•RfePQRT OF THE COMMITTED. ON 
MEDICAL EDUCATION, 
MADE TO 
'('he judical Societi) of the State of California, 
tt 
By Jos. F. MONTGOMERY, M. D., Chairman, 
Extracted from the Transactions of the Medical Society of the State of 
California, for the year 1X76. 
SACRAMENTO : 
Sacramento Leader Printing Office. 
1876. REPORT OF THE COMMITTEE ON 
MEDICAL EDUCATION, 
MADE TO 
The j|cdic;il of the of California, 
At the Annual Session, Held at San Francisco, April, 187 G, 
By Jos. F. MONTGOMERY, M. D., of Sacramento, 
Member of the California State Board of Health, and of The American Medical 
Association ; Member, and one of its Board of Examiners, of the Medical 
Society of the State of California; Member and Ex-President of 
the Sacramento Society for Medical Improvement; Ex-Pres- 
ident of the Sacramento City Board of Health, Etc. 
Extracted from, the Transactions of the Medical Society of the State of 
California, for the year 1876. 
SACRAMENTO : 
Sacramento Leader Printing Office. 
1876. REPORT OF THE 
COMMITTEE ON MEDICAL EDUCATION. 
BY JOS. F. MONTGOMERY, M. D., OF SACRAMENTO, CHAIRMAN. 
At the fifth annual meeting of the Medical Society of the State of 
California, since its reorganization, convened in the city of Sacramento, 
April 21, 1875, the Committee on Medical Education, appointed for the 
ensuing year, was composed of the following members, viz : Jos. F. 
Montgomery, Sacramento, Chairman; F. W. Hatch, Sr., M. D., 
Sacramento; H. H. Toland, M. D.,San Francisco; T. H. Pinkerton, 
M. D., Oakland; Asa Clark, M. D., Stockton. 
The four last named gentlemen were all written to by the Chairman, 
and requested to contribute to the preparation of the Annual Report, 
but none of them responded. 
The duty has therefore devolved upon him to undertake the work 
unaided, and as the result of his labors he begs leave respectfully to 
offer the following report : 
. So much has been written and published from time to time within the 
last thirty years, on the subject of medical education, and so many 
able and exhaustive reports on the same interesting and important 
theme have been prepared and presented by committees of State Medi- 
cal Societies and of the American Medical Association, and which 
appeared in their respective Transactions, that it would be out of place, 
now, to offer to this Society a detailed account of the discussions and 
controversies that have been indulged in; of the changes that have 
been made in the character and the curriculum of the medical schools, 
whether for good or ill, here or elsewhere, or to present a very full 
comparison of the systems of instruction generally prevailing in such 
institutions in this country and with other civilized nations. 4 
But we must not be indifferent observers of the conflict long pending 
and still existing on a subject that affects us so vitally as a profession, 
and in which the well-being of the public is so profoundly involved. 
It is a conflict, in a great measure, between truth and error, between 
generous, enlightened philanthrophy and sordid, sharp-witted selfish- 
ness. Or, at best, the result must determine whether we shall have 
learned, accomplished, skillful physicians, who would command public 
confidence and respect, and satisfy the demand for medical council and 
assistance; or whether we shall have imposed upon us ignorant, unre- 
fined and blundering practitioners, who would disgust their patrons, 
destroy the confidence of such in the regular profession, and drive 
them, as is now being the case in many instances and apparently in a 
steadily increasing degree, to the artful, specious disciple of Hahne- 
mann, or to the follower of some other pretended new system of the 
healing art. 
Although it is discouraging that so little comparatively has been 
accomplished in this country by the labors expended in behalf of the 
general reformation and improvement of the profession, and the eleva- 
tion of the standard of medical education, it will never do to give up in 
despair, and to surrender the field to those who dishonor their calling 
by entertaining low views in relation to professional learning and ethics, 
and who are, many of them, really inclined to virtual empiricism or 
arrant charlatanry. Rather should the true and courageous advocates 
of a great cause become the more determined and resolute in the face 
of disappointment and difficulty, and be inspired to redouble their 
efforts in such behalf. To be incited to this course, and to realize the 
need of it, let them but remember that not only the dignity and future 
usefulness of a noble profession depend upon their continued and 
stronger exertions, but also the health and, more or less, the very life 
of individuals, of communities, and of nations; for our mission is to 
conserve, to the extent of our ability, the health, the life and the gen- 
eral well-being of the entire human race. An antagonism unfortun- 
ately exists hero between individual physicians, between the medical 
schools, and between the members of the medical societies and asso- 
ciations, on this vital subject of medical education, and we should all 
promptly and boldly take sides in a contest so urgent and momentous. 
The issue is well made up-one side, as you are aware, favoring a decided 
elevation of the standard! of education, both preparatory or literary 
and professional, urging considerable addition, to the former or existing 
curriculum of studies, and insisting upon thoroughness in teaching and 5 
and learning in every department; while the other opposes the exaction 
of any preliminary education or examination, and favors generally a 
low standard of professional requirements for the doctorate, at a small 
cost to the student. We unhesitatingly and decidedly take our stand 
with the first, that favoring progression and the successive elevation of 
the standard of education until it shall have attained the huffiest 
degree of comprehensiveness and thoroughness that may seem at all 
desirable or really of any practical utility. 
