CHAPTER XXV. THE LEARNED PROFESSIONS AND SOCIAL CONTROL.1 The qualifications demanded by the States of the Union for admission to the practice of medicine or of law-The preparations of the French professor for his vocation as a member of a faculty of medicine or law-The institutions in which medical and other scientific instruction is given in Germany, together with their staff and pay of instructors-The interest of society in and its interference with the admission to practice medicine or law. The existence in a community of a group of individuals devoted to the office of protection and culture may be regarded as an evidence of an advanced stage of civilization. The profession of the law is devoted to the protection of property; the profession of medicine to the protection of the body; the profession of divinity exclusively to the culture of the people. Some of the phases of social life have their analogues in the life of animals, but no animals so far as known have any special groups of individuals corresponding to those that fill the professions in human society. Such professions in fact, as we find them in civilized nations, prove the inheritance of their civilization from the Greeks, who were the intellectual ancestors that first investigated the laws of mind, and from the Romans, who formulated the laws that govern advanced social organizations. This ancestry has been appealed to for intelligent direction after the terrible epoch of the year 1,000 in the name of bodily safety, during the period called the Renaissance in the name of intellectual freedom, and at the outbreak of the English Revolution of 1688, and of the French Revolution of 1789, in the name of personal equality before the law. Each of these social revolutions has been marked-possibly a mere coincidence-by a predilection for a certain line of study. During the Middle Ages theology held sway, during the Renaissance law, and later its offspring, culture, was the favorite study, and during the period of which the present forms a part the study of medicine predominates. The close of the Middle Ages is usually placed at 1453, the year of the taking of Constantinople by the Turks. In 1400, at the celebrated University of Cologne, in the domains of the ecclesiastical monarch called the Archbishop of Cologne, the study of jurisprudence, probably in the form of church or "canon law," was already gaining decidedly on the study of theology proper. Not quite 71 per cent of the students of the three faculties of the university were studying law, 27 per cent were studying theology, and but 2 per cent were studying medicine. Sixty-five years later the law students had increased to 86 per cent, the theological students had fallen to 12 per cent, and the medical students were still 2 per cent of the whole body of students of law, theology, and medicine of the University of Cologne. But a new business had in the meantime arisen-the business of studying for the sake of enlightenment; and it is fair to say that, though this effort was the result of the study of Greek literature, the way for the comprehension of that literature had been paved by the study of jurisprudence. The study of law, says Burke, is one of the first of human sciences, worth, in my opinion, all the others put together for quickening and invigorating the intellect, but is not so well adapted for opening and enlarging it. In 1400 there were 126 students in the University of Cologne, just 1 By Mr. Wellford Addis, specialist in the Bureau. half of whom were in the faculty of liberal arts, such as it was then. In 1476 there were 607 students in the same university, 81 per cent or more of whom were in the faculty of liberal arts, such as it had become. In the same interval theology had fallen from 11 per cent of the whole attendance at the university to 1.8 per cent, law from 28 to 12.5 per cent, and medicine was nowhere. In 1476, however, the University of Cologne had lived nearly a century; it perhaps had become antiquated and had "traditions;" but the University of Halle, founded in 1693, represented new ideas in Germany even after the crushing and blinding effect of the religious wars and excitement of that and the preceding century. This is shown by statistics of 1693–1700 in the following table: It is evident, therefore, that, while in England and France what is represented by the German faculty of philosophy was drawing the brightest minds away from theology in Germany during the eighteenth century, the faculty of theology seems to have obliterated the faculties of philosophy and medicine and dwarfed that of jurisprudence. It must be remembered that church and state were very intimately connected in Prussia (as has been remarked by Professor Paulsen in his Die Deutsche Universitäten) until the present century, the first decade of which saw the liberation of the serfs and the right of others than noblemen to hold public office. Passing now to the eighth decade of the present century, the importance which the study of medicine is assuming is at once noticed by glancing at the following diagrams (pp. 1189 and 1190); and medicine is the embodiment of science, as jurisprudence is of ethics and theology of metaphysics or the immaterial part of the world.' It is hoped that the intimate relation between the learned professions and the susceptibility of an age to favor a certain class of practitioners has been shown. In the sequel an attempt is made to show what is being done at home and abroad to prepare physicians for their responsibilities in the age of medical science. I. THE PREPARATION FOR THE STUDY OF THE LEARNED PROFESSIONS. As the student of the history of medical instruction in the United States runs over the discussions of that question since 1850, the date at which an interest in the subject began to be awakened, he is impressed by the value which medical practitioners place upon a "college training," and their distrust of mere mother wit and the practical instinct of the Anglo-Saxon. As early as 1847 Drs. Ware, Bigelow, and Holmes, all teachers of medicine, declare that the only means known to them of elevating the profession of medicine is either to require that the applicant for admission to a medical school be a graduate of a college or that the course of study in the medical school be made to cover a longer period. Though it is evident that the second alternative presented by the committee of Harvard professors in the report above quoted was adopted when a change was made, about the beginning of this decade, yet it is to be borne in mind that in the catalogue of Harvard Univer sity for 1897-98 the following announcement is made: Beginning with the year 1901, candidates for admission to regular standing must present a college, scientific, or medical degree, or must satisfy the faculty of their having equivalent qualifications for membership in the school. Considering a true