LXXVI. 
REPORT ON THE MEDICAL AND DENTAL 
SCHOOLS 
To the Board oe Overseers of Harvard College : — 
HI 
Your Committee have the honor to report that the inadequacy of 
the present building for the needs of the Medical School is so serious 
a matter that some action has become necessary. This fact was 
recognized several years ago, and a number of meetings were held of 
a Committee, consisting of some members of the Faculty of the 
School and some members of the Visiting Committee, at which the 
subject wras fully discussed and immediate action decided on. This 
decision was, however, modified at a subsequent meeting in view of 
the fact that no alterations or additions were practicable in connec- 
tion with the present building which could be more than a temporary 
makeshift, and which would not be outgrown in a few years. Never- 
theless these alterations would be very expensive, and it was held 
that if the community were to be appealed to for money at all, it 
would be unwise to ask them to contribute a considerable sum for a 
temporary modification of the old building, when it was evident that, 
in a few years at most, it would be necessary to appeal to them again 
for aid in the construction of a new one. 
Action was therefore deferred, and as your Committee believe, 
wisely deferred, in order to await events and to see whether the 
increase of value of the land on which the building stands, an 
increase necessarily largely dependent on the character of the build- 
ings erected in the neighborhood, would be such as to justify its sale. 
Since that time no marked change has occurred, and in the meantime 
the need for more room inside the building has increased very much 
year by year. The need for enlargement was urgent then : it is now 
imperative. 
An increase in room sufficient to relieve immediate need could be 
obtained at the minimum of expense by the erection, on the vacant 
ground on each side of the Sear’s Laboratory, of a one story build- 
ing of corrugated iron, or such other inexpensive construction as 
would afford adequate protection against the weather without increas- 
ing the danger of fire. Such a building could be lighted by sky- 534 
lights, if desirable, and would not be high enough to interfere with 
the light of any of the adjoining rooms of the School. 
Your Committee recommend that such buildings be erected at once. 
Another point to which your Committee desire to call attention is 
the arrangement of courses in the Medical School and the employ- 
ment of the students’ time. 
This question is one of the great problems of modern education 
and is not confined to medical teaching. The enormous growth of 
science during the last two or three decades has made many of the 
single branches so vast that a life-time might be spent in learning 
each one of them; while the development of specialties in medical 
practice, and the necessity of having each thoroughly taught for the 
benefit of such students as intend to follow it, has tended to throw 
out of perspective, more or less, the various parts and elements of 
which the general education, common to all practitioners, must of 
necessity be made up. It is nearly twenty-five years since Professor 
Huxley said that the great problem of the day in education was not 
what to teach students, but what not to teach them, and this problem 
is comparably more serious now than it was then. 
No conscientious instructor who is thoroughly acquainted with his 
subject can see, without grave regret and even something like self- 
reproach, the student leave his course possessed with only a fraction 
of the knowledge which he himself has and which he would be only 
too glad to impart if time permitted; and in every large school the 
actual division of the studies is practically largely determined, in 
the last resort, by a compromise between the apparent claims on the 
students’ time of the various departments, which, again, may be 
dependent in part on the urgency with which these claims are pre- 
sented. It is impossible that it should be otherwise. The student 
is, therefore, during his brief years of medical study, placed in a 
trying position. There undoubtedly results a certain definite sur- 
vival of the fittest; but — and this is the point — it is the survival of 
the fittest to survive under the given conditions and not necessarily of 
the fittest for the use of others. 
