A CENTURY OF MEDICAL EDUCATION IN THE UNITED STATES. The hundredth,

anniversary

of the declaration of

dence of the United States of America has other effects the issue

by

indepen-

produced

among the Bureau of education of an

important series of reports on the progress of education during the century, one of which, by Dr. N. S. Davis, of Chicago, gives a concise and interesting sketch of medical schools and societies since the declaration of independence. For many years after their first settlement in the country the colonists had to trust for medical aid either to old wives' remedies or to the chance services of any one who chose to call himself

a

physician.

In anew and

thinly-peopled country diplomas

THE INDIAN MEDICAL GAZETTE.

204 and other evidences of

closely ;

men are

qualification

cannot be

enquired

into too

taken much at their own valuation, and the

loudest pretender is apt to have the greatest clientele. in those

The

had immi-

days only regularly qualified practitioners grated from Europe, too often for reasons not greatly to their credit, or had gone thither for their education, returning to bring to their countrymen the benefits of European skill, and to be the true pioneers of the noble body of scientific physicians and surgeons now scattered all over the Continent. In nine cases out of ten, however, the medical practitioner had had

other education than

no

an

apprenticeship

to some estab-

up to a recent date, the student was bound to serve for two, three or four years, giving his services and perhaps a premium in return for instruction in the lished doctor.

As in

England

mysteries of physic. practice, and picked up knowledge and many

He learned the

ordinary

routine

of

from his own Gamaliel much useful shrewd and valuable

hints, and though capacity of a cone or to write an essay on dentigerous cysts, was, no doubt, if diligent and clever, as good a family doctor and as much trusted and respected by his patieuts as the more elaborately educated practitioner of to-day, who has all the sciences at his finger ends, and is expected to answer on demand any preposterous question We do not undervalue modern that may be put to him. medical education, but wo believe that, in the arrogance of superior attainments, we are apt to be unjust to our professional forebears and to forget that they had advantages in the way of practical teaching which we have too rashly given up. The raison d'etre of the physician is to cure diseases, and we are somewhat in danger of forgetting the end in our too great devotion to the means. Lord Bacon's remarks on reading apply with great force to the two methods of medical study?

probably

the

unable to calculate the cubic

practical "

and the theoretical.

Too much of the latter may

"

ready man." We have seen a native doctor, absolutely ignorant of anatomy, but carefully taught by practice, perform lithotomy with a skill and coolness which Fergusson might have envied, and we have heard of a British soldier sent home from a far-off foreign station for the same operation, although there were several British surgeons on the spot, carefully trained and warranted qualified in anatomy and surgery. There are extreme cases, but they point our meaning when we say that the old practical method of teaching had its advantages, and that the American of a hundred years ago was probably not so badly off in the way of medimake

a

full man" but not

cal attendance

as

a

the almost total absence of medical

schools

to suppose. Among a population of 3,000,000 in 1776 there were about 3,000 to 3,500 medical practitioners,

would lend

us

all but 400 of whom had received

usual

no

lhe Medical

apprenticeship,

other education than the of

College Philadelphia department of King's College, New York, were the only schools of medicine, but the country was so vast and the difficulties of travelling so great that, up to their interruption by the war, only fifty-one degrees had been conferred by the two colleges. The sraallness of the towns?there were not more than fifteen with 5,000 inhabitants and the distances between them often led to odd combinations, the cure of souls or the practice of agriculture being joined to the cure of and the medical

bodies

by

the dire

the

war

physic in very many cases, and when practice time came, wc find many American physician? of

then

now

as

of

[Apbil 1,

higher relative

aristocratic countries?giving up

social

1878.

importance than

in

the lancet for the sword

and leaving their books and their patients to lead their countrymen to the fray. Stout Dr. Warren of Boston, great-greatgrand uncle of the present distinguished surgeon of that name, leaving his day book written up to date and putting his prayer book in his pocket marched out to command at Bunker's IIill, and fell immortal

on that bloody field. colleges named seem to have been intended rather to complement than to supersede the system of apprenticeship in The apprenticeship was still insisted on vogue. together with a knowledge of pharmacy, the Latin tongue, mathematics, and a smattering of natural philosophy, and the only attendance required was on one course of lectures. At Philadelphia there were at first only two professor?, but these were soon increased to five, four of whom were young graduates of Edinburgh ; and the traditions of Edinburgh have been largely follow-

Tbe two

ed in many of the American schools.

The ordinary degree at Medicine, but candidates were expected to return afrer three years' additional study for promotion to the degree of Doctor, after publicly defending a thesis. It was found, however, that few candidates did so return, and after a few years the Bachelor's degree was abolished, the standard required for the doctorate being generally fixed at two college sessions. The schools thus formed in Philadelphia and New York seem to have been faithful copies of the Edinburgh model. But we must remember that during the last century the medical school of Edinburgh, though now rapidly acquiring a high European reputation, was by no means the perfect educational instrument which it has since become ; no chair of surgery existed till 1831, that important subject, being a mere branch of anatomy. All things were dislocated by the war, but no sooner had peace been made and independence secured, than the young country, determined to rely on its own resources, began to show renewed activity in the matter of medical education. Two schools were soon at work in Philadelphia ; but, after a short time and somo unseemly jealousy and bickerings, these were merged into one. Two sprang up in New York, one of which was speedily closed for want of adequate support. In 1782, Dr. John Warrens brother or nephew of the hero of Bunker's Hill, started a class of anatomy at Cambridge, Mass., for the students of Harvard, and a regular faculty was organised in 1783, and formed the nucleus first was Bachelor of

one of the best in the states, established at Hanover, New Hampshire

of tbe modern school at Boston, Another school and

a

was

seventh in connection with the

in Baltimore.

