A (DEFENCE 
OF THE 
“SIX MONTHS LECTURE TERM.” 
REPORT OF A SPECIAL COMMITTEE 
OF THE 
AMERICAN MEDICAL ASSOCIATION, 
APPOINTED (MAY, 1849) TO PREPARE 
“A STATEMENT OP THE PACTS AND ARGUMENTS WHICH MAY BE ADDUCED 
IN PAYOUR OP THE PROLONGATION OP THE COURSES OP 
MEDICAL LECTURES TO SIX MONTHS.” 
[From the Transactions of the American Medical Association, Vol. II ] 
PRINTED BY T. K. AND P. 0. COLLINS. 
P lIIL A D E L P-lIIA 
1849. A DEFENCE 
OF THE 
“SIX MONTHS LECTURE TERM.” 
REPORT 
Of the Special Committee appointed to prepare 11A Statement of the 
Facts and Arguments which may he adduced in favour of the 
prolongation of the Courses of Medical Lectures to six months 
The Medical Faculty of Harvard University, transmitted to the 
Committee on Medical Education, a formal defence and advocacy of 
four months’ course of instruction in the medical schools. It was 
communicated to the Association, appended to the report of the 
committee, and directed to be published with it. 
The views upheld in that paper, are in direct opposition to the 
views and action of this Association, from its commencement to the 
present time. While, therefore, from deference to the highly re- 
spectable institution from which this document emanated, it has been 
placed on our Transactions, the Association felt that it was due to 
its own self-respect and consistency, and to prevent misconception, 
that it should be accompanied, at the same time, with the views and 
principles it has uniformly maintained on the same subject. 
The undersigned, a committee appointed to carry out that pur- 
pose, in pursuance of their duty, make the following exposition:— 
The medical profession was deeply impressed with the belief, 
that it had gradually become lowered in its standing. It no longer 
occupied the high position in public confidence that was once accorded 
to it. Everywhere it met with successful competition from empirics 
and pretenders; while absurd, fallacious, and dangerous doctrines 
were countenanced, not by the ignorant and vulgar alone, but by 
the educated and intelligent. It was not difficult to trace this abase- 
ment of the profession to its true cause. It had ceased to be a 4 
highly educated class. In its ranks were found those not only de- 
void of all pretensions to general science, hut many who were abso- 
lutely illiterate. He must have occupied a low station, indeed, who 
could not produce the evidence of a diploma. The parchment re- 
fused in one quarter could be procured from another. To the im- 
perfect and restricted courses of the schools, and to the low standard 
for medical graduation, were attributed the superficiality and the 
degradation of medicine. Dissatisfaction pervaded the profession, 
and distrust of the profession spread throughout society. The bar- 
riers that had separated the cultivated physician from the rude pre- 
tender and empiric, were broken down. Before the community, they 
stood on the same level, bore the same title, and presented the same 
outward attributes of professional knowledge and skill. 
Such was the feeling on this subject, possessed by the profession 
throughout the country, that no sooner was the tocsin struck, in a 
distant and obscure village, by an earnest heart and hand, than it 
was responded to throughout the land. A wide-spread movement 
of the profession took place. From that movement this Association 
had its origin; it stands, in some measure, pledged to accomplish a 
reform in the medical education of the country. Should it pass by, 
or fail to render effective this leading idea of the profession, it will 
have neglected a chief object of its institution, and will disappoint 
the just expectations of its founders. 
The subject of medical education is not limited to a mere consi- 
deration of the interests of students and schools. They are not the 
only parties it concerns; it occupies a much wider field, and embraces 
interests and relations of much deeper import. To discuss this 
question in its true spirit, and to reach all its consequences, it must 
be examined in all its bearings. Results without this course must 
be invalid. It is this broad view that governed the decisions of this 
Association at its former meetings, and its reatfirmance of them at 
its present session. On this question it was regarded that the pub- 
lic, the science, and the profession had interests as deeply involved 
as the students and the schools; and that the Association was bound 
to look to and protect them. A brief recapitulation will establish 
this point. 