Your Committee feel that any steps that might be found possible 
toward the diminution of the amounts of required studies in the 
School, while leaving the fullest opportunities accessible to special 
courses, would be in a measure of benefit to, and be hailed as a 
relief by both teachers and pupils. And, further, they believe that 
it would be to the advantage of both teachers and pupils if some of 
the required courses could be more nearly approximated to the mini- 
mum of essential knowledge. 535 
It has been said that applied therapeutics should be taught in the 
Clinical Courses in the Hospitals and Dispensaries. This is true; 
but it is not enough. Notwithstanding the excellent lectures on 
Clinical Therapeutics now given in the departments of Clinical 
Medicine and Theory and Practice, the School would still, in our 
opinion, be strengthened by the establishment of a separate chair in 
Therapeutics, additional to all the valuable and indeed indispensable 
instruction detailed further on. A mature, judicious general prac- 
titioner would be the proper person to fill such a chair. 
Your Committee hope that the Board of Overseers will favor the 
passage of an amended Anatomy Act soon to be presented in the 
Legislature. It is a vital question for Science. 
Clinical Medicine. 
There has been no change this year in the amount or method of 
instruction in the Department of Clinical Medicine. The course in 
Infectious Diseases given in the South Department of the City 
Hospital for the first time last year has been and will be continued. 
The Fourth Class, in divisions of eight or ten men, thus have, in 
the second half-year, the precious opportunity to become practically 
familiar with scarlet fever, measles and diphtheria instead of going 
out into practice with only a book knowledge of these common and 
important diseases. Such an opportunity can be afforded by but 
few medical schools in this country. 
Plans are under consideration to still further increase the clinical 
facilities for the Fourth Class, and it is hoped that efficient means 
to this end may be secured before long. The main difficulty is the 
fact that the School does not control the appointments and terms of 
service in any hospital. The position, even of a welcome guest, is 
not just the same as is that of a proprietor. There are good grounds 
for the belief that the clinical advantages in the Harvard Medical 
School are second to none in this country, but there is still room for 
improvement. The personal work of both professors in the Depart- 
ment has been interrupted in the current year by illness, but all the 
assistants have stepped into the breach with cheerful and efficient 
service, and there is no reason to believe that the students have 
suffered. 
Theory and Practice of Medicine. 
The principal change in this department lias been the addition of 
a lecture by the Professor in charge of the Fourth-Year students, an 
addition made at the request of the students themselves. The work 
of the department seems to be very satisfactorily conducted. 536 
Dr. D. W. Cheever reports : — 
I have attended lectures, and held personal interviews with the 
heads of each department assigned to me to visit in the Medical 
School. 
My general impression is of intense activity and of great pro- 
gress in teaching in Anatomy, Surgery, Clinical Surgery and Path- 
ology, and of a much more thorough instruction in Materia Medica 
than I had supposed. Whether or not a due perspective is observed 
as to the teaching and importance of the subjects can only be deter- 
mined by comparing this with the reports on the other departments 
of the School. 
Anatomy is taught in the whole of the first year; the whole of the 
second year; and a part (elective) of the fourth year. One hundred 
and seventy-six (176) lectures, and thirty-six (36) recitations are 
given. 
The dissecting room is supervised by six qualified Assistants, each 
of whom has charge of eighteen students. The latter are examined 
and quizzed on their work three times a week; and the Assistants 
spend two to four hours a day in the dissecting room, in turn. The 
student dissects at least two parts the first year, and one the second 
year. An accurate record is kept of every student’s dissection, and 
he may be conditioned in it. He has demonstrations on the subject 
by the Demonstrator, and also instruction in sections, by the Assist- 
ants, daily, in October, November, December, April and May. Once 
a week the Instructor in Anatomy holds a formal recitation on the 
lectures through the first year. Three and one-half weeks are con- 
sumed in dissecting each part, and discipline and care are strictly 
enforced. There can be no waste. 
In the second year, eight students who have reached grade A in 
the Anatomy examination, are given much larger privileges in dis- 
secting for the lectures, under the name of Prosectors. 
In the fourth year there are two elective courses in Anatomy, 
covering three months; and in these the student dissects three 
parts. 
Thus, those who wish, can refresh all their anatomical knowledge 
before graduating. There is then no lack of abundant instruction 
on the cadaver, but there is never a surplus of material. The 
supply of anatomical material has not kept pace with the growth of 
the School, and certainly not with the greater demands of a more 
thorough instruction. 
