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Abstract
In Finnish historiography, received wisdom about increasing German influence in the universities throughout the nineteenth century and the first half of the twentieth century prevails. However, along with the German neo-humanistic model, universities in Sweden and, particularly, Russia also played an important role in reforming the Finnish higher education system. Broadly speaking, medical education at the University of Helsinki followed general European developments, in which German universities indeed often took the lead. These developments included: (1) the increasing need to concentrate education for all the medical professions at the universities; (2) the gradual replacement of clinical education by research training; and (3) increasing specialisation. This article will show, however, firstly that in all these respects, Finnish scholars took inspiration from further afield than just Germany, and secondly, that characteristics which were taken from foreign models were always adapted to the needs of the indigenous society – creating a distinctive Finnish model of medical training. The Finnish example will make clear the extent to which a scientifically based practice such as medicine is far from universal, but rather is subject to local cultural influences, and how educational practices are bound up with the political and cultural relationships within a geographical region. The starting point for this analysis of the specificity of medical education at the University of Helsinki is a series of two essays published in 1922.
Notes
1Jaakko Ignatius, “Lääketiede, farmasia ja molekyylibiologia,” in Suomen tieteen vaiheet, eds. Päiviö Tommila and Aura Korppi-Tommola (Helsinki: Yliopistopaino 2003), 278–92.
2Päiviö Tommila and Aura Korppi-Tommola, eds., Research in Finland - A History (Helsinki: University Press, 2006), 47. In several passages, and also in the longer, Finnish version of this volume (Päiviö Tommila, ed., Suomen tieteen historia, 4 vols. (Helsinki: WSOY, 2000-2002)), the authors show their somewhat traditional understanding of German universities as autonomous institutions which combined teaching and research, without taking into account sufficiently the current relativisation of the existence of the ‘German university model’. During the past years, many (German) researchers have pointed out important geographical differences, as well as shifts over time and contradictions caused by the actual interpretation of some specific characteristics of the model concerning daily practice. See Sylvia Paletschek, “Die Erfindung der Humboldtschen Universität. Die Konstruktion der deutschen Universitätsidee in der erste Hälfte des 20. Jahrhunderts,” Historische Anthropologie 10 (2002): 183–205.
3See, among other publications, Rainer Christoph Schwinges, ed., Humboldt International. Der Export des deutschen Universitätsmodells im 19. und 20. Jahrhundert, Veröffentlichungen der Gesellschaft für Universitäts- und Wissenschaftsgeschichte, no. 3 (Basel: Schwabe & Co. AG Verlag, 2001); Marc Schalenberg, Humboldt auf Reisen? Die Rezeption des “deutschen Universitätsmodells“ in den französischen und britischen Reformdiskursen (1810-1870), Veröffentlichungen der Gesellschaft für Universitäts- und Wissenschaftsgeschichte, no. 4 (Basel: Schwabe & Co. AG Verlag, 2002); Philipp Löser and Christoph Strupp, eds., Universität der Gelehrten – Universität der Experten. Adaptionen deutscher Wissenschaft in den USA des neunzehnten Jahrhunderts, Transatlantische Historische Studien, no. 24 (Stuttgart: Franz Steiner Verlag, 2005) and Pieter Dhondt, Un double compromis. Enjeux et débats relatifs à l’enseignement universitaire en Belgique au XIXe siècle (Gent: Academia Press, 2011).
4Matti Klinge, Eine nordische Universität. Die Universität Helsinki 1640-1990 (Helsinki: Otava, 1990), 207.
5Matti Klinge, The Finnish Tradition. Essays on Structures and Identities in the North of Europe (Helsinki: SHS, 1993), 49.
6Matti Klinge, “Intellectual Tradition in Finland,” in Let us Be Finns – Essays on History (Helsinki: Otava, 1990), 159.
7Jan Hecker-Stampehl, “Functions of Academic Mobility and Foreign Relations in Finnish Academic Life. A Historical Survey from the Middle Ages until the Middle of the 20th Century,” in The Challenge of Mobility in the Baltic Sea Region, eds. Catherine-F. Gicquel, Victor Makarov and Magdalena Zolkos, The Baltic Sea Region. Nordic Dimensions – European Perspectives, no. 2 (Berlin: Berliner Wissenschaftsverlag, 2005), 15–39.
8Pieter Dhondt, “A Difficult Balance between Rhetoric and Practice: Student Mobility in Finland and Other European Countries from 1800 to 1930,” in Students, Staff and Academic Mobility in Higher Education, eds. Mike Byram and Fred Dervin (Cambridge: Scholars Publishing, 2008), 48–64.
