Medical Education in the United States Before the Civil War [Reprint 2016 ed.] 9781512805000

Table of contents :
Foreword
Contents
Part I. Introduction
Part II. Factors in Early American Medical Education
Part III. Medical Schools of Pennsylvania
Part IV. Medical Schools of New York State
Part V. Medical Schools of New England
Part VI. The Schools of the Old South
Part VII. The Schools of Transappalachia
Part VIII. Evolution of the American System of Medical Education
Bibliography
General Index
Index of Personal Names

Citation preview

MEDICAL EDUCATION IN T H E UNITED STATES BEFORE T H E CIVIL WAR

MEDICAL EDUCATION IN THE

UNITED STATES BEFORE THE CIVIL WAR By WILLIAM

FREDERICK

NORWOOD

Associate Professor of the History of Medicine and Associate Dean in the School of Medicine College of Medical Evangelists, Los Angeles

Foreword HENRY

by

E. SI G ERI

ST

PHILADELPHIA UNIVERSITY OF PENNSYLVANIA PRESS LONDON: OXFORD

HUMPHREY UNIVERSITY 1

9 4 4

MILFORD PRESS

Copyright

1944

UNIVERSITY OF PENNSYLVANIA Manufactured

in the United

PRESS

States of

T H E P U B L I C A T I O N O F THIS

America

VOLUME

HAS BEEN AIDED BY A G R A N T F R O M T H E A M E R I C A N C O U N C I L OF L E A R N E D SOCIETIES F R O M A F U N D PROVIDED BY T H E C A R N E G I E C O R P O R A T I O N OF NEW

YORK

Affectionately

inscribed

to my twin

brother

GEORGE EDWIN NORWOOD and to the memory

of our

father

JOHN WILLIAM NORWOOD clergyman

and student

who first stimulated to explore

of

history

in me a desire the past

FOREWORD In a recent very eloquent paper, Richard H. Shryock stressed the need for studies in the history of American science.1 He very justly pointed out that if we wish to trace the cultural development of our people as a whole, we must pay more attention to science and the part it has played in the life of the nation, even if this part has been a negative one. " T h e value of studies in the history of American science is not to be found primarily in contributions to the history of science as such, but rather to the history of the United States." Shryock's statement fully applies to the history of medicine, and more than justifies the present study. Medical education as it was practised in the United States before the Civil War had certainly nothing to give to the world, and yet it was undoubtedly an important factor in the life of the nation. Every profession, in every country, has the natural tendency to glorify its past. We constantly pay tribute to our heroes and justly emphasize the great contributions that American medicine has made. How much has been said and written about Benjamin Rush, Ephraim McDowell, Daniel Drake, William Beaumont, about the introduction of anesthesia, the differentiation between typhus and typhoid and similar achievements. On the other hand, we tend to minimize shortcomings or to apologize for them. Or when we point to them, we do it as a matter of contrast, in order to show how bad conditions were in the past and how much progress we have achieved. This obviously is a very unhistorical approach. Every period of our history in every section of the country must be investigated in all its aspects. Health conditions have played a very important part in the shaping of our history, and we must know what was done in the past to combat disease. T h e history of American medicine, like the history of American science, is therefore one aspect of our national history that must not be neglected. In studying it, it must not be our purpose to praise or condemn, to approve or disapprove. We must try to interpret conditions and developments so that we may understand them. Medical education, like education at large, always presupposes an educational ideal. Every society has an ideal doctor in mind, and through its medical schools endeavors to train young people so that they will conform with the medical ideal, or at least come as close to it as possible. T h e picture a society has of its ideal physician, on the other hand, is the result of the social and economic structure of that society and of the technology of medicine prevailing at a given time. ι Isis, X X X C (1944), 10-13. vii

FOREWORD

viii

Hence while the technology of medicine was similar in France and in America during the first half of the nineteenth century, yet the peculiar and unique social and economic conditions that prevailed in this country necessarily led to different results in medical education. T h e proprietary school characteristic of the period was not so much the result of an emergency as rather the expression of a society that worshipped the principles of unchecked free enterprise and unlimited laissez faire, one in which money gave power and prestige. It would have been tempting to write the history of medical education after the Civil War, when the nation had regained its unity, when the frontier came to an end, the cities and the industries developed, and American medicine began its rise to world significance. W e must be very grateful to Dr. Norwood that he chose the much more arduous task and never tired of digging into sources, consulting an endless number of documents in order to give us a vivid picture of medical education as it developed in this country before the war. In doing it, he has made an important contribution not only to the history of American medicine but, first of all, to the cultural history of the United States. H E N R Y E . SIGERIST

The Johns Hopkins of the History of April 22, 1944

Institute Medicine

PREFACE study is not intended to be a technical consideration of the early teaching of medicine in the United States. It is a survey of the rise and progress of the American system of medical instruction and the institutions of medical learning up to the time of the Civil War. Little effort has been made to introduce new information concerning some of the larger, well-known schools, but there has been a genuine intent to draw from obscurity many relatively unknown institutions. Wherever pertinent, the various aspects of the subject have been laid on a background of the social and intellectual phases of the American scene. Emphasis has been placed on the economic and social aspects of the rise and decline of individual medical schools, but the study is in no sense a treatise in sociology or economics. It merely purports to examine a phase of American medical history from a broader point of view, which until recent years was not employed by medical historians. THIS

T h e beginning of the Civil War as a point of termination for this study is not as arbitrary as it might seem. Before Fort Sumter hundreds of Southern medical students attending Northern colleges and universities returned to Southern schools which they had previously regarded as inferior. About three hundred students were said to have left Philadelphia on one day. Practically all of the Southern schools closed before the end of the first year of hostilities. T h e impact of this national conflict, then, registered heavily in both sections of the country. T h e decade of the fifties was a critical period in the medical reform movement. By drawing attention to other problems and eliminating the Southern membership from the American Medical Association, the war temporarily stalemated the movement to elevate standards of medical education. Extending the scope of the study to include the renaissance in medical education which began at Harvard and was emphasized at Johns Hopkins later in the century would make of the book too bulky a tome. No better point of division than that marked by the beginning of the Civil War suggested itself to the author. T h e term American is used rather freely in the restricted sense of referring to the United States. T h e Old South of Part VI refers to the Atlantic tier of states from Maryland to Georgia. T h e T r a n s a p p a l a c h i a of Part V I I refers to all of the country west of the Appalachian Mountains. Within Part VII, the terms West, Middle West, and Far West are used rather freely, but it is believed that the context will remove any questions as to the exact areas designated. Part VII also makes use of the term New South, which is intended to designate the Gulf tier of states from Alabama ix

χ

PREFACE

to Louisiana with Tennessee added on the north. The Southwest designates, as it did a century ago, the lower Mississippi Valley. Any acknowledgements with reference to this study must begin with a recognition of the late Erik McKinley Eriksson, for ten years friend and counselor of the author, and Dr. Eriksson's committe associates: The late Drs. Paul McKibben and Gilbert Giddings Benjamin, and Drs. Owen C. Coy and Eugene J . Harley, under whose direction this study was first prepared as a doctoral dissertation in the Department of History, University of Southern California. T h e author well remembers that his plan to prepare a paper on the subject of this book dated from the receipt of a friendly suggestion made by Dr. Newton Evans, pathologist of the Los Angeles County General Hospital. Other friends and colleagues, too numerous to mention, in the faculty of the School of Medicine in the College of Medical Evangelists have by kind suggestions and encouragement helped the project along. T h e author is especially indebted to the officers and trustees of the College of Medical Evangelists for a leave of absence extending through most of a year, during which time the Library of Congress and several important medical libraries of the country were extensively consulted. This phase of the project was aided materially by the kind generosity of the author's brother, Dr. George Edwin Norwood. Invaluable counsel and advice have been received in personal interviews with Dr. George Dock of Pasadena, California; Dr. Henry E. Sigerist, director of the Institute of the History of Medicine of the Johns Hopkins University; Dean William Pepper of the University of Pennsylvania School of Medicine, whose private collection was made available; Dr. Sanford Larkey, librarian, William H. Welch Medical Library, Baltimore; Dr. W. B. McDaniel, II, librarian, College of Physicians Library, Philadelphia; Dr. Archibald Malloch, librarian, New York Academy of Medicine; James F. Ballard, director, Boston Medical Library; Christian Bay, librarian, John Crerar Library, Chicago; and by helpful suggestions from Dr. Frederick C. Waite of Western Reserve University and Drs. Ε. B. Krumbhaar and Richard H. Shryock of the University of Pennsylvania. In addition to the libraries noted above, the author collected material from Lane Medical Library, Stanford University; Army Medical Library, Washington, D.C.; Library of the Medical and Chirurgical Faculty of Maryland, Baltimore; University of Maryland Medical Department Library, Baltimore; the University of Pennsylvania School of Medicine Library, Philadelphia; Harvard University School of Medicine and Public Health Library, Boston; Tulane University of Louisiana School of Medicine Library, New Orleans; Library of the Council on Medical Education of the American Medical Association, Chicago; the libraries in both divisions of the College of Medical Evangelists, Loma Linda and Los Angeles; Los Angeles County Medical Association Library; and last but very important because of its splendid collection of Americana and

xi

PREFACE

the extraordinarily good service of its staff, the H e n r y E. H u n t i n g t o n L i b r a r y of San Marino, California. D u e recognition is hereby given to Francis R . Packard's two-volume set, History of Medicine in the United States, w h i c h the author has referred to frequently. O f special importance also is H e n r y Burnell Shafer's m o n o g r a p h , The American Medical Profession, 1783-1850, and W y n d h a m B o i l i n g Blanton's, Medicine in Virginia in the Eighteenth Century. T h e s e volumes a n d other secondary authorities too numerous to mention have been very h e l p f u l . T h e author's interest and activity in this project have spread over a decade, d u r i n g which time he has appreciated the excellent service of the f o l l o w i n g secretaries and stenographers: Margaret H o x i e , Ethel Stuart, H e l e n Barr, Francella Schoberth, Grace Anderson, Doris Henry, Lottie Ziprick, Esther Matthews, Y v o n n e Olsen, and A d a h A r a g o n . Ella Moyers, librarian of the W h i t e M e m o r i a l Library of the College of Medical Evangelists, w i t h the aid of several interested helpers prepared the index of persons, and w i t h her assistant, Joyce Marson, performed accurately the task of checking the bibliography. O t h e r bibliographical service was rendered by two medical students, Genevieve Joy a n d V e r n o n Foster, w h o e x h i b i t e d more than ordinary interest and ability. T h e burdensome task of p r o o f r e a d i n g was lightened by the friendly volunteer help of several interested friends, especially H o m e r J. Eastman a n d Betty Flaiz. For all of this aid the author is genuinely grateful. H e expresses his deep gratitude a b o v e all for the w i l l i n g a n d patient helpfulness of his sympathetic wife, R u t h Irvine N o r w o o d , in the gathering and arranging of the materials used in bringing this study to completion. T h e problem of securing an a d e q u a t e subvention for the production of this volume with its limited circulation was simplified by a liberal grant f r o m the A m e r i c a n C o u n c i l of Learned Societies on the recommendation of the History of Science Society. T h e project was also materially supported by the f o l l o w i n g friends and colleagues: Drs. John Harvey Kellogg, H e n r y R . Harrower, G e o r g e T h o m a s o n , P a u l D. Foster, R o g e r W . Barnes, H . James H a r a , T h e o d o r e S. K i m b a l l , M a l c o l m R . Hill, Florence Keller, Elisabeth Larsson, Eric A . Royston, Ivan C . B o h l m a n , a n d the A l u m n i Association of the School of Medicine, College of Medical Evangelists. W i t h o u t this much-appreciated assistance, publication of the manuscript w o u l d have been impossible. WILLIAM

Los Angeles January 1944

FREDERICK

NORWOOD

CONTENTS PART

I:

INTRODUCTION

Chapter

Page

ι.

John Morgan and the College of Philadelphia

2. 3.

Colonial Practitioners of Physic Colonial Literature and Practice of Physic PART

II: FACTORS

IN EARLY AMERICAN EDUCATION

ι 9 21 MEDICAL

4.

Medical Legislation and Societies

29

5.

T h e Preceptorship and Other Methods of Instruction

32

6.

Military Medicine and the Beginning of Formal Instruction

57

PART

III: MEDICAL

SCHOOLS

OF

PENNSYLVANIA

7.

The University of Pennsylvania School of Medicine

63

8. 9.

Jefferson Medical College of Philadelphia Other Medical Schools and Facilities in Philadelphia

86 94

T h e Medical D e p a r t m e n t of Pennsylvania C o l l e g e Philadelphia C o l l e g e of M e d i c i n e Franklin Medical C o l l e g e Penn Medical University of Philadelphia Special Facilities for Medical E d u c a t i o n

PART

10.

11.

IV: THE

SCHOOLS

OF NEW

YORK

94 97 100 101 101

STATE

The College of Physicians and Surgeons of Columbia College 109 King's and C o l u m b i a ' s Schools of M e d i c i n e

109

College of Physicians and Surgeons

113

Queen's, Rutgers', and Geneva's Medical Schools in New York City

125

12.

New York University Medical College

13.

Miscellaneous Medical Schools in New York City and Brooklyn 139 N e w Y o r k School of M e d i c i n e N e w York Hospital School of xiii Medicine

134

139 139

xiv

CONTENTS

Chapter

ρ age 140 143

New York Medical College Long Island College Hospital Bellevue Hospital Medical College 14.

M e d i c a l Schools of Upstate a n d W e s t e r n N e w Y o r k 149 T h e College of Physicians and Surgeons of the Western District of the State of New York 150 T h e Auburn Medical School 154 Geneva Medical College Albany Medical College igg Department of Medicine, University of Buffalo 163

PART

V: MEDICAL

SCHOOLS

OF NEW

ENGLAND

15.

T h e M e d i c a l School of H a r v a r d University

167

16.

T h e Medical D e p a r t m e n t of D a r t m o u t h C o l l e g e

186

17.

T h e M e d i c a l Institution of Y a l e C o l l e g e

192

18.

Miscellaneous T o w n a n d R u r a l M e d i c a l Schools of N e w England Brown University Medical School T h e Medical School of Maine of Bowdoin College Castleton Medical College University of Vermont Medical Department Berkshire Medical Institution of Massachusetts Vermont Medical College Miscellaneous Contributions to Medical Education in New England

199 igg 201 204 208 211 215 218

PART

VI:

THE

SCHOOLS

OF

THE

OLD

SOUTH

19.

T h e C o l l e g e of M e d i c i n e of M a r y l a n d , and U n i v e r s i t y of M a r y l a n d C o l l e g e of M e d i c i n e 223

20.

W a s h i n g t o n M e d i c a l C o l l e g e of B a l t i m o r e Miscellaneous Contributions to Medical Education in Baltimore

242 246

21.

M e d i c a l Schools in the District of C o l u m b i a Columbian College Medical Department Georgetown College School of Medicine

248 248 250

22.

T h e Medical C o l l e g e of South C a r o l i n a ; M e d i c a l C o l l e g e of the State of South C a r o l i n a 251

23.

T h e Schools of V i r g i n i a 259 Medical Lectures at William and Mary College 259 College of Physicians of the Valley of Virginia at Winchester; Winchester Medical College of Virginia 261 T h e Medical Department of the University of Virginia . 262 T h e Medical Department of Randolph-Macon College 267 T h e Medical Department of Hampden-Sidney College 269 T h e Medical College of Virginia 273

CONTENTS

XV

Chapter 24. T h e Schools of Georgia

Page 876

Medical College of Georgia Savannah Medical College Atlanta Medical College Oglethorpe Medical College

PART

VII:

THE

SCHOOLS

276 279 280 281

OF

TRANSAPPALACHIA

25.

T h e West and Medicine

284

26.

T h e Schools of Kentucky

289

Medical Department of Transylvania University Louisville Medical Institute University of Louisville Medical Department Kentucky School of Medicine

27.

T h e Schools of Ohio

289 298 299 301

304

T h e Medical College of Ohio 304 Miami University Medical Department 310 T h e Medical Department of Cincinnati College 318 Cincinnati College of Medicine and Surgery 321 Miami Medical College 322 Willoughby Medical College 325 Starling Medical College 328 Cleveland Medical College; Medical Department, Western Reserve College 329 28.

T h e S c h o o l s of I n d i a n a LaPorte University Medical Department Indiana Central Medical College Medical College of Evansville

332 332 334 336

29.

T h e Schools of Illinois

337

30.

Franklin Medical College Medical Department of Illinois College Rush Medical College Medical Department, Lind University

337 338 339 344

Other Schools in the Old Northwest

346

Wisconsin Medical College Madison Medical College Rock Island Medical College College of Physicians and Surgeons of the Upper Mississippi College of Physicians and Surgeons of the Iowa University University of Michigan Medical School

31.

T h e Schools of Missouri T h e Medical Department of Kemper College Medical Department of Missouri State University Medical Department of the Missouri Institute of Science Medical Department of St. Louis University St. Louis Medical College

346 347 347 348 349 350

353 353 354 355 356 357

CONTENTS

XVI

Chapter

Page Medical Department of Franklin Medical and Literary College of St. Louis 358 St. Louis College of Medical and Natural Sciences 359 Humboldt Institut 360

32.

T h e Schools of N e w Orleans

362

T h e Medical College of Louisiana Medical Department of the University of Louisiana New Orleans School of Medicine

33.

363 367 368

Other Schools in the N e w South

372 372

Memphis Medical College Medical Department of the University of Nashville T h e Medical College of Alabama

34.

373

376

Medical Education in California

377 377

University of the Pacific, Medical Department

PART

VIII:

EVOLUTION OF OF MEDICAL

THE AMERICAN EDUCATION

SYSTEM

35.

T h e Apprenticeship and the Origin and Control of Medical Faculties 380

36.

Financial Support of Medical Schools

387

37.

T h e Cost of Medical T r a i n i n g

392

38.

T h e C u r r i c u l u m , T e x t b o o k s , and T e a c h i n g Problems

396

39.

Degrees and Licensure

403

40.

W o m e n and Medical Education

407

Medicine and the Emancipation of Women Boston Female Medical School Elizabeth Blackwell Woman's Medical College of Pennsylvania Woman's Medical College of New York Infirmary New York Medical College and Hospital for W o m e n

407 408 409 412 414 415

41.

T h e Rise of Sectarian Schools

416

42.

R e f o r m Movements

422

43.

Conclusion

429

Bibliography

435

General Index

463

Index of Personal Names

475

PART I INTRODUCTION

CHAPTER

1

J O H N MORGAN AND T H E COLLEGE OF PHILADELPHIA IN THE third quarter of the eighteenth century, when William Penn's "holy experiment" was in its eighty-third year and the City of Brotherly Love, with a scant twenty-five thousand population, was the metropolis of the English colonies in America, a commencement exercise of the College of Philadelphia took on more than ordinary significance. Organized in 1751 as the Philadelphia Academy, the College had scarcely discarded its swaddling clothes by 1765. Despite its callow years, this institution, as viewed from the vantage point of the twentieth century, occupied a unique position among the few colleges founded in the colonies up to that time. Beginning with Harvard in 1636, all the colonial colleges were patterned after the English educational system as embodied in Oxford and Cambridge. 1 All studies revolved around theology, with Latin and Greek as the vehicles of thought and learning. Harvard and Yale opened under Puritan auspices; William and Mary under Anglican control; and Princeton, King's College, Queen's College, Brown, and Dartmouth were strongly motivated by sectarianism or missionary zeal.2 The College of Philadelphia—now the University of Pennsylvania— was distinct in that it departed from this theological design. Such an innovation was due to two influences: first, the milder theological climate of Philadelphia; and second, the driving energy of Benjamin Franklin. The Quakers, the dominant religious element in Philadelphia at this time, were unlike their Puritan brethren. They too counseled simplicity in life and manners, frowning upon the lusts of the flesh, but dealt less in terms of sin, hell, and the devil. The simplicities of Jesus rather than the mysteries of dogmatics fortified their faith. Hence the Quaker philosophy possessed some of the elements of academic freedom. Furthermore, Philadelphia had one of the most cosmopolitan populations of any of the colonial cities.3 1 Influences of lesser significance are attributed to important achievements by the Dutch, Germans, Scots, and the Hugenots. 2 Dartmouth alone was non-sectarian. Most of these institutions departed from orthodoxy by admitting students of various persuasions. Charles A. and Mary R . Beard, The Rise of American Civilization, 1: 167 ft. 3 Stephen Pefeil, "Philadelphia," The Encyclopedia Americana, 1932, 2 1 : 7 2 7 . Cf. William Ε. H. Lecky, American Revolution, pp. 23 fi. 1

2

MEDICAL

EDUCATION

BEFORE T H E

CIVIL

WAR

These elements combined made of the metropolis a fit place for the culture of advanced ideas. In this atmosphere, Benjamin Franklin had no difficulty accommodating himself after fleeing the province of Cotton Mather. A m o n g Philadelphians he popularized the idea of one's thinking things out for himself. He himself became a member of the Royal Society, as were the Winthrops and Cotton Mather of New England. He organized in 1728 a literary club, the Junto, which after some evolution became the American Philosophical Society in 1769. Franklin, with his coterie of thinking men, projected and made a reality the Philadelphia Academy, which admitted its first class in 1751. By 1755 the institution assumed the title of college. T h e curriculum for the new institution was worked out by the first provost, William Smith, and by Franklin. T h e conventional Latin, Greek, and scholastic subjects were included, but thanks to the superior intelligence of one who had never been college trained, and for the benefit of boys who did not seek a professional career in law, medicine, or divinity, such practical studies as mathematics, surveying, navigation, and accounting were offered. Mechanics, physics, chemistry, agriculture, natural history, history, civics, ethics, government, trade, commerce, and international law were also added. ". . . and finally, for the worldly wise and curious," as Charles and Mary Beard put it, "training in modern languages" was instituted. 4 T h e principal speaker at the extraordinary commencement occasion in May 1765 was burdened with a theme of such profound importance that he was given the platform on two consecutive days. H e was John Morgan, just returned from five years of extensive medical study in Britain and on the Continent. His theme was the institution of medical schools in America and the revamping of medical practice. By the time the two sessions were over, the young Aesculapian had vivisected the art of physic and surgery, including the mode of medical instruction and the ethics of practice. He spoke boldly and with authority, for he was an alumnus of the College, having graduated with the first class in 1757. Dr. Morgan had studied medicine under Philadelphia's most noted medical preceptor, Dr. John Redman, had served as resident apothecary to the Pennsylvania Hospital for thirteen months; and had been active as a surgeon with the Pennsylvania troops in the French and Indian War. He had returned after five years spent in the world's great centers of medical education, where he had worked under the Hunters, Cullen, and other eighteenth-century immortals. In 1763, the University of Edinburgh had conferred on him the M . D . degree. 5 Before returning to America, he had been elected to the R o y a l Society and had been made a member of the College of Physicians of Edinburgh and a licentiate of the College of Physicians of London. A n excursion on the continent added to his honors membership in the Society of Belles-Lettres of R o m e and an associate fellowship in the Académie Royale de Chirurgie de Paris. * Beard and Beard, op. cit., p. 172. 6 Morgan ably defended a thesis, De Puopoicsi, in which he demonstrated that the pus, which in that pre-antiseptic day was expected to rise in every wound, had its origin in the blood vessels and not in the body tissue.

C O L L E G E OF P H I L A D E L P H I A

3

Doctor Morgan's recommendations were not all in the form of degrees and professional honors. H e brought with him letters of approval from T h o m a s Penn and two former trustees of the institution, James Hamilton and R i c h a r d Peters, who were at the time residing in England. In part Penn wrote: We are made acquainted with what is proposed to be taught, and how the lectures may be adopted by you, and since the like systems have brought much advantage to every place where they have been received, and such learned and eminent men speak favorably of the doctor's plan, I could not but in the most kind manner recommend Dr. Morgan to you, and desire that he may be well received, and what he has to offer be taken with all becoming respect and expedition into your most serious consideration, and if it shall be thought necessary to go into it, and thereupon to open Professorships, that he may be taken into your service. When you have heard him, and duly considered what he has to lay before you, you will be best able to judge in what manner you can serve the public, the Institution, and the particular design now recommended to you. 6 Morgan arrived home in April, and Penn's letter was presented to the Trustees on M a y 3. In the interim Morgan must have labored with apprehensive members of the board, for a glance at the board's minutes for M a y 3 indicate that the project met with immediate approval. At a meeting of the Trustees held this day, John Morgan, of this city, M. D., corresponding member of the Royal Academy of Surgery at Paris, Licentiate of the Royal College of Physicians at London, and member of the Arcadian (Belles Lettres) Society at Rome, was unanimously elected Professor of the Theory and Practice of Medicine in the College of Philadelphia. At the ensuing commencement he will deliver an address (which will be soon afterwards published), in order to show the expediency of instituting medical schools in this seminary, and containing the plan proposed for the same; in which there will be room for receiving professors duly qualified to read lectures in the other branches of medicine, who may be desirous of uniting to carry this laudable design into execution. Dr. Morgan's plan has been warmly recommended to the Trustees by persons of eminence in England, and his known abilities and great industry give the utmost reason to hope it will be successful, and tend much to the public utility. 7 So when the thirty-year-old spellbinder entered the rostrum on May 30, he was already the Professor of the T h e o r y and Practice of Medicine in the College of Philadelphia. A school of medicine had been born on the periphery of western civilization. Dr. Morgan's remarks at this memorable function were addressed to the "Trustees of the College and the Citizens of Philadelphia." Since the trustees had previously committed themselves, the two days were obviously devoted to an effort to secure the active interest and support of the medical profession and the general public. T h e occasion was a sort of graceful Chamber of Commerce gesture. T h e speaker's appearance in a professor's robe lent academií sanctity to the gathering, and the presence of the governor and a concourse of leading β Cited by George W. Norris, The Early History of Medicine in Philadelphia, 150-51. 1 Cited in Ibid., p. 152.

pp.

4

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

citizens made the affair both auspicious and momentous. T h e discourse was delivered at the old Academy on Fourth Street near Arch. B u t John Morgan was not a window dresser. He dealt with what were to him glaring facts and incontrovertible truths. T h e entire address was, after some delay, published with an extensive preface. 8 T h e Morgan Plan set forth the following: (1) A systematic classification of the various branches of medical knowledge and the order in which they should be studied, (2) T h e importance of education preliminary to the study of medicine, (3) A general view of the state of physic in America, and the "effects of ignorant and presumptious practice," (4) T h e arguments for the circumstances favoring the institution of a medical school, (5) T h e recommended mode of practising physic, (6) Advantages to be expected from the proposed institution, (7) Counsel to prospective students of medicine, and (8) Words of gratitude and encouragement to the trustees. Franklin's newspaper, in making note of the discourse, declared that " A s it is soon to be printed, we would not wish to anticipate the judgment of the public, and*shall only say, the perspicuity with which it was written and spoken drew the close attention of the audience, and particularly of the gentlemen of the Faculty of Physic." 9 Perhaps in the audience sat one William Shippen, Jr., M. D „ a gentlem a n of Pennsylvania's upper stratum of society, as was Morgan. T h e i r lives had paralleled in other respects. Shippen had studied medicine under his father in Philadelphia while Morgan had been apprenticed to Redman. T h e n their paths had diverged: Shippen's had led to Edinburgh and advanced study, while Morgan's had led to practical opportunities as a medical lieutenant in the state militia. After three years their paths had paralleled again for a brief period. Shippen's last months in Edinburgh were Morgan's first. If never before, here they must have discussed at length the project of instituting formal instruction in physic in the colonies. James T h o m a s Flexner, in a journalistic vein asserted: It was impossible for the two Colonials not to compare the educational opportunities of Europe with conditions at home; they discussed it many an evening over the bitter Scottish ale. Shippen confided to his friend that he intended to expand the apprentice system by delivering lectures in Anatomy as several other Americans had done before him. Perhaps when Morgan returned he would join him and lecture on physic. Morgan agreed and that spring Shippen sailed back to put his part of the plan into operation. 10 β John Morgan, A Discourse Upon the Institution of Medical Schools in America; Delivered at a Public Anniversary Commencement, Held in the College of Philadelphia May jo and 31, 1765. With a Preface Containing, Amongst Other Things, the Author's Apology for Attempting to Introduce the Regular Mode of Practising Physic in Philadelphia. T h e book was inscribed to his intimate friend, Samuél Powel, Esquire, w h o had accompanied him on his European tour. Powel was later mayor of Philadelphia. T h e address was originally prepared while Morgan was in Paris. Before delivery it was submitted for criticism to professional and personal friends, among whom were Doctors Fothergill, Hunter, and Watson and his companion, Samuel Powel. β Cited in Norris, op. cit., p. 155. N o exact reference is given by Norris. 10 James T h o m a s Flexner, Doctors on Horse-Back, p. 13.

COLLEGE OF

PHILADELPHIA

5

Shippen returned to Philadelphia in 1762, and in spite of opposition from the ignorant and pious w h o felt he was blasphemously exposing the secrets of nature, he conducted public lectures in obstetrics and anatomy. W i t h him from England he brought the gift of Dr. John Fothergill to the Pennsylvania Hospital—a series of anatomical drawings and casts. In his accompanying letter Dr. Fothergill wrote: I n w a n t of real subjects, these will h a v e their use a n d I h a v e r e c o m m e n d e d to D r . S h i p p e n to give a course of a n a t o m i c a l lectures to such as m a y a t t e n d ; h e is very well qualified f o r the subject, and will soon be f o l l o w e d by an a b l e assistant, Dr. M o r g a n , both of w h o m I a p p r e h e n d will n o t o n l y be useful to the P r o v i n c e in their e m p l o y m e n t s , but if suitably c o u n t e n a n c e d by the L e g i s l a t u r e will be a b l e to erect a school of physic amongst you that may d r a w m a n y students f r o m v a r i o u s parts of A m e r i c a a n d the W e s t Indies, a n d at least f u r n i s h them with a b e t t e r idea of the r u d i m e n t s of their profession than they h a v e at present the m e a n s of a c q u i r i n g o n y o u r side of the w a t e r . 1 1

Just what transformation of motive or design occurred to render impotent the Morgan-Shippen liaison of 1762 is not known. Possibly M o r g a n decided that Shippen's proprietary approach to the problem was undignified and mercenary. Had Morgan's numerous honors made him egocentric? Was he designing to appropriate to himself the honor of instituting America's first school of medicine? Penn's letter, solicited by Morgan, makes not the slightest mention of Shippen. Neither do the trustees' minutes of May 3, though William Shippen, Sr., was a member of the Board. 1 2 Was the fact that young Shippen was an alumnus of New Jersey College and not of the local institution a cause for isolation? He was by reputation possessed of a happy disposition, but the publicity accorded John Morgan must have lighted the flame of resentment within the breast of the anatomist. T h e inhibitions of Christian graces perhaps restrained Shippen when, in the midst of his discourse, the commencement orator averred: It is w i t h highest satisfaction I a m i n f o r m e d f r o m D r . S h i p p e n , j u n i o r , that in an address to the p u b l i c as i n t r o d u c t o r y to his first a n a t o m i c a l course, h e proposed some hints of a p l a n for g i v i n g m e d i c a l lectures amongst us. B u t I d o n o t learn that he r e c o m m e n d e d at all a collegiate u n d e r t a k i n g of this k i n d . W h a t led me to it was the o b v i o u s utility that w o u l d a t t e n d it, a n d the desire I h a d of presenting, as a tribute of g r a t i t u d e to my alma mater, a f u l l a n d e n l a r g e d p l a n f o r the institution of medicine, in all its branches, in this seminary w h e r e I h a d p a r t of m y e d u c a t i o n , b e i n g a m o n g s t the first sons w h o shared in its p u b l i c honours. I was f u r t h e r i n d u c e d to it f r o m a consideration that schemes of p r d ^ a g a t i n g k n o w l e d g e are instable in their n a t u r e , and that the c u l t i v a t i o n of useful l e a r n i n g can o n l y be effectually p r o m o t e d u n d e r those w h o are patrons of science, a n d u n d e r the a u t h o r i t y a n d d i r e c t i o n of m e n i n c o r p o r a t e d for the i m p r o v e m e n t of literature.13 n Norris, op. cit., pp. 126-27. 12 Joseph Carson, A History of the Medical Department vania, 1869, p. 53. 13 Morgan, op. cit., pp. 34-36.

of the University of Pennsyl-

6

MEDICAL EDUCATION

BEFORE T H E CIVIL

WAR

T h e forensic artist t h e n d r e w a breath a n d h a n d e d a sop to his belittled colleague. Said he: S h o u l d the trustees of the C o l l e g e think p r o p e r to f o u n d a professorship in A n a t o m y , D r . S h i p p e n h a v i n g been c o n c e r n e d already in teaching that b r a n c h of m e d i c a l science is a c i r c u m s t a n c e favorable to o u r wishes. Few h e r e can be i g n o r a n t of the g r e a t o p p o r t u n i t i e s he has had a b r o a d of q u a l i f y i n g himself in A n a t o m y , a n d that he has already given three courses thereof i n this city, a n d designs to e n t e r u p o n a f o u r t h course next W i n t e r . 1 4 T h u s s y m p a t h e t i c f r i e n d s of D r . S h i p p e n w e r e p u t at ease; t h e d o o r w a s t h r o w n o p e n . S o u n d i n g b r a s s a n d t i n k l i n g c y m b a l it m a y h a v e b e e n t o t h e twenty-nine-year-old p h y s i c i a n w h o h a d risked his life d o d g i n g the missiles of the m o b w h e n he i n t r o d u c e d anatomical dissection three years previously. Y e t h e h a d t h e i n w a r d satisfaction of h a v i n g p r e p a r e d the w a y f o r s o m e t h i n g g r e a t e r . 1 5 A f t e r t h r e e m o n t h s it a p p e a r e d t h a t t h e M o r g a n p l a n , s o f a r as t h e C o l l e g e w a s c o n c e r n e d , w a s m o v i n g f o r w a r d . W i l l i a m S h i p p e n , J r . , p e r h a p s s u p p r e s s e d p e r s o n a l p r i d e w h e n , o n S e p t e m b e r 23, h e p e n n e d to the trustees of the C o l l e g e the f o l l o w i n g : T h e i n s t i t u t i o n of M e d i c a l Schools in this country has b e e n a f a v o r i t e o b j e c t of m y a t t e n t i o n f o r seven years past, a n d it is three years since I p r o p o s e d the e x p e d i e n c y a n d p r a c t i c a b i l i t y of teaching m e d i c i n e in all its b r a n c h e s in this city in a p u b l i c o r a t i o n r e a d at the State House, introductory to my first course of A n a t o m y . I s h o u l d l o n g since h a v e sought the p a t r o n a g e of the T r u s t e e s of the C o l l e g e , b u t w a i t e d to be j o i n e d by D r . M o r g a n , to w h o m I first c o m m u n i c a t e d m y p l a n in E n g l a n d , a n d w h o p r o m i s e d to unite with me in every scheme we m i g h t t h i n k necessary for the e x e c u t i o n of so i m p o r t a n t a point. I a m pleased, however, to h e a r that y o u , g e n t l e m e n , o n b e i n g a p p l i e d to by Dr. M o r g a n , h a v e app o i n t e d that g e n t l e m a n Professor of M e d i c i n e . A Professorship of A n a t o m y a n d Surgery, w i l l be a c c e p t e d by gent., Y o u r most o b e d i e n t a n d v e r y h u m b l e servant, WILLIAM

SHIPPEN,

JR.18

S o b e g a n , i n the s a l u b r i o u s i n t e l l e c t u a l c l i m a t e of c o l o n i a l P h i l a d e l p h i a , t h e first s c h o o l o f m e d i c i n e i n t h e E n g l i s h c o l o n i e s o f A m e r i c a , a n d

the

M o r g a n - S h i p p e n feud. T h e institution, e x p a n d i n g w i t h the years in spite o f d i f f i c u l t i e s , h a s s p l e n d i d l y f u l f i l l e d t h e p r o p h e c y f o r its f u t u r e as u t t e r e d b y its f o u n d e r i n t h e c l i m a x o f h i s d i s c o u r s e : P e r h a p s this m e d i c a l i n s t i t u t i o n , the first of its k i n d in A m e r i c a , t h o u g h small in its b e g i n n i n g , m a y receive a constant increase of strength, a n d a n n u a l l y e x e r t n e w v i g o u r . It m a y collect a n u m b e r of y o u n g persons, of m o r e t h a n o r d i n a r y abilities; a n d so i m p r o v e t h e i r k n o w l e d g e as to spread its r e p u t a t i o n to distant parts. B y s e n d i n g these a b r o a d d u l y qualified, or by e x c i t i n g a n e m u l a t i o n κ Ibid., p. 35. « Kieffer thinks that Morgan recommended Shippen's appointment to the chair of anatomy out of loyalty to his friend. See John E. Kieffer, "Philadelphia Controversy," Bulletin of the History of Medicine, 10: 152, February, 1942. Mr. Kieffer has written an excellent account of the Morgan-Shippen feud, but this author is inclined to disagree on the point noted above. i e Carson, op. cit., pp. 55-56. Shippen was unanimously elected.

COLLEGE OF

PHILADELPHIA

7

amongst men of parts a n d literature, it may give b i r t h to o t h e r useful institutions of a similar nature, o r occasional rise by its e x a m p l e , to n u m e r o u s societies o f different kinds, calculated to spread the light of k n o w l e d g e t h r o u g h the whole A m e r i c a n c o n t i n e n t , wherever i n h a b i t e d . 1 7 T h e r i s e a n d d e v e l o p m e n t o f t h e U n i v e r s i t y o f P e n n y s l v a n i a S c h o o l of M e d i c i n e will b e c o n s i d e r e d in a l a t e r c h a p t e r . So also will c e r t a i n ramifications of the m a l i g n a n t strife between Drs. M o r g a n a n d S h i p p e n ,

which

l a s t e d u n t i l t h e f o r m e r w a s r e m o v e d by d e a t h . I n t h i s c h a p t e r o n e o t h e r p h a s e o f t h e Discourse

will be n o t e d .

A f t e r s e t t i n g f o r t h t h e n e e d o f o r g a n i z e d p r e m e d i c a i e d u c a t i o n a n d delineating the deficiencies of A m e r i c a n a p p r e n t i c e - t r a i n e d physicians

who

" m u s t unavoidably be in continual perplexities," M o r g a n built a hypothetical case against the average colonial physician. " S h o u l d we for a m o m e n t turn o u r eyes," he declared, " u p o n the m a n , w h o dares to enter u p o n the practise of Physic, without being properly initiated in the science, o r i n s t r u c t e d in the i m p o r t a n t duties of the profession, h e w o u l d s o o n p r e s e n t us with a m e l a n c h o l y p r o s p e c t . " T h e n M o r g a n e x p a n d e d t h e p i c t u r e : I f not past all feelings of h u m a n i t y , what c o m p u n c t i o n s of conscience, w h a t remorse would n o t fill his breast f r o m practising at r a n d o m a n d in t h e d a r k n o t k n o w i n g w h e t h e r his prescription might prove a w h o l e s o m e remedy, o r a destructive poison. T o discover the n a t u r e of an u n c o m m o n disease, o r to a c c o u n t f o r an unusual symptom, puzzles his i n v e n t i o n . I g n o r a n t o f every true p r i n c i p l e , f r o m which, by a just reasoning, he might be a b l e to d e d u c e p r a c t i c a l inferences, h e knows n o t what prognostic to make, o r what p l a n o f t r e a t m e n t to observe. Unsteady a n d irresolute, he a t t e m p t s a variety of m e a n s , such as e i t h e r avail not, o r such as h e i g h t e n the d a n g e r of the disease, already t o o v i o l e n t . H e may thus i n t e r r u p t the salutary attempts of nature, or, n o t k n o w i n g h o w to second them, t a m p e r with the life of his p a t i e n t , a n d idly w a i t i n g to see what n a t u r e herself is capable of doing, neglect to succor her, till it is too late, a n d the fatal h a n d of death is j u s t closing the gloomy scene. 1 8 A t this p o i n t d e g r e e l e s s p r a c t i t i o n e r s i n t h e a u d i e n c e m a y h a v e

fidgeted

n e r v o u s l y a n d c r e d u l o u s l a y m e n b l a n c h e d as t h e y c o n t e m p l a t e d t h e l i m ited credentials of t h e i r family physicians. B u t M o r g a n , w i t h t h e zeal o f a crusader, went

right

on:

W r e t c h e d is the case of those w h o m chance, or m i s i n f o r m e d j u d g m e n t , shall throw i n t o his hands, to fall victims of his temerity. G r e a t is the havock which his i g n o r a n c e spreads on every side, r o b b i n g the a f f e c t i o n a t e h u s b a n d o f his d a r l i n g spouse, o r r e n d e r i n g the t e n d e r wife a helpless widow; i n c r e a s i n g the n u m b e r of o r p h a n s ; mercilessly d e p r i v i n g them of their p a r e n t s ' s u p p o r t ; b e r e a v i n g t h e afflicted parents o f t h e i r only c o m f o r t a n d h o p e , by t h e u n t i m e l y d e a t h of t h e i r beloved infants, a n d laying whole families desolate. R e m o r s e l e s s foe to m a n k i n d : actuated by m o r e than savage cruelty! hold, h o l d thy e x t e r m i n a t i n g h a n d . 1 9 O n e can readily imagine that tears coursed the cheeks of the e m o t i o n a l l y m i n d e d by t h e t i m e s p e a k e r M o r g a n r e a c h e d t h i s r h e t o r i c a l c r e s c e n d o . I n a h a l f c o n c i l i a t o r y m o o d h e t h e n c l i n c h e d his c l i m a x o f t h e first d a y : 17

Morgan, op. cit., pp. 58-59. !» Ibid., pp. S J - Î 4 . 1» Ibid., p. *4·

8

MEDICAL EDUCATION

BEFORE T H E CIVIL

WAR

G l a d should I be to moderate this too cxact description of the effects of ignorant and presumptuous practice; but what j u d g m e n t can we pass o n those, w h o have been scarcely instructed in the first elements of medical science, and yet force themselves into practice, as if they meant to sport themselves with h u m a n life, a n d h u m a n calamities? 20

Such remarks, thinks Flexner, were an insult to practically every physician on the continent. 2 1 Many of the physicians who heard or read the discourse no doubt had the same opinion. Subsequent events, however, indicate that the profession and the thinking portion of the populace took seriously the proposal for a medical school but heavily discounted the balance of Morgan's remarks, as the panacea of an unseasoned zealot. A n d yet John M o r g a n was respected. N o one could deny that he was the Philadelphia boy w h o had made good in Europe. -o Ibid.,

p . 25.

