Compliments of the Author. 
ass%% 
BEFORE THE 
:|(l|ode \ sland j|cdical 
JUNE 16th, 1873. 
-15V- 
EDWARD T. CASWELL, M. D JVE^Sid^ 
DELIVERED BEFORE 
Cjje Jljjok Island fjjekcal Jswqetg, 
AT ITS 
Annual Meeting, June 16, 1875. 
BY 
OF PROVIDENCE, R. I. 
PrQYi&gnQQi 
Printed by' the Providence Press Company, 22 Weybosset St. 
1875. ADDRESS. 
Mr. President and Gentlemen of the Society : 
Another year has passed around and to-day finds us 
once more assembled, to celebrate the sixty-fourth anniver- 
sary of the foundation of our Society, to set the machinery 
in motion for another year, to discuss such topics of pro- 
fessional and scientific interest as may come before us, to ex- 
tend to each other the cordial hand of friendly greeting, and 
to welcome among us members of our profession from sister 
societies. These are pleasing duties to the performance of 
which we all come, I doubt not, with ready hearts, and 
thoughts on high purpose bent. The usages of the day also 
impose upon you, and upon me, another duty. They demand 
that you shall interrupt the spirited discussion of some in- 
teresting topic, and, with appetites keenly alive to the repast 
that is awaiting you in yonder hall, that you shall yet stop 
to listen to an annual address ; and of me, in the present in- 
stance, they demand that amount and degree of mental pabu- 
lum that shall keep you from longing too much after the 
flesh-pots, and shall yet put you, after your animated discus- 
sions, into that most favorable condition of repose that shall 
best fit you for the more arduous labors yet in store. In 
obedience then to these established customs I shall claim 4 
Medical Education. 
your attention for a few moments while I present to you a 
subject which has long elicited my most earnest sympathies 
and support, and for which I shall hope to claim yours. 
I purpose to consider the subject of Medical Education as 
it exists among us, and to show what 1 consider its deficien- 
cies, and I trust that it may not be considered presuming in 
me to bring this subject before you at this time. We are all 
of us called upon to direct the course of young men who 
come within the circle of our influence, and who seek to fol- 
low in our footsteps. To each one of us may and will come 
the responsibility of giving advice at least, and it behooves 
us to consider well the chart that we place in the hands of 
the young voyager,—to know thoroughly the strength of the 
timber, and the completeness of the rigging before we 
launch our crafts upon the ocean. I say a sense of responsi- 
bility should attach itself to every one of us, who advises' a 
young man to enter upon the study of our profession, or 
who directs his footsteps therein ; and hence it is fit that we 
should stop to consider what we propose to do. 
We must all acknowledge, I think, that the course of 
education in our profession has not changed materially in 
the country at large for the last fifty years. I do not now 
refer to the teachings of the schools ; they have kept pace 
with the advances in the physical and medical sciences. But 
the course which a young man follows to-day, with few ex- 
ceptions, is very much the same as that followed by our 
fathers and by theirs. A young man fresh from school en- 
ters his name in your office, reads a little medicine for a 
year, rides a little, sees some of the patients that come into 
your office, attends two courses of lectures, and graduates 
a doctor. More than eighteen hundred young men have, in 
this year of grace 1875, received the degree of Doctor of 
Medicine from the different colleges in our land, and of how 
large a proportion do you suppose any other statement Medical Education. 
5 
would be correct than the one I have just given ? Is it. proba- 
able, or perhaps even possible, that one-half of them can lay 
any just claim to the title that has been conferred upon 
them ? What does the very name of doctor imply but that 
he who bears it is learned, and think you that one-half of 
these young men are in any sense learned'? Would that 
they were for their own interests and for the interest of 
those whose lives and whose well-being will be entrusted to 
their care. But a natural sifting process will be constantly 
going on, and of those eighteen hundred how many shall we 
find at the end of five or ten years have slipped out of the 
harness \ A mistake was made in the choice of the pro- 
fession—or the way was too rugged—or some gilded prize 
was within their reach, and they forsook the path that had 
been unwisely laid out for them. Of the rest some will at- 
tain to the highest places in our profession known and read 
of all men. Many more will fall into the rank and file, pur- 
suing with earnestness and devotion, with the true esprit du 
corps, the duties which engross one’s whole thought, which 
involve weary days and sleepless nights, which at times 
weigh heavily with responsibilities and anxieties, but which 
bring with them, and happy they to whom it so comes, the 
satisfaction of duties faithfully and honestly performed. 