9For instance, the Baltic German professor of classics in Dorpat, Ludwig Preller, explicitly pointed to these particularly Finnish features of the university when musing on his visit of Helsinki University on the occasion of its bicentenary in 1840. See Pieter Dhondt, “The Bicentenary of Helsinki University in 1840. The Jubilee of a Russian University in a Nordic Context,” in National, Nordic or European? Nineteenth-Century University Jubilees and Nordic Cooperation, ed. Pieter Dhondt (Leiden: Brill 2011), 27.
10James T. Flynn, The University Reform of Tsar Alexander I, 1802-1835 (Washington: The Catholic University of America Press, 1988).
11Robert D. Anderson, European Universities from the Enlightenment to 1914 (Oxford: University Press, 2004), 24–25.
12Finland as a bridge between East and West is a recurrent view in the publications of Laura Kolbe and many other historians, sociologists and political scientists. See for example Laura Kolbe, ed., Portraying Finland. Facts and Insights (Helsinki: Otava, 2005), 32–35.
13Antonie M. Luyendijk-Elshout, “Medicine,” in A History of the University in Europe. Volume III: Universities in the Nineteenth and Early Twentieth Centuries (1800-1945), ed. Walter Rüegg (Cambridge: Cambridge University Press, 2004), 543–91.
14On the importance and tradition of medical travel in European university history, see Ole Peter Grell, Andrew Cunningham and Jon Arrizabalaga, eds., Centres of Medical Excellence? Medical Travel and Education in Europe, 1500-1789 (Leiden: Brill, 2010).
15The Finnish Medical Society Duodecim (Suomalainen Lääkäriseura Duodecim) was founded in 1881 by 12 young Finnish-speaking doctors to improve the standing of the Finnish language in medicine. Together with the journal of the professional medical association (Finska Läkaresällskapets Handlingar), issued from 1841, Duodecim gradually became one of the leading journals in the field. See Bertelvon Bonsdorff, The History of Medicine in Finland (Helsinki: Societas Scientiarum Fennica, 1975), 17–19.
16Anto Leikola, “Karvonen, Jaakko (1863–1943),” Suomen kansallisbiografia, http://artikkelihaku.kansallisbiografia.fi/artikkeli/3501/ (published October 13, 2004).
17Gunnar Soininen, “Einar Palmén 1886-1971,” Duodecim 87 (1971): 1579–80.
18Jaakko Karvonen and Einar Palmén, “Onko lääketieteellinen opetus yliopistossamme nykyään käytänössä toimivan lääkärin kannalta tarkoitustaan vastaava?,” Duodecim 38 (1922): 1–12 and 61–74.
19More details on the medikofiili follow in this article.
20Palmén, “Onko lääketieteellinen opetus tarkoitustaan vastaava?,” 62.
21Karvonen, “Onko lääketieteellinen opetus tarkoitustaan vastaava?,” 1.
22See Jaap Goudsmit, Anderhalve eeuw dokteren aan de arts. Geschiedenis van de medische opleiding in Nederland (Amsterdam: Socialistische Uitgeverij, 1978), Christian Bonah, Instruire, guérir, servir. Formation et pratique médicales en France et en Allemagne (Strasbourg: Presses Universitaires, 2000) and Dhondt, Un double compromis.
23For example Thomas Neville Bonner, Becoming a Physician. Medical Education in Britain, France, Germany, and the United States, 1750-1945 (New York: Oxford University Press, 1995), 33–60.
24Rita Schepers, De opkomst van het medisch beroep in België. De evolutie van de wetgeving en de beroepsorganisaties in de 19e eeuw, Nieuwe Nederlandse Bijdragen tot de Geschiedenis der Geneeskunde en der Natuurwetenschappen, no. 32 (Amsterdan: Rodopi, 1989).
25Matti Klinge and others, Keisarillinen Aleksanterin Yliopisto 1808-1917 [The Imperial Alexander University 1808-1917] (Helsinki: Otava, 1989), 377.
26The chair in anatomy, surgery and obstetrics was founded in Helsinki in 1784.
27Claudia Huerkamp, “Ärtze und Professionalisierung in Deutschland. Überlegungen zum Wandel des Ärtzberufs im 19. Jahrhundert,” Geschichte und Gesellschaft 6, no. 3 (1980): 350–82.
28Ilo Käbin, Die medizinische Forschung und Lehre an der Universität Dorpat/Tartu 1802-1940. Ergebnisse und Bedeutung für die Entwicklung der Medizin, Sydsvenska medicinhistoriska sällskapets årsskrift Supplementum, no. 6 (Lüneburg: Nordostdeutsches Kulturwerk, 1986), 388.