21 Flexner, loc. cit.

CHAPTER 2

COLONIAL PRACTITIONERS OF PHYSIC T H E m e d i c a l profession w h i c h J o h n M o r g a n , A m e r i c a ' s first professor of the theory a n d practice of medicine, proposed to r e v a m p in 1765 was not an i n c o n s e q u e n t i a l g r o u p . By the o p e n i n g of the R e v o l u t i o n a r y W a r there were r e p u t e d to be in the colonies u p w a r d s of 3,500 p r a c t i s i n g physicians. O f these, it has been estimated that not m o r e than f o u r h u n d r e d h a d received the M . D. degree f r o m a m e d i c a l college. M o s t of these h a d received their degrees f r o m E u r o p e a n institutions. B y 1776 o n l y fifty-one b o n a fide M . D. degrees h a d been c o n f e r r e d by the t w o schools established u p to that t i m e — t h e C o l l e g e of P h i l a d e l p h i a a n d K i n g ' s C o l l e g e . 1 For a century a n d a half a g r a d u a l l y increasing n u m b e r of practitioners h a d been responsible for the health of the colonists. T h e y were a heterogeneous g r o u p . A m o n g them were physicians, clerics, barbers, butchers, magistrates, a n d in fact a n y o n e w h o , by choice or u n d e r f o r t u i t o u s circumstances, e n t e r e d u p o n a practice of the h e a l i n g art. T h e E u r o p e a n distinction b e t w e e n physicians and barber-surgeons d i d not survive to any e x t e n t in the colonies. T h e r u g g e d life m a d e absolute d e m a n d s o n any m a n w h o passed as a healer. T h r o w n on his o w n resources, the s u r g e o n l e a r n e d to prescribe for fevers and fus, and the physician treated w o u n d s a n d r e d u c e d fractures. 2 O n e specialty only m a i n t a i n e d its identity t h r o u g h o u t this col o n i a l period, a n d that was obstetrics, w h i c h for m o r a l a n d t r a d i t i o n a l reasons was almost entirely in the hands of w o m e n . Early in c o l o n i a l history physicians a n d surgeons b e g a n to carry their share of burdens in the b u i l d i n g of a new w o r l d . M e d i c a l historians record w i t h some gusto the account of h o w Dr. W a l t e r Russell, a 1608 a r r i v a l at the J a m e s t o w n C o l o n y , saved the life of C a p t a i n J o h n S m i t h . T h e historian James G . M u m f o r d p r o v i d e d most of the detail. It seems that S m i t h w i t h a g r o u p of p i c k e d men, i n c l u d i n g Russell, e m b a r k e d o n a small c r a f t a n d set o u t to e x p l o r e some of the n e a r b y estuaries. In a n effort to supplem e n t their provisions one of the party l a n d e d a sting ray. T h e c a p t a i n u n f o r t u n a t e l y received a sharp w o u n d in the f o r e a r m f r o m the dorsal fin of the fish. T h e poison i n j e c t e d by the spine w o r k e d r a p i d l y . T h e great S m i t h 1 J. M. T o n e r , Contributions to the Annals of Medical Progress and Medical Education in the United States, Before and During the War of Independence, p. 106; N . S. D a v i s , History of Medical Education and Institutions in the United States of America, pp. 9-10. - A g a i n s t this custom of the g e n e r a l practice of m e d i c i n e John M o r g a n i n v e i g h e d in his Discourse, p a r t i c u l a r l y in the twenty-six-page preface. F o r h i m s e l f he p r o p o s e d that h e w o u l d only diagnose, prescribe, a n d treat m e d i c a l l y , l e a v i n g to his assistant, D r . D a v i d L e i g h t o n , all surgical p r o c e d u r e s a n d the c o m p o u n d i n g of d r u g s .

9

10

MEDICAL EDUCATION

BEFORE T H E CIVIL

WAR

seemed doomed; at least his comrades began making preparations for a simple burial. A portion of the contemporary account is worthy of notice: N o blood nor wound was seen, but a little blew spot, but the torment was instantly so extreme, that in four hours had so swolen his hand, arme and shoulder we all with much sorrow concluded his funerali, and prepared his grave in an island by, as himself directed: yet it pleased G o d by a prescious oyle Doctor Russell at the first applyed to it when he sounded it with the probe (ere night), his tormenting paine was so well asswaged that he eate of the fish to his supper, which gave no less joy and content to us than ease to himselfe, for which we called the Island Stingray Isle after the name of the fish.3

Though lacking the romance of the Pocahontas legend, this story suggests the adventurous life to which early American doctors were subjected. Maryland lays claim to Dr. Russell because this bit of drama was staged on the eastern shore of the Chesapeake. In point of time the hero Russell was preceded by Dr. Thomas Wotton, whom J . M. Toner spoke of as surgeon-general of the struggling colony and as being among the first colonists. He is credited with having subsisted, along with his fellows, solely on crabs and sturgeon for a long time. 4 A Dr. Anthony Bagnali is mentioned as surgeon to the Jamestown fort in 1608. He also accompanied Smith on an excursion, during the course of which a flying arrow passed through his hat without injury to him. Other company doctors early associated with Jamestown were Lawrence Bohun, 1610, and Dr. John Pott, who became governor for a short time in 1628." Apparently no reliable practitioner was in the young colony in 1609, for in that year Captain Smith went to England for surgical treatment after he was injured in an explosion of gunpowder. In addition to the above, Thacher names fifteen early Virginia physicians of prominence during the colonial generations. Practically all of these men were European trained, several having graduated from Edinburgh. John Mitchell, M. D., settled in Virginia in 1700. He wrote extensively on botany and climatology. Another one of the fifteen was a Dr. Siccary, reputed to be a Portuguese Jew. He is credited with having introduced "that admirable vegetable, the tomato." It was his opinion that "these apples" possessed qualities of elixir and that the person who should eat a sufficient abundance of them would never die. One of Virginia's early physicians, Hugh Mercer, M. D., distinguished himself as a general in the Revolutionary War, and like Warren of Bunker Hill fame, Mercer fell in the defense of liberty, at Princeton in 1777. He had previously practised with distinction at Fredericksburg. Among Virginia's adopted sons was a respectable Scotch physician, James Craik, trained at Edinburgh. He came to America in early life and was with Braddock's army in 1755, serving as surgeon. At that time he became an intimate of George Washington. Later he made his home in Virginia, and when the Continental Army was organized he accepted an appointment in the Medical Department, rose to 3

James Gregory Mumford, A Narrative of Medicine in America, pp. s o - 2 1 . * Toner, op. cit., pp. 1 0 - 1 1 . s Francis R . Packard, History of Medicine in the United States, 1: 5-6.

COLONIAL PRACTITIONERS

11

high rank, and served with distinction. He attended Washington in his final illness. Generally speaking, the physicians of early Virginia were gentlemen of excellent training for their day. Some reasons for this will be noted later.® A m o n g the survivors of that stricken band which clung tenaciously to the fringe of the new wilderness at Plymouth during the fateful winter of 1621 were pious Deacon Samuel Fuller and his equally devout wife. T h e Deacon was eminently useful as a physician and surgeon to this first Massachusetts colony, and Sister Fuller served many years as midwife. Samuel Fuller had been deacon in John Robinson's church in Leyden and probably attended some lectures in "physick" at the school of medicine in that city. Francis R . Packard declared that Fuller held no medical diploma, but that he served unofficially as medical adviser to all the colonists about that part of Massachusetts Bay. T h e r e is record of two trips made by him to Charleston and Salem at the request of Governor John Endicott, to succor the victims of an outbreak. 7 In a letter to Governor W i l l i a m Bradford in 1630 he wrote: " I have been to Matapan, and let some twenty of those people blood." T h u s Dr. Fuller continued from year to year, extending his services to both his brethren and the aborigines, making his home in Plymouth. A n "infectious fever" struck this settlement in 1632, and the excellent and revered T h o m a s Fuller was among the "upwards of twenty men, women and children" w h o succumbed. 8 His wife, the accoucheuse, labored on. T h e Massachusetts Bay Company, in 1628, through the London Court of Assistants, placed two medical men under contract for duty in Massachusetts. One, Mr. Pratt, a surgeon, settled and practised in Cambridge until 1645. Dissatisfied with his emolument, he embarked on a vessel for a venture in Spain, but lost his life when the ship was wrecked on rocks near the Spanish coast. T h e other, Robert Morly, contracted to serve as a barber and surgeon on all "occasyons belonging to his Calling." Nothing is known of the details of his residence in the colony. In 1629 J ° h n Endicott of Salem was informed by the company officials that an agreement had been made with chirurgeon Lambert Wilson to serve the settlers and neighboring Indians for three years. Wilson further agreed to give medical training to one or more young men. T h e latter obligation, if carried out, might well be cited as the first effort at medical education, unpretentious though it was, in the English colonies. 9 N o t a few of the early colonial practitioners of physic were men of the cloth. James T h a c h e r explained that the nonconformists for more than twenty years before the 1620 emigration were subjected to sharp persecution, and the possibility of the clergy among them subsisting on the exercise of their sacred duties was very doubtful. Hence as a precautionary measure a considerable number of the clergymen at that time obtained a β James Thacher, American Medical Biography: Or Memoirs of Eminent Who Have Flourished in America, 1828, pp. 73 If. ι Packard, op. cit., p. 8. β Thacher, op. cit., p. 17. » Packard, op. cit., pp. 3 f.

Physicians

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

12

medical education. Also, it was not uncommon in that day for the reading of Hippocrates, Galen, Aretaeus, Celsus, and other medical authorities to be incorporated in the accomplishments of a finished scholar. When clergymen with such training accepted appointments in the colonies they often found that small congregations were unable to provide comfortable support. T h e practice of medicine, therefore, fitted very conveniently and admirably into the regular program of parochial duties. 10 In 1869 Oliver Wendell Holmes reported to the Massachusetts Historical Society on the medical profession in colonial Massachusetts. His preparation for the paper included a survey of Savage's Genealogical Dictionary of the settlers who came before 1692, and their descendants to the third generation. Holmes found in the four "crowded volumes" the names of 134 medical practitioners. From incomplete data he discovered that at least twelve practised surgery, three were barber-surgeons, and six or seven and probably a larger number were ministers; one was schoolmaster and poet, one a tavern keeper, one a female practitioner, Anne Moore, employed by her own sex, and one a butcher. T h e last, in his will, designated himself as surgeon, a union of callings which suggested to Holmes's keen mind an obvious pleasantry. A bit of homely sentiment is recorded of one of these early knights of the lancet, William Dinely, a surgeon who lost his life in a tempest of wind and snow between Boston and Roxbury. T e n days later his widow was delivered of a son, on whom was saddled the name "Fathergone" Dinely. Of another, who was also a minister, it is reported that he took to grog and tumbled into the Connecticut River and so ended his mortal life. Holmes's figures on the avocations of these early practitioners can be regarded as significant only in that they indicate that the profession of medicine was not always separate and distinct from other callings. 11 Thacher made reference to thirty or more Massachusetts physicians whose lives and work are identified with the first century and a half of the colony's history. A few only will be noted here. In 1633 Giles Firmen was a respected deacon in the Boston church and also an able physician. Holmes probably had the same man in mind when in 1869 he quoted from the Massachusetts Historical Society Collections a letter which John Eliot, apostle to the Indians, had written to Mr. Shepard, a minister of Cambridge: "We never had but one anatomy in the country, which Mr. Giles Firmen, now in England, did make and read very well." 1 2 Giles Firmen, as Holmes said the name was commonly spelled, practised physic in this country for a time, and his lectures on anatomy, according to Holmes, were the first scientific teachings of the new world. In this matter Holmes was mistaken. T h e work of Lambert Wilson, noted above, takes precedence by several years. However, Firmen's lectures seem to have been more of a formal attempt at medical education than Wilson's tutoring. 13 Firmen found his practice a poor business, and with his mind "strongly 10 11 12 13

Ibid., p . 14. O l i v e r W e n d e l l H o l m e s , The Medical Profession in Massachusetts, Massachusetts Historical Society Collections (third series), 4: 37. P a c k a r d , op. cit., p . 25, spells the n a m e F i r m i n .

1 8 6 9 , p p . 6 f.

COLONIAL PRACTITIONERS

3

sett upon to studye divinitie" he returned to England. Observation of Puritan divines w h o drew support from their congregations and in addition collected medical fees may have influenced his action. A t any rate he found that physic alone "is but a meene helpe." 14 A t Harvard's first commencement, in 1642, Samuel Bellingham and Henry Saltonstall were graduated. Both men later earned the M. D. degree in E u r o p e a n d were reputed as skillful physicians. L e o n a r d Hoar, a 1650 H a r v a r d graduate, took a medical degree in England and returned to the presidency of his alma mater for a brief period. Charles Chauncy Rogers, a physician, was president of H a r v a r d in 1652. He had an English medical education. His six sons graduated from H a r v a r d and studied medicine. A l l of them are said to have become eminent physicians. Dr. Nathaniel Williams, a H a r v a r d graduate and ordained minister, was popular as a practising physician, being affectionately called the "beloved physician" for his kind and tender deportment in the sickroom. 1 5 Eminent among Massachusetts colonial physicians was T h o m a s T h a c h e r , w h o came to New E n g l a n d in 1635. He was educated for both the ministry and medicine. In the former capacity he served as the first minister of old South Church in Boston, and as physician he secured medical and historical fame by writing and publishing in 1677 A Brief Guide in the Smallpox and Measles, the first medical publication in the colonies. In 1 7 2 1 , after an absence of nineteen years, smallpox again invaded the settlements. A b o u t this time the learned divine, Dr. Cotton Mather, read in the Philosophical Transactions printed in L o n d o n an account of inoculation by T i m o n i and Pylarini in T u r k e y . He communicated the information to several Boston physicians, who treated the suggestion with contempt. H e then approached Dr. Zabdiel Boylston, w h o had received his medical training under his father, T h o m a s Boylston, and Dr. J o h n Cutter of Boston. In the face of vituperative opposition, Dr. Boylston, on J u n e 27, 1 7 2 1 , inoculated his only son, a young boy, and two Negro servants. T h e initial experiment was completely successful. Opposition subsided somewhat, and Boylston and others within a year had inoculated 286 persons, only six of whom died. In the same period, of 5,759 w h o naturally contracted the disease, 844 died. Before prejudice was broken down, Dr. Boylston was assaulted in the streets and loaded with every species of abuse. His house was so outrageously attacked that his family was not safe. Some pious people were of the opinion when he commenced the practice that he should be held for capital punishment should any of his patients die. A n act even passed the lower house of the legislature, but not the Council, m a k i n g the practice of inoculation subject to severe penalties. A n intemperate and free-for-all controversy was precipitated in which the clergymen in general acted an honorable part, and the medical faculty formed the violent and active opposition. Some of the clergy actually re1* Holmes, op. cit., p. 15. T h e best account of colonial anatomy is E d w a r d B . K r u m b h a a r , " T h e Early History of Anatomy in the United States," Annals of Medical History, 4: 2 7 1 - 8 6 , March, 1922. 15 T h a c h e r , op. cit., pp. 17 ff.

ι4

MEDICAL EDUCATION BEFORE T H E CIVIL W A R

ceived personal injury. They were hardly safe in their own homes, and their Sunday services were disdained until the success of the practice induced the people to believe that Providence was with their ministers. Cotton Mather's leadership must have been responsible for holding the majority of the preachers in the fold of liberalism on an issue of this nature. The scourge in 1752 was greatly ameliorated by wholesale inoculation. When in 1792 there was another visitation of the malady the entire town was inoculated in three days.16 Any discussion which purports to survey briefly medical practice and practitioners of colonial New England is not complete without mention of the Governors Winthrop, John Sr., of Massachusetts and John, Jr., of Connecticut. These magistrates were turned to by their people for succor of all sorts, especially medical counsel and advice. John Endicott of Salem gave medical advice. Consciousness of his own deficiencies in medical knowledge may have influenced him to permit his son to become a physician. John Winthrop, the governor of Massachusetts, took his responsibility so seriously that he obtained from a friend in England, Dr. Ed. Stafford, a list of prescriptions designed to simplify his task of prescribing for the sick. The original manuscript was discovered among the Winthrop Papers, and Dr. Oliver Wendell Holmes submitted a paper on it to the Massachusetts Historical Society in February 1862. 17 Packard looked upon the document as the standard if not the only medical textbook in the colony at the time.18 At least Winthrop had at hand definite prescriptions and therapeutic directions for treating specific diseases and symptoms. This was just what Winthrop needed for a sort of "mail-order" practice, but today one reads Stafford's prescriptions with mingled emotions of disgust and pity. According to Sigerist the last paragraphs only, which are said to be the earliest document of American medical ethics, are worth reading. 1 ® John Winthrop, Jr., the first governor of Connecticut, was a Dublin graduate and scientist of eminence in the English world. While in London, before coming to New England, he became one of the founders of the Royal Society of England, and made communications to it from time to time. Mumford suggested that the young Governor's practice, like that of John Endicott and Edward Winslow, who was regarded as a healer both before and after he became governor at Plymouth, was of the nature of a board of health. It seems that he was more of a supervisor than a constant active practitioner. Like his father he had some mail-order practice. Extant prescriptions of these magistrates conform to the general low state of therapeutics in the seventeenth century.20 Judge Samuel Sewall dabbled considerably in medicine. His famous Diary throws flashes of light on both lay and professional practice. He was a strong advocate of fervent prayer for ie T h a c h e r , op. cit. " Oliver Wendell Holmes, editor, Medical Directions Written for Governor Winthrop by Ed. Stafford of London in 164), reprinted from the Proceedings of the Massachusetts Historical Society, 1862. >8 Packard, op. cit., p. 15. 18 Henry E. Sigerist, American Medicine, p. 35. 20 M u m f o r d , op. cit., p. 26.

COLONIAL PRACTITIONERS

»5

the sick, as he quaintly expressed it, "to give him a lift Heavenward." 21 Besides its noted Governor Winthrop, Connecticut's annals do not want for names of successful physicians. T h e first physician to be licensed by the General Court of Connecticut was Thomas Lord, in 1652. T h e action of the court not only licensed him but also authorized a salary of fifteen pounds and set maximum fee rates. Presumably the practice of medicine was not contingent on the issuance of a license. 22 T h e Reverend Gershom Bulkeley combined medicine with divinity and practised the former for fully ten years before the General Court granted him a license in 1686. He had a good medical library and apparatus for preparing medicines. Jaspher Gunn, a Hartford physician, was in 1649 excused from "training, watching and working during his practice of physic." Besides his practice, Dr. Gunn was a dealer in metalware. In his account books are recorded charges, indicating that he turned from kettle- and skillet-mending to dispensing potions, or vice versa, as occasion demanded. Phineas Fiske, a Yale divinity graduate of 1704, was esteemed for his successful treatment of epilepsy and insanity. He taught both theology and medicine to his son-in-law, Moses Bartlett of Portland, Connecticut. Another Yale alumnus who combined spiritual and medical gifts was Jared Eliot. It is stated that he educated many physicians, among whom was his son-in-law, Benjamin Gale. One of Eliot's classmates in Yale was Jonathan Dickinson, who became the first president of Princeton. His "Observations on that terrible disease vulgarly called the throat distemper," published in 1740, was said by William H. Welch to have been the first medical publication by a graduate of Yale. 23 Little consideration has been given New Hampshire by medical historians of early colonial times, but Rhode Island demands some attention. Dr. J o h n Clark, originally of London, was driven from Boston with Roger Williams and became the pastor of the first church organized in Rhode Island in 1644. A long line of Bowens adorns the medical annals of the small colony. Richard Bowen was first and was followed by Drs. Ephraim, William, and Pardon. In 1633 the General Court of the colony licensed Captain J o h n Cranston "to administer physicke and practice chirurgerie." T h e legislative body further stated that he "is by this Court styled doctor of physick and chirurgery by the Authority of this the General Assembly of this Colony." T o n e r looked upon this act as the conferring of a medical degree, and as such, the first in this country. 24 Packard is apparently more correct in regarding it as little more than a license to practise. 20 Many more New England physicians who have been saved from oblivion by the painful research of Holmes and Toner might be mentioned. But to do so would make of this narrative a mere biographical register of the medical profession. Such data as have been noted portray a faculty of physic in 21

Packard, op. cit., p. 31. 22 W. Russell Gurdon, "Early Medical Men of Connecticut," Proceedings of the Connecticut State Medical Society 189j, pp. 33-35. ¡¡a William H. Welch, "The Relation of Yale to Medicine," Yale Medical Journal, 8: 1*8-3*, 1901-2. 24 Toner, op. cit., p. 70. « Packard, op. cit., p. 37.

i6

MEDICAL EDUCATION BEFORE THE CIVIL WAR

colonial New England, heterogeneous in membership, sans professional group consciousness and any organized system of medical instruction, but with a spirit of sacrifice and devotion equal to that of the courageous pioneers who depended upon it for succor in the wilderness. New York, until 1664 called New Netherlands, was, of course, first supplied with Dutch physicians. Therefore the school of medicine at Leyden, one of Europe's foremost centers of medical progress in the seventeenth and eighteenth centuries, had a salutary influence on the beginning of medicine in New York. T h e English came into control of the colony in 1664, after which English doctors began settling on Manhattan and along the Hudson. Some Huguenots are also listed among the physicians practising in early New York. T h e Dutch West India Company, which began its settlement of the colony in 1621, made provision for the health of the pioneers, as did the English companies. T h e charter of the Dutch Company provided for a "comforter for the sick." 28 T h e quaint expression "comforter for the sick" introduces a pleasant thought. A twentieth-century medical student might think these words were lifted from the Florence Nightingale Pledge, but to the Dutch colonists of three centuries ago they meant a trained physician or surgeon. Mumford says that Mynderts van de Bogaerdet, surgeon, who arrived in 1631 aboard the Endragh, was the first of the "comforters," but like Wotton of Virginia he came and went. Six years later Johannes L a Montagne, a Huguenot and graduate of Leyden, was esteemed both as a physician and as a member of the Governor's Council. In 1641 he helped defend Fort Good Hope. When Director-General William Kieft of the West India Company arrived in 1638 he had with him two surgeons, Gerritt Schult and Hans Kierstedt. Samuel Megapolensis was a Harvard graduate. He later took degrees in both theology and medicine at Utrecht and practised both professions in New Amsterdam. In 1664 he was one of the commissioners who negotiated the treaty of transfer with England. Dr. Abraham Staats, a practitioner at Fort Orange, was concerned in treaty-making with the Indians. T h e latter fired his house, taking the lives of his wife and two sons. A surviving son, Samuel, studied medicine in Holland and practised with success in New York until 1716. T h e resident surgeon at Fort Albany in 1661 was a Frenchman named De Huise. In 1689 a Scotchman, Dr. Lockhart, held the post. Cadwallader Colden, an Edinburgh graduate, practised medicine several years in New York City but gave it up for politics in 1720. T h e physicians cited above were representative of the much larger group which practised in New York up to the middle of the eighteenth century. Considered as a group, the New York colonial physicians present fewer instances of combining divinity and medicine than does the profession in New England. It may also be concluded with a considerable degree of accuracy that a larger proportion of New York's early physicians were university trained and held degrees. Undoubtedly the Dutch colonial policy and the luster of Leyden as a school of medicine were largely responsible for this condition. Mumford, op. cit., p. 3 1 .

COLONIAL PRACTITIONERS

»7

T h e Dutch colonists did not limit their activities to New York. In 1623, to protect their settlers they went down the Delaware, which they called the South River, and established Fort Nassau, on the present site of Gloucester, New Jersey. In 1638 the Swedish West India Company sailed two vessels up the Delaware and exchanged a copper kettle with the Indians for land along the west side of the river. Fort Christina was built on the site of Wilmington, and the colony was called New Sweden. Thus were founded the opposing settlements of the Dutch and Swedes on the Delaware. Samuel X . Radbill narrated in interesting detail the service of barbersurgeons to these settlements. There were many painful years of privations and devastating maladies. T h e first of these surgeons was apparently Hanns Janeke, who arrived in March 1638, and was attached to the Swedish expedition. T h r e e months later barber-surgeon J a n Piertersen was stationed at Fort Nassau up the river, with a salary of ten guilders a month. From year to year expeditions continued to come from Sweden to strengthen the struggling colony. Surgeons often accompanied these expeditions under contract to serve the voyagers and the settlers. T i m o n Stidden was so employed, and labored in the colony for four or five years previous to 1644, and returned again in 1654, but not under company appointment. He became a pioneer and extensive land holder in the Wilmington district. 27 T h e royal charter executed by Charles I I in 1664 incorporated in the domains of the Duke of York both New Amsterdam and the Delaware settlements. T h e Duke soon conveyed to L o r d Berkley and Sir George Carteret the portion of his grant now known as New Jersey. T h e proprietors immediately began to encourage settlement. Both Puritans and Friends were attracted to the territory. Among the Quakers were educated physicians who devoted themselves to business and land speculation, though giving some time to professional demands. Apparently there were times when the populace were generally in a good state of health. Charles Gordon of Woodbridge, East Jersey, writing to his brother in 1685, described the salubrity of the climate and then added that except for "some agues and some cutted fingers and legs" there were no diseases to cure. 28 Stephen Wiekes held that much of the doctoring in sparsely settled regions of New Jersey was done by women. He quoted William Winterbotham, who wrote a history of America in 1796, as saying that in Cape May County medicine was administered by women, except in extraordinary cases.29 « Samuel X . Radbill, "Barber Surgeons Among the Early Dutch and Swedes," Bulletin of the Institute of the History of Medicine, 4: 718-44, November, 1936. Radbill, in collaboration with Van Laer, showed quite conclusively that Peter Tyneman, referred to so often by Samuel Hazard, Annals of Pennsylvania, and others, as surgeon to the Delaware settlements, was none other than Timon Stidden noted above. He also showed that Toner was wrong in stating that de Marco Chertser and van Belcamp, surgeon and druggist respectively, resided on the Delaware. Both men lived in Amsterdam, Holland. 28 Whitehead, Contributions to the History of Amboy; cited by Stephen Wiekes, History of Medicine in New Jersey and of Its Medical Men, p. 15. 2» Wiekes, op. cit., p. 16.

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

8

T h e earliest medical records of Essex C o u n t y reveal clergymen, as in N e w E n g l a n d , p e r f o r m i n g the d o u b l e duty of caring for the spiritual a n d physical interests of their flocks. Jonathan Dickinson, the first president of the C o l l e g e of N e w Jersey, filled a Presbyterian pulpit in Elizabethtown, and practised m e d i c i n e u n t i l his death in 1747. T h e oldest N e w a r k physician of w h o m J. H e n r y C l a r k e f o u n d record was W i l l i a m T u r n e r , w h o was tutored by a French physician, in R h o d e Island in 1690. Little is k n o w n of h i m besides the fact he h a d three wives, the second of w h i c h he m o u r n e d in a homely c o u p l e t s c u l p t u r e d on the tomb stone of the departed spouse: God dealeth just, none may complain, Though Turner's left alone again. In 1690 D r . D a n i e l C o x of L o n d o n purchased the greater part of W e s t Jersey a n d was a p p o i n t e d governor of the grant. However, a deputy served in his place a n d T o n e r is of the opinion that C o x probably never practised in N e w Jersey. W i e k e s believed that few of the early N e w Jersey physicians were competently trained. T h e profession, he said, was at first largely composed of those w h o h a d only a brief preceptorial training. 3 0 T h e better-trained physicians a m o n g t h e m were probably D u t c h or Swedish barber-surgeons, Puritan divines, a n d Q u a k e r business men. M u c h of w h a t h a p p e n e d d u r i n g the first decades of colonization a l o n g the D e l a w a r e was a prelude to the greater and more successful venture of W i l l i a m P e n n o n the west b a n k . T h e Pennsylvania enterprise was less of a pioneer u n d e r t a k i n g than was the f o u n d i n g of most of the original thirteen colonies. W h e n P e n n anchored at N e w Castle in 1682, Boston was nourishing its third generation. N e w Y o r k had been British for nearly twenty years, a n d V i r g i n i a w i t h its plantations and experienced legislature h a d w r i t t e n seventy-five years of history. 3 1 Penn's "holy e x p e r i m e n t " was especially attractive to p e o p l e w h o were less adventurous than some w h o came to the N e w W o r l d in 1607 a n d 1620. Nevertheless, Penn's v e n t u r e was not free from difficulty. One-third of the e x p e c t a n t settlers died of smallpox before reaching the promised land. A survivor was D r . T h o m a s W y n n e , an accomplished W e l s h m a n a n d learned physician. P a c k a r d said the first Pennsylvania physician of real eminence was Griffith O w e n , also a Welshman. 3 2 H e was an e m i n e n t Friend, a n d as a physician he was of great value a n d importance t o his community. W i l l i a m P e n n p a i d h i m a high c o m p l i m e n t in a letter in w h i c h he spoke of O w e n as "tender Griffith O w e n , w h o both sees a n d feels." 33 M a n y of the early P h i l a d e l p h i a physicians were W e l s h m e n and not a few were kinsmen. M o r e so than in N e w York or Boston, concluded M u m ford, the medical profession in Philadelphia was looked u p o n w i t h popu30 Ibid., p. 35.

Mumford, op. cit., p. 34. 82 Packard, op. cit., p. 40. »a Norris, op. cit., p. 11. 81

COLONIAL PRACTITIONERS

19

34

lar f a v o r and social distinction. T h i s can, with reason, be traced to the fact that Philadelphia as a community never suffered such severity of existence as was experienced by some of the earlier settlements. Medicine was mingled less with divinity and there was more time to devote to the arts and sciences. T h i s state of affairs produced excellent physicians in Philadelphia, some of whom went to Europe for degrees, and eventually contributed to the founding of the first school of medicine in the colonies. Other early Pennsylvania doctors of note were Daniel Wills, Edward Jones, J o h n Cadwalader, Lloyd Zachary, Phineas Bond, and J o h n Redman. Little can be said of the medical profession of colonial Maryland. Eugene Fauntieroy Cordell does not begin his Medical Annals of Maryland in earnest until the eighteenth century. J o h n R . Quinan's Medical Annals of Baltimore go back to 1608 to incorporate Walter Russell's marvelous " o y l e " cure of Captain J o h n Smith, but makes mention of little else before the opening of the eighteenth century. Charles Frederick Wiesenthal, a Prussian by birth, came to Baltimore in 1755 and was prominent as a popular medical preceptor. He was deeply revered by both pupils and patients and was looked upon as the "Sydenham" of the town. Wiesenthal was typical of the higher type of early Maryland doctor. T h e Carolinas were among the later colonies to be founded. Charleston became the principal center of culture south of the J a m e s R i v e r and remained so for many decades. F. St. L . Moncure believed that the names David Ramsay, William Bull, Alexander Garden, J o h n Lining, James Moultrie, Alexander Barrow, and Samuel Wilson will always make the early medical history of South Carolina illustrious. 35 L i n i n g wrote a classic description of yellow fever and carried on extensive experiments in metabolism. Bull was the first native Carolinian to receive the M. D. degree. He graduated at Leyden and practised in Charleston. David Ramsay, a prolific writer in various fields, is especially noted for his study on the soil, climate, weather, and diseases of South Carolina. Alexander Garden was a naturalist of note as well as a physician. Linnaeus, the great Swedish botanist, honored Garden by naming the odoriferous cape jessamine the "gardenia" after him. Georgia and North Carolina had few physicians of note before the Revolution. A survey of available information leads one to conclude that the South had a goodly number of foreign-trained and graduate practitioners. Generally speaking, they were devoted to their work and did not combine medicine with other pursuits. David Ramsay's statement that, before the time of B e n j a m i n Rush's brilliant work, Charleston excelled any other part of the American continent in the number of experiments made, observations recorded, and medical papers published is often quoted by historians. 36 One is inclined to discount Ramsay's assertion on the grounds that he was a patriotic resident of Charleston. Nevertheless the development of a landed gentry and 34

Mumford, op. cit., pp. 36-37. as F. St. L . Moncure, " T h e South in Medicine and Surgery," Virginia Medical 63: 460, November, 1936. 36 David Ramsay, A Review of the Improvements, XVUl Century.

Progress and State of Medicine

Monthly, in the

20

MEDICAL EDUCATION BEFORE T H E CIVIL W A R

slavery throughout the South tended to place leisure hours and money at the disposal of the upper stratum of society. T h e best-trained physicians no doubt were in this class, since their training demanded considerable means and time spent abroad. Not pressed with the necessity of making a living, scholarly physicians so situated naturally devoted time to investigation and writing.

CHAPTER

3

COLONIAL LITERATURE AND PRACTICE OF PHYSIC THE total contributions of American physicians to the literature of medicine throughout the colonial period were not imposing, but a few were very respectable and must be mentioned. The first printing press in the colonies was installed by Harvard College in 1639. In 1662 a strict censorship was placed on the press because it had turned out some matter of a questionable theological nature. The first press in Virginia, installed in 1681, was completely muzzled from 1683 to 1729. All the while the New England press was turning out orthodox Puritan theology. In 1677, A Brief Guide in Smallpox and Measles, by Reverend Doctor Thomas Thacher, was published. This was the first medical publication in the colonies.1 During the next hundred years the colonial physicians published many medical pamphlets and books, including inaugural dissertations. Packard listed scores of them (probably all that were available) and added details of interest to many.2 In 1850 N. S. Davis listed twenty-eight publications of twenty writers, covering the pre-Revolutionary period. Presumably he regarded his selections as the most important contributions.8 Seven 6f the twenty writers were New Englanders, each with one publication. Nine were from the middle colonies, seven of which had one contribution each while one had two and another had four. John Bard was the author with two publications', Extra Uterine Foetus, and Essay on the Nature and Cause of the Malignant Pleurisy, which prevailed on Long Island in the winter of 1749. Cadwallader Colden produced four on Davis' list. Besides taking a vigorous part in public life Colden was one of the most prolific medical writers of colonial times. Davis listed his An Account of the Climate and Diseases of New York, 1720; Observât ions on the Fever which Prevailed in the City of New York in 1J41 and '42; On the Virtues of Great Water Dock; and Sore Throat Distemper which prevailed Epidemically in this Country in 1J35. There were four contributors in the southern group: John Mitchell, who wrote Letters on the Yellow Fever in Virginia and An Essay on the Causes of the Different Colors of People in Different Climates; John Clayton, also of Virginia, who wrote The Flora of Virginia; John Lining, who reported his statistics on metabolic experi1 In 1708 there was issued in Boston a reprint of The English Physician by Nicholas Culpeper. Packard, op. cit., p. 491. 2 Packard, op. cit., pp. 491-51«. s Ν. S. Davis, History of Medical Education and Institutions in the United States . . . 1850. pp. 30-32.

si

22

MEDICAL E D U C A T I O N BEFORE THE CIVIL W A R

ments i n v o l v i n g h u m a n excretions in 1743, and wrote in 1753 a Description of American Yellow Fever; and L i o n e l Chalmers, w h o submitted in 1754 a paper, Opisthotonos and Tetanus, in 1768 An Essay on Fevers, a n d in 1776 Weather and Diseases of South Carolina. T h e contributions selected by Davis did not represent all the efforts of their authors, b u t they were representative of the body of colonial medical literature. A m o n g the twenty authors was John Jones, whose contribution o n w o u n d s a n d fractures in 1776 was a most welcome gift to the colonies, then in n e e d of medical military information. John Morgan's inaugural dissertation i n 1763 d e f e n d e d the thesis that pus is a b l o o d secretion. W i l liam D o u g l a s of Massachusetts wrote on the therapeutic value of calomel in i n f l a m m a t o r y diseases. T h e s e citations are sufficient to demonstrate that isolated physicians here a n d there were keenly observing nature's manifestations a n d reactions, c o n d u c t i n g careful investigations, and recording the results. A l l the w h i l e the greater body of the profession groped in darkness. T h e general character of the profession could not have been elevated. T h e b i g majority of practitioners were preceptorially trained, a n d anyone c o u l d be a preceptor. I n r e v i e w i n g the state of A m e r i c a n medicine before the R e v o l u t i o n , J o h n B r o a d h e a d Beck in 1842 described quackery as flourishing in N e w Y o r k . H e cited the frequently q u o t e d words of the early N e w Y o r k historian W i l l i a m S m i t h w h o referred to quacks as a b o u n d i n g "like locusts in E g y p t . " * Q u a c k e r y flourished not only in colonial N e w York but t h r o u g h o u t the colonies. T h e r e were all shades of regulars a n d irregulars. A n d so empiric were the methods of some of the so-called regulars one finds difficulty in m a k i n g a n arbitrary division between the groups. Probably n o more than twelve per cent of the 3,500 physicians reputed to be in the colonies in 1776 h a d medical degrees. 6 T h a t well-trained physicians of the time recognized a n d a b h o r r e d the d e p l o r a b l e situation is well illustrated in the remarks of a D r . Douglass, w h o settled in B o s t o n in 1718 a n d later wrote on the character of medical practice in the colonies: In our plantation, a practitioner, bald, rash, impudent, a lyar, basely born and uneducated, has much the advantage, of an honest, cautious, modest gentleman. In general, the physical practice in our Colonies is so perniciously bad, that excepting in surgery and some acute cases, it is better to let nature take her course than to trust to the honesty and sagacity of the practitioner; our American practitioners are so rash and officious, that the saying of the Apocrypha may, with propriety be applied to them: "He that sinneth before his maker, let him fall into the hands of the physician . . ." Frequently there is more danger from the physician than from the distemper. . . . In the most trifling cases there are a routine of practice. W h e n I first arrived in New England I asked a noted and facetious practitioner what was their general method of practice. He told me it * W i l l i a m Smith, History of New York, p. 326, cited by John Broadhead Beck, " A n Historical Sketch of the State of American Medicine before the Revolution," Transactions of the Medical Society of the State of New York (1842), p. 122. 5 Supra, p. 15.

COLONIAL LITERATURE AND

PRACTICE

»3

was very u n i f o r m — b l e e d i n g , vomiting, blistering, purging, anodynes, etc. If the illness continued, there was repetendi and finally murderandi. N a t u r e was never to be consulted or allowed to have any concern in the affair. Blood-letting and anodynes are the principal tools of our practitioners. 6

Wiekes thought that Douglass' account, allowing a bit for exaggeration, was substantially correct. It is probable that very few of the profession shared so intense a feeling, and that no laymen were so keenly sensible to the plight of the colonists. T h e most charitable thing that can be said of the body of early American apprentice-trained physicians is that they practised faithfully what they were taught. But charlatans and impostors there were. T h e following item from the New York Gazette of December 6, 1751, is representative: In July, 1751, was committed to the care of Dr. Peter Billings, an experienced physician and man-midwife, and formerly in the King's service, the most extraordinary and remarkable cure that ever was performed in the world, u p o n one Mrs. Mary Smith, single woman, sister to Captain A r t h u r Smith, on James' River, C o u n t y of Surry, in Virginia. She had been upwards of eighteen years out of her senses (most of the time raving mad), eating her own excrements, and was completely cured by him in two months, contrary to the o p i n i o n of all w h o knew her, n o doctor in the province daring to undertake her.

T h e final paragraph of this presumptuous bit of advertising on the part of Dr. Billings threw out scintillating hope to sufferers from venereal diseases and is typical of such charlatanry in port cities. N. B. T h e contagious distemper so frequently h a p p e n i n g to the bold adventurers in the wars of Venus, when recent, will be cured by h i m for three pistoles in hand, tho' the common pricc be five pounds all over N o r t h America. A n d all other cases curable in Physick and Surgery proportionable to the circumstances of the people. 7

W h e n journals and newspapers became common and looked to the professions and business for support, quackery did its share to make the small news sheets a financial success. Newspaper advertising by physicians was apparently frowned upon as unethical by the better element in the profession. A t least inserts by such men as Benjamin R u s h of Philadelphia were exceedingly few and in the nature of brief announcements, such as a change of office address. As noted early in this chapter, colonial practitioners, because of the importunacy of their clientele, tended to become general practitioners and not merely internists or surgeons. However, obstetrics retained its identity as a special and independent branch of clinical medicine. T h e continental custom of leaving midwifery in the hands of women, some of whom were trained, was adopted in America. Male physicians felt that it was beneath their dignity to act as obstetricians. Women, therefore, monopolized the 6 C i t e d by W i e k e s , op. cit., p p . 16-17. T h e D r . D o u g l a s s q u o t e d is p r o b a b l y D r . W i l l i a m D o u g l a s s , e m i n e n t Scotch physician, w e l l l e a r n e d , b u t g r e a t l y c o n c e i t e d a n d possessing a n o u t r a g e o u s t e m p e r , w h o assailed Dr. B o y l s t o n u n m e r c i f u l l y at the t i m e of t h e i n o c u l a t i o n discussion. ? C i t e d in ibid., p. 17.

*4

MEDICAL EDUCATION BEFORE T H E CIVIL W A R

practice, and male physicians were seldom in attendance except as consultants in difficult cases. Herbert Thorns quoted Wyndham Blanton as stating that a midwife was safer than a man in the days before the cause of puerperal fever was known. Men impatiently made examinations before birth, and women just waited. 8 T h e vital statistics of the colonies indicate that birth control was little known and practised less. T h u s there were large families. Early marriages were also the custom. But infant mortality and death rate of mothers were high. Unless girls were married at an early age their chances at marital bliss became very questionable. Packard noted J o h n Dunton's reference to a Miss Wilkins, an old maid of twenty-six, looked on in Boston as a "desired spectacle." J o h n Higginson, he said, wrote of some young ladies that "are like to continue ancient maids, Sarah being twenty-five or twentysix years old." T h e extreme youth of the parents may have been a cause of mortality among both mothers and infants. It was not uncommon f o r girls to have several children before leaving their teens. Bereaved widowers usually employed the wiles of cupid rather promptly to replace the loss. J o h n Winthrop, Sr., was twice a widower and seven times a father by the time he was twenty-seven. 9 T h e r e is record of an instance in which one mother had twenty-six children. Families of ten to fifteen were common. 1 0 T h e Roger Clap Family of Dorchester had fourteen children, among whom were Experience, Waitstill, Preserved, Hopestill, Wait, T h a n k s , Desire, Unite, and Supply. T h e first midwives in the colonies were women who had previously practised abroad and were brought here because of their skill. Winthrop's Journal, J a n u a r y 1630, related that a "woman in our ship fell in travail, and we sent and had a midwife out of the J e w e l , " an accompanying vessel. Bridget, the wife of pious Deacon Fuller, and an accoucheuse, was a passenger on the Mayflower in 1620. She was in demand as late as 1663. Early N e w Haven records named Widow Potter, Widow Bradley, and Goodw i f e Beecher as midwives in the community. R u t h Barnaby of Boston practised her art for forty years and died at the age of 1 0 1 . In 1 7 3 0 at Philadelphia Mrs. Mary Brodwell, a midwife, rested from her labors at 100 year and one day. A gravestone in the Charlestown, Massachusetts, burying ground bears the epitaph of Mrs. Elizabeth Phillips who brought into the world over 3,000 children. 1 1 Of all the colonial midwives and doctresses, and there were many, A n n e Hutchinson was the most famous. Her fame rested upon misfortunes resulting from her theological ventures and not on her skill as a midwife. Coming to Boston in 1634 with her husband, she soon developed as a spiritual leader among the women of her community. T h e weekly religious meetings conducted in her home were well attended. But alas for Anne, her theology was not sound. She claimed divine revelation, and her little » Herbert Thorns, " T h e Beginnings of Obstetrics in America," Yale Journal and Medicine, 4: 669, May, 193«. β Packard, op. cit., pp. 43-44. 10 Thorns, op. cit., p. 668. 11 Thorns, op. cit., p. 666.

of

Biology

COLONIAL LITERATURE AND

PRACTICE

25

circle oí communicants enjoyed ecstasies not approved by the local divines. T h e result was a form of trial, and as a result Anne Hutchinson was excommunicated and ordered banished. She went to Rhode Island and later lost her life at the hands of Indians. During the latter part of her residence in Boston, Anne Hutchinson was at the bedside of her intimate friend, Mary Dyer, who was delivered of an anencephalic monster. T h e child was premature and stillborn, and was buried secretly soon after. Only the midwife, J a n e Hawkins, and Mrs. Hutchinson saw the fetus, except a mouthy woman who had only a glance at it. T h e story leaked out, about the time of the Hutchinson expulsion. After taking counsel with the elders and magistrates, the Governor had the unsightly monster exhumed. Winthrop discussed the affair in detail. In the light of Puritan theology he saw the tragedy in the Dyer family as the retributive judgment of God. Though Anne Hutchinson left Boston, her private affairs were matters of public interest, with a theological interpretation. It seems that the unfortunate exile was delivered of a hydatid uterine cyst. When he heard of it, the Reverend John Cotton visioned another monster and in open assembly at Boston ". . . gathered that it might signify her errour in denying inherent righteousness, but that all was Christ in us, and nothing of ours in faith, love, etc." T h e Governor thoroughly investigated the report and became convinced that Mrs. Hutchinson had not been pregnant. When Mr. Cotton learned of his erroneous spiritual application he was gracious enough to acknowledge his mistake in the next public lecture hour. 1 2 T h e practice of obstetrics in the middle and southern colonies was essentially the same as in New England. Outside of the few trained midwives who came from England and the continent, the average American accoucheuse practised her profession, if it may so be called, guided by a modicum of empiric knowledge mixed with superstitions and misconceptions. A few probably had access to English authors on the subject. It was a virtue of these early midwives that they were not greatly inclined to interfere with the normal course of nature. After the middle of the eighteenth century there is evidence that the artificial delicacy surrounding the subject was beginning to fade. Public prejudice was weakening, and a few male physicians were exhibiting an interest in the study and practice of obstetrics. T h e first male obstetrician of whom there is record was J o h n Dupuy, who practised in New York and died there in 1745. His death notice is significant: Last night, died in the prime of life, to the almost universal regret and sorrow of this city, Mr. John Dupuy, M. D., a man midwife, in which last Character it may be truly said as David did of Goliath's sword, there is none like him. 1 3

Dr. J o h n Moultrie, who had been trained in Europe, practised medicine from 1733 to 1773 in Charleston, South Carolina. At least in his later years he was noted for his success in obstetrics. Thacher reported that his death 12 Winthrop's Journal, cited in Packard, op. cit., pp. 46-48. 1» Quoted in Packard, op. cit., p. 52.

