!.,'■ fr!ii! .'ii«iiiii ■■I i,l::,ii,-l!,i--.;ii!!Ji'ir'l HJililiiiiimiJuwi." illllilmOinfllnBIBUnTOHnlllB HI STORY or MEDICAL EDUCATION AND INSTITUTIONS IN THE UNITED STATES, FROM THE FIRST SETTLEMENT OF THE BRITISH COLONIES TO THE YEAR I860; WITH A CHAPTER ON THE %xisttA Cnnitfa irafr WaiAs nf tjp ^rnfeasiira, AND THE MEANS NECESSARY FOR SUPPLYING THOSE WANTS, AND ELEVATING THE CHARACTER AND EXTENDING THE USEFULNESS OF THK WHOLE PROFESSION. BY N. S. DAVIS, M.D., PB0^™,T™TLES AK" PRACT,CE °F MBDICNE IN RUSH MED.CAI. COLLEGE ■ MEMBER OF THE AMER. MED. ASSOCIATION ; PERMANENT MKMBER ' OF THE MED. SOCIETY OF THE STATE OF NEW YORK-" CORRESPONDING MEMBER OF THE N. Y. MED ' ASSOCIATION ; MEMBER OF THE ILLINOIS STATE MEDIUM, SpcigTV • v< IDIIARY. *? CHICAGO^ S. C GRIGGS & CO., PUBLISHERS, 111 LAKE-STREET. W. J PATTERSON, PRINTER, 73 LAKE-STREET. KOCffLi, fN Br.tprort according to Act of Congress, in the year 1850, By Nathan S. Davis, In tbe Clerk's Office of the District Court of the State of lll'uioi* TO MY ESTEEMED FRIEND AND BENEFACTOR. DR. WILLARD PARKER, OF NEW YORK, ESPECIALLY ; AND TO THE MEDICAL PROFESSION OF THE UNITED STATKS GENERALLY, THIS WORK IS MOST RESPECTFULLY INSCRIBED BY THE AUTHOR. PREFACE, Thk prominent position which the sub- ject of Medical Education now occupies in the minds of all enlightened members of the profession, makes a review of the past not only peculiarly appropriate, but also, in the highest degree, profitable. Indeed, without such review, and a careful tracing of present evils and defects to their origin and remote causes, no member of the pro- fession can be prepared to act wisely his part in the great progressive movements of the age; or can discharge, with fidelity, the duties devolving on him, as a member of a learned and honorable profession. Wherever changes are made, or improve- ments attempted, in matters affecting, more or less directly, the interests of large classes of men, it is to be expected that much diversity of opinion will prevail con- cerning the propriety and ultimate effects VI. PREFACE. of such changes or improvement?. But if is not unfrequently the case, that far the greater share of such diversity arises either from ignorance of the real nature of the evils to be remedied, or a misapprehension of the proposed remedies. Hence, if we would aid in the correction of abuses our- selves, or even avoid standing as stumbling- blocks in the way of the action of oilers, we must search carefully the progress of medical education from the commence ment of our existence as a nation, and thereby trace effects to their real causes ; for it is not every coincident that bears the rela- tion of cause and effect; or every appa- rently remote object or consequence that we are to consider as, prima facie, inde- pendent of what has preceded. And there is probably no more difficult menial task than that of tracing accurately the chain of causation in the progress of any class of human society. Yet on this depends the whole value of history. Without it, in- stead of being " philosophy teaching by example," it becomes a mere record of PREFACE. Vll. isolated facts, quite as susceptible of a wrong as a right application. It is fro*n this cause that much of what bears the nun of history, both civil and military, h is been of so little practical benefit to mankind. Keeping this important truth constanty in mind, I have endeavored, in the follow- ing pages, not only to embody all the facts in regard to the educational history of the m Ileal profession in this coun+ry, but also to develop the origin or causes of each, anl the object it was designed to accom- p':h. If I have h?en successful in this, I am conscious that the work will be found of great value to the profession, and, through it, to mankind. For man is so constituted that he can judge rationally of the future only by the experience of the past; and that man, or that class of men, will possess the highest degree of practical wisdom, who treasure up this experience with most care and correctness. Why is it that one g leration after another, not of individuals viii. PREFACE. only, but of whole communities and na- tions, are found pursuing the same general course, committing the .same errors, suffer- ing the same evils, and finally perishing from essentially the same causes ? Simply be- cause they learn nothing from the history of those who have preceded them. Hence the youth who, when admonished by his father to shun certain vices, because he had experienced their folly, replied that he wished to " know their folly by experience, too," is a fit representative of communities and nations. And it ever will be so, until history itself advances from a mere record of facts, concerning the movements of con- tending armies and the intrigues of courts, to the character of a true exponent of hu- man motives, means, and ends, both indi- vidually and collectively. When history attains this character, and becomes uni- versally studied, then will man profit by the experience of his fathers, and each gene- ration become wiser than its predecessor. In the following pages, I have divided the educational history of the medical pro- PREFACE. IX. fession into three periods. The first, or colonial period, extends from the first set- tlement of the colonies to the termination of the Revolutionary War; the second ex- tends from this period to the year 1806, when the profession in the state of New York was organized into societies, by legal enactment; and the third extends from the termination of the second to the present time. To these I have added a fourth char- ter, stating more fully what I consider errors and defects in the present system, and my views concerning the appropriate remedies. For a large portion- of the facts pre- sented, I am indebted to the various medi- cal periodicals of our country, and especially to the writings of Drs. J. B. Beck, T.. Romayne Beck, S. W. Williams, John Stearns, Benjamin Rush, Nicholas Ro- mayne, William Douglass, John Morgan, Peter Middleton, and others. I am conscious that much has been omitted which it would have been proper to insert, especially in regard to medical X. PREFACE. societies in many of our cities; but as most of these were strictly local in their charac- ter, I have used less exertion to obtain historical facts in relation to them. I am also conscious that many of the views pre- sented, particularly in the last chapter, will meet with severe animadversions from a portion of the medical press ; but, as they are the result of an extensive examination of facts and mature reflection, I give them to my professional brethren, asking no other favor than that they be attentively read, fairly and truthfully quoted or repre- sented, and criticised with that spirit of frankness and candor which is due to all subjects of importance. N. S. DAVIS. , Chicago, III., November, 1850. CONTENTS. CHAPTER I. FAGF. History of the Medical Profession and Medical Education in the British Colonies of America, from their first settlement to tbe achievement of their Independence, 13 CHAPTER II. History of Medical Educat on and Institutions in the United States of America, from the year one thousand seven hundred and eighty-three to one thousand eight hundred and six,.......*° CHAPTER III. The same continued from the year one thousand eight hundred an 1 six to the piesent time (one thousand eight hundred and fifty,)......8S CHAPTER IV. On the Present Condition and Wants <>i the Medical Pro- fession in the United States, and the Remedies for those wants,........ HISTORY OF MEDICAL EDUCATION, ETC. CHAPTER I. KROAI THE FIRST SETTLEMENT OF THE COLONIES TO THE YEAR 1783. The origin of the institutions of this, unlike those of most other countries, is involved in no obscurity ; and is to be traced to no remote chi- valric or feudal age. On the contrary, they have ail had their birth' since the middle of the seven- teenth century; and been exposed to the full gaze of an enlightened world. This, together with the fact, that they have not only had their beginning, but their maturity thus far, among the most enterprising people, and under the influence of the most liberal govern- ment on earth, renders every thing connected with their history doubly interesting and import- ant, as affording the fairest illustrations of human 1 14 MEDICAL HJST0RV. progress, and. consequently, the most valuable lessons of human experience. . The medical profession in the United States, and, indeed, throughout the civilized world, con- stitutes an important part of society ; for while, on the one hand, its ranks can boast, not only of names of the highest eminence in every depart- ment of science and literature, but can also claim to be equal with the foremost in every enterprise for extending human knowledge, and ameliorating human suffering, its free access to the homes and firesides of all classes, gives it a moral and social influence of the most potent character. And in no part of the world is this influence more exten- sively or happily felt, than in this country, where the absence of all hereditary distinctions and privileged orders, leaves learning and virtue free to assume their own native eminence. As far as can now be ascertained, but very few regularly educated physicians embarked with the first colonists that planted themselves in the wild- erness of America. We are told by Dr. S. W. Williams, of Deerfield, that Dr. Samuel Fuller, a regularly educated physician and highly esteemed man, accompanied the first emigrants who landed at Plymouth in 1(520. He was a faithful and de- voted practitioner, and died of an infectious fever at Plymouth, in 1632. The name of Dr. llussell is MEDICAL HISTORY. 15 also mentioned as a companion of Captain Smith, in his survey of Chesapeake Bay in an open boat. in 1608. But the fact that Smith was obliged to return to Europe the very next year, to procure surgical aid, on account of an injury to his hand, " there being none to be had in the colony," shows that Dr. Russell's stay was short, or else he was not a man skilled in his profession. These are the only names that we can find mentioned among the first settlers, either at Jamestown, Ply- mouth, or New York. The fact that there were either very few physicians among the early colo- nists, or that they were poorly prepared to dis- charge their responsible duties, is further corrobo- rated by the almost total neglect of those sanitary regulations so necessary to preserve their health, and the consequent great mortality that took place in all the colonies during the first few years. A surgeon is mentioned as on board one of the ships sent to aid Capt. Mason in his expedition against the Pequoit Indians in 1637, but whether he be- longed to the colony, or the ship merely, is not known. In 1649, we find a law passed by the Massachusetts Colony, forbidding "Chirurgeons, Midwives, Physicians, or others, to exercise, or put forth any act contrary to the known rules of art, in each mystery and occupation, to exercise any force, or violence, or cruelty, upon or toward 16 MEDICAL HISTORY'. the body of any, whether young or old (not even in the most desperate cases) without the advice and consent of such as are skillful in the same art, (if any such may be had,) or at least, of the wisest and gravest there present, and consent of the patient or patients, if they be mentis compol'S, much less contrary to such advice and consent. etc." This provision is sufficiently indicative <>i the condition of the profession, at this early pe- riod, in the New England States. Indeed, with the exception of the two Govern- ors Winthrop, one of Massachusetts and the other of Connecticut, and a few of the clergy, we rind no names of even respectable attainments in the profession, during the first half century after the commencement of our colonial existence.— The younger Winthrop not only practised medi- cine extensively, but was also a member of the Royal Society of London, to which he made seve- ral respectable communications. And even so late as 1753, we are told by the Independent Re- flector, a paper then published in the city of New York, "that it (the city of N.Y., then containing about 10,000 inhabitants) could boast of more than forty gentlemen of the faculty, the greatest part of whom were mere pretenders to a profes- sion, of which they were entirely ignorant: and convincing proofs of their incapacity were MEDICAL HISTORY. 17 exemplified in their iniquitous practices. The advertisements they published proved them igno- rant of the very names of their drugs" etc. etc. Dr. Nicholas Romaine, in his annual address before the Xew York State Medical Society, (in 1811) speaking of this early period, says : " It would be. painful to intrude on your notice, the hu??ible coi d tion of medicine which seems to have existed for more than a century after the first settlement of this State.—It could only consist of a statement of the arts and intrigues, by which the practitioners of physic succeeded in advanc- ing their private interests and professional emo- luments." The reasons for such a state of things, at this period, are obvious,—there being no medi- cal schools in the colonies, or any institutions for the instruction of medical students, the only sources of supply consisted in emigrations from the mother country, or in the sending of native young men to the hospitals and colleges of Eu- rope. The circumstances of the country during the whole of the first century were such, that no man already established in practice on the other side of the Atlantic, would think of leaving it for the hardships, the poverty, and wilds of America; while the absence of all those medical societies and institutions, which constitute so powerful an 1* 18 MEDICAL lifSTOKY. object to the aspiring ambition of the thoroughly educated student, equally prevented this class from resorting hither. Hence, as a general rule, onlv those physicians who had failed to obtain a practice at home, or were too conscious of their own unfitness to make the attempt, emigrated to America. On the other hand, the great expense attending the education of young men beloneU'g to the colonies, in the m.dical institutions of Eu- rope, operated as an equal barrier to this source. Thus it was. that while persecution filled the cle- rical ranks of the colonies with men of the deep*, st. piety, and the most varied learning, and the patronage of the crown induced a fid! supply of legal talent, the profession of medicine Mink to a comparatively low state. In New England, the greater number of' those who practiced medicine were priests, whose medi- cal knowledge was chiefly derived from the writings of Hippocrates, Galen, Areta-us, etc.. which they had read during their collegiate edu- cation in Europe. Some of the nonconformist clergy, however, who were persecuted or silenced in the Old World, went through with a regular course of medical studies before leaving home, and afterwards became exceedingly useful, both as physicians and preachers, among the colonists here. Of this number, were Drs. Gif i'inaer MEDICAL IH-'TOUY. 10 and John Fisk : the first arrived in A\ x England 1633. and the last in 1637. Both lived to an advanced age. and were highly respected. Dr. Thomas Thatcher also came about the same time: and his pamphlet, entitled "A Guide in Small-Fox and Mrasles." published in 1677, is said to be the first medical publication in America. About the middle of the seventeenth century, Drs. Bellinghnm and Henry Saltonstall, after receiv- ing a. general education at Harvard College, went to England, where th-ew completed a full course of medical studies, received the degree of M.I)., and returned to practice their profession in the Massachusetts Colony. These were the first vouuir men of whom we can get any account. who left the colonies to obtain a regular medical education in the mother country, for the purpose of practicing hei-e. But during the latter part of the first half of the eighteenth century, a new era begin to dawn mi the medical profession in America. It was during this period that we find several young men of the highest order of native talent, after receiv- ing a thorough course of instruction in the medi- cal institutions of Great Britain and the Conti- nent, returning to practice their profession in Ihr \ew World. Annnig these we find- the names of Dr. Zabdiel Boylston and Dr. James 20 MEDICAL HISTORY. Lloyd, of Massachusetts; Lieut. Gov. Golden and Dr. James Ogden, of New York ; Drs. John Morgan, William Shipper), Jr., and Benjamin Rush, of Pennsylvania; Drs. John Mitchell and Thomas of Virginia; and Dr. Lining of South Carolina—names, that will ever remain- as orna- ments to the medical profession in America. During this period, other circumstances also occurred which aided very much the advance- ment of the profession.—Wars between England and France, were carried on, with only short intervals of peace, during the greater part of the eighteenth century. And so early as 1690, hos- tilities commenced between New York and New England, on the side of England, and the French settlements in New Brunswick and Canada. From this time to the final subjugation of the French colonies in 1763, many expeditions were sent from England to aid the colonists, and each was accompanied by a well appointed medical staff. These being almost constantly in the colo- nies, with the military hospitals which necessarily accompanied the movements of regular armies, supplied the place, in some degree, of medical schools, and doubtless excited the ambition of many of the young men, who, during the latter part of this period, spent some time in Europe, and returned to become the founders of medical MELUCAE II (.-TORY. 21 science in America. What Dr. .Nicholas Ito- maine says of tiie influence of the->e. on the medical profession of Xew Vork, i- equally true ot New England, Pennsylvania, and Virginia. In his annual address to the Medical Society of the State of New York, in 1811. to which we have already alluded, Dr. Romaine says. ••The war which effected the conquest of Canada, was. per- haps, the first circumstance which materially improved the condition of medicine in this State (Xew York). The English army employed for that purpose, left Europe, accompanied by a highly respectable medical staff, most of whom landed in the citv of New York, and continued some years in the neighboring territories, a Hording to manv young Americans opportunities of attend- ing the military hospitals, and receiving such professional instruction as gave them afterward consideration with the public. The physicians and surgeons of tie,- Anglo-American army gamed the confidence of the public, by their superior deportment and professional information. The military establishments in this State, after the Canadian war, required medical and surgical attendants, so thai, the people had the benefit of their advice. In this manner a new order of medical men was introduced into the connnu- nity. '~i' in 1776. And the same year Dr. Lionel Chalmers published his able work on the "'Weather and Diseases of South Carolina." " An Es3ay on Fevers " had been published by the same author in 1768. Many of these productions are characterized by a variety of learning, an accuracy of observa- tion, and an originality of thought, which would do credit to any age or country. Thus, Dr. Lining's " Description of American Yellow Fever," stands to the present day, unrivalled for its accuracy and minuteness of description ; and Dr. Douglass, in his " History of the New Epidemical Fever " of 1735—6, not only gives the best account of thai fatal disease, but also enjoys the honor of first suggesting the use of calomel as a remedy. Dr. Clayton's "Flora Virginia" attracted so much attention that it was republished at Leyden, 1762,- and very few papers exhibit a greater MEDICAL HISTORY. 33 degree of philosophical acumen and learning than Dr. Mitchell's on the " Causes of the Different Colors of Difterent People." Of Dr. Jones and his work on Wounds and Fractures, Dr. J. B. Beck speaks as follows, viz.: " The only work he has left us is a volume upon wounds and frac- tures, which was first published in 1776. In the situation in which the colonies were then placed, this was a most acceptable present, both to the profession and to the public. It was so well re- ceived, that a second edition was called for the same year. Although a plain and unpretending work, it was admirably fitted to the purposes for which it was intended, and it shows the author to have been a man of strong sense, combined with a thorough knowledge of his subject. Al- together, Dr. Jones has left behind him a most enviable reputation. He was the physician of Washington and Franklin, the latter of whom he attended in his last illness. Not merely as the skillful operator, but as the scientific surgeon, and the first teacher of surgery in the colonies, he justly deserves to be styled the father of Ameri- can surgery." The work of Dr. Chalmers on the Climate and Diseases of South Carolina, in two volumes, is particularly worthy of attention, as well as that of the same character concern- ing New York, by Dr. Colden. And the credit 84 MEDICAL HISTORY. of originality, in promulgating the true doctrine in regard to the formation of Pus, though usually ascribed to Dr. John Hunter, undoubtedly be- longs to Dr. John Morgan, who, in his Inaugu- ral Thesis, maintained with great ability the doctrine that Pus is a Secretion. This is fully and honorably acknowledged by Dr. James Curry, lecturer at Guy's Hospital, so early as 1817. Nor is this the only instance of fair claim to originality, which has been appropriated else- where. The use of mercury in the treatment of inflammatory diseases and eruptive fevers had its origin with Dr. Douglass, of Boston, in 1736; the preparation used was calomel. But to Dr. James Ogden, of Long Island, are the profession indebted for pointing out more systematically the indications for its use, and the manner of using it. He used it extensively, and with the happiest effects, in the Angina Maligna of 1749; and its use was rapidly extended to the treatment of nearly all the Phlegmasia.—Again, to Dr. Richard Bayley, are we indebted for first pointing out the true inflammatory nature of the Cynanche Trachealis, or Croup, and the great utility of blood-letting and antimony in its treatment. Yet all of these have been often set forth as originating on the other side of the Atlantic. Dr. James Lloyd, of Mass., and Dr. Wm MEDICAL HISTORY. 35 Shippen, of Philadelphia, were the first regular and successful practitioners of Midwifery in this country. The one settled in Boston in 1754, and the other in Philadelphia in 1756; and to their skill, boldness, and decision of character, are we indebted for the rescue of that most delicate and important branch of practice from the hands of ignorant and credulous females. Although a consideration of medical practice does not come strictly within the scope of our present work, yet an occasional glance at this, and the character of diseases prevalent at differ- ent periods of time, will be both interesting and profitable. Indeed, a carefully written history of diseases, their variations of type and severity, in connection with the prevalent modes of medical practice, and the ever-varying customs of society, would be of great value to the profession. It would explain the origin of many theories and systems in medicine, and reconcile much that now seems discordant and contradictory in our medi- cal literature. Thus says Dr. Rush:—" The success of nature in curing the simple diseases of Saxony, laid the foundation for the Anima Medica of Stahl. The endemics of Holland led Dr. Bcerhaave to seek for the causes of all diseases in the, fluids. And the universal prevalence of diseases of the nerves 36 MEDICAL HISTORY. in Great Britain, led Cullen to discover their peculiar laws, and to found a system upon them —a system which will probably last till some new diseases are let loose upon the human species, which shall unfold other laws of the animal economy." During the greater part of the period included in this chapter, the Humoral doctrines of Bcer- haave held an unlimited sway over the minds and practice of physicians, both in this country and Europe. Endemic and epidemie fevers prevailed frequently in nearly all the colonies, and some- times produced great destruction to life. This was the case, to some extent, even among the Indians, before white settlements were formed. Thus, we are told by Dermer, Mather, and Gookin, that in 1618—19, a pestilential fever pre- vailed among the Indians in New England, with such severity that whole tribes were nearly de- stroyed ; and in some places, in 1620, their dead bodies were found unburied, putrefying in the sun. The first colony of Pilgrims that landed at Plymouth, in 1620, suffered dreadfully from sickness during the few following years. And in 1632—33—38, a pestilence, resembling the yel- low fever, prevailed extensively in the New Eng- land settlements, which, with the small-pox, cut off many of the inhabitants. Dr. Rush tells us MEDICAL HISTORY. 37 that between the years 1760 and 1766, intermit- ting, bilious, and yellow fevers were common in Philadelphia and its environs; that influenza was epidemic in 1761, and the malignant sore throat in 1763. He also states that deaths were "com- mon between the fiftieth and sixtieth years ot life, from gout, apoplexy, palsy, obstructed livers, and dropsies." This last paragraph is worthy of a moment's consideration. Why were these diseases so fre- quent and fatal, when, thirty years after, the same author tells us they were comparatively rare in the same city? A very satisfactory answer to this question will be found in the habits of the citizens at the two periods referred to. Alluding to these habits during the period intervening be- tween the years 1760 and 1766, Dr. Rush says " the diet of the inhabitants of Philadelphia, during those years, consisted chiefly of animal food. It was eaten in some families three times, and in all twice a-day. A hot supper was a general meal. To two and often three meals of animal food in a day, many persons added what was then called ' a relish' about an hour before dinner. It consisted of a slice of ham, a piece of salted fish, and now and then a beef steak, accompanied with large draughts of punch or toddy. Tea was taken in the interval between 38 .MEDICAL HISTORY. dinner and supper. In many companies, a glass of wine and bitters was taken a few minutes be- fore dinner, in order to increase the appetite. The drinks, with dinner and supper, were punch and table beer. Besides feeding thus plentifully in their families, many of the most respectable citizens belonged to clubs, which met in the city in the winter; and in its vicinity, under sheds or the shades of trees, in the summer, once or twice a week, and, in one instance, every night. " They were drawn together by suppers in win- ter, and dinners in summer. Their food was simple, and taken chiefly in a solid form. The liquors used with it were punch, London porter, and sound old Madeira wine. " From this general use of distilled and fer- mented liquors, drunkenness was a common vice in all the different ranks of society."* Wrho can feel surprised that, in the midst of a people in- dulging in such habits, death from " gout, apo- plexy, palsy, obstructed livers, and dropsies," should be remarkably frequent ? The same writer tells us that one club, " con- sisting of about a dozen of the first gentlemen in the city, all paid, for their intemperance, the for- feit of their lives; and most of them with some * See Rush on the state of Medicine, between 1760 1766 and 1809. ' ' MEDICAL HISTORY. 39 one or more of the diseases that have been men- tioned." These few facts are introduced here, for the purpose of showing how poorly we are qualified to judge of the propriety of any system of prac- tice, at a given period of time, without an inti- mate acquaintance with the condition and customs of the people at ths same period. We have already said that practitioners during most of our colonial period, were much controlled in practice by the doctrines of Bcerhaave ; but during the latter part of the time, these began rapidly to yield to the advancing school of Cullen. There were not wanting, however, many bold and inde- pendent practitioners, who did not hesitate to throw off the shackles of prevailing systems, and adapt their treatment to the prevailing type or character of disease, or introduce new remedies, as the preceding facts abundantly show. Of these, none were more deserving of notice than Drs. Boylston, Colden, Ogden, Bayley, Morgan, and Bond. So rapid was the decline of the Bcerhaavian influence, that before the close of the Revolutionary War, we find blood-letting, purges, vomits, bark, opium, and mercury all used with more or less freedom throughout the profession. The last named remedy was extensively and very 40 MEDICAL HISTORY. successfully used by some physicians, in preparing the system for the small-pox, both in the natural way, and after inoculation. This practice was commenced as early as 1745, by Dr. Thomas, of Virginia, and Munson, of Long Island. And by it, we are told, they reduced the number of deaths after inoculation from one in one hundred to one in eight hundred or one thousand. Dr. Zabdiel Boylston, of Boston, first introduced the practice of inoculation for the small-pox into the country, by inoculating his own son, thirteen years of age, and two colored servants. This was on the 27th of June, 1721, only two months after the inoculation of the daughter of the celebrated Lady Wortley Montague, the first that was practiced in England, and certainly before any knowledge of the latter case could have reached Boston. Dr. Boylston was induced to commence the practice by Rev. Dr. Cotton Mather, who had read an account of the inocula- tion in Turkey, published in the transactions of the Royal Society of London. His first three experiments proving successful, and the small- pox raging fearfully in the city of Boston, Dr. Boylston inoculated, during that year, 247, of all ages and both sexes, and 39 were" inoculated by other physicians,—making a total of 286, of whom only six died; while of 5,759 who were attacked MEDICAL HISTORY. 