength of a united Germany, evident to physicians studying there, thoroughly frightened many in the rest of Europe.

By the turn of the twentieth century, the drive to make medicine more scientific and comprehensive and to limit its ranks to the well prepared had had a profound effect on student populations. Almost universally, students were now older, better educated, more schooled in science, less rowdy, and able to spend larger amounts of time and money in study than their counterparts in 1850 had been. Their ranks, now including a growing number of women, were also likely to include fewer representatives of working- and lower-middle-class families, especially in Britain and America, than a half-century before. Nations still differed, sometimes sharply, in their openness to students from different social classes. The relative openness of the German universities to the broad middle classes, as well as their inclusion of a small representation of “peasantry and artisans,” wrote Lord Bryce in 1885, was a sharp contrast with “the English failure to reach and serve all classes.” The burgeoning German enrollments, he noted, were owing to “a growing disposition on the part of mercantile men, and what may be called the lower professional class, to give their sons a university education.” More students by far from the farm and working classes of Germany, which accounted for nearly 14 percent of medical enrollment, he observed, were able to get an advanced education than were such students in England. A historic transformation in the social makeup of universities, according to historian Konrad Jarausch—from “traditional elite” to a “modern middle-class system”—was taking place in the latter nineteenth century. In France, rising standards in education, together with the abolition of the rank of officiers de santé—which for a century had opened medical training to the less affluent—were forcing medical education into a middle- class mold. In the United States, the steeply rising requirements in medicine, along with the closing of the least expensive schools, narrowed the social differences among medical students and brought sharp complaints from the less advantaged. The costs of medical education in some countries threatened to drive all but the most thriving of the middle classes from a chance to learn medicine.

This chapter presents an English translation of selected passages from John Warren’s Lectures on Anatomy, delivered between 1783 and 1812. Most of the lectures deal with technical aspects of anatomy, ranging from the structure and parts of the body through characteristics of bones and ligaments to making anatomical preparations. Here Warren offers valuable insights into American medical history and progress. The present selection focuses on the history and theory of anatomy that Warren taught as part of his course over the first three decades in the history of Harvard Medical School (HMS). Warren was one of the founders of HMS on September 19, 1782, with Aaron Dexter and Benjamin Waterhouse. He served as the school’s first Professor of Anatomy and Surgery.

Chapter 5 tracks the work of Walter Cannon from the beginnings of his career when he pioneered the use of X-rays for the study of internal phenomena to the late 1920s when he developed the modern concept of homeostasis. We show how Cannon moved from (a) identifying experimentally and epistemologically the mechanisms on which the digestive system was built to (b) theorizing the neurophysiological and pathological arrangement of the emotions, and eventually to (c) presenting the body as an integrated system that he called a “fluid matrix.” The digestive machine had given way to a hormonal and emotional whole and, later, to a homeostatic self. More than any of our other protagonists in this book, Cannon exemplifies the shift to a concept of the individual as brittle and constantly imperiled. “Our bodies,” he pronounced over and over in the 1930s, are “made of extraordinarily unstable material”; only organism-wide stabilization processes hold our bodies together.