29Heino Gustavson, “Suomalais-virolaisista lääketieteellisistä siteistä 1900-luvun alkuun saakka [Über die finnisch-estnischen medizinalen Zusammenhänge bis zum Anfang des 20. Jh.],” Hippokrates. Suomen lääketieteen historian seuran vuosikirja 5 (1988): 124–30 and Timo Rui, “Die Deutschsprachige Universität Dorpat im 19. Jahrhundert als Hochschulort für Finnland,” in Der finnische Meerbusen als Brennpunkt. Wandern und Wirken deutschsprachiger Menschen im europäischen Nordosten, eds. Robert Schweitzer and Waltraud Bastman-Bühner, Veröffentlichungen der Stiftung zur Förderung deutscher Kultur, no. 9 (Helsinki: Stiftung zur Förderung deutscher Kultur, 1998), 183–9.
30Palmén, “Onko lääketieteellinen opetus tarkoitustaan vastaava?,” 66–7 and 71.
31Palmén, “Onko lääketieteellinen opetus tarkoitustaan vastaava?,” 61.
32Wolfram Kock, “Scandinavia since 1600,” in The History of Medical Education: An International Symposium Held Februrary 5-9, 1968, ed. Charles Donald O’Malley, UCLA Forum in Medical Sciences, no. 12 (California: University of California Press, 1970), 263–97.
33Karvonen, “Onko lääketieteellinen opetus tarkoitustaan vastaava?,” 3.
34Karvonen, “Onko lääketieteellinen opetus tarkoitustaan vastaava?,” 5.
35Niilo Pesonen, Terveyden puolesta – sairautta vastaan [For health – against illness] (Porvoo: WSOY, 1980), 667.
36Pesonen, Terveyden puolesta – sairautta vastaan, 7 and 668.
37Onni Vauhkonen, Terveydenhuollon historia [The history of health care] (Jyväskylä: Gummerus Kirjapaino Oy, 1992), 239.
38Figures are available for 1880, when mortality in Sweden and Norway was about 16.6 and 17.8 per mille, against 22 per mille in Finland. Toni Saarivirta, Davide Consoli and Pieter Dhondt, “Suomen terveydenhuoltojärjestelmän ja sairaaloiden kehittyminen – vaatimattomista oloista modernin terveydenhuollon eturintamaan [The position of hospitals in the Finnish health care system: An historical approach],” Kasvatus & Aika, kasvatuksen historiallis-yhteiskunnallinen julkaisu 3, no. 4 (2009): 38.
39Minna Harjula, Terveyden jäljillä. Suomalainen terveyspolitiikka 1900-luvulla [Putting Health on the Right Track. Finnish Health Policy in the 19th Century] (Tampere,:University Press, 2007), 16–18.
40Heikki S. Vuorinen, Tauti(n)en historia [A History of Illness(es)] (Tampere: Vastapaino, 2002).
41Pesonen, Terveyden puolesta – sairautta vastaan, 7.
42Von Bonsdorff, The History of Medicine in Finland, 266.
43Pieter Dhondt, “Ambiguous Loyalty to the Russian Tsar. The Universities of Dorpat and Helsinki as Nation Building Institutions,” Elite Formation in the Other Europe (19th-20th Century), ed. Victor Karady – special issue of Historical Social Research / Historische Sozialforschung 33, no. 2 (2008): 99–126. This policy is perfectly in conformity with prevailing nationalist, romantic tendencies in other parts of Europe that led to increased attention to national culture in the arts. See for example Jo Tollebeek, Frank Ankersmit and Wessel Krul, eds., Romantiek & historische cultuur, Denken over cultuur, no. 3 (Groningen: Historische uitgeverij, 1996).
44Tommila and Korppi-Tommola, eds., Research in Finland, 74 and 309.
45About the democratic tradition of Finnish university life, see Matti Klinge and Laura Kolbe, “Talonpoikas – ylioppilas [Farmer’s son – University student],” in Suomen ylioppilas (Helsinki: Otava, 1991), 78–82 and Laura Kolbe, “Rural or urban?,” in University and Nation. The University and the Making of the Nation in Northern Europe in the 19th and 20th Centuries, eds. Märtha Norrback and Kristina Ranki, Societas Historica Finlandiae. Studia Historica, no. 53 (Helsinki: SHS, 1996), 51–63.
46Karvonen, “Onko lääketieteellinen opetus tarkoitustaan vastaava?,” 1-2.