4 J with it in the natural way, during the same period, 844 died. It is not strange that, when this practice wa3 first introduced, it should have met with most violent opposition, requiring no small degree of firmness and perseverance, on the part of those who had undertaken it, to stem the torrent of popular indignation, which was much exasperated by the conduct of a portion of the profession, a! the head of whom was Dr. Wm. Douglass, a man of much abdity and strong prejudices. Indeed, the history of our profession brings to light no controversy of a more exciting and violent cha- racter, than that which arose, both in the colonies and the mother country, from the introduction of this practice. And none better illustrates the power of truth to triumph over error, even when entrenched behind the strongest bulwarks of human prejudice and passion ; for the success of Dr. Boylston rapidly won to tbe cause intelligent members of the profession, and, in a short time the practice was extended through all the colo- nies. And, as we have already stated, such was the success attending a proper preparation of the system for the reception of the disease, that, in- stead of losing six out of two hundred and eighty- six, as shown during the first year of its intro- duction, in less than twenty years after, the 42 MEDICAL HISTORY. average mortality of those inoculated did not ex- ceed one in eight hundred. Notwithstanding, the popular prejudice which was excited against Dr. Boylston was, for a time, strong and highly embittered, yet he lived to receive ample com- pensation in the good opinion of his fellow-men, both at home and abroad. He afterwards visited England, and besides receiving the most gratify- ing marks of attention, he had the honor of being the first physician in the colonies who was made a member of the Royal Society of London. We are told by Dr. J. W. Francis, in his Anniversary Discourse before the New York Academy of Medicine, that Dr. Beekman Van Beuren, as physician to the Alms House, in the city of Sew York, " was the first physician who introduced the practice of inoculation for the small-pox in our public institutions." The first post mortem examination that took place in America, of which we have any record, was made in ljgfcL by Dr. Johannes Kerfbyl, assisted by five other physicians of the city of New York, The body examined was that of Governor Sloughter, who had died suddenly under suspi- cious circumstances. It was not until 1750, nearly sixty years after, that the first human body was dissected, for the purpose of imparting medi- cal instruction in the colonies. This was done MEDICAL HISTORY. 43 by the learned Drs. John Bard and Peter Middle- ton. The study of Botany also received attention from some of the earliest and most learned phy- sicians of the colonies. Among these Drs. Cad- wallader Colden, of A:ew York, and John Bar- tram, of Pennsylvania, stood pre-eminent. The first named of those eminent men taught the Linncean system or classification of plants, on the Banks of the Hudson, several years before it was recognized in England. Colden doubtless derived his knowledge from the traveler, Kalm, who was pupil of Linnaeus; and so highly was he esteemed by the botanists of the Old World, that one of the most beautiful plants of the tetran- drous class was named Coldenia, in honor of his name. John . Bartram, though living at a little later period of our history, enjoyed a still more extens- ive reputation in this department of science, and probably was favored with a more extensive correspondence with the scientific men of Europe than any of his cotemporaries. He was the first Anglo-American who attempted to establish a botanic garden in this country- This garden was located on the Schuylkill, about three miles from Philadelphia, and contained about five acres, well covered with a great variety " of new, 44 MEDICAL HISTORY. beautiful, and useful trees, shrubs, and herbaceous plants." We are told that his garden attracted the attention, and induced the visits of many learned men ; and Bartram himself continued to travel extensively through the country, and make collec- tions in the various departments of natural science, until he was over seventy years of age. Dr. John Clayton, who came from England to Virginia in 1705, has already been referred to as the author of the Flora Virginica, published in 1743 ; and Dr. Alexander Garden, of South Caro- lina, was no less distinguished both as a naturalist and physician. He kept up a correspondence with Linnaeus in Latin, by whom he was held in high estimation. The beautiful flowering shrub called Gardenia, was so named in honor of Dr. Garden. The practice of sending native young men from the colonies to be educated in the Medi- cal Schools of Europe, was more prevalent in the southern than in the eastern colonies. So early as 1734, William Bull, a nativeCarolinian, received the degree of M.D. at Leyden. John Moultrie graduated at Edinburgh, in ,1749, and published his Thesis, " de Febre Flava ;" and we are told by Dr. Ramsey, that ten other natives of that colony obtained the same honor between MEDICAL HISTORY. 45 1768 and 1778. In the middle and southern States, there was much less disposition to merge the duties of physician and priest in the same hands, than in New England. Indeed, they seem to have been much better supplied at an early pe- riod, with well educated physicians from England and Scotland, than the more northern colonies ; and in the same proportion did the profession en- joy a higher reputation, both at home and abroad. East New Jersey appears to be entitled to the credit of making the first attempt to improve the condition of the profession by means of social or- ganization. So early as 1766, a numerous meet- ing of physicians was held at New Brunswick, and a constitution and by-laws adopted for a per- manent organization. Delegates were present from all parts of the State, and the objects, as set forth in the preamble to the constitution, were " Mutual improvement, the advancement of the Profession, the promotion of the public good, and the cultivation of harmony and friendship among their brethren." These were objects worthy the attention of enlightened minds ; and they seem to have been strictly adhered to, and successfully carried out; the society meeting reg- ularly twice in each year, until interrupted in 1775, when not a few of its members left the so- cial circle and the bed-side, to bind up the wounds 46 MEDICAL HISTORY. of bleeding freemen, or with them, share the deadly strife in freedom's cause. The second important movement in this direction, was in the colony of Massachusetts, a little before the close of the war. In 1781, the Massachusetts Medical Society was incorporated, embracing about thirty members, with the venerable Edward Holyoke, as its President. Among the original members, we find the names of John Warren, Aaron Dex- ter, Joseph Fisk, Edward A. Holyoke, and James Lloyd. During the same year, Dr. John Warren, who was then surgeon of a military hospital in Boston, commenced a course of anatomical lectures, which were the first of which we have any account in New England. They were continued several years, and attended by many of the students of Harvard University, until a Medical Faculty was organized in connection with that institution, Such is a brief view of medical institutions and practice, during the colonial period of our history. And if we consider the condition of the American colonies, the many dependencies on the mother country, on the one hand, and the almost con- stant aggressions of the French and Indians, on the other, the scattered state of the population etc., we doubt whether any profession, under sim- ilar circumstances, ever progressed with greater MEDICAL HISTORY. 47 rapidity than the medical profession of the colo- nies, during the twenty-five years succeeding the middle of the eighteenth century. Still quackery, in all its forms and guises, was everywhere flou- rishing ; and the profession itself destitute of that internal organization or associated effort at im- provement, which is so necessary to high respect- ability and permanent prosperity. Even the prohibitory laws of 1760, in New York, and of 1772, in New Jersey, seem to have had very little influence in accomplishing the object for which they were designed, viz.: the elevation of the pro- fession, and the suppression of irregular practice. But the time of their continuance before the commencement of the war of 1775, which, for a period of eight years, effectually diverted the at- tention of all classes from all other subjects, was too short to allow any inference of value to be drawn in regard to their success or failure. Not- withstanding the adverse circumstances in which the country was placed, and the admitted degra- dation of a great proportion of the medical prac- tice of those times, still we cannot but admire the liberal views, the close and patient observation, and the bold cast of originality, exhibited by those whose education had fitted them for the high res- ponsibilities of their calling. And equally must we admire, the broad and liberal basis on which 48 MEDICAL HISTORY. they planted their infant institutions in Philadel- phia and New York; requiring as they did, a preliminary education and a curriculum of medi- cal studies, superior to that of any medical institution now existing in our boasted republic. If, any doubt this, let them compare the regula- tions of the Philadelphia Medical College of 1768, as already quoted, with those of any of our existing institutions. CHAPTER II. 1U0M THE YEAR ONE THOUSAND SEVEN HUNDRED AND EIGHTY-THREE TO ONE THOUSAND EIGHT HUNDRED AND SIX. During that great Revolutionary struggle, which terminated in the establishment of the In- dependence of the American 'colonies,~but little time or means was afforded for the cultivation of any science or profession, save that of arms and the arts of war. And perhaps no class were more faithful or vigilant in their country's cause than the practitioners of medicine. They not only followed the military camp, sharing its pri- vations and toils as surgeons, but no small num- ber exchanged the lancet for the sword, and the Esculapian wig for the cap of the military chief; and long will the pages of American history glow with the names of Warren, Mercer, Rush, etc., the two former of whom sealed their devotion to the cause with their lives. During the war, both New York and Philadelphia fell into the hands of 3 o(.r MEDICAL HISTORY. the British, and the operations of the medical schools, like all other institutions in those places, were suspended until their evacuation. Even the Medical Society of New Jersey, as already stated, was compelled to suspend its functions during the hostile incursions of the proud invader. But, while these ordinary means of facilitating medical education were suspended, another school of quite a different character was opened for the (raining of our profession. We have alluded, in a previous chapter, to the benefits derived by the profession of the Colonies from the medical corps attached to the English armies, sent against the French colonies in.the war which terminated in 1763; but the war for Independence afforded another and severer school than the one which had preceded. In the former, the Colonial pro- fession held the position of pupils and] assist- ants, while in the latter they were left entirely to their own resources, in a direct contest against their former guides and masters. It was during this trying period, when the profession was comt pelled to act independently, and often without even a proper supply of drugs, that, animated and encouraged by the noble spirit of a Rush, it rose equal to every emergency, and acquired that self- reliance which enabled it, at the close of the eventful struggle, to set about resuscitating its MEDICAL HISTORY. 51 infant institutions, with a zeal that could not fail of success. Hence, no sooner was Philadelphia evacuated by the British army in 1778, than we find the functions of the College and Hospital resumed by the same teachers, and under the same regulations, as before. The number of students in attendance during the winter and spring of 1779, was not less than sixty, although no graduates are reported for that year. Indeed, the number of graduates during the whole of the period under consideration, amounting to nearly a quarter of a century, scarcely averaged ten annually. This was neither owing to the small number of students in attendance on the lectures, nor to the difficulties in the way of graduation, but to the much less relative importance which was at this period attached to the degree. The degree, either of Bachelor of Medicine, or Doctor, conveyed, at that time, no special privi- leges in regard to practice ; and hence was re- garded, like all other literary degrees, as a mere honorary title,—therefore, we find students resort- ing to the Medical College, not so much for the title it was authorized to bestow, as for the real medical knowledge it was capable of dispensing. In 1779, the Pennsylvania legislature abro- gated the charier of the College, and founded another, called the University of Pennsylvania, 52 MEDICAL HISTORY. endowing it liberally with funds derived from the confiscated estates of the royalists of that com- monwealth, and provided^for a medical depart- ment in place of that in connection with the one whose organization had been dissolved. This, however, produced but little other effect on the Medical College than a change of name, for the same professors were in reality continued, until 1789, when the legislature, acknowledging the injustice of their predecessors in abrogating the former charter, restored it again, with all the powers and privileges belonging thereto; but, at the same time, permitting the University to re- main unaltered. This act brought into existence two Colleges, each possessed of the privilege of having a medical department annexed, and neither willing to forego that privilege in favor of the other. The result was the organization of two medi- cal faculties during the following year. But ex- perience soon taught them that the patronage was too limited to sustain two institutions, either literary or medical, hence they were united in 1792, under the name of the University of Penn- sylvania, which has been retained until the pre- sent time. The Medical Faculty of the united school was composed of Dr. William Shippen, Prof, of Anatomy, Surgery, and Midwifery; and MEDICAL HISTORY. 53 Dr. Caspar Wistar, Adjunct; Dr. Adam Kuhn, Prof, of Theory and Practice of Medicine; Dr. Benjamin Rush, Prof, of the Institutes of Medi- cine, and Clinical Medicine ; Dr. James Hutch- inson, Prof, of Chemistry; Dr. Samuel P. Griffitts, Prof, of Materia Medica; Dr. Benjamin S. Bar- ton, Prof, of Botany and Natural History. Some important changes were also made at this time for the government of the College, and the conferring of degrees. The Bachelor's degree was wholly abolished, and that of Doctor of Medicine conferred under the following rules, viz.: " 1. That the candidate should not be under twenty-one years of age, should have studied medicine for three years, and for two, at least, in connection with the University. 2. That he should have attended at least one course of lec- tures of the several professors, with the exception of the professor of Botany and Natural History, and should also have attended one course of Natural and Experimental Philosophy in the in- stitution, unless he had received instruction in this branch elsewhere; and 3. That he should undergo a private examination before the faculty; and if approved by them, should be again pri- vatelv examined by the faculty, in the presence of as manv of the trustees as might choose to 5i MEDICAL HISTORY. attend : and finally, if found to be properly quali- fied, should offer a thesis, to be printed at his own expense, and defended in public at the Annual Medical Commencement.'* No one can fail to mark the contrast between these requisitions and those adopted by the first College, in 1768. Here, instead of a preliminary education, embracing mathematics, the natural sciences, and some knowledge of the Latin lan- guage, we have a simple requirement in regard to some instruction in "Natural and Experimental Philosophy ;" and, indeed, the whole requisitions for the degree of Doctor of Medicine, are much below those previously required for that of Bachelor. And we may here date the commence- ment of that lowering policy, and that disregard of preliminary education on the part of medical schools, which has worked great injury to the profession. But why was the original standard departed from, and particularly in the downward direction ? Before answering this question, we will turn our attention to the condition of medi- cine in the neighboring city of New York. Soon after the close of the war, attempts were made to revive the medical department of King's (now changed to that of Columbia) College. * See " An Historical Sketch of the University of rcnn- fylvariia," published 1836. MEDICAL HISTORY. 55 Through some mismanagement, the attempt not only failed, but was attended with some circum- stances which gave rise to a strong popular out- break, commonly called the " Doctor's Mob." This arose from a suspicion that some bodies had been stolen from the grave-yard for dissection. The mob broke into the dissecting room of the Col- lege, and finding several subjects partially dis- sected, they exhibited the fragments to the multitude without, which so increased the excite- ment, that all law and order were trampled under foot for two or three days. Several medical gentlemen were grossly insulted, and many of the students were confined in prison for personal safety. This unhappy event not only tended very much to degrade the profession in the public estimation, but also greatly to retard the progress of the College. To counteract, as far as possible, the evil in- fluences brought to bear on the profession, and to improve medical science, several of the more enlightened young members formed themselves into a private society ; and in 1787, they suc- ceeded in inducing the magistrates of the city to establish an apothecary's shop, at the public expense, and freely tendered their professional services for the sick poor. Among the more pro- minent of these men were Drs. Wm. Moore, 56 MEDICAL HISTORY. Nicholas Romaine, Benjamin Kissam, Wrigh! Post, and Valentine Seaman. They not only gave gratuitous attendance on the poor for seve- ral Years, but connected therewith lectures on most of the branches of medicine, thereby con- stituting the first real hospital and dispensary, connected with practical instruction, under the corporation of the city. So great was their suc- cess, that in 1790, more than fifty students attended their instructions. Encouraged by their success, and failing in the establishment of a College of Physicians and Surgeons, for the sole purpose of medical instruction, another effort was made to revive the medical department oi Columbia College. In the fall of 1791, the pri- vate association introduced no less than sixty medical students into the College, and thereby in- duced the legislature to make a grant of ove. $30,000 to the trustees, for the purpose of enabl- ing them to enlarge their buildings, etc. In the following year, the medical faculty was re- organized, by the appointment of Drs. Bailv, Post, Rogers, Hamersly, Nicoll, and Kissam, Professors; and Dr. Bard, Dean of the Faculty. Some of these appointments were so unsatis- factory to the students that many of them aban- doned the College, and erased their names from the register. Indeed, such were the internal MEDtCAL HISTORY. 57 jealousies, and outward prejudices, that the insti- tution, though it maintained an existence until 1810, yet never attained a degree of prosperity equal to the private association to which we have alluded. About this time also, the buildings for the New York Hospital, which had been destroyed by fire previous to the war, were again so far completed as to allow of the admission of patients. Soon after the close of the war, the subject of medical instruction began to attract attention in the Eastern States. And we have already seen that so early as 1782, some courses of lectures on the different branches of medicine were given, in connection with Cambridge University. This was mainly in consequence of several liberal dona- tions from some wealthy and enlightened friends of the cause. In 1788, a medical faculty was established in connection with Harvard College, headed by Dr. John Warren, with Drs. Water- house and Dexter for associates. This was con- tinued with a reasonable degree of success, and under fair regulations, until 1810, when it was removed to Boston, where it soon obtained a much higher degree of prosperity. How much the almost simultaneous establishment of these several schools, and particularly the school and hospital in the rival city of New York, influenced the markea lowering down of the requisitions for 58 MEDICAL HtSTORY. graduation, to which we have alluded, in the Medical School of Philadelphia, every reader must judge for himself. It was doubtless these things, aided by the prevailing spirit of the times, that led to this sad change of policy. The Massachusetts Medical Society was estab- lished by an act of the legislature of that state in 1781. The objects set forth in the act of incor- poration were, the promotion of medical science, and the regulation of all matters pertaining to the profession. To enable it to accomplish these de- sirable objects, the society was authorized to ap- point a Board of Censors, whose duty it was to examine all candidates for admission into the pro- fession in that state, and grant licenses to such as were found qualified. This society, together with that formed soon after in New Haven, and the New Hampshire Society, chartered in 1791, ex- erted a very salutary influence over the profession throughout the Eastern States. Their powers and duties were modified from time to time, until at length the organization of each became complete, and they had severally adopted fixed regulations for the examination and admission of candidates, and enlightened codes of medical ethics, as we shall see in the sequel. To stimulate into action individual talent, and encourage still further the cultivation of medical MEDICAL HISTORY. 59 science, a wealthy and enlightened citizen of Boston, Ward Nicholas Boylston, Esq., established in 179d, a perpetual legacy, yielding $133 per an- num. Thirty-three dollars of this sum was to aid in the establishment of an anatomical museum, and the remaining one hundred to be awarded annually for premiums for medical essays, under the direction of the Fellows of the Massachusetts Medical Society. The noble intentions of the donor have been faithfully carried out by the so- ciety, wdio have thereby annually called forth a number of interesting essays, which now embrace many of the most important topics belonging to medical science. The Massachusetts Medical Society also enjoys the honor of being the first in this country to issue a regular volume of transac- tions, made up of the most interesting papers read before the society. The first number of the transactions was pub- lished previous to the year 1800, and contained papers written by Drs. E. A. Holyoke, of Salem ; Wm. Baylies, of Dighton ; Joseph Orne, of Sa- lem ; N. W. Appleton, of Boston ; Edward A. Wyer, of Halifax, N.S.; Isaac Rand, of Cam- bridge ; Isaac Rand, Jr., of Boston ; Joseph Os- good, of Andover; Thomas Welsh, of Boston; and Thomas Kast, of Boston. The most import- ant of these papers, were: " An account of the (JO MEDICAL HISTORY. weather and epidemics of Salem, in the county of Essex, for the year 1786 ; with a bill of mortality for the same year; by Edward A. Holyoke, M.D., written in 1787,"—" A case of Empyema, successfully treated by an operation, by Isaac Rand, in 1783,"—" Observations on Hydrocepha- lus Internus, by operation, by Isaac Rand, Jr., in 1789,"—and " an account of an Aneurism of the Thigh perfectly cured by an operation, and the use of the limb preserved, by Thomas Kast, in 1790." The second number of the society's transactions was not published until 1808. The first medical society organised south of New Jersey, was the Philadelphia College of Physicians, which was instituted in 1787, and incorporated by the legislature of the state in 1789. The Philadelphia Medical Society was organized in the same city in 1789, and was incorporated in 1792. An interesting notice of the history of the last-named society, may be found in the Medical News and Library for January, 1843. It was during the period under consideration that another powerful means of diffusing medical knowledge, and promoting the welfare of the pro- fession, was brought into requisition. I allude to the medical periodical press. The first medical periodical published in America, was commenced in the city of New York, and was called the MEDICAL HISTORY. 61 Medical Repository. It was commenced by Drs. Samuel L. Mitchell, Edward Miller, and Elihu H. Smith, in 1797; and the first named of this eminent trio continued its principal editor through the whole of the first sixteen volumes. At the end of this time it passed under the editorial care of Dr. James R. Manley, assisted by able associates, who maintained its reputation unabated until the end of the twenty-third volume. The Repository was a good sized quarterly journal, and its pages were enriched with many of the ablest medical and scientific productions of the period through which it was published. In 1804, two medical journals were started in Philadelphia, one called the Philadelphia Medical Museum, the other, the Philadelphia Medical and Physical Journal. The first number of the Museum was issued in September, 1804, edited by Dr. John Redman Coxe. The Medical and Physical Journal was commenced in November of the same year, under the editorial management of Benj. Smith Barton. These several journals soon called into action much talent that had hitherto been dormant, by eliciting essays and communications from many of the most intelligent members of the profession in every part of the country, by publishing the proceedings of medical societies at home and abroad, and by affording a free channel for 6J MEDICAL HISTORY. dignified scientific discussions. They thus became powerful auxiliaries in the great work of medical education and advancement. The medical department of Dartmouth College was organized in 1797, on much the same plan with the first schools in Philadelphia and New York. During the first nine years after the medical department was established, medical honors were conferred on thirty-three candidates, only one of whom took the higher degree of Doctor of Medi- cine, all the rest taking the degree of Bachelor. The same course was continued up to 1812, after which, the degree of Doctor seems to have been the only one conferred by the college. During the period now under consideration, we find very little done by the several state legislatures, either to promote the education of the profession, or pro- tect the interests of the community against em- piricism. The first legislaiive act which we find on record, having for its object the regulation of medical practice, subsequent to the war, was adopted by the legislature of New York, in March, 1792. This law required all students who had graduated at some literary college in the United States, to study two years, and those who had not so graduated, to study three years with some repu- table practitioner ; and then undergo an examina- tion before the Governor, Chancellor, the judges MEDICAL HISTORY. 63 of the Supreme Court, the Attorney-General, the Mayor, and Recorder of the city of New York, or any two of them. The examining officers were allowed to take to their assistance any three prac- titioners whom they might choose; and if the candidate was found qualified, he received a li- cense, which authorized him to practice medicine in all its branches. But all persons destitute of such license, were prohibited from collecting pay for their services, except such as were already in practice before the law was enacted. This law was in all respects similar to the colonial law of 1760 ; and, like it, was limited in its operations to the city and county of New York. The act con- tinued in force five years, when it was repealed, or rather superseded, by another passed by the legislature in 1797, which prohibited all per- sons from practicing physic or surgery in that state without a license from one or more of the officers mentioned in the act of 1792, under a penalty of twenty-five dollars for each offense. The period of study was extended to four years, with a deduction of one year in favor of those who had graduated at some literary college. Each candidate was also required to furnish the exam- ining officers with a certificate of the time he had studied, verified by the oath of his 64 MEDICAL HISTORY. preceptor ; and his license was to be filed in the clerk's office of the county, where he commenced practice. Those who had received the degree of Bachelor or Doctor of Medicine from a medical college, were permitted to practice on filing a copyT of their diploma in the county clerk's office, without any further examination. The great defect in this law, consisted in the fact, that the certificate, setting forth the time of study, etc., and verified by the oath of the preceptor, became the only test of qualifications for practice ; it being only neces- sary to exhibit this to the proper officer, and file it in the office of the county clerk. It, however, remained with only slight amendment until 1806, and its provisions embraced the whole state. The medical society which had existed in New Jersey since 1766, was regularly incorporated by the legislature of that state, in 1790, under the name of the " Medical Society of the state of New Jersey." The act of incorporation conferred the power to appoint censors tor the purpose of examining and licensing candidates for permission to practice in that state ; also, to establish district or county societies, whose delegates were to con- stitute the parent or state society. The term of study required, and all the regulations adopted, MEDICAL HISTORr. 65 were very similar to those prescribed by the law of 1797, in New York. The Medical Society of South Carolina was incorporated in 1794, but no provision for examining and licensing candi- dates for admission into the profession, was made until 1817. In 1799, the " Medical and Chirurgical Faculty of the state of Maryland" was incorporated, with power to elect "by ballot, twelve persons of the greatest medical and chirurgical abilities in the state, who shall be styled the Medical Board of Examiners for the state of Maryland." It was the duty of this board " to grant licenses to such medical and chirurgical gentlemen, as they, either upon a full examination, or upon the production of diplomas from some respectable college, may judge adequate to commence the practice of the medical and chirurgical arts." Under a supplementary act passed in 1801, the Board of Examiners required all graduates of me- dical colleges, as well as others, to apply for and obtain a license before being authorized to prac- tice. The penalty for practicing in violation of the foregoing provisions, was fifty dollars for each offense, to be recovered in the county court where the offender may reside ; and the judges of those courts were directed to give the several acts re- lating to medicine and surgery, annually, in charge 66 MEDICAL HISTORY. to their respective grand juries.