MEDICAL EDUCATION: 
WHAT IT IS, AND WHAT IT MIGHT BE MADE. 
A~N ADDRESS 
BEFORE THE 
SOCIETY OF THE ALTJMNI 
OF THE 
MEDICAL DEPARTMENT 
OP THE 
UNIVERSITY OF PENNSYLVANIA, 
AT ITS 
Annual Meeting, March 12, 1873. 
ALFRED STILLS, M.D. 
BY 
PUBLISHED BY THE SOCIETY. 
PHILADELPHIA: 
COLLINS, PRINTER, 705 JAYNE STREET. 
1873. MEDICAL EDUCATION: 
WHAT IT IS, AND WHAT IT MIGHT BE MADE. 
AIN ADDRESS 
BEFORE THE 
SOCIETY OF THE ALUMNI 
OF THE 
MEDICAL DEPARTMENT 
OP THE 
UNIVERSITY OF PENNSYLVANIA, 
AT ITS 
Annual Meeting, March 12, 1873. 
BY 
ALFRED STILLS, M.D. 
PUBLISHED BY THE SOCIETY. 
r*» 
PHILADELPHIA:. 
COLLINS, PRINTER, 705 JAYNE STREET. 
1873. Gentlemen : 
The greater number of the audience I have 
the honor of addressing are newly emancipated 
from the thraldom of lectures, and naturally 
will expect that the professorial tone of the 
speaker shall he laid aside, and that they shall 
be treated as equal brothers rather than as sons 
under tutelage. They may very properly hope 
to be entertained with something different from 
the discourses that have saturated and satiated 
them for the last three or four years, and that in 
this jubilant hour of their new departure they 
may be spared a disquisition on either the scien- 
tific or the clinical aspects of medicine. 
Moreover, the Society of the Alumni is not 
a scientific society. However high it desires 
to raise the medical profession, it does not seek 
that object by direct means, but leaves all such 
matters where they belong, in the hands of the 4 
numerous associations created for the purpose. 
In the words of its Constitution, “ The object 
of the Society shall be to sustain and advance 
the interests and influence of the Medical De- 
partment of the University of Pennsylvania, by 
the promotion of sentiments of general brother- 
hood and amity among the graduates, and by 
aiding in all efforts to elevate the standard of 
medical education, and to extend the progress 
of medical science and art.” It is a family 
gathering of the children and grandchildren of 
Alma Mater, to do her honor and repay her 
some portion of the debt which they owe her; 
to acknowledge her care, affection, guidance, 
and instruction at a time when they were unable 
to think for themselves or to find other protec- 
tion against the errors and temptations of the 
world; to proclaim their pride in her scientific 
reputation, in her skilful teaching and her un- 
stained honor; and to inspire one another with 
zeal to make her future as honorable as her past 
career, and still more eminent and useful. 
If this were merely a social reunion of our 
medical family we might indulge in pleasant 
reminiscences, in a little pardonable and harm- 
less laudation of the present state of the Medical 
Department of the University, and enjoy a com- 
placent outlook on the fresh fields and pastures 5 
new that invite ns in the future. Enough of such 
things might be said to fill the passing hour, and 
leave us at its end in a state of serene and con- 
tented self-admiration. "We might parade our 
domestic gods, and while we burned incense to 
the Lares and Penates of the University, inhale 
a little of the intoxicating fumes for our own de- 
lectation, and exclaim—“Behold in us the chil- 
dren of heroes who shall be held hereafter to 
be heroes ourselves!” It is so pleasant to be 
self-satisfied! It animates the heart with such 
benevolent sentiments towards our fellow men! 
For, being filled ourselves, how can we conceive 
that others may be starving, or imagine that 
there is any better food than has satisfied our 
wants ? 
In this serene and contented frame of mind 
the natural bitterness of the human heart turns 
to sweetness; the fires that we burn in our own 
honor and for our own glory upon the domestic 
altar, shed their pyrotechnic rosiness even upon 
our rivals, and we behold in them, also, heroes 
of successful campaigns in the fields of medi- 
cine, prodigies of genius inferior only to our- 
selves, who have, like us, and with the same 
weapons and in similar wars, achieved reputa- 
tions which shall forever be glorious. Our 
rivals, not to be outdone, asperge us with the 6 
rose-water of flattery and anoint ns with unctu- 
ous praise, until, at last, we and they and all of 
us, filled with the intoxicating spirit, join to- 
gether in a vast society of mutual admiration at 
whose banquets one toast at least never fails to 
bring down the house—“ Our Isolde Selves !” 
When we have thus bestowed upon that which 
stands first in our affection and admiration the 
homage we conceive to be its due, we naturally 
widen our embrace until it includes the peculiar 
medical institutions of the rest of the country. 