But what is there in our profession that should draw 
such a crowd of young men to its ranks ? Is it the glitter- 
ing success of the few, or is it the idea that though it in- 
volves a life of hardship, it secures to its faithful follower a 
respectable position, and if nothing more a competency ? To 
my mind it is neither of these, but rather the interest which 
the pursuit of the study itself possesses. The mind that is 
fond of acquisition may, indeed, like Goethe’s Faust, roam 
through all the realms of philosophy, jurisprudence, medi- 
cine, and theology, and gather the sweets from every flower. 
But to many minds the study of the medical sciences has the 6 
Medical Education. 
pre-eminent attraction of dealing with their own corporeal 
beings, with that which they can see and feel, which is part 
of themselves ; and it is this study of our own humanity 
which I think is the real source of attraction. Now if the 
study of our profession does prove so attractive to young 
men, it is of the utmost importance that they should be so 
directed as to make that study of the utmost value to them. 
And here it is that I think your influence and mine can be 
of some avail. 
I know that this matter of medical education has occu- 
pied the attention of the profession in our country for some 
years. You all know that a few years since it figured 
quite largely in the debates of the American Medical 
Association, and an association of instructors in medical 
colleges was formed with the view of elevating the standard 
of professional education. I fear, however, that its efforts 
were altogether nugatory, and if I mistake not, the associa- 
tion is now defunct. A recent article in one of our leading 
medical journals expresses the opinion that no action of 
State and county societies, nor of the parent society, will be 
of avail in this matter, but that in the fulness of time public 
opinion will force a change upon the profession. It seems 
to me that the power to control also lays with us as indi- 
viduals—that the influence of each individual, exerted 
upon those around him, will accomplish the end for which 
colleges and societies may have labored in vain—that we 
shall thus lead the opinion of the public. 
And here I may say that this very force of public opin- 
ion is constantly making stronger and stronger demands 
upon us as a profession. It keeps pace with the latest in- 
vestigations in the science, with the latest applications of 
the art of medicine, and calls upon us to evince our know- 
ledge of the former and make use of the latter. It commits 
the health of communities to our guardianship, and beyond Medical Education. 
7 
the care of the sick, it calls upon us to prevent disease. It 
demands to know what are the influences that are most fa- 
vorable to life and health, and what means are to be taken 
to avert disease. If it finds that cities and towns and vil- 
lages are decimated by the ravages of epidemic disease, it 
asks us why we did not instruct the ignorant, point out to 
them the danger they were in, and see to it that the sources 
of infection were closed. If it finds that its boasted system 
of public instruction for the young is attended with evils, 
that its children, while seeking an education, are laying the 
seeds of disease from neglect or from excess of zeal, it calls 
upon us to show to them the juste milieu where they can 
travel in safety. And if we are passive in these matters, if 
we err through blindness, it visits our ignorance and our 
slothfulness with severe contempt and well merited rebuke. 
In short, public opinion is, as it seems to me, constantly de- 
manding a higher and more thorough education for our pro- 
fession, from the very fact that it is constantly submitting to 
us questions which the highest education only can answer, 
and calling upon us to put in practice that which is the re- 
sult of it alone. 
It might seem as if the wide-spread influence of quack- 
ery controverted this ground, but I do not believe it. There 
always have been, and there always will be, a certain pro- 
portion of the population, who delight in being imposed 
upon, whatever form that imposition may take. It does not 
answer to say that this class belong to the illiterate and the 
uneducated, for unhappily that is not the fact. It belongs, 
however, to a peculiar mental constitution. Minds of a 
weak and uncertain tenure are those from whom quackery 
fills its pockets for a time, and only for a time. Quackery 
snatches at every new advance in the profession, and ever 
and anon assumes a new garb, sometimes even within the 
walls of science, and flies from pillar to post to maintain its 8 
Medical Education. 
hold upon its victims. It is for this very purpose of unmask- 
ing quackery in its various forms, of enlightening and con- 
vincing the public, I maintain, that the highest type of 
education is a necessity to our profession. There is thus a 
reciprocal relation between the two. On the one hand, the 
public makes the demand for the highest medical education 
imperative, and on the other we demand it for ourselves 
and for them. 