The greatest difficulty the profession has had to contend with, and 
which still confronts it, and the most formidable hindrance to its 
intellectual and moral worth, and to the steady advancement of scien- 
tific learning in its schools and among its members, has arisen from the 
establishment of an inferior order of medical colleges by unworthy or mis- 
guided men, who are and have been willing, apparently, to prostitute 
and degrade their calling for gain, by offering cheap but poor instruction, 
and granting diplomas to large numbers of persons devoid of the men- 
tal or educational qualifications to fit them for the delicate and respon- 
sible duties devolving upon the medical practitioner, to the sore 
reproach and detriment of the entire fraternity. 
To cure this crying evil, and to purify and elevate the profession, the 
American Medical Association was instituted in 1847. The purpose of 
those who conceived and carried into effect that grand enterprise was 
eminently pure and noble ; and for their wise foresight in projecting and 
their judicious action in organizing that potent and beneficent instru- 
mentality, which has proved by its sound instruction and its admirable 
ethical laws such a blessing and rallying point to all true-minded mem- 
bers of the profession everywhere, they should ever be esteemed and 
honored, and their names be rendered illustrious in the annals of 
medicine. 
The Association has, indeed, accomplished much, by bringing the pro- 
fession together from every quarter of the country ; by inspiring among 
them a spirit of emulation ; by encouraging habits of more careful 
observation and wider research; by inducing the production of many 
able and valuable papers on the nature and treatment of the diseases 
prevailing in different sections of the land, and especially by engender- 
ing a true and real esprit de corps among its members. It has also 
achieved much in the line of the chief purpose of its original institu- 
tion-the elevation of the standard of medical education, through the 
agency of its numerous exhaustive reports, and its wise and earnest 
recommendations, favoring that grand aim. We have had this illus» 6 
trated in the advanced changes made towards that end by many of o ur 
best and most distinguished schools ; for as the professors of those 
institutions are generally members of the Association, it is reasonable 
to infer that their mingling and conferring together at its meetings 
exerted a happy influence upon all of them, and had much to do with 
their action in elevating the grade of education within their respective 
spheres of labor. We should not, however, at the same time, withhold 
any credit due personally to those gentlemen as individuals, or in their 
character as members of Faculties, for whatever they may have done in 
the direction indicated. Here we have a reliable verification of the 
influence and effect of its moral power. 
But in the meantime, the advocates of an imperfect education, 
recreant members of the profession, have been industriously at work, as 
heretofore intimated, in establishing poor schools ; in attracting to them 
crowds of comparatively ignorant students through the tempting induce- 
ment held out of a short and easy course of instruction for only trifling 
compensation in return, and then in granting indiscriminately, in 
exchange for money as in any other traffic, diplomas that confer upon 
their holders all the rights and privileges appertaining to the vocation 
of medicine. But for such base and notorious proceedings, so calcu- 
lated to cast more or less suspicion and distrust upon all bearing the 
title of physician, added to lesser faults in other directions, our profession 
should serve as a sure passport to social position and to the respect and 
confidence of the afflicted, while its votaries would probably be readily 
accorded, without a resort to chicanery or other unworthy means, ample 
remuneration for their professional services. 
The case or example here presented, though true, is an extreme one; 
but there are many other establishments of defective character, varying 
and ranging in degree all the way up from this worst of the brood to 
the lowest grade of medical school that is recognized by the highest 
class of our medical universities and colleges, end whose graduates are 
accepted by the more enlightened and discriminating portion of the 
public. 
Notwithstanding what the Association has effected, as claimed for it, in 
its noble efforts to promote the cause of thorough education, many of 
its ablest and most zealous members are greatly tried and discouraged 
because it has accomplished no more in that behalf ; and they attribute 
its short-comings in that respect in a great measure to the fact that 
many of the teachers and graduates of these inferior schools have gained 
.admission into its body, and have there interposed every impediment 7 
in their power to the success of any scheme or measure having in view 
a radical change in the existing faulty system of instruction, and any 
material addition to the curriculum of studies, either academic or pro- 
fessional, designed to be adopted by all, and to be satisfactorily passed 
through by every candidate as an imperative pre-requisite to his gain- 
ing what would then unquestionably be the honorable degree of Doctor 
of Medicine. Under these circumstances it is clearly the duty of every 
State Medical Society, and of every local society, to lend a helping 
hand, to the extent of their ability, in this vital struggle, and to offer 
every encouragement to their distinguished brothers who are bravely 
striving for the supremacy of truth, of right, and of science, to subserve 
the dignity and honor of the profession, and to protect the life, pre- 
serve the health, and promote the general well-being of the people 
at large. 