* Every person li- censed bv the Examining Board was, by virtue of such license, constituted a member of the state so- ciety. It is thus seen that Maryland was, not only among the earliest to enact laws to protect her citi- zens against the inroads of ignorance and empiri- cism, but also that her laws relating to this subject wereatoncesimpleandeffectual. By the foregoing, it will be seen that six of the original thirteen states had recognized their right and duty to legis- late oh the subject of medical education and prac- tice during the first twenty years after the Revo- lutionary \V ar. Concerning the general condition of the profes- sion at this time, we have the testimony of some of its most distinguished members, as well as other authority of a reliable character. In the preamble to the law passed by the legislature of New York, in 1792, it is stated that " many ignorant and un- skillful persons presume to practice physic and surgery within the city and county of New York, to the great detriment and hazard of the lives and limbs of the citizens thereof," etc. And the venerable Dr. John Stearns, in speaking of this period, says : " those who witnessed the original and progressive settlement of the northern 'and * See act of Incorporation, Supplementary Acts, fhcers, and transact such other business as the utcrests of the profession should require. It was Jso required to divide the state into four medical jstricts, and appoint a board of censors for each, vdiose duty it was to examine all candidates for cense to practice medicine and surgery, who 88 MEDICAL HISTORY. should present themselves, after having studied the required length of time. The law also forbid any to enter the profession, and collect pay for their services, without first procuring either a li- cense from a county or state society, or a diploma from some regularly organized medical college. Candidates who might be rejected by the county boards had the right to appeal to the censors of the state society for another examination ; but not vice versa. Within two years after the passage of this law, nearly every county in the state had its regularly organized medical society, with its board of cen- sors and library. The first meeting of the state society was held at the capital in February, 1807, and completed its organization, according to the provisions of the law. Thus two great and all important ob- jects were accomplished, viz. : a thorough organ- ization of the profession in a manner most favor- able to its advancement and elevation, and the provision for having all candidates examined be- fore admission, by practitioners themselves, with- out the intervention of any other class. In the following year, 1807, an act was passed, making some further provisions for the internal organiza- tion of the state society, and also prescribing a penalty of five dollars per month for practicing MEDICAL HISTORY. 89 without being authorized according to the act of the previous year. This penalty, however, was not to apply to persons using, for the benefit of the sick, any roots or herbs, the growth of the United States. In May, 1812, the legislature in- e leased the foregoing penalty to twenty-five dol- lars for each offense, and required that all licenses in future should be deposited in the county clerk's office. In 1813, these several acts were revised and consolidated into one statute, and continued without alteration until 1818, when the legislature passed an act increasing the term of study to four years ; but one year might be deducted if the stu- dent had pursued classical studies that length of time, after the age of sixteen years> or had at- tended a complete course of lectures, delivered by each of the professors on all the branches of medi- cal scienc'3 in the medical colleges of this state, or elsewhere. In the following year, another act was passed, prohibiting the medical colleges from granting the degree of* Doctor of Medicine to any student who had not fully complied with the requisitions of the act of 1818. The next law of importance enacted in this state was that passed by the legislature in 18J7. This leaves the term of study, and the conditions for obtaining a license to practice, es- sentially the same as before; but the 12th section 90 MEDICAL HISTORY. provided that " no person shall receive from the regents of the university a diploma conferring the degree of Doctor of Medicine, unless he shall have pursued the study of medical science for at least three years, after the age of sixteen, with some physician or surgeon duly authorized by law to practice his profession, and shall also have at- tended two complete courses of all the lectures delivered in an incorporated medical college, and have attended the last of such courses in the col- lege, by which he shall be recommended for his degree." And section 20th declares, that no per- son under the age of twenty-one years can be en- titled to practice physic and surgery in this state. Another provision of this law required all regu- larly licensed physicians to file a copy of their license or diploma in the county clerk's office, and become members of the county society in the county of their residence, before they were legally entitled to collect pay for their services. , Such are the essential features of the legislative enactments, adopted from time to time for the in- ternal organization and regulation of the medical profession in the state of New York ; and though exceedingly defective in many respects, they exerted a decided and beneficial influence over the great mass of the profession. The fre- quent contact with each other, and the mutual MEDICAL HISTORY. 91 interchange of sentiments, which took place in the county societies, soon led the practitioners to a more thorough knowledge of each other, and, consequently, to the adoption of by-laws and sound rules of ethics for their mutual government. This again led to a far more dignified and honorable intercourse with each other in private practice. The meetings of these societies were occupied in the reading of essays, the relation of cases, and the discussion of topics connected with medical practice, and generally with the diseases of their own counties ; and not a few of the papers read at their meetings would do credit to any learned body. The presidents of the societies were also generally required to deliver an address at each anniversary meeting. Some of these were pub- lished either in pamphlet form or in the medical journals—some found their way into the transac- tions of the state society, and all were not only interesting, but well calculated to excite a spirit of investigation, and divert the attention of prac- titioners from the petty jealousies of private com- petition to the study of medicine as a science. In the early part of this period, the number of medical colleges in the Union were but few, and the degrees conferred by them much less sought after than at present; and hence many of the candi- dates for admission into the ranks of the profession 92 MEDICAL HISTORY. were examined and licensed by the county so- cieties, and the fees derived from the granting of such licenses were in most cases devoted to the purchase of books toconstituteacountylibrary. By this means the latest and best medical works were constantly being brought within the reach of every practitioner; and hence these libraries be- came powerful auxiliaries in the general diffusion of medical knowledge. The same ends were still further promoted by the action of the state so- ciety, which was organized February 3d, 1807.* Thus we find the society at its first meeting di- recting each member " to present a geological and topographical description of the county in which he might practice, and also a history of such diseases as might prevail in his particular place of residence, etc." Accordingly, in the following year, we find reports in compliance with this direction, from no less than seven members, viz.—Dr. Alex. Sheldon, of Montgomery; Dr. David R. Arnell, of Orange; Dr. Wm. Wheeler, of Dutchess ; Dr. John Stearns, of Saratoga.; Dr. Hugh Henderson, of Jefferson; Dr. Horatio Powell, of Clinton, and Dr. Lyman Cook, of West- chester. At this second annual meeting (Feb., * For a brief history of this society, including the names of its officers from year to year, see the United Slates Medical and frirgU-al Journal, vol. ii.; and also the published transactions. MEDICAL HISTORY. 93 1808), the society presented to the profession still stronger inducements to engage in medical inves- tigations, by offering three premiums, viz. :—a medal of the value of fifty dollars for the " best dissertation on the topography, geology, and mineralogy of any county in the state, together with an account of the prevalent diseases in said . county." Another of the value of twenty-five dollars for the second best dissertation on the same subject; and a third premium, consisting of a medal of the value of twenty-five dollars, for " the best dissertation on the causes, and best method of preventing and curing, the typhus mitior, or low nervous fever, which prevailed in different counties of the state." These offers called out several well written essays, and the first premium on the topography, etc., was awarded to Dr. John Stearns, of Sara- toga County. The efforts to improve medical science, and elevate the character of the profes- sion, thus early and actively commenced, have been continued with unremitting zeal by this so- ciety until the present time. But though the in- fluence of the state and county societies has been highly beneficial to the profession, yet that influ- ence has been in some measure counteracted by defects in the laws, and other circumstances, over which they had not control. Thus, while the 94 MEDICAL HISTORY. law of 1812 increased the penalty for practicing without a license or diploma to twenty-five dol- lars for each offense, it was rendered almost en- tirely void in practice, by the proviso, " that it should not be so construed as to prevent any person from prescribing for the benefit of the sick, any roots, barks, or herbs, the growth and produce of the United States." * Although the design of this provision was, un- doubtedly, simply to shield nurses in their com- mon practice of using simple domestic teas or in- fusions, in cases of sickness not considered suffi- ciently severe to require the attendance of a phy- sician, yet in practice it was made to cover every species of empiricism, it being only necessary to plead the use of indigenous remedies. Hence, al- though the statutes of New York have contained, apparently, strict prohibitory or protective laws in regard to medical practice for more than thirty years, those laws have been practically inopera- tive from their own defects, and cannot, therefore, be considered as any test of the practicability or inpracticability of suppressing quackery by penal enactments. Another important defect in the laws regulating the education of the profession consisted in the entire omission of any standard of preliminary education as a requisite, before commencing the study of medicine. This defect MEDICAL HISTORY. 95 not only existed in the laws regulating the pro- fession, but equally so in the rules adopted by medical societies and colleges for granting the diploma; hence we have been, and still are, an- nually witnessing the ridiculous spectacle of young men, possessing the high and dignified title of Doctor of Medicine, conferred by institutions called colleges and universities, who are destitute of even a competent knowledge of English gram- mar. These facts sufficiently explain why, not- withstanding the existence of a good internal or- ganization, and the united efforts of state and county societies during a period of forty years, every species of quackery still abounds in this state —they show, too, that the repeal of that part of the law prescribing a penalty of twenty-five dollars for practicing without a license or diploma ; and also, that which renders the unlicensed incompetent to enforce payment for their services, which took place in 1813, was rather the repeal of an obsolete form than the removal of an operative law. The medical laws of New Jersey were so amended in 1816 as to prohibit all unlicensed persons, who were not already engaged in prac- tice, from entering upon those duties in that state, under a penalty of twenty-five dollars for each offense. Such persons were also disqualified from collecting any compensation for medical services. 96 MEDICAL HISTORY. But, instead of containing the neutralizing proviso which we have noticed in the laws of New York, it declared that, " this act shall be so construed as to prevent all irregular bred pretenders to the healing art, under the names or titles of practical botanists, root or Indian doctors, or any other name or title, involving quackery of soolj species, from practicing their deceptions, and imposing on the ignorance and credulity of their fellow-citi- zens." Some unimportant alterations in the medical laws of this state were made by the legislature in the years 1818, '23, '25, '30, "38; but their main features still remain in full force. And though the penal provisions against unlicensed practitioners are very seldom enforced; yet the influence of their state, and district or county societies, has been most salutary in promoting friendly intercourse, stimulating investigation, and elevating the professional character. State and district medical societies were organized at an early period in all the New England States. We have, in a previous chapter, mentioned the origin of those in Massachusetts, Connecticut, and New Hampshire. The Maine Medical So- ciety was incorporated in 1821, and that of Rhode Island, in 1812. The regulations adopted in all these states were very similar. They all required the establishment of state or district boards of MEDICAL HISTORY. 97 censors, for examining and licensing candidates to practice ; also some degree of preliminary edu- cation, a term of medical study not less than three years, and the attainment of the age of twenty- one years. In Massachusetts, Rhode Island, and New Hampshire, the boards of censors were un- connected with the medical colleges of those states ; and the laws required all persons intend- ing to commence practice, whether educated in those states or already licensed by the institutions of other states, to apply to some one of the boards of censors for alicense before they were authorized to enforce payment for their services. In Con- necticut and Maine, but one board of censors was established in each state, which was authorized to examine all candidates, whether for a license or the higher degree of M.D. These boards are composed, in the one state, of the medical faculty of Yale College, associated with an equal number of censors appointed by the president and fellows of the Connecticut Medical Society, the president of the society always being one of the number: and in the other, of the Medical Faculty of Bow- doin College, and an equal number of censors chosen by the Maine Medical Society. In January, 1822, the Medical Society of the state of Delaware was authorized, by an act of the legislature, to appoint a medical board of 98 MEDICAL HISTORY. examiners, consisting of fifteen members, whose term of office was to continue five years ; and who were directed to examine and license all candidates for admission into the profession in that state. The requisites for admission to an examination by such board were, three years' study with some respectable practitioner, the attendance on one full course of lectures in some medical college, and the attainment of twenty-one years of age. But graduates of respectable medi- cal colleges were licensed on the exhibition of their diplomas, without an examination. The same penalties were enacted against unlicensed practitioners as in the state of Maryland. The Medical Society of the district of Columbia was incorporated by an act of Congress in 1819, with power to appoint a board of examiners, com- posed of five practitioners, whose duties and pri- vileges were the same as those appointed by the Delaware Medical Society. And the same penalty was enacted against unlicensed and irregular practitioners. The states of South Carolina, Georgia, Alabama, Mississippi, and and Louisiana have all had laws of a similar character, for the regulation of medical education and practice. In 1817, the legislature of South Carolina enacted a law establishing two medical boards MEDICAL HISTORY. 99 of examiners, one in Charleston and the other in Columbia. They were required to examine all applicants for permission to practice in that state, except such as had received a diploma from some medical college, and grant licenses to those they deemed qualified. And every one practicing without such license was liable to be indicted and fined in a sum not exceeding five hundred dollars, and imprisoned a term not exceeding two months. These regulations continued, in force until 1838, when all restrictions and penalties were abolished bv an act of the state legislature. The act by which a fine of five hundred dollars was imposed on all who should practice physic in Georgia without a license from the board of physicians, was passed by the state legislature in 1826, and continued in force until 1835, when it was repealed. In 1839, the examining board of phy- sicians was re-organized, and again invested with power to examine applicants and grant licenses; but with the following proviso, which nullifies the whole act, viz.:—" Provided nothing in the said revised act be so construed as to operate against the Thompsonian or Botanic practice, or any other practitioner of medicine in this state." It should also be mentioned that the Thompsonians have had for several years a regularly incorpo- rated college in that state, with all the usual 100 MEDICAL HISTORY. collegiate powers; but at present its existence appears to be merely nominal. In Alabama, an act was passed in Dec, 1823, requiring the establishment of five boards of medical examiners in the state, each consisting of three members, elected by a joint vote of both houses of the state legislature. Their powers and duties in regard to examining and licensing candidates were the same as those existing in South Carolina. The penalty for practicing with- out such license or a diploma from some medical college, was a sum not exceeding five hundred dollars for each offense. But the examining boards were all abolished some eight or ten years since, which operated as a repeal of all law on the subject. The medical laws of the state of Mississippi are coeval with the existence of the state itself. They provided for the establishment of three boards of examiners, appointed by the state legislature. These boards were required to examine all candidates for permission to practice medicine and surgery in their respective districts, whether graduates of a medical college or not, and grant licenses to such as they found qualified. By an act passed in 1827, all licenses were required to be filed in the clerk's office of the county where the holder of said license should commence practice, within six months from the MEDICAL HISTORY. 101 time of such commencement. All attempts to practice without procuring a license from one of the examining boards, and having it duly recorded - in the clerk's office, was punishable by a fine not exceeding five hundred dollars, and imprisonment not exceeding six months. It was further made the duty of the county clerk to present a complete list of all licenses recorded in his office to the grand jurv of each county court; and such grand jury were required to present to the court all such persons as, from their own knowledge, or from information given by others, were practicing physic or surgery without a license. In 1829, another act was passed by the legislature, autho- rizing the establishment of a " Medical Society of the State of Mississippi." These laws were very complete, and effectually accomplished the object for which they were designed. But when the state constitution was revised in 1834, the several hoards of examiners were omitted, which operated as a repeal of all restraints on ihe practice of medicine in that state; and though the state medical society has maintained its organization, yet, since the year 1834, there have been no legal provisions for discouraging quackery in any of its forms. The first laws relating to the practice of physio and surgery in Louisiana were passed in 1808. They were revised and amended in 1816-17-20, 102 MEDICAL HISTORY. In the latter year, two medical boards were estab- lished, one for each supreme judicial district in the state. These boards were composed of six mem- bers each, appointed by the governor, with the advice and consent of the senate, with one apo- thecary attached to the board in the first district. These boards were to examine all applicants for license to practice in their respective districts, and license such as were found qualified; but such as had graduated at a respectable medical college were permitted to obtain a license on ex- hibiting their diploma, without an examination. The apothecary attached to the board in the first district, was to examine and license apothecaries, who were under the same regulations as practic- ing physicians. The penalties prescribed for vio- lating the laws of this state, by practicing without a license, were a fine of one hundred dollars for the first offense ; and for the second, a fine not ex- ceeding two hundred dollars, and imprisonment not more than one year. The attornev-ireneral was required to prosecute for all violations of the laws. The licenses were required to be filed in the parish or county-clerk's office, the same as in Mississippi. A state medical society was incor- porated in Tennessee, in 1830, with a board of censors authorized to examine and license all per- sons who may present themselves for examination, MEDICAL HISTORY. 103 touching their skill in the practice of medi- cine and surgery. No term of study, or other preliminary condition, is required of the applicant, except that he be twenty-one years of age, and of good moral character; and no penalties are pro- vided against practicing without a license. The legislatures of Ohio, Indiana, and Michi- gan, have all passed laws incorporating state and county or district medical societies, with power to appoint censors, and license candidates to practice much the same as in New York. These laws also laid some moderate restrictions on un- licensed and irregular practitioners ; but, as in most of the older states, all these restrictions have been repealed within the last ten years, leaving the regularly organized societies to main- tain the honor of the profession, and protect the interests of the community as best they could. From the hasty glance we have now taken of medical legislation throughout the Union, it will be observed that, during the first quarter of the nineteenth century, the legislatures of all the older states, except Pennsylvania, Virginia and North Carolina, enacted laws for the avowed pur- pose of protecting the citizens against the impo- sitions of ignorance and empiricism, and of pro- moting medical science. That these were the real motives for enacting laws on this subject, and 104 MEDICAL HISTORY. especially the first one named, that of protect ins-. the citizens against imposition, is abundantly shown by the preambles and titles attached to the several acts themselves. The idea of protecting the profession, or invest- ing it with special privileges, seems to have been the discovery of a later period, as we shall see in the sequel. Again, the business of examining and licensing candidates for admission into the ranks of the profession, was not only uniformly com- mitted to medical men, but, with very few excep- tions, those men were also selected by the profes- sion, or rather byr regularly organized medical societies. Another important fact is, that during this period, medical societies were regularly or- ganized in almost every state in the Union,; hence the same effects that we have ascribed to the medical organization of New York, was felt to a greater or less extent throughout the whole Union. The intercourse between medical men was every- where more dignified, medical intelligence was more rapidly and generally diffused, the importance of a good knowledge of anatomy, physiology, and chemistry became better appreciated, and in the same proportion, medical colleges were more gene- rally patronized, and medical literature cultivated. Such were the legitimate and highly beneficial in- fluences exerted by medical associations throughout MEDICAL HISTORY. 105 the country. The number of graduates from medical colleges during the earlier part of this period was comparatively small, and in some of the states even those were obliged to procure licenses before entering into practice—far the larger share of those who entered the regular profession being examined and licensed by the boards of censors, appointed by state or district medical societies— a considerable fund was thus derived, which, in most instances, was appropriated, as in New York, to the support of the several societies, and the promotion of their legitimate objects;—hold- ing thus, as it were, the keys of the profession, and aided, to some extent, by the funds derived from licenses, the medical organization of the several states and districts was actively and vigo- rously sustained. The organization of medical societies through- out the Union, also brought into beneficial action another powerful stimulant to human enterprise —viz., ambition. Every society, whether county, district, or state, must have its official stations, its posts of honor ; and hence, every right-minded member of those societies would be so influenced in his conduct as to gain the esteem and confi- dence of his professional brethren, without which he could not hope to be honored by them. But while the internal organization of the profession 5* 106 MEDICAL HISTORY. was thus rapidly improving its character and influence, other agencies were brought into operation, some of which exerted a widely diffe- rent effect, both on the profession and the com- munity. At the commencement of the period now under consideration, only about five hundred students were in attendance on the lectures in the four or five medical colleges then existing in the Union, and the whole number of graduates for the year 1807 did not exceed fifty. No sooner, however, did the study of anatomy, physiology, chemistry, etc., become better appreciated through the in- fluences already detailed, than the students at- tending the colleges began rapidly to increase, and the number of colleges increased also. The small degree of prosperity which attended the Medical Department of Columbia College, led many members of the profession to use their in- fluence to establish another college in that city. Accordingly the regents of the University of New York granted a charter for a new college in 1807, called the " College of Physicians and Surgeons of New York." This school was placed under the direction of a board of trustees, consisting of the whole medical society of the city and county of New York, and the degree of M.D. was con- ferred by the regents of the University of the MEDICAL HISTORY. 107 state, on the recommendation of the trustees and faculty of the College. The first course of lec- tures was given in the winter of 1807-8, to a class of fifty-three students, and was continued regularly thereafter until the present time. In 1810, the Medical Department of Columbia College was finally discontinued, leaving the Col- lege of Physicians and Surgeons the only one in the state, with a class of students numbering eighty-two. But instead of that rapid prosperity which the friends of the institution, and the re- gents of the University now anticipated, the very numerous board of trustees, being mostly medical practitioners in the immediate vicinity of the college, soon became distracted by opposing coun- cils, and jealousies between them and the mem- bers of the faculty, which caused much difficulty, and greatly retarded both the prosperity of the college, and the progress of medicine, in that city. The Medical Department of the University of Maryland, in Baltimore, was incorporated by the legislature of that state in 1807, and was soon supplied with an able faculty, and has continued to enjoy a fair share of public confidence and prosperity until the present time. In 1810, a medical department was attached to Yale College, at New Haven, but the first course of lectures was not delivered until the winter of 108 MEDICAL HISTOR-V- 1813-14, since which time they have been regu- larly continued, the class usually numbering be- tween fifty and one hundred, and the number of graduates varying from three to twenty-nine annually. The next medical institution established in the country was at Fairfield, Herkimer County, New York, in 1812, called the " College of Physicians and Surgeons of the Western District." It was char- tered by the regents of the state, with the same pow- ers and duties as the College of Physicians and Surgeons of the city of New York, The degrees were conferred by the regents on the recommenda- tion of the faculty and trustees of the college. The first course of lectures was given in the win- ter of 1813-14, to a class of thirty-three students, The course of this institution was marked by a pretty uniform degree of prosperity until 1834, when the class numbered two hundred and seven- teen. From this period it began gradually to de- cline, owing to the influence of neighboring schools, and in 1840 the whole faculty resigned their places, and no successors were appointed. Two new colleges were established in 1818, one at Castleton, Vermont, called the " Vermont Academy of Medicine," and the other at Lexing- ton, Kentucky, called the "Medical School of Transylvania University." The degrees of MEDICAL HISTORY. 109 Castleton Medical School were conferred by Middlebury College until 1828, since which time they have been conferred by the college under its independent charter. The number of students in attendance have varied from twenty-four, in 1818, to one hundred and thirty, in 1836, and the num- ber of graduates averaged about twenty-five an- nually .Since 1835, two courses of lectures have been given annually ; one in the spring and an- other in the fall. The Transylvania Medical School rapidly attained a high degree of prospe- rity, the number of students averaging over two hundred annually, and the graduates varying from seven, in 1820, to eighty-three, in 1835. The jNJedical College of Ohio was incorporated in 1819, located at Cincinnati, and has continued with a fair share of prosperity until the present time. In the following year, the Medical School of Maine was established at Brunswick, in connection with Bowdoin College. The first course of lec- tures was delivered in 1W21, to a class of twenty- one students, while in 1836 the number had in- creased to one hundred, and the number of gra- duates to twenty-seven. The medical school at- tached to Brown University, at Providence, Rhode Island, was established in 1821, but was discontinued after a few years. In the year 110 MEDICAL HISTORY. following, the Medical School of the University of Vermont was commenced at Burlington, but was also discontinued previous to 1840. The Berk- shire Medical School was established at Pittsfield, Massachusetts, in 1823, and has continued its annual courses of lectures to classes varying from seventy-three to one hundred and seventeen, until the present time. The next medical college established in the country was at Charleston, South Carolina, in 1824, called the " Medical College of South Ca- rolina." This school appears to have been under the control of the medical society of the state, and enjoyed a fair share of public patronage until dissensions arose between the faculty and the governing body, which caused the former to re- sign their places in 1832. Their places were im- mediately filled, and the annual courses of in- struction continued, but to a greatly reduced class, for several years. In the meantime, the profes- sors wdio had resigned obtained from the state legislature, in 1833, a charter for another school in the same city, called the " Medical College of the state of South Carolina.." The first class attending the new college in the winter of 1833-4, numbered one hundred and three, and the school seems to have sustained a fair degree of prospe- rity up to the present period. During the year MEDICAL HISTORY. Ill 1824, another school of medicine was also estab- lished in Philadelphia, called the " Jefferson Me- dical College." But the first course of lectures was given in the winter of 1825-6, to a class of one hundred and ten students. It has since ac- quired a degree of popularity, second only to that of the University of Pennsylvania, so long estab- lished in the same city. In 1825, two other colleges were established, viz.