With this demand then, what shall be done to meet it ? 
What can you and I do l In the first place, I think much 
may be gained by a careful selection of the young men to 
whom we shall recommend a medical career. My revered 
friend and instructor, the late President Way land, used to say, 
that “ many a good cabinet-maker had been spoiled to make a 
poor minister,” and so we may think that many a man has 
been thrust into a medical career, who would have done 
himself ampler justice in some other pursuit. Of the quali- 
ties that constitute a good physician I shall say nothing. 
You all know them as well as I do. But I will say that I 
think it is of the utmost importance in advising young men to 
study our profession that we should demand above all a high 
morality and purity of life, fair intellectual gifts, and a 
capacity and fondness for study ; for we are all students, 
though not of books alone, and must continue such, and he, 
who has no fondness for study, will make but little progress 
in his profession. I fear, indeed, that many of us, who are 
in active life, do little more than study our cases, but I 
would fain believe that it is the lack of opportunity which 
constrains us. 
Then I think we are too apt to lead young men into 
the study of the profession at too early an age, and with too 
little preliminary training. The boy who graduates from 
our schools or academies, in his sixteenth year, is too young, 
too immature to undertake the studies which will be put Medical Education. 
9 
upon him. His mind lacks both training and development. 
I must say, though you may not agree with me-, that I do 
think a collegiate education is the fitting preparation for 
entrance upon professional studies. Of course, my remark 
includes the preparation gained by attendance upon scien- 
tific schools as of nearly equal value. I think that, after a 
boy has left our academies and high schools, he should 
spend three or four years, in college or in a scientific school, 
in learning how to study. It is not so much the knowledge 
gained in these institutions, although that is not to be 
despised, but it is the learning how to acquire knowledge, 
the drilling and training of the mind, as the athlete does his 
muscles, enabling it to concentrate its energies, to endure 
prolonged effort, teaching it how to grapple with severe 
problems, how to distinguish the sources of error in human 
judgment so that they may be avoided—teaching it to think 
for itself—these are the prime advantages to be derived 
from such a course. And then come the more secondary 
advantages of the acquisitions themselves. In this prelimi- 
nary education, he will acquire some foundation in the 
physical sciences, in chemistry for instance, which will be of 
life-long value to him in his professional career. He will 
gain at least enough Latin and Greek to enable him to 
appreciate the full force of, and rightly employ, the many 
terms derived from these languages, in daily use in our pro- 
fession, and he will also gain the mental discipline which 
these studies involve, lie will secure an introduction to 
the knowledge of those foreign tongues, which certainly are 
to-day an essential for a well-read physician. Not long 
since, I met with a quotation from Prof. Seelye, of the Uni- 
versity of Cambridge, in England, in which he tersely says, 
“ As a rule, good books are in German.” Without going so 
far as that with regard to our medical literature, I will 
appeal to any one of you who is familiar with the latest and 10 
Medical Education. 
best writings in any branch of it, and ask if you have failed 
to observe' the constant reference to German monographs 
and to German investigations, as reported in their rich and 
varied periodical literature. German and French are, I 
think, indispensable, and Italian will soon have to be added. 
For the new awakening, that has come over that smiling 
land in the last twenty years, has touched its men of science, 
and they are rousing themselves from their slumbers, and 
shaking off the lethargy of ages, and it may be that those 
ancient medical schools of Salerno and Naples, and the far- 
famed Universities of Bologna, and Padua, and Florence, 
may yet again rejoice and blossom like the rose. 
Then, too, as a result of such a preliminary education, 
in addition to those advantages having a direct bearing 
upon his professional career, he will find profit in the 
breadth of culture which is opened up to him—in the eleva- 
ted tastes which his contact with the minds of the past will 
develop,—and throughout his whole life, his sources of 
enjoyment and his capacity for benefiting his fellow-men 
will be increased. It is not, I regret to say, that these 
benefits accrue to every one, to whom the opportunity of 
acquiring them is offered, nor are they, on the other hand, 
always withheld from those, whom a sterner fortune has not 
led to these founts of learning. Indeed, to my mind there 
is nothing more ennobling than the endeavor made, by many 
an earnest gifted man, to supply in after-life the deficiencies 
of youthful opportunities. I have known such men, of 
mature years, in the active pursuit of our profession, set 
themselves deliberately down to the acquisition of a foreign 
tongue, and accomplish it to that degree, that the whole 
wealth of its literature was open to them. Such men will 
educate themselves in spite of every difficulty, and in 
truth we are all, in one sense, self-educated, for if we do not 
educate and train ourselves who can do it for us ] But by Medical Education. 