26

MEDICAL EDUCATION BEFORE THE CIVIL WAR

was regarded as a public calamity. Some women of Charleston bedewed his grave with tears. Several of his patients, on hearing of his death, became unusually depressed, and in a number of cases the consequences were fatal. In Europe at that time William Smellie, Andre Levret, and William Hunter were raising obstetrics to the plane of medicine and surgery. Dr. James Lloyd, a pupil of Smellie and Hunter, settled in Boston in 1753 and began a midwifery practice. William Shippen followed in Philadelphia in 1762, and J o h n V. B. Tennant, in 1767, was appointed to a special chair on the subject in the newly founded school of medicine at King's College, New York City. T h u s began the emancipation of obstetrics in the English colonies." Besides the fortuitous circumstances incidental to the development of a pioneer society, which condition strongly molded the beginnings of American medicine, the greatest influence on physic in the colonies was the European impress. T h i s force operated in two respects: first, through the presence in the colonies of English and continental medical publications; and second, by reason of the fact that the best-trained American physicians were students of the old-world masters or had been apprenticed to physicians who were well trained in Europe. T h e European influence eventually imbued the American profession with a consciousness of its heterogeneity, responsibilities, and possibilities. In Europe the work of the pioneers of the Renaissance flung open the gates to untouched fields of human thought. In the seventeenth century the romance and adventure which came from loosened bands of tradition and authority swept men on to individual scientific endeavor in fields of science, philosophy, and religion. This century thus became a period of intense individualism. It was the age of Shakespeare, Milton, Bach, Cervantes, Molière, Newton, Bacon, and Locke. England, Italy, and Holland did the most for medicine during this century. With William Harvey, who in 1628 described the heart as a muscular force-pump, physiology had its modern inception. A layman, Leeuwenhoek by name, first saw protozoa under a lens in 1675. Malpighi (1628-94), with the use of a simple microscope, laid well the foundations of histology, and Sydenham (1624-89), who revived the Hippocratic method of observation and experience, ennobled internal medicine by his common sense and superior bedside observation and study. Leyden, Paris, and Montpelier were the greatest centers of medical education. In brief summary of eighteenth-century medicine in Europe, it may be said that the period was an age of propounding theories and building systems. Wonderment over the seventeenth-century advances in science, and the gains in spiritual and intellectual freedom seemed for a time to hypnotize progress. Much of the current philosophizing was to no good end. Theorizing and methodizing led to a formalism which thwarted for a time free rationalism in medicine. Numerous theories absorbed the time of physicians who might well have been contributing to the body of medil i T . Gaillard T h o m a s , "Obstetrics and Gynecology," in Edward H. Clarke, et al., Λ Century of American

Medicine,

pp. 220-21.

COLONIAL L I T E R A T U R E AND P R A C T I C E

τη

cal thought. T h e Monros and Cullen of Scotland, the Hunters and Jenner of England, and Boerhaave, Lavoisier, and Morgagni on the Continent were refreshing exceptions to the trend of the century in which they lived. Edinburgh arose as the principal seat of medical thought and instruction. 1 5 It has been noted that many of America's first physicians were trained before undertaking the western adventure. A n increasingly larger number, as the decades passed, had training limited to informal guidance at the hands of practising physicians who acted as preceptors or tutors. A l l the while a limited number of young men w h o had sufficient funds were from time to time going to England and the continent to finish their medical education. N. S. Davis thought that the attendance of several excellent young men of the highest native talent at European universities after the middle of the eighteenth century marked the beginning of a new order, which culminated in the founding of medical schools and hospitals in America. T h e r e is no way of telling just how many physicians in the first century and a half of American history were foreign trained. O n e finds no reason to think that more than a comparative few ever received degrees abroad. Further, one may reasonably conclude that practically all w h o studied abroad continued their studies long enough to bring home the coveted degree. Some light is thrown on the subject by a T o n e r manuscript in the Library of Congress, which purported to list all American graduates in medicine at Edinburgh from 1749 to the close of the year 1800. O f the 122 names listed, seventeen were classified merely as Americans; their exact home residence was apparently unknown. T h e remaining 105 names were listed by colonies as follows: Virginia forty-nine, South Carolina fifteen, Pennsylvania fifteen, New York ten, Maryland eight, Georgia three, Massachusetts two, New England one, and Delaware one. These figures give credence to the generally accepted theory that the South looked to the home country for higher education and that New England provided her own. Before the close of the eighteenth century not enough had been done in the colonies to produce graduate physicians in sufficient numbers to compare in any way with the actual number of men w h o were going into practice each year. Assuming that Toner's figures are accurate, one can be sure that among 122 graduates there must have been a large number who took to tutoring and propagated European theories of medical practice. If the American graduates of other European schools were distributed in a comparable manner to those of Edinburgh, there is abundant reason to believe that the South, particularly Virginia, had a more adequate supply of competent physicians than any other part of the country. T h u s colonial medicine in America must have reflected, perhaps dimly, the trends of medicine in Europe. In the eighteenth century, popular medical theories were subscribed to and practised by doctors in the western wilderness. First was the system of Boerhaave. T h e n came Cullen's purely theoretical pathology and nosology, followed shortly by the speculations of is Fielding H . Garrison, An Introduction passim.

to the History of Medicine,

1929, pp. 245-406,

28

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

B r o w n . L a t e in the eighteenth century, B e n j a m i n R u s h , the Sydenham of America, propounded the first American theory of disease and treatment. T h e R u s h system was simpler "but no improvement on previous hypotheses. Physic in the colonies, then, was born of necessity, molded by the vicissitudes of a hardy and resolute people, nurtured by Europe, and practised by a few trained physicians and surgeons, men of the cloth, and a multitude of irregulars.

PART FACTORS

IN EARLY

II

AMERICAN

MEDICAL

EDUCATION

CHAPTER

4

M E D I C A L L E G I S L A T I O N A N D SOCIETIES MEDICINE received no attention as a branch of formal education during the first century and a half following the Jamestown settlement. Schoolhouses followed the pioneers; academies and colleges soon sprang up, but no provision was made for the training of physicians. As a profession and art, medicine was left without adequate protection, encouragement, or recognition by legislators. Medical legislation in the colonies prior to 1760 was a medley of acts passed in several colonies, designed to correct certain evils. T h e intent of these acts was usually to throw some protection around the public. Some even reflected a spirit of public suspicion of the profession. Fee rates, quarantine, inoculation, criminal neglect, and responsibility of practitioners were usually the subjects of these statutes.1 T h e first law to make any provision for the examination of candidates for the profession was passed by the Assembly of New York in 1760, and was intended to regulate medical practice in New York City: W h e r e a s many i g n o r a n t a n d u n s k i l f u l persons in physick and surgery, in o r d e r to gain a subsistence, d o take u p o n themselves to administer physick a n d practice surgery in the city of N e w York, to the e n d a n g e r i n g of the lives and limbs of their patients, a n d many poor a n d ignorant persons i n h a b i t i n g the said city, w h o have been great sufferers thereby; for p r e v e n t i n g such abuses for the future— I. Be it enacted . . . T h a t f r o m a n d after the p u b l i c a t i o n of this act n o o n e whatsoever shall practice as a physician or surgeon in the said city of N e w Y o r k b e f o r e he shall first have been e x a m i n e d in physick and surgery, a n d a p p r o v e d of a n d admitted by o n e of H i s Majesty's C o u n c i l , the judges of the supreme court, the King's attorney-general, a n d the mayor of the city of N e w Y o r k for the time being, or by any three or more of them, taking to their assistance for such examinations such p r o p e r person or persons as they in their discretion shall think fit. 1 F. R . Packard, History of Medicine in the United States, 1: 163-77, has carefully listed these miscellaneous enactments, b u t gives credit to J. M. T o n e r , Contributions to the Annals of Medical Progress. . . ; S. Wiekes, History of Medicine in New Jersey. . . ; a n d S. A . Green, A Centennial Address Delivered Before the Massachusetts Medical Society, for consulting the colonial archives.

»9

jo

MEDICAL EDUCATION

BEFORE T H E

CIVIL

WAR

A n d if any candidate, after d u e examination of his learning and skill in physic and surgery as aforesaid, shall be approved and admitted to practise as a physician a n d surgeon, or both, the said examiners, or any three or more of them, shall give, u n d e r their hands a n d seals, to the person so admitted as aforesaid, a testimonial of his examination a n d admission.

II. And be it further enacted . . . T h a t if any person shall practise in the city of N e w Y o r k as a physician or surgeon, or both as a physician and surgeon, without such testimonial as aforesaid, he shall, for every such offence, forfeit the sum of five pounds, one-half thereof to the use of the person or persons who shall sue f o r the same a n d the other moiety to the churchwardens and vestrymen of the said city for the use of the p o o r thereof . . . 2

A similar enactment was passed by the New Jersey Legislature in 1772. T h e New York and the New Jersey acts were the only laws passed under the colonial governments designed to control or limit the number and specify the qualifications of practising physicians. T h e New Jersey act, in some ways, was more stringent than the other. T h e penalty, however, did not apply to physicians who performed charitable work, and out-of-state doctors, called in on special request. Traveling mountebanks whose custom it was to sell medicines from the stage were taxed out of business with a levy of twenty pounds for each offense. Legal regulation of medicine became more common under the states of the young republic, but by 1842 ten states had repealed their regulatory acts. Another development of a public nature which raised the standards of medical practice and indirectly operated in favor of better-trained physicians was the organization of professional societies. These organizations exerted an important influence on the progress of American medicine, and professional relationships among practitioners. T h e earliest state societies had the responsibility of licensing candidates after conducting some sort of formal examination. So it was that medical societies came to be in many places the active agents in determining the standards of medical education. Eventually, in most places the responsibility of maintaining standards of medical education was automatically shifted to medical schools when some state societies began accepting an M.D. degree in lieu of passing the society examination. As early as 1766 a meeting of physicians was held at New Brunswick in New Jersey. A constitution and by-laws were adopted for the New Jersey State Medical Society, the first body of its kind in the country. Its objects were: . . . m u t u a l improvement, the advancement of the Profession, the promotion of the public good, and the cultivation of harmony and friendship a m o n g their brethren. 3

T h e society met faithfully twice yearly until interrupted by the Revolutionary War. 2 Cited by Packard, op. cit., pp. 1 7 1 - 7 2 . » S. Wiekes, op. cit., p. 44.

MEDICAL LEGISLATION AND SOCIETIES

31

In 1 7 8 1 the Massachusetts Medical Society was incorporated with some thirty members, with the venerable Edward Holyoke as president. By the close of the century seven state societies had been organized. T h e other five were: Delaware and South Carolina 1789, New Hampshire 1 7 9 1 , Connecticut 1792, and Maryland 1799. Local medical groups are known to have been functioning rather loosely in several centers. Burrage cited a letter of William Douglass of Boston to Cadwallader Colden of New York, dated February 18, 1735, in which Douglass mentioned the organization of a society and its design "to publish some short pieces." Shafer noted rather scanty evidence of a "Weekly Society of Gentlemen in New Y o r k " known to have been in existence as early as the winter of 1749. J o h n Kearsley, J r . , and J o h n Morgan were principals in the founding of the Philadelphia Medical Society in 1766. T h i s organization was not very successful but was, in 1787, followed by the institution of the College of Physicians of Philadelphia, which society has maintained an uninterrupted existence to the present day. In Baltimore a short-lived society had a beginning in 1787, but dissolved under the pressure of what seemed to be professional jealousies. 4 American medical journalism, which became so prolific in subsequent years, had its start in the eighteenth century. T h e first American medical journal was a quarterly, The Medical Repository, edited by S. L. Mitchell, Edward Miller, and E. H . Smith, a n d published in New York City from 1797 to 1824. 5 T h o u g h no other journals were started before the close of the century, American presses were beginning to turn out a respectable quantity of medical literature. In the last quarter of the century, according to Billings, American medical books to the extent of fifty-one volumes were published, besides forty-nine volumes of reprints and translations, and seven volumes of society transactions. T h e s e societies, and ventures in medical journalism, though they probably were not conceived as a part of medical education per se, were most certainly adjuncts to the struggling profession which was not yet awake to its f u l l responsibility. * Walter L. Burrage, A History of the Massachusetts Medical Society, 1781-1933, p. 1 . Henry Burnell Shafer, American Medical Profession, iyS) to 1850, p. a i . J o h n S. Billings, " L i t e r a t u r e and Institutions," Edward H. Clarke, et al., A Century of American Medicine, 1776-1876, pp. 344-46. Eugene Fauntlerov Cordell, The Medical Annals of Maryland, 1J99-1899, pp. 1 6 - 1 8 . 5 Billings, op. cit., p. 330.

CHAPTER

5

T H E PRECEPTORSHIP AND OTHER METHODS OF INSTRUCTION THE pioneer fathers were too much absorbed in subduing the wilderness to give much time or thought to medical matters, except in case of stark necessity. They did, however, practise a generally accepted mode of medical instruction. T h e plan was simple. Any young man who desired to become a doctor or whose parents designed he should read physic, apprenticed himself to a practitioner, who was thereafter looked upon as a preceptor. In colonial America the traditional seven-year period was often employed and the teacher was called "master." After the Revolutionary War the term of tutelage was generally accepted as three years. This change perhaps resulted from the establishment of several medical schools, each of which required not more than three years of apprenticeship of candidates for the M. D. degree. 1 T h e status of the student ranged from indentured servant to medical technician. T h e duties of a young man so attached were numerous. He learned to make pills, mix potions and powders, cup, bleed, and do bedside nursing. Not a few of these half-fledged youths were also expected to act as sweep and stable boy for the doctor. It is conceivable that many young knights of the scalpel spent time administering grease to the master's chaise, oats to his mare, or running errands for his wife, which might have been spent more profitably with a volume of Cowper's anatomy or Haller's physiology from the doctor's office, if indeed the master owned a reference library. Students who lived with the preceptor's family and took part in the domestic affairs of their instructor's household often paid little or no fee for their education. In time it became more common for apprentices to live at home, with relatives, or in boarding houses while serving their apprenticeship. Under such circumstances they were not obliged to perform domestic duties outside the doctor's office, except duties pertaining to the care of horses, saddles, harness, and chaise or buggy. T h e quality of instruction must have varied immensely, since there was no limitation on the number of physicians who might become preceptors. Ordinarily the preceptor furnished a skeleton, books, and other useful materials. Fortunate were the students of conscientious preceptors who ι Frederick C. Waite, " T h e Professional Education of Pioneer Ohio Physicians." Ohio State Archaeological and Historical Quarterly, X L V I I I , 3: 191-95, J u l y , 1939.

32

The

M E T H O D S OF

INSTRUCTION

S3

were well trained and took seriously the business of m a k i n g physicians of rustics as well as city lads. It was not to the honor of the profession that many practitioners in ignorance or venality accepted preceptorial fees and certified for practice youths w h o knew not even the simplest rudiments of the art. Obviously the maintaining of standards of preliminary medical education was in the hands of the preceptors as long as no legislatures or societies decreed otherwise. T h e qualifications of the candidates beginning stúdy must have varied greatly. It was a very common practice to require of a student a knowledge of the classic languages, especially L a t i n , at the beg i n n i n g or at least before the termination of his period of study. Mathematics, English grammar, and natural history were regarded as fundamental by many preceptors. Yet the general state of ignorance a m o n g the profession, especially in rural districts, is a b u n d a n t evidence that m a n y a young man began practice with no background of liberal education worthy of mention. One hundred dollars a year was the usual yearly fee. Shafer, w h o investigated the economic aspects of early American medicine, cited the apprenticeship fee rate as established by the Essex South District of the Massachusetts Medical Society: For the three years advance payment was $ 1 5 0 or at the end of the term $200; for two years advance payment was $ 1 2 0 or at the end of the term 5 1 3 3 ; for one year advance payment was $ 6 5 or at the end of the term $ 7 5 · 2

T h e experience of D a v i d Hosack, a successful N e w Y o r k physician, indicated the possibilities there were for exploiting the preceptor business. Without mentioning the number of students, Hosack stated that he made $1,400 between 1826 and 1829 on tutoring private pupils. 3 T h e r e is no reason to believe that Dr. Hosack's students were not well trained. H e was well known as a medical educator, having served on the faculties of C o l u m b i a College, College of Physicians and Surgeons, and Rutgers Medical College. Fee rates for apprenticeships, however, were not u n i f o r m throughout the colonies. Economic conditions in various localities h a d a bearing u p o n the amount paid. T h e following letter from one W i l l i a m Adams, J u l y 1788, to a Dr. Stringer of Albany indicated that bargaining was entered into by parents to obtain medical education for their sons: Dear Sir As my son has yet an inclination of living some time with you I have therefore sent him down for that purpose, in case you can afford to take him for thirty Pounds a year, which is the same I paid for my other son to Dr. Scott in N e w Brunswick, 8c indeed as times are at present, is as much as I can well afford & should also hope that his being of present service, would make up for the difference 2

A. L . Pierson, Letter Book (MS in Boston Medical Library); cited in Shafer, op.

cit.,

Ρ· 33· 3 David Hosack, List of Private Pupils Educated in the Office of . . . (MS in the New York Academy of Medicine); cited in Shafer, op. cit., p. 34.

34

MEDICAL E D U C A T I O N BEFORE T H E CIVIL W A R

however if you try him for 2 or 3 weeks, you will be better able to Judge, till which I remain yr. Hum. Servt.— (Signed) W M . A D A M S 4

The following apprenticeship contract, given by Wiekes, is meticulously drawn and representative of carefully planned apprenticeships. Although nothing more is known of William Clark, the preceptor, other than what information is contained in this indenture, the student, Jacobus Hubbard, later built a large practice and was highly esteemed in Monmouth County, New Jersey." T h i s Indenture made the Seventh day of August, in the thirty-fourth year of his Majesty's reign George the Second, and in the year of Christ, One thousand Seven Hundred and Sixty, Witnesseth that Jacobus Hubbard Son of James Hubbard of Gravesend on Nassau Island and Province of New York Farmer, hath put himself and by these presents doth voluntarily and of his own free will and accord and by and with the consent of his Father and Mother put himself as an Apprentice unto William Clark of Freehold in Monmouth Co. in East New Jerseys Doctor and Surgeon, to be taught in the said practice of a Doctor and Surgeon, and in all the several branches of Physic which the said William Clark practices within the said town herein mentioned: and with him to live after the manner of such an Apprentice to continue and serve from the day of the date hereof unto the full end of Four years and Eight months from thence next ensuing and fully to be completed and ended. During all which T e r m the said Apprentice his said Master well and faithfully shall serve, his secrets keep, his lawful commands gladly every where obey. He shall do no damage to his said Master, nor see it be done by others without letting or giving notice to his said Master. He shall not contract matrimony within the said term. At cards, dice or any other unlawful game he shall not play, whereby his said Master may have Damage. He shall not absent himself day or night from his said Master's Service without his leave, nor hant Ale houses Taverns or play houses, but in all things as a faithful Apprentice he shall behave himself towards his said Master all during his said term. And the Said Master during the S'd term shall by the best of his Means or Methods Arts and Mysteries of a Physician and Surgeon as he now Professes Teach or cause the said Apprentice to be taught to perfection in consideration of the sum of One Hundred Pounds Lawful money of New York to him in hand paid by the said James Hubbard (in four payments) that is to say Thirty Pounds in hand down, and the remainder in Four Equal payments, One each year till the whole is paid. And the said William Clark Acknowledges himself therewith contented and the Receipt thereof. And the said Master is to provide his said Apprentice with sufficient Meat Drink Washing and Lodging and Mending his said clothes within the Said term. And the said James Hubbard is to find him in wearing apparel during said term aforesaid. A t the end of Said term Said Master shall and will give unto the Apprentice a new set of surgeon's pocket instruments—Soloman's Dispensatory, Quence's Dispensatory and Fuller on Fevers, and for the true performance of all and every of the said covenants and agreements of Either of the said parties Do bind themselves Jointly and Sev* W i l l i a m Adams, July 1788, to Dr. Stringer, Albany, New York Library of Congress). s Wiekes, op. cit., p. 292.

(Manuscript in the

METHODS OF

INSTRUCTION

35

erally t o the o t h e r by these presents. I n witness whereof they have h e r e u n t o set their hands a n d Seals the Day and Date, first written.®

A high type of preceptor in the eighteenth century was John Redman of Philadelphia, a Leyden graduate who had also studied at Paris and Edinburgh. In addition to an extensive practice, his position as consulting physician at the Pennsylvania Hospital, after 1751, made the reading of physic in his office attractive to ambitious young men. Among his many pupils were such characters as John Morgan and Benjamin Rush, both of whom were college graduates when they entered the office of Dr. Redman. "I have experienced great kindness from Doctor Redman I had little reason to expect," wrote Rush to a friend in 1765, "and have ever found in him not only the indulgent master, but the sincere friend and Father." 7 During his five and a half years of tutelage under Dr. Redman, Rush eagerly read the medical works in his master's library and began keeping carefully prepared notes on remarkable occurrences in his experience. Before the establishment of schools, medical diplomas were not given in the colonies. A t the termination of the contract, or if no contract existed, when the preceptor decided that his pupil was qualified to begin a practice he issued to him a certificate. Following is Dr. Redman's certificate to Mr. Samuel Treat, issued in 1765: Philadephia. T h i s is to certify all whom it may c o n c e r n that M r . Saml. T r e a t h a t h served as an A p p r e n t i c e to m e for nearly f o u r years, d u r i n g which time he was constantly employed in the practice of Physic a n d Surgery u n d e r my care, n o t only in my private business, but in the Pennsylvania Hospital in which character he always behaved with great fidelity and industry. I n T e s t i m o n y of which, I have h e r e u n t o set my h a n d this first day of September O n e T h o u s a n d Seven H u n d r e d and Sixty-five. Signed

JOHN

REDMAN.

Other features of a student's training were at times certified by his instructors, as in the case of Treat's hospital experience and attendance on Dr. William Shippen's anatomical lectures. T h e following paragraphs were appended to the Redman certificate: W e whose n a m e s are underwritten do certify, that M r . Samuel T r e a t h a t h diligently attended the practice of Physic and Surgery in the Pennsylvania Hospital for several years. Signed

THOS.

CADWALADER

PHINEAS TH. WM. C.

BOND

BOND SHIPPEN

EVANS

β Ibid., pp. 100-1. Another good example of a contract for private instruction is given by Frederick C. Waite, " A Contract for Private Medical Teaching in Northern Ohio in 1846," The Ohio Slate Medical Journal, XXXIII, 5: 545-47, May, 1937. 7 Benjamin Rush, Correspondence, XXXIX, 7, May si, 1765, Cited by Nathan Goodman, Benjamin Rush, Physician and Citizen, pp. 10-11.

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MEDICAL EDUCATION B E F O R E T H E CIVIL WAR

T h i s is to certify that Samuel T r e a t hath attended a course of Anatomical Lectures with the greatest diligence and assiduity. S i g n e d WILLIAM SHIPPEN, JR.®

Not all preceptors were so well equipped for their teaching or so highly rated by their pupils as was Redman. Charles Caldwell, prominent in the ranks of medical educators of the Ohio Valley during the second quarter of the nineteenth century, never looked back with any degree of satisfaction on his apprenticeship. With reference to his early medical training he wrote: I removed to the town of Salisbury, and placed myself under the tuition of a gentleman of reputation and standing, who had been not long previously graduated in medicine, in the University of Pennsylvania. But, in relation to the advantages for improvement which I anticipated, I encountered a sad and mortifying disappointment. T h o u g h my preceptor was a man of respectable talents, and no inconsiderable stock of knowledge, and though he was exceedingly attentive and communicative to me, in conversation, that was almost the only source of which I could avail myself. H e had no library, no apparatus, no provision for improvement in practical anatomy, nor any other efficient means of instruction in medicine. Had it not been for the apparent and I believe sincere attachment to me, and my regard for him, as the brother of my former and only favorite teacher, Harris . . . I would not have continued with him three months. But from an unwillingness to mortify him, or in any way disoblige him, I protracted my stay for about a year and a half—an instance of self-neglect which I afterwards sincerely regretted—because it involved the most unqualified and indefensible waste of time I ever committed. 9

At the time of his apprenticeship Caldwell perhaps felt some of the conceit which he so magnificently exhibited in later life. Nevertheless he probably did not overestimate the weakness of his preceptor's educational equipment. Many students had similar experiences but were less able to recognize the deficiency. Foremost among Philadelphia's physicians of the middle eighteenth century was J o h n Kearsley, Sr., whose office was a medical college for an important group of young Americans. Under Kearsley's tutelage came such prominent figures as Zachary, Cadwalader, William Shippen, Sr., the Bondis, Cadwalader Evans, Redman, Bard, and John Kearsley, J r . John Bard, who became a distinguished practitioner in New York City and father of Samuel Bard, who founded the medical faculty of King's College, was bound as apprentice to Kearsley at fourteen years of age. Kearsley was eminent in his profession and public and social life, but dealt sparingly in kindness to his pupils. 10 T h e chief virtue of the preceptorial system was that the students so trained were not inclined to be mere theorists. T h e practical clinical experience and observation which most students had from the first, though 8 Wiekes, op. cit., p. 102. β Harriot W. Warner, editor. Autobiography of Citarles Caldwell, 1855, pp. 77-78. 10 William S. Middleton, " T h e John Kearsleys," Annals of Medical History, 3: 391-93, December, 1921.

METHODS

OF

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37

too often they were ill prepared to appreciate what they saw, built into the American medical profession that spirit of self-confidence and practicability which has characterized it down to the present time. T h i s virtue, however, is pointed to as a vice by critics who witness the work of physicians possessed of a zeal without knowledge. After all, the early American plan of medical education was not only well adapted to the unpolished state of society but was to some extent a product of the wilderness culture. Anatomical dissection and post-mortem examinations, indispensable to modern medical instruction, were seldom made available to early American students of medicine. Early colonial records yield occasional accounts of coroners' inquests. Packard noted, from the researches of Steiner, Hoadley, and Green, six or eight autopsies during the seventeenth century, the first of which was in 1639 on a servant boy who fell a victim of "unreasonable correction," with a fractured skull. 1 1 Maryland, however, lays claim to an inquest and autopsy two years earlier (1637), on a man killed by a tree. 12 Obviously these post-mortem examinations yielded little to the betterment of medical instruction as they were not conducted for educational purposes. 13 As noted in Part I, Chapter 2, the first instance of an effort to conduct medical instruction was connected with the work of chirurgeon Lambert Wilson, employed in 1629 by the Massachusetts Bay Company to act as surgeon to the settlers and Indians, and further to give medical training to one or more young men of the colony. There seems to be no record of the extent of his tutelage. Eighteen years later missionary J o h n Eliot, who was doubtless interested in seeing developed medically trained missionaries for work among the aborigines, made the following lament in a letter to preacher Shepard at Cambridge: O u r y o u n g students in Physick, m a y be trained u p better than yet they bee, w h o have only theoretical knowledge, a n d are forced to fall to practise before ever they saw an A n a t o m y made, or duly trained u p in m a k i n g experiments, for w e never had b u t o n e A n a t o m y in the Countrey, which M r . Giles F i r m i n n o w in E n g l a n d did m a k e a n d read u p o n very well, b u t n o more of that n o w . 1 4

Packard believed that, since a skeleton was formerly called an anatomy, Firmen's teaching was principally the demonstration of bones. J o h n Eliot was not alone in feeling that the colony was deficient in facilities for medical instruction. One month after he wrote to Shepard 11 Packard, op. cit., pp. 54-58. Walter R . Steiner, "Some Early Autopsies in the United States," Johns Hopkins Hospital Bulletin, 14: 201-03, August, 1903. Packard also cited Charles J . Hoadley, "Early Post-Mortem Examinations in New England," Proceedings of the Connecticut State Medical Society, i8g2; and S. A . Green, A Centennial Address Delivered Before the Massachusetts Medical Society, 1881. 12 Thomas S. Cullen, Early Medicine in Maryland, p. 1, quotes this (probably from Quinan, Medical Annals of Baltimore) as "probably the earliest recorded autopsy in America." is T h e best history of anatomy in the colonial period is Edward B. Krumbhaar, "Early History of Anatomy in the United States," Annals of Medical History, 4: 2 7 1 - 2 8 6 , March, 1922. Massachusetts Historical Society Collection, series 3 , 4: 37.

38

MEDICAL EDUCATION

BEFORE T H E CIVIL

WAR

(1647), the General Court Records declared the right of students of physick to "reade anatomy & to anatomize once in four years some malefactor." 18 Just how much medical education benefited from this action is not known. The passing of such a liberal act must have been due in no small measure to the fact that many of the Puritan divines were medically minded. Probably, few bodies of executed criminals were ever available for dissection. T h e corpses of the few witches who suffered death for theological reasons are not known to have been used by anatomists. Lack of anatomical opportunities was ever a weakness of the early American system of private instruction in medicine. The preceptorial system, after the establishing of schools of medicine, was incorporated as a part of the general scheme of medical education. The plan universally adopted was to require of each candidate for the M. D. degree a certificate of a three-year apprenticeship in addition to attendance on certain lecture courses. Thus the apprentice system with both its virtues and vices was perpetuated. But the institution of medical schools did not mean that all students of medicine attended formal lecture courses in some college. Only a minor portion of the matriculants ever remained in school long enough to graduate. And still a greater number were satisfied or for economical reasons were forced to enter practice at the termination of an apprenticeship, having heard no lectures. It is not strange that some of these physicians with a limited training found themselves in a rather pitiable plight with the progress of medicine and the advent of a more widely circulated literature of the profession, the nomenclature of which they were unable to appreciate. With admirable frankness, such a practitioner addressed himself to the editor of the Boston Medical and Surgical Journal in 1828. In part he said: I like the monthly report of Diseases in the dispensary very much, the plan of it. But 'tis more than I can do to understand it. T h e names are all new, and for all the knowledge I get of 'em the diseases might just as well be new too, just as well. I mind just as well when they changed the names of medicines the first time I was plagued in the same way, I never did much in the drug way before, but this change of names fixed me . . . But I hadn't ought to complain, for the whole country has changed in my time, I mind the Revolution; and now there is to be a new President over all and a new Mayor over you. I write sildom and meant to have filled my time and paper with a case . . . for I never saw the inside of a corpse. 16

The weaknesses of the preceptorial system caused concern as long as it existed. The anniversary oration before the New York Academy of Medicine in 1849 was delivered by Alfred C. Post, a prominent New York surgeon. He was very positive in his portrayal of the weaknesses of office training. He held that no doctor should undertake the instruction of private pupils, without being amply provided with books, engravings, and 15 18

Packard, op. cit., pp. 25-26. Boston Medical and Surgical Journal,

1799; cited in Shafer, op. cit., pp. 19 f.

METHODS OF I N S T R U C T I O N

39

anatomical preparations, to aid them in the prosecution of their studies. Post criticized busy doctors for assuming the responsibilities of private teaching when they were so fully immersed in the cares of an extensive practice that they could not devote a large amount of personal attention to the instruction of their pupils. " T h e s e things ought not so to be," averred the anniversary orator, "and the medical man w h o looks upon the relation between teacher and pupil as a mere mercenary affair, betrays a narrowness of mind which is inconsistent with the true dignity of the profession which he represents." 17 In the evolution of American medical education one stage of development stood between the establishment of the preceptorial system and the opening of medical schools. T h i s feature of the movement was the giving of systematic lecture and demonstration courses to groups of students. Anatomy was the subject usually covered. T h e s e courses were promoted as individual enterprises and were not sponsored as features of a college curriculum. As early as 1717 Cadwallader Colden, an Edinburgh graduate w h o came to Philadelphia in 1710, seemed to have a not too well-defined plan for beginning a "public physical lecture" course in the Quaker City. A l l that is k n o w n of the plan is a brief reference to it in a letter by James Logan of Philadelphia, written May 1, 1717. It seems that the scheme involved paying Colden for attendance on the poor of the city and the establishment of a course of lectures to be supported by a levy on every single man above twenty-one years of age. Presumably C o l d e n was to be the lecturer. Logan's feeling that "our Assembly would never go into them, that of the lectures especially" was subsequently fully justified. 1 8 A f t e r his return to Philadelphia from England, where he is said to have studied and dissected under the direction of W i l l i a m Cheselden, T h o m a s Cadwalader, in 1730 or 1731, made practical demonstrations of anatomy for the instruction of the elder William Shippen and others w h o had not studied abroad. It was complimentary to the scientific spirit of his pupils, some of whom were considerably older than the twenty-two-year-old Cadwalader, that they enthusiastically followed his course. Dr. Cadwalader performed a post-mortem examination in 1742, said to be the first scientific autopsy in the country. In 1750 a N e w York criminal, Hermanus Carroll, was executed for murder. Drs. John B a r d and Peter Middleton secured the body and dissected it for the instruction of young men w h o were engaged in reading physic. T h i s is the first known effort in the colonies to diffuse medical knowledge by dissection. T h e New York Weekly Postboy, January 27, 1752 carried an advertisement declaring that, Whereas Anatomy is allowed on all Hands to be the Foundation both of Physick and Surgery and consequently qualified to practice either; This is there1 7 Alfred C. Post, Anniversary Oration Before the New York Academy of Medicine, 1849, PP- 3' f· 1 8 See Krumbhaar, op. cit.; Packard, op. cit., p. î86. Packard does not state where the Logan letter may be found.

4o

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

fore to inform the Public: That a Course of Osteology and Myology, is intended to be begun, some time in February next, in the city of New Brunswick (of which Notice will be given in the Paper, as soon as a Proper Number has subscribed towards it). In which Course all the human Bones will be separately examined, and their Connections and Dependencies on each other demonstrated: and all the Muscles of a human Body dissected; the Origin, Insertion and use of each, plainly shown, etc. This course is proposed to be finished in the space of a Month. By 19 T H O M A S W O O D , Surgeon A n addendum to the above stated that the price of the course was six pounds, three pounds payable at the beginning and three at the middle of the course. Further, the Doctor promised that if proper encouragement were given the course, another series covering "Angiology and Neurology" would be given. T h e announcement further promised that the course would conclude "with performing all the Operations in Surgery on a Dead Body: the use of which will appear to every person, who considers the Necessity of having (at least) seen them performed; before he presumes to perform them himself on any living Fellow Creature." 20 T h e r e is no evidence to indicate that Wood ever gave his course. Since nothing is known of W o o d or his qualifications it is difficult even to conjecture. Probably a sufficient number did not subscribe to attend. A b o u t the same time that Thomas W o o d was attempting to inaugurate his course at New Brunswick, William Hunter, a Scotchman educated under the elder Monro, settled in Rhode Island. Hunter was a relative of the two famous brothers, John and William Hunter. From 1754 to 1756 this eminently successful physician, who settled at Newport, gave lectures on anatomy, history of anatomy, and comparative anatomy, which were advertised in the Boston papers. 21 Mention has been made previously of William Shippen, Jr., who prepared the way for the opening of a medical school in Philadelphia. After spending five years abroad, during which time he studied anatomy under John Hunter, midwifery with William Hunter and McKenzie, and took his medical degree at Edinburgh, the young Shippen returned to Philadelphia. T h e subject of his graduation thesis, De Placentae cum Utero Nexu, was sufficient to indicate the field of his specialized activity. In March of the year he returned (1762) Shippen began a series of lectures on obstetrics, the first course of its kind to be given in this country. T h e series was announced in the Pennsylvania Gazette as a course of about twenty lectures in which . . . he will treat of that part of anatomy which is necessary to understand that branch, explain all cases of Midwifery—natural, difficult, and preternatural— and give directions how to treat them with safety to the mother and child; describe the diseases incident to women and children in the month, and direct to 1® Francis R. Packard, "Thomas Cadwalader," Howard A. Kelly, editor, A Cyclopedia of American Medical Biography, 1: 154. 20 J. J. Walsh, History of Medicine in New York . . . 1: 47-48. zi An excellent sketch of William Hunter's life and work is given by E. B. Krumbhaar, "Doctor William Hunter of Newport," Annals of Surgery, 101: 506-28, January, 1935.

M E T H O D S OF I N S T R U C T I O N

41

p r o p e r remedies; will take occasion d u r i n g the course to e x p l a i n a n d a p p l y those curious a n a t o m i c a l plates a n d casts of the g r a v i d uterus at the H o s p i t a l , a n d conclude the whole with necessary cautions against the d a n g e r o u s a n d cruel use of instruments.

The announcement further noted that beds had been provided for the accommodation of poor women who might otherwise want for proper care in delivery. Thus provision was made for the presence of clinical material. T h e lecturer offered to give instruction privately to female students and proposed giving consultation to midwives on difficult cases. The charge for attendance on two courses was five guineas and for perpetual students ten guineas.22 From the extracts of notes on Shippen's lectures, given by Norris, one is able to know something of the outline followed by the young obstetrician. In his opening remarks he spoke disparagingly of the quality of obstetrics practised by the "unskilful old women about them." On seeing their clumsy management with its resultant suffering, when called in consultation, Shippen had resolved to introduce a course of lectures. He encouraged his students to believe that he would in time be able to present to each one a natural labor. In the meantime he proposed to demonstrate all kinds of labor and management on a "machine." His presentation of the subject was in logical sequence. The final lectures covered the diseases of women and children, the history of midwifery, and the necessary qualifications of a man midwife. He counseled "grave deportment" with appropriate conversation, "avoiding religiously any jokes about the patient or profession." He condemned the drinking habit and admonished charging patients according to their ability to pay.23 In the fall of the same year Dr. Shippen advertised his intention of introducing a course of anatomical lectures. The Pennsylvania Gazette of November 11 informed the public that A course of A n a t o m i c a l Lectures will be o p e n e d this w i n t e r in P h i l a d e l p h i a , f o r the a d v a n t a g e of the y o u n g g e n t l e m e n n o w e n g a g e d in the study of Physic, in this a n d the n e i g h b o r i n g provinces, whose circumstances a n d connections will not a d m i t of their g o i n g a b r o a d f o r i m p r o v e m e n t to the a n a t o m i c a l schools in Europe.24

The course was also for the entertainment "of any gentlemen who may have the curiosity to understand the anatomy of the Human Frame." In the series Shippen proposed to cover gross and surgical anatomy with incidental attention given to diseases, their indications and methods of cure. Tickets for the course, which was to be given at his father's house, were offered at five pistoles each. Gentlemen inclined to see the subject prepared for the lecture and interested in the art of dissecting were asked to come early and pay five pistoles extra. An introductory lecture to the course was delivered at the state house in September. 22

Packard, op. cit., p. 30g. 28 George W. Norris, The Early History of Medicine in Philadelphia, 24 Packard, op. cit., p. 321, gave the entire announcement.

pp. 36-38.

4*

MEDICAL E D U C A T I O N BEFORE T H E CIVIL WAR

E v e n l i b e r a l P h i l a d e l p h i a w a s n o t u s e d t o t o l e r a t i n g dissections of h u m a n b o d i e s , w h i c h p r a c t i c e s u g g e s t e d t o the p o p u l a c e t h a t g r a v e s h a d b e e n r o b b e d . O n l y t e n s t u d e n t s e n r o l l e d f o r this course. I n the t o w n there dev e l o p e d a p o t e n t o p p o s i t i o n w h i c h m a n i f e s t e d itself in m o b v i o l e n c e . Several times the little b u i l d i n g w h i c h housed Shippen's anatomical materials a n d s e r v e d as a c l a s s r o o m w a s v e h e m e n t l y a t t a c k e d a n d t h e w i n d o w s w e r e b r o k e n . N o r r i s r e l a t e d t h a t i n o n e of these a t t a c k s S h i p p e n m a d e a n a r r o w e s c a p e t h r o u g h t h e a l l e y , l e a v i n g his c a r r i a g e , w i t h b l i n d s d r a w n , s t a n d i n g b e f o r e t h e b u i l d i n g . T h e r a b b l e , t h i n k i n g the D o c t o r w a s in t h e c a r r i a g e , s h o w e r e d it w i t h missiles, a l o n g w i t h w h i c h w e n t a m u s k e t b a l l t h r o u g h the c e n t e r . A t t i m e s h e h a d t o flee his o w n d w e l l i n g a n d c o n c e a l h i m s e l f to avoid harm. B y p u b l i c a p p e a l s t h r o u g h t h e press a n d the i n f l u e n c e of b r o a d - m i n d e d citizens S h i p p e n g r a d u a l l y o v e r c a m e opposition. O n several occasions he a s s u r e d t h e p u b l i c t h a t t h e r e p o s e of the d e a d h a d n o t b e e n d i s t u r b e d , e x c e p t f o r suicides, e x e c u t e d c r i m i n a l s , a n d " n o w a n d t h e n , " h e f r a n k l y a d m i t t e d , " o n e f r o m t h e P o t t e r ' s F i e l d . " 25 In D e c e m b e r , t h e s e c o n d m o n t h o f t h e c o u r s e , a press n o t i c e r e g a r d i n g a N e g r o s u i c i d e w h o s e b o d y h a d b e e n t u r n e d over to Dr. S h i p p e n for anatomical purposes n o d o u b t h e l p e d ease the s i t u a t i o n . N o r r i s also n o t e d a Gazette i t e m c a l l i n g a t t e n t i o n t o the e x e c u t i o n of a G l o u c e s t e r , N e w Jersey, c r i m i n a l , w h o s e b o d y w a s o r d e r e d s e n t t o D r . S h i p p e n ' s a n a t o m i c a l t h e a t r e f o r d i s s e c t i o n . I n F e b r u a r y the l e c t u r e r a n n o u n c e d t h a t o s t e o l o g y , " T h e most d r y , t h o u g h t h e m o s t necessary p a r t of a n a t o m y , " w a s finished, a n d i n v i t e d g e n t l e m e n t o g r a t i f y t h e i r c u r i o s i t y a t a n y p a r t i c u l a r l e c t u r e f o r five shillings. D r . S h i p p e n ' s p o p u l a r ity i n c r e a s e d w i t h t h e d e c l i n e of i g n o r a n t p r e j u d i c e . I n s u b s e q u e n t y e a r s he h a d as m a n y as t w o h u n d r e d a n d fifty in a class. 20 T h e p r o p r i e t y of g i v i n g c l i n i c a l lectures at t h e P e n n s y l v a n i a H o s p i t a l w a s s u g g e s t e d to t h e m a n a g e r s in 1766 by D r . T h o m a s B o n d . B o n d ' s app r o a c h w a s r a t h e r m o d e r n . H e i n v i t e d the h o s p i t a l b o a r d t o his h o m e , as a f r i e n d l y g e s t u r e , a n d t h e n r e a d to t h e m a p r e p a r e d l e c t u r e , " A n Essay o n t h e U t i l i t y of C l i n i c a l L e c t u r e s . " T h e m a n a g e r s a p p r o v e d , B o n d ' s essay w a s o r d e r e d i n s e r t e d i n t h e m i n u t e s , a n d the c l i n i c a l l e c t u r e s w e r e introd u c e d . B o n d ' s l e c t u r e s at t h e h o s p i t a l c o u l d n o t h a v e b e e n o t h e r t h a n v a l u a b l e t o s t u d e n t s a n d p r a c t i t i o n e r s a l i k e . In effect, t h e c o u r s e w a s pract i c a l l y a p a r t o f the C o l l e g e o f P h i l a d e l p h i a m e d i c a l s c h o o l c u r r i c u l u m , b u t s i n c e D r . B o n d w a s a t r u s t e e of the c o l l e g e it w a s r e g a r d e d as u n e t h i c a l t o g i v e h i m a f a c u l t y a p p o i n t m e n t . N e v e r t h e l e s s h e c o n t i n u e d the c o u r s e u n t i l his d e a t h i n 1784, b e i n g e s p e c i a l l y r e q u e s t e d t o c o n t i n u e b y t h e coll e g e trustees a n d f a c u l t y in 1768. It is o b v i o u s t h a t the c o u r s e w a s g e n e r a l l y w e l l r e c e i v e d , b u t J a m e s A r m s t r o n g , o n e of the first g r a d u a t e s of t h e n e w s c h o o l , p e n n e d o n t h e b a c k of his a d m i s s i o n c a r d t o D o c t o r B o n d ' s 1767 c o u r s e t h e w o r d " i n t o l e r a b l e . " 27 Norris, op. cit., pp. 38-40. 2β Ibid., p. 38. " T h i s card is in the collection of Dr. William Pepper, present dean of the University of Pennsylvania School of Medicine. 25

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43

A prelude to the founding of the Medical Institution of Harvard University was John Warren's anatomical dissections and demonstrations of clinical material while he was stationed at the Continental A r m y hospital in Boston, 1780-83. He gave a series of lectures on anatomy two consecutive years. His success, in spite of troubles over securing bodies for dissection, so favorably impressed the Harvard authorities that they asked him to lecture at Cambridge and aid them in founding a medical department, which was opened in 1783. D u r i n g the winter of 1789-90 in Baltimore, Dr. George Buchanan, a former student of Charles Frederick Wiesenthal and W i l l i a m Shippen, and an Edinburgh student and Pennsylvania graduate of 178g, lectured to a class of nine on diseases of women and children and the Brunonian system. His course was paralleled in the same city by A n d r e w Wiesenthal, recently returned from extensive medical studies in Philadelphia and London, where he served an internship at St. Bartholomew's under John Sheldon, W i l l i a m C. Cruikshank, John Marshall, and Percival Pott. Wiesenthal lectured to a class of fifteen on anatomy, physiology, pathology, operative surgery, and the gravid uterus. Cordell describes the efforts of these two doctors as an effort to begin a medical school. Perhaps it was little more than two independent lecture courses being conducted at the same time in the same city. T h e "medical school" idea never matured, but courses were given by physicians from time to time in Baltimore until a school was organized early in the nineteenth century. 28 Independent lecture courses did not disappear with the advent of medical schools and their loosely organized curricula. T h e y became more numerous. A t times they served as valuable adjuncts to organized institutions, covering subjects of premedicai importance or of a postgraduate nature. T o o often they were prematurely projected. Some lasted a few seasons and disappeared, while others expanded into recognized schools and competed with older established institutions. Some respectable physicians who lectured independently in Philadelphia during the last quarter of the eighteenth century were: A b r a h a m Chovet, anatomy; John Foulke, "Chirurgical and Physical subjects;" and Benjamin Duffield, "Diseases of Hospitals and Jails," and "the American Practice of Physic." 28 W h e n John Morgan, on the College of Philadelphia commencement platform in May 1765, outlined a program for American medical education he emphasized the place of hospitals in the training of medical men. Speaking of the appropriate facilities for clinical instruction in Philadelphia the zealous orator remarked: Besides men of great abilities and eminence, under w h o m they may see private practice the hospital of this city is a great persuasive to determine a concourse of medical students to this place. It would be doubly useful to them, and increase their motive of repairing here, if they could be first properly initiated in the principles of their profession, by regular courses of lectures duly delivered.