In this important work the Association has been assisted by its better 
and more prominent members, particularly by its Presidents, including 
our lamented Logan, but, we regret to say, two of its presiding officers, 
one in 1872 and the other in 1875, both, noticeably, residents of the same 
State, have thrown the weight of their talents and official position on 
the side of the obstructionists, to the great damage of the righteous 
cause that we esteem above all others affecting us. This gross betrayal 
of a sacred trust should not be meekly tolerated and passively submitted 
to ; but the' Association should, in all such cases, express itself in the 
most decided terms of disapprobation and condemnation, and signally 
rebuke all, however exalted in station, who may dare to insult 
the well-understood sentiments of its loyal members, and rebel 
thus openly against the avowed objects and purposes of its original 
organization, and the declaration of its principles and policy, oft 
repeated, enunciated by its chosen committees to whom the 
special subject of medical education has been confided for consid- 
eration and recommendation. We cannot afford to trifle or compro- 
mise with error, in whatever guise, where so much is at stake ; and no 
individual guilty of a grave wrong should be exempt from the severest 
chastisement, or even the direst disgrace if necessary, to subserve the 
interests of a noble cause or a great people. One of these addresses 
just alluded to, the one delivered in 1872, was most thoroughly and tri- 
umphantly answered in a paper of rare merit, in both diction and argu- 
ment, readj before this Society in October of that year, by our able 
and accomplished medico-legal friend, Dr. E. R. Taylor. Of this con- 
tribution to the cause of sound and thorough learning we have a right 8 
to be abundantly proud, and for it the author is richly entitled to 
an unanimous vote of thanks. 
A large majority of the honorable members of the profession every- 
where agree, we believe, as to the necessity for reform and a very 
high standard of education, coupled with thorough practical training, 
but the difficulty is to secure perfect harmony of views, earnest 
co-operation, and cordial concert of action on the part of the Asso- 
ciation, the medical societies and the respectable schools of the 
country. The Association being a national representative body, 
to which the societies and the schools should in a great measure 
defer, particularly as all of them may be well represented therein, 
should be looked to for the initiative and quasi-authoritative step in 
the important work contemplated, and all others should cheerfully 
strengthen and sustain it by their earnest words of counsel and encour- 
agement. 
It should, therefore, at its approaching session, no longer doubting 
or hesitating as to its duty, boldly and confidently prepare and promul- 
gate a system of education contemplating or prescribing the highest 
standard and the most enlarged curriculum that in its judgment may 
be deemed wise or desirable for the general adoption of the schools, 
with the unequivocal and emphatic declaration at the same time that 
no teacher or graduate of any school not accepting or adopting it should 
be admitted into its sacred and exclusive fold. Let it but do this and 
we have the abiding conviction that the great mass of the profession 
would enthusiastically rally to its support, and that the schools, one 
after another, would fall into line, as would, under like stress or incen- 
tive, the intrepid defenders of a holy faith. 
Some may regard these propositions and predictions as impracticable 
and visionary; but if they be so to some extent, it should be remem- 
bered that if we would accomplish anything of special note-would 
achieve any great reformation, or attain any grand and beneficent end, 
we must prescribe for ourselves exalted aims, and engage in the work 
laid out with a fervid zeal and an untiring energy. If we aim at little 
in this important undertaking, or faint by the wayside, we shall accom- 
plish far less than hoped for, and be compelled to plod on under the 
same unsatisfactory and vexatious condition of things we have been so 
much deploring. 
To awaken general interest with the profession and to concentrate 
effort, the Association should issue an address to all medical schools and 
State Medical Societies in the Union, as well as to local medical socie- ties and prominent members of the fraternity in every State, urging 
co-operation in the important work, and advising the formation of State 
Societies where none may at present exist, that such concerted action 
may be utilized as far as practicable in accomplishing the end aimed at. 
To this extent the moral influence of the Association would be exerted, 
and would do good by exciting general interest and inducing the need- 
ful co-operation. 
But inasmuch as such efforts have thus far been inadequate to 
effect the improvement intended, the strong arm of the law must be 
invoked to compel and perpetuate the reform deemed so indispen- 
sable. To secure this potent agency, which has operated so happily 
in European countries having strong governments, it should memo- 
rialize the State Legislatures in all the States, entreating all such 
legislative departments, in the interest of the people, not of the pro- 
fession, not only not to grant any more charters for medical schools, 
but to repeal or revoke many already granted, to the end that the spec- 
ial evil in question shall be abated as far as possible. It should also 
ask for a remodeling of all existing charters, prescribing in the amended 
form the amount and character of the preliminary education to be ex- 
acted to allow admission into the schools, and setting forth, in clear 
terms, the curriculum of studies to be adopted by them; the number 
and length of the sessions or semesters into which the entire term shall 
be divided, and the time to be devoted to each subject and the order 
and manner in which it shall be dealt with. In short, the entire sys- 
tem of education required to be conformed to, before the honor of the 
doctorate shall be conferred, should, in all its essential details, be pre- 
scribed by law, and suitable and effective penalties be provided and 
rigidly enforced for any violation of the terms and conditions of such 
amended charters. Without this action, brought about by the united 
appeal and zealous co-operation of all true medical men everywhere, 
whether in Faculties, in Societies, or in the Association, no absolute 
reform need be hoped for or anticipated. That is the opinion of many 
able men in our ranks, as we have gathered from their writings; and 
neither the Association, nor any respectable school or society anywhere, 
seems to cherish any hope or expectation of realizing any substantial 
benefit by further reliance upon mere moral suasion, and an appeal to 
the pride and professional spirit of the profession at large. There are, 
unfortunately, too many in the ranks, or engaged in teaching, who 
lack the genuine espret de corps so highly prized and sedulously cultivated 
by the nobler and more honorable members, and who are too selfish, or 
9 10 
too indifferent to the real wants of the country in this particular, to 
heed or respond to such appeals. Tufts or clods alone will not avail 
with these, and solid stones only, dealing hard and stunning blows, can 
be relied on to bring such incorrigible recusants to their senses. 