Fired with new zeal as we contemplate its gran- 
deur and their greatness, we hurst into a paean of 
jubilant praise, soaring as on eagles’ wings into 
the highest regions of hyperbole. There, serenely 
surveying the universe beyond our boundaries, we 
regard with a pitying eye those benighted nations 
among whom the most prodigious labor is essen- 
tial to the most eminent success; where many 
indeed are called, but few are chosen, for the 
highest professional rank; where the State com- 
pels all its citizens or subjects to contribute to 
the fund which will enable the meanest of them 
all in social station, and the poorest in purse, pro- 
vided that God has given him genius or talent, to 
rise to the very highest degrees of knowledge 
and power. And then we congratulate ourselves 
on our open gates, our freer roads and easier as- 7 
cent, and the ntter unconcern of our government 
whether those who travel on such roads, are 
equipped for their journey, or hindered, or helped, 
or ruined by the way! 
Having become somewhat chilled by this in- 
voluntary but inevitable comparison, and perhaps 
a little wearied by our empyrean flight, we de- 
scend once more to ordinary levels, and after this 
manner commune with ourselves: By common 
consent, patriotism is ranked among the noblest 
sentiments. To be without it is to be less than 
man. Yet, when we come to trace its sources, 
and analyze its nature, it is found to be akin to 
the love of our native village or of our childhood’s 
home, to the love of family, and the love of self. 
It is an instinct rather than a sentiment; is 
fostered by habit and example, and not by reason ; 
and its exaggerations may move to pity, but ought 
not to provoke censure. Since it belongs to all 
civilized nations, and even to savage tribes, it 
can as little be expected that other nations will 
confess our pre-eminence, as that we shall admit 
their superiority over ourselves. Like all other 
instincts, this one has its noble qualities as well 
as its base influences and tendencies. It is, for 
example, at the foundation of all national inde- 
pendence and greatness. Egypt, China, Greece, 
Rome, England, and France, has each in its 8 
turn ruled the world, and maintained the exclu- 
siveness which regarded all other nations as 
more or less outside barbarians, tit only to be 
harried in war, or taxed in peace, but beneath 
consideration as examples to be respected, or as 
teachers to be obeyed. But in every one of these 
countries the time arrived when it became evident 
that there was a larger circle of human sympathy 
and co-operation than could be bounded by family 
or nationality; that however salutary the love of 
self, and home, and friends, and even of country, 
there are limits beyond which it ceases to be a 
virtue, begets some of the least amiable qualities, 
such as conceit and pride, tends to narrow the 
range of thought and action, to petrify virtues 
into mere habits, and dwarf the character instead 
of elevating it. 
It is folly for us to compare ourselves with 
ourselves alone, when commerce and travel 
oblige us to learn the excellencies and defects 
of others. To claim exclusive merit when the 
superiority of other nations is conspicuous all 
around us, is simply to imitate the idiot avIio 
shuts his eyes and denies that the sun is shin- 
ing. They who flatter us by extolling our 
methods of professional culture, for example, 
like all other flatterers, are false. They speak of 
that which they do not know, and cannot under- 9 
stand. No American of ability and character, 
unless his education has been altogether excep- 
tional, has spent even a year or two of study in 
foreign schools without feeling his own inferiority 
in knowledge, and recognizing the radical defects 
of the system he has hitherto pursued. The 
spring-time of his life is passing, the buds of 
his future hopes are swelling, and he finds that 
unless he can succeed in enriching the soil from 
which he draws his intellectual sustenance, he 
will be in great danger of seeing the fruit which 
nature fitted him to produce, dwarfed and unsa- 
vory instead of being full flavored and nutritious. 
When he seeks reasons for the shortcomings 
of our homebred physicians, he is not long in 
discovering them. Pie knows that it is impos- 
sible to gather grapes from thorns, or figs from 
thistles, and that what a man sows, that will he 
also reap; he perceives that it is folly to look for 
a general high attainment in medical science from 
a profession, the most of whose members received 
no scientific training before entering on the study 
of the most intricate, extensive, and difficult of 
all the sciences; or for perfection in skill among 
those whose period of instruction was but three 
years of nominal, and perhaps less than one year 
of real and earnest study, of an art in which the 10 
experience of a lifetime must still leave them 
comparatively unskilled. 