28 Cordell, op. cit., pp. 17-18. 2® Norris, op. cit., pp. 91, 121.

MEDICAL EDUCATION BEFORE THE CIVIL WAR

44

Morgan's hope of making use of the clinical material of the hospital for teaching purposes was enhanced by the fact that six physicians of the "most unquestionable skill" were on the hospital staff and that five of these were trustees of the college. This interlocking of directorates led Morgan to infer that complete facilities would be available for students of medicine in Philadelphia. " T o which nothing can contribute more," he added, "than a course of clinical practise, and clinical lectures, by physicians of knowledge and experience." 30 In 1765 no other city in the colonies could have compared with Philadelphia in clinical facilities for medical instruction. T h e Pennsylvania Hospital was the first and in 1765 the only hospital in the British colonies of America intended solely for the care of the sick and wounded. Philadelphia also had an infirmary in connection with the poorhouse, where paupers who were mentally unbalanced or physically distressed received more than routine care. There were other institutions of a medical nature, similar to hospitals, before the Pennsylvania Hospital was opened in 1752, but none was of a permanent and general medical nature. From the commercial character of the colonies along the fringe of the Atlantic coast it is easy to understand why the first medical establishments were lazarettos or rest homes for seamen and others infected with communicable diseases. Early in colonial history institutions of this type were founded in and near centers of trade. One was established on Rainsford Island in Boston Harbor, and another on State Island in the Delaware, for convenience of the Philadelphia port. Poorhouses which were established in some colonial centers were not hospitals, but merely living quarters charitably provided for indigents. Sickness, however, was not uncommon among the inmates. After the practice of inoculation became an accepted medical procedure, so-called hospitals were established in various places for the purpose of conducting patients through the process. These establishments were privately promoted and never received legislative aid. Hence they were short lived and did not play a conspicuous part in the development of early American medicine. Their influence on medical education was probably little more than negligible. In such institutions pupils may have observed some contagious diseases or done inoculations under the direction of their preceptors. Such establishments were few, and the literature does not support the assumption that more than a little instructional use was made of them before the establishment of medical schools.31 Morton traces the history of the Pennsylvania hospital movement back to 1709, but nothing of permanence was effected until the middle of the century. T h e energy of two men, Thomas Bond and Benjamin Franklin, is responsible for the founding of the Pennsylvania Hospital. A brief his80

30 f.

John Morgan, A Discourse on the Institution

of Medical Schools in America, pp.

a l John Brodhead Beck, "An Historical Sketch of the State of American Medicine Before the Revolution," Transactions of the Medical Society of the State of New York, (184s), p. 137.

METHODS OF INSTRUCTION

45

tory of the institution, published in 1754 and ascribed to Franklin, noted the distressing social conditions which gave rise to the movement to f o u n d a hospital. T h e presence in Philadelphia of several well-established physicians of repute by the middle of the eighteenth century was quite a drawing card. Health seekers from near and far sought relief from their ills by applying for the service of Drs. Bond, Shippen, Cadwalader, Redman, and others. By 1850 the inability of the "distemper'd" from out of town, especially the poor, to obtain suitable lodging and other conveniences proper for their respective cases became very apparent. It was even intimated by Franklin that some had lost their lives because of inadequate care and facilities. He further felt that the poor of the city, when ill, could be cared for more satisfactorily in a properly equipped house. A well-ordered hospital, patterned after some recently established in England, would help to solve yet another social problem of the province. Several of the inhabitants, " w h o unhappily became disordered in their Senses, wander'd about, to the T e r r o r of their Neighbours." In 1750 there was no place to house and care for the insane except the house of correction, which had no means f o r giving the unfortunates the proper care. Dr. T h o m a s B o n d must have felt the seriousness of the situation more keenly than others. It was he who first set about soliciting donations to a f u n d designed to finance a hospital building. His success was not assured until after he approached Franklin and secured his active support. Subscriptions were more free and generous after Franklin published illuminating editorials on the need of such an institution. Franklin also drew u p a petition to the provincial Assembly, which was signed by thirty-three "sundry Inhabitants." T h e objection that the paying of physicians and surgeons " w o u l d eat u p the whole of any F u n d " which could be reasonably expected was promptly answered by three physicians, Lloyd Zachary, T h o m a s Bond, and Phineas Bond, who generously offered to attend the hospital gratis f o r three years. T h e other objections "being by Degrees got over," the bill was by the following May enacted into law, and each subscriber of ten pounds or more legally became a constituent. While the first president of the board, Joshua Crosby, bickered with the proprietor, T h o m a s Penn, over land on which to erect the building, the Assembly advanced £ 1 , 0 0 0 with which a house was hired and furnished in order to get started. T h e managers set up rules of operation which excluded patients regarded as incurable or suffering with infectious distempers. Children of patients would not be cared for by the hospital. T h e overseers of the poor and the justice of the peace were invested with socialservice authority to certify the hospitalization of out-of-town patients. Other regulations pertained to hospital routine and were remarkably modern. T h e industrious managers had the institution ready for business on February 10, 1752. T h e following M a y the medical staff was increased to six. Until December following, the physicians furnished all drugs f o r poor patients. T h e n the "charitable Widows, and other good Women of the C i t y " supplied the managers with funds to buy medicines for the poor. It is interesting to note that early in 1754 spinning wheels were provided

46

MEDICAL EDUCATION

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for the employment of women patients able to use them. T h i s might be regarded as an early experiment in vocational therapy were it not for the fact that the plan seemingly originated with the managers and was a business measure. A n abstract of cases for the period from February 11, 1752, to April 27, 1754, showed a miscellany of one hundred and seventeen cases, mostly in the category of internal medicine. Sixty of the one hundred and seventeen were cured. Eleven were relieved; seven were incurable; and ten were removed by friends. Only ten died, and three were discharged because of irregular behavior. Sixteen were remaining at the close of the period. T h e abstract listed the cases as ulcers, lunacy, dropsies, scorbutic and scrofulous diseases, rheumatism and sciatica, and twenty-six other ailments. 32 T h i s new institution was of some consequence to attending physicians w h o had office pupils. For the first time in the history of medicine in America students of the art of physic began "walking the wards." T h o m a s Bond had not yet started his clinical lectures, but many a bedside explanation may have expanded into the proportions of a lecture. T h u s began the special role of hospitals in the drama of American medical education. Philadelphia's best physicians, like their masters in Leyden, Edinburgh, Paris, and Rome, in full dress and with becoming dignity moved from patient to patient, followed by a cortege of young disciples of Aesculapius. T h e new building was not ready for occupancy until 1756. It consisted of the east wing of a building planned to have a center portion and a corresponding west wing. T h e latter part of the building was finished in 1796. In his Continuation of the Account of the Pennsylvania Hospital . . . , 1761, Franklin recorded the fact that divers inconveniences resulted from the practice of washing patients' linen in the common kitchen. It was therefore "concluded expedient to build a Wash-House, a small distance from the House . . ." 33 A n educational feature of the Hospital was the museum, which had a small beginning in 1757, with a skeleton for teaching purposes. T h e gift of the anatomical casts and drawings by Dr. John Fothergill in 1762 constituted the real beginning of the collection as an educational adjunct of the Hospital. In a letter to James Pemberton, April 7, Dr. Fothergill explained that he designed the anatomical materials to be placed in the Hospital under the care of physicians, and "to be by some of them explained to the Students or Pupils who may attend the Hospital." K n o w i n g the lack of real anatomical subjects in the colonies, Dr. Fothergill felt that the drawings would fill an actual need. William Shippen, w h o began lectures in 1762, found it convenient to use the Fothergill materials in his course. During the summer of 1763 he demonstrated the collection in fortnightly lectures to lay persons desirous of gaining a knowledge of human anatomy. T h e fee was one dollar per person, all funds going to the benefit of the Hospital. 34 32 Benjamin Franklin, Some Account of the Pennsylvania Hospital. . . , pp. 4-36. 33 Benjamin Franklin, Continuation of the Account of the Pennsylvania Hospital.

P- 54·

s« Packard, op. cit., pp. 3x9-20.

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T h e Hospital Board of Managers made the Fothergill preparations available for any professor who might be "desirous to exhibit lectures." All pupils were to pay a pistole each for the privilege. Early in the history of the Hospital the library had its beginning. In the same year in which Dr. Fothergill sent the anatomical preparations, he forwarded as a present to the Hospital a book entitled An Experimental History of the Materia Medica, by William Lewis. T h e next year, 1763, the members of the staff agreed that the fees from their hospital pupils should apply to "the founding of a Medical Library in the Hospital which we judge will tend greatly to the Advantage of the Pupils & the honor of the Institution." T h i s plan proved to be a valuable source of revenue for the new library. It seems that the managers recognized the library as an important factor in the development of medical education in the colonies. In 1774 William Strahan, a prominent bookseller of London, received the following letter from a committee of the managers: Respected F r i e n d . — T h e Managers of the Pennsylvania Hospital having deputed us to procure some books for the Medical L i b r a r y , as we apprehend thou canst supply us in the most advantageous T e r m s we herewith send thee a List of them desiring thee to prepare and ship them by the first vessel coming to this Port that they may be here before the W i n t e r . T h i s we are very desirous of as the y o u n g Students w h o f r o m the neighboring Provinces attend the Lectures of the several professors in o u r Medical School may then have the benefit of reading them a year sooner than they can if they should not arrive before next Spring; for the Cost of them we will send thee a timely R e m i t t a n c e . . . 3 5

Strahan was requested, in the future, to forward books and essays on any branch of medicine, such as were of small cost, and charge them to the hospital. Information on the more costly items was also requested. At one time Dr. J o h n Coakley Lettsom, a prominent London teacher, was asked to use his judgment and select books which he felt the library should have. Gifts, donations, and legacies through the years added much to the regularly purchased books. In 1807 space on the second floor was fitted up for the library. From 1824 to 1835 the library was housed elsewhere, but in the latter year the collection was returned to the second-floor space which it has since occupied. It would be difficult to overestimate the value of the Hospital library in the experience of many hundreds of student physicians of Philadelphia, even before the middle of the nineteenth century. In time it became customary for physicians attending the Hospital to have their advanced pupils dress wounds and otherwise tend their hospital cases. In addition to the regular pupils, there came to be a group of freelance students attached to no physician, who were permitted to make the rounds and observe the hospital practice. So many young men began availing themselves of the opportunity that the managers in May 1763 resolved: s» T . G. Morton and F. Woodbury, The History of the Pennsylvania

1895. P· 347·

Hospital,

175»-

48

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

. . . that such of them at least who are not apprentices to the Physicians of the House, should pay a proper Gratuity for the Benefit of the Hospital for their privilege . . . 3e A t a later meeting of the managers it was decided to charge each student not apprenticed to a physician six pistoles as a gratuity for the privilege. T h e managers a n d attending doctors were given authority to admit or refuse students. M o r t o n stated that by 1773 the Hospital began the practice of indenturing y o u n g men as apprentices to the institution for terms of five years. As was the practice of many preceptors, the Hospital, at the termination of the pupil's term, granted him a certificate of his service. T h e managers also gave to each departing p u p i l a suit of clothes. Apprenticeships of this sort were the custom in the Pennsylvania Hospital for many years. Pupils, while so indentured, customarily attended the lecture courses in medicine instituted after the College of Philadelphia (later the University of Pennsylvania) established a school of medicine in 1765. According to Packard, the service of house pupils in the Pennsylvania Hospital was later raised to a postgraduate level. Beginning in 1824 candidates for such appointments were required to be graduates. 37 Such "residents" were no doubt useful to some extent in the teaching program carried on in the Hospital. From the first, the Pennsylvania Hospital was closely associated with medical education in Philadelphia. O n its staff have been many of the makers of medicine in America. Philadelphia's preeminent leadership in medical education for so many decades can be traced in a large measure to the superior clinical facilities offered by the Pennsylvania Hospital and similar institutions in the Quaker City. T h e Philadelphia General Hospital (Blockley) had its beginning as the City Almshouse. A l t h o u g h the first almshouse was completed in 1732, early medical annals of the institution are vague. Little medical significance can be attached to the Almshouse before 1768, at which time there was record of Drs. Cadwalader Evans' and T h o m a s Bond's reappointment to the infirmary staff. A s early as 1770 an obstetrical clinic was established for the benefit of students. Soon afterward the educational program was expanded by the beginning of medical and surgical lectures and the opening of the wards to non-resident pupils and to resident physicians. 38 In 1834 the Almshouse (known as the Bettering House after 1768) was moved f r o m its downtown location to Blockley T o w n s h i p , west of the Schuylkill River. T h e following year the official name of the institution was designated as "Philadelphia Hospital," but the name " B l o c k l e y " was generally used. M e a n w h i l e instruction in clinical medicine made definite progress. T h e Almshouse became a popular resort for students seeking bedside instruction. W . S. M i d d l e t o n said the popularity of the Almshouse rivaled se Morton, and Woodbury, op. cit., p. 460. " Packard, op. cit., pp. 326-27. se Alfred Stengel, " T h e Importance of the Philadelphia General Hospital in Medical Education," Medical Life, 151: 153-54, April, 1933.

METHODS OF INSTRUCTION

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the Pennsylvania Hospital by 1 8 1 1 . In 1 8 1 5 the Almshouse steward made a friendly gesture by inviting the Pennsylvania Hospital residents to witness an operation at the Almshouse. A standing invitation thereafter perpetuated the courtesy. In 1820 the house pupils, who had to pay a fee for the position, became known as house physicians or house surgeons. T h r e e years later only graduates could hold the position. Just before the move to Blockley in 1834 there were 220 students registered as taking clinical courses in the Almshouse. As early as 1829 a committee of physicians expressed themselves as opposed to moving the Almshouse out of town. T h e y felt that such a move would make the hospital inaccessible to medical students and lose for Philadelphia its supremacy as a center of medical education, incidentally robbing Philadelphia citizens of a certain revenue which they enjoyed from out-of-town students. 39 As is often the case, the board composed of laymen prevailed and the Blockley site was selected. T h e new building provided unusual teaching facilities. T h e hospital unit was designed for six hundred beds, and the student amphitheatre would seat five hundred. T h e Medical Board was so pleased with the new arrangements that the members agreed to forego their annual stipends of fifty dollars and requested that the equivalent amount along with student fees be appropriated for the medical library. T h e removal to Blockley created a transportation problem which threatened to limit clinical opportunities for pupils and curtail the student-fee income of the Hospital. T h e problem was solved by the Hospital providing a fleet of omnibuses which transported the students one morning a week to Blockley. Some went by way of the Market Street bridge and some by the South Street ferry. A l l together it was a spectacle of life and excitement. D. Hayes Agnew recalled the weekly excursions as "admirably calculated to relieve the tedium of town and regale the lungs with more invigorating air." J o h n H . Brighton spoke of the Saturday morning jaunts as disorderly, but of great delight to all small urchins on the route, especially in snow season when the packed vehicles afforded "inestimable chances for snowballing and boyish sharp-shooting." 40 T h e first staff which graced Blockley was an aggregate of clinicians probably unequaled in any contemporary institution. Clinical instruction gained a tremendous impetus from the superior teaching ability of such men as William E. Horner, Samuel Jackson, H u g h L . Hodge, Samuel G. Morton, J a c o b R a n d o l p h , R i c h a r d Harlan, Henry Neill, and F. S. Beattie. T h e prospects for Blockley as a national center of clinical instruction in medicine in 1834 were brilliant, but not fully realized for many years. Both the University of Pennsylvania and Jefferson Medical College were approached with the proposal that both schools require Blockley house tickets of all their graduates. T h i s opportunity to raise the standards of medical education by requiring clinical instruction was refused by the 39 William Shaine Middleton, "Clinical T e a c h i n g in Philadelphia Almshouse Hospital," Medical Life, 152: 208-10, May 1933. *o Ibid., pp. 3 1 1 - 1 2 .

and

5o

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faculties of both schools. A movement to establish a summer course in practical medicine and surgery at the Hospital likewise failed of adoption. T r a n q u i l l i t y in the institution was not aided by the friction between the schools, resulting from Jefferson's demand for equal representation on the medical staff with the University Medical School. T h e University fought vigorously for its priority in the Almshouse, claiming credit for the advancement of clinical instruction so far achieved in the institution. In 1835 the University conceded to the change of the clinical lecture from Wednesday to Saturday so that the seventy-nine Jefferson students might attend. More serious difficulties arose from traditional differences between the medical and business staffs. In 1845 the Hospital Committee of the Board of Guardians severely criticized the medical staff, w h o were nearly all professors or lecturers, for their use of inmates for demonstration purposes. T h e Committee also strongly disapproved of the staff's custom of allowing the eight young house physicians, contrary to the rules, to prescribe for patients and conduct the Hospital quite as they pleased. T h e actual situation in the Hospital was probably not so serious as believed by the Committee. T h e true casus belli, as suggested by Stillé, was the lack of cordial harmony between hospital managers and resident physicians. " T h e exercise of power is as dear to the one" said Stillé, "as intolerance of it is natural to the other. T h e one lacks sympathy and the other humility." 1 1 T h e situation at Blockley was intensified while the resident physicians sat at dinner with the steward, June 30, 1845. T h e i r indignation suddenly flared as a typical Blockley cockroach strode impudently across the table. W h e n their request for a transfer to the matron's table was refused they walked out in a body, for which act they were discharged by the board. T h r e e weeks later, in the face of the pleas of Samuel Jackson and other physicians, a new visiting staff was appointed and Blockley was closed as a teaching hospital. For nine years the excellent clinical material of the Philadelphia Hospital was not available for teaching purposes. T h e eleven years of plenty from 1834 to 1845 were followed by nine lean years, 1845 to 1854, after which time students again walked the wards of " O l d Blockley." Eighteen years after T h o m a s Bond and Benjamin Franklin launched a formal drive for funds which terminated in the founding of the first incorporated hospital in the colonies, a similar movement was inaugurated in N e w York City. T w o years before (1767) a simple beginning in medical education had been made by the establishment of a medical department at King's College. T h e occasion for launching the hospital movement in 1769 was the first commencement exercises of the new medical school. T h e affair was held in Trinity Church. A notable assemblage, including Governor Sir Henry Moore, was present. T h e speaker was Samuel Bard, a former King's College student, a medical graduate of Edinburgh University, and Professor of the Practice of Medicine in the new school. First he impressed the two candidates for medical honors with the importance of their calling. T h e part of his address that made history was «1 Cited by Middleton, op. cit., p. a 15.

M E T H O D S OF I N S T R U C T I O N

5»

addressed to the p u b l i c , a n d constituted an e l o q u e n t a p p e a l for m e d i c a l e d u c a t i o n a n d the e s t a b l i s h m e n t of a g e n e r a l hospital. T h e G o v e r n o r a n d his c o u n c i l h a d previously e n c o u r a g e d the p l a n . Sir H e n r y M o o r e h e a d e d the s u b s c r i p t i o n list, b u t d i d not live to see the c o m p l e t i o n of the project. Drs. Peter M i d d l e t o n a n d J o h n Jones, b o t h members of K i n g ' s C o l l e g e School of M e d i c i n e F a c u l t y , j o i n e d Dr. B a r d in 1770 a n d presented a petition to the a c t i n g g o v e r n o r , D r . C a d w a l l a d e r C o l d e n . T h e institution was organized, a n d a c h a r t e r was granted in 1771. By 1775 a b e a u t i f u l a n d usef u l structure h a d been erected west of B r o a d w a y , opposite Pearl Street. Just w h e n the b u i l d i n g was practically ready for o c c u p a n c y an accidental fire g u t t e d the interior of the structure. T h e u n d a u n t e d governors m a d e a n e w a p p e a l for funds, a n d w i t h i n a year the b u i l d i n g was completed. A t this j u n c t u r e the W a r of the R e v o l u t i o n i n t e r r u p t e d the p l a n n e d dev e l o p m e n t of the N e w Y o r k Hospital. First, the Safety C o m m i t t e e o r d e r e d the q u a r t e r i n g of C o n t i n e n t a l troops in the b u i l d i n g , and w h e n the city fell, British a n d Hessian troops f o u n d the b u i l d i n g c o n v e n i e n t as b o t h barracks a n d m i l i t a r y hospital. For seven years the structure was so used. A f t e r a time of tedious r e a d j u s t m e n t f o l l o w i n g the w a r the b u i l d i n g , in 1791, b e c a m e a n " A s y l u m for P a i n a n d Distress," as o r i g i n a l l y p l a n n e d . In the course of years the p l a n t west of B r o a d w a y i n c l u d e d three large buildings w i t h a bed capacity of five h u n d r e d and several smaller structures, a n d was actively o c c u p i e d u n t i l 187ο. 42 D r . Bard's 1769 address portrayed a f e a t u r e of the proposed institution i n t i m a t e l y a n d necessarily connected w i t h the care of the sick, namely, the e d u c a t i o n of doctors. 4 3 T h e 1770 petition for charter a n d an a p p e a l to the G o v e r n o r the f o l l o w i n g year both a v o w e d the e d u c a t i o n a l purpose of the institution. A n a p p l i c a t i o n to the Legislature for a grant in 1792 also dec l a r e d the intent to train physicians. C e r t a i n l y the faculty in N e w Y o r k were n o t u n m i n d f u l that the only other A m e r i c a n school of medicine, the C o l l e g e of P h i l a d e l p h i a , h a d at its disposal the clinical facilities of t w o respectable hospitals. A spectacular e v e n t of the N e w York Hospital's early history was the " D o c t o r s ' M o b " r i o t of 1788. T h i s d i s r e p u t a b l e occurrence resulted m o r e f r o m the i g n o r a n c e a n d p r e j u d i c e of the p e o p l e against the dissection of h u m a n bodies t h a n f r o m any indiscretion on the part of the medical school faculty. T h e d i s t u r b a n c e cost the lives of seven rioters, a n d as m a n y m o r e were w o u n d e d . T h e g o v e r n o r s of the H o s p i t a l washed their hands of any responsibility, c h a r g e d the professors a h e a v y fee a n d ousted them f r o m the b u i l d i n g s . O f course n o g o o d accrued to the cause of medical e d u c a t i o n f r o m this d i s g r a c e f u l h a p p e n i n g . W h e n the H o s p i t a l r e o p e n e d for patients in 1791 the medical staff became a t e a c h i n g f a c u l t y a n d organized b o t h clinical lectures a n d general instruction for students. L a r g e numbers of students took advantage of the E d w a r d W . S h e l d o n , " A n H i s t o r i c a l A d d r e s s , " The Society of the New York Hospital, Commemorative Exercises ijoth Anniversary, pp. 13-19. 1 3 S a m u e l B a r d , Two Discourses Dealing with Medical Education in Early New York, p p . 1-48 passim.

52

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library a n d other facilities provided by the Hospital a n d its staff. King's College students of medicine were made welcome. T h e same privilege was extended to the students of other schools established later, to unattached students in the city, and to visiting doctors and students from the country at large. T h r e e h u n d r e d students regularly attended clinics in the main b u i l d i n g of the old B r o a d w a y plant, and as many more received instruction a n d observed in the newer South Building. A library started in 1796 f o r the benefit of students and staff grew steadily until it was one of the largest a n d best in the c o u n t r y . " T h e qualifications for house physicians in the New York Hospital were, that they should be at least twenty-one years of age, have been pupils of a practising physician or surgeon for three years, during which time they must have attended a complete course of lectures in one of the colleges, have attended the daily practice of the Hospital for one year, and have produced a m p l e testimonials of good moral character. In addition all candidates f o r the position were submitted to an examination by the physicians a n d surgeons of the staff. 4 5 In connection with the N e w York Hospital the L u n a t i c Asylum was established in 1808. T h e practice of receiving and housing mental cases along with other types proved very unsatisfactory. By 1 8 1 8 a permanent site on B l o o m i n g d a l e R o a d was selected. T h e hospital established there was the progenitor of the Bloomingdale Asylum for the Insane. In 1899 Dr. D. B . St. J o h n Roosa, a former intern of the New York Hospital, honored his hospital alma mater with the following very generous remarks: T h e N e w Y o r k H o s p i t a l has always been pre-eminently a medical school. It was one of the first,—if not the first institution in our country, to place itself o p e n f o r clinical instruction. . . . It was one of the first in the world to demonstrate thoroughly the fact that n o instruction in the practice of medicine and surgery is worth the n a m e that is not clinical. It was the great school of surgery of the w h o l e country. . . . A h a l o will always encircle its brow. 4 0

B e l l e v u e Hospital of N e w York is a lineal descendant of the infirmary department of the " P u b l i c k Workhouse and House of Correction of the City of N e w Y o r k , " established in 1735. Because there was in this early institution a room especially set apart as an infirmary, to be used for no other purpose, a n d a physician, J o h n Van Buren, was appointed, Carlisle drew the conclusion that Bellevue Hospital is the oldest hospital in the U n i t e d States. It must be noted that the infirmary of the old Workhouse was only an emergency provision for illness which might appear within the insti« Sheldon, op. cit., pp. 20-28. In 1805 the Hospital acquired the library of Dr. Nicholas Romayne and the State Medical Society library in 1805, on condition that the doctor sons of the members should have free use of the Hospital's library. In 1811 there were 3,000 volumes. Packard, op. cit., p. 242. T h e above requirement was practically equivalent to graduation from a medical school. « Ibid., pp. 29 f.

METHODS OF INSTRUCTION

53

tution. It was not intended to be and did not operate as a hospital in the broad sense of the word. 47 T h e vicissitudes of this early city institution were many and more properly belong to a medicai or social discussion not primarily devoted to the education aspects of a hospital. It is sufficient to say that Bellevue Hospital, as it came to be known after 1825, was subject in a great measure to the whims and caprice of local politics. Carlisle cited a Medical Repository note of 1804 as the first reference to medical teaching in Bellevue Hospital. T h e item was an announcement that Dr. Valentine Seaman had begun a course of lectures on obstetrics in connection with the lying-in-ward of the Almshouse. 48 Packard said that clinical lectures were given irregularly from 1844 t o ^ ó 2 · ^ n e w a n d better era for clinical instruction opened at Bellevue in 1847, when the Medical Board made plans for teaching, and in 1849 opened an amphitheatre especially provided for medical lectures. T w e l v e years later a charter was obtained by the Hospital for a medical school. In 1798 T h o m a s Boylston of Boston named a f u n d in his will for the erection of a smallpox hospital and a hospital for the insane. About the same time William Phillips left $5,000 to the town of Boston for the same purpose. By 1 8 1 0 the need for such an institution was very apparent. A hospital was not only a social necessity but an educational need. A t the same time plans were being laid to move the Harvard Medical Institution from Cambridge to Boston. Obviously the school could not compete with the New York and Pennsylvania schools without clinical facilities. Drs. James Jackson and J o h n C. Warren of the medical school began soliciting subscriptions for a hospital. A charter was obtained in 1 8 1 1 and five years later the commonwealth made a substantial gift, but the Massachusetts General Hospital was not opened until 1 8 2 1 . U p until this time the Harvard professors were limited to the Boston Almshouse for giving clinical instruction. In 1 8 1 0 the Overseers of the Poor passed a resolution permitting the "said Professors" to visit the sick in the Almshouse with their pupils, provided the poor who thus fell under their care should receive all care and medicines without cost to the city. T h i s arrangement was in force until the opening of the Hospital, after which no teaching was done at the Almshouse. 49 In 1818, three years before the opening of the General Hospital, the Corporation erected a building at Charlestown for the accommodation of the insane patients. T h e cornerstone for the General Hospital was laid J u l y 4, 1818, amid Masonic ostentation. T h e staff was appointed the previous year, but the Hospital did not receive patients until September 1 8 2 1 . Besides eight consulting physicians, James Jackson was acting physician and J o h n C. Warren was acting surgeon. Drs. Jackson and Warren conΊ" Packard, op. cit., pp. 253-54; c f · Robert J . Carlisle, An Account of Bellevue Hospital with a Catalogue of the Medical and Surgical Staff from ¡7}6 to 189J, pp. 1 ÍT. 43 T h e Carlisle citation is in Medical Repository, 2: 408, 1804. 49 Henry R . Viets, A Brief History of Medicine in Massachusetts, p p . 1 2 7 - 2 8 . Also note N. I. Bowditch, A History of the Massachusetts General Hospital, pp. 1 - 6 0 , passim.

54

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

tinued on the staff for many years and were leading figures in the profession in Boston. Henry R . Viets and N . I. Bowditch have little to say about the role of the Massachusetts General Hospital in medical education. Presumably Harvard's professors and students walked her wards, a n d young graduates served as residents in medicine and surgery quite the same as elsewhere. E v e n brief mention of the Massachusetts General Hospital is not complete without stating that it was within those stone walls that a dentist, W . T . G . Morton, in 1846 demonstrated the use of ether as a sleep-producing inhalant. O n e of the earliest hospitals founded in territory that is now within the limits of the United States was in New Orleans, far removed from the English colonies strung along the Atlantic coast of the new continent. In 1736 J e a n Louis, a Louisianan, died, and according to A. F. Fossier's account left a bequest to the City of New Orleans for the f o u n d i n g of a hospital for the sick. 50 Five thousand dollars, augmented by native help, was spent for the construction of a brick building and an equal sum for the interior furnishings and equipment. T h i s was the original Charity Hospital of Louisiana. It was named St. J o h n but mentioned in official, legal records as " l ' h ô p i t a l des pauvres de la Charité." F r o m an interesting memorial to the minister in France in 1737 Fossier gleaned the information that the institution had five patients and served the dual purpose of hospital and asylum to the indigent poor. Packard seized upon this information to demonstrate that this progenitor of the Charity Hospital was part almshouse and therefore not a hospital of greater antiquity than the Pennsylvania Hospital. 5 1 Packard is f u r t h e r fortified in his contention by the absence of any information on the early medical management of this charitable institution. A f t e r a devastating hurricane destroyed the Hospital in 1779, a wealthy Spanish noble, Don Andreas de Almonaster y R o x a s , offered a considerable sum for its rebuilding and yearly support. Not until 1784 was the new a n d commodious structure a reality. A n inventory in 1796 indicated an institution of twenty-four beds. A f t e r a removal in 1801 a n d destruction by fire in 1809, the cornerstone of an extensive plant was laid in 1 8 1 5 . T h e city directory of 1823 boasted that the Hospital was clean, wholesome, and as well conducted as any such institution in the U n i o n . D u r i n g the previous year 1,700 patients were admitted, 500 of whom died, half of yellow fever. Another move was made in 1832 and a 540-bed institution was completed the following year. W h e n New Orleans' first medical school was organized in 1834 several reasons were given by its founders for having located it in N e w Orleans. T h e second reason as given was: Because its hospitals, which will be opened to the undersigned for the purpose of instruction, are the largest in the Southern and Western States, so that Prac50 Albert E. Fossier, " T h e Charity Hospital of Louisiana," Reprinted from New Medical and Surgical Journal, p. 7., May to October, 1923. 61 Packard, op. cit., p. 26g.

Orleans

M E T H O D S OF

INSTRUCTION

55

tical Medicine and Surgery can be taught at the bedside of the patient, the only place for this study.

In 1843 'he professors of the Louisiana Medical College offered the legislature their professional service to the Hospital without charge for ten years if space on the public square were granted for the building of a "College Edifice." A counter petition from other physicians protested the idea of exclusive attendance by the professors. A contract with the school was finally made, granting the public building site but only making the professors subject to calls for ten years. T h e Charity Hospital followed the general custom of admitting several house students whose duties were similar to those of an intern or resident. T h e New Orleans Medical and Surgical Journal of May 1844 called attention to the opportunities and hazards of the Hospital work: Admirable opportunities are afforded these students to prosecute their studies; but a few of them, however, can be induced to remain at their posts during the sickly season; and it is melancholy to relate that of the three who determined to stay last summer two died of Yellow Fever. 52

T h e hospitals discussed above were the earliest and most important facilities utilized by American professors of medicine for clinical demonstration and instruction to large groups. As the demands of society and medical professors accumulated momentum, similar institutions were founded in such medical centers as Baltimore, Charleston, Cincinnati, Louisville, St. Louis, and Chicago. Reference will be made to them in subsequent chapters. T h e intrinsic value of hospital instruction in medical education was early recognized by Morgan, Bard, Warren, and many others, but a century passed before the policy of American medical educators at large bore witness to this patent truism by making hospitals a fundamental and inherent feature of the medical college program. As late as 1850 very few of the half a h u n d r e d American schools required of their graduates attendance on hospital wards. Schools which had hospital connections spoke boastfully in their circulars of clinical opportunities, but their faculties for many decades consistently refused to make attendance on the wards a requirement, for fear their competitors might surpass them in enrollment. T o compensate for their lack of hospitals the schools located in rural communities—and many were so located during the first half of the nineteenth century—established "college clinics" where some operations were performed and ambulatory patients were treated. Anxiety over dwindling numbers in their classes, because of the trend toward city schools, led faculties in some country colleges to advertise the most meager equipment as a hospital. Others boldly faced the situation and declared the hospital not f u n d a m e n t a l to clinical instruction for pupils who proposed to practise in frontier communities. R o b e r t Peter, a prominent medical professor of L e x i n g t o n , Kentucky, wrote in 1838 that the time had not yet come in the 52 Fossier, op. cit., pp. 24-25.

56

MEDICAL EDUCATION BEFORE T H E CIVIL W A R

western country when hospital medical practice could be of great advantage to the western student. Except for surgical cases, he declared the practitioner's office the best place for clinical observation and practice. 53 T h u s circumstances conspired to delay the gravitation of hospital instruction to its legitimate place in the curriculum of the American medical college. T h e pioneer state of American society, except in a very few metropolitan centers, was such that it was impossible to organize or successfully support hospitals. T h e profession itself, with its training and experience largely limited to country office practice, was often not a positive force in promoting the hospital movement. So many of the schools of medicine were proprietary in fact or in spirit that very few professors were willing to make hospital attendance obligatory for a degree and hence run the risk of fewer students and a curtailed income from tuitions. Several decades passed. Schools that had the opportunity did not take full advantage of these clinical facilities, and schools unable to establish such hospital connections created weak substitutes or blandly ignored their profound importance. Even where hospitals existed, lay managers were not always educationally minded and sparingly permitted the development of teaching projects. These aspects of the development of medical education are more fully considered in subsequent chapters. S3 R o b e r t Peler, Thoughts on Medical Education in America. . . , p. u . D r . Peter was Professor of C h e m i s t r y and P h a r m a c y at T r a n s y l v a n i a University, w h i c h h a d n o h o s p i t a l in 1838.

CHAPTER

6

MILITARY MEDICINE AND THE BEGINNING OF FORMAL INSTRUCTION ANOTHER f e a t u r e of e a r l y A m e r i c a n l i f e a n d a c t i v i t y h a d a d i r e c t b e a r i n g u p o n the d e v e l o p m e n t of A m e r i c a n m e d i c i n e a n d c o n s e q u e n t l y i n f l u e n c e d the e v o l u t i o n of m e d i c a l i n s t r u c t i o n in the c o l o n i e s a n d the n e w r e p u b l i c . A s e a r l y as 1690, hostilities b e t w e e n the E n g l i s h a n d F r e n c h c o l o n i s t s of the N e w W o r l d w e r e m a n i f e s t . T h i s f r i c t i o n b e t w e e n E n g l a n d a n d F r a n c e c o n t i n u e d i n t e r m i t t e n t l y u n t i l the s u b j u g a t i o n of the F r e n c h in 1763. D u r i n g this t i m e B r i t i s h m i l i t a r y e x p e d i t i o n s w e r e c o n t i n u a l l y c o m i n g a n d g o i n g in the colonies. W i t h e a c h e x p e d i t i o n a r y f o r c e w e r e w e l l - e q u i p p e d m e d i c a l officers. P e r m a n e n t m i l i t a r y e s t a b l i s h m e n t s also h a d t h e i r staffs of m e d i c a l a n d s u r g i c a l a t t e n d a n t s . T h u s w e r e i n t r o d u c e d i n t o this c o u n t r y m e d i c a l m e n of s u p e r i o r t r a i n i n g . N o t o n l y d i d the l a i t y i n the n e i g h b o r h o o d of m i l i t a r y c a m p s h a v e the b e n e f i t of their p r o f e s s i o n a l service, b u t y o u n g A m e r i c a n s w i t h a b e n t to l e a r n p h y s i c h a d the o p p o r t u n i t y to observe the w o r k of a n d r e c e i v e i n s t r u c t i o n f r o m these s k i l l e d p r a c t i t i o n e r s in t h e h o s p i t a l a n d o n the field. T h e m e d i c a l officers of the A n g l o - A m e r i c a n a r m y g a i n e d the c o n f i d e n c e of the p u b l i c by t h e i r d e m o n s t r a t i o n of s u p e r i o r a b i l i t y a n d p r o f e s s i o n a l d e p o r t m e n t . A m b i t i o u s A m e r i c a n pract i t i o n e r s w e r e i n s p i r e d to e m u l a t e t h e i r E n g l i s h b r e t h r e n . D a v i s t h o u g h t this i n f l u e n c e resulted f r o m the F r e n c h a n d I n d i a n W a r a n d w a s the first i m p e t u s to the i m p r o v e m e n t of A m e r i c a n m e d i c i n e . 1 M i l i t a r y activities d e m a n d e d the o r g a n i z a t i o n of the c o l o n i a l m i l i t i a , in which many physicians and surgeons received a valuable training. In the H u n t i n g t o n L i b r a r y is a letter f r o m D r . J o h n M o r g a n , w h o s e r v e d in t h e P e n n s y l v a n i a m i l i t i a , w r i t t e n at F o r t A u g u s t a , S e p t e m b e r 28, 1 7 5 7 , to G o v e r n o r W i l l i a m D e n n y of P e n n s y l v a n i a . M o r g a n h e l d a c o m m i s s i o n as e n s i g n , w h i c h he w i s h e d to r e s i g n b e c a u s e of his h e a v y d u t i e s as s u r g e o n to t h e g a r r i s o n . Since my arrival here, the Extream Sickness of the Garrison which still continues keeps me so constantly employed that I am incapable of performing any other Duty. As there is but little Prospect at present of the Number of Sick being diminished, or of my being able to act as Ensign, in which Capacity I have the H o n o u r to bear a Commission; I think myself in duty bound to acquaint you therewith, and to beg your Honour's Permission to resign that Commission to which my Post as Surgeon at present renders me incapable of performing . . T h e r e m a i n d e r of M o r g a n ' s letter e m p h a s i z e d his n e e d f o r m o r e h e l p i n c a r i n g f o r his p a t i e n t s . A score of years l a t e r D r . M o r g a n f o u n d h i m s e l f 1 N . S. Davis, History

of Medical

Education

and Institutions

57

in the United

States,

p . 21.

58

MEDICAL EDUCATION

BEFORE T H E CIVIL

WAR

director of the Medical Department of the Continental Army. His early training no doubt proved of real value when later he directed the fortunes of the Medical Department. By toilsome research T o n e r drew from the records of the Revolution the names of nearly 1,200 medical men who aided in achieving American independence. 2 He believed that about one hundred of them had the M. D. degree. It is reasonable to conclude that a large number of the 1,200 had seen service of a medical nature in the war that terminated in 1763, and were thus trained in military medicine under the flag of Britain. A few years later they found themselves pitted against their former masters. Dr. J o h n Jones, who served in the conquest of Canada, published in 1764 a work entitled Plain Remarks on Wounds and Fractures which was the American surgeon's handbook during the War of Independence. A respectable job the 1,200 did, if Toner's opinions are correct. . . . I may add that the supply of competent officers throughout the W a r proved ample to the demand. T h e careful student of this part of our history will discover that any difficulty which existed with the medical directors and surgeons, was not so much their want of education or professional attainments, as tht novelty of their situation.

In referring to a difficulty "which existed with the medical directors" T o n e r no doubt meant the almost continual unpleasantness that characterized the administration of the Medical Department throughout the War. T h e first director-general of the Department was Dr. Benjamin Church. He was discharged after a few months because of treasonous correspondence, and Dr. J o h n Morgan, principal founder of America's first medical school, succeeded to the post on October 16, 1775. Facing the problems of meager supplies and petty politics, Dr. Morgan made little headway in the colossal undertaking. After he labored diligently for a year Congress provided for a division of the labor, giving to Dr. William Shippen, Jr., complete charge of the territory west of the Hudson, while Morgan retained the eastern side. With no head, confusion naturally resulted. Shippen, who had been humiliated by Morgan twelve years previously, now came into his own. Morgan was dismissed and his colleague, Shippen, became director-general. T h e enraged Morgan demanded a hearing. After two painful years a hearing was granted and Morgan was exonerated but not appeased. T h e wound was too deep. When Morgan retired from the army Benjamin Rush became surgeongeneral of the Middle Department. Experience on several battle fronts and in improvised hospitals at Wilmington and Princeton showed Rush the revolting conditions in the army medical work. Poor food, little or no equipment, and scant medicines produced horrible conditions. Death rates were enormous, being higher among the hospitalized than among those who could not be crowded into the limited space. Rush soon became obsessed 2 J . M. Toner, The Medical Men of the Revolution, pp. 117-29. Toner also stated that an honorable array of medical men took part in political aspects of the Revolution. Benjamin Rush was a signer of the Declaration of Independence.