11 
pursuing the course of instruction of our colleges and scien- 
tific schools, the mode of acquiring that education is made 
ten-fold easier than it would be, if we werd left to our own 
unaided resources. 
Nor need the item of expense deter young men from 
entering upon this preliminary course. The mere cost of 
collegiate education was never so little as it is now. In 
nearly all r ur schools and colleges, endowments stand ready 
for the use of those who will but apply, and why should not 
the young man who aspires to heal the sick, and bind up 
the bleeding wound, secure the advantages of these endow- 
ments, as well as he who is to be looked up to as our father 
in God. The young man who is bent upon acquiring an 
education will accomplish it at all hazards. The difficulty 
is to arouse that desire in his heart, and here is where you 
and I must use our influence. • Tell him that the few years 
spent in acquiring this preliminary education, instead of 
being lost to him in a professional sense, will be a positive 
gain ; tell him that, if he is true to himself, his subsequent 
professional progress will be the more rapid for this delay 
at the start; tell him that, with these additional years of 
study, he will at the end be quite young enough to assume 
the grave responsibilities that are lying in wait for him. 
You see, then, gentlemen, the opinion which I hold, 
and I submit to you, if it is not the wisest and best. If 
ours is to be, what it is considered, one of the learned pro- 
fessions, shall we not as members qualify Ourselves for that 
high place, by no one-sided education, but by a broad and 
liberal culture, which makes us in the truest sense educated 
men? 
With these views, which I have long held, I hail with 
gladness the omen which comes to us from old Harvard. The 
announcement is made that “In and after September, 1877, 
all students seeking admission to the Medical School must 12 
Medical Education. 
present a degree in letters or science, from a recognized 
college or scientific school, or pass an examination in Latin 
or French or German and in Physics.” “ The examinations 
will be conducted in writing, and in judging the work of the 
candidates, the spelling, grammar and construction will be 
considered.” That I maintain is a long step forward, and 
in the right direction. It will, I think, do more to elevate 
the standard of professional attainment than all that has 
been accomplished by a score of associations. It will not 
be long before the other leading medical colleges will follow 
this good example, and a preliminary examination or a 
degree will be the pre-requisite for entering upon the 
course of professional study. But I believe that this is but 
the thin edge of the entering wedge, and in a short time, 
if I mistake not, the degree alone will be accepted. 
Since these lines were penned, I see that the President 
of the American Medical Association, at its late session, 
addressed that body upon this same subject, and has made 
this demand already, although in terms which it seems to 
me, at least, are not felicitous, and at the same time adding 
to it a complicated machinery. He proposes that it should 
be “ solemnly resolved by the Association, that it shall be 
regarded as derogatory to the character of any physician, in 
any part of the United States, to take under his care as a 
student of medicine, any one who cannot exhibit evidence of 
having taken a degree in a regularly chartered college, or a 
certificate of qualifications necessary to become a student of 
medicine from a Board of Examiners, appointed for this 
purpose by the American Medical Association.” Such is 
his language. I fully agree with the editor of the Boston 
Medical and Surgical Journal, in declaring this at the least 
premature, and as for the examination by a Board of the 
Association, I should have very little faith in the amount of 
work such a Board would perform. rIhe action in this Medical Education. 
13 
matter must, it seems to me, emanate from the medical 
schools, in response to a demand from the profession, and 
therefore, it is to the individual that the appeal must be 
made, and to you, therefore, I make it. But although it 
may at present he premature to demand that every appli- 
cant for medical studies shall have putsued a college course 
or its equivalent, I think the time is close at hand when this 
order will be established, and I am sure it would be for the 
best interests of the profession, and for it I would enlist 
your support. 