Ist. The 'public are interested.—No well-constituted society can 
exist without a professional class devoted to watching over and pre- 
serving the health of its members. Man, from the nature of his 
existence, is subject to suffering, to disease, and to death. The 
causes by which these conditions are produced are ascertainable, may often be removed, or mitigated in tbeir action; while disease 
may be cured, suffering relieved, death averted. But for those ends, 
knowledge, obtainable only by profound research, long devotion of 
time, accumulation of experience and observation, and great mental 
efforts, is indispensable. Without these requisites, medicine fails 
in its objects; it injures where it seeks to benefit; it does harm where 
it would do good; it excites distrust; and, in its imperfect condition, 
resembling an empiric art, maintains in the public mind a predilection 
for empirical practice. It is the interest of the public, that medicine 
should be elevated above the rank of an empirical art to that of a 
science and a philosophy, which it is capable of becoming, and which 
is its true character. This is to be effected, principally, through a 
sound and fully developed educational training and system. 
2d. The science is interested.—Many intelligent men have doubted 
whether medicine was, or could be, a science. This skepticism still 
prevails extensively amongst the educated. It was not without 
foundation until a comparatively recent period. But within the 
last half century, no one acquainted with the progress of medicine 
can hesitate to recognize its rapid expansion into a science, and that 
it is rapidly entering the circle of the positive sciences. It is now 
far more certain in the judgments and opinions of wTell-educated 
medical men, than are the law, theology, or the moral sciences. 
The advances now being made are so rapid, that every department 
of medicine is acquiring more and more of this positive character. 
It cannot be denied, that this new impulse to medicine, if it did 
not originate in, was mainly produced by the new organization of 
the medical schools of France, during the progress of the French 
revolution, and since; as well as in the extension and improvement 
effected in the medical schools of Germany, and, of late, in England. 
We cannot enter any claim to an active participation in this move- 
ment of progress. 
The new branches that have been created, and which constitute 
the scientific basis of medicine, are unknown even by name to large 
numbers of our practitioners. 
It cannot be said that any of them belong to the proper courses 
of our schools. It is vain to expect that medicine, as a science, can 
be widely known and diffused, when it is not taught as a science in 
the schools. 
3d. The profession is interested.—There is a limit for the demand 
for medical services. That limit is more than reached in this coun- 
try. The profession is full to redundancy. It is not supply that is 6 
wanted: there is more than sufficiency as to quantity; it is an im- 
provement in the quality, that the public good now requires. 
An over-crowded profession brings on its degradation. Compe- 
tition takes a false direction. It cheapens labour and services. The 
practice ceases to be compensatory for the time, expenditure, mental 
and physical labour, required for high professional attainments and 
the services rendered. Men of distinguished abilities abandon the 
profession; educated youth feel no ambitious incitements to enter 
its ranks, and the lower motives of human action predominate in 
and overshadow the whole profession. 
But more serious evils flow from over-crowding the profession. 
The pressure of hard necessity and of grinding want, all experience 
warns us, is the fertile source of moral delinquencies, of vices, and 
of crimes. How many, placed in this condition, cannot consent to 
starve. They save themselves by resorting to quackery, by a de- 
basement of honourable principles, and by a servile subserviency to 
the prejudices and ignorance of the community; or, sinking still 
lower, pander to the vicious, and become accessories to atrocious 
crimes. 
The profession accuse the schools of hastening this disastrous 
state. 
The number of graduates, besides the influx of irregular practi- 
tioners, that annually swell the ranks of the profession, is far greater, 
it is believed, than are required by the increase of the population. 
Taking the number of graduates in the European schools, and the 
proportion to population, as compared with our own country, the 
statement will be borne out. On the continent, furthermore, it will 
be remembered that the number of irregular practitioners is repressed 
by the law, and is therefore small. 
The profession look to the schools to reform this evil; and they 
anticipate longer courses, new branches added, higher requisites for 
graduation, and an adequate preliminary education, as the means by 
which it is to be accomplished. 