—the Medical School of Columbian College, in the district of Columbia, and the Medical School of the University of Virginia, at Charlottsville. The organization of this latter school is somewhat peculiar. Its periods of instruction continue through ten months of each year, and all the branches are taught by three professors, in much the same manner as other sciences are taught in collegiate institutions. The number of medical students in attendance, in 1835-6, was sixty-three. The Washington Medical College was established at Baltimore, Maryland, in 1827, its degrees being conferred by Washington College, in Pennsyl- vania until 1833, when it obtained a regular char- ter from the legislature of Maryland. In 1834, the number of graduates was only ten, and in 1838-9, the whole number of students was fifty- three. The next medical institution was the " Medical 112 MEDICAL HISTORY. College of Georgia," located at Augusta, and in- corporated in 1830. The first course of lectures, however, was not given until the winter of 1832-3, when twenty-seven students were in attendance. In 1831. theWilloughby University, at Willough- bv, Ohio, was incorporated, and supplied with a medical faculty, who gave their first course of lec- tures in the winter of 1835-6 to a class of twenty- three students. It enjoyed a moderate degree of prosperity until the year 1847, when the medical department was transferred to Columbus, and re- organized under the name of the " Starling Medi- cal College," in honor of Lyne Starling, who made the very liberal donation of thirty thousand dollars for the benefit of the institution, and five thousand dollars more for the establishment of an hospital. During the year 1835, no less than four medical schools were added to the number already estab- lished in the Union, viz.—the Medical College of Louisiana, at New Orleans; the Medical Institu- tion of Geneva College, at Geneva, New York ; the Medical Department of Cincinnati College, at Cincinnati, Ohio; and the Vermont Medical School at Woodstock, Vermont. The Louisville Medical Institute, at Louisville, Kentucky, and the Medical Faculty of the University of the City of New \ ork, were established in 1837, and the MEDICAL HISTORY. 113 Medical Department of Hampden Sidney College, at Richmond, Virginia, in 1838. In the following year, still two more were added, viz.—the Albany Medical College at Albany, New York, and the Medical Department of Pennsylvania College, at Philadelphia. During the period intervening between 1840 and the present time (1850), no less than thirteen new medical colleges have been established, viz. —two at St. Louis, Missouri, called the Univer- sity of Missouri, and the St. Louis University ; one at Chicago, Illinois, called the Rush Medical College ; one at Cleveland, Ohio, called the West- ern Reserve College; one in Indiana, called the Indiana Medical College, located at La Porte; two in Philadelphia, called the Philadelphia Col- lege of Medicine, and the Franklin Medical Col- lege ; one at Buffalo, New York, called the Medi- cal Department of the University of Buffalo ; one at Memphis, Tennessee, called the Memphis Medi- cal College ; one at Evausville, and another at Indianapolis, in Indiana; one at Devanport, Iowa, called the College of Physicians and Surgeons of the Upper Mississippi; and one in Michigan, lo- cated at Ann Arbor, being a department of the University of that state. Of the forty-three medical colleges which have thus been organized, we believe that seven have 1 14 MEDICAL HISTORY. been wholly discontinued, while others have merely changed their names or localities, leaving thirty-six now in active operation in the United States. Of these, seven are in the eastern or New England States, nine in the middle, seven in the southern, and thirteen in the western. It will be noticed that only six medical colleges were organized prior to 1810, five between 1810 and 1820, eight between 1820 and 1830, eleven be- tween 1830 and 1840, and thirteen between 1840 and 1850. The number of students in attendance on the several colleges, at each period of ten years, may be stated as follows, together with the number of graduates, viz. :— Whole Ncmbku of Students. Graduates. In 1810, - - 650 " 1820, - - 901 " 1830, - - 2125 " 1840, - - 2800 " 1850, - - 4500 In 1810, - - 100 " 1820, - - 1S2 " 1830, - - 597 " 1840, - - 775 " 1850, - - 1300 These numbers are not claimed as entirely accurate, owing to the difficulty of obtaining complete and reliable information on the subject; but they are sufficiently so for all the purposes of comparison. Theyr illustrate very clearly what we have already stated when detailing the organ MEDICAL HISTORY. 115 ization of medical societies, viz., that the medical college's were patronized just in proportion as the importance of the fundamental branches of medi- cal science became better and more universally appreciated, through the medium of such societies. Thus, during the ten years following 1820, a period when the medical societies of most of the states were in their most active and influential state, the number of students attending the medi- cal schools were more than doubled, and the number of graduates increased threefold. It is a fact also worthy of notice, that the number of graduates have been constantly increasing faster than the whole number of students. Thus, in 1810, the ratio of graduates to the whole number of students attending the schools, was 1 to 6, 5 ; in 1820, 1 to 5, 3; in 1830, 1 to 3, 6; in 1840, 1 to 3, 6 ; in 1850, 1 to 3, 4. But this exceedingly rapid inci-ease in the num- ber of students who resort to the medical colleges, and the number taking degrees, by no means in- dicate an equally rapid increase in the whole number of those pursuing the study of medicine. For, it must be remembered, that medical exam- iners had been appointed in a large majority of the states in connection with their social organ- ization ; and, during the first quarter of the present century, a much larger number of students were 116 MEPICAL HISTORV. probably examined and admitted by these nume- rous boards of examiners than by tbe colleges. But a large majority of the states having made the collage diploma a legal admission into the profession, with all its rights and privileges, it soon became the paramount object of the student's pursuit. This, together with the absence of all preliminary requisites in regard to general educa- tion, and the many facilities afforded by the rapid multiplication, and consequent competition of the colleges with each other, caused the licenses from local examining boards to be comparatively ne- glected. Thus, in 1820, only thirty-eight students received the degree of M.D. from the medical colleges of the state of New York, while three times that number were examined and licensed by the censors of the state and county societies. In 1830, the graduates from the medical colleges of the same state numbered fifty-six, those licensed by the censors of the state society, seventeen, and probably one hundred more by the numerous county boards. While, in 1810, the whole number of graduates in the state was two hundred and forty-six, the number licensed by the censors of the state society was only three, and those reported by the county societies, five. Although it is quite probable that a few were licensed by the county societies who were not reported to MEDICAL HISTORY. 117 the state society, yet the whole number for two or three years previous had not averaged ten annually. The effects of this rapid change were twofold. The local societies being gradually deprived of the funds derived from granting licenses, soon found their libraries neglected, and their regular meetings diminishing both in interest and in the numbers in attendance. This gave rise to a general feeling of indifference on the part of the profession, during the prevalence of which many local societies ceased to maintain an active existence ; and whatever laws for restraining quackery had been enacted by the legislatures of the several states, were, with very few exceptions, repealed. While, on the other hand, the great increase of patronage bestowed on the medical schools, literally begot a mania for college making. And this mania was rendered still more intense by the regulations almost universally adopted as requisites both for graduation and license. These o-ave no credit for any courses of instruction, how- ever extensive and complete, except such as should be delivered- in a regularly-established college. Hence, every professional man who be- came ambitious of distinction as a teacher, sought a professorship in some college as the only posi- tion in which that ambition could be gratified. And as there are always more such men than 118 MEDICAL HISTORY. there are places for them to fill, the constant and inevitable tendency is to the creation of more places. If the state legislature, to whom applica- tion is made for an act of incorporation, happens to be so stupid as not to perceive the necessity of establishing a new school, a bargain is soon struck with some literary college, already possess- ing the right to confer degrees, to furnish the necessary diplomas, and straightway a new medi- cal college, with all the usual honors and privi- leges, springs into existence. To so great an extent has this spirit been carried, that scarcely a single year has passed since 1830, without wit- nessing the birth of one or more of these institu- tions. If the standard of preliminary education had been elevated, and the requisites for gradua- tion increased in proportion to the multiplication of schools, no evils would have resulted to the profession or the community; but, there being practically no standard of preliminary education, and the professors, with only two or three excep- tions, being the sole judges of the student's quali- fications, the addition of every new college only served to increase the competition, and add to the facilities for obtaining diplomas. Indeed, to such an extent has this spirit and practice been carried, that any young man can obtain the once high and honorable title of M. D. for a less MEDICAL 111 STORY. 119 expenditure of time and labor than it takes to obtain the primary literary title of A.B. It is true that the professors in many of the colleges would gladly have stayed this tendency of things ; but it was not in their power. Hence, with only two or three recent exceptions, eight months' attendance on a medical college—three years' study, including the eight months—twenty- one years of age—and a thesis on some medical subject, constitute, practically, all the qualifica- tions required of the candidate for medical honors, previous to his examination. If we contrast these with the qualifications required in other countries, or with those origin- ally required by the founders of the old school in Philadelphia, we shall cease to be surprised either at the crowded state of the profession, or at the heterogenous mixture of all grades, characters, and degrees of attainment which it presents. The impossibility of any faculty of five or six profes- sors doing anything like justice to the whole field of medical science in the short space of four months, to say nothing of the perfect absurdity of attempting to crowd an amount of material so vast and varied on the mind of the student in so short a space of time, early attracted the attention of many enlightened members of the profession, among whom were some of the ablest professors 120 MEDICAL HISTORY. connected with our schools. Hence, attempts were made from time to time to extend the courses of college instruction, and elevate the standard of medical attainments; but so rapid was the increase of new schools, and so active the rivalship, that every attempt to produce con- cert of action among the schools of even a limited number of states proved abortive. We believe the earliest of these efforts was made by the colleges of New England, some of whom, in good faith, carried into practice an agreement to extend their courses of instruction; but others, wholly neglecting the movement, soon induced all to return to the former limits. In 1835, the faculty connected with the Medi- cal College of Georgia called the attention of their professional brethren to the same subject; and, both byT correspondence and through the columns of the Southern Medical and Surgical Journal, urged the propriety of a national con- vention of delegates from all the colleges, not only to agree upon a longer term of instruction, but also upon a higher standard of medical edu- cation. These efforts were favorably responded to by a large proportion of the colleges then exist- ing, but the time and place for holding the con- vention was left to the medical faculty of the University of Pennsylvania, who, by declining to MEDICAL HISTORY. 121 take any action on the subject, effectually ar-- restcd the whole movement. Notwithstanding this failure, the able efforts of the Medical Faculty of the Georgia School were not wholly in vain; for they served, in no small degree, to arouse the attention of the profession generally to a subject of so much importance. Hence, articles in medical journals, and resolutions adopted by medical societies, touching the subject, continued occasionally to make their appearance. The following preamble and resolution, offered by Dr. John M'Call, of Utica, were adopted by the Medical Society of the State of New York, at its annual session, in February, 1839, viz.— " Whereas, a National Medical Convention would advance, in the apprehension of this so- ciety, the cause of the medical profession through- out our land, in thus affording an interchange of views and sentiments on the most interesting of all subjects—that involving men's health, and the means of securing or recovering the same : there- fore, Resolved, That, in our opinion, such con- vention is deemed advisable and important; and we would hence recommend that it be held in the year 1840, on the first Tuesday in May of that year, in the city of Philadelphia,—and that it consist of three delegates from each state medi- cal society, and one from each regularly 6 j.22 MEDICAL HISTORY. constituted medical school in the United States, and that the president and secretary of this society be, and they are hereby instructed and re- quired to transmit, as soon as may be, a circular to that effect to each state medical society and medical school in said United States." This proposition was sanctioned by so many of the societies and colleges in other states, that the New York Society, at its next annual meet- ing, in February, 1840, appointed three delegates, one or two of whom proceeded to Philadelphia at the appointed time, where they met one delegate from Ohio, and one from one of the Eastern states. But, finding no others, not even a local delega- tion from any of the medical institutions of Phi- ladelphia itself, they returned without accomplish- ing any of the objects for which they went. Medical education, however, continued to be a topic of discussion in the medical periodicals of the country, as well as the theme for many intro- ductory and valedictory lectures in the colleges; and every succeeding year only served to make the defects and evils of the present system more prominent, and the necessity of some general and harmonious action on the subject, more apparent. At the annual meeting of the New York State Society, in February, 1844, several resolutions, having for their object an elevation of the stand- MEDICAL HISTORY. 123 ard of medical education in that state, and the establishment of a more uniform and perfect system of examinations, were introduced ; some by Dr. Alexander Thompson, of Cayuga county, and some by the author of this work. After a short discussion, the whole subject was referred to the Committee of Correspondence, with in- structions to report at next annual meeting; and, in the meantime, to address circulars to the seve- ral county societies, asking their views on the same subject. Accordingly, at the next annual meeting of the society, two reports were made, one by myself, as chairman of the committee, zealously advocating reform, and a minority re- port, by Dr. M. II. Cash, of Orange county. The resolutions appended to these reports underwent a lengthy and animated discussion, during which it was admitted by all parties that the standard of medical education was too low, and that the num- ber of tribunals authorized to examine and license candidates, or, in other words, the number of avenues into the profession, were too great and too diversified ; while, on the other hand, it was urged with much force, especially by those di- rectly interested in the medical schools of the state, that the standard in that state was as high as in any oLi the surrounding states; and, there- fore, any measures for exacting of the candidates 124 '"MEDICAL HISTORY. for admission into the profession, higher qualifi- cations, instead of accomplishing the objects de- sired, would only serve to drive students from their own institutions to those of other states, over which they could have no control. It was at' the close of this debate, after the writer had been vainly striving to obviate the foregoing ob- jection, that Professor March, of Albany, sug- gested to me that the difficulty might be over- come by getting the profession in all the states to act in concert. The suggestion was no sooner received than I rose and submitted the following preamble and resolutions, viz.: " Whereas, it is believed that a National Con- vention would be conducive to the elevation of the standard of medical education in the United States ; and whereas, there is no mode of accom- plishing so desirable an object, without concert of action on the part of the medical societies, col- leges, and institutions of all the states, therefore, " Resolved, That the New York State Medical Society earnestly recommend a National Con- vention of delegates from medical societies and colleges in the whole Union, to convene in the city of New York, on the first Tuesday in May, in the year 1846, for the purpose of adopting some concerted action on the subject set forth in the foregoing preamble. MEDICAL HISTORY. 125 " R'solvcd, that a committee of three be ap- pointed to carry the foregoing resolution into effect." This proposition was very generally regarded as entirely Utopian, and impossible of fulfillment; and in proof of its possessing this nature, all the former attempts to assemble a National Convene tion of medical men, and their entire failure, was alluded to by some of the oldest and ablest mem* bers of the society. Still, feeling some of the warmth excited by the previous debate, instead of yielding to discouragements of any kind, the ancient maxim, pcrseverantia omnia vincit, was adopted, and the society reminded that a project which was in itself good and highly important, should never be abandoned on account of one failure, or a dozen. Besides this, the dilemma into which many of the society had unconscious; y fallen, viz.—that of contending during the pre- ceding discussion, that no higher standard of medical attainment could be exacted in this (New York) state, because such standard was already as high as in any of the surrounding states, and now again contending that the only measure which could bring the profession in all the states to ret in concert was Utopian and impracticable ; from which the absurd conclusion would inevitably follow, that the cause of medical education must 126 MEDICAL HISTORY. remain indefinitely in statu quo, was urged with much effect. After a short discussion, the preamble and re- solutions were adopted by a large majority, and a Committee, consisting of Prof. J. M'Naughtofi, and Dr. Peter Van Buren, of Albany, and myself, appointed to carry the measure into effect. An extended and laborious correspondence was im- mediately commenced by me, as chairman of the committee, and carried on with such success, that at the next annual meeting of the society, in February, 1846, the committee were enabled to report a pledge of delegates from a fair majority of the medical societies and colleges in the whole Union. Still, the societies and colleges in two of the most influential sections of the country, viz. —Philadelphia and Boston, stood entirely aloof from the movement, with the single exception of the Medical Department of Pennsylvania College, whose faculty gave it a liberal and earnest sup- port. It appeared, from subsequent correspond- ence, that this want of co-operation on the part of the profession in those places, was not so much from a want of interest in tbe movement, as from a false conception, arising from the fact, that the Convention was requested to meet .in the college edifice of the New York University. It was thought that this was calculated to attract the MEDICAL HISTORY. 127 attention of the profession to the medical schools of New York, and particularly to the ]\ew York University. Fortunately, at this period, Profes- sor Martyn Paine, one of the able professors in that school, published a valedictory address to the graduating class of the university, in which he denounced, in no measured terms, not only the project of a convention, but also, all who were engaged in promoting it, including the New York State Medical Society generally, and the chair- man of the committee in particular. A perusal of this address, which was very ex- tensively and gratuitously circulated through the country, soon satisfied all parties that the con- vention was not, at least, designed to promote the interests of the University of the city of New York. Hence, Professor R. M. Huston, president of the oldest medical society in Philadelphia, very soon convened the members of that society, which resulted in the appointment of twelve able and active delegates from that city. Thus, this address, the style and sentiments of which were directly calculated to prevent the attendance of delegates from other states, was made the imme- diate instrument of bringing in the full, active, and efficient co-operation of that important sec- tion of the Union; and when the first Tuesday in Mav, 1846. came, we were gratified with the 128 MEDICAL HISTORY. privilege of meeting in convention, in the city of New York, at least one hundred delegates, repre- senting medical societies and colleges in sixteen states of the Union, viz. — "Vermont, New Hampshire, Massachusetts, Rhode Island, Con- necticut, New York, New Jersey, Pennsylvania, Delaware, Maryland, Virginia, Georgia, Missis- sippi, Indiana, Illinois, and Tennessee. The convention was permanently organized by the election of Professor J. Knight, of New Haven, President; Drs. John Bell, of Phila- delphia, and Edward Delafield, of New York, Vice-Presidents; and Drs. Richard D. Arnold, of Savannah, and Alfred Stille, of Ihiladelj hia, Secretaries. The general dignity and harmony, the spirit of forbearance and mutual concession, and the noble zeal for the accomplishment of the objects for which it had convened, which charac- terized the proceedings of this convention, was no less a disappointment to its enemies, than an honor to the profession. All the prominent topics connected with medical education were appro- priately discussed, and referred to able commit- tees, with instructions to consider and report in full at an adjourned meeting of the convention, to be held on the first Wednesday in May, 1847, in the city of Philadelphia. , In the mean time a committee, of whom Dr. MEDICAL HISTORY. 129 J. Knight, the president, was made chairman, was directed to issue an address to the profession, setting forth the objects of the friends of the con- vention, and inviting a more complete and uni- versal representation at the adjourned meeting to be held in the following May at Philadelphia. This duty was satisfactorily performed, and a nobler spectacle was never presented by the medical profession of any age or country than was witnessed on the assembling of the adjourned convention in 1847. About two hundred and fifty delegates appeared and took their seats, representing more than forty medical societies, and twenty-eight colleges, embracing the medical institutions of twenty-two states, and those of the district of Columbia, viz., New Hampshire, Ver- mont, Massachusetts, Rhode Island, Connecticut, New York, New Jersey, Pennsylvania, Delaware, Maryland, Virginia, South Carolina, Georgia, Mississippi, Louisiana, Missouri, Illinois, Indiana, Michigan, Ohio, Kentucky, and Tennessee. This second convention was organized by the election of Dr. Jonathan Knight, president; Dr. Alexander II. Stevens, New York, Dr. George B. Wood, Pennsylvania, Dr. A, II. Buchanan, Ten- nessee, Dr. John Harrison, Louisiana, vice-presi- dents ; and Dr. Richard D. Arnold, Georgia, Dr. Alfred Stille, Pennsylvania, Dr. F. Campbell 6* 130 MEDICAL HISTORY. Stewart, New York, secretaries. All the com- mittees appointed at the previous convention reported promptly, and their reports, with one exception, were adopted. The committee on a standard of preliminary education proper to be required of the student before commencing the study of medicine, of which Dr. J. Couper, of Newcastle, Delaware, was chairman, concluded their report with the following resolutions :— " Resolved, That this convention earnestly recommend to the members of the medical pro- fession throughout the United States, to satisfy themselves, either by personal inquiry or written certificate of competent persons, before receiving young men into their offices as students, that they are of good moral character, and that they have acquired a good English education, a knowledge of natural philosophy, and the elementary mathe- matical sciences, including geometry and algebra, and such an acquaintance, at least, with the Latin and Greek languages as will enable them to appre- ciate the technical language of medicine, and read and write prescriptions." " Resolved, That this convention also recom- mends to the members of the medical profession of the United States, when they have satisfied themselves that a young man possesses the quali- fications specified in the preceding resolution, to MEDICAL HISTORY. 131 give him a written certificate stating that fact, and recording also the date of his admission as a medical student, to be carried with him as a war- rant for his reception into the medical college in which he may intend to pursue his studies." " Resolved, That all the medical colleges in the United States be, and they are hereby recom- mended and requested to require such a certifi- cate of every student of medicine applying for matriculation ; and when publishing their annual lists of graduates, to accompany the name of the graduate with the name and residence of his pre- ceptor, the name of the latter being clearly and distinctly presented as certifying to the qualifica- tion of preliminary education." These resolutions were adopted by the conven- tion with much unanimity; and they have since received the sanction and warm approval of almost every medical society whose members have been regularly convened since the adjourn- ment of* the former body. The following facts, taken from the report of this committee, will show the condition of the profession in this re- spect at ihe commencement of that year:— " The committee have been favored with very full and explicit answers to their circular from thirty-nine gentlemen, representing twenty-one states of the Union. The replies which have been 132 MEDICAL HISTORV. received to the first three questions establish the fact, not only that there is no uniform standard of preparatory education exacted of medical stu- dents throughout the United States, but that there is no general rule adopted in any particular state or district, which has been authorized or recom- mended by medical societies or other official bodies, or established by common consent or custom. The whole subject is left to private preceptors, many of whom recommend, and a few exact, an elevated standard, while others leave it to the discretion of the students them- selves, or their parents." Hence, the standard recommended by the committee, and adopted by the convention, although not all that we could desire, is perhaps as high as it would be judicious to insist on at the present time ; and from it we anticipate the happiest results. The committee appointed to report on the sub- ject of a uniform and elevated standard of require- ments for the degree of M.D., of whom Dr. Haxall, of Richmond, Virginia, was chairman, also pre- sented an able and interesting report, which closed with the following specific recommenda- tions, viz. :— "Resolved, 1st, That it be recommended to all the colleges to extend the period employed in lecturing from four to six months. MEDICAL HISTORY. 