lie looks around him upon the ranks of the 
profession at home and abroad, and observes 
here and there men whose world-wide reputation 
is founded upon something accomplished by them 
beyond what others have done; by their skill as 
practitioners ; by their eloquence as teachers; by 
their power or learning as writers ; by their origi- 
nality as observers and experimenters. On in- 
quiring to what their superiority and their fame 
is due, he learns the secret of their success. In 
no single instance does he find that it has been 
obtained by original genius merely, however ele- 
vated or brilliant that may have been; he dis- 
covers that every one of these eminent men has 
been an earnest student, during many years, of 
the groundwork of his profession, and a toiler in 
the field he selected for especial culture, concen- 
trating upon it alone the whole of his native 
energy and acquired knowledge, until it pro- 
duced fruits which not only deserved but com- 
manded admiration. He has not frittered away 
his time nor wasted his strength in the vain 
attempt to grasp more than he could hold, but 
has deliberately devoted all his energies to 
making his knowledge and skill, within deter- 
minate limits, perfect. In pursuing this object, 11 
also, his motive has not been a sordid one. He 
has toiled, not for money as his chief end, hut 
for fame. If wealth has flowed in upon him as a 
consequence of his useful discoveries in the 
science, or of his valuable improvements in the 
art of medicine, he lias not been apt to feel 
puffed up by its possession, but has regarded it 
rather as an incident of that more solid wealth of 
wisdom which gold cannot purchase, and of 
which not even the bankruptcy of nations can 
rob him. But riches are not commonly the re- 
ward of the highest attainments in medicine, or 
in any other scientific pursuit. Our travellers 
abroad are surprised to find how simple in their 
habits, how frugal in their expenses, how modest 
in their demeanor, are many of the men whom 
they have been accustomed to think of as kings 
and princes in the intellectual world, and whose 
judgments and precepts actually control the 
opinions and the acts of thousands in every 
civilized nation. 
These results are the flower and the fruit of a 
civilization which has been growing, through 
many vicissitudes, for thousands of years, and 
similar productions are not to be looked for from 
a comparatively youthful civilization like our 
own. The expectation that communities, in 
which the standard of education is relatively 12 
low, however generally that education may be 
enjoyed, should adopt a high grade of general 
or professional study, is quite as chimerical as 
to expect that nations who have had neither 
instruction nor experience in self-government 
should establish and maintain republican institu- 
tions. All the world knows the bloody and dis- 
astrous ending of attempts to do so. We can- 
not expect gardens to bloom and harvests to 
thrive upon the sands of the sea-shore. 
We boast of being “the fastest nation in all 
creation,” and although the vaunt may not be 
gainsayed, we should not forget the adage, “ The 
more haste the worse speed.” The country is 
vast, its energy prodigious, and its achievements 
are equally so. Yet, if you look back at the 
steps that it has taken, you will observe from 
what rude beginnings, and by what gradual pro- 
gress we have reached our present position in 
material things. The hut of rough boards that 
sheltered the solitary pioneer upon the prairie, or 
in the recesses of the forest, has been followed by 
a decent farm-house; the farm-house by a village, 
the village by a town, the town by a city. In 
many a city, in the very oldest of them all, per- 
haps, may be found relics of the primitive dwell- 
ings of our great-grandfathers not altogether 
out of sight of the brick mansions of our fathers, 13 
and of the marble palaces in which the luxury 
and wealth of the present generation reside. 
Have we made a corresponding progress in the 
development of intellectual wealth? It will 
hardly be affirmed that we have; nor is it singu- 
lar that we have not. In the natural order of 
things the material has always preceded the 
spiritual. Yet, when we examine the seething 
mass of humanity that peoples the United States, 
we cannot fail to observe that centres of intel- 
lectual crystallization have sprung up within it, 
which tend to grow year by year in an increasing- 
ratio. But all of these centres are formed by 
men who owe their acquirements either to a pro- 
longed residence abroad, or to an earnest and 
successful culture of foreign science, literature, 
and art. Let us understand that it is no dis- 
paragement of our national credit to recognize 
the necessity of going to school to foreign 
masters. In doing so, we are but repeating 
and renewing the process by which knowledge 
has been diffused from the beginning of the 
world. What were the Greeks until Egypt 
taught them letters and science? Mere barba- 
rians. What were the Romans before they im- 
ported the arts from Greece? Or the French 
before Italian culture polished them? Or the 
English until the Norman conquest civilized 14 
them ? A purely indigenous literature or science 
is a thing as unknown to history as an original 
language, as impossible as a living being without 
progenitors. Are we at once so ignorant and 
stupid, or so in love with ignorance, as to expect 
to perform a miracle, and build up a science and 
an art upon foundations exclusively our own? 
In material civilization, in the mechanical 
arts, in practical legislation even, so far as it 
relates to masses of men and the ruder forces of 
Nature, the American people have revealed, and 
are every day developing an intelligence which 
no other nation ever exhibited on so grand a 
scale. Even popular education is more general, 
interests and occupies a greater number of per- 
sons, creates a larger number of pupils imbued 
with the rudiments of knowledge, than in any 
other country. In all this we may feel pride 
without boasting, and pleasure without being 
accused of self-complacence. But when we ask 
ourselves what has been accomplished among us 
in science, learning, polite literature, and art, in 
those departments which require the utmost 
exertions of genius, and the steady, patient, 
and laborious application of knowledge and skill 
to the production of great results, a different 
answer must be given. We are compelled to 
admit that our scholars and writers, our scientists 15 
and artists, who have gained the highest repu- 
tation, are pupils of European masters, and have 
themselves often been trained in European 
schools. In spite of ourselves, as it were, our 
younger civilization is nursed by the elder, and 
we draw from its exuberant stores the nutriment 
on which our higher culture thrives. 
