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4 MEDICINE *
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,ooo, there were probably about 35oo physicians in the colonies, of whom it is estimated that not more than 4oo had received medical degrees. In New England the clergyman was often the
"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 Pennsylvania) 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 Io 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 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 I 1 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.”
* 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.
* 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 come the strongest states, and the standard maintained by these states would act as a stimulus to weaker political divisions. In dentistry New York, Pennsylvania and New Jersey have already moved in this direction and in medicine there will be a similar movement when the regents have the statutory power on unanimous recommendation of a state board of medical examiners to indorse the licenses of those whose preliminary education and professional training meet the requirements of the New York law. The Wayne co, (Michigan) medical society has addressed a circular to licensing bodies asking n if reciprocity with political divisions that have practically the same licensing requirements would be favored, 2) it statutory amendments necessary to secure such reciprocity would be advocated, Sep, 14, isoo favorable answers to both inquiries had been received from so political divisions, with few exceptions statutory amendments would be necessary,
At the June 1899 meeting of the National confederation of state medical examining and licensing boards the committee on minimum standards for admission to medical schools recommended graduation from a four years' high school course or its equivalent. This committee outlined an alternative examination that represents less than three years of high school work. It also provided for an allowance of the first year of professional study to graduates of reputable literary or scientific colleges after satisfactory examination on the work of the first year.
At the June 1899 meeting of the Association of American medical colleges, a special committee made an interesting report on the condition of medical education in the United States. The committee had corresponded with all the medical schools, 82 in number, which had appeared as members of the association in 1897 and 1898. The replies received from 56 schools show great discrepancy in teaching facilities and in the requirements for graduation. Following are some of the most significant facts:
Laboratory work, including dissections. 1 school makes no report; I gives less than 3oo hours of laboratory work in four years; 5 give between 3oo and 500 hours; 27 between 5oo and Iooo hours; 14 between Iooo and 1.5oo hours; 8 over 1500 hours.
Practical work. 5 schools offer less than Ioo hours; Io give from Ioo to 200; 13 from 200 to 3oo; 11 from 3oo to 5oo; 16 over 5oo hours.