Medical America in the Nineteenth Century: Readings from the Literature

Introduction

INTRODUCTION A glance at the section devoted to medical education in ProfessorGenevieve Miller's Bibliography reveals the extent of the interest in this aspect of the history of medicine.1 Coupled with the truly staggering numbers of inaugural discourses and graduation orations available in the medical journals and the bound pamphlet files of many libraries, there is material for many volumes. Much of what has been written, it is true, is of local character, but certainly the history of medical education is not one of the neglected fields. It is well known, for instance, that apprenticeship was the primary method of medical education for nearly 200 years in the American colonies. This was an efficient method for practical training and moulding the medical character, as George Corner has said, but it failed to provide systematic instruction in the principles of medicine.2 In the middle and latter nineteenth century an increasing number of medical schools were founded. These were sometimes an integral part of an already established college. Occasionally, groups of practitioners formed a school and then sought a college affiliation. A few medical societies sponsored schools, but, unfortunately, the largest number were proprietary in nature. In these schools the professors collected the fees and so were not eager to carefully screen students or to fail them once they began to study medicine.3 Until the last quarter of the nineteenth century the average student spent three or four years as an apprentice to a practicing physician. During this time the student usually attended two terms of lectures at a medical college, each lasting three to four months. The second "year " of medical school was often a repeat of the first. In addition to the prescribed apprenticeship and medical 1 Bibliography of the History of Medicine in the United States and Canada, 1939-1960 (Baltimore: The Johns HopkinsPress, 1964). 2George W. Corner, "Apprentice to Aesculapius," Proc. Am. Phil Soc. 109 (1965): 249-58. 3 William F. Norwood, Medical Education in the United States before the Civil War (Philadelphia: University of Pennsylvania Press, 1944), pp. 380-86. Norwood's is the most comprehensive secondary source available. 3 4 MEDICAL EDUCATION school matriculation, the requirements for a degree were that the candidate be of good moral character and that he be twenty-one years of age. Some Americans completed their medical education abroad, where they walked the wards of Europe's famous hospitals.4 One of the first orders of business for the newly formed American Medical Association in 1847 was to assess the state of medical education in the country. With this in view, a committee was appointed and given the following charge: . . . 1st, prepare an annual report on the general condition of medical education in the United States, in comparison with the state of medical education in other enlightened nations; noticing as occasion may call for, 2d, the course of instruction, the practical requirements for graduation, the modes of examination for conferring degrees, and 3d, the reputed number of pupils and graduates at the several medical institutions in the United States during the year. Noticing 4th, the requirements of the United States Army and Navy Boards of Medical Examiners; 5th, the legal requirements exacted of medical practitioners in our several states, and 6th, all such measures, prospective or established, in reference to medical education and the reputable standing of the profession, as may be deemed worthy of special consideration.5 This broad charge summarized the existing problems. The succeeding volumes of the Transactions supplied some of the answers to the questions. One point the committee made in this first report was that our system, in general, was defective and lagged behind the great European centers. "In the United States alone," the committee warned, "is continued an obsolete system of teaching demonstrative science by description, of teaching the manipulations of surgery, and the art of recognizing and healing diseases without exhibiting the practice of either, and of explaining the movements and changes of living bodies to those who are ignorant of the laws which govern inert matter."6 In the session of 1846-47, the committee found 4,192 students in 25 schools of medicine. One must remember, though, that those were so-called "regular" schools only. By 1849, in another survey, 39 schools appeared on the list, but a few of these were reorganizing or had just closed. As Abraham Flexner has shown, the greatest spurt in the number of new schools came in the final decades of the nineteenth...