[Reprinted from The University Magazine.] 
THE OUTLOOK FOR MEDICINE. 
BY BAYARD HOLMES, B. S. (PAW PAW INST., 1874), M. D. (CHICAGO, 1888), 
SECRETARY OF THE COLLEGE OF PHYSICIANS AND 
SURGEONS, CHICAGO. 
I N the best schools of medicine in the United States, the course of study 
has increased during the past six years from a course requiring about 
twelve majors (720 hours), extended over a minimum of eighteen months 
from the beginning to the end of the course, to one requiring about forty 
majors (2,400 hours), and covering not less than three years and a half from 
the beginning of the course to graduation. The greater part of this addition 
to the curriculum has been made in the department of normal and patho- 
logical histology. The teaching of these subjects is necessarily laboratory 
teaching. The practice of antiseptic surgery and the application of modern 
principles to hygiene presuppose in the surgeon and physician a practical 
knowledge of bacteriology. Antiseptic wound treatment has placed the 
practice of surgery in the hands of every physician, and again, imposes upon 
each and every one of them the necessity of a thorough practical knowledge 
of pathology for diagnostic use. The study of pathology requires an exact 
knowledge of normal histology, and well directed practice in the complicated 
methods of modern histological study. 
Clinical teaching is conducted in medical schools by teachers who, with 
rare exceptions, receive no salaries. The fact of teaching carries with it a 
productive reputation through acquaintance with patients and students. The 
receipts from consultations which come to the occupant of a clinical chair in 
a well established institution are, in themselves, a fair recompense for the 
service rendered the school. The same cannot be said of laboratory teach- 
ing. It must be conducted by men who have more than ordinary training. 
It consumes a large amount of the instructor’s time both in the class-room 
and in the preparation-room. It brings to the teacher no productive reputa* 
tion, and allows little time for the cultivation of a private practice. On 
these accounts the laboratory teacher must be paid. 
Laboratory teaching requires not only salaried teachers, but also large 
and expensively equipped laboratory rooms, with laboratory servants and a 
complicated store-room, from which to furnish, and in which to repair and 
even manufacture equipment and supplies. All of these new requirements 
are expensive, while, at the same time, the income of the medical school 
which adopts them is cut down by the smaller attendance upon the longer 
and more exacting course. Thus the subject of endowment of medical schools 
is brought prominently forward. 
From information collected by the Bureau of Education,* I am able to 
give a partial statement of the condition of medical endowments. 
* Forthcoming report of the Bureau of Education, Chap. ix. and Welford Addis 
of the Bureau. The hundred and more medical schools in the United States reported 
to this Bureau in June, 1892, the following facts : They were possessed of 
buildings and grounds valued at $7,507,937, and productive funds amounting 
to $611,214. Medical departments of State universities also received State 
aid in 1891-92 amounting to $40,500, which, if capitalized at 5 per cent, 
would be equal to an endowment of $810,000. Thus the total reported en- 
dowment of the hundred or more medical schools in the United States, with 
an annual enrollment of 16,736 students, foots up to $1,421,214. 
It is interesting to compare the same items as reported at the same time 
by the schools of theology, which have received the most liberal private en- 
dowment, and the schools of technology, which are the most liberally en- 
dowed by the State. The theological schools with 7,672 students, reported 
buildings and grounds valued at $10,720,860, and productive funds amount- 
ing to $17,599,979. The schools of technology with 10,921 students, report- 
ed productive funds amounting to $13,299,940, and annual (1891-92) State 
aid of $747,504, equaling, if capitalized at 5 per cent., an additional endow- 
ment of $14,950,060. Thus the total endowment of the schools of techno- 
logy was $28,180,020. 
Medicine has not a single well endowed school. There is no medical 
school connected with a university in which medical education is vigorously 
pursued. In the University of Pennsylvania, the course of study is still 
three years. In the medical school of Harvard University, the endowment 
is very meagre, and the professors are paid less than the tutors in the literary 
department. Johns Hopkins University has not yet opened its medical 
school, and even with the lately acquired endowment which has been re- 
ceived conditional upon opening this department to women, and with the 
cooperation of the Biological and Hospital Faculty, it will be much pinched 
for funds to furnish instruction to any considerable number of students. 
The University of Michigan has a medical school which receives a 
moderate support from the Regents. Unfortunately, it is located in a small 
town and far from clinical instruction. The effort lately made to place the 
clinical department in Detroit was, unfortunately for medical education, un- 
successful. The University of Minnesota supports her medical department 
liberally. It has just opened two very well constructed buildings for the 
schools of Pharmacy, Dentistry, Homoeopathy and Medicine, and appropri- 
ated $25,000 for the support of these departments for the year. The school 
is well located in Minneapolis-St. Paul, and will soon have very good clinical 
facilities. The University of Michigan insists upon a four-year course ; the 
University of Minnesota, a three-year course. The entrance requirements of 
each is about equal to that for admission to the Freshman class in their re- 
spective literary schools. In both institutions two years of the course may be 
taken in the years necessary for the Bachelor’s degree. 
In all the medical schools of the country the course of study is ironclad. 
Too much goes by tradition and precedent. In most schools elementary 
chemistry is taught. This is a waste of energy. It should be required on 
admission. In nearly all schools the course of study has little supervision, and the curriculum is made to accommodate itself to the requirements of the 
faculty. In the large schools classes of one and even two hundred are in at- 
tendance on lectures and clinic. The preference of medical teachers for 
large classes is considered rather than the needs of students for instruction. 
The schools are closed during four or six months of every year. 
The great impediments to medical education in the United States lie 
nowin three directions: (i.) The absurd rules or laws, in all but a few 
States, which make the diploma of a medical school a license to practice 
medicine. This makes the pressure to turn the educational institution into a 
diploma mill irresistible. (2d.) The medical schools are manned for the ad- 
vantage of the unpaid professors, and these professors magnify that portion 
of medical instruction which conduces most to their own financial interest. 
Thus clinical instruction in some schools is begun as early as the first year. 
Lectures come next in value to the professor, and they are overcrowded. (3d.) 
The total lack of endowment compels the medical schools to consider im- 
mediate incomes, and thus the school with the shortest, easiest and most 
superficial course is, as a rule, the largest and most prosperous. 
Before the State Board of Examiners of Minnesota,* the four medical 
schools having the largest enrollment had a notably larger percentage of 
their graduates rejected than did any or all of the other reputable schools. 
To the conscientious physician, to the humanitarian and to the educator 
the condition of our medical schools is all but hopelessly deplorable. A 
hundred diploma mills stare us in the face, with seven millions of dollars in- 
vested. If each institution has twenty professors, there are no less than two 
thousand of our leading physicians who are interested financially in keeping 
up the present condition of affairs. Of the forty university medical schools 
not one is managed on the educational basis of other departments, and few 
have any vital connection with the University. All other educational 
institutions are being liberally endowed, either by the State or by private 
individuals or societies ; but medicine alone is neglected. Medicine is un- 
popular with University faculties, with students, with State Legislatures, and 
with benevolent millionaires, in spite of the fact that in no other department 
of science during the past thirty years has such great advancement been 
made, in no other department of applied science has such remarkable life- 
saving results been attained, and in no other field of experimental research 
are such brilliant results likely to be attained in the immediate future. 
Medicine furnishes a sphere of usefulness to the altruist, the scientist and 
the scholar, independent and varied beyond that of any other profession or 
calling. And yet hardly ten per cent, of the graduates of literary institutions 
seek in medicine a career. 
*Perry Millard, Proceedings of the American Academy of Medicine, 1892.