M I L I T A R Y MEDICINE: F O R M A L I N S T R U C T I O N

59

with the conviction that the medical organization was very inefficiently administered by Shippen. Eventually R u s h virtually accused Shippen of graft. His scriptural guide was "cry aloud; spare n o t . " As the contention approached a climax a n d Congress investigated the Department, Shippen refused to serve longer with R u s h in the Department. Shippen had strong political support, so R u s h resigned. Soon after, Morgan's hearing resulted in his vindication. He immediately preferred charges against Shippen, who asked for a court-martial hearing. With zest and relish R u s h added fuel to the flames. E x t r a o r d i n a r y excitement and personal venom characterized the trial. S h i p p e n was finally acquitted, inasmuch as the charges were not clearly proved. H e was then discharged by Congress, but reappointed the next year (1780). Disappointed in the outcome of the affair, R u s h continued his scathing abuse. H e began pointing out weak spots wherever they might be found. Because of outspoken criticism of General Washington, R u s h became linked with the infamous Conway Cabal. T h e r e is no positive evidence that R u s h had any organic connection with the C a b a l , but his criticism of Washington coming at the same time of the C o n w a y a f f a i r was rather condemning evidence. In later life R u s h deeply regretted his troubles with Shippen and Washington. 3 T h e episodes in the Medical Department indicated that the Continental A r m y was struggling against odds common to any organization loosely knit and lacking effective supreme authority. T o n e r probably approached accuracy when he concluded that the Army did not lack for trained men. T h e lack was in physical equipment and supplies, a fact so exasperating to the impatient R u s h . T h e r e is reason, however, to believe that trouble would have existed in the Department even if supplies had been abundant and equitably distributed. T h e whole affair was another chapter in the irreconcilable Morgan-Shippen feud. It was intensified when R u s h took the part of Morgan. Medical education in Philadelphia d i d not derive advantage f r o m this disreputable quarrel between men of the medical school faculty, as the next chapter will show. T h e W a r of the R e v o l u t i o n was, of course, a potent factor in the broadening of American medicine. Surgery in particular benefited· from the seven-year struggle. Wherein the knowledge and practice of medicine and surgery were elevated, the mode and quality of medical instruction were also improved. T h e war also had its pernicious influence. T h e medical faculties of both N e w York a n d Philadelphia were disorganized, and their schools closed. It will be noted later that the material a n d spiritual shock sustained by medical education was not readily overcome. 3 T h e discussion of the Medical Department affairs has been drawn largely from an unprinted manuscript by the author, entitled: Doctor Benjamin Rush, His Life and Work, 94 pp. Following are the principal sources cited on the army episode: Louis C. Duncan, Medical Men in the American Revolution, pp. 7 - 1 6 , 294-98; Paul Leicester Ford, " D r . R u s h and General Washington," Atlantic Monthly 75: 635-40, May 1895; and N a t h a n C. G o o d m a n , Benjamin Rush, Physician and Citizen, pp. 9 2 - 1 2 7 .

6o

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

American medical education at the close of the eighteenth century was yet in its cradle. Few schools had been organized and only 312 physicians had received American degrees, thirty-nine of which were honorary. T h e first medical degree conferred in. the colonies was honorary and granted by legislative act of the Rhode Island Assembly which convened in March 1663/64. T h e authorities having taken notice "of the great blessing of God on the good endevers of Captayne John Cranston of Newport, both in phissicke and chirurgery," had him "styled and recorded Doctor of phissicke and chirurgery." T h e Assembly acted on the basis that a principal has as broad power as does his agent. Since colleges created by legislative act grant degrees, why could not legislatures confer degrees? T h e Rhode Island Assembly did so, but the act was little more than the granting of a license.4 T h e next instance of the conferring of a degree in the colonies was also rather questionable from an educational standpoint. At the turn of the seventeenth century, Daniel T u r n e r was a practising surgeon in London and a member of the chartered Barber-Surgeon Company. Like some other surgeons, he was irritated by his close association with barbers, whom surgeons looked upon as a lower order in the practice of the art. Seemingly he was encouraged to believe he would be accepted by the Royal College of Physicians if he broke with the Barber-Surgeon Company. T h i s he did, paying a disfranchisement fine of fifty pounds. Three months later he became a licentiate of the College of Physicians. It seems that Turner's reception was not entirely cordial when it became known that he held no professional degree. T h e ex-surgeon then began the exercise of his wits on the possibility of obtaining a medical degree elsewhere than at Oxford and Cambridge, where dissenters were not admitted. Through unknown circumstances he fell into the company of Jeremiah Dummer, the London agent for Connecticut, who was earnestly seeking gifts for Yale College, established about twelve years previous (1701). Just how all the negotiations proceeded is not known, but the outcome was that T u r n e r made a gift of books to the College and some time later (1723) the honorary degree of doctor of medicine was conferred on him by the Reverend Mr. Timothy Woodbridge, T u r n e r being in absentia. Lane pointed to some of Dummer's 1725 correspondence with Woodbridge which makes clear that Turner's choice of Yale for his degree was because "Eminent practisers" of London were enraged because "little Operatours in medicine about this City have for small sums obtained degrees at Glasgow . . ." T h e College of Physicians did not accept the Yale diploma. Turner continued as licentiate, never rising to the rank of fellow. Ninety years later Yale College established a medical school. Acceptance of the Turner degree by the College of Physicians might have encouraged the struggling school at New Haven to institute medical instruction long before the advent of Nathan Smith, the founder of the Medical Institution in 1813. How different might * Frederick C. Waite, "Medical Degrees Conferred in the American Colonies and in the United States in the Eighteenth Century," Annals of Medical History, g: 312-20, J u l y , 1937. Waite cited material from Rhode Island Colonial Records, 2: 33.

MILITARY MEDICINE: FORMAL INSTRUCTION

61

have been the eighteenth-century history of American medical education! 5 Seven types of medical degrees were granted during the eighteenth century in the United States. At first the English system of giving the bachelor of medicine, followed by the doctor of medicine if the candidate studied an additional year, including the writing of a thesis, was adopted. T h i s plan was soon abandoned and only a doctorate in medicine was given. These three were earned degrees, or degrees in course. Of honorary degrees, there are known to have been both bachelor of medicine and doctor of medicine. T h e r e were also the ad eundern degrees. W h e n a candidate held the same degree from another institution he was admitted to degree, ad eundem graduiti. Both bachelor's and doctor's degrees of the ad eundem type were given, making seven kinds in all.® Of the thirty-two collegiate institutions established in the colonies or states by royal charter or legislative act by J a n u a r y i, 1 8 0 1 , all had sufficiently broad charters, according to Waite, to give medical degrees whether they offered instruction in medicine or not. T e n of these institutions established medical instruction in the eighteenth century, each in the year as indicated, namely: College of Philadelphia (1765), King's College (1767), William and Mary College (1779), Harvard College (1783), University of the State of Pennsylvania (1783), University of Pennsylvania (1792), Columbia College (1792), Queens College (1793), Dartmouth College (1797), and Transylvania University (1799). William and Mary gave but one medical degree and that was honorary, and Transylvania gave none before the close of the century. Waite also concluded that Yale College and Washington College of Chestertown, Maryland, neither of which had medical instruction, gave five and one honorary medical degrees respectively in the eighteenth century. T w o ad eundem degrees were given by Yale. D u r i n g the same time the Connecticut State Medical Society, empowered to give the doctor of medicine degree, conferred ten honorary and four ad eundem degrees. Eight colleges gave earned as well as honorary and ad eundem degrees before the opening of the new century. T h e y are as follows, the figure in parentheses indicating the total number of degrees (all kinds) granted: College of Philadelphia (45), University of the State of Pennsylvania (75), University of Pennsylvania (79), Kings College (18), C o l u m b i a College (16), Queens College (15), Harvard College (51), Dartmouth College (14). Altogether, during the eighteenth century, twelve institutions granted 355 degrees, of which 149 were bachelor of medicine, 19 advanced doctor of medicine (following M. B.), 108 regular or initial doctor of medicine, 1 ad eundem bachelor of medicine, 39 honorary doctor of medicine, and 18 ad eundem doctor of medicine. Of these 335, twenty-three were duplicates, which means that only 3 1 2 candidates received degrees. 7 5 J o h n E. Lane, " D a n i e l T u r n e r and the First Degree of Doctor of Medicine Conferred in the English Colonies of North America by Yale College in 1 7 2 3 , " Annals of Medical History, 2: 367-80, Winter, 1919. 6 Waite, op. cit., p. 3 1 5 , explains the types of degrees f u l l y . τ Ibid., pp. 3 1 7 - 1 9 . T h e standards for graduation in these schools will be discussed in subsequent chapters.

62

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

T h e eighteenth century, with reference to medical education in the colonies and the young republic, was a period of orientation. A race of pioneers, devoted to the building of a nation, practised the arts of statesmanship and theology but left the art of healing to Providence and practitioners, many of whom were ill trained. Legislators gave transitory attention to regulation and protection of the profession. Organized education took no cognizance of medicine as a branch of learning. Practitioners trained apprentices. Each preceptor produced, after his kind, fledglings in the art of physic. Few were equipped to act as masters. T h r o u g h the agency of European-trained physicians and the writings of their masters, the profession in America emerged from fallow years. Lecture courses in midwifery and anatomy were given, dissections were made, hospitals were founded, and schools were started. T h e profession served admirably through seven years of bloodshed and gathered from the experience scientific improvement and professional consciousness. Medicine was moving forward, but organized instruction was yet in its formative years. Schools were few and poorly equipped. Attendance, on the whole, was small. T h e practitioner's office was yet the school of medicine.

PART MEDICAL

SCHOOLS

III OF

CHAPTER

PENNSYLVANIA

7

T H E UNIVERSITY OF PENNSYLVANIA SCHOOL OF MEDICINE (College

of Philadelphia,

University

of the State of

Pennsylvania)

DR. JOHN MORGAN was elected to the professorship of theory and practice of medicine in the proposed school of medicine of the College of Philadelphia, M a y 3, 1 7 6 5 . O n the last two days of the same month he delivered his address on the institution of medical schools in America. F o u r months later, September 23, W i l l i a m Shippen, J r . , was unanimously elected by the B o a r d to the chair of anatomy and surgery. T h e first official public announcement of the newly formed school of medicine appeared in the Pennsylvania Gazette three days later: As the necessity of cultivating medical knowledge in America is allowed by all, it is with pleasure we inform the public that a Course of Lectures on two of the most important branches of that useful science, viz., Anatomy and Materia Medica, will be delivered this winter in Philadelphia. W e have great reason, therefore, to hope that gentlemen of the Faculty will encourage the design by recommending it to their pupils, that pupils themselves will be glad of such an opportunity of improvement, and that the public will think it an object worthy their attention and patronage. In order to render these courses the more extensively useful, we intend to introduce into them as much of the T h e o r y and Practice, of Pharmacy, Chemistry, and Surgery as can be conveniently admitted. From all this, together with an attendance on the practice of the physicians and surgeons of the Pennsylvania Hospital, the students will be able to prosecute their studies with such advantage as will q u a l i f y them to practise hereafter with more satisfaction to themselves and benefit to the community. 1 B e l o w the above general announcement were inserted advertisements from both of the professors. Dr. Shippen announced a course of sixty lectures to begin N o v e m b e r 14, . . . in which the situation, figure, and structure of all Parts of the H u m a n Body will be demonstrated on the fresh subject; their respective uses explained and their Diseases, with the Indications and Methods of Cure, briefly treated of; all 1 Cited by Joseph Carson, A History of the Medical Department of the University of Pennsylvania, p. 56.

63

64

MEDICAL E D U C A T I O N BEFORE T H E CIVIL

WAR

the necessary Operations in Surgery will be performed, a Course of Bandages given, and the whole will conclude with a few plain and general directions in the Practice of Midwifery. Each person to pay six Pistoles. T h o s e w h o incline to attend the Pennsylvania Hospital, and have the Benefit of the curious anatomical Plates and Casts there, to pay six Pistoles to that useful Charity. 2 T h e materia medica course by M o r g a n was a n n o u n c e d for N o v e m b e r 18, t h r e e l e c t u r e s w e e k l y , t o c o n t i n u e f o r t h r e e o r f o u r m o n t h s . T h e f e e was f o u r pistoles, a n d tickets for the course were for sale b y the doctor. A d o l l a r m a t r i c u l a t i o n fee w a s c h a r g e d f o r t h e p u r p o s e o f c r e a t i n g a m e d i c a l s c h o o l l i b r a r y f u n d . I n o r d e r t o r e n d e r h i s c o u r s e as p r a c t i c a l as p o s s i b l e the lecturer proposed . . . to give some useful Observations on Medicine in general, and the proper manner of conducting the study of Physic. T h e authors to be read in the Materia Medica will be pointed out. T h e various Substances made use of in Medicine will be reduced under Classes suited to the principal Indications in the cure of Diseases. Similar virtues in different Plants, and their comparative powers, will be treated of, and an Enquiry made into the different Methods which have been usel in discovering the Qualities of Medicines; the virtues of the most efficacious will be particularly insisted u p o n ; the Manner of p r e p a r i n g and combining them will be shown by some instructive Lessons upon Pharmaceutic Chemistry: T h i s will open to students a general Idea both of Chemistry and Pharmacy. T o prepare them more effectually for understanding the art of prescribing with Elegance and Propriety, if time allows, it is proposed to include in this course some critical Lectures u p o n the chief Preparations contained in the Dispensatories of the R o y a l College of Physicians at L o n d o n and Edinburgh. T h e whole will be illustrated with many useful Practical Observations on Diseases, Diet and Medicines. 3 T h e s e n o t i c e s in t h e Gazette v i r t u a l l y c o n s t i t u t e d t h e first a n n u a l circular or a n n o u n c e m e n t of the school. T h i s prospectus of the c u r r i c u l u m s h o w s p l a i n l y t h a t t h e t w o c o u r s e s , t h o u g h l i s t e d as a n a t o m y a n d m a t e r i a medica, w e r e really p l a n n e d to survey a m u c h w i d e r scope of the m e d i c a l field. For t w o years Drs. M o r g a n a n d S h i p p e n delivered lectures u n d e r the a u s p i c e s o f t h e C o l l e g e . M o r g a n ' s s e c o n d c o u r s e ( 1 7 6 6 ) w a s a n n o u n c e d as o n t h e t h e o r y a n d p r a c t i c e of p h y s i c " f o r t h e b e n e f i t o f m e d i c a l s t u d e n t s , w i t h a preparatory course on Botany, Chemistry, a n d the M a t e r i a Medica, b e i n g t h e s u b s t a n c e o f a set of l e c t u r e s d e l i v e r e d t o his p u p i l s last w i n t e r . " H i s s e c o n d c o u r s e , t h e n , w a s d e s i g n e d t o f o l l o w t h e first series. T h i s s e c o n d y e a r c o u r s e w a s t h e first A m e r i c a n c o u r s e in t h e o r y a n d p r a c t i c e . D u r i n g M o r g a n ' s s e c o n d series D r . T h o m a s B o n d d e l i v e r e d b e f o r e t h e Pennsylvania H o s p i t a l managers a clear exposition o n the advantages of clinical instruction in connection w i t h medical e d u c a t i o n . B o n d ' s zealous i n t e r e s t i n t h e p r o g r e s s of t h e s c h o o l is w e l l i l l u s t r a t e d b y t h e f o l l o w i n g p a s s a g e f r o m his a d d r e s s : - Ibid., 3 Ibid.,

p. 213. p p . 213 f.

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65

Therefore, from principles of patriotism and humanity, the Physic School here should meet all the protection and encouragement of the friends of their country and well-wishers of mankind can possibly give it. Though it is yet in its infancy, from the judicious treatment of its guardians it is already become a forward child, and has the promising appearance of soon arriving at a vigorous and healthy maturity. T h e professors in it at present are few, but their departments include the most essential parts of education . . . . and I think he has little faith, who can doubt that so good an undertaking will ever fail of additional strength and providential blessing; . . .* Dr. B o n d w a s a u t h o r i z e d by the managers to begin clinical lectures at the H o s p i t a l the f o l l o w i n g year (1767). A l t h o u g h there seems to be n o evidence that B o n d ever received an official a p p o i n t m e n t to the medical school f a c u l t y , his course of lectures augmented the c u r r i c u l u m of the school a n d f o r all practical purposes was a part of the course offered by the institution. 5 A t the request of the medical trustees and professors, the R e v e r e n d D r . W i l l i a m S m i t h , provost of the College, began delivering a course of lectures on n a t u r a l a n d e x p e r i m e n t a l philosophy in 1766. T h e course was given gratis a n d was instituted for the purpose of g i v i n g medical students a n o p p o r t u n i t y " o f c o m p l e t i n g themselves in the L a n g u a g e s a n d any parts of the M a t h e m a t i c s at their leisure hours." T h e course also included a few lectures on electricity g i v e n by Ebenezcr Kinnersley, A . M., professor of oratory a n d E n g l i s h , w h o h a d been associated with F r a n k l i n in some of his e x p e r i m e n t s . A p p a r e n t l y students w h o lacked t r a i n i n g in some of the f u n d a m e n t a l s w e r e k n o c k i n g f o r admission to the medical school. T h i s course m a d e possible the p u r s u a n c e of natural a n d e x p e r i m e n t a l philosophy a l o n g w i t h medical scicncc." In 1767 e f f o r t was m a d e to correlate the work of the medical school with the general a c a d e m i c organization of the College. Several physicians w h o were m e m b e r s of the B o a r d of T r u s t e e s met w i t h Provost W i l l i a m Smith a n d Drs. M o r g a n a n d S h i p p e n . T h i s committee drew u p a code f o r the new school, w h i c h was a d o p t e d by the board on M a y 12, 1767, a n d subsequently p u b l i s h e d in the Pennsylvania Gazette. F o l l o w i n g are the qualifications a n d course of studies enacted as prerequisite to candidacy f o r the different degrees in m e d i c i n e . For a Bachelor's Degree in Physic:— ι. It is required that such students as have not taken a degree in any College shall, before admission to a Degree in Physic, satisfy the Trustees and Professors of the College, concerning their knowledge of the Latin Tongue, and in such * Ibid., pp. 57 f. * George W. Norris, The Early History of Medicine in Philadelphia, p. 171. Norris reported Bond was "elected to the chair of Clinical Medicine" in 1769, but cited no documentary evidence. Carson was not able to find any record that Bond had a faculty appointment, although he lectured until his death in 1784. Presumably Bond was encouraged to carry on the lectures but received no official appointment because he was a member of the Philadelphia College Board of Trustees. The double position of Trustee and teacher was not ethically acceptable. 0 Ibid., pp. 61-63.

66

MEDICAL EDUCATION

BEFORE T H E CIVIL

branches of Mathematics, N a t u r a l a n d E x p e r i m e n t a l j u d g e d requisite to a M e d i c a l E d u c a t i o n .

WAR

Philosophy,

as shall

be

2. Each shall attend at least o n e course of lectures in A n a t o m y , M a t e r i a M e d i c a , Chemistry, the T h e o r y a n d Practice of Physic, a n d o n e course of C l y n i c a l lectures, a n d shall attend to the practice of the P e n n s y l v a n i a H o s p i t a l for o n e year; a n d may then be a d m i t t e d to a public e x a m i n a t i o n for a B a c h e l o r ' s Degree in Physic; p r o v i d e d , that in a previous private e x a m i n a t i o n by the M e d i c a l T r u s t e e s a n d Professors, a n d such o t h e r T r u s t e e s or Professors as choose to attend, such students shall be j u d g e d fit to u n d e r g o a p u b l i c e x a m i n a t i o n w i t h o u t a t t e n d i n g any m o r e courses in the M e d i c a l School. 3. It is f u r t h e r r e q u i r e d that each student, previous to the B a c h e l o r ' s D e g r e e , shall h a v e served a sufficient a p p r e n t i c e s h i p to some respectable p r a c t i t i o n e r in Physic, a n d to m a k e it a p p e a r that he has a general k n o w l e d g e in P h a r m a c y . Qualifications

for a Doctor's

Degree

in

Physic:—

It is r e q u i r e d for this D e g r e e that at least three years shall h a v e i n t e r v e n e d f r o m the time of t a k i n g the Bachelor's Degree, a n d that the c a n d i d a t e b e f u l l 24 years of age, a n d that he shall w r i t e a n d d e f e n d a T h e s i s p u b l i c l y in the C o l l e g e , unless h e s h o u l d be b e y o n d seas, o r so r e m o t e on the c o n t i n e n t of A m e r i c a as n o t to b e able to attend w i t h o u t manifest i n c o n v e n i e n c e ; in w h i c h case, o n s e n d i n g a written thesis, such as shall b e a p p r o v e d of by the C o l l e g e , the c a n d i d a t e m a y receive the Doctor's Degree, b u t his thesis shall be p r i n t e d and p u b l i s h e d at his o w n expense. Fees to Professors N o Professor to take m o r e than six Pistoles f o r a single course, in any of the a b o v e branches, a n d after t w o courses, any student may a t t e n d as m a n y m o r e as he pleases gratis. 7

In adopting these regulations the board felt that its scheme of medical education was as extensive and liberal "as in the most respectable European seminaries." It aimed to make utmost provision for rendering a degree a real mark of honor, "the reward only of distinguished Learning and Abilities." T h e board further felt that the central location of Philadelphia with its well-established medical profession, the advantages of the College, and the public hospital, all conspired to promise success to the design. T h i s more extensive program for the Philadelphia school was in harmony with, though a little less extensive than, the thorough program outlined by John Morgan in his famous address on the institution of medical schools in America, given two years before. T h e College of Philadelphia's plan of medical instruction, as well as the scheme suggested by Morgan, was patterned after the distinguished school at Edinburgh. T h i s seems only natural when one reflects that all members of the first faculty of the American school were graduates of the medical school at Edinburgh. Carson devotes several pages to drawing parallels between the early development of the Scotch and the American schools. 8 T h e relationship is so manifest that the School of Philadelphia may well be called the legitimate offspring of the Edinburgh institution. 7 Ibid., pp. 165-67. 8 Carson, op. cit., pp. 77-85.

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PENNSYLVANIA

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It will be noticed that the 1767 requirements of the College prescribe more than a modicum of premedicai education. L a t i n , mathematics, and natural and experimental philosophy are specified as "requisite to a medical education." It is a credit to the trustees and faculty of the school that such comprehensive requirements were incorporated in the medical school code. T h e history of American medical education for the following one hundred years would have been much more honorable if these standards had been respected by the institutions and teachers who for five score years were custodians of the art and science of medicine. T h e most far-reaching aspect of the 1767 code of the Philadelphia medical school was the requirement that each candidate attend the practice of the Pennsylvania Hospital for one year. H a d this requirement become universal during the first decades of formal medical education in this country there would have been fewer and better schools of medicine in the United States before the Civil War. Unfortunately rigid premedicai and clinical requirements were practically abandoned by all schools after a few years, including the University of Pennsylvania which was the lineal descendant of the College of Philadelphia. T h e bachelor's degree was eventually dropped in Philadelphia a n d other American medical centers which had begun by giving it, because the degree failed to serve the purpose for which it was created, i.e., a stepping-stone to the doctorate. Few students w h o took the first degree ever came back f o r the advanced degree. B e n j a m i n R u s h anticipated this in a letter to J o h n Morgan as early as 1768. Morgan submitted the plan of the school for giving degrees to Rush, who was still studying in Europe but slated to join the faculty of the new school when he should return. R u s h expressed the wisdom of several of his teachers, who felt that few men after receiving the bachelor's degree and entering practice would have time to return for the doctorate. H o w all these changes came about in the various schools and their subsequent results constitute a considerable portion of the subject matter of this book. 9 T h e third member of the College of Philadelphia medical school faculty was Dr. A d a m K u h n , appointed at his request to the chair of botany and materia medica by the trustees, on J a n u a r y 26, 1768. Dr. K u h n was the son of a physician, who was a native of Swabia and man of parts. A d a m was born in Germantown, Pennsylvania, and studied medicine under his father. In 1761 he resorted to the famous Linnaeus of Sweden to study botany a n d materia medica. Later he studied in L o n d o n and received the doctorate in medicine under Cullen and his associates at E d i n b u r g h in 1767. Dr. K u h n returned to Philadelphia from Europe in J a n u a r y 1868 and was the same month appointed to the position for which he applied. T h e subjects of materia medica and botany during the first three years had been covered by Dr. Morgan in his course. Records indicate that K u h n gave lectures in botany for only two years (1768, 1769). He held the chair of materia medica during twenty-one years under the auspices of the College and « Although the requirements as such were largely abandoned, students were encouraged to devote time to clinical observation and experience.

68

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

University, until he accepted the chair of theory and practice of medicine in the University. Dr. Kuhn's other appointments were physician to the Pennsylvania Hospital and consulting physician to the Philadelphia Dispensary. He was one of the founders of the College of Physicians and served as its president in 1808. W i t h the exception of his thesis, De Lavatione Frigida, very few of his writings are extant. H e opposed the Rush system of treating yellow fever in 1793 and published his opinions in the General Advertiser. As a lecturer in the professorships he held, Dr. K u h n "was faithful and clear in the description of diseases and in the mode of applying their appropriate remedies, avoiding theoretical discussions." 10 O n e of his students, Charles Caldwell, commented favorably on Kuhn's extensive education under celebrated teachers but spoke rather brutally of his lecturing. So far was the address, moreover, from containing an original thought, that no portion of it appeared to be even the professor's own. From beginning to end, it was in substance but a transcript from the writings of Cullen. It was therefore no unsuitable preface to the Doctor's course of lectures . . . not a few of which were actual copies of his lectures. 11 Caldwell was equally frank in his description of Dr. Kuhn's appearance and personality. His hair, of which he had an exuberant abundance, was described as unusually coarse, strong, and richly powdered, and at seventyfive he appeared to have quite as much as he had a half century before. W i t h his black breeches, long-skirted light waistcoat, snuff-colored coat, sleeve and bosom ruffles, and his cane handle, snuff-box, and knee and shoe buckles in gold, the austere gentleman was a striking figure in early Philadelphia. Caldwell pictured his teacher as fanatically devoted to habits of regularity and precise order. " W h e n moving from house to house, in his professional business," said Caldwell, . . . so sternly and stubbornly regular were his steps, in both extent and repetition that he could scarcely be induced to quicken or lengthen them, either to escape from a thunder gust or a hailstorm, to relieve colic, to arrest a hemorrhage, or scarcely to save the life of the most meritorious of his patients. 12 Soon after Dr. K u h n joined the staff of the school the first graduation ceremonies were solemnly conducted. " T h i s day," June 21, 1768, as the secretary of the board wrote in his minutes, "may be considered as the Birth-day of Medical Honors in America . . ." T h e trustees, professors, and ten candidates gathered in the "Apparatus R o o m " at nine-thirty and repaired together to the " P u b l i c H a l l " where a "polite assembly of their fellow-citizens were convened to honor the Solemnity." T h e Provost received the mandate for the exercises from the Governor, as president of the trustees, and introduced the function with prayers and a 10 Carson, op. cit., pp. 64 f.; Kelly and Burrage, " A d a m K u h n , " Dictionary of Medical Biography, pp. 713 f. 1 1 Harriot W . Warner, Editor, Autobiography oj Charles Caldwell, pp. 121 f. 12 Loc. cit.

American

UNIVERSITY OF PENNSYLVANIA

69

short L a t i n oration. " O h ! Factum bene!," intoned Provost Smith, as he contemplateci the progress of the school and looked into the faces of America's first graduates in medicine. Following the remarks of the Reverend Dr. Smith, the students presented several numbers, consisting of orations and debates in which they did credit to themselves and their professors. 13 T h e Provost then conferred the degree of Bachelor of Medicine on the ten young gentlemen. Dr. Shippen completed the charge, inviting the graduates to support the dignity of the profession. T h e Vice-Provost concluded the whole with "Prayer and T h a n k s g i v i n g . " T h e local press account proudly noted: . . . a n d t h e w h o l e w a s h o n o u r e d w i t h t h e p r e s e n c e o f a p o l i t e a n d l e a r n e d assembly, w h o by their kind approbation,

testified the satisfaction w h i c h

h a b i t a n t s of this place h a v e in the i m p r o v e m e n t native

of u s e f u l k n o w l e d g e

the in

in-

their

country.14

A t a second commencement held on June 30, 1769, the bachelor's degree was conferred on eight candidates. T h e charge was delivered by Dr. T h o m a s Bond "In a manner so truly feeling and affectionate that it could not fail to make a serious impression on those for whom it was designed." 111 T h e fees relative to graduation are of interest. Fees pertaining to the individual courses of the professors, as previously noted, were not to be above six pistoles (twenty dollars). In May 1768, the trustees agreed u p o n certain other fee rates. Regular medical students and others w h o were taking the Provost's course in natural philosophy were required to pay the sum of twenty shillings "Matriculation Money." T h e graduation fee was on the basis of one guinea to each professor under w h o m work was taken. T h e board minutes make mention of "the usual Fees for the seal to his Diploma and for the increase of the Library," but do not indicate the amount of the former. T h e library fee was one dollar, and permitted the student to have free access to the medical library of the College during his continuance as a student. 1 8 T h e fourth member of the faculty (not including Dr. Bond) was added during the summer of 1769. B e n j a m i n Rush returned from several year's study in Edinburgh, where he received the M. D. degree in 1768. H e disembarked at N e w York on July 14, 1769, and arrived in Philadelphia four days later. O n the last day of the same month Rush applied to the trustees 13 Carson, op. cit., p p . 69 f. T h e ten c a n d i d a t e s were: J o h n A r c h e r , N e w c a s t l e C o u n t y : B e n j a m i n C o w e l l , B u c k s ; S a m u e l D u f f i e l d a n d J o n a t h a n Potts, P h i l a d e l p h i a ; J o n a t h a n Elmer, New Jersey; H u m p h r e y Fullerton, Lancaster C o u n t y ; D a v i d Jackson, Chester C o u n t y ; J o h n L a w r e n c e , East Jersey; J a m e s T i l t o n , K e n t C o u n t y , D e l a w a r e ; a n d N i c h o l a s Way, Wilmington. « P a c k a r d , op. cit., p. 360. is Pennsylvania Gazette, J u l y 6, 1769, c i t e d in C a r s o n op. cit., p. 215. T h e o l d a r g u m e n t o v e r w h i c h school g a v e the first m e d i c a l d e g r e e s in course, C o l l e g e of P h i l a d e l p h i a o r K i n g ' s C o l l e g e , N e w Y o r k , has l o n g b e e n s e t t l e d in f a v o r of t h e f o r m e r . K i n g ' s C o l l e g e g a v e its first m e d i c a l degrees ( B a c h e l o r of M e d i c i n e ) in 1769, b u t it d i d p r e c e d e the P h i l a d e l p h i a c o l l e g e in c o n f e r r i n g t h e M . D . d e g r e e by o n e y e a r , t h e years b e i n g 1770 a n d 1771 r e s p e c t i v e l y . ie P a c k a r d , op. cit., p. 358.

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for a professorship. T h e next day, the twenty-three-year-old physician was offered the chair of chemistry. T h e action of the Board of Trustees was not an impromptu act. Rush was known to the medical profession of Philadelphia. He had served an apprenticeship of six years with Dr. J o h n Redman, had been among the ten students who attended Shippen's first anatomical lectures in 1762, and had attended John Morgan's first course in materia medica, when the medical school opened in 1765. While a student abroad young Rush maintained his connection with the profession in Philadelphia through correspondence, especially with his professor in materia medica. Presumably Morgan made overtures to Rush regarding a future connection with the medical school faculty as early as 1767. In January 1768, Rush expressed his pleasure at the prospect, in a letter to Morgan. I exult in the happy prospects, which now open upon you, of the success of the Medical Schools you have established in Philadelphia. . . . I thank you for the pains you have taken to secure me the Professorship of Chemistry. I think I am now master of the science, and could teach it with confidence and ease. I have attended Dr. Black for two years diligently, and have, I think, received from him a comprehensive and accurate view of the science, together with all his late improvements in chemistry, which are of so important a nature that no man, in my opinion, can understand or teach chemistry as a science without being acquainted with them. . . . I would not, however, urge your interest too warmly in this affair; perhaps I may disappoint the expectations of the Trustees, and prevent a person better qualified from filling the chair. I should like to teach Chemistry as a Professor, because I think I could show its application to medicine and philosophy. . . . I should likewise be able more fully, from having a seat in the College, to cooperate with you in advancing the medical Sciences generally. 17

In October 1768, Rush wrote again to Morgan, expressing thanks to his mentor for carrying the burden of the chemistry lectures until he could return and take over the work. When Rush returned he brought with him a valuable array of chemical apparatus, the gift of Thomas Penn to the College. A letter to the trustees from Penn states that Dr. Fothergill had recommended Dr. Rush to him as a very expert "Chymist." In conclusion Mr. Penn recommended Dr. Rush to the notice of the College. Rush's election to the chemistry chair, on August 1, 1769, was apparently only a final formality in approving the negotiations of Dr. Morgan. 18 J o h n Morgan is rightfully called the father of medical education in America, but it is equally true that Benjamin Rush became its godfather soon after his connection with the medical school of the College of Philadelphia.. No character in the annals of early American medicine exercised a more powerful influence on the profession than did Benjamin Rush. When he spoke, his pronouncements were ex cathedra. Rush and his system of medicine dominated the profession far into the nineteenth century. Any survey of any broad phase of early medicine in the United States must 17 C.arson, op. cit., p. 72. is Ibid., pp. 73 f.

UNIVERSITY

OF

PENNSYLVANIA

7

of necessity devote some pages to the character and life of this distinguished professor. Benjamin Rush, of English Quaker parentage, was born on a fivehundred acre farm at Byberry, near Philadelphia, on January 4, 1746. He was the fourth of seven children. Before he was six years old his mother was a widow. In 1759, when only fourteen years of age Benjamin was given junior standing in the College of New Jersey, where he soon demonstrated exceptional skill in composition and public speaking. After several years in an academy and two years in the College of New Jersey, Rush was granted the Bachelor of Arts degree at the age of fifteen. T h e energetic lad then joined himself as an office student to Dr. John Redman, a distinguished and busy member of the Pennsylvania Hospital staff. Redman was an inspiring teacher, and his connection with the Hospital made it possible for the young apprentice to observe the work of all the physicians on the staff. Since Sydenham and Boerhaave were the principal medical authorities in the early days of Rush's study, it is reasonable to presume that the studious young beginner gave these sources thoughtful attention in the evenings and between duties during the day. Rush maintained his connection with Dr. Redman until July 1766, during which time he was absent from work only eleven days, and spent only three evenings away from the Redman household. Cordial relations existed between preceptor and pupil throughout the term of apprenticeship. On the counsel of his mentor, Dr. Redman, Rush decided to leave his homeland for advanced study in Edinburgh, at the time one of the ranking medical schools of all Europe. Through Jonathan Potts, a fellow medical student and companion on the voyage, Benjamin Franklin was influenced to write a letter of introduction for the young Americans to an eminent Edinburgh physician. Sir Alexander Dick, requesting that he be on the lookout for the new students. T o Dr. William Cullen the colonial agent wrote: " I am persuaded they will improve greatly under your learned lectures and do honor to your medical school." 1 9 T h e studious Rush was no misfit in the scholarly element of the Edinburgh university. He enthusiastically pursued courses in anatomy, chemistry, medicine, natural philosophy, and practice of infirmary. T h e new student was favorably impressed with his new environs. In a letter to John Morgan he noted some impressions and commented most favorably on Dr. Cullen who delivered lectures on the "Institutions of Physick." I am no longer surprised that you used to call him the Boerhaave of his age, and speak of his great merit with all those emotions you were want to do. I find it a p a i n f u l piece of labor to attend these lectures as I should do, and I am n o w more fully convinced than ever, how much sleep you must have sacrificed in transcribing those volumes of learning you carried with you to America. 2 0 T . P. James, Memorial of Thomas Potts, pp. 172-74; cited in Goodman, op. cit., p. 14. 20 Benjamin Rush to John Morgan, Manuscripts, Historical Society of Pennsylvania; cited in Goodman, op. cit., p. 15.

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Little is known of Rush's student life in Edinburgh. Considering his insatiable thirst for learning, one may conclude that he gave scant attention to social and recreational life. The crowning feature of his work was his thesis, De Codione Ciborum in Ventrículo, presented to the faculty before his graduation in June 1768. This study on the digestion of food in the stomach, written in classical Latin, was the first of a long series of contributions made by Rush to the body of medical literature. It won for the young graduate honorable estimation in the profession which he graced for nearly half a century. His thesis is positive proof that he comprehended and appreciated the value of the laboratory method as applied to medical research. Rush attended special lectures in Edinburgh during the summer of 1768, and in the fall went to London for postgraduate work under Dr. William Hunter and other eminent physicians. While in the British capital he met the painter Benjamin West, Dr. Samuel Johnson, and Oliver Goldsmith. A few weeks in France completed his time of semi-relaxation. Of note to Rush were the French charitable institutions for the relief of the poor and sick. Parisian women struck him as lovely, though he felt their beauty was derived from a generous use of cosmetics. Without doubt Rush's advanced medical training, his personal contacts with men of note, and his travels and investigations planted in him the seed of liberalism in matters of education, government, and society, which bore fruit in later life. On returning to Philadelphia, Rush gave himself devotedly to the business of teaching chemistry and establishing a reputable practice. A consciousness of his own superior ability, coupled with a tendency to hold unbending convictions, combined to produce in him certain traits which his enemies were wont to call pig-headedness and intolerance. From then on his life and work were never marked with peace and calm. A narrative of Rush's participation in affairs of state cannot be pressed into the narrow limits of this brief survey. But it should be noted that as a member of the Second Continental Congress he signed the Declaration of Independence. He prevailed upon his friend Thomas Paine to write the little pamphlet Common Sense, which was such a potent force in welding public opinion in favor of independence. In political quarrels Rush often found himself on the losing side. Frequently he was too impatient and intolerant to retain the constant support of his compatriots. His experience in the Army Medical Department is a good example. 21 Nevertheless Rush cannot be denied a place among the faithful burden bearers of the patriotic cause. Continuing his medical practice, though at times it was neglected and interrupted, Rush took one responsibility after another, not sparing himself for the sake of liberty. Dr. Rush's professorship was much to his advantage professionally. Thinking people of Philadelphia held in esteem physicians who had European training and were connected with the medical department of the College. Also the small stipend for his teaching was an advantage to a 21 Goodman, op. cit., pp. 111-13.

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y o u n g m a n j u s t b e g i n n i n g p r a c t i c e . I n 1 7 7 0 the y o u n g t e a c h e r a t t r a c t e d m o r e a t t e n t i o n to h i m s e l f by p u b l i s h i n g t h e first t e x t u a l c o n t r i b u t i o n in c h e m i s t r y t o b e w r i t t e n by a n A m e r i c a n , a Syllabus of a Course of Lectures on Chemistry. A s in p u b l i c affairs so in p r o f e s s i o n a l r e l a t i o n s h i p s , the h o t - h e a d e d , stubb o r n R u s h d i d n o t treat his c o l l e a g u e s t a c t f u l l y . D e e p l y i m p r e s s e d w i t h a sense of his m e d i c a l k n o w l e d g e a n d his i m p o r t a n c e , h e set a b o u t to a b a n d o n the B o e r h a a v e system of m e d i c i n e in v o g u e i n P h i l a d e l p h i a , substit u t i n g f o r it the system of his e s t e e m e d t e a c h e r , D r . C u l l e n . P h y s i c i a n s of m a t u r e years w e r e n o t w i l l i n g to listen to t h e y o u n g u p s t a r t . A c o n t r o v e r s y e n s u e d , in w h i c h R u s h a l i e n a t e d the s u p p o r t of m a n y p r a c t i t i o n e r s . U n t i l 1 7 7 6 n o t o n e of his c o l l e a g u e s r e f e r r e d to h i m a p a t i e n t . 2 2 N e v e r t h e l e s s his p r a c t i c e g r e w u n t i l his a n n u a l i n c o m e in 1 7 7 5 was £900. D e s p i t e h i s w r a t h y d i s p o s i t i o n , R u s h f o r a time o u t r a n k e d the m e m b e r s of his p r o f e s s i o n in P h i l a d e l p h i a . H i s m a n y s t u d e n t s s p r e a d his r e p u t a t i o n t h r o u g h the l a n d as they scattered a b r o a d to practise. A m a i l - o r d e r p r a c t i c e d e v e l o p e d a n d R u s h was c o n s u l t e d by m a n y w h o n e v e r h a d seen h i m . A s u f f e r i n g a d m i r e r in R i c h m o n d w r o t e : Being under the impression that you are the greatest physician in the United States; and thinking that I have contracted a nervous complaint; excites me to take the liberty of writing you by way of stating my case. 23 A l l k i n d s of letters w e r e r e c e i v e d by the b u s y p h y s i c i a n . F i n a n c i a l , domestic, a n d social p r o b l e m s w e r e l a i d b e f o r e h i m . F o l l o w i n g is a t e a r f u l m o a n f r o m a d i s a p p o i n t e d soul: . . . I am now in a most dreadfull dilemma, will you be so favourable as to give me your ingenious observations on the passion of love, it will tend to extricate me from the dreadful s i t u a t i o n — T o love & be disappointed most unhappy dreadfull state! and advise how to forget a lady whom for years (think it not recent for it subsisted four years) I had the most ardent passion & enjoyed every promise and privilege, save only I can say we were not u n i t e d . — T e a c h me the noble science to forget? T e a c h me how to conduct myself when frequently in her company, she appearing to triumph at my mortification. 24 D r . R u s h ' s a n s w e r to this p i t i f u l i n q u i r y is n o t a v a i l a b l e , b u t it was p r o b a b l y i n h a r m o n y w i t h his c o u n s e l g i v e n in lectures o n diseases of the passions. W i l l i a m D a l l a m , w h o a t t e n d e d R u s h ' s c o u r s e in p r a c t i c e of p h y s i c in 1798 k e p t notes o n the course, f r o m w h i c h is g l e a n e d the f o l l o w i n g r e g a r d i n g the c u r e of " l o v e , " o n e of t h e diseases of passions: C u r e — w h e n there is much sighing-restlessness and Fever, you should have recourse of Bloodletting and Blistering—Ovid advises what he calls "Binan Amicam" for as Fire expels Fire, and Pity, Pity, so Love expels love.—Ovid also advises the Lover to think much of his Mistress's bad qualities—if she has a bad voice, get her to sing by all means etc. and do any thing to expose h e r — A v o i d 2z B i d d l e , op. cit., p p . 56 f.; cited by G o o d m a n , op. cit., p. 35. -3 R u s h , Correspondence, X V I I , p. 3, N o v e m b e r 30, 1803; cited by G o o d m a n , op. cit., p. 142.

Ibid., 1: 132.