Comparing the period when I was Demonstrator, 1860 to 1868, 
with the present, we find in 1806 that anatomical material had 537 
increased seventy-five per cent., and in 1897, only fifty per cent. 
Meanwhile the classes have increased from 200 to 250 students 
then, to over 500 now. 
In addition to this the valuable courses on operative surgery con- 
sume much anatomical material. A full course of eight exercises is 
given before the whole of the third and fourth classes in Surgical 
Operations, on the dead body, and an elective course for the fourth 
year of fifteen exercises, where each student has one half of a 
cadaver for operations. These privileges attract many students 
from other schools; but this year, dearth of material has obliged 
four students to share each cadaver. 
A still more serious demand for material is made for the Dental 
School. Hitherto, dental students have been required to dissect one 
part; now they are obliged to dissect two parts. It will be impos- 
sible to carry this out unless the supply can be increased, and here, 
in my judgment, the pruning knife should be applied and economy 
practised. The other alternative is the hope of securing such 
changes in the Anatomy Law before the Legislature as will make 
the furnishing of dead bodies to medical schools, and to them only, 
mandatory, where it is now permissive. This should apply only to 
those dying and being buried at public expense and not claimed by 
friends. Extreme care is taken to respect all private feelings now 
in our Medical School, and a decent burial of all remains is strictly 
enforced. 
The lectures in Anatomy are illustrated by most complete and 
admirable models, plates and preparations, the theme is succinctly 
and carefully handled, and the teaching clear and concise. We 
observed, with regret, at the lecture at 9 a.m, that although the 
entire class, or about 160 students, attended, there were very many 
late in entering. These late comers entered until 9.35; the lecture 
ended at 9.55; thus, there was only twenty minutes of absolute 
quiet. 
Surgery. 
The course covers three years. Beginning the second-year class, 
this year is devoted to the scientific part of surgery, to practical 
details and to laboratory work, and recitations. Surgical Pathology 
is the chief feature. 
There are recitations in Surgical Pathology by Dr. C. A. Porter 
at the Massachusetts General Hospital. There is a laboratory 
course on Surgical Pathology by Dr. E. H. Nichols, and there are 
clinical demonstrations of this course at the City Hospital by Drs. 
H. L. Burrell or J. C. Munro; there is a course on apparatus and 538 
bandaging (to sections) by Drs. Munro and Porter. An endowment 
of $5,000 has been made for Dr. Nichols’ laboratory course on 
Surgical Pathology. 
Third Year. The very important field of Surgical Pathology 
having been thus provided for, the student enters on a systematic 
course of lectures by Dr. J. C. Warren, fifty-one (51) in number; 
fourteen recitations keep pace with the lectures, in proportion of 
one to three. There is also a clinical lecture each week, and at 
each hospital, illustrating the didactic lectures. 
Of the fifty-one lectures twelve are on fractures and dislocations, 
but the newer fields of surgery receive large attention, as evidenced 
by ten lectures on the abdomen (including hernia) and five on the 
head and spine. 
Every student is required to see, observe, follow up and report on 
a case of fracture. Half the class go to the Massachusetts and half 
to the City Hospital. Drs. Scudder and Monks supervise this very 
important branch. There are visits in each hospital, in three or four 
sections, once each week. 
In the fourth year, there are lectures, systematic and clinical, on 
genito-urinary surgery, throughout the year by Dr. F. S. Watson; 
and a course on ovarian tumors by Dr. Homans. 
Clinical Surgery. 
A Clinical Surgical Conference is held by Dr. C. B. Porter once a 
week at the Massachusetts General Hospital; cases are written up 
and reported by third-year students, and criticized. This is a very 
popular course, and the papers have much improved in character. 