133 " 2d, That no student shall become a candidate for the degree of M.D. unless he shall have devoted three entire years to the study of medi- cine, including the time allotted to attendance upon the lectures. "3d, That the candidate shall have attended two full courses of lectures, that he shall be twenty- one years of age, and in all cases shall produce the certificate of his preceptor, to prove when he commenced his studies. " 4th, That the certificate of no preceptor shall be received who is avowedly and notoriously an irregular practitioner, whether he shall possess the degree of M.D. or not. " 5th, That the several branches of medical education already named in this report (theory and practice of medicine, principles and practice of surgery, general and special anatomy, physiolo- gy and pathology, materia medica, therapeutics and pharmacy, midwifery and diseases of women and children, chemistry and medical jurisprudence) be taught in all the colleges, and that the number of professors be increased to seven. " 6th, That it is required of candidates that they shall have steadily devoted three months to dis- sections. " 7th, That it is incumbent upon preceptors to avail themselves of every opportunity to impart 131 MEDICAL HISTORY. clinical instruction to their pupils, and upon medi- cal colleges to require candidates for graduation to show that they have attended on hospital prac- tice for one session, whenever it can be accom- plished, for the advancement of the same end. " 8th, That it be suggested to the faculties of the various medical institutions of the country to adopt some efficient means for ascertaining that their students are actually in attendance upon their lectures. " 9th, That it is incumbent on all schools and colleges granting diplomas, fully to carry out the above requisitions. " 10th, That it be considered the duty of pre- ceptors to advise their students to attend only such institutions as shall rigidly adhere to the recommendations herein contained." After some discussion, during which consider- able opposition was manifested to the clause extending the term of lecturing in the colleges to six months, all these requisitions were adopted by a large majority. How far they will be complied with on the part of the schools remains to be seen. It is worthy of remark, however, that the movement has received the full sanction of two of the oldest and most influential schools in the country, viz., the University^ of Pennsylvania, and the College of Physicians and Surgeons in New MEDICAL HISTORY. loO York. Both these colleges have added more than one month to their regular term, besides a pre- liminary course, extending the whole beyond the six months required by the convention. The in- fluence of the recommendation is" still farther perceptible in the fact, that most of the colleges which have not extended their regular term, have at least added a preliminary course of one month, and several of them an additional profes- sorship ; and there is no doubt but a steady ad- herence, on the part of the American Medical Association, to the standard adopted by the con- vention, will speedily insure its entire practical adoption by the schools. Indeed, we are satisfied that a very large majority of the colleges would have yielded to so reasonable and necessary a measure as the extension of the regular college term to six months at once, if each had not feared that its neighbours and rivals would not. And this again strongly illustrates the importance of a national organization, in procuring connected and efficient action on subjects affecting the interests of the whole profession. Another important resolution adopted by the first convention was as follows, viz.:— " Resolved, That it is expedient that the medi- cal profession in the United States should be governed by the same medical ethics, and that a 136 MEDICAL HISTORY. committee of seven be appointed to report a code for that purpose, at a meeting to be held at Phila- delphia, on the first Wednesday of May, 1847." The committee appointed under this resolution consisted of Drs. John Bell, Isaac Hays, and G. Emerson of Philadelphia; Dr. W. W. Morris, of Delaware; T. C. Dunn, of Rhode Island; A. Clark, of New York; and R. D. Arnold, of Georgia. At the ensuing convention in Phila- delphia Dr. Bell, chairman of the committee, made an able report, which was unanimously adopted by the convention. This report, from its intrinsic importance, its general adoption by the profession, and the consequent index which it presents of the present tone of moral feeling among medical men, would legitimately constitute a part of our history. But its length is such that we must be content with a few extracts, wdiich will indicate the character of the whole :— " Medical ethics." says the introduction to the code, " as a branch of general ethics, must rest on the basis of morality and religion. They com- prise not only the duties, but also the rights of a physician, and, in this sense, they are identical with medical deontology—a term introduced by a late writer, who has taken the most comprehen- sive view of the subject." Again, in speaking of the duties of the physi- MEDICAL HISTORY. 137 cian to his patients, the committee says—"a phy- sician should not only be ever ready to obey the calls of the sick, but his mind ought, also, to be im- bued with the greatness of his mission, and the responsibility he habitually incurs in its discharge. Those obligations are the more deep and endur- ing, because there is no tribunal other than his own conscience, to adjudge penalties for careless- ness or neglect. Physicians should, therefore, minister to the sick with due impressions of the importance of their office, reflecting that the ease, the health, and the lives of those committed to their charge, depend on their skill, attention, and fidelity. They should study, also, in their deport- ment, so to unite tenderness with firmness, and condescension with authority, as to inspire the minds of their patients with gratitude, respect, and confidence." And, ao-ain, " there is no profession, from the members of which greater purity of character, and a higher standard cf moral excellence, are re- quired, than the medical; and to attain such eminence is a duty every physician owes, alike to his profession and to his patients. It is due to the latter, as without it he cannot, command their respect and confidence, and to both, because no scientific attainments can compensate for the want of correct moral principles. It is also incumbent 138 MEDICAL HISTORY. upon the faculty to be temperate in all things, for the practice of physic requires the unremitting exercise of a clear and vigorous understanding; and, on emergencies, for which no professional man should be unprepared, a steady hand, an acute eye, and an unclouded head, may be essen- tial to the well-being, and 'even to the life, of a fellow creature." The same liberal and enlightened sentiments pervade the whole report, and its general adoption bespeaks a commendable tone of moral feeling throughout the profession. Able reports were also made to the Philadelphia Convention on the sub- ject of " a Registration of the Births, Marriages, and Deaths occurring in the populations of the several States," and on " a Nomenclature of Dis- eases adapted, to the United States, having refe- rence to a general registration of deaths." These reports, together with the nomenclature recom- mended by the committee, and adopted by the convention, may be found in the published '■ Pro- ceedings of the National Medical Conventions, held in May 1846, and 1847." At the convention in New York, the following resolution was presented, and, after some discus- sion, was referred to a committee of seven, with instructions to report at the next convention in Philadelphia :—"Resolved. That the union of the MEDICAL HISTORY. 139 business of teaching and licensing in the same hands, is wrong in principle, end liable to great abuse in practice. Instead of conferring the right to license on medical colleges, and state and county medical societies, it should be restricted to one board in each state, composed in fair pro- portion of representatives from its medical col- leges, and the profession at large, and the pay for whose services, as examiners, should, in no degree, depend on the number licensed by them." The committee consisted of Drs. James M'Naughton, of Albany, NY.; J. R. Manly, and J. W. Fran- cis, N.Y.; Isaac Parrish, Philadelphia ; R. Blake- man, Fairfield, Conn.; J. Cullen, Richmond, Virginia: and Thomas Cock, N.Y. At the succeeding convention in Philadelphia, two reports were presented from this committee, a minority report by Dr. M'Naughton, the chair- man, which, though in its general tenor opposed to the sentiments contained in the resolution, vet yielded something, as will be seen by the follow- ing resolutions appended to the report, viz. :— " Resolved, That inasmuch as an opinion prevails to a considerable extent in the profession, that certain abuses have crept into some of the col- leges—namely, that they confer degrees upon persons who have not fully complied with their own requirements, or on those who do not possess 140 MEDICAL HISTORY. the requisite amount of knowledge to entitle them to such distinction, it is deemed expedient by this convention, in order to satisfy the just wishes of the profession, and to remove just grounds of complaint, that such colleges as do not already possess mixed boards of examiners, should consent to have associated with them, in the examination for degrees, some members of the profession not engaged in teaching, or otherwise interested in such institutions. " Resolved, That the number of boards for granting licenses in the several states, should be "as limited as would comport with the convenience of examiners and candidates in each state." This report was signed by only two members of the committee. The majority report was made by Dr. Isaac Parrish, and signed also by Drs. J. R. Manly, Thomas Cock, and J. W. Francis. It presents, in clear and forcible lan- guage, not only the liability to, but the actual ex- istence of, abuses in the granting of diplomas, and the right of the profession to apply some appro- priate remedy. Without, however, specifying in what an appropriate remedy would consist, the re- port concludes with the following preamble and resolution, viz. :—" Whereas, a general sentiment prevails in the medical profession, that the active competition existing among the medical colleges MEDICAL HISTORY. 141 of the Union, has a tendency to lower the stand- ard of professional requirement, and to depreciate the value of the degree ; " And, whereas, the facility with which char- ters for medical corporations are obtained from our state governments, exposes the medical pro- fession to the continuance and increase of such abuses, inasmuch as these corporations possess alike the power of granting the license to prac- tice ; therefore, " Resolved, That in the opinion of this conven- tion, some additional checks to the exercise of this right should be established by the great body of the medical profession.." This whole subject was finally disposed of, by adopting the following resolution, viz. :—" Re- solved, That in view of the necessity hereby de- clared for reform, in the maimer of conferring degrees, the two reports submitted by the com- mittee, on the separation of teaching and licens- ing, be published and referred to the committee on medical education, with instructions to report at the next annual meeting of the American Me- dical Association." But, perhaps, the most important part of the proceedings of this convention remain to be re- ferred to—namely, the formation of a permanent national association. Among the resolutions 142 MEDICAL HISTORY. adopted by the first convention, were the follow- ing, viz.:—"Resolved, That it is expedient for the medical profession of the United States, to institute a national medical association for the protection of their interests, for the maintenance of their honor and respectability, for the advance- ment of their knowledge, and the extension of their usefulness. " Resolved, That a committee of seven be ap- pointed to report a plan of organization for such an association, at a meeting to be held in Phila- delphia, on the first Wednesday in May, 1847." The committee appointed in accordance with this last resolution, consisted of Drs. John Wat- son, John Stearns, F. Campbell Stewart, New York ; A. Stille, Philadelphia ; N. S. Davis, Bing- hamton, N.Y. ; W. H. Cogswell, New London, Connecticut; E. D. Fremer, New Orleans. At the second convention, the chairman of the committee, Dr. J. Watson, presented the follow- ing report, which was adopted,' and signed by nearly all the members of the convention :— " Whereas, The medical convention, held in the city of New York, in Slay, 1846, have declared it expedient ' for the medical profession of the United States to institute a national medical as- sociation ;' and, inasmuch as an institution so conducted as to give frequent, united, and emphatic MIDICAL HISTORY. 143 expression to the views and aims of the medical profession in this country, must, at all times, have a beneficial influence, and supply more efficient means than have hitherto been made available here, for cultivating and advancing medical know- ledge, for elevating the standard of medical edu- cation, for promoting the usefulness, honor, and interests of the msdical profession, for enlighten- ing and directing public opinion in regard to the duties, responsibilities, and requirements of medi- cal men, for exciting and encouraging emulation and concert of action in the profession, and for facilitating and-fostering friendly intercourse he- tween those engaged in it; therefore, be it re- solved, in behalf of the medical profession of the United States, that the members of the medical convention held in Philadelphia,-in May, 1847, and all others who, in pursuit of the objects above mentioned, are to unite with, or succeed them, constitute a national medical association, and that for the organization and management of the same, they adopt the following regulations :— " I. Title of the Association.—This institu- tion shall be known and distinguished by the name and title of ' the American Medical Association.' " II. Members.—The members of this institu- tion shall collectively represent, and have cogniz- ance of, the common interests of the medical pro- 144 MEDICAL HISTORY. fession in every part of the United States, and shall hold their appointment to membership either as delegates from local institutions, as members by invitation, or as permanent members. The delegates shall receive their appointment from permanently organized medical institutions of good standing in the United States. Each delegate shall hold his appointment for one year, and until another is appointed to suc- ceed him, and shall participate in all the busi- ness and affairs of the association. Each local society shall have the privilege of sending to the association one delegate for every ten of its regular resident members, and one for every ad- ditional fraction of more than half that number. The faculty of every regularly constituted medi- cal college or chartered school of medicine, shall have the privilege of sending two delegates. The professional staff" of every chartered or municipal hospital containing one hundred inmates or more, shall have the privilege of sending two delegates; and every other permanently organized medical institution of good standing shall have the privi- lege of sending one delegate. " The Members by Invitation shall consist of practitioners of respectable standing, from sec- tions of the United States not otherwise repre- sented at the meeting. They shall receive their MEDICAL HISTORY. 145 appointment by invitation of the meeting, after an introduction from any of the members present, or from any of the absent permanent members. They shall hold their connection with the associa- tion until the close of the annual session at which they are received, and shall be entitled to partici- pate in all its affairs, as in the case of delegates. " The Permanent Members shall consist of all those who have served in the capacity of dele- gates, and of such other members as may receive the appointment by unanimous vote. Permanent ' members " shall, at all times, be entitled to attend the meetings, and participate in the affairs of the association, so long as they shall continue to con- form to its regulations, but without the right of voting; and, when not in attendance, they shall be authorized to grant letters of introduction to reputable practitioners of medicine residing in their vicinity-, who may wish to participate in the busi- ness of the meetings as provided for the members by invitation. Every member elect, prior to the permanent organization of the annual meeting, or before voting on any question after the meeting has been organized, must sign these regulations, inscribing his name and address in full, specifying in what capacity he attends, and, if a delegate, the title of the institution from which he has re- ceived his appointment. 146 MEDICAL HISTORY. "III. Meetings.—The regular meetings of the association shall be held annually, and commence on the first Tuesday in May. The place of meet- ing shall never be the same for any two years in succession, and shall be determined for each next succeeding year by vote of the association. " IV. Officers.—The officers of the association shall be a president, four vice-presidents, two se- cretaries, and a treasurer. They shall be nomi- nated by a special committee of one member from each state represented at the meeting, and shall be elected by vote on a general ticket. Each' officer shall hold his appointment for one year, and until another is elected to succeed him. " The President shall preside at the meetings, preserve order and decorum in debate, give a casting vote when necessary, and perform all the other duties that custom and parliamentary usage may require. " The Vice-Presidents, when called upon, shall assist the president in the performance of his duties, and, during the absence, or at the request of the president, one of them shall officiate in his place. " The Secretaries shall record the minutes, and authenticate the proceedings, give due notice of the time and place of each next ensuing meeting, and serve as members of the committee on publi- MEDICAL HISTORY. 147 cation. The secretary first in nomination shall also preserve the archives and unpublished trans- actions of the association. " The Treasurer shall have the immediate charge and management of the funds and pro- perty of the association. He shall be a member of the committee on publication, to which com- mittee he shall give bonds for the safe keeping, and proper use, and disposal of his trust; and through the same committee he shall present his accounts, duly authenticated, at every regular meeting. " V. Standing Committees.—The following standing committees, each composed of seven members, shall be organized at every annual meeting, for preparing, arranging, and expediting business for each next ensuing year, and for car- rying into effect the orders of the association not otherwise assigned—namely, a committee on ar- rangements, a committee on medical sciences, a committee on practical medicine, a committee on surgery, a committee on obstetrics, a committee on medical education, a committee on medical literature, and a committee on publication. " The Committee on Arrangements shall, if no sufficient reasons prevent, be mainly composed of members residing in the place at which the asso- ciation is to hold its next annual meeting, and 148 medical history. shall be required to provide suitable accommoda- tions for the meeting, to verify and report on the credentials of membership, to receive and an- nounce all essays and memoirs voluntarily com- municated, either by members of the association, or by others through them, and to determine the order in which such papers shall be read and con- sidered. " The Committee on Medical Sciences shall prepare an annual report on the progress of medi- cal sciences in America, noticing, as occasion may require, the important improvements and discoveries in anatomy, physiology, hygiene, gene- ral pathology and therapeutics, medical jurispru- dence, materia medica, and other branches of natural science, bearing directly on the condition and progress of medical knowledge in America, during the year of their service. " The Committee on Practical Medicine shall prepare an annual report on the more important improvements effected in this country, in the management of individual diseases, and on the progress of epidemics, referring, as occasion re- quires, to medical topography, and to the charac- ter of prevailing diseases in special localities, or in the United States generally, during the term of their service. " The Committee on Surgery shall prepare an medical history. 149 annual report on all the important improvements in the management of surgical diseases effected in America during the year. " The Committee on Obstetrics shall prepare an annual report on all the improvements in the ob- stetric art, and in the management of diseases peculiar to women and children, effected in America during the year, " The Committee on Medical Education shall prepare an annual report on the general condition of medical education in the United States, in com- parison with the state of medical education in other enlightened nations; noticing, as occasion may call for, the courses of instruction, the prac- tical requirements for graduation, the modes of examination for conferring degrees, and the re- puted number of pupils and graduates at the seve- ral medical institutions in the United States, dur- ing the year ; noticing, also, the requirements of the United States army and navv boards of medi- cal examiners, the legal requirements exacted of medical practitioners in our several states, and all such measures, prospective or established, in re- ference to medical education and the reputable standing of the profession, as may be deemed worthy of special consideration. The Committee on Medical'Literature shall prepare an annual report on the general character 150 MEDICAL HISTORY. of the periodical medical publications of the United States, in reference to the more important articles therein presented to the profession, on original medical publications, on medical compila- tions and compends of American writers, on American reprints of foreign works, and on all such measures as may be deemed advisable for encouraging and maintaining a national literature of our own. " The Committee on Publication, of which the secretaries and treasurer must constitute a part, shall have charge of preparing for the press, and of publishing and distributing such of the proceed- ings, transactions, and memoirs of the association, as may be ordered to be published. " The six members of the committee who have not the immediate management of the funds, shall, also, in their own names, as agents of the associa- tion, hold the bond of the treasurer for the faith- ful execution of his office, and shall annually audit and authenticate his accounts, and present a state- ment of the same in the annual report of the com- mittee, which report shall also specify the charac- ter and cost of the publications of the association during the year, the number of copies still at the disposal of the meeting, the funds on hand for further operations, and the probable amount of the assessment to be laid on each member of MEDICAL HISTORY. 151 the association, for covering its annual expen- diture. "VI. Funds and Appropriations.—Funds shall be raised by the association for meeting its current expenses and awards from year to year; but never with a view of creating a permanent income from investments. Funds may be ob- tained by an equal assessment of not more than three dollars annually on each of the members, by individual voluntary contributions for specific objects, and by the sale and disposal of publica- tions, or of works prepared for publication. The funds may be appropriated for defraying the expenses of the annual meetings ; for publishing the proceedings, memoirs, and transactions of the association ; for enabling the standing committees to fulfill their respective duties, conduct their correspondence, and procure the materials neces- sary for the completion of their stated annual reports; for the encouragement of scientific in- vestigations, by prizes and awards of merit; and for defraying the expenses incidental to specific investigations, under the instructions of the asso- ciation, where such investigations have been accompanied with an order on the treasurer to supply the funds necessary for carrying them into effect. "VII. Provision for Amendments.—No amend- 152 medical history. ments or alterations shall be made in any of these articles except at the annual meeting next subse- quent to that at which such amendment or altera- tion may have been proposed; and then only by the voice of three-fourths of all the members in attendance. And in acknowledgment of having adopted the foregoing propositions, and of our willingness to abide by them, and use our endea- vours to carry into effect the objects of this asso- ciation as above set forth, we have hereunto affixed our names." Such is the plan of organization adopted, and finally carried into effect on the 7 th of May, 1847, by the election of the following officers, viz.:— Dr. Nathaniel Chapman, of Pennsydvania, presi- dent ; Drs. Jonathan Knight, Connecticut, Alex. H. Stevens, New York, James Moultire, South Carolina, A. H. Buchanan, Tennessee, vice-presi- dents; Drs. Alfred Stille, Philadelphia, J. R. W. Dunbar, Baltimore, secretaries; and Dr. Isaac Hays, Philadelphia, treasurer. The several committees required by the consti- tution were also appointed, and, in addition, a committee of one from each state represented in the association to report, in obedience to the following resolution, which I had the honor to present to the association, viz.:—Resolved, That medical history. 153 a committee of one from each state represented in this convention be appointed by the president, whose duty it shall be to investigate the indigenous medical botany of our country, paying particular attention to such plants as are now, or may be hereafter during the term of their service, found to possess valuable medicinal properties, and are not already accurately described in the standard works of our country ; and report the same in writing, giving not only the botanical and medical description of each, but also the localities where they may be found, to the next annual meeting of the American Medical Association." On a motion made by Dr. John B. Johnson, of Missouri, the committee on medical education were instructed to " inquire into the expediency of establishing a school or schools of pharmacy in the respective states, for the special purpose of preparing persons for the business of apothecaries; and also the expediency of adopting a rule that no physician ought to patronize a druggist or apothecary who deals in patent and secret medicines; and report at the next annual meeting of the association." The reader will now see, from the foregoing liberal extracts from the proceedings of the two conven- tions, that we, not only have an American Medical Association, truly national in its character, em- bracing, as it does, every interest fairly within the 7* 154 MEDICAL HISTORY. profession, organized on a sound and liberal basis, but also that such association has entered upon the work of cultivating medical science, fostering our own medical literature, and elevating the medical character, with a unanimity and zeal honorable alike to its founders and to the whole profession of our country. For proof of this, we need only refer to its annual volume of transac- tions, embodying a series of reports, and papers of great interest and value,—reports and papers, indeed, which should be in the hands of every physician throughout the country. The annual meetings of the association have steadily increased both in interest and in the number of delegates in attendance. The interest developed by the organization and successful carrying on of the American Medical Association, has extended itself until it involves the profession of the whole Union; and, besides the results already detailed, it has led to the re-animation and activity of old societies and associations—to the formation of new ones where none existed before—to a more free and liberal intercourse among medical men— and to a more lively and universal sense of the high aims, interests, and responsibilities of the profession. Hence, notwithstanding the abolishment of all laws regulating the practice of medicine in so MEDICAL HISTORY. lOO large a number of states, and the consequent absence of all legal protection, the profession was, probably, never making more rapid advancement in its education, its science and literature, and its social position, than at the present time. Yet, as we shall see in the subsequent chapter, much remains to be done, in the two preceding chap- ters, we have given a brief account of the medical works published, and of the improvements made during each period; but even a simple enumera- tion of these, during the last forty years, would extend the limits of this work too far, and contri- bute but little to its main design. Yet the charge has been so often made, that the profession in this country is not only destitute of a literature of its own, but its records also unadorned by any important discoveries in the various departments of our science, that we can- not conclude the historical part of this work with- out devoting a brief space to this interesting topic. I have already alluded in the preceding chapters to such important improvements as were made previous to 1806, and hence we need not refer to the records anterior to that period. So early as 1809, a period several years anterior to that which ushered in the brilliant discoveries of Sir Charles Bell, in relation to the cerebro-spinal nerves, Dr. James II. Miller, of Baltimore, commenced a 156 MEDICAL HISTORY. series of experiments and observations on the structure and functions of the great sympathetic or organic system of nerves, from which he was soon enabled to deduce those conclusions which have been since generally received by physiolo- gists, and for a detailed account of which the reader is referred to Miller's edition of Wilson Philip, or to an Essay on Discoveries in the Physiology of the Nervous System, in Transac- tions of the Medical Society of the State of New York, vol. 5th, page 21. These important de- velopments in relation to that portion of the nervous system were publicly taught by Dr. Miller in the Washington Medical College, in 1827, two or three years previous to the publica- tion of M. Brachet's views on the same subject. If we add to the discoveries of Dr. Miller the experiments of Dr. Henry H. Smith, of Philadel- phia, in reference to the extent of the respiratory tract in the medulla spinalis, and the patient and intensely interesting researches of Dr. S. G. Mor- ton, as embodied in his work entitled Crania Americana, and the still more recent investigations of Dr. B. Dowler, of New Orleans, we shall have claimed for our countrymen the merit of origin- ality in developing an important share of our present knowledge concerning the .physiology of the whole nervous structure. If we add to these MEDICAL HISTORY. 157 the highly valuable experiments of Dr. Beaumont on digestion—the experiments of Dr. J. K. Mitchell, of Philadelphia, on the absorption of liquids and the transmissibility of gases through animal tissues—those of Dr. R. E. Rogers, proving so conclusively the existence of carbonic acid in veinous blood, and the facility with which it penetrates through animal tissues whenever ano- ther gas is brought in contact with the opposite side of the same tissue, and thus placing at rest the long-disputed question, whether the carbonic acid thrown off' in respiration is formed by thc\ union of carbon and oxygen in the lungs, or is brought to the lungs ready formed in the veinous blood—and those of several other original investi- gators of scarcely less importance, we shall readily perceive that our countrymen can no longer be justly reproached with having made no positive additions to the general stock of knowledge on the subject of physiology. Again, if we look over the resources of the materia medica, we shall find many additions to the common stock of the very first importance, and associated therewith a list of names whose lustre is scarcely exceeded by those of any other country. Among the latter may be named the Bartons, Bigelovv, Woods, Eberle, Chapman, Griffeth, Gray, Torry, etc., etc.; while belonging ■^1 158 MEDICAL HISTORY. to the former are the Sanguinaria Canadensis, Cimicifuga Racemosa, Rumex Obtusifolium, Ge- ranium Maculatum, Erigerons, Trilliums, Prunus Virginiana or Cerasus, Cornus Florida, Lobelia Inflata, Lactucarium, Spigelia Marylandica, Gil- lenia Trifolia, Juglans Cinerea, Podophyllum Pel- tatum, Secale Cornutum, and many others. Here we have Vegetable Alteratives, Astringents, Tonics, and Febrifuges; Anodynes and Anthel- mintics ; Emetics and Cathartics ; of equal value with any foreign articles belonging to the same classes. And if we add to these, the recent brilliant application of ether to the prevention of pain during surgical operations, we shall see, at a glance, that the profession of no country have made, during the same length of time, more nume- rous or valuable additions to our resources for combating disease and alleviating pain, than that of our own. And if we turn from these to ther- apeutics and operative surgery, we shall find our national credit still better sustained. For though we can boast of the invention of no great hypo- theses or systems, which, like the Brunonian, Cul- lenian, or Broussaian, have swayed the minds of a large portion of the medical world, we can claim what is far more important to the interests of science, viz., a great .accumulation of facts bearing on almost every question connected MEDICAL HISTORY. 