To complete this recapitulatory summary, we may add:— 
4th. The students are interested.—Numbers of the students do 
not understand their true interests. They enter on the study of 
medicine, wholly ignorant of its true character, and of its high re- 
quirements. Adopting the vulgar and common opinion, they look 
on the practice of medicine solely as a trade, as a means of subsist- 
ence, or as a road to wealth. Influenced by these considerations, 
they suppose it is their interest to enter the profession and begin the 7 
trade, with the smallest outlay of time, money, and application 
possible. Whatever or whoever favours this course finds, with this 
class, a preference. 
Too late, the error is discovered. 
True and permanent success in practice depends on the confidence 
of the enlightened public; and that confidence is withheld when it 
has no other foundation than a short and hurried preparation for so 
high a calling. The superficially educated physician will always be 
regarded by the public as very little raised above the common em- 
piric. Mediocrity or disgraceful failure must be the lot of the larger 
portion of those who thus err from misinformation and mistaken 
views. The true friends of the student, who best consult his lasting 
welfare, will oppose them in this lamentable mistake. Intelligent, 
educated, and endowed students, understand the subject better, and 
appreciate more justly their proper interest. They spare no pains, 
time, or expense, in fitting themselves for the great mission and 
responsible duties of their profession. They rise steadily in public 
confidence, and attain eminence and distinction. Such constitute a 
fragment only of the medical classes. They are capable of working 
out their own course, and of gaining their proper position independent 
of the rules and regulations and training of the schools. It is not 
for them they are to be framed; but for the masses, who must be 
made to walk in the way they should go, and who do not know, or 
who neglect, their best and truest interests. 
oth. The schools are interested.—But the strongest temporary inte- 
rest of the schools, it is believed, is frequently opposed to the import- 
ant interests that have above been passed in review. The object of 
every school is to attract classes of the largest numbers, to exhibit 
the most numerous graduating class each year, and to obtain the 
highest revenue. But the schools have been, and are still placed 
in an anomalous and a false position. The students are the patrons 
of the schools, and in some measure regulate the courses of instruc- 
tion ; for a school that wmuld take a stand, at once placing its courses 
as to number and time on a level with the science, and demanding the 
necessary requisites, would soon be compelled to close its doors. 
The schools the best disposed can do no more than exact what the 
classes are prepared to bear. 
In the present position of the schools, there is a temptation, es- 
pecially in the matter of graduating students, to court popularity, 
and, by too much leniency, to run counter to the interests of the 
public, the science, and the profession. 8 
This relation of the schools to the student, is the great obstacle 
to every advance in medical education. Its change, is the first step 
to medical reform. The patronage of the schools should belong to 
the profession at large. They are the only competent judges of the 
proper merits of the schools, and are the fittest advisers of the 
students. 
In the great work of medical reform now in action in our country, 
a large portion of it must be the task of the profession. Without 
their aid, the schools can effect but little. The initiation into the 
profession is in the hands of the practitioners. To them it belongs 
to insist on a full preliminary education, and good moral standing 
as requisites, before receiving students into their offices. They should 
insist on directing their education to its conclusion, and on the selec- 
tion of the schools at which to graduate. 
The schools sustained by the profession, and independent of the 
classes, will then find their interests to coincide with all the great 
interests of medicine. They can enlarge and prolong their courses, 
can demand higher requisites for medical instruction, and elevate 
the standard of graduation. 
Such is a brief outline of the views entertained by the Association, 
the representative and legislative body of the medical profession, in 
the great scheme of medical reform they have now in hand. A re- 
ference to what is embraced in the idea of a scientific education, and 
to the means by which it may be realized, will be sufficient to de- 
monstrate their soundness, and vindicate them from the charge of 
extravagance. 
Education, or systematic plans of instruction, the mental culture 
and training for the acquisition of knowledge, are exponential of 
the knowledge, intelligence, and intellectual wants existing in any 
community. The one is always in adaptation to the other. This is 
true of the special instruction of a particular branch of knowledge, 
as well as of general education. A scheme of scientific instruction 
should embrace the whole science; no part should be omitted. The 
entire science should be placed before the student. The teachers 
are not justifiable in suppressing any portion. No plan can perfectly 
fulfil the requisitions of scientific instruction, can do justice to the 
student, or promote the diffusion of science and of truth, when a 
large portion of the body of the science is subjected to a trenchant 
excision, or any portion is imperfectly taught. 