Minor Surgery is taught to sections of ten students, at each 
hospital, in courses of two weeks, in the out-patient department. 
This is eminently a course of personal instruction. This lasts from 
October to May. Clinical visits are made in the wards of each 
hospital in sections of twenty, weekly. 
In the fourth year, in both the Massachusetts General and City 
Hospitals, clinical lectures in the ampitheatres are given to one half 
the class, weekly. Clinical diagnosis is taught to sections of one 
fourth the class, weekly, in each hospital. This course lasts from 
October to May. The subjects treated are: Diagnosis, Steri- 
lization, Medico-legal examinations, Surgical Therapeutics, and 
Feeding. 
Major surgical operations are done, especially on public operating 
days, in each hospital, once a week. 539 
A course in Emergencies and Accidents is given to small sections, 
at the Massachusetts General Hospital every evening, for the fourth 
year. On the completion of the new surgical buildings this course 
will also be given in the City Hospital. There remains also for the 
fourth year the course on operative surgery, twice a week, for two 
months, by Dr. Porter, and finally, fifteen exercises where the fourth 
year students operate themselves on the cadaver, from two to four 
students on each body. 
A more complete course than that combined in Surgery and Clinical 
Surgery, could hardly be devised. It covers the second, third and 
fourth years in the Medical School. First, Surgical Pathology, 
both by text-books and by laboratory work; second, Bandaging 
and Apparatus; third, Minor Surgery, in small sections; fourth, 
systematic lectures and recitations in Surgery; fifth, a case of 
fracture ; sixth, Clinical illustrations and lectures ; seventh, Genito- 
urinary Surgery and Ovarian and Abdominal Surgery; eighth, the 
Clinical Conference ; ninth, Clinical Visits ; tenth, a course of drills 
in diagnosis; eleventh, a course (practical) in emergencies and 
accidents; twelfth, Operative Surgery taught by the Professor, 
and finally performed by each student. 
Pathology. 
The new and well equipped laboratories for pathology in both 
hospitals offer great facilities, and have awakened much enthusiasm 
in this important branch. 
Pathology is a second year course, but some advanced instruction 
in autopsies and in pathological histology is given in other years. 
Two lectures in general pathology and pathological anatomy and one 
recitation are given throughout the year. A course (practical and 
laboratory combined) is given twice a week by Professors Council- 
man and Mallory, Doctors Wright, Nichols, and numerous assist- 
ants, through the year. The class is divided into six sections, or 
groups, around long tables, and morbid specimens are shown, 
described to, and handled and examined by each group. The 
instructors go over the specimens six times in one hour. This 
recalls Virchow’s celebrated course in Berlin. Twice a week there 
is, in sections, a drill in pathological histology, with specimens, 
description for fifteen minutes, each student making drawings of 
specimens for forty-five minutes. 
Autopsies are held in both hospitals, and the student is expected 
to attend tiventy. Advanced students are also allowed to make 540 
the autopsies. Professor Councilman thinks ten autopsies at least 
should be required, for graduation. 
There is a summer course to advanced students, or graduates, by 
Professor Mallory, which could be indefinitely expanded, and which 
this year has attracted eleven applicants from the Johns Hopkins 
School. 
Professor Councilman sums up the needs and future of his depart- 
ment, as follows : — 
1. A Clinical Laboratory for Pathology in the Medical School 
building. 
2. A hospital attached to the School, where the student could fol- 
low' the case in the Clinic, and even follow the fatal case in all the 
details of an autopsy, thus connecting clinical and pathological 
instruction; and also, where in surgical cases he might be able to 
see the tumor before operation and after operation in the patho- 
logical laboratory. 
3. The development of private and post-graduate courses, and of 
publications. 
In this connection it may be noted that Baltimore, Philadelphia 
and New York already have hospitals attached to and controlled 
by their Medical Schools. It is also a gratifying fact that in 
Boston, Dr. Sears has continued his benefactions to the Sears’ 
Laboratory by a gift of $500 a year for the library and for pub- 
lications, and that this year he has generously donated one thousand 
dollars. 
