HA R VA R I) UNI VERS 1T Y. 
REPORT. 
The Committee appointed to visit the Medical and Dental 
Schools and the School of Veterinary Medicine respect- 
fully report that: — 
The School of Veterinary Medicine has 21 regular 
and 4 special students. It is admirably equipped and sup- 
plied with abundant material. 2017 animals were treated at 
its Hospital during the year ending Oct. 31, 1880. 
As in other departments of the University, the resources of 
this School are not sufficient to carry on the required work 
except by the most rigid and onerous economy. If these could 
be exemped from the necessity of paying rent and taxes a 
heavy burden would be removed. 
Although the employment of its own graduates — possible 
this year for the first time — has in part met the difficulty of 
finding qualified teachers willing to sacrifice their own business 
for the interests of the School, its management rests at present 
largely on a single professor. His disablement by any of the 
vicissitudes of life or health would leave the School with no 
one to assume its responsibilities. An addition to the Faculty 
would cost between two and three thousand dollars a year ; but 
the necessity for such an addition seems to be the imperative 
requirement of* a School, the scientific importance of which is 
made more manifest with each year’s accession to our knowl- 
edge of the pathology of animals, of* the transmission of disease, 
of* the causes of epidemics, of many fatal maladies, and of the 
important relations existing between veterinary medicine and 
the great subject of food supply. 
It is doubted by your Committee if this School of Veteri- 
nary Medicine is as well known throughout the State or New 
England as it should be ; or if the community appreciate the 
advantage in having questions as to the physical condition of 
animals decided by men of* reputation, rather than entrusted 
to the well-known uncertain knowledge of those who are 
usually resorted to. 2 
The Harvard Dental School was the first of its kind to 
require preliminary examination for admission, instruction in 
Anatomy, Physiology, and Chemistry as with medical students, 
and three full years of study to obtain a degree. 
The prestige of its diploma attracts students from Great 
Britain and the Continent. English graduates from the Lon- 
don Dental Hospital, who have acquired the L.D.S. (Licentiate 
of Dental Surgery), come here to get the Harvard degree. 
There is always one or more such in the School. At present 
there are two. It has furnished professors and organizers of 
dental schools in this country and abroad, as well as dentists 
of high repute for most of the great cities of Europe. 
At its Dispensary from 6000 to 8000 dental operations are 
performed year by year. One hundred and fifty sets, or more, 
of artificial teeth are furnished annually. The students per- 
form from 80 to 150 gold fillings each during a single course, 
besides many with the cheaper and more easily worked ma- 
terials. This enormous clinique, which, owing to the neglect 
of dental care by the poor, furnishes a peculiar experience not 
to be obtained in private practice, is carried on under the eye 
and direction of an instructor who examines the quality of the 
work done, and approves it before it is permitted to go out. 
During the whole of its existence the Dental School has 
suffered from a want of money. An effort to raise $30,000, 
made in 1881 by the President of the University and others, 
succeeded in obtaining $100, — the only gift the School has 
ever received. It is at present $9000 in debt. The instructors 
and professors, one by one, resign on account of the smallness 
of their pay. The supply of material for teachers is becoming 
exhausted. The School is suffering for the want of a permanent 
faculty, and is at a critical period of existence from lack of 
necessary funds. 
Several of the departments of the Medical School are in a 
satisfactory, condition. Those, for instance, of Physiology, 
Anatomy, Chemistry, and Pathology. There is general testi- 
mony on the part of the Committee that those of Obstetrics 
and Gynaecology are admirably taught. The material for 
illustrating the latter is abundant and available; but the 3 
latter is not yet supplied with all the clinical opportunities 
desirable. These are, however, more numerous than they 
were and are increasing. Your Committee think that if the 
number of assistants in this department were greater it might 
be an advantage. 