It is undeniable that we have too many schools of medicine author- 
ized to grant diplomas, and the consequence is that the profession is 
overcrowded in every portion of the country with notorious incompe- 
tents. It is only necessary to state these patent facts to challenge their 
acceptance as true by all who are even moderately well-informed on the 
subject, and hence the necessity for the incisive, sweeping remedy 
demanded. 
To know how we stand relatively with our brethren in some of the 
more enlightened countries of Europe, and to learn our duty to our- 
selves, it is sufficient to compare the systems of education as existing 
there and here, and to cite the laws enacted in the two regions, designed 
to regulate the practice of medicine, and to protect the public and the 
profession against every species of imposition and injustice. 
In France, Austria, Prussia and Italy, where the systems and the 
curriculum of studies are very similar, the terms of study continue 
from four to six full years, or ten months in each year, divided into two 
sessions or semesters of five months each, the curriculum embracing 
from fifteen to twenty-five different subjects and requiring from twenty 
to thirty-five full professors, besides assistant professors or other subor- 
dinate teachers, numbering, altogether, in some institutions, about one 
hundred persons. All these medical institutions require a liberal pre- 
liminary education, attested by certificates from literary or scientific 
schools of repute at which the applicants may have been educated, and, 
in all, the most rigid and exacting rules are enforced, that the pre- 
scribed requirements shall be fully and faithfully complied with-no 
evasion, or shirking, or partial compliance, under any pretext whatever, 
being allowed or tolerated. They also have schools of pharmacy con- 
nected with the regular medical schools, which, under their require- 
ments, must be attended a certain time. 
In all their schools clinical and practical teaching, most thorough, in 
the different departments of medicine, is conducted by able and compe- 
tent men ; and besides the hospitals on an extensive scale, with several 
divisions for all important classes of disease, and the numerous beds 
and other superior facilities for a number of distinct classes, the collec- 
tions, museums, libraries, laboratories, botanical gardens, etc., consti- 
tute a remarkable array of material aids And every student is required 11 
to attend regularly upon hospital instruction and to avail himself of all 
the other aids enumerated. He is also subjected at stated intervals to 
the most searching examinations, to test his fidelity and measure his 
knowledge, that there may be no opportunity for lagging or evading any 
exaction. And after the final examination and the granting of the di- 
ploma by any particular institution, the graduate is still, in some of 
these countries, subjected to a further State examination before lie is 
allowed to enjoy the full privileges of the profession ; and in all a cer- 
tain service is prescribed in practice prior to such full enjoyment, to in" 
sure the experience and practical skill necessary for the safe exercise of 
his professional duties as a general practitioner. 
In all the countries named the most absolute laws are stringently ex- 
ecuted to prevent any one from practising in any department of medicine 
or in pharmacy, without the required credential; and upon any having 
the temerity to disregard these laws the severest penalties are very 
surely inflicted. 
While in these great and populous cpuntries there are many prepara 
tory medical schools, there are in each only from three to four superior 
schools competent to confer the degree of doctor of medicine, which 
alone, in addition to other requirements, secures the privilege of full 
practice in medicine and surgery. 
In Great Britain the number of medical schools recognized by the 
highest medical authority is from thirty-five to forty. The schools 
proper are divisible into such as grant degrees, and such as only give 
certificates of study. To the first, belong the university schools in gen- 
eral ; to the latter, hospital schools and most of the independent schools. 
The second class stand, therefore, in a relation somewhat like that of 
grammar schools to the degree-conferring institutions. This second 
class agree in giving instruction in the same essential branches of medi- 
cine, and having a winter session and a summer session, which together 
occupy the entire year, and also in expecting the students to follow the 
courses of study at least three years. 
The courses of instruction in the institutions having power to confer 
degrees differ from those in the foregoing only in that they extend 
through a period of four years, and, in general, are given by a class of 
more eminent men, each confined to one individual branch named in 
the curriculum of study. 