None hut the ignorant or the wilfully blind 
can doubt these truths. The very first to con- 
fess it are the historians, the artists, the scholars 
of every sort, the learned lawyers, and the sci- 
entific physicians, who have done most by their 
own genius and industry to advance our intel- 
lectual civilization. The best of the lectures 
that we hear would be unspoken, and of the 
books by American authors that we read would 
be unwritten, were they not supplied from the 
overflowing fountain of European learning. Into 
the youthful, virgin, active mind of America the 
stream of European knowledge is perpetually 
pouring, just as, centuries ago, Greek and ori- 
ental wisdom fructified the germs of European 
thought. It is generating here a brood of ideas 
which in due time will rival their progenitors in 
the intellectual field, as American handicraft is 
already rivalling that of the old world, filling 
our shops and our houses with the fruits of in- 16 
genuity and skill, and to the same extent, exclud- 
ing the rival products of foreign manufacture. 
In arriving at this successful competition it 
has never, for a moment, been proposed that we 
should rely upon our own genius and experience 
alone. On the contrary, there has been a per- 
petual effort to discover the most successful 
methods and mechanical appliances in use abroad, 
which are generally concealed with cautious jeal- 
ousy ; we have imported materials and workmen 
and instruments, and in every way sought to 
excel our rivals by using their own methods, 
and improving upon them. 
Even with these advantages we should have 
failed now, as we have often failed before, had it 
not been that circumstances aided us unexpect- 
edly. A few years ago, and all the energy, and 
talent, and skill, and industry of our producing 
classes struggled manfully, but in vain, against 
foreign and domestic competition. From every 
town where the hum of the cotton mill, or the 
clang of the machine shop was heard, went up the 
despairing cry to the government, “Save us, or 
we perish! ” But the government, always doing 
right by halves, distracted by opposite counsels, 
divided by conflicting interests, gave to the in- 
dustry of the manufacturers a faint-hearted and 
feeble support; and while foreign merchandise 17 
glutted our markets, the hum of the cotton mill 
died away, and the ring of the anvil was still. 
Then came the civil war, in some ways an unpar- 
alleled calamity, in others an unspeakable bless- 
ing. In proportion as it compelled the imposition 
of duties upon foreign merchandise, it offered 
the strongest inducements to native production. 
Immediately the hives of domestic industry 
awakened from their lethargy, and poured forth 
their products, as from a horn of plenty •* foreign 
training, taste, and knowledge were enlisted by 
high rewards; the importation of foreign goods 
was more and more restricted to articles of lux- 
ury ; the greatest establishments waxed greater 
in capital, enterprise, and skill, and devoured 
their leaner rivals. Hard as it might be upon 
the individual, society was immeasurably bene- 
fited by the extinction of the weak, and “the 
survival of the fittest;” and strangest of all, the 
very populations and trade interests which before 
had clamored most loudly for protection, being 
now assured of their ability to stand against all 
comers, became the most earnest in their argu- 
* “ The census of 1850 showed the value of the annual product of 
all our industries to be $1,019,106,616. Ten years later this had in- 
creased nearly ninety per cent., the annual product ill 1860 being 
$1,885,861,676. The census of 1870 showed that the annual product 
of our manufactures is more than two and one-third times the annual 
product of 1860, the total reaching the enormous figure of $4,232,- 
825,442.” 18 
ments and appeals for free trade, just as the 
English had already done when protection to 
their manufactures had dispelled their fears of 
foreign competition. 
And now may I not say to the medical profes- 
sion, to the schools of medicine, to our own Uni- 
versity, u De tefabula ncirratur” f Does not this 
epitome of industrial and commercial progress 
teach a lesson which may be profitable to us in 
considering the causes which tend to obstruct 
and hamper the higher developments of medicine 
in this country ? For it is evident that just in 
so far as the commercial element enters into a 
profession it must be subject to commercial laws ; 
and it is certain that the expenses of a medical 
education, and the prospect of deriving a support 
from its use in medical practice, must determine 
the average amount of it which wrill be acquired 
by the members of the profession. 
May not this lesson be profitable to us in view 
of the present condition of our profession, and 
especially of our schools ? Does it not show that 
in teaching, as in trade, development is depend- 
ent upon one or on both of two things, protection 
and capital, and that where both of these are 
wanting, success, in any high or enlarged sense, 
is simply impossible? 19 
As regards protection—that is to say, the pos- 
session by certain institutions of exclusive rights 
and immunities, and the extinction of all rival 
institutions, that, it need hardly be remarked, is, 
under our political system, simply impossible. 