In an extended system of instruction, there is much the student 
will not master, much that will have escaped his attention, much 9 
which he ought to know, that he has not learned. But this is not a 
sufficient reason for the mutilation of the science; still less is it an 
apology for superficial and imperfect instruction. It is far better 
the student should leave the schools impressed with the conviction 
that he is ignorant, that there is a vast amount of knowledge which 
he must acquire, than that he should suppose the small and limited 
circle of his scholastic studies forms the boundary of the science, 
and the limits of his acquisitions. 
In defence of the present system, it is alleged that it is as much 
as a student can bear; that additions to the number and time of 
the present courses would oppress the mind, and bewilder the intel- 
lect of the student, whose powers would fail and faint beneath the 
augmented burden. We give no credit to this statement. It may 
be, that some who now enter the ranks of the profession, with a 
low grade of intellectual endowments, and a lower grade of acquire- 
ments, could not master the difficulties of a higher order of scien- 
tific education, and would be excluded from the schools and the 
profession by their incapacity. But this would be a desirable result, 
and an advantage to the individual, to the profession, and to the 
public. 
The assertion has no application to the large body of the students. 
If it were correct, that American students are incompetent to go 
through the labours imposed on European students, there must 
be degeneracy in the race, and our position wrould be lamentable 
and hopeless. We must abandon all expectation of becoming ori- 
ginal in knowledge or science, and resign ourselves to continue, 
what we have been for too long a time, the mere recipients of the 
ideas, thoughts, and discoveries of the European investigators, and 
cultivators of medical science. 
The American students are not, as a body, deficient in applica- 
tion and energy, or in intellectual vigour and endurance. The work 
they are set to do is done well and effectually. It is not their fault 
if they do not understand medicine as the most elaborate of sciences, 
requiring extended, varied, and profound knowledge. Nowhere is 
it presented to them as such; not by their first preceptors, who 
practice medicine as an art, and too often look on it only as an em- 
ployment; nor by the schools whose courses of lectures cover but 
partially the field of medical research. Let the profession, the stu- 
dent, and the public, understand the nature of medicine cultivated 
as a science; the enlargement that will follow in the greater expanse 
of its usefulness, and the improvements it will introduce into the 10 
art, and it will be found the medical instruction of this country 
will not be lagging in the rear; nor our medical students incapable 
of anything that may be required of them. 
It belongs to the schools to spread this knowledge before the 
community. They ought to be the depositories of science; it should 
be their special office to keep pace with the progress of knowledge, 
and to infuse it into each successive body of students, who recruit 
the ranks of the profession. This is one of the methods by which 
the profession is to be kept on a level with the advances of medical 
science. In this important duty, the schools of this country have 
been defaulters. They have been thrown into a false position by 
an adherence to the defective system first adopted in the infancy of 
our civilization. They cannot escape from this dilemma; they can- 
not perform their duties to the science, to the public, the profession, 
the students, or do justice to themselves, while four month courses 
are persisted in. This, the first step in more extensive and import- 
ant reform, must be made. 
It will be said, that the prolonging of the courses of the schools 
to six months cannot effect this object. That is true; and is not 
expected of it. But it is one of the primary and most essential 
steps to be taken, in carrying into effect the plan of proceedings for 
the purpose in view. A beginning must be made, and this is the 
beginning of the reform in medical education. 
It is absurd to suppose that any effectual improvement can be 
made in the education of our schools, bringing their instruction up 
to the present elevation of medical science, while the four month 
courses are retained. 
The plan of four month courses of lectures belongs to the origin 
of medical schools in this country, and arose out of the neces- 
sities of the case. The establishment of medical lectures at all was 
a bold innovation; and, lest it might act as a discouragement to stu- 
dents, the term was made as short as possible, and limited to four 
months. Yet, at that period, medicine had but a moderate expan- 
sion, and scarcely made pretensions to a scientific character. 