159 with medical and surgical pathology and prac- tice. The medical literature, of no country, furnishes the materials for settling more satisfactorily, the endemic or non-contagious character of yellow fever, as well as all the forms of bilious remittents and intermittents, while the labors of Drs. Ger- hard, Pennock, Stewardson, James Jackson, and Hale, afford some of the best contributions ex- tant, concerning the pathology, anatomical lesions, and treatment of the two great forms of continued fever. One of the earliest, and, therefore, most important diagnostic signs of pulmonary tubercles, viz., the prolonged bronchial expiration, was first pointed out by the late and accomplished Dr. James Jackson, Jr., while our knowledge of other forms of pulmonary disease has been much im- proved by the investigations of Drs. Morton, Gerhard, Clark, Camman, Bowditch, and others, i In practical surgery, the important operations first devised and performed by American surgeons are, the application of anaplasty to the relief of cicatrices and deformities produced by burns, by Dr. Mutter ; the formation of an artificial penis, by Dr. Mettauer, of Virginia; and still other im- provements in the same department by Drs. Mott, J. K. Rogers, A. C. Post, of New York; and J. M. Warren, of Boston ; the exsection of the lower 100 MEDICAL HISTORY. jaw for osteo-sarcoma, by Dr. Mott; tying the right subclavian artery without the scaleni muscles, by Dr. Wright Post; tying the left subclavian within the scaleni muscles, by Dr. J. K. Rogers; tying of the arteria innominata, and primitive illiac, by Dr. V. Mott; division of the masseter muscle for immobility of the lower jaw, by Dr. J. M. Carnochan; the formation of artificial joints by excision of a portion of bone, by J. Rhea Bar- ton ; exsection of the knee joint to remove de- formity occasioned by anchylosis, by Dr. G. Buck; the effectual separation of web fingers and toes, by Dr. J. K. Rogers ; tying of both corotids within a few days of each other, by Dr. R. D. Mussey, of Cincinnati; the introduction of setons for the cure of artificial joints, by Dr. P. S. Physick; the cure of aneurism by anastimosis, by the appli- cation of hot needles, by Dr. G. S. Patterson; successful operation for the removal of introsus- ception, by J. R. Wilson, of Mississippi; and many others, by such men as A. H. Stevens, Physick, Dorsy, Parrish, Pancoast, White, etc., etc. The profession in no country is, probably, more purely eclectic in its character than our own. Deprived, in a great measure, of the accumulated wealth of many of the countries on the other side of the Atlantic, but few members of the profession MEDICAL HISTORY. 161 here find time and means to devote their lives to experimental inquiries ; and hence we have none who can fairly be compared to a Bell, a Majendie, etc. But owing Do the rapid re-publication of books, and the numerous medical periodicals in our country, the profession is readily supplied with the valuable investigations occurring in Europe, whether written in English, French, or German ; and those investigations are as readily and thoroughly sifted for whatever they may contain susceptible of practical application. We have now finished the strictly historical part of our task, and shall proceed, in a supplementary chapter, to enter more fully into the [present condition and wants of the profession, and the proper means for supplying those Wants. CHAPTER IV. THE PRESENT CONDITION AND WANTS OF THE PRO- FESSION, AND THE REMEDIES FOR THOSE WANTS. There are, probably, between thirty and forty thousand practitioners of medicine in the United States, claiming to belong to the regular profession. Of those residing in the eastern and middle states, far the larger portion have regularly studied three years, attended tw.) courses of lec- tures, and obtained a diploma from some medical college. According to a report made by a com- mittee, and found in the annual volume of Trans- actions of the American Medical Association for 1848, it appears that of nine hundred and seventy- two physicians practicing in seventy-five towns and counties of Virginia, taken promiscuously from all sections of the state, only six hundred and seventy-eight were graduates of any medical school, or possessed any form of license to prac- tice. Of the remaining two hundred and forty- w •*%. MEDICAL HISTORY. 10J nine, one had attended two courses of lectures, ten had attended one course, leaving two hundred and thirty-eight, or one fourth of the whole num- ber, without having attended any medical lec- tures, or pursued any systematic course of medi- cal study. This may, doubtless, be taken as a fair sample of the state of the profession, in this particular, throughout the southern states. In most of the western states, I am satisfied, both from inquiries and personal observation, that scarcely one-half of the whole number of practitioners have ever been examined or licensed, either by colleges or societies, and very many of them have never at- tended a lecture in any medical institution. While, as I have already shown, the legislatures of most of the states have freely granted charters for medical colleges, and passed acts incorporating medical societies, scarcely one of them present, now, any practical provisions for protecting the health and lives of the citizens from ths grossest and most fatal impositions, both from within and without the regular profession; hence, every species of medical delusion and imposition is al- lowed to spring up and grow without any legal restraint. The public press, that engine all pow- erful alike for good or evil, lends itself freely as the hired vehicle, for heralding every variety of 164 MEDICAL HISTORY. pretended medicinal compound or nostrum, that the ingenuity of man can invent. Indeed, without this aid of the public press, and the patronage of the patent department of our government, neither the various forms of quackery, nor the gigantic system of nostrum vending, which annually take millions of dollars from the credulous and unsuspecting, would ever find access to popular favor. In this matter, the conductors of the political, literary, and even religious press, are unconsciously bear- ing a responsibility of tremendous weight—we say, unconsciously, for surely we cannot suppose that this large class of enlightened men are aware of the nature or extent of the evils of which they are the chief supporters. Did they know what a little serious investigation would soon teach them, viz., the greediness with which persons, laboring under chronic or imaginary ailments, catch at the confident, alluring, and certain promises of relief, held out in the medical advertisements of every newspaper that reaches their fireside, and the consequent millions of money which they are thereby induced to pay for what is to them of no value whatever, and what, in reality is, in nine hundred and ninetyT-nine cases out of every thou- sand, a simple mixture of the common drugs, known and used by the medical faculty for ten centuries, we are sure they would cease to lend MEDICAL HISTORY. 165 themselves, as paid instruments, for carrying on such a wholesale system of swindling. I am not now speaking at random, or in the exagge- rated terms of prejudice, for I have taken the trouble to examine this subject with some degree of care, and I find that, estimating the pay for each medical advertisement, in our daily and weekly journals, at the moderate sum of five dol- lars per annum, it would amount to more than one hundred thousand dollars ; and if we allow this sum paid for advertising to constitute one-tenth of the entire proceeds of the sale of such medicines, we shall have the enormous sum of one million dollars annually taken from the pockets of the people, not only without an equivalent, but for what is worse, a positive injury to their health and happiness. Our legislators, in their wisdom, have enacted just and severe laws against frauds, and the ob- taining of goods or money by false pretenses. Hence, if a man goes to a merchant and, by false representations, obtains from him fifty dollars worth of goods on credit, he may be indicted, dis- graced, and punished. But the publisher of a newspaper may daily send to the fireside of the invalid, the most bold and reckless statements in regard to certain pretended remedies, and thereby induce him, not only to spend fifty dollars in 166 MEDICAL HISTORY. money, but perhaps, also to trifle away the only time that, if rightly improved, would save him from a premature death, and, instead of being punished for the fraud, he cooly pockets his fee, and calls it a fair business transaction. But I would seriously ask these men, whether it is the greater crime to defraud the man of business in health, with his eyes open, or the poor invalid, enfeebled in body and mind, and predisposed to catch at every alluring promise that designing men may make. In our view, the latter is as much more criminal than the former as health is more valuable than money. Indeed, I think it high time that both statesmen and publishers should bestow a little serious attention on this subject. Of the thirty-six or thirty-seven medical colleges now in active operation in our country, only six- teen are so located as to afford those in attend- ance on them, as students, any opportunity for witnessing hospital or bedside instruction, five continue their regular courses of lectures less than sixteen weeks; twenty-six continue from sixteen to eighteen weeks ; two have extended their courses, in compliance with the advice of the National Convention of 1847, and which has been reiterated by every meeting of the American Medical Association since, to little more than five MEDICAL HISTORY. 167 months. These are the University of Pennsyl- vania and the College of Physicians and Surgeons of the state of New York. The newly organized medical department of the University of Michigan is to continue its regular term seven months, and that of the University of Virginia extends to ten, as already stated in the preceding chapter, The requisitions for graduation are pretty uniformly the same in all, viz., the attainment of twenty-one years of age, the presentation of certificates of good moral character, of having studied medicine three years, of having attended two full courses of lectures in some regularly incorporated medi- cal college, and a written thesis on some medical subject. We have at present no less than eighteen medical periodicals, of which three are published quarterly, five bi-monthly, eight monthly, and two weekly. A large majority of them are under the editorial charge of those connected as professors with medical schools ; and though most of them are conducted with an ability and zeal that would do honor to the profession in any country, yet they necessarily represent the sentiments of the several colleges, rather than those of the great body of the profession. The social organization of the profession in most of the states is exceed- ingly imperfect. In some, there is a simple state society, embracing a few of the leading practi- 168 MEDICAL HISTORY. tioners in the state; while others have both state and district or county societies, embracing nomi- nally nearly all the regular members of the pro- fession. But I doubt whether there is a single state in the Union in which one half of the prac- titioners are in the habit of meeting their brethren in a social capacity an average of once a-year ; although in this respect a great improvement has taken place since the meeting of the first National Medical Convention, in 1846. But without entering more fully into detail in regard to the present condition of the profession, its wants mayr be summed up as follows, viz.:— 1st. The adoption of some plan which shall insure the practical enforcement of the standard of preliminary education agreed upon in the National Convention of 1847. 2d. The adoption of a more extended system of medical instruction, both public and private, and also such a system of examinations as will actually test the qualifications of the candidate. 3d. The accomplishment of a more complete and thorough organization of the profession, on such a plan as to embrace in the local societies every regular and scientific practitioner, and to provide each state with a board of examiners, before whom every candidate for admission into the profession should be examined, whether pos- MEDICAL HISTORY. 169 sessed of a college degree or not. and, if found qualified, he should receive a certificate or dip- loma, admitting him both into the profession and to membership in the state society. 4th. We want, a fund, other than that derived from the voluntary contribution of members, which shall be devoted exclusively to the support of the professional organization of each state, and the direct promotion of original investiga- tion in the various branches of medical science. 5th. "We want to adopt such a system of col- lege organization and rate of lecture fees, as will induce a far larger proportion of those who prac- tice medicine, to first qualify themselves tho- roughly for the responsible duties they assume to perform. To most of these propositions, every enlight- ened member of the profession will readily yield his assent. But then comes the all-important question—How are these wants to be supplied ? or, in the language of Professor Jackson, " What remedies can reach them?" In regard to the first proposition, we have already seen in the his- torical part of this work, that the initiatory step for its accomplishment has been taken. The late National Convention, assembled in Philadelphia, proclaimed a standard of preliminary education, and earnestly recommended its adoption by the 8 170 MEDICAL HISTORY. whole profession; and we are happy to see that the recommendation is being cordially seconded by state and local societies in almost every sec- tion of the country. This standard makes it necessary that every applicant for admission into the office of a physician, as a student of medicine, shall satisfy such physician that he has " acquired a good English education, a knowledge of natu- ral philosophy, and the elementary mathematical sciences, including geometry and algebra; and such an acquaintance, at least, with the Latin and Greek languages, as will enable him to appreciate the technical language of medicine, and read and write prescriptions." If we take a glance at the vast field of medi- cal science, and reflect on the discipline of mind which ought to be brought to the task of its suc- cessful acquirement; and also, on the important collateral bearing that almost every other branch of science has on it, we shall readily see that the standard recommended is defective and inade- quate. Still, it is a great and important advance from no standard at all; and is perhaps as high as it would be wise to demand at this time. But we hope the day is not far distant when it will be made to include every branch of natural science and the French and German languages; and we also hope that some more efficient measures will MEDICAL HISTORY. 171 be speedily adopted for carrying into practical operation the standard already recommended. It is true that many of the medical societies have adopted resolutions, making it the duty of every member to receive no student who does not first satisfy him, either by personal examination or written certificates from competent persons, that he has complied with the above requisitions. This however, is, leaving the matter altogether too much exposed to the influence of personal friendship, individual partiality, and other inte- rested motives. The only way that any standard of preliminary education can be effectually car- ried out in practice is, by establishing, in connec- tion with every regularly organized medical society, a board of censors for preliminary exa- mination, whose duty it shall be to examine every applicant for admission into the office of any member of such society ; and no applicant should be received without the certificate of such board, signed by a majority of its members. This would certainly be placing no unnecessary burthen on the student; for there would be more propriety, and far more justice too, in rejecting an unpre- pared applicant at the outset, than in permitting him to spend three years' time and some hundreds of dollars, and then either rejecting him, or im- posing him a curse on the community, and a 172 MEDICAL HISTORY. disgrace to the profession. Indeed, it is surpris- ing that this initiatory entrance, this outer gate of the profession, has been so long left wide open, and entirely unguarded; for it not only operates injuriously to the honor of the profession and the interests of the community, but it works still more injuriously on the individuals concerned. For members of the profession to receive young men into their offices, who are totally unprepared by previous mental discipline, by literary and scientific acquirements, or by good moral cha- racter, to enter successfully upon the extensive, laborious, and difficult branches of medical science, is, indeed, the hight of injustice. If they are finally rejected, they have spent that time and money for nought, which, if otherwise applied, might have placed them in a prosperous and re- spectable position in society: and, if admitted, they suffer a still greater wrong—they are thereby ushered into a profession, whose honor they are incapable of maintaining; they are called to act in a sphere for w Inch they are unqualified; in a word, they are placed in a false position in so- ciety—and that I deem the worst of all posi- tions. Hence, the admission of unqualified mem- bers into the medical profession, whether as students or practitioners, is an act of threefold injustice, — that is, unjust to the individual MEDICAL HISTORY. 173 admitted, to the whole profession, and to the community at large. I dwell with greater em- phasis on this subject of preliminary education, not only because here has been one of the great- est defects in our past system, but I am satis- fied that here must be laid the foundation of all real reform or improvement. I am well aware of the objections that have been a thousand times urged, viz.—that b}^ adopting such a standard, and rigorously adhering to it, we should hinder many young men, of strong minds and noble am- bition, but with little pecuniary means, from en- tering our ranks; while from this class have hitherto arisen many of the brightest ornaments of the profession. While I freely admit the truth of the last paragraph, we wholly deny that of the first; and for the correctness of my views, I ask no bet- ter evidence than is ailorded by the very cases usually adduced for the opposite purpose, viz.— those who have risen from the lowest pecuniary circumstances, and the most limited educational advantages, to the highest rank in the medical world; for no man can rise from an attentive perusal of the lives and characters of these men without being satisfied first, that their mental energy was equal to the accomplishment of any reasonable requisitions; and second, that they 174 MEDICAL HISTORY. were obliged to acquire, after their admission, just what should have been done before, and thereby suffered innumerable embarrassments, some of which seriously impaired their usefulness through life. No; it is not the strong minded and nobly ambitious son of the poor man who is discouraged by ordinary obstacles, or stopped be- cause of any just requirements; for upon his banner is ever inscribed, in indelible characters, nil desperandum, perseverantia omnia vincit; and, if need be, he can roast his own potatoes, and subsist on twenty-five cents per week, rather than relinquish his objects. But it is the vacilat- ing, the imbecile, and those who have been cradled in the lap of luxury, who faint at obsta- cles, or continually cry out, in the language of the good book, for " a little more slumber, a little more folding of the hands to sleep ;" who spend half their lecture terms in eating houses and places of amusement; or who leave the college when only three of the four short months have passed away. Indeed, the young man who has not sufficient industry and energy of character to qualify himself for entrance upon medical studies, when such qualifications are fairly pointed out to him, is not calculated either to honor the profession or do justice to the community,—and hence the more effectually he is stopped at the MEDICAL HISTORY. 175 threshold, at the first initiatory step, the better it is for all parties. The propriety of the second proposition is no less manifest than the first. That the true rela- tions of preceptor and pupil are greatly neglected; that the duties of the former are too often made to consist in simply furnishing a slovenly office and a musty library ;* and those of the latter, in reading a limited series of text-books, without order or method, and often without a question once a-month, is a humiliating truth. And if the recent National Conventions, and the American Medical Association, which has grown out of them, should do no more than to establish in practice a liberal standard of preliminary educa- tion, and a proper system of private instruction and pupilage, it would be a blessing to mankind of sufficient magnitude to enroll the names of their authors among the benefactors of our race. The truth is, that no man should admit a student into his office, unless he is willing and able to devote, at least, an hour per day for two days in each week, to systematic examinations of such student, accompanied by familiar illustra- tions and experiments, in whatever branches he may be pursuing at the time. He should also see that the course of study is judiciously arranged and methodically pursued, ever remembering that 176 MEDICAL HISTOUY. the acquisition of knowledge is one thing, and the attainment of true mental discipline and correct habits of thought, is another, and scarcely less important thing. And it is equally incumbent on the preceptor, during the last year of the student's pupilage, to make him, as far as possible, his com- panion in visiting the sick—not merely in witness- ing important surgical operations, but just as far as a true sense of propriety and the feelings of patients will permit, also, to the ordinary bed-side practice, that he may be able to go out, not only well skilled in the great leading principles of medicine, but also familiar with those practical details which make up so much of the daily duties of the physician. It would, doubtless, tend much to the elevation of the business of private teaching, if the estab- lishment of regular private medical schools was everywhere encouragsd. By such means the work would be concentrated in fewer hands, and those almost necessarily better qualified, both by their natural inclinations and their scicntfic at- tainments ; and the students, by being thus con- gregated in small classes, would keep alive in each other the spirit of emulation, and would effectu- ally prevent their becoming mere " office keepers," instead of men ardently devoted to the task of mastering an extensive and intricate profession. MEDICAL HISTORY. 177 And, in regard to the period of public instruc- tion in our medical colleges, there seems to be but one opinion in the profession, and that is, that the term of four months, s long and universally adopted in this country, is entirely too short, either for the professors to fairly present their respective branches, or for the students to properly digest the matter which is offered them. So manifest, indeed, is this truth, that the recent Aational Convention, after mature deliberation, almost unanimously passed a resolution strongly recommending an extension of the college term to six months. And, if any further evidence was wanting, we have it in the valedictory of almost every professor in the country. For the number of them who do not annually set forth the short- ness of time allowed them, as their apology for having omitted many things of importance, is very small indeed. And not a few, like the illus- trious professor of surgery in the University of New lork, close their four months' work by in- forming their classes that they have scarcely passed over half of their course. The very idea of presenting to the mind of a student all the various branches of medical science—anatomy, general and special, physiology and pathology, chemistry and materia medica, obstetrics and diseases of women and children, tlieorv and prac- 8* 178 MEDICAL HISTORY. tice of medicine, principles and practice of sur- gery, medical jurisprudence, etc., together with practical anatomy by dissections—all in the space of sixteen weeks, is in itself so absurd, that the reflecting mind wonders why it was ever seriously attempted. The practical effect of such short terms has been to cause almost eveiy student to neglect two or three of the branches taught in the colleges, for the sake of gaining time to pay the requisite attention to the rest; and, as a mat- ter of course, the neglected branches are generally those which are supposed to have the least direct utility at the bedside of the sick, and will be most leniently passed over in the final examination. Hence, while most of our graduates leave the colleges tolerably well versed in the ordinary de- tails of medical and surgical practice, very few, indeed, have even a superficial knowledge of general anatomy, physiology, medical jurispru- dence, or chemistry. The consequences of this are exceedingly injurious, both to the profession and the community7. If the daily visits to the sick constituted the whole duty of the physician, the slighting of certain less directly practical branches would be a matter of minor consequence, although they are even here capable of valuable application almost every day. But, when we remember that there is not a member of the pro- MEDICAL HISTORY. 179 fession, in the remotest corner of the country, who is not liable to be called on for medico-legal opinions and investigations, and on the correct- ness of which may depend, not only the mainten- ance of justice, the health of the community, but also the reputation and lives of his fellow-men, we begin to appreciate the magnitude of the evil. Indeed, there is scarcely a judicial district in the country, that has not suffered the loss of thousands of dollars, seen the ends of justice totally defeated, and the reputation of the profession itself lowered in the estimation of the community, from the lack of a competent knowledge of chemistry and medi- cal jurisprudence on the part of medical men. Hence, we have, as an invariable result of a four months' college term, either the acquisition of a very superficial knowledge of'all the branches of medicine, or the neglect of some for the more thorough study of the others. Suppose a class in one of our academies or literary colleges were seriously requested to thorougly review their natural philosophy, chemistry, astronomy, algebra, geometry, botany, and moral philosophy, all in the short space of sixteen weeks, would they not ridi- cule both the proposition and its inventor ? And vet these branches of science fall far short, in number and intricacy, those presented to the medical class during each lecture term. 180 MEDICAL HISTORY. Yet, plain as may ;,ppear the necessity of re- form, in this respect, to an uninterested observer, still, the colleges seem to enter on it with extreme reluctance. This arises chiefly from two causes, viz.—mutual jealousy or rivalship, and the fear that students cannot be induced to attend a period of six months. The time has been, and that, too, not long since, when the bare mention of this first cause would have been repelled as a slander on our medical institutions; but its powerful influence is being de- monstrated even at this moment so clearly, that the perverted vision of self-interest itself, cannot fail to see it. More than three years since, the whole profession, represented in a convention at Philadelphia, solemnly declared its wish that the college terms might be extended to six months. One or two out of the whole number promptly re- sponded to this wish, a few others timidly advanced from sixteen weeks to eighteen or twcntyT, while far the greater number contented themselves with the declaration, that they were ready to comply with the request so soon as it shall appear that all the other colleges will do so to. Thus it is not because the professors are unwilling to lecture a longer time, not because it would increase the expenses of the colleges, but, in plain English, be- cause each college fears to lay a single item of MEDICAL HISTORY. 1» 1 burthen on the student, even in the way of afford- ing him p reater facilities for obtaining knowledge lest some neighboring college, by failing to add such burthen, should prove a more successful rival. The second reason for not extending the period of college instruction, is equally the exclusive fault of the institutions themselves. I very well re- member that in the same convention to which I have alluded, it was urged by Professor Mitchell, of Transylvania University, Professor Hare, of Philadelphia, and others, that it would be useless to extend the college term, for it was now a noto- rious fact, that scarcely half the students could be kept together through a term of four months, and much less would they attend six. It was even said, and truly, too, that very many do not now arrive at the college until the term is nearly half gone, and others leave a month or six weeks before its close. Now, there is a very plain rea- son why these things are so. It is simply because the colleges keep their matriculating books open until the middle of their terms, and credit stu- dents for full courses who leave before three- fourths of the lectures have been given. If a man should employ a dozen laborers, and let them know in the beginning that he should give them credit for a full day's work though they should 182 MEDICAL HISTORY. not actually labor six hours out of the twenty- four—does any one suppose his men would be very particular about going to their work at a very seasonable hour in the morning, or remaining at it until the usual time in the afternoon ? Cer- tainly not. And yret, such a supposition would be just as reasonable as to expect all our medical students to attend punctually the entire college term, whether it be four or six months, while they know very well that they can get their names duly registered, and obtain the same objects, by attending scarcely more than half of that period. If all our medical colleges should adopt, and rigidly adhere to the rule, that no student should be credited for a full term who failed to be pre- sent and take his matriculating ticket, within ten days from the commencement of the regular term, or who should leave more than ten days before its close, we are satisfied that there would be very little difficulty in keeping the classes together during any length of term which might be agreed on. Iience, it is plain that this objec- tion, which is the only real one urged by the col- leges against the adoption of the six months' term, has its whole foundation in their own erroneous practice. And it could be urged, with just as much propriety and force, against a three, as a six months' course, for in either case it would be MEDICAL HISTORY. 