We have thus far had to do merely with the prelimi- 
nary education of the medical student. I propose briefly to 
consider the course of professional study; and here, I think, 
many changes are to be affected, which will be of infinite 
advantage to the student. Indeed, since I graduated in 
medicine, many changes have been introduced but more, I 
am sure, are to follow. I know that I am treading upon 
difficult ground, and one on which many contests have 
occurred, but I think free discussion of the subject will 
cause the truth eventually to appear, and its agitation will 
perhaps hasten the development that is desired. The ad- 
dress to which I have referred, and that of the President of 
the Association of Medical Editors, on the preceding even- 
ing, show that the professional mind in different parts of 
the country, is thoroughly awake to the consideration of this 
subject, and this, I trust, will eventually lead to decided and 
concerted action. 
As to the plan of study in the medical colleges, we all 
know that, in the most of them, it consists of attendance 
upon two full courses of lectures in successive winters. 
That is, the student goes over the same ground twice. All 
of us remember the months that we have spent listening to 
lecture after lecture, hour after hour, during the day, with 
the attendance upon quiz classes in the interVals, with 14 
Medical Education. 
evenings given up to dissection, and with weekly or bi- 
weekly interruptions of the lectures to attend upon the 
clinics. How this plan of teaching ever came to assume 
the position it holds, and has held for so long a time I can- 
not imagine. To me it seems radically wrong; wrong in its 
conception, and wrong in its execution. Too much is 
crammed into the student’s head to find any lodgment 
there. No time is allowed for arranging and digesting all 
that is forced upon him. Anatomy and physiology, chem- 
istry, materia medica, theory and practice, surgery, and 
obstetrics, have all been paraded before him, and he catches 
a glance here, and a glance there. And as the matter now 
stands, this is for the stripling who is just out of a high 
school, as well as for him who has gone through a college, 
and already attended one or two courses of lectures. It is 
indeed true that, in some of the larger medical colleges, 
these courses are supplemented by a summer course, in 
which the pupil comes into closer relations with the instruc- 
tor, but the proportion of the winter class in attendance 
upon the summer course is quite small. 
I have always believed that recitation is the most valua- 
ble method for fixing knowledge in the mind. If a young 
man is required to state, in his own language, what he 
knows about the matter in hand, he will be much more 
likely to arrive at accurate and certain ideas, than if he 
merely listens to a lecture, and perhaps takes notes of the 
points that strike him as important, and trusts to these until 
the final day of reckoning comes, when he is summoned to 
appear for examination. It is to supply this very need that 
quiz classes are established in connection with every college. 
They endeavor to satisfy this want of the student. They 
doubtless do a certain amount of good work, and they re- 
lieve the professor of much of the drudgery that would be 
inherent in any other system. But I do not think they take Medical Education. 
15 
the place of oral examinations by the instructor himself 
upon the lecture of the preceding day. It seems to me, and 
I am speaking of that in which I have had no experience, 
and I may be ignorant of the difficulties that would pertain 
to such a course, but it seems to me, that the instruction 
should be by lecture and recitation combined. This, of 
course, would throw the didactic instruction upon the 
younger and less distinguished men, and would leave the 
brilliant lecturer free for clinical instruction. It would also 
involve a greater expenditure of time; that is, it would 
lengthen the time that a young man would be in attendance 
upon the medical school, and this is a result I should desire. 
Shall I venture to say what I think would be of the 
greatest value to the young man, and to the profession ? 
Without being a graduate of Harvard, I must say that I 
have watched with deep interest the experiments that have 
been there made, in this matter of a change in medical edu- 
cation, and I am glad to believe that it seems likely to be 
successful. They have carried out what has for a long time 
seemed to me to be the true plan. I do not know the entire 
detail of the system as is there used, but it is sufficient to 
say that it expands the course of instruction over three full 
years, at the college, dividing appropriately the time given 
to the different studies, and examining the student at the 
end of each year upon the work gone over. That is, to my 
mind, the truest and best plan, and I say, all hail to Har- 
vard, with all my heart, for taking so long a step in advance 
of all the medical colleges in the land. What, as I have 
said, does the study amount to in the office of the instructor, 
in the interim of lectures as otherwise pursued? Often 
practically nothing, and sometimes worse than nothing. Let 
the study be continuous and in an ascending gradation. Do 
not make the veriest tyro listen to the differential diagnosis 
between mitral insufficiency and stenosis, wrhen he scarcely 
knows that there is such a thing in the human machine as a 16 
Medical Education. 