If it were possible, it would still be undesirable, 
as a system containing within itself the seeds of 
its own decay; for it would perish of dry gan- 
grene, from very lack of quickening stimuli and 
vitalizing nutriment. The only remaining source 
of safety to our medical schools as they now ex- 
ist, the only possible agency for their future de- 
velopment, is Capital. 
If we look around upon American medical 
schools, and examine the qualifications of their 
teachers, we shall find, in all the leading ones, 
that the faculties are composed of men, a great 
number of whom would be distinguished in any 
civilized country for native talent, elaborate cul- 
ture, earnestness, thoroughness, and skill in teach- 
ing. If they fail to educate their pupils up to 
the standard which they know to be the best and 
only true one, it is because they are fettered on the 
one hand by the defective training of the stu- 
dents, and their consequent inability either to ap- 
preciate the merits or to detect the shortcomings 
of their teachers; and on the other, and far more 20 
heavily, by the fact that the success of a school is 
dependent, not only on its merits, but also on the 
number of its students.* This it is which de- 
stroys the independence of the schools, and 
compels them to perpetuate a system of educa- 
tion which their judgment condemns, and their 
conscience reprobates. Were they not forced by 
the inexorable laws of trade to keep down the 
value of their wares, and furnish them at the 
same price as their rivals charge, some among 
them would soon be found to supply a system of 
medical education in accordance with their own 
attainments, with the ambition of their educated 
* We once conversed with an accomplished professor concerning 
the prospects of a new medical journal which had appeared in his 
native city, and incidently upon lectures. Ilis remarks were more 
pungent than flattering, hut may serve to point the moral of our text. 
“The journal,” said our professor, “is too dignified to succeed. 
Physicians outside of the large cities, and a majority in them, prefer 
a gossiping, trifling journal, which is all the time giving them receipts 
which are ‘good’ for this disease or the other. Your country doc- 
tor, like his antitype in town, has half the time no library but what is 
left of his text-books, and those of the most antediluvian editions ; and 
if he takes a journal at all, he does not want one that obliges him to 
observe and think, but one that has all the impudence and self-asser- 
tion of a quack advertisement. There is no use in preaching over the 
heads of your audience. They are sure to fall asleep, and your dis- 
courses are very apt to be interrupted by their porcine grunts and 
snores. You must come down to their level. I myself,” he con- 
tinued, “ once imagined that I should be able to lift my audience up 
to my own level, and fill them with the same love of scientific medi- 
cine which I felt myself; but I have seen my mistake, and I now go 
through a round of elementary lectures which are wearisome to my 
spirit, and humbling to my pride, but which are strongly relished by 
my class.” 21 
pupils and the wants of the profession, and in 
harmony with the higher standards used in Euro- 
pean schools.* 
To place them upon this firm footing and ena- 
ble them to remodel education, making its foun- 
dations stronger and wider, its superstructure 
higher, and in every part of it employing more 
durable materials, the schools must be rendered 
independent of one another, so that the earnest 
and true shall not be held back by the apathetic 
and incompetent. Whenever the support of the 
professors shall cease to depend upon the number 
of the students, and shall be drawn from funds 
in the hands of the college corporations, this end 
will be attained. Upon the continent of Europe 
it has never been otherwise; and the professors 
* The plan of making the incomes of professors dependent upon the 
number of students in medical schools was originally borrowed from 
the University of Edinburgh, which, in so many other respects, served 
as a model for our medical institutions. To this day each of its medi- 
cal professors receives four guineas from every student in attendance 
on his lectures, a sum almost identical with our own fee. They are 
also paid salaries varying in amount from $500 to $1000 (£100 to 
£200), derived from endowment funds. The system of fees paid by 
the student to the several professors is the prevalent one also in Lon- 
don and Dublin. It may very pertinently be asked why it is that so 
many students from the United Kingdom should, after graduating at 
home, repair to the centres of medical education upon the continent, 
while it is almost without example that a German or French physician 
receives any portion of his medical education in Great Britain. It 
may also be remarked that among British medical men who have been 
distinguished as scientific physicians, the greater number have en- 
joyed the advantages of a training in continental schools. in its schools would probably find it difficult to 
comprehend that they were expected not only to 
teach science, but at the same time to manage the 
domestic economy of their respective institutions, 
and exhibit their skill in the invention of ingenious 
devices to entice students. It is related of the 
builders of the Jewish temple that the sword was 
girded at their side while they plied the tools of 
their craft; but our medical professors, and by a 
monstrous anomaly the medical professors alone, 
are obliged to be tradesmen and politicians as 
well as philosophers and physicians, to fight on 
one side with Mammon, and on the other, work 
for God. It is a familiar fact that they who live 
constantly in a tainted atmosphere grow insensi- 
ble to its foulness, and no doubt it is for some 
similar reason that we become unconscious of 
the manifold influences around us that tend to 
lower the dignity and impair the usefulness of 
our medical institutions; and that familiarity 
with their homeliness renders us dull to perceive 
the charms of a nobler type, or emulous to pos- 
sess it. It has even been suggested that if the 
schools of medicine were endowed, their profes- 
sors would grow supine and indolent, wanting 
the stimulus to exertion supplied by the present 
struggle for emolument. The object is a valid 
one just in so far as professors are unworthy of 23 
the chairs they occupy; and the very object of 
the proposed plan is, among other things, to 
render this anomaly more rare. It is very evi- 
dent that, under that plan, incompetent profes- 
sors would be appointed less frequently than 
now; for the honor and success of the schools 
would forbid it. In every country of continental 
Europe professors have fixed salaries, and we 
imagine that if the suggestion were made to them 
that the arrangement tends to foster indolence, 
they would be utterly unable to comprehend the 
criticism. jSTo ! it is these salaried teachers to 
whom the progress of medicine is mainly due. 