The

University

aim of all these schools

of

was

Maryland

similar?to

to their students in one

systematic course a general they had learned piecemeal as apprentices. In only Philadelphia and New York, however, were there up to 1810 any facilities for clinical instruction, for only there and at New Orleans did general hospitals exist. The total number

impart

review of what

of students at the close of the third decade after the about 650, two-thirds of whom

were

at the

University

war was

of Penn-

Since that time colleges and schools have sprung up directions, the total number founded since 1810 having 63, excluding several transient abortions. Of the eighty

sylvania. in all been

institutions thus started in the century, 16 have ceased to exist, leaving sixty-four in active operation. Of these, New

Apeil 1, 1878.] VITAL STATISTICS OP THE NATIVE ARMY OP BENGAL FOE 1876. York has nine; Ohio has

seven;

Pennsylvania

has

four;

Vermont, Maryland, Georgia, Kentucky, Missouri, Illinois, Indiana, and the district of Columbia three each ; Maine, Virginia, Louisiana, California, Iowa, and Michigan, two; New Hampshire, Massachusetts, Connecticut, Texas, Tennessee, and Origon, one ; no

school at all.

South

Carolina, Alabama,

while thirteen States have

The total attendance in the session of 1875-

76

was 6,650, of whom 2,200 graduated. The population of the States has grown from 3,000,000 in 1776 to upwards of

40,000,000

1876,

in

increased in about

an

so

that the

equal

colleges and students general increase.

have

ratio to the

The report is of course silent as to the relative merits of the schools, but some of its statements are suggestive. Started as individual ambition prompted, and almost always without State aid, the very existence of many of the schools depended on their securing students, and this was too often done by relaxing the conditions under which a degree could be obtained, and reducing the time and expense required to qualify to the lowest limit. Every teaching body is a licensing body, and a village college, which gives no facilities for practical instruction at all, can issue as imposing a diploma, and can dub its graduates with as good a face, as the most complete college in the capital surrounded with hospitals and all appliances for clinical teaching. The existence of such schools, there-

fore?there

are

some

sixteen

now

down the standard of the others

in existence?tends to

just

as

one

or

keep

two boards in

the United Kingdom did for many years. As time has gone oil, great changes have occurred in the educational system.

Apprenticeship

has

disappeared, or is merely nominal, and the putting a finishing touch on the acquirements of a two or three years' indenture, have to take men in the raw and turn them into practitioners after one or at most two courses, the second being a precise repetition of the first; and in many cases without any efficient practical instruction. The demand for preliminary education is practically nil; and, were it not that most Americans are fairly educated and are diligent in their efforts to make the most of their opportunities, we should say that medical education was bad indeed. As it is, although many unqualified men are let loose upon the public, and the facilities for obtaining a degree are much too great, ?we have good reason to believe that the general practitioner in America is on the whole as good as he is elsewhere, while the leaders of the profession would do honour to any country in the world, whether as physicians, as original workers or as cultured gentlemen. For, with many bad schools and with the general educational standard kept low by these bad schools, the States possess several medical colleges, with unsurpassed facilities for acquiring a perfect theoretical and. practical knowledge schools,

instead of

of modern medicine in all its branches.

reform

the

was

medical

department

The of

leader in the

the

Nortli-West

Chicago, where the instruction is spread over three graduated courses and includes attendance on a large hospital, and special training in the use of the latest modes of diagnosis*. Harvard and Philadelphia and New York have followed suit, and there are indications of a general improve-

University

at

ment in the educational standard.

Association,

a

The American Medical

representative body composed ?

of

Tide I. M. O. tot July 1875, page 181.

delegates

from

-^5

the various States and local medical

societies, has taken up the licensing from the teaching Vested interests 'will be strong against reform, and, being educationally independent, difficulties are

question of the separation of faculties. the States sure

to be

the

met with before any

general reform?and unless

fail?can be introduced ; but the

good sense roused, many States have already passed Acts to defend their people from irregular practitioners, and free trade in physic is likely to give place to protection. As, in a new country, there must be rough and ready ways and manners, less finish and repose than in long settled communities, we general it must of the profession

is

roughness and want of education; yet, with such men as Elint and Sims, Thomas and Grosse, Warren and Oliver, Wendel, Holmes, Otis and Woodward, Billings, Peters, Elijah, Harris, Tower, Davis and hundreds of others equally accomplished, if not equally well known, America has reason to be proud of her doctors and need not blush for the colleges which have produced them. must expect for some time a certain

finish in American medical

A Century of Medical Education in the United States.

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