mitral valve. Let his knowledge come to him gradually, 
and in something like a natural sequence, and let him have 
time to make himself thoroughly master of what has been 
presented to him. Above all things let him have the op- 
portunity of avoiding what is the most detrimental to all pro- 
gress—the most blighting of all curses—a superficial knowl- 
edge. I think we may go one step farther, and say let him 
give his two or three years to the didactic study of the pro- 
fession, and to the study of pathological and microscopic 
anatomy, and then let him build upon this noble structure, 
well and securely founded, the superstructure of his clinical 
experience; then let him enter the hospitals, and have daily 
opportunities of acquiring a practical knowledge of his pro- 
fession, and of verifying the principles and truths with 
which his mind has been stored. Thus will he become truly 
a learned man,—a Doctor of Medicine. He will feel him- 
self, like the Knight of old, armed at all points. Dismay 
will not settle on his countenance at the suspicion of dan- 
ger. Responsibilities, grave though they be, will not be 
shirked, but met with the firm conviction that he is equal to 
the emergency. 
It has been said that this high degree of education 
would do very well to fit men for practice in the large cities, 
and as an introduction to the study of specialties ; that the 
majority of professional men practice in the country, and 
for them such an education is unnecessary. This view I 
have met in private and in the medical press. Granting 
that the larger number of physicians will find the sphere of 
their labors in the more sparsely settled regions of the 
country, is that any valid reason against a thorough educa- 
tion ? Is not human life as precious in the country, as in the 
city \ Are not the complications that may arise in disease 
the same fof the one as for the other \ And will it not re- 
quire as much, nay, perhaps even more knowledge, skill, 
and originality to conduct a case to a successful issue on the Medical Education. 
17 
frontier, far from all the appliances of civilization, as it would 
among the busy haunts of men ? A situation like this, to 
my mind, only increases the value of the armament with 
which the physician has fortified himself. Forced to rely 
upon himself alone, he will feel strong in the dictates of 
his own judgment, he will have no blind faith in his intui- 
tions, but one well grounded, and for which he can give a 
reason ; and in no situation will the mental resources at his 
command prove themselves more valuable to him. Lati- 
tude and longitude call for no distinction in the degree of 
education, which will make a man thoroughly at home in 
his profession, which will rightly prepare him for the issues 
of life and death, that, humanly speaking, will be placed 
in his hands. 
Do not think that the sketch I have made is without 
its foundation in reality. The young men who enter our 
profession in France and Germany go through very much 
the same training that I have delineated. Let me give you 
an extract from an interesting work, entitled “ Democracy 
and Monarchy in France,” by Prof. Adams, of the University 
of Michigan. In the introduction to that work he portrays 
some of the causes which, to his mind, were the essential 
elements of the success of the Germans in the Franco- 
Prussian War. Pie says that the whole fabric of German 
society rests upon the theory “ that whether you want a man 
for war or for peace, for a profession or for a trade, there 
is no way in which you can make so much of him as by 
training him, and training him not in parts, but as a whole: 
and furthermore that in all the contests of life, other things 
being equal, the trained men are sure to attain the highest 
success.” 
“ The law makers of Germany said ‘ first of all to every 
parent, you must have every child of yours in school from 
the age of six to the age of fourteen : to neglect this obli- 
gation is a crime against the State, and will be punished by 18 
Medical Education. 
law.’ Then to the child they said ‘ Whatever business or 
profession you desire to follow in life, for that you must 
thoroughly fit yourself either as an apprentice or as a pro- 
fessional student.’ ” If it were the latter they said to him, 
“ ‘ You must spend eight or nine years in a gymnasium,’ 
corresponding to our academies and colleges, ‘ after which 
you must devote at-least three years to the study of your 
profession in a university.’ They said to him ‘ Without 
these twelve years of preliminary training, eight or nine of 
which are collegiate, and three or four of which are profes- 
sional, you can receive no degree, and until you have re- 
ceived a degree, you can collect no fee for legal advice, you 
can write no prescription, you can have no place as instructor 
in the smallest gymnasium in the land.’ ” 
In order to show you what this degree in medicine means, 
let me quote from a letter published in last week’s Nation with 
regard to this ordeal at the University of Leipzig. “ The can- 
didate must first present certificates of his whole course of 
instruction from the time he learned the alphabet down to 
the day he presents his application for the doctorate. His 
technical course is to cover a period of ten semesters (or five 
years). If his character and credentials are acceptable, he 
is required then to write an original disputation on any sub- 
ject (chosen by himself) that may lie within the range of his 
profession. This is duly deliberated upon by the Faculty, 
being passed from one to the other until each has read it. 
