A. [REPLY 
TO 
DR. JOHN VAN BIBBER 
ON 
“ THE FUTURE INFLUENCE OF THE JOHNS 
HOPKINS HOSPITAL ON THE MEDICAL 
PROFESSION OF BALTIMORE.” 
BY 
JOHN S. LYNCH, M. D., 
Professor of Principles and Practice of Medicine in the College of 
Physicians and Surgeons ; Member of the Medical and Chi- 
EUEGICAL PaCTJLTY OP MARYLAND ; CORRESPONDING MEMBER 
op the State Medical Association of Alabama, 
&c., &c. 
A Reprint from “Southern Clinic. 
RICH M O N D : 
WHITTET & SH EPPERSON, PRINTERS, 
1879. A REPLY 
TO 
DR. JOHN VAN BIBBER 
ON 
“ THE FUTURE INFLUENCE OF THE JOHNS HOP- 
KINS HOSPITAL ON THE MEDICAL PRO- 
FESSION OF BALIMORE. 
Baltimore, August, 1879. 
Editor of the Southern Clinic. 
Dear Sib: At the last meeting of the Medical and Chi- 
rurgical Faculty of Maryland, Dr. John Van Bibber, of Bal- 
timore, read a paper whose title wTe have given above, and 
which that body, very properly we think, twice refused to 
print in its transactions; whereupon Dr. J, Yan Bibber 
printed and published it at his own expense, and, as appears, 
sent copies of it to the secular press of this and possibly of 
other cities. The Sun, a daily paper published in Baltimore, 
received a copy, and in its% issue of July 18th prints an ex- 
tensive notice of the paper, in which most of the statements 
that were so objectionable to the Medical and Chirurgical 
Faculty are reproduced, apparently with entire approval and 
evidently with great, glee. 
It would probably be a useless task to undertake to show 
the Sun writer that he was entirely in error in attributing 
to the Medical and Chirurgical Faculty the motive tor re- 
fusing to reprint this paper—that its strictures were “ un- 
palatable”—but rather that they were untrue; and he would 
doubtless feel grossly insulted if we told him that he did not A REPLY TO PR. JOHN VAN BIBBER. 
understand what he was writing about. But it is well known 
to every medical man that the ignorance evinced by the editors 
of the secular press of all medical matters is absolutely phe- 
nomenal. And yet it seems there is not one of them, from 
the editor of the blew York Herald down to him of the 
smallest village thumb-paper, who does not seem to think 
himself competent to instruct the ablest professor in the 
world how best both to teach and practice medicine. 
* ‘All other callings are by calm behest 
Resigned to those who understand them best 
But every wordy theoretic leech 
Can tell the teacher how he ought to teach. ” 
We shall therefore leave the editor of the Sun to the enjoy- 
ment of his sublime self-complacency. 
But as Dr. Yan Bibber’s paper contains several proposi- 
tions which we think questionable, a brief discussion of them 
in the Clinic seems to us neither “ unwise” nor “ unneces- 
sary.” In this paper Dr. John Yan Bibber has undertaken 
the ungrateful task of belittling his native city and depre- 
ciating the culture and enterprise of his profession by assert- 
ing (for he offers no proof) that “Up to this time we have 
had no general hospital in Baltimore. Unfortunately a few 
small institutions of limited means and circumscribed useful- 
ness have proved our poverty in this regard,” etc. That the 
state of the medical profession in this city is “in almost the 
same condition as we might expect to find the profession of 
a much more obscure and less populous community. It de- 
rives little or no advantage from the institutions that should 
exist in a city of 100,000 inhabitants.” That “having no 
centre of observation and research, the literary efforts of 
medical men here have been meagre, scanty, and unimpor- 
tant.” That “during the last fifteen years the standard of 
medicine here has even descended lower. About that time, 
by a certain combination of circumstances, the ranks of the 
profession suddenly received great accessions, partly from 
strangers selecting this city as their home, and in great part 
by the unwise and unnecessary establishment of two new A REPLY TO DR. JOHN VAN BIBBER. 