The standard of the anatomical examinations, as shown in 
last year’s books, is a high one. The questions were difficult, 
and the failure of 33 °]o of the class to pass appears to be 
due to the student’s inability to cover, with equal and uniform 
completeness in the time at his disposal, the whole range of 
details in so comprehensive a subject, involving a great deal of 
accurate memorization. It is therefore a cause of satisfaction 
to know that a recent vote of the Medical Faculty, passed at 
the urgent solicitation of the Professor of Anatomy, provides 
for “an examination of one and a half hours in elementary 
anatomy at the end of the first year; and an examination of 
three hours in advanced anatomy at the end of the second year, 
it being understood that each examination covers the work of 
the preceding year only.” It seems to your Committee that 
the anatomical examination should be partly oral, and also, if 
possible, partly practical. 
In a report of last year the recommendation was made that 
an elective in Anatomy should be offered to students of the 
undergraduate department of the University. It is again 
urgently advocated by this Committee as a measure offering 
advantages to those intending to enter the Medical School. 
Besides the text-books which the several departments of the 
School designate for the use of students, some of the professors, 
at the beginning of the term, furnish them also with a synopsis 
of their special branch of instruction, — a syllabus of the whole 
subject presented in that particular course. This is not only a 
great help to the student’s memory at the time and to his clear 
understanding of the subject, but it prevents wasting attention 
in the taking of notes. Probably the use of such concise 
digests in all branches in which they could be furnished could 
be profitably adopted. 
In the recent report (1886) of the Illinois State Board of 
Health on Medical Education and Medical Colleges in the 4 
United States and Canada, it is stated that “ the average length 
of lecture terms has increased from weeks in 1882 to nearly 
25 weeks in 1886-87.” That of the Harvard School is nomi- 
nally 34 weeks. Holidays reduce it practically to 31 or 32 
weeks. This excellent authority further says that the num- 
ber of colleges requiring attendance on three or more lecture- 
courses before graduation has increased from 22 in 1882- 
83 to 41 in 1886-87. The committee of the Hoard of Health 
who make the report state also that they have “ followed up 
the careers of 7811 out of 1000 physicians who studied four 
years and who attended three terms before graduating. They 
are,” it says, “with few exceptions, the successful and promi- 
nent members of the profession in the different communities 
in which they reside. They are successful as a rule because 
they have fitted themselves to command success.” 
In the Harvard Medical School the requirement for a degree 
is evidence of having studied medicine three or four years, and 
the passing of the required examination. The size of classes 
when they enter the School and when they reach the beginning 
of the third year presents a striking difference. In 1876-77 
the first class had 111 students. At the beginning of 1878-79 
that class, which was then the third, numbered 54. It had lost 
57 members, or about 50%. 
The third class of 187D-80 had lost 30, or about 33% 
“ 1880-81 “ 28, “ 25% 
“ 1881-82 “ 24, “ 25% 
“ 1882-83 “ 6, “ 10% 
“ 1883-84 “ 12, “ 15% 
“ 1884-85 “ 27, “ 33% 
“ 1885-86 “ 27, “ 25% 
“ 1886-87 “ 32, “ 31% 
Examinations, conducted chiefly in writing, are held at the 
end of each year, and no student can advance with his class 
or receive his degree, until he has passed them satisfactorily. 
The number of students “plucked” at the final examinations 
has varied very much. From 1880-81 to 1885-8G it has run 
as follows : /9, -fa, -|-f, TYo> || - It is probable that one 
of the principal causes in this falling otf of the third class is the 
standard of these required examinations ; but your Committee 
think that it is for the best interests of the School that their 5 
high standard should be kept up and maintained. The annual 
increase of population in this country is less than 2% ; the an- 
nual increase of medical men is over 5%. While the annual 
percentage of graduates to matriculates in the different medical 
schools of the country varies more or less, the Illinois report 
shows that, as a general rule, wherever a student is required to 
study the least, there the greater will be the relative number of 
matriculates who pass their final examination for the degree of 
M.D. In 11 regular schools, in which only two courses of lec- 
tures are required, the percentage is over 38%. In 33 regular 
schools, in which three years of study are required, but attend- 
ance only on two full courses of lectures, —that is, in the greater 
number of the regular schools, —the average percentage is not 
quite 32%. In 8 regular schools requiring three full courses 
of lectures, in which the average for nine years is given, the 
percentage is a little over 26%. In the Harvard School the 
percentage for the last nine years is 25%. 