This requires from fourteen days to three weeks alone. The 
disputation being declined, the matter ends there. If, how- 
ever, the candidate is so fortunate as to have his work meet 
the approbation of the Faculty, he is then admitted to 
a rigorous examination .... in anatomy, micro- 
scopical, comparative, and general; physiology, general and 
special; general and special pathological anatomy ; general 
and special surgery ; general and special medicine ; obstet- 
rics, ophthalmic surgery and medicine, diseases of children, Medical Education. 
19 
diseases of women, materia medica,” &c. At the end of the 
first two years and a half he has been examined in all the 
elementary branches, such as botany, chemistry, physics, 
zoology, &c. Such is the experience of a graduate in medi- 
cine at Leipzig, and it corresponds materially with the de- 
mands at other German universities. 
Do you wonder then, that, with all this careful prepa- 
ration, German authorities abound, that the profession 
occupies an exalted position, where not a man can take 
a degree without all this preparation? In France as well, 
the medical career is much the same, and in both of 
these countries the practice obtains, to which I have al- 
luded, of adding on the clinical instruction to the didactic 
courses already attended. The young men who swarm 
through the cliniques at Vienna, and Berlin, and Paris, 
have already accomplished their studies in anatomy and 
physiology, chemistry and materia medica, and now give 
their undivided attention to the practical part of the pro- 
fession. 
Contrasts have often been drawn between the relative 
standard of the profession in this country and abroad, and it 
has been asserted oven and over again, with I think con- 
siderable truth, that among us the intellectual life of the 
profession is not active ; that it is not productive. If this is 
true, and I think it is in a measure, it does not apply to the 
practical part of the profession. American surgery, we all 
know, is quoted and held in high esteem all over the conti- 
nent of Europe. American ingenuity and boldness have led 
the way to hiany surgical triumphs. But when we come to 
consider the other branches of medical study, the experience 
of the past has shown us that most, I do not say all, of the 
original work, of the thorough pains-taking investigation, has 
come to us from the other side of the water. I am fully 
aware that this is less so now than formerly. The past ten 
years have witnessed great changes in this respect. The re- 20 
Medical Education. 
suits of American studies in different branches of physiology, 
as for instance in the functions of nerves, and in the diseases 
arising from injuries to nerves, in the anatomy of the dislo- 
cations of the hip joint, and in venereal diseases, will 
compare favorably with the results of the best German 
efforts. Other instances might also be cited where admira- 
ble work has been achieved by our American brethren, but 
taken all together, they are by far too few. In order to 
place our profession here in the front rank, as compared 
with other countries, I believe we have great need of this 
higher medical education. We need that our medical men 
should be more prompt and ready to place at the disposal of 
others, the fruits of their long and varied experience. We 
need that the intellectual life of the profession should be 
stimulated, as it alone can be, by holding before it a lofty 
standard of excellence. 
If, gentlemen, you have agreed with me in what I 
have said, you will admit that the ideal we hold before 
us is certainly high. Is it unattainable1? I fain would 
hope that it is not. You and I may not live to see it 
realized, but I trust that our children will. What better 
legacy can a father leave to his children than a thorough 
and liberal education ? Which one of us does not covet for 
his son better opportunities than he has himself enjoyed ? 
If success has crowned your efforts; if some of you, with 
noble and heroic labors, have triumphed over the scanty 
advantages of your earlier days, how much more will your 
sons achieve, if you give them the opportunities that stand 
open to their hand. Thus will you fit them most thoroughly 
for the duties that will come to them, as they have come to 
you. Thus will you do your share towards elevating the 
standard of the profession. Thus will they become as shin- 
ing lights, guiding public sentiment with wisdom, and 
achieving more than we for the benefit of their fellow- 
men.