Reprint from Penn Monthly, April, 1882. 
IN a copy of the Pennsylvania Gazette published in Philadelphia 
on June 30th, 1768, will be found an account of the first an- 
nual commencement at which medical degrees were conferred in 
America. The occasion was that of the commencement of the 
College of Philadelphia, of which the University of Pennsylvania is 
the direct lineal descendant and successor. At this commence- 
ment, held June 21st, 1768, the degree of bachelor of medicine was 
conferred upon ten candidates. The charge, as it was then called, 
was delivered jointly by the Provost, Rev. Dr. William Smith, and 
Dr. Shippen, the Professor of Anatomy and Surgery. From that day 
until this, except in 1772, and for five years more, during which 
the operations of the College were interrupted by our national 
struggle for independence, the annual roll-call, as heard to-day, 
has been repeated, until the number of its medical graduates ex- 
ceeds ten thousand. One hundred and seven times has this roll 
been called; one hundred and seven times has the parting charge 
been made ; and well may he, to whose lot it has fallen to make 
the one hundred and eighth, look about him and ask what is there 
left for him to say. Sound advice, cheering words and wholesome 
warning have been spoken again and again by men whose impres- 
siveness I cannot hope to equal. These, therefore, I will not attempt 
to-day. There is, however, one subject which I deem quite worthy 
of the present occasion, and I shall be glad if I can excite in you 
even a small portion of the interest I feel in it myself. That sub- 
ject is higher medical education and the position your Alma Mater 
has taken in relation to it. 
It is well known to you that, five years ago, the feeling of dissatis- 
faction with the then prevailing system of medical education, which 
had for some time existed in the minds of the trustees of this univer- 
sity, culminated in a determination to make an immediate change. 
According to the old system, a student could, if he desired, earn the 
degree of doctor of medicine in two courses of medical lectures of 
HIGHER MEDICAL EDUCATION* 
* A valedictory address delivered at the Commencement exercises closing the one 
hundred and sixteenth annual session of the Medical Department and the fifth of the 
Dental Department of the University of Pennsylvania, March, 15th, 1882. 2 
but five months’ duration, while each one of these courses was an 
exact repetition of the other. All other trades and occupations 
required three and even more years, not of verbal instruction, but 
of actual hand labor, before the learner was considered fit to carry 
on his business independently of his master or teacher. This was 
the case with the carpenter, the stone-cutter and the machinist; 
but the physician, who dealt with human life and its tenement, ex- 
ceeding in delicacy and intricacy the most subtle of machines, 
was often qualified by eighteen months’ instruction, and even less. 
And yet the profession of medicine has always been accorded a 
place among the liberal professions, which are so called because 
of the amount and variety of acquirement and the intellectual train- 
ing which are prerequisites to those entering them. These condi- 
tions are, and always have been, observed in European countries, 
and that they were also observed in the early history of this 
may be learned from an examination of the history of the medi- 
ical department of this university, where it will be found that, at 
its origin, each student, before being eligible to the degree of bache- 
lor of physic, was required either to have taken a degree in college, 
or to satisfy the trustees and professors of the school concerning 
his knowledge of the Latin tongue and such branches of mathe- 
matics and experimental philosophy as were judged requisite to a 
medical education. Finally, the degree, not of doctor, but of bach- 
elor of physic, was conferred upon those who had complied with 
these requirements, had served a sufficient apprenticeship to some 
reputable practitioner, attended at least one course of lectures, ex- 
tending over six months, on anatomy, materia medica, chemistry, the 
theory and practice of physic, one course of clinical lectures, and 
the practice of the Pennsylvania Hospital for one year; also, passed 
a private and public examination before the medical trustees 
and professors, and publicly defended a thesis in the English or 
Latin tongue. The degree of doctor of medicine was conferred 
only after three years more had intervened, the candidate had 
attained the age of twenty-four years, and had written and publicly 
