VP&S: The Early Years (1767-1928)

On November 2, 1767, a parade of dignitaries walked in procession for the opening ceremonies of a new medical school at King’s College, the first medical school in New York and the second in the American colonies. Peter Middleton, King’s College professor of physiology, delivered the opening address, Historical Inquiries into the Ancient and Present Systems of Medicine. His lecture would be the first medical history published in America. The institution he addressed 250 years ago, known today as the Columbia University Vagelos College of Physicians and Surgeons (VP&S), would factor prominently in the future—and eventually, the history—of the healing arts.

From its first modest quarters at the southern tip of colonial New York City, the new medical school periodically moved north, until finally reaching its current home, in the neighborhood of Washington Heights, in the 1920s. There, VP&S would anchor a novel institutional alliance that helped to usher in a new age of collaborative, evidence-based medical discovery and clinical care. Two-and-a-half centuries after admitting its first students, P&S continues to change how medicine is practiced around the world by training the physician-scientists who lead the field.

Challenges Along the Way

“Do not therefore imagine, that from this Time your Studies are to cease; so far from it, you are to be considered as but just entering upon them; and unless your whole Lives, are one continued Series of Application and Improvement, you will fall short of your Duty.”

—Samuel Bard, MD, one of New York’s leading physicians delivering the commencement address, 1769

King’s College Medical School granted its first baccalaureates in medicine in 1769, and the first MD degree in North America in 1770, taking a place at the front line of the evolution of medical education and the medical profession in New York. It would also establish an important institutional legacy embedded in Samuel Bard’s advice to graduates at the inaugural commencement—namely, to pursue lifelong learning, the driving force behind today’s clinical and basic science research and best clinical practice.

King’s College closed its doors during the American Revolution. Some medical faculty sided with the loyalists; others left New York in support of the patriot cause. In 1784, King’s College reopened as Columbia College. The medical school resumed in 1791 with a new faculty and Dr. Samuel Bard as dean.

By 1800, Columbia was one of only four medical schools in the nation. The norm for medical training was a three- to four-year apprenticeship, and these varied widely in quality. Medical textbooks were hard to come by, part of the reason why students took the same course of lectures twice. Men with means pursued their medical education abroad, typically in Edinburgh and London. They brought back the most current ideas about medical practice and became the first professors in our nation’s first medical schools, which for years supplemented rather than replaced the apprenticeship system.

In his 1769 commencement address, Dr. Bard called for the founding of a hospital to serve the community and to provide clinical instruction for medical students. New York Hospital opened in 1791, the same year Columbia’s medical school reopened. The Almshouse, the city’s home for the poor and forerunner of Bellevue Hospital, offered another opportunity for practical instruction. With these hospital affiliations, VP&S enjoyed a promising outlook as a medical school, but few students attended, faculty personalities clashed, and the institution struggled to re-establish itself.

In 1806, the city’s physicians organized a new professional organization, the Medical Society of the County of New York, and elected Nicholas Romayne, MD, a Columbia professor, as its first president. Romayne led the society’s effort to establish a rival medical school. In 1807, the Regents of the University of the State of New York granted a charter for the College of Physicians and Surgeons in the City of New York, “for the public good and the promotion and improvement of the medical profession and sciences.” Romayne also served as the first president of P&S; the initial faculty included David Hosack, MD, another former Columbia professor, perhaps best known for attending Alexander Hamilton after his fatal duel with Aaron Burr.

As Columbia College Medical School continued to struggle and P&S prospered, a union began to make sense. In 1814, the two medical schools officially merged, creating a larger, stronger faculty. The merger would better position the institution against competition from new medical schools in New York and elsewhere in the second quarter of the 19th century. In 1860, VP&S obtained its independence from the Regents and formed a nominal relationship with Columbia. In 1891, VP&S fully merged with the University it spun off from 84 years prior.

Forward Momentum

“The College of Physicians and Surgeons of the City of New York, having lately undergone a material improvement, is now placed under the direction of able Professors, who are pursuing a wise and rational course of education that must soon raise that institution to an enviable station. And as that city must eventually become the commercial emporium of this country, it is presumed that the period is not far distant, when in a medical point of view, it will also become the London or Paris of America.”

—Joseph White, MD, president of the New York State Medical Society, 1816

The way forward was not without bumps in the road, whether conflicts over governance, faculty appointments, or other matters. However, VP&S never strayed from its vision to advance medical education for the good of patients, science, and the profession, or from its place at the vanguard of institutions striving to raise the standards of medical education. In the mid-19th century, VP&S enriched the curriculum with increased attention to and resources for such basic sciences as pathology, physiology, dissection, and microscopic anatomy. When the school moved north to 23rd Street in 1856, this focus was reflected in new faculty appointments and facilities, including a laboratory funded by the Alumni Association.