183 allowing the colleges to take advantage of their own errors. But the real difficulty here is the same as in the preceding case, viz.—the rivalry and want of concert existing among the several schools. Thus, if a student applies for admission into one of our colleges six weeks after the com- mencement of the term, the faculty dare not re- fuse him, lest he turn on his heel and walk di- rectly into the halls of some rival institution; and yet there are those among us who seem to see nothing in the multiplication of medical schools, and the active rivalry carried on among them, in the least degree calculated to lower the standard of education in the profession. But if our sys- tem of instruction, both public and private, needs improvement and extension, the mode of exami- nation for testing the qualifications of the student, and admitting him into the ranks of the profession, needs it still more, We have already shown, in the historical part of this work, that the college diploma has been recognized as a sufficient license to practice medicine and surgery in almost every state in the Union, and, consequently, it has now become almost the only regular passport into the ranks of the profession. In several of the states, as in New York, this is made so by the laws granting the charters of the several schools, while in others 184 MEDICAL HISTORY. the diploma of the college is made a sufficient evi- dence of qualifications, by the laws establishing state and district board of censors, or by the rules adopted by the boards themselves. Hence, prac- tically, the business of teaching and licensing is united in the same persons, and, with a very few partial exceptions, these persons are exclusively the officers and professors in the several medical schools. We have also seen that the means they adopt for testing the qualifications of the candi- dates, generally consist of one oral examination, continuing from fifteen minutes to one or two hours, and a written thesis on some medical subject. That such means are insufficient, and entirely unsatisfactory, seems evident to every impartial and reflecting mind. They are insufficient, be- cause they are addressed almost exclusively to the memory of the student, without necessarily calling into action either the perceptive or reason- ing faculties, and hence they are unsatisfactory, as affording neither a test of his quickness of per- ception, his soundness of judgment, or his ability to apply both to the practical duties of his profession. If the college diploma is to be regarded as a mere certificate of attainment, or as evidence that the holder has attended a certain number of lectures, then, the mode of examination which the officers and faculty adopt, is a matter of little consequence MEDICAL HISTORY. 185 to the profession. But when such examination is to constitute the test of a student's fitness to enter into the ranks of a profession, whose sole business is to guard the public health, heal the sick, and alleviate human suffering in its ever varying forms, it should always be so conducted as to secure fully the following objects and condi- tions, viz.:— 1st. The examining board should be so consti- tuted as to possess -no interest whatever in the result of the examinations, either direct or indi- rect, pecuniary or moral. If a juryman is selected to determine an issue between two neighbors, in- volving a value of twenty shillings, he must not only be sworn to decide impartially, but must also be entirely free from all interest in the result of the decision, and free from having even expressed an opinion in regard to the merits of the case. The same is equally true of the justice or the judge on the bench. Indeed, the principle of en- tire disinterestedness on the part of those who, in any or all the relations of life, are to act as judges of the rights and interests of others, is so inter- woven with all our ideas of justice, that nothing would elicit more speedy or universal censure, than its designed transgression in any of the ordi- nary business transactions in life; and, if the principle is thus sacred when applied to the ordi- 186 MEDICAL HISTORY. nary pecuniary transactions between man and man, how much more so should it be when brought to bear directly on, not only the honor and usefulness of a noble profession, but also on the health, and even lives, of hundreds and thou- sands of our fellow-men. But are the professors and officers of our medi- cal colleges thus disinterested in regard to the examinations which they conduct ? Have they no interest, either direct or indirect, in the result ? To answer these questions satisfactorily, involves a full knowledge of the interests and motives of every college trustee and professor. These are, first, his own personal reputation and that of the school with which he is connected; second, the pecuniary profits resulting from such connection ; and, third, the desire to do good as a teacher of others. That the first two of these objects are the para- mount and controlling ones which govern the conduct of professors in medical schools, as well as that of everyr other class of enlightened men in Christendom, so far as temporal matters are con- cerned, is too evident to need a word of comment. It is equally evident, that these objects will be accomplished just in proportion to the number and intelligence of the classes they are able to draw into their respective schools. Hence, it is MEDICAL HISTORY. 187 the first, and most prominent object oif those con- nected with every school, to increase, as far as possible, the number of students in attendance. For this purpose they send forth their annual catalogues and circulars, enlist the co-operation of their friends, and arrange their courses of in. struction, and of course their examinations also, in such a way as they think best calculated to please and satisfy the students themselves. And as the principal objects of the student are, to gain the requisite amount of knowledge with as little expenditure of time and money as possible, and make sure his success at the final examination, the strong and inevitable tendency will be for the schools to vie with each other in their facilities for the accomplishment of these two purposes. Thus to accommodate the dilatory, the matricu- lating books are kept open during half of the en- tire term ; to catch the poor they offer credit, or even receive gratuitously; and to conciliate all, they make the final examinations as short and lenient as their consciences will permit. And on this point the consciences of every faculty are easily satisfied with the belief, that they examine quite as rigidly as any of their neighbors and rivals. But this is not all, for every diploma granted brings from fifteen to thirty dollars into, either the pockets of the professors 188 MEDICAL HISTORY. or the treasury of the school to which they belong. It is thus seen that every faculty of professors, so far from being disinterested and impartial examiners of their own classes, are under the direct influence of the strongest motives to swell, as far as possible, the list of successful candidates. These motives are nothing less than personal re- putation and pecuniary gain, stimulated by the direct competition of rival institutions. Hence, every faculty of professors who resolve them- selves into a board of examination, to sit in judg- ment on the qualifications of their own students, are placed in such a position, that their own per- sonal interests are in direct collision with their duty to the whole community, and their regard for the honor and welfare of the profession to which they belong. The true position of every medical examiner is plainly that of a judge sitting in judgment on the dearest interests of the student, on one side, and those of the community on the other. Now, if the matter at issue between these two parties was a few dollars in money, instead of the reputation of the one and the health of the other, no sane man would pretend that a judge ought to' be placed over them who was directly and strongly' interested in one of the parties. And is it not equally a direct violation of all correct MEDICAL HISTORY. 189 principles to do so in the other case ? If I have succeeded in demonstrating the fact, that every professor is necessarily an interested party in everything relating to the students in his own school, (and to deny it, is to assume the absurd position that he cares neither for his own reputation or the amount of his own salary,) then nothing can be more clear than that the union of the business of teaching and licensing in the same persons is entirely " wrong in prin- ciple." That it is liable to great abuse in prac- tice, the actual condition of the profession at this moment fully proves; for how else shall we ac- count for the fact, that scores are annually added to the profession, with college diplomas in their pockets, who are destitute alike of preliminary education or sound medical knowledge; others who are open and avowed homoeopathists in faith and practice; and still others who have divided half of the time professedly spent in the college, between the house of ill-fame and the grog-shop ? 1 am not here censuring the conduct or impeach- ing the motives of those connected with our medi- cal schools. They, like all the rest of mankind, are governed by a sincere and laudable desire to advance the immediate interests and prosperity of themselves and the institutions to which they are attached. To expect them to do otherwise, would 190 MEDICAL HISTORY. be as unreasonable as contrary to the ordinary tendencies of human nature. Indeed, while every student is left free to choose what college he will attend, and permits the question where he can most certainly and cheaply graduate, to be one of the most potent elements in determining his choice, a faculty of professors could scarcely be guilty of greater folly than the attempt to exact of every candidate such qualifications, both moral and intellectual, as the true interests of the com- munity require, while they could exert no con- trolling influence over the examinations of other and rival faculties. But, in thus attributing the present low standard of education, and the great defects in the mode of examining candidates, to the natural and inevitable workings of the system adopted, we illustrate still more forcibly the in- correctness of the principle involved. It is no more than just, however, to state, that there are those who not only insist on the correctness of the principle involved in the union of teaching and licensing, but who also contend that such union is beneficial in its practical operation. This is the view taken by the able chairman of the committee who reported on this subject at the National Convention in Philadelphia, 1847, but whose report received the sanction of only a minority of the committee, and was not adopted MEDICAL HISTORY. 191 by the convention. His reasons for this view are thus presented in the report, viz.:— " 1st, It will probably be admitted that, taking teachers as a body, they are at least as well qua- lified to conduct the examinations, and to judge of the fitness or unfitness of candidates to be in- vested with the privileges of the profession, as any other class of practitioners. " 2d, Under the present organization, each school has it in its power to elevate or degrade the value of its diploma, and to make the posses- sion of it an honor, or otherwise, according to the character of the school from which it emanates. The faculty of each college is interested in main- taining the reputation of the institution with which it is connected. " 3d. The character of the graduates will, in a great measure, depend on the character, as men and as teachers, of the professors. When the professors are men of elevated sentiments, the students insensibly imbibe the same high tone of feeling. The young graduate is proud of seeing the names of men whom he honors, and, perhaps, venerates, attached to his diploma, while teachers cannot fail to begra ified in attesting to the qua- lifications of diligee.t and well-deserving pupils It may well admit ol doubt whether it would be 192 MEDICAL HISTORY. advantageous to break up this sympathy between students and their instructors. " 4th. The teachers have the best opportunities of knowingthe characters and capabilities of candi- dates, from witnessing their general deportment in the class-room, etc. The necessity for good behavior, and regular attendance, for obtaining a degree, contributes greatly to secure that dis- cipline and decorum in the class-rooms so essen- tial to the advancement of the pupil, and the suc- cess of the teacher. If the professors were to be excluded from the board of examiners, or not to have a preponderating control, their influence over their classes would be greatly impaired." Such are the reasons given for the continu- ance of the union of teaching and licensing, by one of its ablest advocates ; and it may be added, that they are the most plausible and ingenious that can be adduced. But, pray, what do they amount to, when weighed in the balance of sound reasoning ? The abstract truth of the first, pro- vided the teachers have no personal interest in the success of the candidates to be examined, no one denies ; while the others consist in little else than a full admission of nearly all for which we have contended. Thus, we are told, in plain terms, that the professors in each college are MEDICAL HISTORY. 193 " interested in maintaining the reputation "—i. e the popularity and prosperity—" of the institution with which they are connected;"—that "it is in their power to elevate or degrade the value of its diploma," and, of course, also, the character and qualifications of those on whom they confer it; —that there is a strong and mutual bond of " sympathy between students and their instruc- tors ;"—and, finally, that the students themselves are greatly influenced in their conduct, and, con- sequently, in their choice of colleges also, by the fact that they are dependent on the professors for the attainment of the chief object of their am- bition, viz.—the diploma. Now, if all this is not a full and explicit admis- sion that both teachers and pupil are strongly and mutually interested parties—nay, but mutually dependent parties, then I know not the meaning of language. The one is dependent for the pros- perity of his school, the other for his diploma. Hence, until it is proved that it is a correct prin- ciple of action to make interested parties judges or jurors, it will remain a stubborn truth, that the union of teaching and licensing in the same per- sons is " wrong in principle;" for no sane man will pretend that the medical examiner is any- thing else than a real judge, whose duty is, to pro- tect the dearest interests of the profession on the 9 194 MEDICAL HISTORY. one side, and those of the whole community on the other. Neither am I alone in asserting this doctrine; for so early as 1837, the same view was advocated by some of the ablest members of the faculty in Philadelphia. They even went so far as to organize an institution for the purpose of examining candidates and conferring degrees, wholly independent of the business of teaching; and the legislature of that state wyas petitioned for a charter, sanctioning their organization; and, though such petition was signed by one hundred and twenty-six physicians, practitioners of Phi- ladelphia, including almost every medical man of note in that city, not connected, officially, with the two chartered schools then in existence there, it failed to meet with the approbation of the legislature; and, consequently, it was never fully carried into operation.* Again, at the annual session of the Medical Society of the State of New York, for 1839, one of the resolutions re- ported by a committee, was as follows, viz.— "Resolved, That the right of teaching ought to be separated as much as possible from the power of conferring diplomas of license." This resolution was freely discussed by the society, and adopted, by a vote of fourteen to four. * See Eclectic Journal of Medicine, vol. i., page 80 MEDICAL HISTORY. 195 The same year, a committee was appointed by the society, consisting of Drs. J. R. Manly, of ATew York, T. R. Beck, of Albany, and J. M'Call, of Utica, to consider maturely, and report on the whole subject of medical education, at the next annual meeting of the society. The report of this committee was duly made the following year, by Dr. Beck, and one thousand extra copies were published by the society for distribution. In that report we find the following language, viz.:— "But, in view of the diploma becoming depre- ciated by the rapid establishment of new schools, it may well become a question deserving serious consideration, whether, at no distant period, the right of teaching and licensing should not be dis- joined..........An incidental difficulty to the adoption of this suggestion, is the fact that w7e are surrounded by institutions in other states, who might or might not follow it, and thus our students might be induced to desert our own colleges." * When we remember that this is the well- guarded language of one of the ablest and most experienced teachers in our country, it is at least entitled to some consideration; and particularly * See Transactions of State Medical Society, vol. r 196 MEDICAL HISTORY. the last paragraph, which is another direct ac- knowdedgment of the powerful influence exerted over both professors and pupils by the privilege of granting degrees. The proposition for separating the right of teaching and licensing was again brought to the notice of the New York State Society, at the annual session of 1844, and through it, also to the notice of the several county societies in that state; and the published transactions of the fol- lowing year show, that it not only received the sanction of the state society, but also of a very large proportion of county societies then in active existence. It was, as has already been shown in a previous chapter, the discussion on this proposi- tion, at the annual meeting of the state society, in 1845, that gave rise to the call for a National Medical Convention, to be held in May, 1846. To this convention, when assembled, the following resolution was presented, viz.—" Resolved, That the union of the business of teaching and licens- ing, in the same hands, is wrong in principle, and liable to great abuse in practice," etc. It was freely discussed, and, after various motions to lay it on the table, or otherwise prevent its being brought prominently before the profession of the whole country, it was sustained by a majority of the members of the convention, and referred to a MEDICAL HISTORY. 197 special committee of seven, wi.h instructions to report to the next convention, to be held in Philadelphia the following year. The results of such reference have been already detailed in the preceding chapter. From these historical facts, the reader will be able to judge of the propriety, as well as truth, of the following sentence quoted from an editorial article in the New York Journal of Medicine and Collateral Sciences, for July, 1847, viz.:— " With respect to the long agitated question of uniting the business of teaching and licensing in the same hands, we were gratified in finding the convention unanimously scouting the idea, that such union ' is wrong in principle,' although ad- mitted to be 'liable to great abuses in practice.'': 1 think it would puzzle the most attentive wit- nesses of the doings of that convention, or readers of its published proceedings, to find any evidence of such unanimous scouting. It is true that, in one of the reports made to that convention by the committee, it is said, " If the resolution means to affirm that there is a moral wrong involved in the union, they cannot accord with it." But who ever before thought of confounding a principle of action or legislation, affecting whole classes of men or institutions, with a moral right or a moral wrong ? By a wrong principle, I mean one which, 198 MEDICAL HISTORY. when carried into practical operation, is found to bear such a relation to the nature of man and the institutions of society, that it directly, and as it were, necessarily, leads to bad results; while a moral wrong is either a known commission of evil, or a designed omission of good. About the first, the most upright and intelligent men may and do honestly differ in opinion. Thus, some think it a correct principle of action to pro- tect certain branches of industry by taxing the products of foreign labor of the same kind ; others again, contend that it is a wrong principle of legislation to tax articles of commerce, eyen for the support of government. Hence, when we speak of the correctness or incorrectness, the soundness or unsoundness of a principle, we have reference strictly to its adaptation to the nature and condition of the community or institutions to which it may be applied, and its tendency, when carried into practice, to improve ox. injure such community or institutions. If this is a correct definition, then it is evident that the question of morality, in the ordinary meaning of that term, can have nothing to do with the subject. And, consequently, to determine whether the principle involved in the union of teaching and licensing in the same persons is right or wrong, it is only necessary to inquire whether the practical opera- MEDICAL HISTORY. !»» tion of such union tends to elevate the character of the colleges, extend the usefulness of the profes- sion, and protect the interests of the community, or not. That this union does not tend to elevate the character of the medical colleges, is abundantly evident from the history of every one of these institutions, since the time of Drs. John Morgan and William Shippen. If we ask any one college to extend the length of its course of instruction, the ready answer is, " Our course is now as long as that of our neighboring schools, and if we re- quire a longer time of the student, he will abandon us for our rivals." If we ask for greater strictness in examinations for the diploma, we are told that " Our faculty are already as strict as any of our neighbors, and if we exact more of our candidates, we shall only drive students from our halls to other schools, without any benefit to the profession." If we ask for an increased number of professors, and a more perfect division of labor in reference to teaching, the answer is the same. If we go from any single school to all the colleges in any one state, and ask them to act in concert with each other in the adoption of any improvement, or system of improvements, we are solemnly assured that the system of teaching and the stan- dard of education in the institutions of that state, 200 MEDICAL HISTORY. are quite as elevated as in any of the surrounding states; and if they are raised still higher, it will only cause students to resort to the colleges of other states over which," tue" have no control. Finally, if we call together, in one grand na- tional council, the united wisdom of the whole profession, from Maine to Texas, and unanimously ask all the colleges to add two months to their regular courses of instruction, and add one or two professors to the number of their respective facul- ties, we are most gravely told by each college. that it is ready to comply with the recommenda- tion so soon as all the other colleges shall do the same; and, at the end of three years, with very few exceptions, each is still waiting for all the others. Thus it is, that this union of teaching with the power to grant diplomas, which are licenses to practice, is now, and ever has been, like the flaming sword at the entrance of the Garden of Eden, turning every way to keep out of the colleges the wicked monster, reform or im- provement. Or, still more like the angel in front of the poor prophet, Balaam, and his ass; if the beast went to the right, the angel with his drawn sword was there ; if to the left, he was there .also ; while the walls, like the competition between the colleges, towered up on either side ready to crush the foot of whoever should fall against them. MEDICAL HISTORY. 201 The principal discordance in the comparison con- sists in the fact, that the faculties connected with the several colleges are not, like Balaam, blind, but they see plainly their position, and hence, are very content to let their beasts remain in statu quo, without applying either whip or spur. But this is not all; for the practice of looking to the colleges for diplomas of admission into the profes- sion, changes the very issue or question on which they should depend for their patronage, and tends very strongly to corrupt the minds of the students. The question, and the only legitimate question, which ought to present itself to the mind of the student, in determining his choice of colleges, should be,—where can he obtain the greatest amount of sound medical knowledge, by the ex- penditure of a given amount of time and money ? If this was the case, every college would have to depend for success on the intrinsic merits of its faculty, and its means for illustrating and com- municating professional knowledge. And hence the competition between rival schools would con- sist in a struggle to outdo each other in the num- ber and ability of their faculties, the length of their courses compared with their charges, in the perfection of their system of teaching, and in everything which could aid the student in prepar- ing himself for the arduous duties of his profes- 9* 202 MEDICAL HISTORY. sion, instead of striving to court the favor ot students, by adding to their facilities for obtaining a diploma, which is now too much the case. Hence, the separation of the business of teach- ing from that of licensing, so far from injuring, would directly benefit the colleges, by destroying the advantage which such power now gives to the poorer schools, and compelling each to stand more exclusively on its real merits. If the fore- going observations are correct, it certainly follows, that boards of examiners, to be wholly disinte- rested, should be altogether unconnected, as teach- ers, with the candidates to be examined. 2d. The mode of examination should be such as to constitute a real test of the candidate's qua- lifications, independent of the time or place of his study. To accomplish this, the candidate should not only be required to write a thesis on some medi- cal subject, and submit to one short oral examina- tion, but he should be required to report in writ- ing one or more cases of disease, minutely detail- ing the symptoms, pathology, prognosis, and treat- ment ; and also examine and prescribe for one or more patients in the presence of the board, giving not only the diagnosis and treatment, but the rea- sons for both. Such an examination, fairly car- ried out, would form something like a real test of MEDICAL HISTORY. 203 the intellect and judgment, as well as mere me- mory of the student; and, taken in connection with the proper evidences of good moral charac- ter, would enable a board of examiners to judge, with some degree of certainty, whether he was prepared to maintain the honor of the profession, and do justice to the community, or not. If the foregoing views, in regard to the qualifi- cations which ought to be possessed by a board of censors or examiners, and the kind of examina- tion which should be exacted, are admitted, the question arises—how, and by whom, shall such board or boards be appointed ? That they ought to emanate from, and be responsible to, the great mass of the profession, very few reflecting men will either doubt or deny; for certainly the profession alone have the right to determine who ought to be admitted into its ranks, and who shall, or shall not, be recognized as brethren and co-workers in the great and responsible work of alleviating and preventing human suffering. And to pretend that this high duty ought to be left with thirty or forty irresponsible and independent chartered institu- tions, acting under the strong influences of mu- tual rivalry and self-interest, is an absurdity with- out a parallel, in all the relations of human society. But, without extending these comments further, 204 MEDICAL HISTORY. I shall close this work with a brief statement of my views concerning the particular measures cal- culated to meet the wants, and remedy the de- fects, which have been pointed out, and which, I believe, to constitute the only practicable mode of elevating the profession to that position of honor, usefulness, and learning, which it ought to occupy- in every enlightened community. The experience of all countries has shown that comparatively little reliance can be placed on legislative action for promoting the welfare of the profession, or protecting the health of the people. And especially is this ihe case in our country, where, instead of one central controlling power, we must depend on thirty independent legislative bodies, and even these annually undergoing changes in accordance with the popular will. If this is true, then it follows that whatever is done for the accomplishment of the above objects, must be done by the profession itself. Its social posi- tion, its usefulness, and its honor, is entirely in its own keeping, and dependent on its own action. Indeed, the same may be said of every profession ( r calling in which men engage. For with us, public sentiment is the supreme controlling agent throughout every department of our social and political organization. Legislators and laws are alike its creatures, ever ready to render prompt MEDICAL HISTORY. 