Medical Protestants: The Eclectics in American Medicine, 1825-1939

7. Challenges, 1875-1910

7 Challenges, 1875-1910 Throughout the nineteenth century, American medical education suffered whenever it was compared with the European system, which insisted on a strong preparatory education, demonstrated by rigorous examination. European medical schools offered more disciplines for study and four years of schooling, with each year's program lasting nine months. Individual educators in the United States often lamented the comparison, but most medical schools and their faculties ignored the contrast; nor did they see the need for extending courses from four months to six; for graded courses, with basic disciplines taught before the clinical subjects; for more clinical teaching and hospital experience; for greater emphasis on dissection and examinations; or for separating the diploma from the license to practice.1 Unlike medical colleges in Great Britain and France, which existed as departments of universities, the majority of American medical schools proudly defended their independence from any college or university. By 1877, fewer than twenty of the sixty-five medical schools had any connection with institutions of higher learning. But as Kenneth M. Ludmerer explained in Learning to Heal, the modern medical school was well under way long before the Carnegie Foundation published Abraham Flexner's landmark 198 199 Challenges, 1875~1910 report in 1910. The modern university emerged as a real presence in American higher education beginning in the mid-1880s. The signs of this phenomenon were evident in the revival of state and federal regulatory authority, the dedication of millions of dollars in gifts from industrial barons for the construction of laboratories and teaching hospitals, the employment of full-time faculty , the gradual elimination of proprietary schools, and the increasing function of research. Academic medicine became a real force within the field of medicine, driven by individuals whose goals were to professionalize their respective disciplines and specializations .2 Biting the Bullet Only a few schools willingly tempted fate by implementing their own early reforms. The newly established Medical Department of Lind University in Chicago in 1859 initiated a five-month sequential program with an optional graded curriculum as an alternative to the standard fare of two four-month terms of lectures, with the second identical to the first. Nathan Smith Davis, one of several architects of this reform effort, left the faculty of Rush Medical College and joined the new school (Chicago Medical College) to repair what he felt were shortcomings in the medical-education system. Unlike other medical schools, Chicago Medical College required entering students to be college graduates or to undergo a rigorous examination to ascertain the presence ofa sound preliminary education. The college enrolled far fewer students than did Rush Medical College but persisted in maintaining its higher standards . In 1869, Lind University affiliated with Northwestern University ; and in 1891, Chicago Medical College hecame Northwestem University Medical School.3 Soon after the reforms at Chicago Medical College, the faculty at St. Louis College of Medicine and Natural Sciences, the College of Physicians and Surgeons in St. Louis, and the Women's Medical College of the New York Infirmary for Women and Children adopted graded courses. But not until1871, when Charles W. Eliot (1834~1926), president of Harvard University from 1869 to 1909, took a personal interest in academic reform, did more systemic change take place. Eliot, a longtime admirer of German education, made the Harvard Medical School an integral part of Harvard University, placing faculty on regular salaries, independent of stu- 200 "VIedical Protestants dent fees. This accomplished, academic quality in the school rose, and with it came a graded curriculum, higher admission standards, and new subject matter. The academic year was lengthened to nine months, with three years of required classroom instruction. For HenryJ. Bigelow (1818-90), Oliver W. Holmes, Edward H. Clarke (1820-77), and a few other stalwarts who opposed these reforms, Harvard functioned to train physicians and not necessarily to educate scientists. Indeed, only 20 percent of Harvard's medical students at the time ofEliot's reforms had college degrees. The enmity between Eliot and some of the older medical faculty reflected the intellectual tension that separated two different generations of educators-the advocates of the French clinical school and the emerging laboratory tradition of German education. This was a reform that Eliot, who had trained as a chemist, would win because the empiricism ofthe laboratory had already won adherents among a generation of younger faculty schooled in German postgraduate work. Among some of Eliot's strongest supporters...