They are able to pursue their studies and experi- 
mental researches without being harassed hy 
questions of finance, or hampered by debating 
whether they may dare do this, or dare not do 
that—some act, perhaps, of doubtful probity— 
which a rival school employs to swell the num- 
ber of its students. And so it might still be in 
our own country, unless our ancestors belied the 
ancient sentiment, and changed their nature as 
well as their climate in crossing the sea. 
But, however desirable it must be that medical 
education should be placed upon an independent 
basis, the practical question arises, u Can it be 
accomplished?” Every one knows how unpro- 
ductive of improvement in the programme of 24 
official teaching have been the discussions of its 
inadequacy which have been repeated for so many 
years, as to have at last become wearisome and 
almost impertinent. But no one, we believe, has 
hitherto proposed to untie the knot by cutting 
it, by providing funds, that is, for the endowment 
of professorships in any of the leading medical 
schools. One institution, to its honor let it be 
spoken, has reformed its whole plan of teaching, 
upon the model which reason and experience 
agree in approving as the best. Much as I de- 
sire, in this instance, to be a false prophet, I have 
little fear of meeting with the fate of one, when 
I declare with unfeigned sorrow my conviction 
that the Medical Department of Harvard Uni- 
versity, which has heroically undertaken so diffi- 
cult a task without providing endowments for 
its professors’ chairs, must of necessity fail to 
secure the success which its liberal policy de- 
serves.* 
* From the “Forty-seventh Annual Report of the President of 
Harvard College, 1871-72,” we learn that immediately on the adop- 
tion of the new system of instruction, the number of medical students 
fell from 801 in 1870-71 to 208 in 1871-72. The catalogue of the 
Melical Department for 1872-73 gives the names of 170 students. 
Under the new system, therefore, the classes have thus far progres- 
sively diminished. The receipts have fallen off in the same propor- 
tion, and the professors have nearly twice as much work to do, with 
a. remuneration only half as great as they formerly received. The 
result of this arrangement must necessarily be to compel men of real 
eminence to withdraw from professorships -which are so meanly 25 
Without entering into arithmetical details, 
which on this occasion would he out of place, it 
may be sufficient to say that a fund of less than 
two hundred thousand dollars would produce a 
revenue, which, when added to the fees paid by 
the students themselves, would be sufficient to 
remunerate at least eight professors for courses of 
lectures of not less than six months each.* Even 
salaried, and to substitute for tliem young and immature teachers, 
at lio will regard their position in the Medical College as a passport to 
reputation and practice, and who are willing to purchase this result 
by a few years of unrecompensed labor. By this plan the traditions 
of university education are set at nought, its dignity compromised, 
and its authority impaired. If any profession requires in its teachers 
the weight of character which maturity of intellect and learning and 
ripe experience give, it is certainly the medical; but a plan which 
virtually excludes such qualifications by refusing to compensate them 
is too much in opposition to human nature and experience to succeed. 
The President of Harvard College observes: “It is greatly to be 
regretted that the Medical School is not sufficiently endowed to make 
it practically independent of the number of students.” It may be 
respectfully asked if it would not have been better to secure a suffi- 
cient endowment before adopting a system of education which di- 
rectly diminishes the number of students, by its disproportionate ele- 
vation above the average standard of students’ acquirements ? A 
system which tends on the one hand to sacrifice the best professors 
by reducing their emoluments to a mere pittance, and, on the other 
hand, excludes all students except those only who are really qualified 
to appreciate and profit by the highest instruction, is too illogical, too 
inconsistent with itself, to have a long and vigorous life. 
* Eight wTould be a minimum number of professors; but that num- 
ber should include a professor of General Pathology and Morbid 
Anatomy. It is incomprehensible that those subjects, wrhich lie at 
the very foundation of the science of medicine, should have no pro- 
vision made for them in the curriculum of the largest American medi- 
cal schools. 