The fourth year of the Medical School was established in 
1878-79. In that year there was one student. Since then the 
annual numbers have been 2, 9, 10, 12, 16, 18, and this year, 
1886-87, 21. 
The members of the third class, from which the fourth is 
principally derived, have varied from 81 to 51. They read, 54 
(in 1878-79), 60, 75, 51, 65, and this year 70. 
The fourth-year’s class is divided into four sections, which 
attend, together or separately, the different clinics and exer- 
cises. This subdivision, which is of great advantage to the 
student, makes a large body of instructors necessary, and we 
find the names of 54 connected with the present class of 21 
members. Of these 54 instructors, 14 have no other connection 
with the School. 
The studies of Anatomy, Physiology, Embryology, Chem- 
istry, Materia Medica, Therapeutics, and Pathology are alto- 
gether omitted in the fourth year. Nothing, however, pre- 
vents a student of that year from following, if he desires, 
any branch of the three-years’ course, except the fact that he 
would not have time to do so without neglecting something 
which may be equally important to him; and that he cannot 
so enroll himself among the students of any of the three-year 6 
courses as to secure the advantages of the laboratories. Neither 
can he devote more than a limited time to any one specialty, 
such as the eye, the ear, the throat, except by the sacrifice of 
other studies. 
In other words the fourth-year course, which is almost wholly 
clinical, lacks a well-schemed plan of required study to which 
the previous three years have carefully led up, and does not 
offer the alternative of any free and untramelled elective choice. 
The small but steady increase in the number of the fourth- 
year’s class shows probably that a certain number of students 
desire a more thorough education than they can obtain in the 
prescribed three years of the School. This is still further 
shown in the fact that a demand by graduates in medicine, 
mostly from New England, for special instruction in various 
branches, induces a few, every year, to attend some of the 
clinics of the fourth year. They follow what is called the 
“ Course for Graduates,” which, the Catalogue states, was es- 
tablished “ for the purpose of affording those who are already 
graduates in medicine additional facilities for pursuing clinical, 
laboratory and other studies, for which they had not previously 
found leisure, in such subjects as may especially interest them, 
and as a substitute in part for the opportunities heretofore 
sought in Europe.” The instruction is the same as that given 
to the undergraduates and to the fourth-year class, but with 
this important difference, viz. that the graduate has the privi- 
lege of taking and paying for such branches only as he may 
desire to follow. The graduate therefore seeks to learn, after 
he has begun his profession, what a fourth-year’s student might 
acquire beforehand. The annual number of those who take the 
“ Course for Graduates” varies considerably. During the last 
nine years it has been, in 1878-79, 11, then 5, 7, 8, 10, 11, 3, 
7, and this year it is 11. 
The Harvard School does not offer either to graduates or to 
fourth-year students the extended instruction in the impor- 
tant branches of pathology and physical diagnosis which New 
York schools do. In the N. Y. Polyclinic there is a course 
of Pathology and Clinical In the N. Y. Post- 
graduate School there are two Professors of Pathology and 
General Medicine. 7 
It seems to your Committee that the future usefulness of the 
Harvard Medical School will depend a great deal on its fourth- 
year instruction. At present the course is marked out and its 
hours are fixed. The student must follow it in all its details 
or lose some of its advantages. He has the opportunity of 
attending a given clinic once a week for four months, for 
example ; but the alternative opportunity of attending a similar 
clinic three times a week for two months, if more convenient, 
is not offered to him. Nor is he given facilities for arranging: 
his studies so that, while following the clinics of the fourth 
year, he can go over again any part of his previous studies, if 
he should wish to do so. 
If the School absolutely required as parts of its fourth-year 
course, Pathology, — a study which bears, directly and practi- 
cally, more on the work of the general practitioner than on 
that of the surgeon or the specialist, — and those special por- 
tions of medicine and surgery which all general practitioners 
must be familiar with, might it not leave other studies of that 
year to the choice of the student himself? 