5 
medical schools without an effort on the part of any of them 
to raise the standard of education. The rivalry to attract 
students, added to the general laxity of examinations (a 
worse abuse), the establishment by certain schools of a bene- 
ficiary system unguarded by any requirements. By the 
working of this questionable system any person, because he 
was a man and wanted to be a doctor, however uneducated 
and unworthy he might he, was launched upon the commu- 
nity to assume all the privileges of a practising physician,” 
etc. (Italics our own.) 
Now, these are all grave charges; and if true, no able, 
cultivated and ambitions member of the profession will ever 
think of selecting this city as the field of his labors, and no 
medical student who desires to obtain a thorough medical 
education will select one of our medical colleges for his alma 
mater. Let us see if they are true! 
That Baltimore has no great hospital, covering acres of 
ground like some of those in Europe, and such as the Johns 
Hopkins Hospital promises to be, is undoubtedly true; and 
we think the people of Baltimore are to be congratulated 
that it is true; for all experience heretofore has proven 
that the larger the hospital and the greater the aggregation 
of patients in them, the greater has been the death rate in 
them. So well established has this fact become, and so 
completely admitted, that the subject of “Hospitalism” has 
formed the theme of discussion for the ablest members of the 
profession in Europe; and for the last twenty-five years a 
very considerable portion of the medical literature of those 
countries has had this fact for its subject. But that “up to 
this time Baltimore has had no general hospital ” we deny. 
For more than forty years we have had one, and for more 
than ten years two general hospitals connected with our 
schools of medicine. These are small, it is true, compared 
to the great hospitals of Vienna, Paris, or London; but they 
are probably as well equipped and supplied as any in the 
world, and up to this time at least have been sufficient for 
the needs of our city, whose population, by the way, is pro- 6 
A REPLY TO DR. JOUR VAN BIBBER. 
bably nearer 300,000 than 400,000, as Dr. Yan Bibber as- 
serts. In addition to these there are numerous hospitals— 
general and special—in this city under sectarian control; so 
that Baltimore is probably as well supplied with hospitals 
as any city in the United States of equal population. 
That our alms-house, as Dr. Yan Bibber asserts, “which 
in other cities would constitute an important element in med- 
ical education, is here rendered useless by the constant 
changes of municipal preferment, and the inaction of polit- 
ical trustees,” is to a certain extent true. But we submit 
that an alms-house was never intended to be—nor should it 
ever be made—a hospital for the treatment of acute diseases. 
Besides, the remoteness of the Baltimore city alms-house 
from the populous centre of the city will always prevent, its 
extensive use as a hospital, and can never be made “an im- 
portant element of medical education,” on account of its in- 
accessibility. 
What that state of the medical profession may be which 
“we might expect to find in a much more obscure and less 
populous city” than Baltimore, we confess that we do not 
clearly apprehend; but when Dr. John Yan Bibber asserts 
that “ the literary efforts of medical men here have been 
meagre, scanty, and unimportant,” he only shows his want 
of knowledge ot the current medical literature of the last 
ten or fifteen years. It is true that no medical man in Bal- 
timore has laboriously collected, translated and collated the 
results of other people’s labors and published them as their 
own, as has been done in some other American cities; but 
this I think is rather a matter of congratulation, not re- 
probation. But if Dr. Yan Bibber has read the medical 
journals faithfully during the period I have mentioned, he 
must have seen many valuable contributions to medical 
literature in almost all departments of medical science by 
Baltimore physicians. The city of Baltimore certainly has 
as many flourishing societies as any other city in the country 
of equal population; and that “two new medical schools’’ 
should have been established within the period mentioned A REPLY TO DR. JOHN VAN BIBBER, 
7 
certainly testifies to the energy, industry, ambition and cul- 
ture of the physicians of Baltimore—qualities which Dr. Yan 
Bibber seems to deny them entirely. 
But was the establishment of these two new schools un- 
wise or unnecessary ? At the end of the war, in 1865, the 
whole country, and the southern states particularly, had 
lost many of their best physicians. Some had found honor- 
able graves upon battle fields; many had succumbed to disease 
contracted in the line of duty in camp, field and hospital; 
while others had retired in the natural order of things from 
age and growing infirmities. In the mean time the ordinary 
supply of new physicians had been completely cut off in the 
south, by the closure of all the southern colleges for four 
years ; and partially also in the north by the diversion of 
young men to the array, and to more lucrative pursuits 
opened to them by the “ ephemeral and fictitious financial 
prosperity engendered by the war.” 