The following schedule presents a plan of medical studies which 
might, we think, be adopted within a very few years : ls£ Tear. 26 
if the higher grade of instruction which would 
then he given and required, should cause, for a 
time, one-quarter or even one-third of the present 
average number of students to prefer institutions 
where the value of the teaching is proportioned 
to its smaller cost, the University would lose 
nothing permanently, hut would gain exceedingly 
in reputation and rank. 
Is this plan Utopian? Is it to he added to the 
many that, like bright bubbles, have burst upon 
the surface of the stagnant waters of medical 
education? Whatever might have been thought 
regarding it a few years ago, such a judgment 
of its merits would be rash now when so much 
has been accomplished in behalf of the University 
at large, and especially of its Collegiate and 
Scientific Departments, and so great liberality 
has been displayed in providing a site and funds 
for the erection and endowment of the Univer- 
sity Hospital. That we may be encouraged not 
only to hope but to work, let me conclude this 
Chemistry, lectures and laboratory; Anatomy, lectures and dissec- 
tions ; Physiology ; Materia Medica, Medical Botany and Pharmacy. 
2d Tear. Anatomy ; Physiology ; General Pathology ; Morbid Ana- 
tomy ; Materia Medica and Therapeutics; Clinical Medicine and 
Surgery. 3d Year. Medicine ; Surgery ; Obstetrics ; Diseases of 
Women and Children ; Clinical instruction in these branches ; Medi- 
cal Jurisprudence and Toxicology. Examinations at the end of every 
year’s course, their result to determine the fitness of the student to 
advance. 27 
Address with a sketch of what has been done for 
the permanent illustration of clinical medicine 
and surgery in the University, and of what it is 
hoped to do for the erection of a new building 
for the medical department. It is known to most 
of my audience that, several years ago, it was 
determined to remove the University from its 
present site to another on the western side of the 
Schuylkill, where ample grounds had been secured 
by purchase, or in the aggregate at a nominal 
price, from the city. Already in that situation 
stands the imposing edifice of the collegiate and 
scientific departments, and there the medical de- 
partment and its hospital will soon be erected. 
The latter is indeed already begun. For some 
time previous to the spring of 1871, the subject 
had been freely canvassed; but the first definite 
step taken was at the meeting of the Alumni 
Association in that year, when a motion was 
adopted to appoint a committee to confer with 
the Faculty and Trustees as to the feasibility of 
securing the erection of a hospital in connection 
with the University. This committee addressed 
the Faculty on the subject, and were answered 
by the appointfnent of a committee to act in 
concert with the Committee of the Alumni. 
An address was presented to the Trustees, and 
a resolution was adopted by them, agreeing to 28 
appropriate a portion of their ground in "West 
Philadelphia for the erection of a hospital. The 
joint committee then prepared an appeal to the 
public which was signed by a number of influ- 
ential citizens and widely circulated. At a 
meeting of the signers of this appeal an Execu- 
tive Committee was appointed, which was soon 
enlarged into the Finance Committee, by which 
all subsequent movements were directed. 
Efforts were then made to obtain subscriptions 
and individuals : the amount 
determined to be necessary for carrying out the 
project being $700,000. The subscriptions in 
most instances were made payable in four annual 
instalments; and by a special resolution of the 
Board of Trustees it was determined that $5000 
should endow one free bed. Several of the great 
railway corporations have subscribed in this way, 
and a number of large firms and individuals 
have done the same. 
In the early part of 1872 the subscriptions 
having reached the sum of about $125,000, ap- 
plication was made to the Legislature for an 
appropriation of $100,000 to be spent in the 
erection of the building. In order to show how 
strong was the support given to this enterprise 
by the citizens, the appeal for the appropriation 
requested that it should be made contingent upon the additional subscription of $250,000. This 
appropriation was unanimously voted, and when 
on November 15th, the subscription reached the 
required sum of $250,000, application was made 
to the State Treasurer, and the amount appropri- 
ated ($100,000) was paid. 
Finding that as the sum of the subscriptions 
rapidly increased, it would be possible to erect a 
much larger hospital than was at first deemed 
possible, application was made in May, 1872, to 
the City Councils for a lot of ground as ajbuild- 
ing site; and by an ordinance, approved May 
18th, 1872, a piece of ground (extending between 
Thirty-fourth and Thirty-sixth Streets, embrac- 
ing nearly six acres in immediate continuation 
of the remaining property of the University), 
was given to the Trustees in trust as a building 
site for the proposed hospital. In return the 
Trustees agreed to complete the building within 
five years, and to permanently maintain in it at 
least fifty free beds for the use of the poor of the 
community disabled by accident or sickness. In 
addition to the smaller private subscriptions, the 
sum of fifty thousand dollars has been contribu- 
ted by a generous and benevolent gentleman, 
payable so soon as the endowment fund shall 
actually amount to $250,000. 