The degrees conferred in Great Britain are those of bachelor of med- 
icine, master of surgery and doctor of medicine. The degree of doctor 
of medicine is conferred only upon candidates who have obtained the degree of bachelor of medicine, have spent since their graduation at 
least two years in attendance upon a recognized hospital, or in the mili- 
tary or naval medical service, or in medical and surgical practice, and 
are either possessed of the diploma of bachelor of arts from a recog- 
nized university, or have passed a satisfactory examination showing an 
amount of knowledge entitling them to such diploma. In the entire 
Kingdom there are only three institutions, as we understand, author- 
ized to confer the degree of bachelor of medicine or doctor of medicine, 
and in London ,only one-the University of London. This is a corpo- 
ration entirely unconnected with teaching, but consisting of a body 
possessed of legal power to examine all applicants for degrees who have 
complied with a curriculum prescribed by its ordinances. This plan of 
having the degree-conferring institution separate from and independent 
of those that teach is advocated by some as being the only reliable one 
to guard against the vicious system of granting diplomas to many who 
are really undeserving of such honor, but who are thus generously dealt 
with because of the sympathy or interest of their respective teachers or 
faculties. 
An Act of Parliament, passed in 18G8, entitled ' ' The Medical 
Act," and since improved by successive amendments, laid a broad 
foundation upon which has been built up a very complete and harmoni- 
ous system of medical education. It requires all practitioners to be 
registered, or else they cannot recover a charge; that no one shall be 
registered who is not certificated, licensed or graduated by one of the 
legally authorized societies or collegiate bodies named in the Act, and 
on the basis of qualifications already recited; provides a council to su- 
pervise all institutions to determine the faithfulness with which they 
fulfill their offices as educators, examiners and licensers, and to strike 
them from the authorized list if they fail to comply with the standard. 
The execution of this law is fully intrusted to this general council of 
medical education and registration, composed of persons of the highest 
character and attainments, invested with power to regulate the course 
of study, the manner of conducting examinations, the conditions of 
granting the diplomas, and generally with every authority necessary to 
insure the complete fulfillment or realization of the purposes of the Act. 
Such, in outline, are the advanced systems of medical education in 
Europe. 
And we may even go to South America to find models of medical edu- 
cational institutions that we might profit by patterning after. 
There are in Brazil two medical faculties, one being located at the 
12 13 
capital, both under the same governmental regulations. The course 
of study in these schools extends through a period of six years, and 
embraces twenty-one full professors, and twenty-one assistants, all of 
whom are appointed by the government, after .competitive examinations. 
Admission to medical study in these faculties is only after an examin- 
ation in the leading branches of a general education, applicants being 
particularly examined in Latin, French, English, history and geography, 
rational and moral philosophy, arithmetic, geometry and algebra. 
The annual and final examinations are rigid, and cover the whole 
ground of the medical course. The diplomas conferred are those of 
apothecary, bachelor of medicine, and doctor of medicine ; and no per- 
son is allowed to practise either pharmacy or medicine without such 
evidence of scientific preparation. Even foreign graduates of medical 
schools, with diplomas certified to by the consul accredited from the 
country where they were issued, and resident in Brazil, must pass an 
examination by one of the imperial faculties before they are permitted 
to offer themselves for practice. 
And now, when we turn to the United States, what do we find ? A 
few of the medical schools, how many we know not, much to their credit, 
have already demanded a more liberal preliminary education, have 
enlarged their range of professional study, and extended the length of 
their sessions, particularly noticeable among which we may mention the 
University of Pennsylvania, Harvard University, and the Chicago Medi- 
cal College. The University of Pennsylvania has very recently resolved 
that the time of instruction should be extended to three years, the 
diploma being granted after examination at the end of the third year; 
that the annual course of instruction should be prolonged, and that 
such instruction should be graded. It has also united the Medical 
Faculty and the Hospital Stall, t6 some extent, and has added four 
professorships to the Faculty of Medicine, making eleven altogether. 
Harvard has ten full professors, besides assistants, and its course of 
instruction has been so enlarged as to extend over three years, nine 
months being employed in study each year, and the studies so arranged 
as to carry the student progressively and systematically from one sub- 
ject to another in a just and natural order. 
"The Chicago Medical College," it seems, "was established in 1859, 
expressly for the purpose of carrying into effect the system of graded 
classes, longer lecture terms, and a much more extended as well as a 
much more systematic course of medical study and teaching. The sys- 
tem then adopted, and since carried out, of three courses, consecutive 14 
or graded, so as to secure one for each year of the student's period of 
study, with complete hospital facilities in every department, (each 
Didactic Chair having its corresponding Clinical Chair,) and laboratories 
for practical chemistry and mineralogy, together with a regular college 
term of nearly six months, and a supplementary term of three months, 
is in practice actually more complete than that of Harvard," or the Uni- 
versity of Pennsylvania. 
But very few of our medical schools employ more than from six to eight 
professors, or teach more than that number of subjects, their course or 
term extending over only four or five months per annum, with a sum- 
mer session of three months that students may or may not attend at 
their option, they not being required to do so as a part of the regular 
course prescribed for candidates for graduation. Here we allude to 
the respectable schools, many of which have been in operation many 
years, and have established a good reputation. 