Several branches were assigned to a single chair. Anatomy, Sur- 
gery, and Midwifery, were the department of one professor. Che- 
mistry was rudimentary, and was attached to various chairs at dif- 
ferent times. A single experiment illustrated the whole course. 
Until a recent time, the institutes of medicine, and the theory and 
practice were combined in one course. During the life of the late 
Professor Rush, the lectures of the first department occupied from 11 
the first of November to the middle of January; and those of the 
second, from the middle of January to the first of March. After 
his decease, the institutes, for some years, no longer formed a part 
of medical education. It is only in the last twelve years that the 
institutes, in some schools, have formed an independent course, while 
in many others, neither the institutes, nor any of the important 
branches embraced by them as a whole, are included in the curri- 
culum of instruction. 
Since the first establishment of the medical schools, the field 
of medical science has changed its entire aspect. The new depart- 
ments that have been developed, exceed in extent, and equal in im- 
portance, the rudimentary branches forming the original scheme of 
medical education. They embrace what may correctly be desig- 
nated the higher and scientific branches of medicine. 
To include them with the original courses, in lectures of four 
months’ duration, is wholly impossible. The question, therefore, re- 
solves itself into this simple proposition—Shall the medical education 
of the schools of this country be restricted to the original rudimen- 
tary branches of medicine, laying aside the modern and scientific 
departments; or the course of lectures be prolonged, for the gradual 
introduction of them, into the instruction of the schools ? 
But laying aside all considerations of new courses of lectures, in 
the present state of medical science indispensable to every sound 
scheme of instruction, it is unhesitatingly affirmed, that four months 
are insufficient for the lecturers to treat in full the subjects even 
of the present courses taught in the schools. 
There is not a single branch whose expansion, by the amount of 
new matter infused into it, from the improvements, discoveries, and 
more enlarged views of the last thirty years, has not rendered the 
time appropriated to the lectures wholly inadequate. There is not 
a course at present delivered in the schools, in which subjects of im- 
portance are not omitted, slurred over, or superficially treated from 
lack of time. This report is already too extended, or it would be 
easy to show, by a review of each branch, the correctness of the 
above statement. 
There is one, however, the leading department, that of the theory 
and practice of medicine, which may be adduced in evidence. No 
one will pretend that this subject could, by any possibility, be satis- 
factorily taught in a course of four months. Six months of lectures, 
for two years, and four times a-week, would barely suffice to go over 
the ground once. But clinical teaching has been made, by its higher 12 
perfection in modern times, the most important part of instruction 
in the practice, and illustrative of the didactic course. Its import- 
ance cannot be overrated, or expressed in terms too warm. No 
medical education can be complete without it. It is useless to ex- 
hibit the incompatibility of these courses, and the four months 
term. 
The question, we repeat it, is narrowed to this point: either the 
term must be lengthened, or all hope of improvement in the profes- 
sion and science of our country be abandoned. Having made this 
statement, somewhat in full, of the broad grounds on which the de- 
cision of the Association was based, in recommending the extension 
of the scholastic term of lectures to six months, the committee have 
performed the purpose of their appointment. But they cannot close 
this report, and they believe it will be no infringement of their duty, 
without some notice of the general position assumed in the commu- 
nication of the medical department of Harvard University. The 
object of that paper is to show, that “the only method which can 
effect the purpose intended by the Association, is private instruc- 
tion, by examinations, by recitations from books, and, in the demon- 
strative branches, by demonstrations on the part of the student.” 
In order to sustain this assertion, public lectures are underrated. 
It is asserted that, in medical education, “they constitute a subordi- 
nate and subsidiary part.” 
It is not necessary, at this day, to vindicate the value of public 
lectures as means of instruction. That is too firmly established 
by the experience of ages, and is demonstrated daily in the great 
schools of Europe. It cannot be weakened by suggestions of this 
kind. A well-digested plan of lectures embraces all that is to be 
known and taught. A complete course of lectures, on any branch, 
is the summary of the whole of that branch; nothing is omitted. 