As the plans that have been adopted for the 30 
hospital will involve an outlay of over $200,000 
in building alone, it has been decided to apply to 
the Legislature for a second sum of $100,000, 
contingent upon the securing of an additional 
$100,000 by subscription.* If this application 
meet with the success which is hoped for and 
confidently anticipated, it will put the Trustees in 
possession, on account of the hospital, of nearly 
six acres of ground, free from all incumbrance; 
a building fund, given by the State, of $200,000; 
and an endowment fund raised by contribution 
of $350,000. 
During the past summer a Building Commit- 
tee, with the aid of the University architect, elabo- 
rated the plans for the hospital with the greatest 
care. The proposed building will harmonize in 
architecture with the already completed Depart- 
ment of arts and science, and like it will be in the 
University Gothic style. Its plan is specially 
designed to admit of the continued growth and 
extension of the hospital without injury to its 
unity or to its architectural symmetry. It com- 
prises a central building and a series of lateral 
pavilions, each designed to accommodate ninety 
patients. The central building consists of a 
basement floor, three stories, and a Mansard roof. 
* This sum lias been appropriated by tbe Legislature. 31 
It is sixty feet front by one hundred and fifty 
deep. It contains a lecture room on the basement 
floor for two hundred persons, and a great amphi- 
theatre in the upper portion, capable of seating 
seven hundred. It contains, also, the general 
kitchen, offices of administration, sleeping rooms 
for Resident Physicians, apartments for private 
patients, etc. 
It is proposed to erect at present but two pa- 
vilions, which are to be connected with the cen- 
tral building by corridors about forty feet long. 
The entire structure will be about two hundred 
and twenty feet long, and will front on the south 
side of Spruce Street but a short distance back 
from the curb, so as to allow as much space as 
possible in the rear for exercise and ventilation. 
Each pavilion will consist of a basement floor 
(devoted to dispensary work, servants’ rooms, 
cells for mania a potu patients, etc.), two main 
floors, and a Mansard roof, with rooms for ser- 
vants. The laundry and heating apparatus will 
occupy a building immediately in the rear of the 
centre building; and the entrance for patients, 
waiting room, morgue, and pathological labora- 
tory another small building on Pine Street. 
The foundations of the central building and 
west pavilion are already far advanced. 
It is generally known that the Board of Trus- 32 
tees of the University determined to sell the 
ground where we now stand in order to obtain 
funds for the erection of the new buildings in 
West Philadelphia, and also that a Commission 
appointed by the Government of the United 
States has reported in favor of its purchase as a 
site for the public buildings required in this 
city. The Congress has made an appropriation 
for this object, and now it only remains for the 
Secretary of the Treasury to approve of the re- 
port of the Commission, which was presented 
several months ago. There is every reason to 
believe that this approval will not be withheld.* 
As soon thereafter as possible, a building for the 
Medical Department will be erected in the imme- 
diate vicinity of the University Hospital. These 
two buildings will harmonize in architecture with 
that of the Department of Arts, whose beauty is 
wTell known, and when they are completed, and 
the grounds around them appropriately inclosed 
and adorned, they will be among the finest public 
edifices of Philadelphia. 
The Medical Department, possessed of a model 
hospital entirely under its own control, will also 
be at the very doors of the Philadelphia Hospi- 
tal, one of the largest in the United States; and 
* Since the delivery of this Address the Report has been approved. 33 
within a short distance, a third, the Presbyterian 
Hospital, will, in a short time, present all the 
characters of a first-rate clinical institution. 
Such advantages, concentrated within so small a 
space, are probably quite unrivalled. To them 
must be added the great gain to the students of 
exchanging a site in the midst of a crowded 
and noisy neighborhood, filled with innumerable 
temptations, for one which is beautiful in itself 
and remote from riot and dissipation, where the 
grounds insure a wholesome atmosphere, and 
where all the surroundings will he harmonious, 
and invite to a decorous and studious life. 
With this statement before you, gentlemen, of 
what our Medical School ought to be, of the 
means by which it can he placed in its proper 
position, of the work that has been performed 
and is still vigorously carried on for erecting and 
endowing its Hospital, and of the advantages 
that will accrue to it from this source, as well as 
from its translation to a new locality, I leave the 
subject to your study, and commend it to your 
earnest and active co-operation. 
Time fails me to present it in all its hearings, 
and especially to elaborate the ideas which crowd 
upon the mind in reference to the harmony which 
ought to exist between this new-birth in material 
things, and a reorganization of our system of 34 
medical education. But if I shall have inspired 
some of those who hear me with fresh motives to 
love and venerate our Alma Mater, and to labor 
for her future greatness, I shall feel the less re- 
gret that the honorable and grateful duty confided 
to me has been so imperfectly performed.