science of anthropology to be something apart and above zoölogy and yet not invention, the characteristic of an "age of machinery." In 1878 so important had this question of the collegiate education of the intending medical student become that an association of medical practitioners was formed for the purpose of carrying on the propaganda. Those who thus advocated the necessity of a college course do not appear to have desired the student to study the sciences such as is taught in the schools the Germans call "real," when using that term in the compound word "real-schulen," for the classical or literary training seems to be preferred to the merely scientific. But the point to be remarked is that these practitioners draw a sharp distinction between the general development of the understanding and the training for a special pursuit. Nevertheless, the alternative of a longer term of study, indicated by Drs. Ware, Bigelow, and Holmes, as a substitute for a course in the humanities seems to be the direction along which the American professional schools are moving. 1881-82 1882-83 1883-84 1884-85 1885-86 1886-87 1887-88 The intellectual equipment possessed by the majority of the attendance at professional schools of the United States about the year 1880 was succintly characterized as "fresh from the high school, academy, the farm, or the backwoods." Dr. Pepper, in making this statement, had in mind the attendance at the medical schools, but an evidence of the supreme reliance in America on mother wit in the learned profession of law is given in the constitution of Indiana. By that instrument "every voter is entitled to practice law in the courts of the State." On the other hand, we find Harvard University refusing to admit into its celebrated law department those who are not graduates of a college, and State after State is now 1 Higher Medical Education the True Interest of the Public and of the Profession, by William Pepper, A. M., M. D., professor of clinical medicine in the University of Pennsylvania, p. 12. 2 Constitution. requiring an apprenticeship in an office or graduation from a law school, very little consideration being given to the potentialities of mother wit unrefined.' The repeated and explicit denunciation by the great national medical and law associations of the short cuts into the practice of medicine and law leave no room for referring to the matter in veiled language. Foreign Governments are taking cognizance of the facts and are inclined to regard American licenses and diplomas as of uncertain value. The profession of medicine has pushed up the standard of the schools of that profession from "two years" to four years; but the profession of law has not succeeded nearly so well. This appears to be natural when it is considered that the advance made by the medical profession is due to the creation and use of a new police power or body by the several States, generally called a State board of health or examiners. Nothing of this kind has been done to any great extent in the case of law. Frequently, indeed, it is the supreme court of a State that makes the arrangements for admitting members, its own officers, "to the bar;" but in other instances the case of Pennsylvania, for example-it is the local court that has complete jurisdiction. But wise precantions are being made against this unevenness of tests even within the same State. West Virginia, during 1897, determined to send all applicants for admission to the bar to the faculty of the law department of her State University, though leaving full power in the hands of the supreme court, while New York, Connecticut, New Jersey, Michigan, Minnesota, Massachusetts, and Wisconsin have a "State board of examiners" or a permanent "standing committee." It is believed that the Supreme Court of the United States has taken no steps to fix the qualifications of those who are to be admitted to practice in the Federal courts, which are, it is believed, subject to the Federal Government in matters of organization. To show the scope of the inquiry, and to testify to the uniform courtesy which the interrogations of the Bureau received at the hands of the attorneys-general and the presidents of the State boards of health or of examiners, the reply from Massachusetts is given as a fit introduction to the tabulation which follows. Others equally In Chapter VI of second volume of Commissioner's Report for 1889-90 there is a compilation of the opinions given both at Harvard and other universities, and also a statement of the action taken at Columbia in regard to shortening the college curriculum for intending medical students. *The duty of ascertaining the fitness of applicants for admission to practice at the bar of this Territory, says Mr. John W. Shartel, to whom the attorney-general of Oklahoma courteously referred the Commissioner's inquiry, rests with the district courts. There is no specific requirement as to the mode of discharge of this duty. The qualifications of the applicants depend largely upon the individual judgment of each court, and I believe it is the uniform practice of the courts of the Territory at the present time, when a motion is made for admission of a person to the bar, to appoint a committee of members of the bar, who conduct the examination of the applicant in open court and ply him with questions, and the committee then makes its recommendation; and in view of such recommendation, and in view of the court's observations of the answers of the applicant, the court then determines for itself whether the applicant shall be admitted. There being no restriction on the power of the court in respect to the admission of attorneys to practice law, the way is open for a very low standard of professional qualifications, though from my own personal observation for the last four or five years I believe the courts have generally required at least a fair exhibition of merit on the part of the applicant before admitting him. (Extract from letter to Commissioner of Education by reference from Hon. C. A. Calbreath, attorney general for Oklahoma, in response to the following letter:) Hon. - DEPARTMENT OF THE INTERIOR, BUREAU OF EDUCATION, Attorney-General (or President Board of Health). DEAR SIR: Permit me to ask your attention to the inquiries made herewith. I am in receipt of many letters from abroad which ask for the conditions under which graduates of foreign faculties of law are admitted to practice in the United States. As cach State has its own regulations respecting such matters, I find it necessary to ask for certain information from you regarding the rules now governing the admission to the bar [to practice medicine] in your State. Such other information as your convenience may allow you to favor this Bureau with will promote, I am sure, the object the inquiries have in view. A franked envelope is inclosed, which will carry your reply free of postage. |