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and a half in a law school may count for an equal period in

clerkship (exceptions)

New Mexico, examination after two years' clerkship or diploma of law school

Pennsylvania, to supreme court on motion after four years' clerkship and one year's practice in county court or diploma of certain law schools after three years; to county courts under varying conditions

Philippines, "A strict examination in open court

by the justices of the supreme court." Those admitted to practise in U. S. courts or in the highest court of any political division may be admitted without examination

Rhode Island, examination after three years in an office or a classical education and two years in an office

Vermont, (old rule) examination after three years with attorney, or one year with attorney and two in office, (rules under 98 law not yet approved)

Alaska has no law. In Cuba and Puerto Rico the requirements are in process of transition.

4 MEDICINE'

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Apprenticeship system Before the establishment of medical schools in this country medical students either went abroad to study or served an apprenticeship with some practising physician. The custom of studying with a preceptor was common in view of the expense incident to work abroad, and this custom in a modified form continued till very recently. As a rule the apprentice had little opportunity for study but was forced to depend on what he could absorb by contact with his preceptor. The physicians of the 17th and 18th centuries who had studied abroad were usually classical students and in their preliminary training set an example that it would have been wise to follow.

First public medical lectures — The first public lectures on anatomy before a class of students in this country are said to have been delivered by Dr William Hunter of Newport, R. I. in 1752. It seems, however, that Dr Giles Firmin as early as 1647 delivered readings on human osteology in New England; that Dr Thomas Cadwallader of Philadelphia gave instruction to students in anatomy between 1745 and 1751, and that Drs John Bard and Peter Middleton dissected the human body in New York city in 1750 for purposes of medical instruction. In 1762 Dr William Shippen of Philadelphia gave a course of lectures on anatomy, illustrated by actual dissections. These lectures were continued till the organization of the Medical college of Philadelphia (now the medical department of the University of Pennsylvania) in 1765. Dissections were rarely performed prior to 1760 and even autopsies were seldom permitted.

Early medical schools-At the time of the American revolution, with a population of 3,000,000, there were probably about 3500 physicians in the colonies, of whom it is estimated that not more than 400 had received medical degrees. In New England the clergyman was often the

1 See Toner's Annals of medical progress in the United States, and Davis' Medical education and medical institutions in the United States.

only available physician. Two medical schools were organized in the colonies, the Medical college of Philadelphia (now the medical department of the University of Pennsyl vania) in 1765, and the medical department of King's (now Columbia) college, in 1768. The first medical degree conferred in this country was that of bachelor of medicine. This degree was granted to 10 men by the Medical college of Philadelphia in 1768. The degree of doctor of medicine was first conferred in 1770 by the medical school of King's college on two students who had taken the bachelor's degree in 1769. 51 medical degrees had been conferred by these institutions before 1776, when operations were suspended by the war. In the colonial period two medical societies (the State medical society of New Jersey, in 1766, and the Delaware state medical society, in 1776) and one permanent general hospital were organized.

Harvard university medical school was organized in 1782, Dartmouth medical college in 1797, the School of medicine of the University of Maryland and the College of physicians and surgeons of New York in 1807. In 1813 the medical department of King's (the name of which had been changed to Columbia) college was finally discontinued. The College of physicians and surgeons became in 1860 the medical department of Columbia university. Of the 156 medical schools now existing in the United States 3 were established between 1765 and 1800, 12 between 1801 and 1825, 22 between 1826 and 1850, 33 between 1851 and 1875, 86 between 1876 and 1900.

At the time of the organization of the early medical schools the practice of obstetrics was relegated as a rule to ignorant midwives; physiology, histology, organic chemistry, pathology and surgery, as now recognized were hardly known. The schools at first conferred the degree of bachelor of medicine on those who had studied two years with a preceptor and attended one course of lectures, the degree of doctor of medicine after three years of study and two courses of lectures. The bachelor's degree was abandoned

in 1813. At first the Medical college of Philadelphia required for admission some knowledge of Greek and Latin, physics, natural history and botany, but the requirement was abandoned about the time of the reorganization of the University of Pennsylvania in 1792. For a century there were as a rule practically no requirements in preliminary general education for admission to medical schools, and even today this is their greatest defect. To the fact that charters for medical schools were to be had for the asking and that those schools were almost wholly self-sustaining is due the multiplication of small schools without facilities for clinical instruction. These schools in their rivalry for fees crowded all instruction into two ungraded lecture courses of from four to five months each. Progressive medical schools were anxious to raise their standards but feared a loss in students. The diploma given as a result of this unsatisfactory instruction admitted to professional practice.

Influence of medical societies-In 1839 the New York state medical society resolved that teaching and licensing ought to be separated as far as possible. In 1837 the same view had been advocated in Philadelphia. Farther discussion of this question led to a call for a convention of delegates from all medical schools and societies in the United States. The convention was held in New York in 1846, and from it sprang the American medical association.

Much has been accomplished by medical societies to elevate the medical profession, specially since the organization of the American medical association in 1846. This national organization, thoroughly representative in character, gave a

1 Results of licensing examinations show the importance of this question. Under the New York licensing laws, for example, 4808 physicians have been examined, of whom 3722 or 77.5% were successful; 916 dentists have been examined, of whom 712 or 77.7% were successful; 67 veterinarins have been examined, of whom 30 or 44.7% were successful. In these statistics each candidate who fails is counted as often as examined, but nevertheless so large a per cent of rejections is astonishing in view of the fact that admission to licensing examinations presupposes the preliminary education required by statute and also graduation with a degree from a registered professional school. Including those unable to meet the requirements for admission to licensing examinations more than 30% of all applicants have failed to secure licenses.

new impetus to medical societies.

In 1876 there was only

one state in the Union that did not have a state medical

society and many affiliated local associations.

The following societies have exercised an important influence in promoting higher standards:

Association of American medical colleges (1890)
American institute of homeopathy (1844)

National confederation of eclectic medical colleges (1871)
Southern medical college association (1892)

The first and fourth of these societies prescribe for admission to medical schools a preliminary general education equivalent to one year in a high school, the second and third demand work equivalent to two years in a high school. All prescribe four courses of lectures in different years as a condition for an M. D. degree, though they give an allowance of one year to graduates of reputable literary colleges and of other professional schools. All tend to improve facilities for teaching, dissections and clinics. The schools registered by these societies are 72, 21, 6 and 11 respectively.

At the June 1899 meeting of the American institute of homeopathy the legislative committee was requested to draft a model bill with a view to obtaining general uniformity in the laws relating to the practice of medicine, preparatory to the introduction in congress of a general law to secure the right of physicians to practise in all states after being authorized to practise in one.2

1 A bill amending the medical law in this respect passed both houses of the New York legislature in 1897 but unfortunately was not signed by the governor. This bill gave the regents power to accept as the equivalent of the first year of medical study "evidence of graduation from a registered college after four years of general preliminary education in addition to the high school course fixed by law as a minimum, provided that such college course included not less than the minimum required for such admission to advanced standing in languages, physics, chemistry and biology."

A uniform standard for admission to practise throughout the United States is impracticable at present owing to varying conditions as to density of population, educational advantages and general development. Weak states can not maintain the standards demanded elsewhere and strong states can not afford to lower their standards. The present needless multiplication of standards, however, is most unfortunate. Instead of a separate standard for almost each political division, two or at most three standards should answer for all. In the first group should

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