But while we may say thus much for the better class of medical 
schools, we regret to be compelled to admit that there is a larger num- 
ber of them claiming to be regular that are glaringly defective in many 
respects, and whose existence is constantly working extensive and 
grievous damage to the public interest and reflecting increasing disgrace 
upon the medical profession. They require no preliminary education; 
have a small corps of inferior teachers; a meagre curriculum, passed 
over in four months at most; whose very slight requirements are not 
rigidly enforced, but where, instead, diplomas are granted almost with- 
out conditions, except the payment of a sum to satisfy the necessities 
of the vendors of these spurious or worthless documents that serve 
only to mislead or deceive, while they are really entitled to no consid- 
eration or respect. And the worst feature in this matter is that schools 
of this very low grade are multiplying far more rapidly than those of 
the better class first alluded to. 
This is, indeed, a deplorable and mortifying condition of affairs, and 
the most distinguished and sagacious philanthropists in the country, 
and the best minds in the profession, including members of the Asso- 
ciation, and the more prominent and wiser of the medical teachers, 
should unite in devising means, or recommending a plan, whereby this 
great evil may be suddenly checked and finally completely eradicated. 
Unless successful action in this direction can be promptly had, a degree 
of demoralization and degradation must ensue in the profession the 
ultimate calamitous effects of which it would be difficult to foresee or 
estimate. In view of this unsatisfactory attitude of a vital question, it is not 
only legitimate for anyone taking a proper interest in the subject to 
express his individual opinions touching the matters involved, but it is 
his duty so to do, such opinions to be taken and estimated for what they 
may be worth. We propose to exercise this privilege, but before pro- 
ceeding to the task, we wish to say that, while presenting the medical 
schools of this country in very unfavorable contrast in many respects 
with similar schools in other countries, and lamenting the comparative 
inferiority of many of them, we are yet gratified that we can point with 
pride to some of them, and rejoice at the indications of improvement 
exhibited by many others. We also desire that our allusions to or our 
attitude towards the medical profession in this country should not be 
misinterpreted. Our sympathies, as one of its members, being all with 
it, and our concern for its character and welfare being decided, we have, 
of course, designed to do it no injustice, but to judge all connected 
with it fairly. There are within its pale every conceivable grade of 
worthiness, of qualification and of merit, as with the schools; and the only 
just rule to apply in estimating its character is to discriminate between 
the members, to judge each separately, and to accord credit or discredit 
to one or another in harmony with his real worth. Many of those 
engaged in active practice in the different sections of the country, par- 
ticularly in the larger cities, are very able and highly accomplished men, 
who have shown by their achievements in every department of medicine 
that they are fully equal as practitioners to their most distinguished 
brothers in foreign lands. Their success under adverse circumstances 
is to be attributed to native genius and vigor of intellect, jointly with 
great industry, and the fact, besides, that many of them have had the 
enterprise to seek and the means to enable them to enjoy the advan- 
tages of the best European schools to which flattering allusion has been 
made. We have a right to be proud of many of these our countrymen, 
but we should take special national pride in founding schools of our 
own fully equal to any to be found abroad. 
In this connection it is timely and proper to say that for many of the 
facts we have stated iu reference to these foreign schools we are mainly 
indebted to the Report on Education, made in 1870, by the United 
States' Commissioners to the Paris Universal Exhibition, held in 1867. 
As the author of this present report, and solely responsible for its 
views, we are ready to avow ourself as being in favor of a most radical 
and revolutionary change in the system of medical education prevailing 
generally in this country, and elsewhere to a limited extent. We would 
15 16 
abolish tho entire system of office instruction by a single practitioner, 
for, he being absorbed-in active practice that really leaves him no time 
for teaching, the pretended instruction he can impart [is necessarily 
faulty and inefficient in the highest degree. Under this system a mere 
office boy, employed in the first instance to perform menial service, and 
without any adequate education to prepare and fit him for the study of 
an intricate profession requiring a vast range of knowledge to qualify 
him for its duties, is often quickly inspired with the thought, and then 
with tho desire of becoming a physician; and after one or two years, 
or perhaps a few months only, of irregular and imperfect study, he is 
sent to a medical college; is hurried through a programme of eight or 
ten lectures a day ; and after attending two such sessions is sent forth, 
armed with a diploma, to assume responsibilities involving life or death, 
to the imminent peril of the diseased and suffering patient. Or a young 
man, after acquiring affair education, enters a physician's office as a 
student and passes through a course, probably of twelve or eighteen 
months' duration, of interrupted and irregular study, and then repairs 
to a medical school, to go through the same round of lectures in con- 
tinuous succession, one hour each, until from six to nine are listened to 
from day to day on as many different subjects. To spend such period, 
in the manner detailed, with a medical practitioner, is worse than waste 
of time, for he obtains by that course only a confused, incongruous 
knowledge of a few facts, and is quite unprepared to pass profitably 
through the hurried, cramming routine mentioned. 