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the Company of the L a d y — T a k e a Voyage or a L o n g J o u r n e y — H o p e should be entirely destroyed— L o v e may also be cured by exciting a stronger Passion or Ambition and Resentment etc. 2 5

Seeing the need for a dispensary for the poor in Philadelphia, Rush worked toward that end. He prevailed upon a blind scientist, Dr. Joyes, to give a public lecture, the proceeds of which should go to the dispensary fund. In the spring of 1786, a clinic was opened on Strawberry Alley, the first free dispensary in America. The Pennsylvania Packet and Daily Advertiser, January 4, 1787, reported that 797 patients were treated during the first seven months after its founding. Rush also had a part in founding the Philadelphia College of Physicians. His name is among the twelve charter members of the society. At one of the first meetings he read a paper setting forth the purpose of the new institution and declaring that a library would be founded in order to "diffuse knowledge among us on easy terms." Today this library, to which Rush was an early contributor, ranks among the very best of the country. On the reopening of the medical school following the close of the war. Rush took up his work and continued until the College of Philadelphia lost its charter in 1779. In protest against this act Rush refused to accept a chair in the newly founded University of the State of Pennsylvania until several years had passed. A few years later (1786) his lectures were advertised as including medicine as well as chemistry. When the old College of Philadelphia was reestablished in 1789, Rush along with Shippen and Kuhn accepted his old position back again. Dr. Morgan had just died, and Rush was given his chair in theory and practice. When the rival institutions were merged in 1791, the professorship of institutes of medicine and clinical medicine was given to the American Sydenham, as Rush was called. Five years later he received the additional appointment of the chair in practice of physic. These appointments he retained until his death. Opinionated though he was, Professor Rush was a popular teacher. He taught more students than any of his contemporaries. His son, James Rush, who had access to various records, estimated that from 1790 to 1812, 2,872 registered in his medical classes. They paid fees amounting to $69,030. Dr. Rush also sponsored a large number of apprentices and private pupils. 26 Evidences of dislike for Rush on the part of his pupils are difficult to find, but there are abundant testimonies in favor of this popular Philadelphia mentor. Charles Caldwell, a Philadelphia student in the early nineties, compared the introductory lectures of Drs. Shippen and Rush in the fall of 1792: 25 William Dallam, Notes From the Manuscript Lectures on the Practice of Physic of B. Rush . . . 1798; a manuscript in the collection of Dean William Pepper, University of Pennsylvania, School of Medicine. wibid., p. 132. Doctor David Ramsay, in An Eulogium Upon Benjamin Rush, p. 19, estimated that in the last nine years of Rush's life he had no more than fifty private pupils.

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O n the d a y f o l l o w i n g . Dr. Rush's I n t r o d u c t o r y was delivered. A n d it was a perf o r m a n c e m u c h superior, in all respects, to that of the p r e c e d i n g day. It was the Doctor's o w n c o m p o s i t i o n ; a n d though, as already stated, that g e n t l e m a n was a v e r y o r d i n a r y speaker, he was o n e of the best p u b l i c readers I have ever heard. A s a mere colloquisi, m o r e o v e r h a v i n g cultivated, with great a t t e n t i o n a n d care, the art of conversation he was u n c o m m o n l y e l o q u e n t , correct a n d interesting. 2 7

Knowing something of Rush's nature, one may safely assume that the respected teacher was not always saintly in his manners, especially when under fire by his colleagues. At times he must have indulged in outbursts of criticism, even before his pupils. Benjamin Rush was one of the most voluminous medical writers of his time. His Directions for Preserving the Health of Soldiers appeared first in the Pe?insylvania Packet, and later by order of the Board of W a r the paper was republished in pamphlet form (1778), "with such additions and alterations as he shall think proper." T h e principles of personal and public hygiene as presented in this pamphlet are largely sound and certainly ahead of the time in which they were proposed. 28 It was honorable of Rush, the critic of the Medical Department, to produce concrete and constructive criticism. In 1789 the Doctor published a volume entitled Medical Inquiries and Observations, inscribed to John Redman, his former preceptor. T h e book contained eighteen papers over a great variety of medical subjects. Four years before his death Rush completed a four-volume set, Medical Inquiries and Observations, which greatly supplemented the onevolume edition of 1789. T h e four volumes were a compendium of the Rush system, the third and fourth volumes being devoted largely to a discussion of yellow fever and a defense of bloodletting as a remedy. Rush's greatest contribution to literature was Medical Inquiries and Observations, Upon the Diseases of the Mind, published in 1812. T h i s volume was for half a century a standard reference in its field. A t the time nothing had been published in Europe to compare with it. A m o n g his many writings are essays in religious and sociological fields. In the more seasoned years of his life the famous teacher was mellowed in spirit. He became reconciled with George Washington and regretted his part in the army medical controversy. He even destroyed some of his papers bearing on that unfortunate affair. His active interest in politics declined. As early as 1796 he wrote to his friend Dr. James Currie of Liverpool: I was o n c e a R e p u b l i c a n , but residence in a large city and a w i f e & eight c h i l d r e n h a v e d e g r a d e d me into a mere Physician . . , 2 9

T h e first twenty years of the school were marked with irregularities and uncertainties. Only one degree was granted in 1770. T h e following year four graduates returned and qualified to receive the doctorate, the first Harriot W. Warner, Editor Autobiography of Charles Caldwell, p. 116. 28 Benjamin Rush, Medical Inquiries and Observations, pp. 1-8 passim. Benjamin Rush, Philadelphia, to James Currie, Liverpool, July 26, 1796. (A manuscript in the Henry E. Huntington Library.)

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given by the school. Seven bachelor's degrees were also given. N o degrees were given in 1772. T w o degrees were given in each of the following years, one of the latter being a doctorate of medicine. Dr. Morgan's lectures were interrupted in 1772-73, because of his absence in the West Indies, where he had been sent by the trustees to solicit funds for the College. By the opening of the Revolutionary W a r attendance in the medical school had increased to thirty or forty, but the exigencies of this struggle caused suspension of instruction. T h e successive service of Drs. M o r g a n and Shippen in the capacity of Director-General, and of Dr. Rush as Medical Director of the Middle Department for a time during the war have been discussed. T w o alumni of the school, Jonathan Potts and James T i l t o n , joined their teachers and rendered medical service to the Revolutionists. 3 0 W h e n Philadelphia ridded itself of redcoats and the war was over and the medical patriots were no longer needed, they returned to civil and professional life. T h e medical profession at large benefited in no small measure from its military experience. T h e r e b y medical education eventually reaped a benefit, but for a time the calamity of disorganization greatly outweighed the benefits. Furthermore, the A r m y Medical Department episodes revived the Morgan-Shippen feud, which continued to be a deterrent to harmony among the leading professors of Philadelphia. T h e postwar decade was for the medical school a period of questionable status, the same as for the country as a whole. A s early as 1779 the College of Philadelphia was caught in the surge of nationalism. It was alleged that some members of the Board of Trustees were Tories and not sympathetic w i t h the new regime. Consequently, by act of the Legislature, November 27, 1779, the charter of the College was abrogated, its officers removed, and its property transferred to a new institution. Presumably this action was anticipated, for the President of the Executive Council of the State had interdicted the efforts of the school administration to grant a bachelor's degree in June of the same year. Nevertheless, as late as October 24, the school announced the beginning of the medical lectures for the first Monday of December. 3 1 T h i s new institution was known as the University of the State of Pennsylvania. T h e trustees at once took note of the Medical Department and appointed a committee to inquire into the state of the former school and make a recommendation to the board. In the meantime the several professors were asked to continue with their lectures as heretofore. Dr. Shippen, a member of the above committee, was the only medical professor to accept a position in the new school. V a i n efforts were made to fill the vacant chairs. William Bartram was appointed professor of botany in A p r i l 1782 b u t declined because of ill health. T h e new provost, Reverend John 30 C a r s o n , op. cit., p. 87. 31 J bid., p p . 88 f. T h e r e seems to be n o u n a n i m i t y of o p i n i o n t h a t t h e 1779 a c t i o n was a b r o g a t i o n . T h e P e n n s y l v a n i a C h i e f J u s t i c e f r o m 1 7 7 7 - 9 9 , d e s i g n a t e d t h e act as a n a n n u l m e n t . Cf. ante, W a i t e , p. 317; note that C a r s o n , op. cit., p. 89, cited G e o r g e B . W o o d in a n u m b e r of references as t h e best a u t h o r i t y o n t h e m e r i t s of t h e 1779 act.

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Ewing, delivered lectures in natural history. In October of 1781 Dr. Bond was persuaded to cover theory and practice in his clinical lectures. For three years the Medical Department of the new institution struggled along, poorly manned. T h e r e was, however, no interruption in the graduation of candidates each year. Presumably Dr. Rush and others gave lectures, but not under the auspices of the University. 32 In November 1783 a new election occurred, which resulted in the appointment of the former professors on terms seemingly satisfactory to them. It is probable that Morgan, K u h n , and R u s h held out as long as they did for more reasons than one. A l o n g w i t h friends of the disfranchised College they no doubt felt that the act of 1779 was unjust. Furthermore, when the new trustees appointed a committee to recommend plans for a new school of medicine, Shippen was the only member of the former faculty included. 33 T h i s act could have been little short of an insult to Morgan and Rush. T h e y may have prevailed u p o n K u h n to stand with them. For twelve years the Medical Department of the University of the State of Pennsylvania carried on with a measure of success, granting seventy-five degrees in all, including seven M. D.'s and one ad eundem degree. A l l the while dissatisfaction of friends of the former institution only slumbered. In 1785 B e n j a m i n Franklin, the founder of the original institution, returned from public service abroad and immediately set about to retrieve the violated charter. A n act of repeal was secured, March 6, 1789. Reverend William Smith was restored to the office of provost, and Drs. Morgan, Shippen, K u h n , and Rush were elected to return to their former positions. Dr. Morgan was sick at the time of his election and never recovered. He died, in October 1789, aged fifty-four. Morgan never recovered from the chagrin actuated by his treatment at the hands of Congress. T h e consciousness of his public disgrace seemed to sap his professional and intellectual vitals like a malignant growth, even after he was publicly exonerated. T h e glory that once was his before the war never returned. William Shippen, to Morgan, was Mordecai in the gate. Events in the medical school subsequent to the war never materially altered the situation. In 1783 Morgan resigned from the staff of the Pennsylvania Hospital under circumstances not very clear, although the minutes of the hospital state that his action was contrary to the will of the managers. 34 T w o years later his wife died. T h e r e a f t e r Morgan withdrew more definitely apart from the outside world. He became old before his time, nursed his wounded feelings, and died alone. Soon after Morgan's death his friend, Benjamin Rush, delivering a eulogy before the student body, said in part: T h e historian w h o shall hereafter relate the progress of medical science in America will be deficient in c a n d o u r and justice if he does not connect the name 32 T h e Pennsylvania Gazette of November 14, 1781, announced a course of lectures on chemistry and the practice of physic by Dr. Rush, to begin Monday next. Drs. Morgan and Kuhn may have done similarly. 33 Other members of the Committee were Thomas Bond and James Hutchinson. 34 Francis R. Packard, "John Morgan," Howard Kelly and Walter L. Burrage, editors. Dictionary of American Medical Biography, pp. 868-70.

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of Dr. Morgan with that auspicious era, in which medicine was first taught and studied as a science in this country. 3 5

J o h n Morgan's place in American medicine is incontestable. He was the founder of the first school of medicine, and an excellent teacher. He proposed the reorganization of medical practice in America by dividing the profession into two groups, surgeons and practitioners of internal medicine. He practised what he taught by limiting his practice to the latter. After Dr. Morgan's death Dr. Rush was elected to the chair of theory and practice. Caspar Wistar succeeded to the chair in chemistry and incorporated with it the institutes of physic. Dr. Kuhn resigned the professorship of botany and materia medica and accepted the chair of practice of physic in the University. Samuel Griffitts was then elected to materia medica and pharmacy, and Benjamin Smith Barton accepted the chair of natural history and botany. In the meantime James Hutchinson became professor of chemistry and materia medica in the University. William Shippen retained the chair of anatomy in each institution, a rather singular situation. 36 One of the first acts of the newly organized faculty of the College was to abolish the degree of Bachelor of Medicine. It had been definitely proved that few graduates ever returned to qualify for the doctorate. November 17, 1789, the Pennsylvania Gazette announced the rules respecting medical education, passed by the trustees of the College. In principle they are as follows: ;• : j 1. Candidates for the doctorate must have attained the age of twentyone. 2. T w o years of medical study in the college are required, plus three years of preceptorial study for students in and near Philadelphia and two years for students from the country (farther than five miles). 3. Each candidate must have attended regularly lectures in the following courses: anatomy, surgery, and midwifery, chemistry and the institutes of medicine, materia medica and pharmacy, theory and practice of medicine, botany, and natural and experimental philosophy. 4. Candidates signifying their intention of graduating are examined privately by professors and if successful are assigned a medical question and a case. T h e student's treatment of the same is submitted to the professors, and if the student is again successful he shall be admitted to a public examination before the trustees, provost, professors, and students of the College. Afterwards, if successful in the public examination, he shall submit to the faculty a thesis in Latin or English. T h e thesis, if approved, is defended by the student at Commencement. 5. Bachelors in medicine may be admitted to the doctorate on publishing and defending a thesis according to the above rules. 37 35 Benjamin Rush, "An Account of the Late Dr. John Morgan," Philadelphia Journal of the Aiedical and Physical Sciences, 1: 441, 1820. se Carson, op. cit., pp. 93 f. T h e faculty reorganization took place between March and December of 1789. 37 Ibid., pp. 95 f. T h e University continued the practice of giving both degrees. In other respects its rules were similar to the regulations of the College.

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One cannot fail to recognize some fundamental differences between these regulations and the scholastic code of the College in 1767, which specifically stated that candidates for the bachelor's degree w h o were not college graduates must "before admission to a degree in Physic, satisfy the Trustees and Professors of the College concerning their knowledge in the Latin tongue, and in such branches of Mathematics, Natural and Experimental Philosophy as shall be judged requisite to a medical education." T h e later regulations merely listed "Natural and Experimental Philosophy" as one of the required courses. T h e provision that the thesis may be in Latin or English, at the option of the student, also indicated a definite downward trend in the preliminary requirements. T h e former requirement of attendance on the practice of the Pennsylvania Hospital was not mentioned. Competition occasioned by the presence of two schools within a restricted area no doubt worked in favor of loosening the requirements. Davis, in 1850, felt that the slackening of the regulations in Philadelphia marked the "commencement of that lowering policy, and that disregard of preliminary education on the part of medical schools, which has worked great injury to the profession." 38 T h e presence of two medical schools within such narrow limits proved to be entirely unsatisfactory. Students moved from one school to the other, and some took work concurrently in both. It was difficult for the faculties to determine the number of their candidates for graduation. Relief from this situation was soon obtained, largely due to the efforts of Dr. Wistar. Both schools finally decided that union was the only satisfactory remedy and petitioned the legislature, which responded with an act, September 30, 1791. It was agreed that the new institution should be called the University of Pennsylvania and that the professors of both institutions should be employed in the new organization. 39 W h e n the faculty of the merged institution was elected in January 1792 it was decided to drop the bachelor of medicine degree. T he rules of the School of Medicine in the new University were essentially the same as adopted by the College in 1789. Several innovations were made in 1805 and 1806. In the former year surgery was separated from anatomy and obstetrics and made a separate chair under P h i l i p Syng Physick, a scrupulous and faithful scholar, later known as the "Father of American Surgery." Physick had received excellent training under John Hunter and at Edinburgh, where he was graduated in 1792. In the same year (1805) the Faculty took its first action regarding the admission of ad eundem students. One, Daniel Newcomb, who had attended one course of medical lectures in Harvard, one at Dartas N. S. Davis, History of Medical Education and Institutions . . . , p. 54. 3» Naturally some sacrifices had to be made in merging the two faculties. Wistar became an assistant to Shippen in anatomy, surgery, and midwifery. K u h n retained theory and practice. Rush accepted the institutes and clinical medicine. Hutchinson retained chemistry, and Griffitts materia medica and pharmacy. Barton received the chair of botany and natural history, but his course was not required for graduation. Ewing continued as professor of natural and experimental philosophy and was also elected provost of the new University.

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mouth, and had studied under a respectable practioner for two years, was admitted to candidacy for the doctorate on the completion of one full course of lectures in the University. This case was considered on its merits only, but in 1 8 1 1 and 1825 general rules were adopted, based upon the principle of this policy. T h i s plan of recognition, i.e., giving one year's credit for one or more year's attendance in some other institution, was generally adopted by American medical schools. In 1806 the faculty petitioned the Pennsylvania legislature to curb the activities of irregular practitioners, but the rulers of the state were not moved to provide the enlightened legislation. 40 At the close of the first decade in the new century several changes were made in the regulations of the school. In 1810 some modifications were made in the rules regarding examinations. Because some difficulties had arisen in the conventional manner of conducting oral examinations, the practice of examining candidates behind a screen was inaugurated. With this plan, known as the "Green B o x , " only the dean knew the identity of the student being examined. T h e scheme was abandoned in 1821. Later the faculty adopted a plan of secret ballot in determining the candidacy of a student. In faculty session each professor was provided with little black and white balls. As the ballot was cast each voter privately dropped into the ballot box a white or a black ball, representing a favorable or a unfavorable reaction. A candidate receiving more than a certain number of black balls failed and was said to have been "blackballed." 41 T h e catalogue of 1841 stated that "if 3 negative votes are not cast the candidate is considered to have passed." If three black balls were cast the candidate was permitted to appear for examination before the entire faculty in a general session. At the close of voting sessions of the faculty the dean was authorized to notify successful candidates in writing, delivered by the janitor. Other changes, near the end of the first nineteenth-century decade, pertained to the medical faculty organization. In 1 8 1 1 the following eight professorships were named as comprising the Medical Department: anatomy, surgery, institutes and practice and clinical medicine, materia medica, chemistry, natural history and botany, midwifery, and natural philosophy. 42 T h e professor of natural philosophy was not given full faculty rights in the Medical Department. As early as 1809, Dr. Caspar Wistar, who succeeded William Shippen in anatomy and midwifery, insisted that separate chairs be established for the two subjects. In 1 8 1 0 the separate chair of midwifery was grudgingly established, but attendance on «o Carson, op. cit., pp. 1 1 4 f. R e g a r d i n g ad eundem admissions sec also Catalogue of the Trustees, Officers . . . of the University of Pennsylvania, 1841. Some of the old class books o£ the University are extant and offer mute evidence of blackballing. Heavy black dots on the record after a name indicated black balls cast against approval of the candidate. Some examples may be found in George B . Wood, Class Book, 1838, (manuscript in the collection of Dean William Pepper, University of Pennsylvania). 42

Carson, op. cit., p. 1 1 6 .

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the lectures a n d e x a m i n a t i o n in the subject was not m a d e prerequisite to g r a d u a t i o n until three years l a t e r . " Some modifications in the rules f o r g r a d u a t i o n were also made in 1 8 1 1 . It was reiterated that a candidate must have attended lectures of the professors in the University f o r two years. T h i s regulation literally meant that a student w o u l d attend the same courses his second year as he d i d his first. Such a p l a n seemingly was justified on the grounds that lack of facilities, i.e., books, laboratory apparatus, anatomical preparations, a n d specimens, a n d sometimes insufficient teachers, m a d e it impracticable f o r a student to cover p r o p e r l y all of the subjects in one term. T h i s plan of taking two terms of the same subjects fastened itself upon the school, a n d continued even a f t e r the institution was sufficiently e q u i p p e d a n d m a n n e d to carry on in a m o r e rational m a n n e r . Other schools copied the plan a n d justified their policy purely because the University of P e n n s y l v a n i a was so organized. 4 4 B y the middle of the century this pattern of medical education was characteristic of the A m e r i c a n system. In 1 8 1 1 , attendance on the wards of the P e n n s y l v a n i a H o s p i t a l was again incorporated as a part of the r e q u i r e d work. T h e thesis r e q u i r e m e n t was continued, but it was not i n c u m b e n t on the student to publish it. W i t h m i n o r modifications, the regulations g o v e r n i n g the School of M e d i c i n e of the University continued the same through the first half of the century. T h e catalogue of 1841 prescribed that the thesis must be in the h a n d w r i t i n g of the candidate. G e n e r a l bad spelling and inattention to rules of g r a m m a r were listed as sufficient causes to preclude a candidate f r o m e x a m i n a t i o n f o r a degree. T h e Report on the Medical Department . . . ISJ^ noted that considerable stress was at the time being placed on clinical instruction. T h e organization of a University dispensary a n d clinic e n h a n c e d the facilities f o r c o n d u c t i n g clinical lectures. F r o m N o v e m b e r 19, 1844, to M a r c h 1 3 , 1845, nearly f o u r h u n d r e d cases were prescribed for in the dispensary. Students also h a d the privilege of treating patients in their homes and caring f o r a n u m b e r of cases of pregnancy. 4 5 Such opportunities were especially v a l u a b l e i n a s m u c h as the wards of the P h i l a d e l p h i a G e n e r a l H o s p i t a l were closed to students a b o u t this time. A t n o time in its history was the University without clinical facilities f o r medical instruction. I n d e e d the a v a i l a b l e facilities were often m a d e scant use o f , because more persistent stress was placed on the dry lectures. T h i s custom, a n o t h e r weakness of the University, was copied a n d exaggerated by m a n y schools throughout the country. Especially the schools with no chance f o r affiliation w i t h hospitals justified themselves in g r a d u a t i n g 43 The gradual emancipation of obstetrics as an art and science in Europe was at this time in progress and reacted favorably on similar efforts in America. ** College of Physicians and Surgeons, Minutes of the Meetings of the Faculty of . . . 1811-181j, 1815-1818 . . . (Manuscript in the Dean's Office), cited by Shafer, American Medical Profession, 1783-1850, p. 35. 45 Report on the Medical Department of the University of Pennsylvania for the Year 1845; To the Alumni of the School, By the Faculty, p. 25.

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classes which had little opportunity for sound clinical instruction. Beginning with J o h n Morgan, who was appointed to the staff of the Pennsylvania Hospital in 1773, seventeen members of the Medical School faculty served on the staff up to 1850. During the period 1 7 7 4 - 1 8 3 7 , fifteen teachers served on the Almshouse (Philadelphia General) staff. Such arrangements certainly were advantageous to the clinical program of the University. 46 Not a few illustrious names appeared on the faculty rolls of the first eighty-five years in the life of the University of Pennsylvania Medical Department. When James Hutchinson died of yellow fever in 1793, he was succeeded in the chair of chemistry by J o h n Carson, who died before taking up his duties. T h e chair was then accepted by J a m e s Woodhouse, former pupil of Benjamin Rush and graduate of the University, after the famous Joseph Priestley had declined the professorship. Woodhouse was succeeded in 1809 by J o h n Redman Coxe, who continued in the chair until 1818 when he transferred to materia medica. T h e professorship of chemistry was then conferred on Robert Hare. In 1796 Benjamin Smith Barton had accepted Samuel Griffitts' chair of materia medica and retained his own in botany and natural history. 47 Nathaniel Chapman occupied the chair of materia medica from 1 8 1 3 - 1 8 1 6 . J o h n Syng Dorsey held the chair the next two years. Dr. Coxe, who took the chair in 1819, served until 1835, when his chair was declared vacant by the Trustees. 4 8 George B. Wood was elected in his place. When Adam Kuhn resigned the chair of theory and practice in 1797, Dr. Rush was asked to combine Dr. Kuhn's work with his own. T h u s he carried on until his death in 1813. 4 9 Dr. Barton took up Dr. Rush's work, but died after giving only one course of lectures. Barton's chair of botany was left vacant when he transferred in 1 8 1 3 , until 1816 when the trustees created a faculty of natural science, in which such a chair was established. T h e chair of practice then went to Nathaniel Chapman in 1816. He held the position until his resignation in 1850. On the death of Dr. Shippen in 1808, Dr. Caspar Wistar became professor of anatomy and midwifery. T h r e e years before, surgery had been detached from the Shippen group and given to Philip Syng Physick. In 1 8 1 0 anatomy and midwifery were divided, Wistar continuing in anatomy and Thomas Chalkley James becoming professor of obstetrics. Dr. Dorsey, who succeeded Dr. Wistar in anatomy, died soon after his introductory lecture (1818). T h e chair of anatomy was then filled by Dr. Physick, and William E. Horner was made adjunct professor in anatomy. William Gibson, in 1820, became professor of surgery. In 1831 Dr. Horner succeeded Dr. Physick as professor of anatomy. 50 Dr. James resigned the chair of Carson, op. cit., pp. 220 f. Dr. Barton founded the Philadelphia Medical and Physical Journal in 1804. T h e action of the trustees resulted from a wholesale protest by the student body against Dr. Coxe as an instructor. « D r . K u h n continued practice until 1814 and died three years later. so Dr. Horner, an excellent anatomist, was dean of the Medical School for thirty years. He died in 1853. See W. S. Middleton, " W i l l i a m Edmonds Horner," Annals of Medical History, 5: 33-44, 1923. 47

UNIVERSITY OF PENNSYLVANIA

83

obstetrics in 1835 and was succeeded by W i l l i a m Potts Dewees, who had been adjunct professor since 1825. Dr. Dewees resigned shortly because of ill health and was followed by Dr. Hugh L . Hodge. In 1835 Samuel Jackson, w h o had been assistant to Dr. Chapman, became professor of the institutes of medicine, Dr. C h a p m a n retaining the professorship of practice of medicine a n d clinical medicine. 5 1 T h e personnel of the faculty remained unchanged for the next twelve years. In 1847 Dr. Hare, who had proved himself to be one of the most eminent chemists of his time, resigned his chair. James B . Rogers was elected to the vacancy. H e died in 1852 and was succeeded by his brother, R o b e r t E. Rogers. In 1850 Dr. W o o d was transferred to practice of medicine on the resignation of Dr. Chapman. Joseph Carson succeeded W o o d in materia medica and pharmacy. Dr. H o r n e r died in 1853 and was succeeded in anatomy by Joseph Leidy. Dr. Gibson resigned the chair of surgery in 1855 and Henry Smith followed. Dr. Wood continued in the chair of practice until i860, and Drs. Jackson and Hodge resigned in 1863.« Surgeon's Hall on F i f t h Street below the Library was the first home of the Philadelphia school. Previous to the erection of this building (probably in the 1780's) the old Academy building on Fourth Street, near Arch, a n d the building in the rear of the William Shippen, Sr., home were used. In 1802 the Medical School moved to an edifice on Ninth Street, which had been constructed for the use of the president of the United States. 53 With certain alterations and additions the building was used until 1829, when the entire structure was cleared away to make way for a new building which served as a home for the School of Medicine until 1890. Medical Hall, as the new building was called, contained three large lecture rooms, commodious quarters for museum, anatomical purposes, and offices for the faculty and administration. T h e anatomical museum of the University was a very remarkable collection by the middle of the century. T h e nucleus of the museum was the gift of the family of Dr. Wistar, who had painstakingly collected and prepared the specimens. T h e Wistar museum was vastly augmented by Drs. H o r n e r and Leidy. 5 4 T h e University of Pennsylvania maintained its position of leadership in medical education at least until the middle of the century. According to figures compiled by George B. W o o d and William E. Horner and published in 1839, a total of 503 were graduated in medicine between 1768 and 1810. 5 5 T h e question of the number of matriculants before 1 8 1 0 is probPackard, op. cit., pp. 372-92, and Carson, op. cit., pp. 99-164, gave the above information. r '- Packard, loc. cit. Lectures on diseases of women and children were usually included in the course on obstetrics. T h e chair came to be known as the " c h a i r of obstetrics and the diseases of women and children." 53 T h e building ivas completed in 1797 and said to have cost $100,000. President Adams declined the use of it. Soon afterward the government moved to Washington. " Carson, op. cit., pp. 2 0 5 - 1 2 . T h e Pennsylvania Hospital collection was also added to the Wistar Museum. 55 Catalogue of the Medical Graduates of the University of Pennsylvania; With an Historical Sketch of the Origin, Progress and Present State of the Medical Department.

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CIVIL

WAR

lematic. Only scant records are extant on this early period. T h e annual register of graduates a n d the records of the trustees constitute about all the primary source material regarding classes for the first torty-five years of the school history. A p p a r e n t l y no systematic faculty records were kept. T h e policy of rotation in the office of dean did not contribute to the accumulation of reliable records. Regularity in this respect was not introduced until Dr. H o r n e r became permanent dean in 1822. 5 9 Carson, w h o in 1869 compiled figures based u p o n the Wood-Horner report of 1839 and subsequent reports, listed the number of matriculants in the Medical Department f r o m 1 8 1 0 - 1 1 to 1 8 5 0 - 5 1 as 16,763. For the same period he lists 5,524 graduates. A s s u m i n g the accuracy of these figures, one concludes that approximately thirty-three per cent of the matriculants continued in the course a sufficient period of time to q u a l i f y for graduation. T h e lack of restraint by state laws was an obvious factor in encouraging men to enter practice poorly equipped. 5 7 I n this forty-one-year period the yearly attendance ranged from 3 1 9 in 1 8 1 4 - 1 5 to 508 in 1847-48. T h e largest class, 190, was graduated in ι849· 55»

26 graduates. During twenty-seven years of existence, the College of Physicians and Surgeons of the Western District of the State of New Y o r k afforded instruction to 3 , 1 2 3 students, 589 of whom were graduated. T h e school acquired favorable attention while it was yet an academy. In its second year ( 1 8 1 1 ) its reputation was strong enough to induce the New York Legislature to grant it $5,000, and when it became a college a further sum of $10,000 was voted. T h e trustees purchased from Fairfield Academy a three-story stone edifice which was altered so as to provide an anatomical theatre, museum, and dissecting rooms. A n obstetrical "machine," "Chemical W a r e , " and "Mineralogical specimens" were also a part of the equipment. " W i t h all these advantages," the trustees and professors " h u m b l y " hoped to continue to "deserve well of medical students and of the public," which objective was declared the height of their ambition, " a n d for which no exertion shall be w a n t i n g . " 4 T h e term at Fairfield began early in November and continued for only three months—a term even shorter than the conventional four months advertised by contemporary schools. L a t e f a l l and early spring f a r m work were said to have been the main reasons for the announcement of such a short term. T h e student of medical history regards this deficiency with charity (in 1822 it was lengthened) when he discovers that this little school on the periphery of civilization revived the generally discarded standards of preliminary education. T h e ordinances of the College of Physicians and Surgeons of the Western District plainly stated: E v e r y p e r s o n w h o shall n o t h a v e r e c e i v e d a c o l l e g i a t e e d u c a t i o n , shall p r e v i o u s l y to his e x a m i n a t i o n g i v e s a t i s f a c t o r y e v i d e n c e t o the P r e s i d e n t , V i c e - P r e s i d e n t , a n d P r o f e s s o r s , that h e h a s an a c q u a i n t a n c e w i t h the L a t i n l a n g u a g e , that h e possesses a c o r r e c t k n o w l e d g e of E n g l i s h g r a m m a r , n a t u r a l a n d e x p e r i m e n t a l p h i l o s o p h y , a n d t h a t h e sustains a f a i r m o r a l c h a r a c t e r . 5

T h e thirty years' existence of Fairfield Medical College is paradoxical. In the first place, Fairfield, an insignificant village off the beaten trails, certainly would never have been picked for its activity and prospect of developing into a populous center. Nevertheless the justly celebrated College of Physicians and Surgeons was for several years known throughout the nation as a reputable center of medical education, excelling at times older established schools in coastal cities. W h i l e the establishment of new schools in N e w York City led to bitter quarrels and destructive feuds, the Fairfield school was chartered and established with a minimum of professional disturbance. 6 In contrast to the shifting faculties in New Y o r k * Alumni Records of Syracuse University 1872-86, pp. 257-59. T h e quotations are cited in Walsh, op. cit., pp. 353 f. 5 Ibid., pp. 355 f. The Circular and Catalogue for 1822 stated that " b y a late regulation the session will continue sixteen weeks." T h e lecture tickets were from ten to twelve dollars each if the entire course was taken. Part-time students were required to pav fifteen dollars for each. T h e graduation fee was twenty dollars. Board was eight to twelve shillings monthly in the village. « It seems that in 1812, before Fairfield received its charter there was a move to establish a medical school in adjoining Oneida county, at Clinton. It was planned that Spaulding

15*

MEDICAL EDUCATION BEFORE T H E CIVIL W A R

C i t y a n d o t h e r centers, t h e teachers at F a i r f i e l d w e r e r e m a r k a b l y perm a n e n t . It is s t r i k i n g l y s i g n i f i c a n t t h a t this l i t t l e w i l d e r n e s s s c h o o l att r a c t e d t o its f a c u l t y s o m e of the most progressive t h i n k e r s in A m e r i c a n m e d i c i n e . P r o v i s i o n w a s also m a d e f o r courses by n o n r e s i d e n t o r v i s i t i n g professors. A l l of this w a s d o n e w i t h p r a c t i c a l l y n o a d e q u a t e c l i n i c a l facilities a n d w i t h very l i m i t e d o p p o r t u n i t y f o r o b t a i n i n g b o d i e s f o r dissection. 7 D r . M a n l e y , in g i v i n g his 1827 p r e s i d e n t i a l address to the N e w Y o r k M e d i c a l Society, c o u r t e o u s l y c o m m e n d e d the flourishing b a c k w o o d s college. Said he: Although it had a small beginning, and has received from the Legislature little or no substantive patronage, it is in a very flourishing condition, and gives promise of increasing usefulness. It appears to have been established by the Regents with a single eye to the improvement of the character of the profession in the interior and remote parts of the State; and it has answered their highest expectations. T h e teachers are men of reputation, who appear to have thought less of borrowing character from their stations, than of making it for the institution; several works, which are alike honorable to the profession and their authors, bear testimony to thç merits of the professors. 8 T h e greatest single f a c t o r in the rise of F a i r f i e l d M e d i c a l C o l l e g e t o d i s t i n c t i o n w a s the e x t e n d e d t e n u r e of s u p e r i o r m e n o n its f a c u l t y . C h i e f a m o n g its p r o m o t e r s a n d professors was W e s t e l W i l l o u g h b y , Jr., a r e s i d e n t i n the F a i r f i e l d v i c i n i t y as early as 1792. H e w a s a n i n c o r p o r a t o r of Fairfield A c a d e m y in 1803, a n d t h e o r g a n i z e r of H e r k i m e r C o u n t y M e d i c a l Society in 1806. W h i l e s e r v i n g in the l e g i s l a t u r e at A l b a n y , it w a s v e r y p r o b a b l e that he was i n s t r u m e n t a l in o b t a i n i n g the first financial aid f o r the y o u n g m e d i c a l s c h o o l . W h e n the C o l l e g e was o r g a n i z e d in 1812 W i l l o u g h b y ' s n a m e a p p e a r e d first a m o n g the t w e n t y - f o u r trustees. A l t h o u g h h e w a s a w a y m u c h of the t i m e — a m o n g o t h e r d i v e r t i n g interests, he served as a b r i g a d e m e d i c a l officer in 1812 a n d later s p e n t t w o years in C o n g r e s s — h i s c h i e f interest was F a i r f i e l d ' s m e d i c a l school. In 1827 he b e c a m e presid e n t of the C o l l e g e a n d so r e m a i n e d u n t i l its close t h i r t e e n years later. L y m a n S p a u l d i n g , first p r e s i d e n t of the C o l l e g e , h a d b e e n t u t o r e d b y N a t h a n S m i t h of N e w H a m p s h i r e a n d was w i t h h i m c o - f o u n d e r of D a r t m o u t h ' s m e d i c a l s c h o o l , w h e r e h e t a u g h t c h e m i s t r y . S p a u l d i n g is k n o w n best of a l l as the f a t h e r of the U n i t e d States p h a r m a c o p o e i a . A p o w e r f u l i n f l u e n c e · in F a i r f i e l d ' s t e a c h i n g staff w a s the p e r i p a t e t i c medical philosopher, J o h n Delamater, w h o continued at Fairfield for a n d W i l l o u g h b y be o n the f a c u l t y , a n i n d i c a t i o n that there w e r e n o strong factions inv o l v e d in d e c i d i n g the m a t t e r . See W a l s h , op. cit., p. 352. 7 O n J a n u a r y 19, 1819, the Fairfield trustees passed a r e s o l u t i o n o r d e r i n g dismissal f o r a n y s t u d e n t concerned, d i r e c t l y or i n d i r e c t l y , w i t h the d i g g i n g u p of a n y h u m a n b o d y f o r the p u r p o s e of dissecting in the C o l l e g e . O n J a n u a r y 20, 1820, the legislature was p e t i t i o n e d for a law g i v i n g the u n c l a i m e d bodies of convicts at A u b u r n State Prison to t h e C o l l e g e f o r dissection p u r p o s e s . H a r d i n , op. cit., p. 173. s C i t e d by W a l s h , op. cit., p p . 356 f. F o r an e a r l i e r e u l o g y on the Fairfield school a n d its f a c u l t y see Joseph W h i t e , " A n n u a l A d d r e s s , " Transactions of the New York State Medical Society, 1816, p p . 101-09.

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thirteen years, lecturing on a variety of subjects. Indeed, Delamater held chairs in nine medical schools during his thirty-eight years of professorship, for a time maintaining several of them simultaneously. His appointments led him from Pittsfield ( 1 8 2 3 - 2 7 ) , Bowdoin ( 1 8 2 9 - 4 1 ) , Dartmouth (1837-40), and the University of Vermont in New England to Fairfield ( 1 8 2 7 - 4 0 ) and Geneva (1840-43) in New York; and on to the Medical College of Cincinnati (1838-39), ist. Charles in far-off Illinois (1842-44), VVilloughby (1840-42) and Western Reserve College (1843-60), all of which were in the great Northwest of that day. T h e influence of this renowned and inspiring teacher is incalculable. At Fairfield and elsewhere literally thousands of medical students came under his dynamic personality, as he delivered lectures in almost every branch of medical science. His restless spirit no doubt influenced scores of young practitioners to go west where opportunities beckoned to trained physicians. As a builder of western medicine Delamater ranks with Daniel Drake. Also among the leading spirits of Fairfield was T . Romeyne Beck, noted above as an authority on medical jurisprudence, who in 1824 delivered an introductory lecture, later published and widely circulated, entitled On the Utility of Country Medical Institutions. T h e address was essentially a defense of the College in Fairfield, the success and reputation of which was eliciting from city educators criticisms not intended to add to the popularity of Beck's school. Beck fired one of the opening guns in the warfare between city and country schools, a conflict which terminated eventually with the extinction of the small-town medical college.9 Thus, with an excellent staff of professors, the College of Physicians and Surgeons of the Western District of the State of N e w York for a few brief years rode high on the tide of westward migration, gaining for itself a justly celebrated though short-lived renown. T h e passing of generations has obliterated the medical influence of this once eminent frontier school, but its unique place in the mechanism of westward expansion—sending practitioners and professors to succor frontiersmen and teach the healing art—is an estimable page in the country's social history. 10 T h e decline of Fairfield began with the opening of Geneva Medical College in 1835 and was hastened by the chartering of Albany Medical College in 1838. But the terminal blow was struck when, through political influence, the small state subsidy enjoyed by Fairfield was transferred to Oneida Academy at Clinton, later known as Hamilton College. 1 1 0 Cushing, op. cit., pp. 9 - 1 4 . High positions in the New York State Medical Society were held by members of Fairfield's faculty from time to time. 10 T h e f o u r men most active in founding the first five medical schools in and near Chicago received all or part of their medical education at Fairfield. See George H. Weaver, Beginnings of Medical Education in and Near Chicago. T h e f o u r men are: Daniel Meeker, Daniel B r a i n a r d , George W. Richards, and David Prince. N'athan S. Davis, a Fairfield graduate prominent in Chicago at about the same time, became the principal founder of the American Medical Association. 11 A worthwhile sketch of the Fairfield school is in Frederick C. Waite, Medical Education of Dr. Marcus Whitman, reprinted from the Oregon Historical Quarterly, X X X V I I , 3. Waite named Whitman as the first graduate of an American medical college to cross the Rockies when he went to Oregon in 1835.

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MEDICAL

SCHOOL

H o w m a n y efforts were m a d e to create medical schools in western N e w Y o r k d u r i n g the early decades of the century is not definitely k n o w n . It is c e r t a i n that not all such attempts were favored, as was Fairfield, w i t h a n established academic organization which served as a sort of s p r i n g b o a r d f o r l a u n c h i n g the enterprise. A n abortive venture of purely proprietary o r i g i n was the i m m a t u r e a n d anemic enterprise at A u b u r n , a b o u t one h u n d r e d miles west of Fairfield. T h e archives of the C a y u g a C o u n t y ¿Medical Society gave the minutes of a m e e t i n g held at the i n n of one C a n f i e l d Coe, at A u b u r n , on F e b r u a r y 6, 1 8 1 7 . Significant was the a p p o i n t m e n t of Drs. Cole, Pitney, a n d Smith as a c o m m i t t e e to consider a n d report on the propriety of establishing a medical school in A u b u r n . H e n r y H a l l , w h o h a d access to the Society's records, m a d e n o mention of any report being m a d e by this committee. P r e s u m a b l y the findings of the committee were not propitious. Some work of an educat i o n a l n a t u r e was, nevertheless, being attempted, as witnessed by a Society p e t i t i o n in 1 8 1 9 to the inspectors of the A u b u r n State prison f o r the bodies of deceased convicts f o r dissection. A u b u r n ' s historian also noted that, a f t e r an interval of seven years, Dr. Erastus D. T u t t l e , physician a n d surg e o n of the A u b u r n penitentiary a n d a g e n t l e m a n of eminence, " u n d e r took to establish on private account, in A u b u r n , a school for the education of y o u n g m e n in medical science . . ." W i t h the h o p e that he might o b t a i n a charter f r o m the legislature, Dr. T u t t l e purchased a lot next to the town bank a n d erected a two-story b u i l d i n g , with a lecture r o o m a b o v e a n d office a n d study below. I n some respects the prospect was encouraging. T u t t l e ' s position gave h i m access to material f o r dissection and anatomical p r e p a r a t i o n s , a solution for one of the most p e r p l e x i n g problems f a c i n g m e d i c a l educators of the time. I n the fall of 1824, T u t t l e , with the a i d of a Professor D o u g l a s of P h i l a d e l p h i a , began lecturing to about a dozen students. I n J a n u a r y 1 8 2 5 , Professor T u t t l e deemed the time auspicious to mobilize p u b l i c o p i n i o n . A t a p u b l i c meeting in the Western E x c h a n g e o n J a n u a r y 2 1 , he a c q u a i n t e d the p u b l i c with his views on local medical education, receiving cordial a p p r o v a l . A committee, i n c l u d i n g p r o m o t e r T u t t l e a n d W i l l i a m H . Seward, was a p p o i n t e d to memorialize the legisl a t u r e a n d secure a charter. P e n d i n g hoped-for f a v o r a b l e action by the state solons in A l b a n y , a n a n n o u n c e m e n t was m a d e in F e b r u a r y of courses to be started at once in anatomy, chemistry, a n d materia medica, to be g i v e n by Drs. T u t t l e , J a m e s D o u g l a s , J e d e d i a h Smith, a n d I r a H . Smith. F i f t e e n or twenty students attended the lectures. T h e charter was not f o r t h c o m i n g — p r o b a b l y because opposed by F a i r f i e l d interests or city schools ill-disposed to permit any more competition in the wilderness— b u t the A u b u r n school continued to offer courses at various dates until the d e a t h of T u t t l e in 1829. T h e school suffered a temporary check until T u t tle's successor at the prison, J o h n G e o r g e M o r g a n , associated w i t h himself D r . T h o m a s Spencer of O n o n d a g a C o u n t y , and as demonstrator D r . F r a n k

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H a m i l t o n of Auburn, and recommenced the lectures in a different building. T h e attempted revival met with limited success for a short time. But in spite of the rather central location of A u b u r n and the practical value of the connection with the state prison, the legislature never authorized the establishment of the school. T h e possibilities of obtaining a charter were finally and completely defeated when Geneva College obtained a charter to establish a medical department in 1834. Morgan and Spencer were shortly offered positions on the Geneva staff. Hamilton continued to give courses in anatomy at A u b u r n until 1839, when he was called to Fairfield. Interest in the A u b u r n project then died out permanently. 1 2 It is difficult to estimate the contribution of the school in Auburn. Although according to Hall its courses were reputed to be very able a n d instructive, the scope of the school's curriculum as a whole must have been, because of limitations of the faculty, much inferior to the work offered at Fairfield and in New York City. Auburn, charterless, never conferred degrees, so her students who completed their medical education probably went to Fairfield or elsewhere for a diploma. Students w h o did not continue elsewhere no doubt applied to the censors of some county society for a New York license or drifted into the O h i o and Mississippi valleys where restrictions on medical practice were for some time practically unknown. In defense of A u b u r n it should be observed that less than one-fifth of Fairfield's matriculants were graduated. A u b u r n then contributed in a very modest manner to fulfilling the manifest destiny of frontier schools, the supplying of frontier physicians to the successive waves of migration that swept westward through New York's central valley. GENEVA

MEDICAL

COLLEGE

Geneva Medical College, chartered in 1834 and opened in 1835, was in reality the Medical Department of Geneva College, founded as an academy and rechartered in 1826 with authority to confer collegiate degrees and diplomas of all sorts. T h e year 1826 in New York medical history is memorable for the secession of the faculty at the College of Physicians and Surgeons in New York City. T h e revolt was led by David Hosack, w h o promptly formed an alliance with Rutgers College of New Brunswick, N e w Jersey, and established Rutgers Medical Faculty in New York City on D u a n e Street. W h e n this liaison was blasted by a legal interpretation charging violation of the state's rights, the professors sought what they believed would be an academic alliance constituting no infringement of that legal principle. Proposal was made to Geneva College for the granting of medical degrees under its liberal charter. T h e result was that the professors on Duane Street then carried on under the queer though accurate title of Rutgers Medical Faculty, Geneva College. T h i s remote alliance also passed away, made extinct by a Supreme Court decision denying Geneva College's right to conduct work off the campus. T h e doctors of the 12 Henry Hall, The History of Auburn, pp. 152-54, 166-68,

I56

MEDICAL EDUCATION BEFORE T H E CIVIL W A R

College of Physicians and Surgeons were elated, the insurgents on Duane Street were foiled, and the trustees of little Geneva College in the Mohawk Valley were wiser for the experiment. It may have been this brief experience in operating a medical department by remote academic control that led the fathers of the Geneva institution to consider seriously the possibilities of establishing a medical faculty on the campus. Fairfield was thriving. T h e idea may have germinated in the minds of J o h n G . Morgan and T h o m a s Spencer, who were struggling to make something out of the proprietary project in Auburn. W h e n the Geneva teaching staff was named in 1834, both Morgan and Spencer obtained chairs. 1 3 Some students of medical history look upon Geneva Medical College as the lineal descendant of Fairfield, thus making Fairfield along with Geneva a foster ancestor of Syracuse University College of Medicine, which Geneva voluntarily became on moving to Syracuse in 1872. T h e only organic connection between Fairfield and Geneva was the transfer of three Fairfield professors, Hadley, Delamater, and Hamilton, to the Geneva faculty when Fairfield broke up in 1840. T h e original faculty which began lecturing at Geneva Medical College c in 1835 w a s ' ° l ° r a n d quality, not unlike the men w h o faithfully lectured at Fairfield. With the exception of Edward Cutbush, a retired senior surgeon of the United States Navy, in his early sixties, the six professors were young and peripatetic in habit. Dr. Cutbush, who allegedly resigned his commission in the Navy for political reasons, became professor of chemistry at Geneva in 1830, and dean of the medical faculty when the Medical College was organized in 1834. 1 4 T h o m a s Spencer, noted in connection with the A u b u r n Medical School, received the chair of institutes and practice of medicine. H e was a New Englander, a Fairfield graduate, and had been a graduate student in Philadelphia. He was succeeded by William Sweetser in 1847. T h e r e a f t e r Spencer served in the Mexican W a r and taught at R u s h Medical College in Chicago and at Philadelphia College of Medicine. T h e professorship of anatomy and physiology went to another roving lecturer, W i l l a r d Parker, a Harvard graduate who reached his chair in Geneva by way of Berkshire and Colby medical faculties. H e remained only two years at Geneva, moving on west to Cincinnati, whence he was called to the chair of surgery in the College of Physicians and Surgeons in New York City. 13 Prominent among the patrons of Christian education in western New York at this time was Episcopal Bishop J o h n Henry Hobart of New York City. He had obtained f o r Fairfield an annual sum of $500 (later increased to S750) from the Corporation of T r i n i t y Church, New York, in 1 8 1 2 . In 1821 Bishop Hobart transferred his affection and with it the annual grant to Geneva Academy. Cushing intimates the possibility that Hobart suggested Geneva to Hosack when he was seeking affiliation with some New York liberal arts college. Cushing, op. cit., pp. 17 f. " For a life of E d w a r d Cutbush see F. L . Pleadwell, " E d w a r d Cutbush, M.D., T h e Nestor of the Medical Corps of the N a v y , " Annals of Medical History, 5: 337-86, winter, 1923. Cutbush fell into disfavor with Secretary Branch of the Navy because he (Cutbush) did not join in with the " J a c k s o n h u r r a h . " Cutbush subsequently submitted his commission.