defended a thesis in the college, unless he was beyond seas or so 
remote on the continent of America as not to be able to attend with- 
out manifest inconvenience; in which case, on sending a written the- 
sis, such as should be approved by the College, the candidate might 
receive the doctor’s degree, but his thesis was to be printed and 
ublished at his own expense. 3 
It will be seen from the above that one hundred and fifteen 
years ago it was not easy to obtain the doctor’s degree in Amer- 
ica, and that he who had complied with its requirements had well 
earned the right to be regarded as one of a liberal profession. This 
is not the time or place to follow the steps of the change; but suf- 
fice it to say that in time these conditions were so far removed that 
large numbers, not only of the uncultured, but even the unscrupulous, 
flocked into the ranks of the so-called profession, and made the protec- 
tion of its standard, the credulity of the people, and the mystery of 
their trade, stepping-stones to success ; while the real professional 
training of the educated physician, obtained under difficulties and 
at great cost, and for the most part in foreign countries, received 
but partial recognition. Such a system of medical education also, 
failing to furnish the training which qualified for original investL 
gation and such thorough study of disease as would lead to im- 
provement in methods of treatment and modes of cure, failed to 
develop the science of medicine proportionately with other knowl- 
edge. This fact could not escape the attention of a people whose 
growing intelligence was a part of the development of a great 
nation, and they could not fail to see the defects in a science so 
pretentious and yet so feeble. Hence, their confidence gradually 
weakened, and they became ready to grasp at anything which 
promised, even if it did not insufe, more satisfactory results at less 
inconvenience. 
Such were the results of medical teaching in this country for 
some years previous to 1870. In that year, Harvard University 
adopted for its medical school a compulsory three years’ course, 
graded, and with an academic year of nine months’ length. In 
1877, in accordance with the action already referred to, this uni- 
versity adopted a compulsory three years’ course, also graded, in 
which attendance was required during an annual winter session of 
five months, while instruction was provided for the entire academic 
year. The step taken by Harvard was a comparatively easy one ; 
for the medical department of that university, although among 
the oldest in the country, had never been a large school, and the 
compensation of the professors was proportionately small. The 
latter, therefore, made no great pecuniary sacrifice in making the 
change, while the change itself advanced the school from a second- 
rate position to one of the highest class. With the University of 4 
Pennsylvania, however, it was different. The reputation of the 
school already exceeded that of any other in the country, and 
its classes, since the removal to the improved new quarters in West 
Philadelphia, were growing rapidly. Grave questions of guarantee 
and compensation had to be settled, while a temporary reduction 
of income to the professors had to be anticipated. All this, how- 
ever, was adjusted, and the change made with the consent of all 
interested. The event is too recent to demand further details now. 
But, instead of the class falling off, as was anticipated, the number 
of actual students was not diminished. The second year of the 
“ new plan,” as it is now commonly called, began with a larger 
freshmen class than the first, and the third with a still larger class. 
But the medical faculty were not satisfied with what had been 
accomplished. One of the most gratifying and immediate re- 
sults was a marked improvement in the previous education and 
gentlemanly bearing of the student of medicine, and a much larger 
proportion of those who came to the University possessed degrees 
in arts or science. But it was found at the term examinations that 
some were still defective in this very important condition of a lib- 
eral profession,—a previous education,—and that, according as this 
deficiency existed, their qualifications in the professional branches 
were also defective, and they were, in consequence, unprepared to 
go on with their classes. This being the case, the question arose: 
“ Why should such begin the study of medicine at all ? Is it not 
better that disappointment should be met at the threshold than at 
a later stage, when both time and money have been expended?” 