47Klinge, Keisarillinen Aleksanterin Yliopisto, 371.
48“The Education of Girls: their Admissibility to Universities,” The Westminster Review 53 (1878): 56–90.
49See Thomas Neville Bonner, “Segregation and Its Effects,” in To the Ends of the Earth. Women’s Search for Education in Medicine (Harvard: University Press, 1992), 24–30.
50Pieter Dhondt, “The Echo of the Quartercentenary of Uppsala University in 1877. Nordic Universities as Examples in Europe,” Scandinavian Journal of History 35, no. 1 (2010): 21–43.
51From its beginning, the clinical institute had a separate delivery section, which proves again the early introduction of obstetrics at university level. See Rainer Knapas, “Kliininen instituutti,” in Klinge, Keisarillinen Aleksanterin Yliopisto, 255–8.
52Jaakko Ignatius and Jussi Nuorteva, “Väittelystä väitöskirjaan – lääketieteellisen väitöskirjan historia [From a Dispute to a Doctoral Dissertation – The History of the Medical Dissertation],” in Kohti karonkkaa. Neuvoja väitöskirjaa tekevälle, eds. Kristiina Patja, Ilpo Huhtaniemi, Elina Ikonen and Kimmo Kontula (Jyväskylä: Duodecim, 1999), 58–60.
53The University of Helsinki belonged in this respect to the European middle group; some German universities introduced the doctoral dissertation as early as 1831, followed by Norway in 1847, Belgium in 1853, France at the end of the 1860s, the Netherlands in 1876. Great Britain, for instance, only introduced the doctoral dissertation in 1919. However, true comparisons are extremely difficult in this regard, due to the very diverse nature of this qualification. See, among other publications, Alexander Busch, Die Geschichte des Privatdozenten. Eine soziologische Studie zur grossbetrieblichen Entwicklung der deutschen Universitäten (Stuttgart: Enke, 1959) and Renate Simpson, How the PhD Came to Britain: A Century of Struggle for Postgraduate Education (Guildford: Society for Research into Higher Education, 1983).
54Ignatius and Nuorteva, “Lääketieteellisen väitöskirjan historia,” 74–5.
55Klinge, Keisarillinen Aleksanterin Yliopisto, 375.
56Karvonen, “Onko lääketieteellinen opetus tarkoitustaan vastaava?,” 11, emphasis in the original.
57Palmén, “Onko lääketieteellinen opetus tarkoitustaan vastaava?,” 69 and Robert Tigerstedt, Den medicinska undervisningen i Sverige, Norge, Danmark, Tyskland och Österrike jämte förslag till förändringar i densamma vid Finlands Universitet (Helsinki: Centraltryckeri, 1911), 28–39. Tigerstedt (1853–1923) was professor of physiology at the Karolinska Institute in Stockholm and, from 1900, at the University of Helsinki.
58Latin had lost much of its prestige since the beginning of the nineteenth century in Finnish academic training in general and in medical training in particular. In 1828 Latin and Swedish were on a par with each other as the language of medical dissertations and only a decade later, Swedish had greatly overtaken Latin. Ignatius and Nuorteva, “Väittelystä väitöskirjaan – lääketieteellisen väitöskirjan historia,” 76.
59This preliminary medical examination is not comparable to the German Abitur or the French baccalauréat. From 1853, Finnish students had to pass a similar examination to those taken by their German and French colleagues before being admitted to the university – the so-called ylioppilastutkinto. In the medikofiili much of the same knowledge included in the ylioppilastutkinto was repeated, but on a higher level and with more emphasis on sciences. See Mervi Kaarninen and Pekka Kaarninen, Sivistyksen portti: Ylioppilastutkinnon historia [The Way to Civilization. A History of the Finnish Abitur] (Helsinki: Otava, 2002).
60Klinge, Keisarillinen Aleksanterin Yliopisto, 376.
61Von Bonsdorff, The History of Medicine in Finland, 21 and 266.
62Hannes Saarinen, “Studien- und Bildungsreisen von Finnen nach Berlin 1809-1914,” in Miscellanea, eds. Antero Tammisto, Katariina Mustakallio and Hannes Saarinen, Studia Historica, no. 33 (Helsinki: SHS, 1989), 203–42; Marjatta Hietala, “Finnische Wissenschaftler in Deutschland 1860-1950. Allgemeine Bemerkungen mit besonderer Berücksichtigung medizinischer Kontakte,” in Deutschland und Finnland im 20. Jahrhundert, eds. Edgar Hösch, Jorma Kalela and Hermann Beyer-Thoma, Veröffentlichungen des Osteuropa-Instituts München. Reihe Forschungen zum Ostseeraum, no. 4 (Wiesbaden: Harrassowitz Verlag, 1999), 373–94 and Dhondt, “Student Mobility in Finland,” 48–64.