We must not lose sight of the fact that the Contagious Depart- 
ment of the City Hospital has added to the Pathological department 
of our School unrivalled facilities for the study of the bacillus of the 
anti-toxine of diphtheria. 
Materia Medica and Therapeutics. 
Lectures and recitations are held twice a week, the whole of the 
second year. Laboratory work, six exercises (pharmacy) two hours 
each, in sections — Dr. Harrington and Mr. Jordan; eight demon- 
strations in experimental therapeutics by Dr. Pfaff. 
The first half-year, lectures on drugs. The second half-year, reci- 
tations, drills, prescription writing, in public; inspection and hand- 
ling of drugs and preparations. 
No subject can be more barren in awakening enthusiasm than 
Materia Medica. YYre must bear this in mind in any criticism on 
the course. 541 
In the systematic lectures, the following order is observed: 
Drugs — (1) officinal preparations and doses; (2) physiological 
action; (3) therapeutic uses. 
On these lectures there are sixteen recitations. The important 
synthetical medicines are described, but not others. Prescription 
writing, in Latin, is practised on the blackboard by four students 
at a time, during many hour exercises. Incompatibles, inert com- 
pounds and poisons are especially illustrated and drilled on. In 
the laboratory exercises the students, in sections, make tinctures, 
powders, mixtures, pills, personally for two hours each lesson, 
under the direction of Professor Harrington and Mr. Jordan, from 
the College of Pharmacy. This is an extremely valuable and popu- 
lar course. I would advise its being enlarged at the expense of the 
lectures. 
The course on experimental therapeusis is of an advanced char- 
acter, and includes original observations by Dr. Pfaff. 
Professor Harrington’s well known ability as a public expert in 
adulterations of food and his valuable courses on hygiene, render 
him especially reliable in teaching. 
Dr. Morrill Wyman reports : — 
The Therapeutic Laboratory has accommodations for eighteen 
students : they come in divisions. A number of officinal drugs and 
chemicals sufficient for the purposes of practical pharmacy are 
properly arranged. Prescriptions are written in accordance with 
the United States Pharmacopaia; the medicines are weighed, com- 
pounded and carefully put up with all the directions as to dose 
time, vehicle, date and signature. 
The most approved methods of dispensing medicines are also 
taught — as flat compressed pills, in capsules or wafers, but in a 
much more acceptable form than we used to see them and flavored 
to taste. They make the taking of drugs under some conditions 
almost a fine art. The laboratory is largely attended and the 
teaching much valued, as is all real instruction. 
No one preparing for the medical profession can over-estimate 
the value of physical training. Anatomy, the study of the machine ; 
physiology, the machine in motion, are the work of the laboratories. 
The art of observation, the medical education of the senses, as it has 
been called, is more valuable as a mental training than all didactic 
lectures. It is the best training for the practice of medicine as an art, 
as a science,and for research. Laennec made and carefully recorded 
The Department of Therapeutics and Hygiene. 542 
nearly 400 autopsies before the sounds heard on the chest by his medi- 
cally educated ear, were connected with the morbid changes within. 
Auscultation conld have been invented in no other way. 
Physical training is essential, from the physical examination of the 
chest at the clinical conference to the composition and dispensing of 
the appropriate remedy in the Pharmacy. Dr. Harrington’s publica- 
tions exposing some of the impudent frauds practised upon the public 
by the vendors of “Extracts of Malt,” “Commercial Lithia 
Waters” and “Food Nostrums” deserve the thanks of all who 
have any regard for the public health. The papers are short, 
spirited and to the point. It is hardly to be hoped that they 
will prevent quackery, but they give people fair warning of the 
imposition, if nothing worse, to which they are exposed. Some 
physicians, thoughtlessly it is to be hoped, by their recommen- 
dation or qualified approval have aided this kind of imposition. 