The answer was so evident that the faculty decided that a pre- 
liminary examination should be instituted, which should be passed 
by all who did not possess a collegiate degree or could not present 
satisfactory evidence of at least a fair English education. Instantly, 
for the session of 1880-1, the first-year class fell from one hundred 
and thirty-five to one hundred and ten, a reduction of nearly twenty 
per centum; for the session of 1881-2, a still further, but not 
greatly increased, reduction in the freshman class occurred. But 
mark the effect on the character of the class ! Of the regular full- 
course students admitted the year previous to the institution of the 
preliminary examination, twenty-five per cent, possessed degrees 
in arts or science; while, of those admitted for the session follow- 
ing, thirty-three per cent, were college graduates, and the propor- 5 
tion of failures at the first professional examination was decidedly 
less. Moreover, of the entire number of full-course students atten- 
ding during the past session, twenty-eight per cent, are college 
graduates, while the percentage in 1879 was but twenty-two 
per cent. 
Further, I ask attention to the following fact as one of no small 
importance. Notwithstanding the usual loss from withdrawals, in 
consequence of failure at examinations, and other causes, the class 
which entered for the session 1880-1, the first after the inaugu- 
ration of the admission examination, began its second year with 
its numbers increased ten per cent, over those of its first year. This 
is something quite unprecedented in the history of colleges with 
graded curricula, each class being, as a rule, largest as a freshman 
class, losing as it ascends in grade, until, as a senior class, it has been 
decidedly cut down. The exception in this case is chiefly due to 
admissions to advanced standing from other colleges, but in part, 
also, to fewer failures in the first professional examinations. Finally, 
the effect of the action of this university on other medical schools 
has also to be alluded to. Slowly they are following in its wake 
and making changes, more or less considerable, all tending in the 
same direction,—towards prolongation of the period of study,— 
showing that the principle of our method is acknowledged and the 
leaven of reform is working as#it should. 
The faculty, therefore, have every reason to be confident of the 
result hoped for, and believe that the temporary falling off is but the 
forerunner of large accessions, as the advantages of a prolonged and 
graded curriculum become known. Indeed, they are already com- 
mitted to further steps in the same direction. At their request, the 
trustees have decided that the length of the compulsory winter term 
of instruction, instead of being five months, shall hereafter be ex- 
tended to six. Nor will they rest satisfied until an academic year 
is obtained of the same length as that of the collegiate department, 
—that is, nine months,—and the finished physician shall not only 
be thoroughly trained in all that pertains to his profession, but he 
shall also possess a university education or its equivalent. Of great 
importance in the accomplishment of the former, are deemed the es- 
tablishment of a course preparatory to medicine in the Towne 
Scientific School of the University and the more recent organiza- 
tion of a fourth year or post-graduate course. These two courses, 6 
in addition to the three years of the regular curriculum, really fur- 
nish the opportunity, to those who desire it, of a five years’ course, 
in which it is believed will be found all the requirements of a 
thorough and complete medical education. 
It has recently been said that “ a university education and train- 
ing make men too dilettante, and seem rather to unfit them for that 
struggle to make and maintain a position which must ever be the 
lot of the medical practitioner.” Such a statement I can only re- 
gard as an apology for an existing low grade of medical education. 
To say that a university education is in any way a disadvantage to 
a physician, seems to me to be almost equivalent to decrying all cul- 
ture. Are the problems of the physician of such an elementary 
character that he does not need the intellectual training and varied 
acquirements acknowledged to be essential in the other liberal pro- 
fessions? Are the refining and purifying tendencies of culture less 
important to him, whose association with men and women is only 
during the hours when their sensibilities and sensitiveness are 
heightened by disease, than to the lawyer, whose contact is only 
with the healthy and strong,—than to the clergyman, whose relation 
to the sick is certainly more limited ? That good and reliable phys- 
icians have resulted from the old methods, none will deny. But the 
advocates of the new contend that it is in spite of the defects of the 
old ; while all must admit, that, among physicians produced by 
the former, the best have been those previously well educated. 
On the other hand, it must also be acknowledged that the profes- 
sion is overrun and degraded by hundreds of the incompetent and 
unprincipled, who are effectually excluded by the new condi- 
tions. With such admissions as these, can there be anyone who 
would not prefer the risk of dilettanteism on the one hand to that 
of ignorance and incapacity on the other? 