UPSTATE

AND W E S T E R N

NEW

YORK

»57

J o h n G . Morgan, associated with Spencer in A u b u r n , assumed the chair of surgery, but stayed only two years. Little is known of his subsequent life, other than that he died in St. Louis. Charles B. Coventry, a Fairfield graduate, was more of the Westcl Willoughby type. He remained at Geneva nineteen years teaching obstetrics, later adding medical jurisprudence. Previously he had been on the Berkshire staff. Coventry was at one time president of the State Medical Society and for several years manager of the state lunatic asylum. T h e sixth member, Anson Coleman, department of medical jurisprudence a n d botany, remained only two years, leaving after the botany lectures were abandoned. Dr. D a v i d L . Rogers succeeded Morgan in surgery, and Frank Hamilton succeeded Rogers in 1840. J a m e s Webster followed Parker in anatomy and physiology, continuing for eighteen years. T h u s it appears that Geneva maintained a respectable teaching staff, several of whom had in their veins the blood of pioneers and could not content themselves by settling permanently in one place. Caught at times by the westward surge, they helped to enact a colorful scene in the d r a m a of migration. 1 5 O n the opening day of Geneva Medical College, Dean Cutbush publicly declared that rivalry had no share in the determination to form the institution. T h e " p u b l i c good and a laudable emulation to advance the cause of science" were held up as the primary object of the founders. Cutbush recognized the greatest mission of the frontier school when he cited the presence in the profession of many practitioners who had never heard a public lecture or seen a demonstration in anatomy. In prophetic hopefulness the head of the medical faculty portrayed to his audience the place of Geneva in the expansion of the young republic. Said he: Should the institution flourish, which we o p e n this day, how g r a t i f y i n g may be the thought that young men, educated within these walls, may, probably, at some f u t u r e period, erect the standard of science in those distant parts of our country which are now enveloped in intellectual darkness, and carry with them the means of arresting the progress of disease . . , 1 6

In many respects Geneva's progressive coterie of professors did for their college just what Dean Cutbush anticipated, and the product of the school went abroad throughout the land, especially to the west, making for N e w York's second frontier medical school a reputation second only to Fairfield that went before. A few years after its founding, when medical education improvement was being agitated throughout the country, an editorial in the New York Medical Journal recommended that, if there were to be changes, the colleges of the land might do well to follow the excellent example of Geneva in making public their examinations, which the censors of the State Society were invited to attend, and in requiring a majority of all the votes before a candidate was graduated. T h e session at Geneva, from the first year, was sixteen weeks. T h e lecture ι 5 Cushing, op. cil., pp. 19-23. Edward Cutbush, A Discourse Delivered at the Opening of the Medical of Geneva College, State of New York, February 10, 1834, pp. 6, 24.

Institution

I58

MEDICAL EDUCATION

BEFORE T H E

CIVIL

WAR

fees (a total of fifty-five dollars) were a little less than at Fairfield. A matriculation fee of five dollars and a graduation fee of twenty dollars were also stipulated in the Circular and Catalogue of 1835. T h e figures given in the 1849 Circular show a consistent growth of the school as indicated by the number of graduates until the year 1846 when forty-four were graduated. Thereafter the decline was equally consistent until 1855 w h e n seven graduated, one more than in the first class in 1835. After 1835 Geneva Medical College continued to show signs of decay until 1872, when it was moved to Syracuse and became the Medical Department of Syracuse University. 1 7 A most interesting sketch of school life at the Medical Institution, as Geneva Medical College was called, is recorded by a student, Elizabeth Blackwell, in her autobiographical sketch. Miss Blackwell was the first woman to be admitted to and graduated from a medical school in the United States. Not until she had been refused at all the schools in Philadelphia and New York did the persistent school teacher make application to several country schools. Only at Geneva was her request considered favorably, indeed uproariously and unanimously, by the students, after her petition passed from trustees to faculty, who were at a loss to know what to do and left the decision with the student body of about one hundred men. Neither faculty nor students had occasion to regret their action. Prim Miss Blackwell is credited with refining the manners of Geneva's medicos and denaturing the strength of the medical jokes commonly passed at the lecture hour. 1 8 Another inside view of the Geneva institution is provided by the thesis of brilliant Andrew Boardman, a critical and outspoken graduate of 1840, w h o attempted an exposé of the weaknesses of the administration and curriculum. His thesis, though judged first class and superior to all others of his class, according to Boardman's report, did not earn for him the gold medal offered each year for the best thesis. Dr. D. L. Rogers, professor of surgery, w h o placed the gold medal at the disposal of the faculty, assured young Boardman before he selected his thesis topic that the broadmindedness of the faculty would insure fair judgment even though Boardman should present views adverse to the current system. W h e n the faculty disqualified Boardman's dissertation because of its critical nature, Professor Rogers resigned in protest against what to him was "a transaction in which there appeared to me a violation of honour and justice, and an attempt to crush instead of encouraging an inquiring independent spirit." Boardman's thesis soon found its way into print under the title An Essay on the Means of Improving Medical Education and Elevating Medical Character, published in Philadelphia. In it he made several rather odious comparisons between the promises of the Circular and the fulfillment by the faculty. " Circular of the Medical Institution of Geneva College, 1849; Alumni Record of Syracuse University of . . . Including . . . Geneva Medical College, 1835-72. pp. 2 8 1 301. In 1851 Geneva College, the mother institution, became Hobari College. Elizabeth Blackwell, Pioneer p p . 68-75, 255-59·

Work in Opening

the Medical

Profession

for

Women,

UPSTATE AND WESTERN NEW YORK

«59

W i t h b r u t a l frankness B o a r d m a n cited the teaching of chemistry by a doctor of divinity, the absence of lectures o n medical jurisprudence a n d physiology, and the providing of only one subject for the entire class in anatomy. T h e Western Hospital, an institution connected w i t h the College, was declared by the Circular to provide the "great advantage of clinical instruction." A l t h o u g h the surgical professors drew a large n u m b e r of patients w h o were operated on before the class, the Western Hospital, the second floor of an old b u i l d i n g labeled " G e n e v a Shoe Store," had only o n e surgical a n d not one medical case t h r o u g h o u t the entire school session. Before finishing his twenty-three-page review, the G e n e v a medic questioned the objectives of some educators seeking national reform, and then concluded with seven propositions which stressed the practical aspects of medical training and the necessity of establishing a national e x a m i n i n g body w i t h sole authority to license physicians. 1 9 B o a r d m a n ' s thesis may have been to his teachers a bit of impious criticism, yet, after a liberal discounting, his charges retain more than a modic u m of truth. Most of the weaknesses pointed out were functional, capable of b e i n g remedied; one condition was organic a n d incurable. Small communities were incapable of establishing and supporting institutions worthy to be called hospitals. In this respect G e n e v a Medical C o l l e g e never succeeded, and for that reason it was d o o m e d to failure long before mute evidences forced its removal to a small city where clinical facilities were available. T h e o p e n i n g of A l b a n y Medical College in 1838 had little visible effect on Geneva, since it drew students principally from the area which h a d been supporting Fairfield College and Berkshire Medical Institution in Massachusetts. But when the University of Buffalo inaugurated a medical department with hospital facilities in 1846, Geneva's glory was distinctly dimmed. Both students and teachers were lost to the new school still farther west. ALBANY

MEDICAL

COLLEGE

T u r n p i k e s , canals, and later the railroad, conspired to make a city of the little upstate town called A l b a n y . A b e g i n n i n g in medical education was made in this town in the early twenties, w h i l e Fairfield was struggling for recognition and before Geneva had yet formed an experimental alliance w i t h the Hosack clique at the m o u t h of the Hudson. T h e story of a modest beginning in 1821 that developed into the A l b a n y Medical College, f o u n d e d in 1838, is primarily a story of the achievement of one m a n — A l d e n M a r c h . Son of a N e w E n g l a n d farmer, M a r c h attended p u b l i c schools a n d then was tutored in medicine by his brother Davis, an army surgeon. H e attended medical lectures in Boston and at B r o w n University in Providence, receiving the doctorate at the latter in 1820. H e shortly settled in A l b a n y , a town of less than fifteen thousand population, a n d promptly (1821) exhibited his interest in medical instruction by g i v i n g a course in anatomy illustrated by dissections. Y o u n g Dr. M a r c h was conia Andrew Boardman, An Essay on the Means of Improving Elevating

Medical

Character, pp. 6-23, passim.

Medical

Education

and

i6o

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

fronted with the very real problem of the scarcity of available anatomical material and the popular prejudice against the use of the human body for instructional purposes. Walsh declared that Dr. March submitted himself to a great personal discomfort, and no little risk to obtain bodies, at times driving as far as Boston and returning with a body in a sack beside him. Within a few years the Albany professor's reputation as an anatomist led to his appointment to the chair of anatomy and physiology, in 1825, in the Vermont Academy of Medicine at Castleton, a Vermont village less than one hundred miles distant. March maintained his professional connection with Vermont Academy of Medicine for a decade, at the same time continuing his lecture courses in Albany. As early as 1827 there appeared an announcement entitled Circular of the Albany Medical Seminary; With a Catalogue of Students, Attending the Course of Instruction for 182J. March and his two associates—William T u l l y , professor of theory and practice of medicine, and Lewis C. Beck, professor of chemistry and natural history—announced in this circular their intentions of supplementing the work done in the different "public Medical schools nearest Albany." In pursuance of this policy (and no doubt to avoid interrupting March's lectures at Castleton) the three Albany professors offered their courses during the intervals between courses at Castleton. Three lectures daily for twelve weeks commenced on the second Wednesday in May. A brief quiz course seems to have been offered during the winter. T h e fee for the work of a calendar year was fifty dollars. T h e winter work was offered at ten dollars for each course. Twenty-five students attended the 1827 session. 20 March made a bid for public interest and support on January 1 1 , 1830, by delivering a public address published by his pupils under the title Expediency of Establishing a Medical College and Hospital in the City of Albany. In 1832 "Dr. March's Practical School of Anatomy and Surgery," as the institution was then called, matriculated only twenty students. A Catalogue published in May 1833 fifSt named the school as "Albany Medical School." T h e r e were then twenty-three juniors, twenty-eight seniors, and a faculty of six lecturers. T h e close relationship between March's school and Castleton Academy at this time is indicated by the declaration that "because of the extent and completeness" of the work in Albany entire courses would be accepted toward graduation at Castleton. Indeed, the tenth page of the Catalogue was an announcement of the Vermont Academy of Medicine. 2 1 Circular of the Albany Medical Seminary . . . iSij. pp. 3 f.: T h e Circulars for 1828 and 1829 note interesting though not significant changes. Walsh presents the nearest complete account of March's early attempt to establish a school, op. cit., pp. 622-34. = 1 Catalogue of the Instructors and Students of the Albany Medical School, May, 1833, pp. 3 - 1 0 . The lecturers were not listed as professors: Edwin James, chemistry and natural history; Alden March, anatomy, physiology, and operative surgery; Henry Green, obstetrics, and diseases of women and children; William T u l l y , materia medica, pharmacy and therapeutics; T h e o d o r e Woodward, principles and practice of surgery; and J o h n J a m e s , theory and practice of medicine. Several of these men had connections with the Castleton school.

UPSTATE AND WESTERN NEW YORK.

i6i

A Catalogue published in 1836 reflected a decline in the success and popularity of the school. Only two lecturers were advertised, Dr. March and his brother-in-law, James H. Armsby, a recent graduate and professor at Castleton. Thirty-seven students that year attended courses in anatomy, physiology, and surgery during a term said to be "about ten weeks." A "subject" was furnished to each group of four students " f o r private dissection," a promise which must have been difficult to fulfill. In order to bridge the depression, which began in 1837, the ardent Armsby put on several publicity stunts in the form of public lectures with an exhibition dissection on human subjects. As many as three hundred curious or publicspirited citizens attended one of these courses. Extraordinary public interest was aroused in favor of establishing a school in Albany, authorized to confer medical degrees. At a public meeting on April 14, 1838, a resolution was adopted and machinery was put in motion to obtain a charter and establish a corporation. At the next meeting, in May, articles of association were adopted and trustees were chosen. A nominating committee was put to work which soon recommended a teaching staff of seven, including March and Armsby. T h e old Lancaster School building was obtained and the citizens of Albany contributed over $10,000 for its alteration and equipment during the next two years. T h e valuable collections of Drs. March and Armsby formed the nucleus of a splendid museum which was materially added to later when Dr. McNaughton of Fairfield joined the faculty. 2 2 Albany Medical College received its charter by a legislative act passed on February 16, 1839, constituting "Daniel Barnard, Samuel Stevens, J o h n T a y l o r , Friend Humphrey, and their associates" a body corporate. T h e l e g i s l a t u r e , in 1 8 4 1 , a p p r o p r i a t e d $5,000 a y e a r f o r three successive years

for library and equipment. T h e appropriation was reduced to $1,000 annually in 1844. State aid throughout the years was made contingent on the granting of free scholarships to one student from each of the first four senatorial districts of the state. In 1850 the building was materially enlarged to make room for a greater institution to be known as the University of Albany of which the Albany Medical College was to be the Medical Department. T o t a l appropriations by the citizens of Albany and the legislature amounted to $31,000 by 1849. 23 T h e difficult problem of financial support of medical schools was discussed by Dr. Gunning S. Bedford, an imported professor from the South, who was selected to give the introductory address on October 1, 183g. In contrast to the increasing burden of debt under which many American schools were struggling, the professor of obstetrics declared that " T h r o u g h the liberality of the capital of the 'Empire State,' we are enabled to bid you 22 The charter gave the trustees the power to appoint professors and the right of removal on a two-thirds vote. The first professors were: Alden March, president, surgery; Ebenezer Emmons, chemistry and natural history; David M. Reese, theory and practice of medicine; James Armsby, anatomy; Gunning Bedford, obstetrics (Henry Green preceded Bedford in obstetrics for a short time); Thomas Hun, institutes of medicine; and Amos Dean, Esq., medical jurisprudence. 2 3 Walsh, op. cit., pp. 628-30.

i6a

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

welcome to these Halls, freed from the heavy oppression of accumulating debt . . ." Being provided with adequate buildings, more than ordinary financial support, and a location in an accessible Knickerbocker city, inspired Bedford to predict "the high destiny" of the College to be beyond all contingency, provided the "professors prove adequate to the discharge of their responsible duties." 24 Bedford's prediction was moderately justified by the subsequent successes of Albany Medical College. When the first course of lectures opened on January 3, 1839, the College had not yet received its charter, but fiftyseven students were in attendance. There was opposition from some quarters in the profession, especially from the three established schools of the state; but the citizens of Albany generally gave strong support to the trustees and faculty in the undertaking. T h e best attendance enjoyed by the College was in its third year, the term ending on February 24, 1841. There were 122 in attendance, thirty of whom graduated. T h e attendance continued to be above one hundred until 1848 when it dropped to eighty-eight. For fifteen years thereafter there were never more than ninety-nine or less than thirty-eight matriculants in a given term. During seven of the years between 1853 and 1863 two courses were given each year. T h e number of graduates each year until 1861 averaged about twenty-five. Rather strangely the attendance actually increased during the Civil War period. 25 Probably the greatest single factor in the consistent existence of the school y a s the fact that many of its professors were illustrious men, several of whom continued for many years on the faculty. March, president and professor of surgery, was the driving force of Albany Medical College until his death in 1869. Throughout those years March's near relative, Armsby, promoted the department of anatomy and then succeeded March as president. Amos Dean held the chair of medical jurisprudence for twenty years. Ebenezer Emmons, a chemist of note, held several different chairs until 1853, and Thomas Hun, in institutes of medicine, continued twenty years. James McNaughton, an Edinburgh-trained anatomist and surgeon, after distinguishing himself by dissecting the body of a criminal soldier, lectured for twenty years at Fairfield and then accepted a chair at Albany in 1840, where he remained thirty-four years. T h e Beck brothers, Lewis C. and T . Romeyne, who joined the teaching staff in 1840 and 1841, both gave distinguished service for more than a decade. 26 This feature of permanency in Albany's early history distinguished it and was in contrast to the shifting faculties in many of the contemporary schools. 24 G u n n i n g S. Bedford, Introductory Lecture Before the Albany Medical College, Delivered October 1, 1839, pp. 5 - 1 3 . passim. s» See Catalogue and Circular of the Albany Medical College, 1839; ibid., 1840-1850. Also see a table in Walsh, op. cit., p. 639. T h e requirements for graduation at Albany were essentially the same as elsewhere. T h e term was sixteen weeks and the combined fees, including five dollars matriculation and twenty dollars graduation fees, were ninetyfive dollars. Other doctors on Albany's Faculty were: H o w a r d Townsend, obstetrics, 1 8 5 3 - 5 5 , and subsequently materia medica until 1867; Ezra Carr, chemistry and pharmacy, 1 8 5 3 57; J o h n V. P. Quackenbush, obstetrics and diseases of women and children, 1855-70; a n d Charles H. Porter, chemistry, 1857-61 (?).

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A rather exclusive feature of the Albany organization was the charter provision for the appointment of five "curators" whose duty it was to examine orally all candidates for the degree. T h i s practice actually existed for half a century. T h e College was also distinguished for its attempt to provide satisfactory clinical instruction, in the absence of hospital facilities before the Albany Hospital was organized in 1851. Dr. March and his associates are credited with starting the college clinic idea. T h e Catalogue and. Circular for 1842 declared that ninety-nine cases were exhibited in eight weeks of the term. T w o years later the Circular reported 190 cases demonstrated in fourteen weeks of the term. From October 6, 1849, to J a n u a r y 19, 1850, a total of 279 cases and operations were listed. T h e establishment of a hospital, after the College's first twelve years of existence, was a progressive move that kept Albany in the van of American medical education. Without its clinic and hospital it might have justly suffered the fate of the backwoods schools. Instead, March and his associates met the challenge of their day and turned a country school into a city school with an extensive museum and library, satisfactory laboratories, and more than ordinary clinical facilities. 27 DEPARTMENT

OF

MEDICINE,

UNIVERSITY

OF

BUFFALO

Buffalo, a key frontier town at the eastern tip of L a k e Erie, was sacked and reduced to ashes by the British and Indians during the War of 1 8 1 2 . Less than a quarter of a century later recovery and development stimulated by the opening of the Erie Canal brought B u f f a l o to the place where its leading citizens contemplated the establishment of a college. During the s u m m e r of 1 8 3 6 s u b s c r i p t i o n s w e r e s o l i c i t e d f o r t h e e s t a b l i s h m e n t of s i x

professorships of five thousand dollars each and a general f u n d of twelve to fifteen thousand dollars. A building site was provided by one of the town's wealthiest men. T h e collapse of the nation-wide speculative craze later in the year put a sudden stop to Buffalo's rather grandiose educational scheme. Buffalo, then a city of twenty thousand or more, was forced to wait a decade before the project was revived. 28 Among the men of foresight and ability taking up residence in New York's western metropolis during the early forties were several physicians —Frank H. Hamilton, Austin Flint, James P. White, and T h o m a s M. Foote, all men of parts, who helped to create prestige for the city of their adoption. When a meeting of leading citizens was called (probably in 1845 or early 1846) to discuss the revival of the college idea, it was the physicians present who pressed the plan of obtaining a liberal university charter rather than limiting the institution to a school of medicine as was suggested by some. T h r o u g h the efforts of Nathan K. Hall a broad charter was granted to the University of B u f f a l o by the legislature on May 1 1 , 1846. T h e governing body, called the council, was made up of distin« Catalogue and Circular . . . 1850. Subsequently the Medical Department of Albany University became the Medical Department of Union University (1873). 28 Henry Wayland Hill, Municipality of Buffalo, Neu· York, A History, 1720-1923, Vol. II, p. 525.

164

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

guished men. T h e honorary office of chancellor went to M i l l a r d Fillmore, w h o retained the honor until his death in 1874. For nearly seventy years the institution was a university in name only, being only a collection of professional schools with little u n i f y i n g influence. Indeed, the Department of Medicine comprised all there was of the University for the first forty years. T h e council of fourteen members appointed a teaching staff of seven members for the Department of Medicine 011 August 25, 1846. Five of the new faculty, Drs. Coventry, Hadley, Webster, Lee, and Hamilton, held chairs in the Medical Institution of Geneva, located in the Finger L a k e district one h u n d r e d miles east. T h e fact that all the first appointees rem a i n e d on the faculty for five years is a record scarcely known in that day of peripatetic professors. Such a condition speaks well for the plans and policies of the council and the ability of the teachers to carry on peaceably. T h e B u f f a l o school continued to operate in a spirit of tranquillity, attracting to its faculty men of more than ordinary ability. T h e tenure of its teachers was less disturbed than the average contemporary school in its early years. 29 Dr. J a m e s P. White, who served in the chair of obstetrics for thirty-five years, h a d been a Fairfield student, but received his medical degree from Jefferson. Brief consideration of his connection with medical education is not complete without mention of his introduction of clinical teaching of obstetrics about 1850. For this innovation he received bitter criticism from both medical men and laymen. In retaliation he sued a newspaper for libel. W h i t e lost his case, but secured the vindication of his methods through the publicity thus afforded. J o h n C. Dalton, who learned experimental physiology under Claude Bernard in Paris, introduced vivisection in A m e r i c a while professor of physiology at B u f f a l o ( 1 8 5 1 - 5 5 ) . His teaching career later led him to the faculties of several other schools. Austin Flint, H a r v a r d graduate, distinguished himself while on Buffalo's faculty by his observations and pronouncements on the etiology of typhoid fever. T h e s e contributions along with the excellent work of other professors established f o r the Department of Medicine, University of Buffalo, an enviable reputation early in its history. 30 M u c h m i n u t i a pertaining to the school's early history is not available, 28

T h e faculty d o w n to the Civil War period was: J a m e s 1'. White, obstetrics, 1846-81; George H a d l e y , chemistry and pharmacy, 1 8 4 6 - 5 1 ; Charles B. Coventry, physiology, 1 8 4 6 - 5 1 ; Charles Lee, materia medica, 1846-70; James Webster, anatomy, 1846-51; Frank H . H a m i l t o n , surgery, 1846-60; Austin Flint, principles and practice of medicine, 184659; J a m e s H a d l e y , chemistry and toxicology, 1 8 5 1 - 7 8 ; J o h n C. Dalton, physiology, 1 8 5 1 55; B e n j a m i n R . Palmer, anatomy, 1 8 5 1 - 5 3 ; Edward M. Moor, surgery, 1852-82; T h o m a s F. Rochester, principles and practice of medicine, 1853-87; Sanford B. Hunt, anatomy, ' 8 5 7 - 5 8 ; T h e o p h i l u s Mack, materia medica, 1857-60; Sanford F.astman, anatomy, 1 8 5 9 70; Austin Flint, J r . , physiology, 1859-G0; Joshua R . I.athrop, materia medica, 1860-64. For the above information see: Annual Circular and Catalogue of the Medical Department of the University of Buffalo, 1846, p. 8; and Walsh, op. cit., p. 492. Several of B u f f a l o ' s faculty distinguished themselves elsewhere either before or after their teaching in B u f f a l o . 30 Walsh, op. cit., pp. 492-94.

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because the council's transactions, 1846-55, have been lost. From other sources Walsh discovered some facts. Lacking a building of its own at first, the Department of Medicine held its first lectures in the First Baptist Church. Soon a building was constructed. T h e Commercial Advertiser, on September 8, 1849, described the school's new edifice as being admirably adapted to the needs of medical education, mentioning especially a spacious dissecting room as unsurpassed in the entire country. T h e fact that the total cost of site and building was under $25,000 does not strongly support the optimistic report of the Advertiser. Second only to its very excellent faculty, the greatest factor in the successful development of the University's Department of Medicine was the adjacency of the Sisters of Charity Hospital, presenting opportunity for clinical teaching. In the light of the history of Fairfield and Geneva, one can readily conclude that the University of Buffalo's clinical opportunities insured its existence and distinguished it from the ephemeral country schools. 31 Buffalo's term of lectures was sixteen weeks in length, its first course beginning in February 1847. T h e reason for the late beginning was the presence of five Geneva professors on the faculty, who had to complete their courses at the Medical Institution of Geneva College before commencing courses in Buffalo. T h e Institution's Annual Circular and Catalogue for 1850 announced the establishment of a one-month preliminary term, a customary attempt in that day to raise medical education standards. T h e department's rules for graduation were comparable to the regulations imposed elsewhere, except that the age standard for graduates was a year higher, being twenty-two. Students having attended two courses at Geneva or one at Geneva and one in Buffalo, according to the school's first Annual Circular and Catalogue, were g i v e n the status of "perpetual pupils" in Buffalo, i.e., they could attend lectures gratis thereafter. Evidently the five professors who served both institutions sought to transfer the affections of their pupils from the country school to the city school. T h e Geneva trustees' toleration in face of the doings of its medical faculty must have been the part of expediency rather than justification. A wholesale dismissal of the five professors no doubt would have precipitated the extinction of the Geneva Institution that otherwise was permitted to suffer a more honorable termination by adoption. Buffalo, with hospital facilities, constituted the greatest single cause for the decline of Geneva, which lacked satisfactory clinical opportunities. Sixty-seven students attended the first session, which ended in J u n e 1847, with the graduation of eighteen. Thirty-four were graduated in 1848. For a decade thereafter the number of matriculants and graduates fluctuated slightly. Beginning with i860 a satisfactory and generally consistent increase in numbers witnessed to the permanency and prestige of Buffalo's first and only medical school established before the beginning of the Civil War. 32 31

Walsh, op. cit., p. 493. 32 Buffalo's fees were ten dollars per ticket (twelve for chemistry), three dollars matriculation, and twenty dollars graduation. Buffalo graduated thirty-four in 1848, two more

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C o u n t i n g separately the various arrangements and conditions under which certain schools existed, some sixteen institutions devoted to the object of offering medical instruction have been considered within the scope of this part. T h a t other schools of importance may have existed is granted but strongly doubted. Not a few plans for formal medical instruction were without doubt generated in the brains of energetic tutors here a n d there throughout the state whose success at private instruction fired them with zeal to expand to the point of blooming into chartered degreegranting schools. Indeed, a few schools actually were conceived in this manner. But where one succeeded, it is safe to presume that several others were stillborn or because of sterility never progressed beyond the point of being hoped for. T h e establishment of specialized and postgraduate schools or courses d i d not flourish in N e w York City or elsewhere in the state before i860, as much as in contemporary Philadelphia. James B a l l a r d has noted the unsuccessful attempt of the Scot, A l e x a n d e r Ramsay, w h o came to the United States with an extensive anatomic preparation and an insatiable desire to establish an anatomic museum and school of which the nation w o u l d be proud. H e repeatedly and unsuccessfully tried to establish schools in various parts of the country, including N e w York. 3 3 A glance at the schools of New York and its vicinity at almost any time during the nine or more decades covered by this study reveals two characteristic traits: first, the lack of harmony and fraternal feeling in the profession, and second, a lack of permanency in the policies of trustees and the tenure of professors. T h e greatest single contribution of the city schools to the development of medical instruction was the liaison of hospital and college, first demonstrated by L o n g Island College Hospital a n d Bellevue Hospital College. T h i s provision for clinical instruction, since more fully recognized as basic and fundamental, was European in origin. Its adoption in New York was accomplished in spite of the instability of the profession and the weakness of the educational structure. T h e upstate and western schools, especially the country schools, were admittedly organically weak in that they lacked clinical and anatomical facilities even more than the city institutions. A redeeming feature was the presence on these faculties of more than ordinary teachers, some of w h o m were nationally known and respected for their individual contributions. For this reason these backwoods institutions for a time compared favorably with the schools of the coast cities and furnished stimulating competition d u r i n g the twenties, thirties, and forties. From the viewpoint of national development Albany, Fairfield, Geneva, and B u f f a l o were sources of supply for the medical needs of western New York and the numberless thousands who trekked westward through the M o h a w k to the promised land. than received the doctorate at G e n e v a the same year. See Annual Circular and Catalogue of the Medical Department of the University of Buffalo, 1846, 1847, 1848, et seq. 33 J a m e s F. Ballard, "Notes on A l e x a n d e r Ramsay and His Anatomic Manuscripts," New England Jounal of Medicine, 206: 6 8 1 - 8 2 , March, 1932.

PART MEDICAL

SCHOOLS

V OF NEW

CHAPTER

ENGLAND

15

T H E MEDICAL SCHOOL OF HARVARD UNIVERSITY THAT seventeenth- and eighteenth-century New England looked to the clergy for much of its medical advice and care has been pointed out. Among the early educated Puritan ministry were those who obtained more or less medical learning in Europe, especially at Leyden. There were also present in the colony a few chirurgeons, apothecaries, and physicians, many of whom practised the preceptorial art. After the founding of Harvard in 1636, a few of its graduates are known to have gone to England or the continent to obtain a formal medical education. According to J . M. Toner's studies, New England was excelled in this respect by both the middle and southern colonies, where larger numbers of young men conventionally sought medical instruction abroad, especially during the eighteenth century. T h e self-contained colonists east of the Hudson seemed content to leave medical matters in the hands of Puritan divines and a few practitioners with various types of credentials. They early devoted themselves to matters of education by founding Harvard College (1636), but long delayed making of the institution little more than a theological seminary. Meanwhile the medical profession of New England hardly kept pace with their professional brethren to the south. T h e heritage of this delayed beginning is manifest in the subsequent development of medical education in Massachusetts and neighboring states.1 Nevertheless there were men who, early in Harvard's history, conceived of an expanded curriculum, including some instruction in medicine. President Henry Dunster in 1647 petitioned the New England Confederation for funds to purchase suitable books, "especially in law, phisicke, Philosophy, and Mathematickes" to further scholarship in "all professions." 2 A document entitled " A Modell For ye Maintaining of students & fellows of choise Abilities at ye Colledge in Cambridge, Tending to advance Learning among us, & to supply the publike with fit Instruments, principally for the work of the Ministry . . ." was presented to the General Court in 1663, by a Senior Fellow of the College, Jonathan Mitchell, ι See Parts I, II. 2 "Petition of Henry Dunster," Records England, I X , 95.

of the Colony 167

of New Plymouth

in

New

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BEFORE T H E CIVIL

WAR

H e s u g g e s t e d , as p a r a l l e l w i t h the n e e d f o r w e l l - t r a i n e d divines, schoolmasters, s t u d e n t s of l a w , etc., t h e w i s d o m of s e t t i n g aside some " S c h o l l e r s " as " p h y s i t i a n s w h o m a y b e c o m e a b l e e m i n e n t & a p p r o v e d in yt f a c u l t y , 8c be a p r i v i l e d g e d society o r C o l l e d g e in t i m e . " 3 A m o n g t h e m o r e t h a n f o u r h u n d r e d v o l u m e s in H a r v a r d ' s first l i b r a r y , w h i c h S a m u e l E l i o t M o r i s o n d e s c r i b e d as distinctly m o d e r n for that time, there w e r e t h r e e b o o k s o n m e d i c a l themes, o n l y o n e o r t w o of w h i c h surv i v e d t h e fire of 1764. 4 T h e loss of H a r v a r d ' s l i b r a r y b u i l d i n g by fire, o n J a n u a r y 24 of t h a t y e a r , d e p r i v e d the s c h o o l of a r a t h e r e x t e n s i v e m e d i c a l c o l l e c t i o n w h i c h h a d b e e n b u i l t u p by the gifts of f r i e n d s of H a r v a r d , a m o n g w h o m w e r e a M r . J a m e s of J a m a i c a a n d the f a m o u s Dr. R i c h a r d M e a d of L o n d o n . T h e a g g r e g a t i o n i n c l u d e d some a n a t o m i c a l cuts a n d a s k e l e t o n o f e a c h sex. T h e Boston Post-Boy and Advertiser, six d a y s a f t e r the fire s i g n i f i c a n t l y r e m a r k e d : T h i s Collection would have been very serviceable to a professor of Physic and Anatomy, when the revenues of the College should have been sufficient to subsist a gentleman in this character. 5 T h i s l o c a l n e w s i t e m l e d H e n r y R . V i e t s to i n f e r t h a t s o m e ideas of org a n i z e d m e d i c a l i n s t r u c t i o n w e r e in c i r c u l a t i o n as e a r l y as 1764 a n d t h a t possibly d e m a n d s h a d a l r e a d y b e e n m a d e o n H a r v a r d f o r s u c h i n s t r u c t i o n . 9 If s u c h i d e a s e x i s t e d t h e y r e c e i v e d t a n g i b l e m a t e r i a l s u p p o r t at least as early as 1770, w h e n t h e d i s t i n g u i s h e d D r . E z e k i e l H e r s e y of H i n g h a m , M a s s a c h u s e t t s , d i e d l e a v i n g a b e q u e s t of o n e t h o u s a n d p o u n d s f o r the e s t a b l i s h m e n t o f a c h a i r in a n a t o m y a n d s u r g e r y at H a r v a r d . H e r s e y ' s w i d o w a d d e d a n e q u a l a m o u n t to the f u n d w h e n she died. 7 T h e d e m a n d s of t h e c o l o n i a l m i l i t a r y forces o n t h e m e d i c a l p r o f e s s i o n d u r i n g t h e R e v o l u t i o n a r y W a r w e r e e x a c t i n g . M a n y of the o l d e r physicians, t r a i n e d a b r o a d a n d e n g a g e d in p r a c t i c e a m o n g i n f l u e n t i a l p a t i e n t s , f o u n d d i f f i c u l t y i n s u p p o r t i n g the R e v o l u t i o n . M o s t of the y o u n g e r m e n easily r a t i o n a l i z e d t h e i r s y m p a t h y a n d service w i t h the patriots. V i e t s m a i n t a i n e d t h a t s u r g e r y m a d e n o a d v a n c e as a r e s u l t of the w a r a n d that the s e r v i c e r e n d e r e d t o t h e t r o o p s was s c a n d a l o u s l y c r u d e . It is t r u e t h a t M a s s a c h u s e t t s c o n t r i b u t e d o n l y m o d e r a t e l y to the l e a d e r s h i p of the M e d i cal D e p a r t m e n t of t h e C o n t i n e n t a l A r m y . D r . B e n j a m i n C h u r c h of B o s t o n served as d i r e c t o r - g e n e r a l f o r a b r i e f term w h i c h t e r m i n a t e d w i t h his conv i c t i o n f o r t r e a s o n . A m o n g o t h e r s , the W a r r e n b r o t h e r s , J o s e p h a n d J o h n , d i s t i n g u i s h e d t h e m s e l v e s i n t h e w a r b o t h as soldiers a n d surgeons. V i e t s ' s 3 " A M o d e l l F o r y e M a i n t a i n i n g of students & f e l l o w s of choise A b i l i t i e s at ye C o l l e d g e in C a m b r i d g e . . ." Publications of the Colonial Society of Massachusetts, X X X I , 318-19. 4 S a m u e l E. M o r i s o n , The Founding of Harvard College, p. 266. 5 C i t e d in H e n r y R . Viets, A Brief History of Medicine in Massachusetts, p. 76. 6 Loc. cit. B y this t i m e m o r e t h a n a century h a d elapsed since Giles F i r m i n h a d att e m p t e d to carry o n s o m e f o r m of i n s t r u c t i o n in a n a t o m y . t O t h e r g i f t s f o r t h e e s t a b l i s h m e n t of professorships in the fields of m e d i c i n e at H a r v a r d were received e a r l y in its h i s t o r y . U p to 1790, $15,333 h a d been left by six persons for the a d v a n c e m e n t of t h e M e d i c a l S c h o o l . See Josiah B a r t l e t t , " A n historical sketch of t h e Progress of M e d i c a l Science, in the C o m m o n w e a l t h of Massachusetts . . . ," Collections of the Massachusetts Historical Society, Ser. 2, I, 116.

HARVARD

UNIVERSITY

d i s p a r a g i n g remark noted a b o v e c a n n o t be f u l l y accepted, because it cann o t be d e n i e d that the need for more a n d better t r a i n e d surgeons was constantly a n d increasingly manifest as the conflict progressed. C o l o n i a l A r m y surgeons k n e w w h a t anatomical k n o w l e d g e m e a n t to the m a n called u p o n to deal w i t h every form of injury to every o r g a n of the b o d y . T h e y h a d been in c o m b a t w i t h dysentery a n d other diseases in the c a m p . A l l too well w e r e they aware of the imperfect m a n n e r in w h i c h m a n y doctors to w h o m the h e a l t h of the c o m m u n i t y was intrusted w e r e t a u g h t . R e c o g n i t i o n of the deficiency was but a step removed from an effort to meet the need. 8 E v e n b e f o r e the R e v o l u t i o n , Joseph W a r r e n , w i t h an e x t e n s i v e practice, was e x p a n d i n g the c o n v e n t i o n a l system of m e d i c a l a p p r e n t i c e s h i p by off e r i n g to his p u p i l s systematic courses in v a r i o u s fields of m e d i c i n e . A m e r i can m e d i c i n e as well as the A r m y sustained a great loss w h e n h e fell in battle at B u n k e r H i l l at the age of thirty-four. H o w m u c h m o r e he m i g h t h a v e c o n t r i b u t e d to A m e r i c a n m e d i c i n e had he lived on, c a n o n l y be imagined. A m o n g the y o u n g H a r v a r d graduates w h o benefited f r o m his instruction a n d e m u l a t e d his ardent patriotism was his y o u n g e s t brother, J o h n . W h e n hostilities broke o u t J o h n left his busy practice w i t h E d w a r d A . H o l y o k e in Salem and v o l u n t e e r e d as a p r i v a t e in the ranks. L a t e r he transferred to the M e d i c a l D e p a r t m e n t a n d h e l d v a r i o u s i m p o r t a n t posts d o i n g w h a t he could to i m p r o v e the f u n c t i o n i n g of a p o o r l y e q u i p p e d a n d loosely o r g a n i z e d medical service. In 1777 W a r r e n b e c a m e s u r g e o n of the military hospital in Boston. T h r e e years later he e m b a r k e d u p o n an e d u c a t i o n a l p r o g r a m designed to elevate the professional standards of the h o s p i t a l physicians u n d e r his direction. H e offered a course of a n a t o m i c a l lectures w i t h dissections a n d demonstrations, the first course so e m b e l l i s h e d to be offered in Massachusetts. W a r r e n repeated the course d u r i n g the n e x t t w o years. T h e efforts of the y o u n g professor were a p p r o v e d by the n e w l y o r g a n i z e d (1780) B o s t o n M e d i c a l Society, the nucleus of the larger a n d m o r e active Massachusetts M e d i c a l Society organized in 1781. T h e lectures were a curiosity in Boston. President W i l l a r d of H a r v a r d and other intellectuals a t t e n d e d . T h e third series, g i v e n at the M o l i n e a u x House, was a t t e n d e d by H a r v a r d ' s senior class. A certain a m o u n t of secrecy a t t e n d e d these courses a n d the a c c o m p a n y i n g investigations at the military hospital. T h e e x i s t i n g p r e j u d i c e against dissection was not to be trifled with, since the e x a m i n a t i o n of the h u m a n body at that time was an e x t r a o r d i n a r y o c c u r r e n c e even w i t h the most i n q u i s i t i v e anatomists. As early as 1771 there existed a m o n g the H a r v a r d u n d e r g r a d u a t e s an a n a t o m i c a l society w h i c h h e l d p r i v a t e meetings for discussion of m e d i c a l a n d p h i l o s o p h i c a l questions. T h e s e y o u n g investigators were the p r o u d possessors of a h u m a n skeleton, b u t they p r u d e n t l y l i m i t e d their dissection to a p p r o p r i a t e animals. In 1774 several m e d i c a l apprentices took steps to s u p p l e m e n t their b o o k a n d e n g r a v i n g k n o w l e d g e of a n a t o m y by m o r e practical a n d first-hand o b s e r v a t i o n . T h e d a n g e r of β "Address Delivered in Huntington Hall," One Hundredth tion of the Medical School of Harvard University, p. 4.