In the south, large communities were sometimes left with- 
out a doctor; and it is well known that in many instances, 
hospital stewards and nurses who showed some aptitude for 
surgery, were appointed by the Confederate government as 
assistant surgeons in the army. 
In consequence of this state of facts, when the war 
ended there was an extraordinary rush to the various medical 
colleges. In some of the schools north of us, there were 
assembled classes of more than six hundred students; and 
the impossibility of affording such numbers any really val- 
uable clinical instruction in the practical art of medicine, 
must be apparent to any thoughtful medical man. Under 
these circumstances, we think the establishment of two new 
schools here, by whose exertions large numbers of western 
and southern men were attracted to Baltimore instead of to 
Philadelphia and Hew York, and by which the classes in the 
schools of those cities .were reduced to something like man- 
ageable numbers, was neither “ unwise ” nor “ unnecessary.” 
A reduction of the rather exorbitant fees for college in- 
struction to the young men of the south, who had been 8 
A REPLY TO DS. JOHN VAN BIBBER. 
financially ruined by the results of the war, by granting them 
special terms, was certainly not a “ questionable ” proce- 
dure, but one perfectly just, humane, and beneficent. But 
that “ by the working of this questionable system, any per- 
son, because he was a man and wanted to be a doctor, how- 
ever uneducated and unworthy lie might be, was launched 
upon the community to assume all the privileges of a prac- 
tising physician” we believe to be totally untrue. We do 
not believe that one single person has studied medicine be- 
cause of the establishment of the two new schools in Balti- 
more, who would not have done so under any circumstances ; 
nor do we believe that any one has passed through either of 
these schools who could not, and would not, have passed suc- 
cessfully through the older schools. 
But the gravest of Dr. Van Bibber’s charges is “ that the stan- 
dard of medicine here has descended even still lower,” partly 
in consequence of the great number of “ strangers selecting 
this city as their home,” but more especially on account of 
the “unwise and unnecessary establishment” of these two 
unfortunate new schools. Let us examine this charge and 
see if there is any truth in it. 
The last number of the Maryland Medical Journal con- 
tains a communication presumably from a member of the 
Faculty of the University of Maryland, in which it is stated 
that in that school— 
“Fifteen years ago, there was a corps of six professors, 
and a demonstrator of anatomy; the branches taught were: 
I. Surgery; 11. Chemistry; 111. Practice of Medicine ; IV. 
Obstetrics, and Diseases of Women and Children ; V. An- 
atomy and Physiology, and VI. Meteria Medica and Thera- 
peutics. 
Clinical Medicine and Surgery were taught practically at 
the Infirmary adjacent to the medical college, by the re- 
spective professors, who gave two clinics on medicine and 
two on surgery every week during the, winter session. Very 
few medical schools then had equal advantages for clinical 
instruction. 
Now let any one examine the circular of the present day, 
and he will find a corps of eleven regular professors, with a A REPLY TO OR. JOHN VAN BIBBER. 
9 
demonstrator of anatomy, an assistant demonstrator, and 
three prosectors. 
He will find the following branches taught: I. Chemistry; 
11. Obstetrics ; 111. Practice of Medicine ; IY. Surgery ; Y. 
Materia Medica and Therapeutics; YI. Physiology and 
Hygiene; YII. Diseases of Women and Children; YIII. 
Opthalmic and Aural Surgery; IX. Anatomy; X. Operative 
Surgery; XI. Dermatology. The professors, moreover, give 
special clinical courses on diseases of throat and chest, and 
on diseases of the nervous system. Yearly all give clinical 
instruction at the hospital, not only daily during the session, 
but during the entire year.” 
And more to the same purpose. 
The College of Physicans and Surgeons has ten professors 
(it had twelve at one time), and the Washington University, 
now defunct (as the editor of “the Sun” does not seem to 
know), had ten or twelve while in existence. 