To become the champions of such a standard as that which is 
the aim of your Alma Mater, I invoke you, members of the class 
of 1882. Be not satisfied with being yourselves one of the first 
fruits of her efforts in this direction, but become active in its sup- 
port and securing its success. Talk of it, write of it, insist upon it 
in the instances of those whose course you may control. The time 
has come when a line must be drawn between those who graduate 
upon the old and upon the new systems. The public have a right to 
know, and you have a right to indicate, that you are graduates under 7 
the latter. To this end you are justified, and it seems to me you 
are required to follow the usual initial letters of your professional 
degree by the words, “University of Pennsylvania,” “Harvard,” or 
whatever the degree may be ; and I am gratified to see that this 
example is set by graduates of many years’ standing. 
To you, graduates of the dental department, I need scarely say 
I make no distinction between you and your brothers of the med- 
ical. What has been addressed to one has been addressed to the 
other. You, also, have an important duty. You rightly aspire to 
be members of a liberal profession, and I, for one, am glad to wel- 
come you. But for you I would make the same conditions as for the 
medical student,—a thorough preliminary training and a thorough 
grounding in all the branches of a medical education. These ac- 
complished, you can select the specialty of your choice without 
fear or favor. Indeed, it is evident that the specialist should pos- 
sess, if anything, a broader culture than the general physician or 
surgeon. For it cannot be denied that the tendencies of the prac- 
tice of a specialty are to narrow the sphere of thought, while it 
also increases one’s knowledge and usefulness in that department. 
It is necessary, therefore, that such tendency should be counter- 
balanced by a breadth of preliminary culture and general profes- 
sional training greater than that of one whose range of thought 
and action is less restricted in practical life. 
With this hour, friends and fellow-alumni, our official relation 
terminates, and your independent professional career begins. It is 
your commencement. From it you go forth to carve your respec- 
tive niches on the temple of the world’s usefulness; we go back to 
the work of conducting others to the goal which you have reached. 
Both have a responsible duty, and each needs the sustaining sup- 
port and encouragement of the other. I have told you what I 
would have you do for us; but I have purposely refrained from 
giving you lengthy advice as to how you might best attain what is 
commonly called success. Success has received various interpre- 
tations at the hands of men. I will not pause to analyze them, but 
will simply say that in my own judgment there are three words 
which comprehend all the conditions of a true success. They are 
thoroughness, truthfulness, and energy. There can be no success 
without thoroughness. Thoroughness, not only in the work and 
duties of your own profession, but in all the responsibilities of life, 8 
be they great or small. Whatever is worth doing it all, is worth 
doing well. A very simple motto, recalled from the associations 
of my own college life, conveys more than pages could other- 
wise express, and you will do well to remember it and live by it. 
It is, “ Minimum minimum est; sed fidelis esse in minimo magnum 
est,”—a very little thing is a very little thing ; but to be faithful in 
a little is great. Again, to be truthful and sincere in all your relations 
—with those who employ you, your professional friends, and, above 
all, to yourselves,—secures a degree of confidence without which no 
success can be permanent. Finally, each of these may be elements 
of a man’s character, and, if not united with an energy of purpose and 
conduct, he will fail of success. Energy alone often leads to chaotic 
results; but, when tempered by thoroughness and a strict regard 
for the truth, the outcome is a dignity and “ repose in energy ” which 
is acknowledged to be fruitful in most lasting if not most rapid 
results. 
With a banner illumined by these words for its device, I do not 
fear to launch you on the swift current of the struggle for success, 
satisfied, that, whatever may be the hidden dangers of your course, 
you will in the end moor safely in the desired haven. It may be, 
scarred and weatherbeaten; it may be, no longeryoung and joyous; 
but none the less masters of the coveted goal and worthy sons of 
an Alma Mater, who, chastened and dignified by well-nigh six 
score years of honorable motnerhood, gives you now her parting 
blessing and bids you “ God speed !” in a useful, happy and pros- 
perous career. James Tyson.