63Matti Klinge, “Det germanofila universitetet,” Historisk Tidskrift för Finland 72 (1987), 523–39.
64Jana Fietz, Nordische Studenten an der Universität Greifswald in der Zeit 1815 bis 1933 (Stuttgart: Franz Steiner Verlag, 2004). On the similar phenomenon of the succession of universities which became the medical schools of choice for ambitious students in early modern Europe, see Grell, Cunningham and Arrizabalaga, eds., Centres of Medical Excellence.
65Ignatius and Nuorteva, “Väittelystä väitöskirjaan – lääketieteellisen väitöskirjan historia,” 77.
66Tommila and Korppi-Tommola, eds., Research in Finland, 305–7.
67Jaakko Ignatius, “Lääketieteet [Medicine],” in Suomen tieteen historia. 3. Luonnontieteet, lääketieteet ja tekniset tieteet (Helsinki: WSOY, 2000), 534 and Anto Leikola, “Otto E.A. Hjelt: “Suomen lääketieteen historian isä” [O.E.A. Hjelt: “The Father of the History of Medicine in Finland”],” Hippokrates. Suomen lääketieteen historian seuran vuosikirja 13 (1996): 9–23.
68George Weisz, Divide and Conquer. A Comparative History of Medical Specialization (Oxford: Oxford University Press, 2006).
69See Torgny T. Segerstedt, Universitetet i Uppsala 1852 till 1977, Uppsala stads historia, no. VI, 2 (Uppsala: Almqvist & Wiksell, 1983), 22–32.
70Veli-Matti Autio, Yliopiston virkanimitykset. Hallinto- ja oppihistoriallinen tutkimus Turun Akatemian ja Keisarillisen Aleksanterin-yliopiston opettajien nimityksistä Venäjän vallan alkupuolella 1809-1852 [Appointment Procedures at the Academy of Turku and the Imperial Alexander University, from the Beginning of Russian Domination 1809-1852], Historiallisia tutkimuksia, no. 115 (Helsinki: Suomen Historiallinen Seura, 1981).
71Jean Donnison, Midwives and Medical Men: A History of the Struggle for the Control of Childbirth, 2nd ed. (New Barnet, Herts: Historical Publications, 1988) and Marius Jan van Lieburg and Hilary Marland, “Midwife Regulation, Education and Practice in the Netherlands During the Nineteenth Century,” Medical History 33 (1989): 296–317.
72Ervo Vesterinen, “Carl Daniel von Haartmanin obstetriikan ja gynekologian luennot [Carl Daniel von Haartman’s gynaecological and obstetrical lectures],” Hippokrates. Suomen lääketieteen historian seuran vuosikirja 21 (2004): 58–71.
73Vesterinen, “Carl Daniel von Haartmanin obstetriikan ja gynekologian luennot,” 58–71.
74Emil Monos, Mária Faragó and Osmo Hänninen, “Semmelweis ja Suomi [Semmelweis and Finland],” Hippokrates. Suomen lääketieteen historian seuran vuosikirja 19 (2002): 43–56.
75Karvonen and Palmén, “Onko lääketieteellinen opetus tarkoitustaan vastaava?,” 7–11, 67–8 and 70.
76Marjatta Hietala, “Kontakte zwischen deutschen und finnischen Wissenschaftlern,” in Am Rande der Ostsee. Aufsätze vom IV. Symposium deutscher und finnischer Historiker in Turku 4.-7. September 1996, ed. Eero Kuparinen, Publikationen des Instituts für Geschichte, no. 14 (Turku: Universität Turku, 1998), 174.
77Hietala, “Kontakte zwischen deutschen und finnischen Wissenschaftlern,” 161–85.
78Päiviö Tommila, Suomen tieteen historia. 1. Tieteen ja tutkimuksen yleinen historia 1880-luvulle [The History of Finnish Science. 1. A General Overview of Science and Research until the 1880s] (Helsinki: WSOY, 2001), 257.
79David N. Livingstone, Putting Science in Its Place. Geographies of Scientific Knowledge (Chicago: The University of Chicago Press, 2003), 1 and 180–1.
80Livingstone, Putting Science in Its Place, 111.
81See Toni Saarivirta, Davide Consoli and Pieter Dhondt, “The Position of Hospitals in the Finnish Health Care System: An Historical Approach,” SENTE Working Papers 29 (2010): 1–20.