Published 8/1/2015
John M. Purvis, MD

Metonyms in Medicine: Town Versus Gown

“Town versus Gown”—what does that phrase mean to you? Often that question leads to blank faces instead of answers. In the medical world, the phrase represents the sometimes prickly relationship between university physicians and community doctors. Those who practice at or near an academic medical center may recognize the phrase and its connotations but perhaps be unaware of its origin or history.

The distinction—and possibly a mutual suspicion—between academic institutions and their surrounding communities has been around for ages. During the medieval period, European university students and teachers wore scholars’ gowns with hoods that distinguished them from the other townspeople. The gown provided warmth in the cold, drafty halls of learning and evolved into a tradition. The colors of the colleges were often added to the hood, adding to their distinction. The gowns were social symbols and certainly hampered any potential physical work.

By the 12th century, universities existed in cities and towns with lecture halls that could be rented, an adequate population, and an established infrastructure. They were often endowed by the Roman Catholic Church and thus were not dependent on municipal revenues. They often were not restrained by civil law. The students’ arrogance and immunity from town laws often resulted in abuses and even criminal behavior. Such autonomy contributed to an adversarial relationship with the town that worsened as university campuses expanded into neighborhoods and communities.

On occasion the “town versus gown” adversity escalated into violence. The St. Scholastica Day riot, which began on Feb. 10, 1355, in Oxford, England, is a famous example.

The trigger for this riot was a complaint by students about the quality of the wine being served them at a local tavern. The argument escalated into fights and spread across the city and into the countryside, with university students on one side and townspeople on the other. The riot lasted 3 days, and resulted in the deaths of 63 scholars and several townspeople.

Both the king and the church stepped in to punish the miscreants. However, the university, as a source of leaders and clerics, fared better than the town, which was required to pay reparations for nearly 500 years before the punishment was lifted. The feud was finally put to rest when, in 1955, on the 600th anniversary of the riot, the vice-chancellor of Oxford University conferred an honorary degree on the mayor of Oxford. In turn, the mayor declared the vice-chancellor an honorary freeman of the city.

So what has this to do with orthopaedics? On occasion, the “town versus gown” issue has caused hard feelings and conflict between academicians at teaching institutions and community practitioners. Today, however, the distinction between private and academic practices is becoming blurred due to an increasing reliance by universities on clinical practice income and the contributions of private practitioners to academic advancements.

I offer this insight into an origin of the “town versus gown” phrase as a reminder of the folly of divisiveness and suggest that the phrase “town and gown” would better reflect the AAOS core value of collegiality in our profession.

John M. Purvis, MD, is an associate professor of orthopaedics at the University of Mississippi Medical Center and a member of the AAOS Now editorial board. He can be reached at jpurvis1@umc.edu