205 obedience to its will. And what is true of the whole mass of the people, is equally so of each individual class or profession; and ail that is ne- cessary, in order to render such agent operative and efficient, is such an internal organization of each profession as will give its real public senti- ment embodiment and expression. Hence it is, that associated action has come to be the great characteristic feature of the present day. Every political campaign is but a grand and systematic organization, to embody and give ex- pression to the public sentiment at the ballot boxes. Our courts of justice serve as an efficient organization for the profession of law, and our numerous ecclesiastical assemblies, conferences, and councils, serve the same purpose still more perfectly for the clerical profession. And if the medical profession ever clears its ranks from the thousand forms of quackery, and assumes that position to which its nature and intrinsic worth entitles it, the same means must be promptly and efficiently applied. Without this, a statute book, full of laws, would be of no avail, and with it such laws would be, to a very great extent, unneces- sary. Hence, as the basis of all permanent im- provement, I must place an efficient internal or- ganization of the profession. Let the medical men of each state form themselves into district, 206 MEDICAL HISTORY. or county and state medical societies, and let these again be united by one national association, in such a manner that the sentiments entertained in the remotest county may be heard and felt at the great national center, and vice versa. Thess associations should be on such a plan as to in- clude in their basis every regular and honorable member of the profession. This basis must be the district or county societies, while the state constitutes the individual, and the national asso- ciation, the general head. Hence, both these latter should be so truly representative in their character, as to give embodiment and expression to the general will. It will be seen, in the preceding chapter, that this work of organization is not only begun, but is even now far advanced towards completion. The national association has been formed, and is actively engaged in the accomplishment of its legitimate objects ; and state and county societies also exist in a majority of the states; but these latter need re-animating, extending, and multiply- ing, until they occupy every state, and include every worthy member of the profession. I have so fully illustrated the ordinary benefits conferred by such associations in the preceding pages of this work, that it is unnecessary to repeat them in this place. But, besides all these, they afford the only MEDICAL HISTORY. 207 means for obtaining concert of action throughout the whole profession, and, without which, no im- portant improvement in medical education can ever be fully realized. But with such an organi- zation, both local and general, as will bring medi- cal men in frequent contact with each other in a social capacity, and bring all parties to act in concert, any important measure that may be de- sired can be carried, even to the enactment of uniform laws by the legislatures of the several states. Henee, a thorough organization of the profession should be the first object of every ad- vocate for medical improvement; and this orga- nization should include—first, a board of censors, appointed by each local society, to examine all candidates for admission as students, in regard to their preliminary education; and no member of such societies should admit a student into his office without a certificate from said board, cer- tifying that he is well versed in all the branches usually taught in our academical institutions, and possesses a good moral character. And second, one board in each state for the examination of all candidates for full admission into the ranks of the profession. This board should consist of, at least, seven members, appointed by the state medical society of each state; and, if advisable, also, one addi- 208 MEDICAL HISTORY. tional member, appointed by each regularly in- corporated medical college; and the presence of two-thirds should constitute a quorum for the transaction of business. The board should meet at such time and place as the state society should direct, and should not only require of each can- didate the ordinary oral examination in the va- rious branches of medical science, but also, the presentation of a written thesis on some medical subject, the detailed report of one or more cases, and the examination of at least one patient, in the presence of the board. The examination, and all the requirements, should be the same, whether the candidate possesses a diploma conferred by a medical college, or not. All who are found qua- lified should receive from the board diplomas, certifying to such qualifications, and entitling them to be recognized as members of the pro- fession throughout the whole country; but with- out such diploma, no one should become eligible to membership in any society, or be countenanced or consulted with as practitioners. All fees de- rived from the granting of diplomas should be paid directly into the treasury of the state so- ciety by which the examining board was ap- pointed ; and the members of such board should be paid a reasonable compensation for the time actually spent in the performance of their duties, MEDICAL HISTORY. 209 as examiners, by the same society,—their bills, duly certified to, being presented to a regular meeting of the society, and audited in the same man- ner as provided for all other bills of expenditure. The advantages of such a plan, when carried into practical operation, are manifold : 1st, It would secure the practical adoption of a fair standard of preliminary education, which is as essential to the elevation and usefulness of the profession as is a knowledge of geography to the naturalist. 2d, It would insure a more uniform, elevated, and practical standard of requirements for ad- mission into the ranks of the profession ; because the several state societies being directly con- nected with each other, through the medium of the National Association, would almost neces- sarily give to their several boards of censors similar rules and exactions. 3d, It would place the responsibility of fixing the qualifications, and regulating the admission of members into the profession, where it rightfully and properly belongs, viz., with the mass of the profession itself. 4th, It would tend greatly to elevate the cha- racter of medical teaching, both public and pri- vate, by making every teacher, and every faculty of teachers, depend entirely on their merits for 210 MEDICAL HISTORY. success. Mere speculating associations, or sham corporations, would no longer be able to draw re- spectable classes of students by the cheapness of their diplomas, the liberality with which they are distributed, or the shortness of time required for college attendance; but the student, knowing that the success of his final examination must de- pend entirely on the amount and readiness of his medical knowledge, his mental discipline, and his moral character,—uninfluenced by the fact that he has spent more or less time and money in this or that college, or the question, whether his approval or rejection will benefit or injure this or that institution,—he will be governed, in his choice of teachers and colleges, by one simple question, viz.—Where can I gain the greatest amount of sound medical knowledge for a given amount of time and money ? With this question as the sole issue between the teacher or the college and the pupil, we should speedily have a radical change in the nature of the competition among our medi- cal institutions. Instead of a struggle to outdo each other in placing the diploma in such a posi- tion, or on such terms, as to be most effectual in decoying students into their own halls, their com- petition would necessarily consist in an effort to ex- cel in the number of their teachers, and the length and perfection of their courses, compared with MEDICAL HlfeTORY. 211 their charges,—a competition tending, necessarily, to progression and improvement, instead of the reverse, which now prevails. Indeed, nothing hangs as a heavier incubus on all attempts to im- prove our system of medical education, than this connection of licensing and teaching. It enables the merest shadow of a college, with its thirteen or fourteen weeks' lecture term, and perhaps two of these in one year, to issue diplomas just as large, couched in just as flourishing Latin, con- ferring just as many privileges, and, as the stu- dent well knows, having just as much influence with the great mass of the community as the best, most thoroughly organized, and most rigid institution in the Union, — hence, one of the strongest motives to real excellence in teaching is done away with, and the poorest college is given a decided advantage over the best. It is on this ground that I have, for several years, urged this separation, as a measure of real benefit to the colleges themselves, and as the only one which would ever enable tho good institu- tions to reap the full benefit of their merits, in opposition to the badly managed and worthless. Indeed, the whole history of mankind, in all ages and countries, has not more clearly demon- strated the truth of any proposition than this— that every class of institutions, whether educa- 212 MEDICAL HISTORY. tional or industrial, not only flourish best, but are most progressive and improving in their condi- tion, when left to depend entirely on their own merits for patronage and success. 5th, It would insure both permanence and efficiency in the social organization. Those who study carefully the history of those medical so- cieties and associations which have been formed, from time to time, in different states, will not fail to perceive that, with very few exceptions, they have flourished for a few years only, and then maintained a nominal, rather than an active, state of existence. Thus, from 1810 to 1830, an active spirit of medical organization prevailed, resulting in the formation of state and county or district societies, in a large majority of the states then existing in the Union. At first, many of these had boards of censors, whose fees, derived from the examination and licensing of students, not onty defrayed their ordinary expenses, but, with a trifling initiatory tax, served to accumulate valuable society libraries, and the interest felt in their regular meetings continued unabated. But, as already shown in the historical part of our work, the college diploma rapidly superseded the state and county licenses in all the states except, perhaps, Delaware and Louisiana, where a state license is still required by law. MEDICAL HISTORY. 213 The societies being thus left to depend entirely on the voluntary contributions of the practitioner, who must tax himself to support the county society, spend his time, and tax himself again to pay traveling expenses, and to sustain the state organization, soon began to loose their interest, and fall into a state of inactivity. So true was this, that, though state and district medica] socie- ties had previously been formed in all the eastern states—in New York, New Jersey, Delaware, Maryland, Mississippi, Alabama, Tennessee, Ohio, Indiana, and Michigan—yet, in 1840, those in Massachusetts and New York were almost the only ones that maintained anything more than a mere nominal existence. And even in the latter state, out of its sixty counties, not more than six- teen or seventeen were represented in the meet- ings of the state society. Since the successful organization of the American Medical Associa- tion, and the general interest which has been excited on the subject of medical education, a new and active spirit of social organization has been rekindled. Hence, during the last four years, most of the old societies have been re-animated, and new ones have been formed in most of the states, where none existed before, such as Penn- sylvania, South Carolina, Georgia, Illinois, Iowa, and Wisconsin. As proof of the present activity 214 MEDICAL HISTORY. of this spirit, it is only necessary to mention, that over four hundred delegates were in attendance on each of the last two meetings of the American Medical Association, the one in Boston, the other in Cincinnatti, and that many of these traveled more than a thousand miles, at their own expense, for that purpose. But does any one suppose that this spirit will contiuue year after year, under the influence of such personal sacrifices of time and money ? It requires only, an ordinary knowledge of human nature, and of the past history of medi- cal associations, to see clearly that, without some collateral aid, some permanent resource for light- ening the burthens and increasing the interest of such organizations, they will inevitably sink into a mere nominal existence, so soon as the exciting subjects which brought them into being cease to be the predominant topics of interest. But if each state organization could receive an annual income sufficient to defray its ordinary expenses, publish its transactions, and, perhaps, enable it to offer a premium for original essays, or defray the expense of original experimental investigations, it would not only insure the permanent prosperity of such organization, but it would prove one of the most powerful means of improving the whole literature and science of the profession. One of the primary objects I had in view when MEDICAL HISTORY. 215 I presented the first series of resolutions in the New York State Medical Society, in 1844, advocating the separation of the licensing from the teaching power in our colleges, and investing it in state censors, was to put into the possession of the state societies such an income, for precisely such a purpose. That this was a leading object, will be seen by a reference to the resolutions themselves, as published in the transactions of that society. It will be seen by reference to the report of the committee on medical education, contained in the Transactions of the American Medical Associa- tion lor 1849, that nearly fourteen hundred were admitted into the profession during the year pre- vious, by receiving diplomas from the several me- dical colleges in our country. These, at twenty dollars each, gave those colleges no less than twenty-eight thousand dollars. Now, suppose this sum was annually received by boards of examiners, one for each state, and turned directly into the treasury of the state societies, every reader will see that it would afford an ample fund for paying the examining boards, publishing the annual transactions of the several societies, and enable each to powerfully encourage original investiga- tions by premiums or experimental committees; and who can calculate the beneficial results that would accrue to the whole profession by thus ren- 216 MEDICAL HISTORY. dering its organizations permanent and prosper- ous, and maintaining an active and ever-increas- ing spirit of scientific inquiry ? It may be said that the loss of this fund would, by crippling the colleges, injure the cause of medical education as much as it would advance it, in the manner pro- posed ; but if we remember that there are about four thousand five hundred students annually7 in attendance on the several colleges, and that a matriculation fee of five dollars for each, after de- ducting five hundred as third course students would give no less than twenty thousand dollars, besides the entire receipts for lecture fees, we shall be satisfied that these institutions would have no cause to complain. And even if such a course should cause a school, here and there, to close its doors, it is by no means certain that either the profession or the community would suffer thereby. This leads us to a consideration of the last sub- ject mentioned, when speaking of the wants of the profession, viz., the adoption of such a college organization, and such a rate of lecture fees, as will induce a far larger proportion of those who practice medicine to qualify themselves thoroughly, before entering upon the discharge of duties so arduous and responsible. Nothing need be added to what has already been said in regard to the MEDICAL HISTORY. 217 insufficient length of our present college terms. That a sixteen weeks' term, with six lectures per day, on as many different and important topics, not only induces the majority of students to pass over the whole hastily, or neglect a part for the sake of mastering the rest more thoroughly, but also effectually prevents the) great mass of stu- dents from paying that attention to practical ana- tomy, chemistry, and clinical practice in hospitals,. etc., even where these latter are abundantly ac- cessible, no man can consistently deny. Let the reader inquire how many of the thou- sand students who annually congregate in Phila- delphia, or of the seven hundred who spend their winter in New York, are daily found studying with care the most important of all subjects, viz. —clinical medicine and surgery, at the bed-side, in the capacious hospitals of those cities ? I speak from personal observation, when I say that not one in twenty are found paying attention to these things. And why ? Simply because they have no time. They must be in the lecture rooms of the college from nine or half-past nine in the morning to half-past twelve, and from three to six in the evening; during which time they must listen to chemistry, anatomy, physiology, mid- wifery, surgery, and practice of medicine: and if, during the interval, we allow to them the same 10 218 MEDICAL HISTORY. necessities for eating and sleeping that we do to other human beings, where is their time for the minute study of anatomy, healthy and morbid, for acquiring practical tact in physical diagnosis, and for patient observation of disease at the bed-side ? The bare statement of the case shows its palp- able absurdity7. If we would ever raise the medical profession to that condition, in regard to learning and prac- tical skill, which justice to itself and the com- munity imperiously require, two things must be done: 1st, All those medical colleges that are so lo- cated as to afford their students the necessary facilities for the study of anatonw, healthy7 and morbid, and the free access to well-regulated hospitals, must not only double the length of time during which their lectures continue, but such time must be suitably divided into minor terms. Thus, if the colleges in all our large cities would continue their courses of instruction through nine or ten months of the year, dividing such time into three sections, and assigning four distinct branches to each section, thereby occu- pying four hours each day in the lecture room, instead of six, and requiring the student to spend the remaining two hours in clinical study at the hospital, including dead-house observations in MEDICAL HISTORY. 219 morbid anatomy, and personal practice in phy- sical diagnosis, they would not only present the requisite facilities for obtaining the right kind of medical knowledge, but would also give the stu- dent a chance to avail himself of those facilities. The different branches should be so grouped in the three sections, that all students studying three years would find it profitable to take tickets, and attend on one section only each year of his study. With such a college arrangement, the student would be enabled to take up four branches each successive year of his study, and by confining his attention to these, both during his attendance on the college and in the interval, instead of skim- ming each year over the whole field of medical sciences, he would make himself thoroughly ac- quainted with each, in its turn, and, at the same time, acquire a mental discipline, far superior to that obtained under the present arrangement. At^present, first course students, many of whom have scarcely studied long enough to learn the number of bones in the human-skeleton, are com- pelled to pay for tickets and listen to lectures on practical medicine, surgery7, and midwifery, before they have the slightest knowledge, either of the organs diseased, the remedies recommended, or the anatomical structures operated on. In a word, they are set to laying the foundation, 220 MEDICAL HISTORY. building the superstructure, and putting in the furniture, all at the same time—a task as difficult as it is absurd. But let the whole annual session be lengthened and divided, in the manner pro- posed, and students, in the first year of study, can take the tickets for that section adapted to their period of progress, and concentrate all their at- tention on a thorough mastery of anatomy, and the other more elementary branches ; those in the second year would take the tickets of another section, adapted to their stage of progress, and spend their time between the lectures in paying special attention to morbid anatomy and path- ology, illustrated by post-mortem examinations; while those in the third or last year, having thus aid a systematic foundation, would take the section embracing instruction in the more purely practical branches, and be able to devote all their time out of the lecture room to genuine clinical medicine and surgery at the bed-side. Such an arrangement would require the student to attend the college no longer in any one year than he does now, would compel him to attend no more branches at one time than he could profit by to the greatest advantage, and yet would give him ten months of college instruction during his period of study, instead of eight, which is now required. MEDICAL HISTORY. *«1 ■ It is not only necessary thus to extend and di- vide the college terms, but the rate of charges for lecture fees must be more nearly adapted to the actual pecuniary condition of the great mass of medical students. The facts, that a propor- tion, varying from one-fourth to one-half, of ail the practitioners, in many of the states, have never attended a course of lectures in any school, —that a considerable proportion of those who do attend are obliged to give notes, and obtain their lectures on credit,—and that almost one-half of of the whole number of those who graduate, do so at schools, so located that they can have no hospital or genuine bed-side instruction whatever, and but a limited access to the study of practical and morbid anatomy,—are abundantly sufficient to prove that the present custom of charging from ten to fifteen dollars per ticket for lecture fees, or from sixty to one hundred and five dollars for each course of four months, is a very great barrier in the way of a more thorough education of the medical profession. It is utterly useless for the American Medical Association to reiterate, from year to year, its recommendation, that medical students be required to pursue practical anatomy, by dissections, and to attend to clinical instruc- tion in hospitals a given length of time, so long,as the amount of lecture fees required by those 10* 222 'medical history. colleges, so located as to afford the required faci- lities, is such as to wholly preclude a large ma- jority7 of the whole number of students from attending them. The object which it is desirable to accomplish is plain and obvious, viz.—to induce a far larger proportion of those (I should rather say, to induce all those) who intend to practice medicine, to prepare themselves more thoroughly and more practically, before commencing their arduous duties. And how can this be done ? Most obviously by placing the required facilities for such preparation more fully within their reach. This position was most ably presented by the learned and eminent Dr. Alexander H. Stevens, of New York, one of the ex-presidents of the American Medical Association, in his annual ad- dress before the New York State Medical So- ciety, delivered in the Assembly Chamber, at Albany, in February, 1849; and to accomplish this object to the fullest extent, he made a most just and well reasoned appeal to the State Legis- lature, to so endow the medical colleges, that the lecture fees might be entirely abolished, and medical education be thereby made free to every deserving student. The address of Dr. Stevens was very extensively read, and its sentiments were generally approved by the profession. Being MEDICAL HISTORY. 223 fully impressed with the importance of the object to be accomplished, and also, of the correctness of the principle involved in the measure proposed for accomplishing it, (viz.—the reduction of the lecture fees,) the faculty of the Rush Medical College, located at Chicago, Illinois, in the autumn of 1819, announced to their class a reduction of their fees from seventy dollars to thirty-six dollars for the whole course. Although this announce- ment was first made in the regular introductory lec- ture to the course, by the author of this work, yet it induced several students, who had not intended to attend the lectures of any school, on account of want of means, to immediately come forward and avail themselves of the advantages of the whole course ; and so well satisfied were the fac- ulty of that school, that the measure would not only work great good to the profession, by enabl- ing a much larger number of those who study and practice medicine to educate themselves better, but would contribute greatly towards doing away with the necessity for giving credit to students, that in their annual announcement for 1850-51, they have reduced the expensesj>f a full course still further, by abolishing the matriculation fee, and making the gross amount of lecture fees thirty-five dollars, payable in advance. During the present year, also, the Medical De- 224 MEDICAL HISTORY. partment, of the University of Michigan, has been organized, and their circular issued for the first regular course of instruction, to commence in the autumn of the present year. This being a depart- ment of the State University, which is liberally endowed with an income derived from the sale of public lands in that state, the professors are paid regular salaries, and no other charge made on the medical student, than a matriculation fee of ten dollars. They have also adopted a lecture term extending through seven months of the year. They have thus made provision for carrying out to the full extent, the important principles an- nounced by Dr. Stevens, and acted upon as far as pecuniary resources would permit, by the Rush Medical College, at Chicago. I see by their re- cent circulars that some of the other western col- leges, have also diminished, to a moderate extent, the gross amount of their lecture fees; so that this reform may be said to have fairly com- menced. But to accomplish fully the object in view, that is, to induce all who study medicine to educate themselves better, it is not only necessary to in- duce all to avail themselves of college instruction, but it is desirable to induce them to attend those colleges, which not only provide a suitable num- ber of lectures, but also abundant anatomical and MEDICAL HISTORY. 225 hospital facilities. This certainly cannot be done undi'r the present system, whch enables those schools, located entirely beyond the reacfi of hos- pital or other facilities for practical instruction, to draw into their halls one half of the whole num- ber of students, by the lower rate of their charges. If all the medical schools in our country, whose location places always at their command ample facilities for genuine clinical or practical instruc- tion, would adopt the system I have developed in these pages, viz.:— 1st. Extend their lecture terms to ten months, instead of four; divide it into three sections, with the medical sciences grouped into twelve divi- sions or chairs, four for each section of the term; and requiring four hours of each day to be occu- pied in regular lectures, and two in special at- tention to tbe study of practical anatomy, healthy and morbid, and to clinical medicine and surgery,. with their appendages, including, of course, phy- sical diagnosis, etc. 2d, Have the several chairs so arranged in each section of the term, that students should be re- quired to attend one section only each year of their studies, the section for tbe last year embrac- ing the branches more especially practical, such as practical medicine, surgery, midwifery, etc. 3d, Instead of the present system of charges, 226 MEDICAL HISTORY. embrace the whole expense of attendance on any one section of the general term, except a charge for anatomical subjects and dissecting ticket, in an initiatory or matriculating fee of twenty-five dollars, payable always in advance—they would immediately induce a much larger proportion of students of medicine to, attend lectures—they would make their medical education far more thorough, systematic, and practical, thereby greatly benefiting both the profession and the community7; and they would rapidly concentrate in their own halls the whole patronage of the profession, and thereby benefit themselves and do much to destroy the petty college competition which is now so rife throughout the country. And if the sum now annually lost to the colleges, by giving students credit, and making deductions in special cases, should be added to that which would be paid by the additional number who would resort to these institutions, it would more than counterbalance the loss by a reduction of fees. Indeed, if the number of students resorting to the colleges should remain the same as at pre- sent (four thousand five hundred), the charge of twenty-five dollars each would give one hundred and twelve thousand, five hundred dollars annu- ally, a sum sufficient to pay two hundred profes- sors an average annual salary of five hundred MEDICAL HISTORY 227 dollars each, and leave twelve thousand five hun- dred dollars to defray the ordinary college ex- penses. These sums, taken in connection with the increased division of labor, in making twelve instead of seven chairs in each school, and the concentration of the whole or a much smaller number of schools properly located, would make stations in the colleges abundantly sought after, and as well paid as any other positions in the profession. And if, in connection with such a system of teaching, a complete and permanent system of social organization, requiring a proper preliminary education, and providing for an effi- cient board of medical examiners in each state, as already pointed out, was adopted, the medical profession of our country, numbering, as it now does in its ranks, many of the most eminent and learned men on the continent, would, as a whole, speedily assume a more elevated position, and occupy a much wider field of usefulness. In regard to the objection, that cheapening medical education would only increase the number of those who would crowd into the profession, I have simply to remark, that the numbers should be restricted by adding to the standard of require- ments, instead of increasing the exactions on the students' pockets—the latter being both injurious and anti-republican in all its tendencies. 228 MEDICAL HISTORY. CONCLUSION. I had originally intended to close this chapter with some observations on the subject of medical legislation, but it has already so much exceeded the limits to which I designed restricting it, that I can no more than allude to the general topic. That the medical profession, as such, either needs or desires any legislation for its own special pro- tection, I most emphatically deny. Legitimate medicine has continued steadily advancing in the accumulation of its facts, in the verification of its principles, and in the extension of its usefulness, for more than eighteen hundred years; and who- ever supposes it needs any legal protection against any or all the thousand forms of quackery or pretended special systems, or isms, or athys, is altogether mistaken. Whether the citizens of this, our noble republic, need any laws to protect them * and their families from the grossest and most fatal impositions, under the name of medicine and medical treatment, is another and entirely diffe- rent question. A question, indeed, not only wor- thy of, but imperiously demanding the most careful consideration of every legislator and friend of humanity. 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