His experiments with formaldehyde as a surface disinfectant, 
undertaken under very considerable difficulties, deserve much credit. 
They must have been carried on inter laedia et labores of a revolt- 
ing character with patience and circumspection. His conclusions 
seem to have been carefully drawn and its value, except as a surface 
disinfectant, considerably modified from what was at first assumed 
for it. 
Obstetric Department. 
The hospital at No. 24 McLean Street — The Boston Lying-in- 
Hospital — is the most interesting department in the teaching of 
obstetrics. It is here that a large part of the clinical instruction 
is given. 
The hospital building is interesting in another point of view. 
Here is a hospital evolved from a block of city habitations with few 
indications towards the object to which it was to be devoted. It is 
an object lesson our students would do well to study. Here were 
rooms not very prepossessing, which by slight but well devised 
changes became, one the Delivery room, another the Recovery room, 
and a third, a Convalescent room, each with simple appropriate, 
easily cared for furniture, neat and clean; add to these a sterilizing 
room and we have the most essential parts of a hospital. The 
Delivery room may be the model, to be approached as near as may 
be by the Externe, during his assigned term of service, and a kettle 
of boiling water his sterilizer, even among the poorest of his patients. 
At this hospital our students receive instruction either as house 
physician or Externes. Of the six house physicians three are con- 
stantly in attendance and are required to reside in the hospital, 543 
where they are furnished with breakfast, other meals being provided 
outside the hospital; they are appointed for six months. 
Our students are required to take charge of at least six cases of 
labor, to receive clinical instruction on at least one of them, to care 
for their patients during the convalescence and to make full written 
reports of the cases. 
Externes appointed by authority delegated by the Trustees of the 
hospital are under the immediate charge of the out-patient House 
Physician. Students who are assigned to take charge of out-patients 
during their confinement are expected to devote their whole time to 
the hospital work during their term of service. They are not allowed 
to perform obstetrical operations. They are provided with printed 
blanks to be carefully filled out, with which they can communicate 
by telephone or otherwise with the Senior House Physician, who is 
always on duty at the hospital and will answer the call at once night 
or day. Externes must visit their patients twice daily for the first 
three days, and at least daily for the three following days, and 
return to the hospital a chart of the temperature and pulse at each 
visit. 
The administration of the hospital seems to be carried on with 
great exactness of detail. The pulse and temperature, the two 
most important elements in forming a correct judgment of the con- 
dition of an obstetrical patient, are recorded twice daily from the 
time of her confinement until she leaves the hospital. These records 
are kept and bound in volumes in a manner most readily accessible; 
each has a copious index of principal symptoms. Those students 
who follow out the course laid down for this hospital with proper 
care cannot but form habits of discipline in the exact observation 
and recording of results that may go with them through their pro- 
fessional lives. 
One hundred and thirty-two house officers have completed their 
terms of service in the hospital and received the Corporation’s 
diploma; clinical instruction has been given to more than 150 
students annually in the houses of the poor to the advantage of 
both practitioner and patient. Since 1881 the students of our 
school have treated 11,142 cases as out-patients during their con- 
finement, with but nineteen deaths — less than 1 in 500. Those 
who remember the rate of mortality previous to 1881, before the 
antiseptic treatment was adopted, can read this statement with 
heartfelt gratitude. 
GEORGE B. SHATTUCK, 
For the Committee. 
April 4, 1898. 544 
The Dental School. 
Your Committee find that the Dental School is in a prosperous 
condition, and that much good work is being done there. The 
requirements of the entrance examination are greater and the fees 
are higher, and yet the total number of students was greater during 
the past year by 29 than ever before. The building now occupied 
by the School on North Grove Street has been renovated and in 
some particulars made more convenient. There have been very few 
changes in the staff of instructors. 
GEORGE B. SHATTUCK, 
For the Committee. 
April 4, 1898.