Extending the academic calendar went hand in hand with enriching the curriculum. When VP&S opened in 1807, the school term was four months. By 1844, the school added supplemental lectures before and after the four-month term. In 1847, extension of the core term to four-and-a-half months, combined with the supplemental courses, provided a six-and-a-half month academic year. According to medical historian William Norwood, “This feature alone, not to mention the eminent faculty, was sufficient to distinguish the College of Physician and Surgeons among the schools of the country.”

The school’s student body grew as the city around it continued to expand. New York City’s population more than doubled from 1800 to 1820 and more than quadrupled from 1820 to 1850, surpassing half a million inhabitants. As the city grew, so too did the number of medical facilities, including The Lying-in Hospital, the New York Dispensary, and the Northern Dispensary. In 1841, Willard Parker, professor of surgery, organized the College Clinics, an outpatient facility where medical students observed patients treated by the faculty, which included new hires called “clinical professors.” By 1849, Bellevue Hospital permitted P&S medical students on its wards to learn from its 4,000 annual cases. Other hospitals established in the city included New York Orthopedic Hospital (1866) and Presbyterian Hospital (1868), which would join VP&S in Washington Heights the following century.

During the Civil War, VP&S, like other northern medical schools, lost students who returned to the South and/or served in uniform. By 1876, VP&S had grown to more than 500 students. By 1886, the school’s last year at 23rd Street, that number surpassed 600.

Gifts Along the Way

“The health, comfort and lives of the whole community are so dependent upon skilled physicians that no profession requires more care in the preparation of its practitioners. Medicine needs a permanent home where the largest opportunities can be afforded for both theory and practice.”

—William Henry Vanderbilt, 1884

The late 1800s ushered in a significant period of growth for P&S. In 1884, New York philanthropist William Henry Vanderbilt donated land between 59th and 60th Streets and 9th and 10th Avenues, plus $300,000 toward the construction of a new building. With ample space for lecture halls seating more than 400 and state-of-the-art laboratories for chemistry, pathology, physiology, histology, bacteriology, and dissection, VP&S was well-equipped for teaching and scientific inquiry. Class size topped 800, and Roosevelt Hospital, located across the street, provided clinical training for VP&S students.

Vanderbilt family members supplemented the initial gift with funds for two more buildings on the site: one for the Sloane Maternity Hospital, the other for the Vanderbilt Clinic (formerly the College Clinics). The campus had the making of a small, but integrated academic medical center and coincided with the founding of several other more specialized medical institutions—Babies Hospital (1887), the Pathological Institute (1896), later the New York State Psychiatric Institute), and the Neurological Institute of New York (1909)—that would go on to become part of the groundbreaking medical center Columbia formed in Washington Heights.

At 59th Street, the medical school’s significantly enriched classroom, laboratory, and clinical offerings warranted extension of the course of study from two to three years, in 1888. Along with other prominent medical schools at this time, Columbia mandated a four-year curriculum in 1894. Increasingly high standards for admission and graduation also raised the quality of physicians earning a P&S degree.

In 1904, Dean Samuel W. Lambert, MD (P&S, 1885), stepped up the requirements for clinical training to include daily service in hospital wards. However, P&S had more medical students than spots on wards. Lambert recognized the necessity of a close and permanent affiliation with a general hospital. This relationship would be realized in a 1911 agreement of alliance between VP&S and Presbyterian Hospital.

In 1910, Abraham Flexner published a seminal study on the state of medical education in the United States and Canada for the Carnegie Foundation. This study marked an important juncture in the field as it led many inferior medical schools to close or merge into more reputable institutions. VP&S fared well in Flexner’s report, which praised the school’s anatomy facilities “as perhaps the most elaborate plant of its kind in the country.” Although the report noted the abundance of clinical opportunities furnished by New York’s many hospitals, it pointed out the limitations of these sites for teaching and scientific purposes, as well as the fact that hospital access was a privilege, not a right.

Thanks to the generosity of another New York philanthropist, VP&S was already in the process of addressing this need by the time Flexner penned his report. In 1911, Edward S. Harkness contributed $1 million to facilitate a union between Columbia University and Presbyterian Hospital. Ten years later, Harkness and his mother donated 22 acres in Washington Heights for construction of a medical center comprised of P&S, Presbyterian Hospital, and several other institutions dedicated to health care and biomedical science. In 1928, the doors opened to Columbia-Presbyterian Medical Center (now Columbia University Irving Medical Center, or CUIMC), a unique alliance dedicated to patient care, medical education, and research.

Over the next 90 years, this alliance would produce successive generations of prominent medical leaders, including more than 20 Nobel Laureates, and innovations in training, science, and clinical practice that have resulted in life-saving new treatments and cures for disease. Originally promoted as “The Fortress on the Heights,” CUIMC remains a model for advanced 21st century medicine—quite the addendum to the “historical inquiry” Peter Middleton presented 250 years ago.