The student is initiated into the knowledge of medicine as it is; he 
begins his study at the point it has reached at his time. It does 
not follow that students, attending on lectures, do not apply per- 
sonally to self-instruction. Observation and experience prove, 
that, excited by oral addresses, they are ardent in the pursuit of 
knowledge, and are the hardest readers. The objection of the Har- 
vard University may apply to the present lectures of our schools; 
for it is admitted they are imperfect; and a principal element of that 
imperfection is, the shortness of the term, which absolutely prevents 
a complete course of lectures. It is to remedy this defect, the first 
on the list for reformation, that the Association has been so strenu- ous in its efforts to lengthen the term. It would have been, it ap- 
pears to us, a more logical conclusion in the Harvard University, to 
have sustained the Association in this measure. “The active, prac- 
tical discipline of the mind,” regarded of so much consequence by 
the Harvard University, is most certainly attained by the student 
in attendance on lectures. The student, in them, is presented with 
the example of methods of investigation, of mental analysis, of cri- 
tical research and logical deduction. The mind is carried along 
with the lecturer, and acquires the habit of rational inquiry, and 
of resolving abstruse and difficult problems. 
It is one of the most serious defects of our present system, that, 
from the shortness of the scholastic course, the student does not 
remain in the schools a sufficient time to imbibe the spirit, and to 
be disciplined in the methods, of scientific research and philosophical 
investigation. The whole scholastic period is eight months; four in 
a year, with an interval of eight months. How is it possible, that a 
disciplining and training of the mind could be accomplished by 
courses so widely separated, and so brief? We have, in this import- 
ant view of medical education, additional motives and inducements 
for extending the term of the lectures, and prolonging the period 
of attendance on the schools. 
In the plan of the Harvard University, the proper order is re- 
versed. Private education is secondary and subsidiary to the public 
lectures. Good private teachers serve to check the public lecturers, 
and compel them to keep posted up with the knowledge of the time; 
they supply what omissions may occur in the lectures, and correct 
the inaccuracies of the student. In Philadelphia, this plan has been 
for many years in existence. There are several associations of 
private teachers, with numerous classes of students, whose influ- 
ence on the medical instruction of Philadelphia has been highly 
beneficial. 
The scheme of instruction recommended, in the view we take of 
it, is not consonant to the genius of medical science. Medicine is 
not a completed science; it does not consist in permanent axioms, in 
established formularies, in positive manipulations, of parts always 
persistent, and principles that are unchangeable. Medicine is in 
progress; its facts are all under investigation, its principles are being 
solved, its doctrine unsifted, its practice fluctuating, and to be 
adapted to all the diversities and dissimilarities of cases and patients. 
The phenomena of life, in health and. disease, must ever be a fluc- 
tuating element; and every case of disease must necessarily form a 14 
problem involving this changeable element, requiring for it correct 
treatment, extensive knowledge, mental combination, and critical 
analysis. 
In the miserable abortion of homoeopathy, it is assumed that, for 
every symptom, there is a specific remedy. It requires for its prac- 
tice, neither knowledge, science, nor intelligence; for its acquisition, 
no other labour than examinations and recitations from books. Not 
so with medicine; “examinations and recitations from books” may 
assist students to graduate, and to make the doctor ; but can never 
produce the physician. There is great danger that such a course 
of education will form mere routinists, and inclose the mind in a 
narrow and vicious circle of ideas. 
The student should be taught to distrust authorities, and to be 
suspicious of facts, until both are confirmed and reconfirmed by 
numerous observations. His best book and truest authority is 
nature. The object of his training and culture should be, to enable 
him to interrogate her for facts ; and to interpret her facts aright. 
It is wiser and better to adhere to the system of teaching approved 
by the experience of past ages, and so modified in our own time as 
to be adapted to the enlarged area of modern knowledge, than 
to enter on an untried experiment. The system of oral instruction 
has conducted medicine to its present stage of progressive advance- 
ment, and gives the strongest indications that, in no distant future, 
it will elevate it to the rank of a developed science, and a profound 
philosophy. 
SAMUEL JACKSON, 
JOHN L. ATLEE, 
ALFRED STILLE.