But in lieu of these objectionable plans, it should be imperatively 
required of every student, as a pre-requisite to matriculation into any 
medical school, that he shall have received a liberal literary and scien- 
tific preliminary education, embracing Latin, Greek to a certain extent, 
Mathematics, Natural Philosophy, the elements of Chemistry, and 
Botany, besides a thorough knowledge of the English language-the 
lack of any previous medical instruction whatever being preferred. 
As to the medical schools, they should be of two classes-the pre- 
paratory and the degree-conferring. In the preparatory school begin- 
ners should be taught for two years or more, and be properly prepared 
to enter the higher school, where their studies would be continued an 
additional period of two years, or until they could pass satisfactorily the 
final rigid examination that should be prescribed for all candidates seek- 
ing the degree of doctor of medicine. The entire course of study 
should extend through at least four years, and each annual term should 
embrace ten months. A pai*t of this course may be spent in the one 17 
class of schools and another in the other, as thus far contemplated. It 
should be competent, however, and probably would be quite advisable, 
for the higher schools, authorized to grant diplomas, to adopt a regular 
course or term of four years, divided into four annual sessions of ten 
months each. In such case they might serve as both the preparatory 
and graduating school, the students being divided into four classes, one 
for each year of the full term, as a freshman, a sophomore, a junior 
and a senior or graduating class, as in literary or scientific institutions. 
It should be allowable, further, for any student to graduate at the end 
of three years, provided he could in that time pass creditably through 
the entire four years' curriculum, and be able to undergo satisfactorily 
the severe test to which he would be subjected at the final examination 
for the high degree sought by him, that of doctor of medicine. And 
where students so preferred they might pass the first two years of their 
time in the preparatory school, and the last two in the higher school 
entitled to grant this much coveted honor. In every school the stu- 
dents should be divided into classes, and the studies be so arranged and 
classified as to present them t'o the learners in proper consecutive order, 
thus preventing confusion, and insuring to them at every step of their 
progress a clear comprehension of the matters taught. 
The complete curriculum should embrace all the subjects usually 
taught in such schools, as well as such cognate subjects as should be 
mastered by the medical man, to prepare him for his great work. 
Among these should certainly be included psychological medicine and 
hygiene. 
It is well known that many of the diseases of the mind in their incip- 
ient stages, if quickly detected and promptly treated, may be arrested 
and cured, when, if neglected at that important and critical time, they 
may become hopelessly incurable. It is a matter of the highest mo- 
ment, therefore, for medical men to be so informed in that special class 
of cases as to be able to discover their true chaiacter at the time of 
their earliest invasion. 
And as for hygiene, its great practical importance and wide-reaching 
usefulness are becoming to be very generally conceded and appreciated, 
and a separate Chair on that subject has recently been established in 
many of the schools where previously it had been entirely overlooked 
and neglected. The importance of sanitary science -of preventive 
medicine-of all the knowledge and means that may be successfully 
brought into use to detect and remove, "stamp out," the causes of 
disease, particularly of endemics and epidemics, and thus to preserve 18 
the health, whether of individuals, of communities, or of nations, are 
facts so apparent and self-evident to all thinking and enlightened per- 
sons that there is no longer any excuse for not insisting upon thorough 
instruction in these subjects as indispensible to the completion of every 
physician's education. 
Nor should we forget the subject of medical ethics in our rapid glance 
at the multiplied departments of learning that have been already added, 
or have been proposed to be added to the curriculum of studies pre- 
scribed for the student to pass through before he shall obtain the docto- 
rate, or be allowed to exercise the functions appertaining thereto. This 
subject should be attached to the Chair of Hygiene, as such association 
seems more appropriate than any other; for while we are engaged in 
laying down rules for the preservation of the physical health of the peo- 
ple, we should be careful also to state and inculcate laws the observance 
of which is so indispensable to the moral health, or to the just moral 
views, of every member of the medical profession, and to wholesome 
harmony and good feeling among its members generally. We have an 
excellent code of medical ethics, provided by the Association at the 
time of its original organization, that if properly understood and ob- 
served by physicians in their daily intercourse with the public and with 
their fellows, would prevent many occasions of heart-burnings and dif- 
ficulty among them that are both annoying and discreditable to a very 
high degree. Unfortunately many are either oblivious of the existence 
of such a code, or knowing better, choose wilfully and culpably to dis- 
regard its wise and reasonable requirements. This code should be care- 
fully taught to all students, and its beautiful precepts be so impressed 
upon their minds that they could not forget them, nor fail to observe 
them in their subsequent professional life. Such faithful teaching, as 
a regular part of their education, would serve to instill into them the 
instincts and feelings of gentlemen, while they were being made learned 
and accomplished physicians. It has ever seemed to us that this sub- 
ject has been too much neglected, and we have aimed for seveial years 
to induce its adoption by the medical schools as apart of their regular 
curriculum of studies. It is to be hoped that it will no longer be es- 
teemed too lightly, nor be allowed in consequence to be still slighted or 
neglected, as in the past. 