The enlargement of the number of professors, and the se- 
lection of gentlemen who had proved themselves specially 
qualified to teach the branches of medical science assigned 
to them, and thus securing more thorough and exact teach- 
ing while facilitating the labors of the student in acquiring 
knowledge; the establishment of a hospital for the practi- 
cal teaching of obstetrics,—something entirely unknown be- 
fore in the South, and as is believed, in the United States; a 
hospital for the treatment of surgical diseases of women, where 
students are taught practically how to treat them ; the estab- 
lishment of an out-door clinic in connection with each of the 
hospitals, and a dispensary, at which more than 30,000 patients 
are treated annually ; special instruction in the treatment 
of diseases of the chest, throat, and eye and ear; the use of the 
laryngoscope and microscope in medicine; these are some of 
the improvements in medical teaching adopted during these 
fifteen pernicious years in which the “standard of medicine 
here has descended even lower,” improvements in which the 
College of Physicians and Surgeons has led the way, and vir- 
tually forced upon both the old school and the new. 
It is with some diffidence that we offer our opinions and 
assertions in opposition to those of Dr. John Yan Bibber 10 
A REPLY TO DR. JOHN VAN BIBBER. 
who was himself “ launched upon the community to assume all 
the privileges of a practising physician” during this dark 
period in the history of medical education in Baltimore; who 
has also given his personal and professional countenance to 
the “ questionable” system he denounces, by accepting a 
lectureship in one of those “ new schools” which, according 
to his observation, did not make “ an effort to raise the stan- 
dard of education,” and who ought therefore to know of what 
he speaks. 
But the writer has also been engaged in teaching in one of 
the new-schools for the last seven years, and while he has 
seen none of the evils which Dr*. John Yan Bibber denounces 
and deplores, he has seen all the improvements and advances 
heretofore enumerated; and can say with absolute truth upon 
his personal knowledge, that the final examinations have 
been made more searching and exacting from year to year, 
as these new and improved facilities for study have been af- 
forded to medical students; and as is proved by the large and 
constantly increasing number of “ rejections” by the school 
with which he is connected. 
Dr. Yan Bibber’s sneer at the “ strangers who have selec- 
ted Baltimore as their home” is as unjust and untrue as it is 
ungenerous. What is the true history of the Medical pro- 
fession in Baltimore since 1864 % 
The number and activity of its Medical societies is 
always, and justly, taken as a measure of the culture of any 
Medical community. If the recollection of this callow 
young doctor could extend back so far, he would know 
that, in 1864 there was one Medical Society in Baltimore, 
the Medical and Ohirurgical Faculty, which dragged along 
a precarious existence, sometimes not meeting for years, 
occasionally publishing a slim pamphlet, which contained 
little else than the minutes of its business sessions; while now 
that faculty is large in membership, flourishing in finances, 
active in scientific work; has established a valuable medical 
libary, which is rapidly growing, and publishes every year a 
volume of transactions that is a credit to the profession of the A REPLY TO DR. JOHN TAN BIBBER. 
11 
city and state. During the period mentioned by Dr. Van 
Bibber eight new Medical Societies have been established, six 
of which are now in a flourishing existence. The “ strangers” 
whom Dr. Van Bibber denounces have taken a leading and 
active part in the formation and sustentation of nearly every 
one of these societies; and a number of these “ strangers” 
may be found in the faculties of both the schools, who are be- 
lieved to be as talented, as honorable and honored, as any of 
those “ to the manor born.” 
Dr. John Yan Bibber ought to know, since he assumes 
specially to treat diseases of the mind and nervous system, 
and must therefore study the causes and motives of human 
action, that when civil commotion is attended by great social 
disaster, the weak and unworthy “ despair and die,” or sink 
under the depressing and degrading influences which assail 
them ; while the brave, the strong and good, tight against evil 
fortune as long as battle can be waged successfully. When 
this can no longer be done, they try to elude fortune by emi- 
grating. 
The profession in Baltimore have received no detriment 
from “ the strangers who have selected this city as thei¥ 
home.” Agrestis.