This brings up a question which is probably of vital import- 
ance to the School, viz. that of “Extra Mural Teaching,” or 
facilities offered students to pursue some of their studies inde- 
pendently of the regular courses given in the School. Such 
facilities are found in Germany and in France, and in connec- 
tion with some of the universities of Great Britain, — for 
instance that of Edinburgh, where, principally to their exist- 
ence, the Medical School owes its great reputation. In France 
the unofficial and independent instruction of the great teachers, 
Louis, Lisfranc, and Ricord, in the middle of this century, 
were among the chief attractions of medical students to Paris. 
They stimulated many famous courses of ‘ ‘ private ” lectures by 
specialists, in Germany as well as in France, which have left 
an influence on medical teaching that is still felt. 
The introduction and encouragement of extra mural teaching 
would undoubtedly advance the interests of our Medical School, 
and attract students by its multiplied opportunities of instruc- 
tion. It would create a competition among teachers, and 
thereby raise the standard as well as the modes of teaching. 8 
It would give a definite aim to physicians able to teach, and 
create a body of teachers from among whom the instructors in 
the Medical School could be advantageously chosen. 
Extra mural teaching should supplement the systematic 
instruction of the School. It cannot be fully established at 
once, but, in the opinion of your Committee, an attempt to 
introduce it should not be delayed. None of the European 
systems can be imported ready-made. That of the Medical 
School of Edinburgh could not be adopted entirely, as it rests 
on a system different from the one followed at Harvard, which 
has excellent features that should be retained. The nearest 
approach to extra mural teaching in this country is the system 
of Quizzes so successfully adopted by the Medical School of the 
University of Pennsylvania. 
Medical and surgical instruction are no longer what they 
used to be. Both of these branches include specialities which 
partially extend beyond the province of the general practi- 
tioner. The systematic course of the School ends with the 
third year. The study of specialities comes up in the fourth- 
years’ course. It would seem possible to commence something 
like the Edinburgh system in the fourth year,—the year prin- 
cipally devoted to special clinical instruction. 
A great impediment certainly exists in the fact that students 
pay the School, at the beginning of the year, a fixed sum for 
which they are promised the opportunity of following all the 
courses of the year. If the School in some way recognised a 
certain number of extra mural clinics officially, — for otherwise 
any one who should happen to give instruction to one Harvard 
student might advertise himself as an extra mural teacher of 
the University,—it might allow the student to choose the 
teachers he would follow, and pay the latter according to the 
number taught. 
Medical education in the United States has made greater 
© 
progress in the last twenty-five years than is generally known 
outside of the profession. A four-years course becomes more 
and more necessary as its high standard becomes more and more 
general. Undoubtedly it will in time become obligatory. It 
is already so in Canada, and the possibility of it is already dis- 
cussed in some of the leading schools of this country. The 9 
Leonard Medical School, the medical department of Shaw Uni- 
versity, at Raleigh, N. C., an institution organized in 1882 for 
the education of colored students of both sexes, is at present 
the only school in the United States with a compulsory graded 
course of study extending over four years. 
The object of the Harvard Medical School is not the promo- 
tion of science, but the formation of superior practitioners. 
Its graduate who leaves the School with more knowledge than 
is actually necessary for use in his practice will make a better 
physician than one who has just enough. What the former 
may forget in course of time will be less detrimental to him 
individually than that which may slip from the memory of the 
latter. One of the objects of a higher medical education is to 
teach the general practitioner what he should not attempt to 
do, and the reasons why. This cannot be accomplished by 
teaching him merely what he can do. If medical teaching is 
reduced simply to what a general practitioner must know, and 
if facilities for original investigation, or for any advanced study 
of medical science which has no visibly practical side, are con- 
sidered as of doubtful good to the School, it cannot turn out 
first-class physicians and surgeons. Your Committee believe 
that the diploma of the Harvard Medical School should not 
merely justify confidence in the knowledge of the man who 
holds it, but be a proof that he is certainly as well educated as 
any American graduate in medicine, and better than most of 
them. 
R. M. HODGES, 
MORRILL WYMAN, 
IIALL CURTIS, 
GEO. C. SHATTUCK, 
S. L. ABBOT, 
A. COOLIDGE, 
FREDERICK WINSOR, 
SAMUEL A. GREEN. 
January 11, 1887.