In all these schools anatomy and chemistry, in their several depart- 
ments, should be especially well taught in the most practical manner, 
because like favorable opportunities for such instruction would not 
probably be subsequently enjoyed. And each student should be thor- 19 
oughly drilled also in the art of physical diagnosis, including the expert 
use of the different contrivances or implements designed to aid in such 
investigations, not excepting the microscope, and the skillful use of the 
instruments employed in general surgical operations, not overlooking 
the obstetrical forceps, as well as those specially adapted to operations 
upon the uterus, the rectum, the eye, the ear, the mouth and the throat. 
In brief, the ability to employ dexterously all the many ingenious con- 
trivances or inventions that have been devised of late years particularly, 
whether for diagnosis or for some delicate and important practical opera- 
tion, should be carefully taught to the student at some time before 
his graduation, that he may be able then to go forth to his work 
sufficiently prepared to devote himself safely to any department or 
specialty embraced within the wide range of the physician's studies, or 
the broad field of his operations. His medical senses, too, should be 
suitably cultivated and developed, that he may be able to exercise them 
with much practical benefit. And all should be encouraged to adopt 
the habit, at the very outset of their practical career, of close and care- 
ful observation at the bed-side, and of taking intelligent and faithful 
notes of the more interesting cases treated by them. 
To make it manifest that a liberal preliminary education should be 
insisted upon, embracing the sciences of mathematics, chemistiy and 
natural philosophy, it is bnly necessary to remember that the physician's 
vocation is one of extensive range, concerning the health and the lif 
of the human race, and reaching even to and affecting to a degree the 
strength and duration of nations. The preliminary study favored is 
necessary to develop the mind, to train it to think, to reason, to inves- 
tigate, and to solve many of the most difficult problems that are ever 
presented to the human understanding for solution. His investigations 
of diseases and their subtle causes require necessarily a very acute 
mind, the power of close and searching observation, sound reasoning, 
and the ability, by virtue of his ample scientific knowledge, to make, 
with the greatest exactness and accuracy, the most elaborate calcula- 
tions. The field of his observations and actions is diversified and im- 
mense, indeed, and none but men possessed of strong intellect, with a 
broad and comprehensive education, should dare to enter it. It is but 
brazen and arrant presumption for any others to do so; and all incom- 
petents should be sternly excluded from the honors and privileges of 
the profession, however long they may have studied, or earnestly 
striven to gain admission to the fraternity upon which is imposed such 
momentous responsibilities and duties. 20 
And should the standard of education as here suggested be adopted, 
and if none but men of liberal attainments and genuine merit were al- 
lowed to enter the profession, the best and brightest youth of the coun- 
try would flock to our superior medical schools, and an ample supply of 
thoroughly educated and highly competent laborers in this important 
and indispensable sphere of effort would soon be in readiness to meet 
the demand in every quarter of the land, in the rural districts as well 
as in the cities and towns. The railroads and other roads of travel, at- 
tended with lines of telegraph, are rapidly penetrating every section of 
the country, and new and inviting fields for occupation are constantly 
being opened up to the young and enterprising, including the medical 
adviser. There would be no danger, therefore, that the rural or 
sparsely settled districts would suffer for medical aid, if the incompe- 
tents and irregulars were debarred the privilege of practice, as it is ar- 
gued by the advocates of the low, lax system would be the case under 
the rigid action we have urged for the protection of all classes and sec- 
tions. 
The main ideas here advanced by the anther, it may be perceived, are 
a liberal preliminary education; the establishment of preparatory med- 
ical schools for beginners instead of having them rely on private pre- 
ceptors for any instruction received before entering a regular medical de- 
gree-conferring school, or that an equivalent provision be made in such 
regular school for that class of students; the greater length of time, 
not less than four years, required to be spent in attendance upon lec- 
tures and other modes of instruction ; the important and considerable 
additions to the curriculum of studies; greater attention to clinical in- 
struction, including physical diagnosis ; the more practical teaching of 
anatomy and chemistry; the thorough drilling of students in the art of 
handling dexterously the various contrivances and instruments used in 
practice, and the classification of students and studies, so as to insure 
the profitable consideration and the clear comprehension of the matters 
taught. 
If these suggestions be adopted and properly carried out, and if the 
numerous teachers and students but faithfully and diligently perform 
their respective parts of the work assigned to them, the graduates would 
emerge from their alma mater so thoroughly educated and qualified in 
every respect that the evils about which so much has been written and 
spoken would soon vanish, and we would hot much longer be troubled 
with incompetent or irregular practitioners, or with pretended new sys- 
tems of medicine. Such plan, taken comprehensively, if truly and 
honestly put in operation, would needs, it seems to us, more promptly 
and effectively overthrow and supersede than would any other expedient 
the faulty system of education heretofore existing and so strongly 
condemned, and remove from among us its natural and bitter fruit, the 
blighting curse of empiricism with which we have so long been afflicted. 
JOS. F. MONTGOMERY, M. D., 
Chairman.