Anniversary

of the

Founda-

MEDICAL EDUCATION BEFORE T H E CIVIL W A R discovery was so great that the effort was abandoned. Warren's lectures, 1780-82, then, were an innovation of more than ordinary significance. U p to that time Boston medical students and physicians w h o were not content without seeing anatomical demonstrations went abroad or to Philadelphia, where prejudice was earlier broken down. 9 J o h n Warren's activities, approved as they were by the Medical Society, strongly recommended him to H a r v a r d College, which had in trust the Herseian bequests. Although the f u n d was not yet sufficient to establish an endowed chair in anatomy a n d surgery as stipulated by the donors, the H a r v a r d Corporation was f u l l y determined to establish a medical institution. Dr. Warren submitted to the corporation a plan for a medical department which was adopted by the College on September 19, 1782. O n N o v e m b e r 27, probably before he had completed his third course of lectures at the A r m y Hospital, Dr. J o h n Warren, a degreeless practitioner, was appointed to the professorship of anatomy and surgery. Dr. B e n j a m i n Waterhouse was selected on December 24 for the chair of theory and practice of physic. At first it was expected that either Warren or Waterhouse w o u l d give the lectures in chemistry and materia medica. T h i s plan was modified in May 1783, when A a r o n Dexter accepted the professorship of chemistry and materia medica. On October 7 following, these three professors were officially inducted into office at the Cambridge meetinghouse, in the presence of civil authorities, including Governor J o h n Hancock, the clergy, college officials, professors, and general public. Professor Dexter was not present, but Warren and Waterhouse were there and delivered learned orations in Latin. 1 0 Professor Warren was of colonial making, a product of the preceptorial system. Seeing the weaknesses of the apprenticeship plan, he threw his whole force into the movement to provide a supplement in the form of public lectures sponsored by a recognized institution of learning. Warren was an excellent lecturer. According to Oliver Wendell Holmes, a professorial descendant of Warren, "the dryest bone of the human body became in his hands the subject of animated and agreeable description." One of Warren's young colleagues declared that the charm of his teaching was "derived from the animation of delivery, from the interest he displayed in the subject of his discourse, and from his solicitude that every auditor should be satisfied both by his demonstration and by his explanation." Warren's lectures, often two or three hours long, combined with a large practice, made a heavy strain on his energies. When the Charlestown ferry to Cambridge was not operating, the zealous professor of anatomy had to drive the long route through R o x b u r y and Brookline. His professorial duties were lightened in 1809 by the appointment of his son, J o h n Collins Warren, as adjunct professor. T h e Warrens faced with ingenuity the problem of obtaining anatomical specimens. When body snatchers failed 9

Bartlett, op. cit., pp. 1 1 0 - 1 7 . According to Bartlett, up to J a n u a r y 1, 1 8 1 3 , seventeen H a r v a r d graduates had received medical degrees abroad and nine in Philadelphia. κ» The Harvard Medical School, pp. 1 - 3 5 . Dr. Waterhouse s lecture called forth the comment that it was not in " N e w England L a t i n . " Dexter was inducted a short time later.

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171

they took advantage of arms, legs, and other materials amputated at the hospital. Dr. W a r r e n must have feared remaining in office until he should be a burden on the institution, for he twice resigned his professorship, but both times it was rejected. He died in 1 8 1 5 , still an active member of Harvard's medical faculty. Dr. B e n j a m i n Waterhouse was a resident of Cambridge, where he established a practice less extènsive than Warren's. 1 1 H e was an ornament to the profession and distinguished himself as the first physician to practise vaccination successfully in this country. T h e fact that he was the only European-trained member of the faculty seemed to have unfitted him for a fraternal relationship with his colleagues. W h e n elected to the chair of theorv a n d practice in 1782 he was only twenty-nine years old, but was no doubt one of the best-trained physicians to return home from Europe u p to that time. Holmes, who carried the scar of Waterhouse's vaccination, remembered him as a pedantic scholar of magisterial air. He was less interested in the clinical aspects of medicine than in the natural history and botanical phases. 1 2 A lecture which he delivered at the close of the 1804 medical course was calculated to show the evil effects of tobacco (especially cigar smoking) on young men. He also lamented that among the students at C a m b r i d g e "unruly wine and ardent spirits have supplanted sober cider." T h e lecture went through six editions and was translated into several foreign languages. Not unlike his contemporary, B e n j a m i n R u s h of Philadelphia, Waterhouse was confident of his ground and equally outspoken. W i t h his scholastic background he must have quickened in his students a desire for a broader knowledge. " T h e good people of Cambridge," recalled Holmes, "listened to his talk when they were well, and sent f o r one of the other two doctors when they were sick." T h e student of medical history today must add another flash of light to Holmes's picture of Waterhouse as a pompous old gentleman with a gold-headed cane a n d powdered hair tied in ribbon. From a vantage point one hundred a n d fifty years removed, the student of history now sees him as a trained scholar, scientist, and physician, trying to reflect the light of E u r o p e a n learning in an outpost of eighteenth-century civilization. T h i s outlook and attitude often brought him into conflict with his colleagues and made him the object of ridicule. Relations between Waterhouse and W a r r e n were at times very tense. Not unlike the co-founders of Pennsylvania's first medical school, J o h n Morgan and William Shippen, these fellow practitioners at times accused each other of deceit, doubledealing, lying, and slander. T h e corporation even acted at times to keep 11 While studying in London young Waterhouse lived with his uncle, J o h n Fothergill, a leading practitioner of that city. Subsequently he studied at E d i n b u r g h and was graduated at Leyden, in 1780. ι 2 Waterhouse's gift of natural history specimens f r o m Dr. J o h n C. Lettsom of L o n d o n formed the basis for a natural history museum at Cambridge. Waterhouse also established the botanical gardens which were considered an asset to medical teaching. His lectures in natural history and botany are said to have brought him more reputation than his purely medical courses. See Viets, op. cit., pp. 1 1 1 - 1 3 .

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the two professors from personal encounter. Waterhouse, after opposing the removal of the School of Medicine to Boston in 1810, lasted only two years more, going down before the attacks of the new and younger element in the school, represented by J o h n Collins Warren and James Jackson, who succeeded to the chair of theory and practice in 1 8 1 2 . 1 3 Aaron Dexter, who accepted the chair of chemistry in 1783, like Warren did not possess a medical degree. He was a Harvard graduate of 1776 and an apprentice of Samuel Danforth, called "the most scientific chemist then on the stage." 14 Dexter enriched his medical experience by serving as ship surgeon during the Revolution. His membership in the Massachusetts Historical Society, the American Academy of Arts and Sciences, appointment to the staff of the Massachusetts General Hospital, and his activity as a founder of the Massachusetts Humane Society brought Dexter into prominence as a physician and citizen. From Holmes's characteristic description of Professor Dexter one learns of colorful and entertaining chemical experiments "not wholly uninstructive," marked by startling precipitations, pleasing changes of color, brilliant coruscations, alarming explosions, and odors innumerable and indescribable. N o great accomplishment marked his connection with the Harvard School of Medicine. With equanimity of spirit Professor Dexter presided over his department until 1816, when he resigned and became professor emeritus. Dr. J o h n Gorham, appointed adjunct professor in 1809, succeeded to the professorship when Dexter withdrew. 1 5 T h e Boston Continental Journal, and Weekly Advertiser, on September, 18, 1783, carried a September 11 dispatch from the University at Cambridge giving an official announcement of the forthcoming opening of the "Medical Institution," hoping that it might meet with general approbation, and surpass "even their most sanguine expectations." T h e long and tedious announcement incorporated what seem to be resolutions governing the administration of the Institution. T h e library was to be enriched with a collection of approved "authors in anatomy, surgery, physic, chymistry, etc." "Complete anatomical and chymical apparatus, a set of anatomical preparations, with a proper theatre . . ." Avere contemplated. It was planned to make application to the General Assembly for the bodies of executed criminals and suicides. T h e professors were at first to receive no sustenance from the University other than the tuition receipts. T h e limited source of income apparently explains the special privilege of being allowed to live outside the campus village, Cambridge. It was required that each professor hold a bachelor of physic or a master of arts degree, and that he be an adherent of the Protestant Christian faith. Under the plan the professors agreed to utilize their private practice as much as possible in providing clinical material. 1 6 1 3 The Harvard Medical School, pp. 15-20. Viets, op. cit., pp. i n f . 14 The Harvard Medical School, p. 31. " Holmes, op. cit., pp. 5-7. Dexter, after 1791, benefited by the Major William Ewing gift of one thousand pounds " f o r the sole purpose of enlarging the salary of the Professor of Chemistry." ι» The Continental Journal, and Weekly Advertiser, September 18, 1783.

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At first clinical facilities were practically limited to what the teachers could prov ide from their private practice, except for what Warren could provide through his connection with the Army Hospital in Boston. Practical use of teaching cases at the Boston Almshouse was not made available for the Institution until 1810, even though Warren and Dexter were both on the attending staff for years and the corporation of the College petitioned the overseers of the poor for the privilege as early as 1783. Viets suggested that Waterhouse had some sort of position which he used to some advantage at the Marine Hospital established at Charlestown in 1803. T h e Boston Dispensary, incorporated in 1801, and a few beds at the Charlestown State Prison, erected in 1805, provided some bedside opportunities. T h e enlargement of the faculty and removal to the city in 1 8 1 0 gave new impetus to teaching, but effective improvement in clinical teaching can hardly be dated before the opening of the Massachusetts General Hospital in 1 8 2 1 . 1 7 T h e first lectures of the Medical Institution were given in the basement of H a r v a r d Hall. Later, rooms were fitted up in Holden Chapel for the three medical professors. At first some twenty students attended the lectures, besides "those members of the Senior Class of the University who obtained the consent of their parents." 18 T h e first courses given by Warren and his colleagues at Cambridge were very short. By 1809 the term of instruction had been lengthened to eight weeks, and a year later the term was approximately three months in length. Candidates who were either college graduates or able to evince an acquaintance with Latin, experimental philosophy, and mathematics were regarded as having met the premedicai standard. Acceptable candidates, who in addition had read two years with a reputable practitioner, attended two courses of lectures in the respective branches and spent another year terminated by the passing of a public examination and the defense of a dissertation, were eligible for the bachelor of medicine degree. Bachelors of seven years standing, who had spent that time in practice, could on the passing of a public examination and the successful defense of a Latin and an English dissertation, q u a l i f y for the doctorate. Not until 1 8 1 1 did Harvard offer a doctorate in course. 19 Waite computed that Harvard gave fifty-one medical degrees before the close of the century, only one of which was an M. D., in the year 1795. Four ad eundem doctorates were conferred up to and including the year 1800. Assuming the accuracy of Josiah Bartlett, who wrote in 1 8 1 3 , all five of these candidates must have fulfilled the seven-year clause. During these same years sixteen honorary M. D. degees were given. T h i r t y bachelor of medicine degrees were granted; one of these was honorary. 20 Thirty-four 1 7 The Harvard

Medical

School, pp. 49—51 ; Viets, op, cit., p. 1 1 3 .

ι» Francis Packard, History of Medicine in the United States, I, 435. T h e citation is quoted by Packard but no reference is given. i»/fei'd., p. 436; Bartlett, op. cit., p. 116. 20 Frederick C. Waite, "Medical Degrees Conferred in the American Colonies and in the United States in the Eighteenth Century," Annals of Medical History, 9: 3 1 8 , J u l y

1937·

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earned degrees in eighteen years was a rather feeble accomplishment for a college-attached school several day's journey from its nearest competitor. Bartlett stated that before the year 1810 forty-seven received the M. B. degree and five the M. D. degree. Presumably he was not including the honorary and ad eundem degrees. 21 T h e lethargic progress of the school at Cambridge until 1810 can be attributed partially to the scarcity of both anatomical and clinical material. T h e Warren-Waterhouse feud must have exhausted some vital energy that otherwise would have been expended in building up the institution. Vestiges of animosities between Tories and Patriots lingered on for a time, but even this did not prohibit both elements from entering into the establishment of the Massachusetts Medical Society in 1781, before the surrender at Yorktown. So far as the medical professors at Harvard were concerned the Revolution was an issue no greater than national politics. Waterhouse later allied himself with the Jeffersonian Republicans, an affiliation untenable to Warren and Dexter, as well as to the majority of New Englanders. Trouble between the Society and the faculty threatened soon after the establishment of the school, but was quickly settled. Some members of the profession assumed that the Society's charter right to examine and license candidates was exclusive. T h e professors at Cambridge and their supporters felt that a charter to conduct a college implied the right to examine candidates and confer professional degrees on those qualified. T o the credit of all concerned, after lengthy conferences it was agreed that the diploma of the College and the certificate of the Society were both satisfactory credentials. 22 Removal of the school to Boston in 1810 was the result of a concerted move to provide better facilities for teaching medicine, to relieve the teachers who lived in Boston from the necessity of traveling to and from Cambridge, and to make possible longer and more minute courses of lectures. Harvard Medical School's new quarters were at what then was 49 Marlborough Street, a room previously opened by Dr. John Collins Warren for the study of practical anatomy. 23 A circular in the form of a letter was issued on September 5 of that year calling attention to the move and consequent opportunities for students to attend the practice of their professors and of the Almshouse without any additional fee. T h e circular expanded at length on all the literary and professional advantages of living in Boston, a city of 30,000 to 40,000 inhabitants, surrounded by the "large towns of Charlestown, Cambridge, Roxbury, and Dorchester." T o answer the conventional charge that the cost of city dwelling was expensive, the letter stated: T h e professors will be able to point out houses, where the students may be lodged and boarded for $ 3 . 5 0 or $ 3 for a week. T h e y will endeavor to render 21 Bartlett, op. cit., p. 1 1 7 . During these twenty-eight years only eight student dissertations were published. 22 Ibid., p. 1 1 9 . 23 Joshua L. Chamberlain, Harvard University, Its History, Influence . . . , p. 116.

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the situation of the students comfortable, and to promote their improvement in medical learning, by every means in their power.24 U n d e r such circumstances it was expected that students would "resort to Boston from every part of the country" so that the school might become " w h a t it ultimately should be, T h e Medical School of New England." T h u s , after nearly three decades of feeble existence as a country school, H a r v a r d Medical School became a "city school" and adapted all its advertising propaganda accordingly. T h e Circular of J u n e 1, 1 8 1 1 , after announcing a reduction of the anatomy fee so as not to exceed the fee in other places, made a declaration which was suggestive of professional difficulties from within and without. Significantly, the statement was signed by all members of the faculty except Waterhouse, whose dismissal from the teaching staff had not yet occurred. In part, the professors declared that they had "never been guided by the hope of pecuniary compensation" in all their relations with the school. On the contrary, they did not "expect to receive any reward of this nature, which will compensate for the sacrifice of private practice to their official duties." Indeed, the anatomy department, which attracted the largest attendance, had operated at a loss, not counting the anatomical preparations and the labor of the professors. T h e teachers felt that they were occupying a place "important to the interests of medical science in this part of the country" and were detemined to fulfill the duties of it to the utmost of their ability, so long as they received the approbation of the respectable portion of the medical community of the state. T h e principal occasion for these significant remarks was an effort on the part of some physicians to obtain a charter for another school to be organized in Boston and to be known as the Massachusetts College of Physicians. At a meeting of the corporation about this time the two Warrens, Dexter, and Jackson frankly declared their determination to serve no longer on the faculty with Waterhouse who, they declared, was furthering the plans for another school, besides circulating false, scandalous, and malicious libels against the Warrens. T h e corporation was sufficiently impressed to act on the case by dismissing Waterhouse in 1812. 2 5 Promotors of the new school idea seem to have obtained the support of the R e p u b l i c a n members of the Massachusetts legislature. T h e charge that H a r v a r d enjoyed a monopoly in the field of medical education was suf24 Circular oj Harvard Medical School, Boston, September 5, 1810. In the J o h n Warren Manuscript Collection of the Boston Medical Library is a manuscript said to be a copy of the first Circular issued by the Medical School, dated November 5, 1 8 1 0 , announcing the beginning of the lectures, fifty to sixty in number, on the first Wednesday in December, the number to gradually increase "till it equals that given in the most respectable seminaries in the United States." T h e establishment of the new professorship in clinical medicine was cited as an effort to do better teaching in diagnosis and therapeutics. T h e fees were announced as: anatomy, physiology, surgery, and midwifery by the Warrens, twenty-five dollars; theory and practice of physic, Waterhouse, fifteen dollars; chemistry a n d materia medica, Drs. Dexter and G o r h a m , fifteen dollars; and clinical medicine, J a c k son, twenty dollars. 25

Packard, -op. cit., pp. 444 f.

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ficient to attract the active interest of T h o m a s Jefferson's disciples. T h e Boston Medical Library contains a pamphlet in which is a letter dated January i, 1812, which was addressed to a Republican member of the lower house. A preface suggested the impropriety of obtruding professional disputes into the newspapers when the subject was to be fully discussed by the legislature. T h e writer (probably John Warren) of the unsigned letter had, before publication, the consent of the " R e p u b l i c a n member," w h o replied in a pamphlet, on January 20. Both gentlemen expressed a sincere desire "to prevent the repetition of disturbances and disp-aceful scenes, which formerly occurred at Philadelphia, and are now existing at N e w York . . ." 2e T h e s e New England gentlemen deserved credit for adhering to a form of professional ethics in the conduct of their quarrels. Nevertheless both writers indulged in the use of vehement epithets born of wounded pride and intense devotion to an ideal. T h e physicians who were sympathetic with Harvard controlled the State Society and were able through power of lobby to block the granting of a legislative charter to the insurgent group. T h u s the Federalists of the medical profession prevailed over the minority group that adhered to the American school of political thought founded by the great Virginian. 2 7 John Collins Warren succeeded to the chair of anatomy and surgery in 1815 on the death of his illustrious father. A l t h o u g h the younger Warren lacked the stimulating platform manner of his father, he was most excellently trained and was noted for the special care with which he prepared his lectures. 28 He was much devoted to dissecting, as is implied by his accomplishments in that field. It must have been the result of his diplomatic insistence that the faculty in 1825 voted to appropriate three hundred dollars annually to be disposed of by the professor of anatomy in encouraging the study of anatomy. Presumably no official records were required or kept to account for the expenditure. Even this gesture of liberality did not solve the problem as long as there was no anatomy law other than the adding of dissection to the capital punishment for murder. A t times popular feeling against dissection was so intense that Dr. Warren feared for the school building and even his own home. In 1825 Warren and Dr. Jacob Bigelow were asked by the School to draw u p a dissection act. Nothing materialized until 1830 when, largely due to the efforts of Warren, the Massachusetts legislature passed the first liberal 2β R e f e r e n c e here is n o d o u b t m a d e to t h e M o r g a n - S h i p p e n - R u s h f e u d , w i t h its m a n y ramifications, in P h i l a d e l p h i a , a n d the N e w Y o r k m e d i c a l s q u a b b l e s i n v o l v i n g N i c h o l a s R o m a y n e , et al. 27 A Letter Addressed to A Republican Member of the House of Representatives of the State of Massachusetts on Subject of . . . ; An A?iswer to A Letter Addressed to . . . T h e a u t h o r of the first p a m p h l e t f o u n d the answer so r e v o l t i n g to h i m that he p e n n e d Reply to a Pamphlet Purporting to be An Answer . . . w h i c h is a r e m a r k a b l e e x h i b i t i o n of v i t u p e r a t i o n s u b m i t t e d w i t h an air of self-righteousness. 2 8 D r . W a r r e n trained f o r o n e year u n d e r his f a t h e r a n d then o b t a i n e d a dressership at G u y ' s H o s p i t a l , L o n d o n , u n d e r the f a m o u s Sir Astley C o o p e r . H e then spent t w o y e a r s i n E d i n b u r g h , H o l l a n d , B e l g i u m , a n d Paris, u n d e r the world's best medical professors, e a r n i n g his d e g r e e at E d i n b u r g h b u t a b s o r b i n g m u c h of P r e n c h m e d i c a l t h o u g h t .

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anatomical law to be enacted in the United States. In 1834 the prescribed time to elapse between death and delivery for dissection was reduced from thirty-six to twenty-four hours. Still greater liberalizing occurred in 1845 when delivery of the bodies was made mandatory rather than permissive. This was a real contribution to anatomical study, but the change of the "shall" back to "may" in 1859 severely crippled the development of the anatomy department. 28 Warren and James Jackson were instrumental in founding the Society for Medical Improvement which subsequently became the Boston Medical Library. With Jackson, Jacob Bigelow, and others, Warren helped to found the New England Journal of Medicine and Surgery, which merged with the Medical Intelligences in 1828 and became the Boston Medical and Surgical Journal. Warren was active in the establishment of the Massachusetts General Hospital which opened in 1821 and provided Harvard Medical School with a more adequate supply of clinical material. Warren's fame as a surgeon was immortalized by his performing an operation on October 16, 1846, at the Massachusetts General Hospital, on a patient anesthetized by ether administered by W. T . G. Morton, who thus publicly demonstrated his epoch-making discovery. Warren's sincere devotion to scientific medicine was curiously evidenced by his final instruction for the dissection of his own body and the preservation of his skeleton, "preserved, whitened, articulated, and placed in the lecture-room of the Medical College, near my bust; affording, as I hope, a lesson useful, at the same time, to morality and science." John Collins Warren longed to be the highest type of physician. In this desire he succeeded honorably. 30 T h e passage of the Massachusetts Anatomy Act in 1830 prepared the way for the establishment of a separate chair in the principles of surgery. Such a chair was created in 1835 and given to Dr. George Hay ward, whose duty it was "to give elementary lectures on the principles of surgery and clinical lectures on the surgical cases in the Massachusetts General Hospital." T h e arrangement did not rob Warren of his eminence in the operative clinic. When Warren resigned, surgery was incorporated in one chair with Hayward as professor. T h e Hersey chair of anatomy was removed to Cambridge, and instead the Parkman professorship of anatomy and physiology was created and given to Oliver Wendell Holmes, who continued until many years subsequent to the events marking the close of this study. Hayward continued in surgery for only two years, being succeeded by Henry J . Bigelow, for many years the leading surgeon of the General Hospital. He served as professor of surgery until 1882, during much of which time he 2» T h e 1830 act became effective in 1831. T h e law carried a penalty for the violation of graves and provided that proper authorities may deliver all bodies, to be buried at public expense, to regularly licensed physicians to be used for the advancement of anatomical science, preference being always given to medical schools. This Massachusetts law preceded by one year the first such act in Great Britain. The Harvard Medical School, pp. 4-6. s» T h e best source on John Collins Warren is Edward Warren, John Collins Warren, (a Vol. i860), from which this information is abstracted. He died in 1855, having been emeritus professor after his resignation in 1847.

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was the dominant member of the faculty. His original surgical procedures gave him professional eminence at home and abroad. 31 Dr. Holmes had given two courses in anatomy at Dartmouth before he accepted the Parkman chair at Harvard in 1847. He was thirty-eight years of age and well versed in anatomy. Holmes was a pioneer in microscopy, beginning in the summer of 1858 a course illustrating the use of the microscope and microscopic anatomy. His recitations on osteology enhanced his reputation for having a detailed grasp of his field. T h e rise in importance of the demonstrator under Dr. Holmes's regime was due to the professor's distaste for handling the practical details of conducting a department, especially the distasteful business of providing bodies. As time went on Holmes became more and more devoted to his lectures, leaving the demonstrator "Autocrat of the Dissecting T a b l e . " 3 2 Dr. Holmes was preeminently a man of letters; hence his lectures served as a natural outlet for some of his talent. His lectures were a veritable storehouse of apt illustrations and unexcelled simile. T h e mesentery he compared to the shirt ruffles of a former generation, a sweat gland to a fairy's intestine, and the brain to an English walnut in its shell. In his earlier years at Harvard, Holmes was given the one o'clock hour for his daily lecture, the time of day when medical students are least disposed to pay respect to a didactic lecturer. With his superior endowment of sympathy and humor, he was the bestequipped professor to preside at such an hour. 33 Dr. James Jackson, who was elected to Harvard's first chair of clinical medicine, was himself a Harvard graduate, having received the bachelor's degree in 1802 and the doctorate seven years later. Previous to 1802 Jackson had studied a year or more in London hospitals, becoming especially interested in the new process of vaccination under Dr. William Woodville at St. Paneras Hospital. On his return to Boston in 1800 he promptly opened an office and began the building of a practice with emphasis on internal medicine. James Jackson's life can not be surveyed without constant notice of the fact that he was intimately and affectionately associated with J o h n Collins Warren throughout his long career. Together they sought to imbue the Harvard Medical School with the scientific spirit of medical centers in Europe. Jackson had much to do with moving the School to Boston, getting the new school building on Mason Street, establishing the General Hospital, and developing medical journalism. He became professor of theory and practice in 1812. Although Jackson was not regarded as an original teacher, investigator, or writer, his persistent labors and all-round grasp of the problems of medicine and medical education made of him a most powerful character in the development of New England medicine. It was said in 1881 that "no physician in Massachusetts ever exerted so large and lasting an influence over his professional brethren 31

The Harvard Medical School, pp. 3-10, 49-54. 32 Six demonstrators served during Holmes's long term, several of whom became prominent surgeons. As a result the demonstratorship came to be regarded as a steppingstone to surgery and a hospital appointment. Six demonstrators also served under John Collins Warren from 1815 to 1847. 33 Ibid., pp. 7-9.

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34

or his patients." Holmes spoke of him affectionately as a " N e w England B r a h m i n , " and "altogether admirable at the bedside of sick." His son, J a m e s Jackson, Jr., writing a description of H a r v a r d Medical School to a friend in Europe, said of his father, " Y o u will not deem it an affectation in me, I am sure, to say that I listen to him with infinite delight and satisfaction . . . he does understand the art of teaching better than any man with whom it has been my good fortune to meet." T h e tragic death of J a m e s Jackson, Jr., in 1834, on the threshold of a promising career, crushed his father and robbed Massachusetts of one of its most brilliant and well-trained young physicians. 35 Dr. Jackson retired in 1836, four years after J o h n Ware had been made adjunct professor of theory and practice at Jackson's request and with the provision that no additional expense would be placed upon the students. Ware was a modest hard-working physician, admired by the students for his sound knowledge and advice, much of which is preserved in several of his published addresses. He warned against specialism at the expense of losing a well-balanced broad view of medicine. A zeal for study he held to be necessary to acquiring a true appreciation of the medical profession. T h e department of theory and practice, according to the Circular for 1 8 4 1 - 4 2 , was equipped with fifty plaster casts imported from Paris. T h e y were colored, and represented "many elementary forms of disease." For fifteen years they continued to be proudly mentioned in the official publications as "recently imported." These ponderous objects were rarely used by the professors to illustrate their lectures. In 1 8 5 2 - 5 3 the pathologist, J . B. S. Jackson, was associated with Ware, and the next year Morrill Wyman became adjunct professor and so continued until 1857. George C. Shattuck succeeded Dr. Wyinan and, in 1859, when Ware resigned, he became the Hersey professor. In that year Henry I. Bowditch appeared as professor of clinical medicine. 3 " In the year before Harvard Medical School was moved across the Charles R i v e r (1809), J o h n Gorham, formerly a private pupil of his father-in-law J o h n Warren and an 1804 medical graduate of Harvard, was appointed adjunct to Professor Dexter in chemistry. T o his special credit he had two years of European training and a disposition which, according to James Jackson, had made no enemies in twenty years. When Dexter received emeritus status in 1816, Gorham succeeded to the Erving professorship which he filled creditably until 1827. His successor, J o h n White Webster, a member of the American Academy and associate of several foreign societies, gave the lectures until 1849, when in a moment of rage he bludgeoned and killed his colleague, George Parkman. 3 7 T h e official University 3·» Packard, op. cit., pp. 436 f. Packard quotes S. A. Green. 35 J a m e s Jackson, Sr., prepared and published in 1835 A Memoir of James Jackson, Jr., M.D. T h e bereaved father pathetically portrays his devotion to his son. 36 When J a m e s Jackson became professor of theory and practice in 1 8 1 2 he continued to carry the responsibility for the chair of clinical medicine. Eventually the idea of a separate chair became rather dormant. Bigelow combined the two f r o m 1 8 4 7 - 5 5 , then Shattuck was assigned to "clinical medicine," inheriting the J a m e s Jackson professorship of clinical medicine when it was created in 1858. 37 Parkman also gave the chemistry lectures on the campus.

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record at the time stated that Ε. N. Horsford was appointed lecturer in chemistry for 1849-50, " i n the absence of the Erving Professor." A permanent appointment was made in 1850 when Josiah Parsons Cooke was named, with instructions to reside in Cambridge and lecture both on the campus and in the city. D u r i n g his six years of lecturing in the Medical School he introduced analytical chemistry. He resigned from his city responsibilities in 1856. John Bacon accepted the chair in 1857 a n d did much to magnify his office by expanding the laboratory facilities and offering summer courses. H e resigned in 1871. 38 In 1815 W a l t e r C h a n n i n g was appointed lecturer in obstetrics, and three years later he was honored with a professorship in obstetrics with medical jurisprudence thrown in. Dr. Channing continued in his dual position for thirty-nine years. T h e Catalogue of 1830 contained the first specific mention of the department's activities by stating it was equipped with models from Florence and plates and preparations. T h e Circular eleven years later offered the information that the class was divided into groups for quizzing and demonstration on a "suitable machine." D. H. Storer took the chair in 1855. Dr. Storer, like many medical professors at midcentury, was imbued w i t h the importance of clinical observation and instruction. Channing's teaching had been almost entirely didactic, with a little m a n i k i n experience and occasional demonstrations on "models made in Florence." Storer attempted seriously to provide practical experience for his pupils. A sort of bounty system was devised. T w o dollars was paid to physicians for each case turned over to the School. T h e Boston Dispensary was the principal source of supply. In 1858 "separate instruction" was offered in operative obstetrics, but this must have been little, as was also the number of cases available for student practice. Many a student before i860 went from school into practice before meeting his first delivery. 38 T h e 1855 Catalogue announced the lectures in obstetrics as comprising the anatomy and physiology of the pelvis, symptoms and diseases of pregnancy, and classifications of labor, well illustrated by specimens and plates. U n d e r the same professorship were offered lectures in medical jurisprudence, with special attention to phases having a bearing on obstetrics, "namely, impotence, superfoetation, retarded gestation, abortion, pretended pregnancy, rape, infanticide, etc." Unfortunately the Harvard Corporation did not see fit to create a separate chair in medical jurisprudence until long past the middle of the century (1878).40 Before 1816 materia medica was taught principally by the professor of chemistry. Jacob Bigelow then began as lecturer in materia medica and in 38 The Harvard Medical suitable laboratory.

School,

pp. 31-34. In 1812 the Corporation voted $170 for a

8» Ibid., pp. 37-40. According to this source, before 1835 t h e relationship of teacher and student under the apprenticeship system was more intimate than after. It seems that a private p u p i l before 1835 received more opportunity to observe and practise obstetrics with his preceptor than when more of the burden of teaching was shifted 011 to the school, which could not yet command necessary material. T h e ever present specter of puerperal fever was also an inhibitory factor. *o Loc. cit.

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1824 was advanced to a professorship, with which he combined clinical medicine from 1836 to 1855. Edward Hammond then succeeded Bigelow. A department of pathological anatomy was created in 1847, with J . B. S. Jackson as professor. Before that time the clinicians tried to pass on their meager knowledge of the subject to the students. T h e importance of pathology was emphasized when George Cheyne Shattuck endowed the chair in 1854, and two years later when pathology was declared a requirement for graduation. Because of interrelationship, physiology was first regarded as in the field of the professor of anatomy. Harvard so regarded it and made it a part of the Parkman chair, to which Holmes was appointed in 1847. Not until 1871 was it made an independent department. As early as 1858 dermatology received some recognition as a specialty when James C. White, by invitation, gave a few lectures on parasites. 41 T h e student of American medical history cannot doubt the superiority of Harvard's faculty during the period of this survey. For the time, the lectures in all branches must have been learned and valuable. T h e extended tenure of its teachers and its more than ordinary freedom from faculty feuds and professional jealousies put it in a class not occupied for any length of time by its contemporary city schools. As has been pointed out, Harvard suffered from lack of anatomical material, but probably no more than the average city school of the day and less than the country schools. With all the glowing announcements of clinical opportunities which the catalogues and circulars featured from year to year following the opening of the Massachusetts General Hospital in 1821, the fact remains that Harvard students whose apprenticeships lacked practical clinical experience often entered practice never having had much training outside of textbooks, lecture halls, and limited laboratory experience. In the first place the General Hospital was not a large institution. By the year 1848, just after the completion of two new wings, the bed capacity was increased from sixty to a maximum of 150. 42 There were never more than seventy-two patients in the institution at one time prior to the year 1847. Thereafter the average was never greater than 140 until the year 1861. 4 3 Harvard was never a large school, in numbers of students, during the years covered by this study. Even then there were probably too many students for the practical use of available clinical facilities. Some of the students who attended the ward visits at the General Hospital in the early and middle decades of the century reported that the number of students was often too great for many of them to get first-hand acquaintance with patients until toward the end of the term. By that time many students had dropped out, leaving the wards less crowded. Obviously the students who withdrew were more poorly prepared for practice than the faithful remnant that continued on.44 T o o often attendance on clinical practice 41

Ibid., •>-' N. I. 43 Ibid., ** The medicine

1-97, passim. Bowditch, A History of the Massachusetts General Hospital (1872), p. 208. p. 702. Harvard Medical School, pp. 75 f. A separate oral examination in clinical (lasting only twenty minutes) was first given in 1856-57.

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was discouraged by reason of the stress attached to the lecture courses, and the failure to require attendance on hospital rounds the same as didactic lectures. O n the whole, students probably learned more surgery than internal medicine at the Massachusetts General Hospital. Surgery was more showy than internal medicine, which had not yet benefited from the rebirth of chemistry and the creation of the science of bacteriology. It is difficult to determine all the reasons why Harvard Medical School developed as slowly as it did so far as numbers of students were concerned. T h e r e was never a graduating class larger than five before the department was moved to Boston. T h e growth thereafter was certain but very slow. Thirteen finished in 1813, seventeen in 1825, thirty-five in 1844, and forty-nine in 1846, during which year there were 159 students in attendance, an attendance approximately double what it was five years before. Not until 1861 did the institution again graduate a class as large. In that year the finishing class numbered fifty-two.45 It is not giving Harvard's excellent medical faculty too much credit to say that it avoided the mercenary ways of other medical schools of the day that boasted of success in terms of the number of matriculants and graduates. T h i s was done by maintaining reasonably well its original standard of preliminary education, i.e., graduation from college or a satisfactory knowledge of Latin and experimental philosophy. In other respects, Harvard's scholastic standards from year to year compared favorably with other institutions. By 1835 the term had been extended to four months. By action of the faculty in 1841, students with advanced standing from other schools were only recognized from institutions having at least six professors and terms not less than four months in length. In 1857 the faculty instituted another move that doubtless accounted largely for the graduating class of only twenty the following year. In that year an attempt was made to reorganize the curriculum so that the two years of study would be graded, the first year being devoted largely to preclinical sciences and the second year to clinical courses and observation. Unfortunately provision for crowding the entire course into one year was still retained. A stabilized graded curriculum was yet a great way off. 48 A n insight into the arrangements between the School and the professors is afforded by a letter written by Dr. Webster, professor of chemistry, to a friend in New York, in 1827. In this letter Webster lamented that his net income from his medical lectures was only $500 or $600, an amount quite unsatisfactory to him. It was a discouraging outlook to Webster, who saw " n o prospect of any increase of this as our medical school will probably never exceed eighty or 100 pupils." Seemingly Webster had no private practice to supplement his meager income. Although Harvard grew slowly, Webster's opinion was an underestimate. He lived to observe and enjoy this growth and development. 47 Annual Circular, (1846), p. 3. «β Catalogue of Students . . . 1844-45. P· 45

Samuel Sweet Green, Medical Letter . . . , p. 3. 47

Education

The Harvard Medical in Boston

and New

School, p. 25.

York in iS27. An

Old

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A jubilant note in the Catalogue of 1845-46 reflected the modest optimism of those New England gentlemen of the healing art who were throwing their souls' energy into the advancement of Harvard's Medical School : T h e Faculty are willing to consider the increased number of pupils in their institution, which has doubled within the last five years, as an evidence that the advantages which they offer to candidates for medical degrees are becoming better appreciated by the community. A n d it gives them pleasure to add, that they believe a greater n u m b e r of teachers for the different medical schools of the U n i t e d States, in proportion have been taken from their graduates than from any other Institution in the country. T h e y think that they have a right to regard this as some evidence of the success of their endeavours to give a thorough course of medical instruction. 4 8

Although the complete truth of the statement is open to doubt, the modestry of the conclusion is classic in contrast to braggadocio that cluttered up many medical school circulars and catalogues of the day. T h e temporary quarters occupied by the Medical School in 1810 were disposed of in χ 816 on the completion of a plain two-story edifice with attic on Mason Street. This building, provided largely through the benevolence of the legislature, was opened under the name of the "Massachusetts Medical College" and occupied until 1847. From 1818 to 1858 the institution was styled " T h e Massachusetts Medical College of Harvard University." In 1831 the College was organized as a faculty separate from the mother institution in Cambridge. T h e Circular for 1846 announced the construction of " A new and elegant Medical College, of ample dimensions . . . situated in Grove Street on land liberally given by Dr. George Parkman, near the Hospital, in a quarter of the City highly convenient for the lodging of students." 49 Extramural medical instruction in Boston existed first in the conventional form of apprenticeship. As in Philadelphia and New York, certain physicians, professionally associated, affiliated themselves in a professorial manner, each man covering a branch of medicine in discharging the preceptorial duties to his and his colleagues' office students.60 Such an arrangement naturally led to the establishment of institutions which were eventually designated as schools. Such organizations were usually under the direction of members of the Harvard faculty, but often included younger men who aspired to professorial appointments. T h e best-known school of this type was the Tremont Street School, established in 1838 by Jacob Bigelow, Edward Reynolds, D. Humphreys Storer, and Oliver Wendell Catalogue of Students . . . (1844-45), P· I 2 · Chamberlain, op. cit., pp. 116 f.; Annual Circular of the Massachusetts Medical College . . . , 1846, p. 3. When Dr. Warren asked the General Hospital Board concerning its views on locating the school near the hospital it reported that it could not "perceive any advantage to this institutien to arise therefrom." Bowditch, op. cit., p. 196. Medical Tuition, a pamphlet dated October, 1835, announced the private course of J . C. Warren, George Hayward, Enoch Hale, and J . M. Warren at a cost of $100 per year, paid in advance. 49

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T H E

CIVIL

WAR

Holmes. Quizzing, dissecting, and clinical observation at the hospital were resorted to, besides lecture courses. The purpose of the school, according to the 1847 Catalogue, was to furnish a full course of instruction to private pupils during the part of the year not occupied by University courses. Under such a plan the Tremont School came to be regarded as a summer school. Indeed, it eventually was recognized as the official summer school of Harvard. The interlocking of professorships between the Harvard and Tremont schools made cooperation a simple problem—a happy situation that prevailed less often in New York and Philadelphia. Trement School was incorporated in 1850. The School had fifteen matriculants in 1839, fortythree in 1847, and fifty-two in 1855. 51 It was this convenient and rather satisfactory arrangement between the two institutions that caused the Harvard faculty, in 1850, officially to oppose the American Medical Association's move to lengthen the winter term, which proposed reform was a part of a nation-wide movement for improvement in medical education.62 A similar though less successful institution was the Boylston Medical School, incorporated in 1847. ^ offered a three-year course of study, although it apparently did not require the three years for graduation. The three years were graded: the first year being devoted largely to anatomy and chemistry; the second to surgery, diseases of women and children, materia medica, practical anatomy, clinical observation, and a review of the first year; and the third year to principles and practice of medicine, pathology, legal medicine, practical anatomy, clinical observation, and special lectures. T w o terms were offered yearly, one winter and one summer, and admission was permitted at any time. It announced its graduates as early as 1851-52 but did not have the right to grant degrees until 1854, at which time its franchise was broadened even though opposed by Harvard. In the end Harvard won by inviting several of the best teachers at the Boylston School to join the Harvard staff. Lacking sufficient active support, the Boylston School passed rather quietly out of existence." It is a singular event in the history of American medical education that Harvard maintained a monopoly on formal medical training in Boston for more than three-quarters of a century, not counting the ephemeral existence of the Boylston School. It seems even more remarkable when it is observed that Harvard's original standards of preliminary education were quite faithfully maintained throughout the period while contemporary institutions, more highly advertised and enjoying larger enrollments, either cast off or neglected the Latin and natural philosophy requirements. During these decades in which Harvard ruled over medical Boston, the medical fraternity in Philadelphia and New York were dissipating profess i Catalogue Boston,

With

of the Past and Present an Account

Students

of its Origin

of the Tremont

and Plan

Street Medical

of Instruction,

School,

in

(1847), p. 3. See also

Catalogue f o r 1 8 5 5 . T h e t u i t i o n \vas o n e h u n d r e d d o l l a r s p e r y e a r . 52 Practical View on Medical Education, Submitted to Members of the American Medical Association by the Members of the Medical Faculty of Harvard University, (1850), pp. 1 - 7 . 53 Catalogue of the Officers and Students and Course of Instruction in the Boylston Medical School, 1852; see also P a c k a r d , op. cit., p . 447.

HARVARD

UNIVERSITY

185

sional energy in feuding and organizing rival schools. T h e more intense rivalry in the Quaker City and the country's metropolis may have been productive of some good, but evidence that better physicians were thereby produced is lacking. This medical-historical phenomenon in Boston is at least partially explained by the presence of a measure of political solidarity in New England and the lack of acute social disturbances occasioned by rapid increase in population which was more manifest in New York and Philadelphia. T h e Harvard tradition, nearly 150 years old when the Medical School was founded, was no doubt a positive factor in restraining minor groups that otherwise would have projected medical institutions with a measure of success. But the fact remains—a fact made resplendent by the deeds of the Warrens, Jackson, Bigelow, Parkman, and others, that the Massachusetts Medical College of Harvard University, as it was called from 1818 to 1858, dominated the Boston area and distinctly influenced medical education in New England and more remote parts of the young republic. 04 « H a r v a r d ' s Medical School, especially after the separate organization in 1 8 3 1 , was on an organic basis little different from the ordinary loose college-medical school affiliation. B u t the active interest and supervision of the Corporation coupled with the H a r v a r d tradition m a d e the ties very tangible and effective, as was well illustrated at a later date, when President Eliot of H a r v a r d forced a reorganization of the medical faculty.

CHAPTER

L6

THE MEDICAL DEPARTMENT OF DARTMOUTH COLLEGE THE TREATY OF PARIS in 1763 opened to New England pioneers additional lands in western Massachusetts and the fertile Connecticut Valley to the north. Seven years later Eleazar Wheelock, Congregational minister, itinerant revivalist, and graduate of Yale College, founded Dartmouth College in the Connecticut Valley, at Hanover, New Hampshire. A m o n g the pioneer families in this newly settled wilderness were the John Smiths, w h o moved their chattels to what is now Chester, Vermont, about the time of Dartmouth's founding. Nathan, a son of the Smiths, born in 1762 while the family yet remained at R e h o b o t h in Massachusetts, grew to maturity in the Connecticut Valley, molded in character by the atmosphere of dash and courage created by such men as Ethan Allen. D u r i n g the troublous years of his youth, when both red men and Britishers disturbed the pastoral tranquillity of the Green Mountains and the fertile valley, Nathan Smith secured enough rudimentary education to qualify for appointment as schoolmaster. T h e n suddenly, as his biographers tell it, young Smith made the great decision of his life. In 1783 he responded to an appeal for assistance in conducting a leg amputation at the thigh, an operation performed by a Dr. Goodhue of Ludlow, Vermont. Smith was so profoundly impressed by surgeon Goodhue's skill, and so interested in the technique of surgery that he appealed to the doctor to accept him as a pupil. A survey of the schoolmaster's educational credentials convinced Goodhue that the aspiring medical student was deficient in preliminary training. W i t h alacrity and energy Smith set himself to the study of Latin and natural philosophy, meeting within a year the standard set by his chosen preceptor. A f t e r serving the conventional term of apprenticeship under Goodhue, Smith established a practice in Cornish, New Hampshire, near where John Wheelock was struggling w i t h his infant educational project. T w o years of practice convinced the young physician of his need for additional training. T h i s he satisfied in a measure by attending Harvard's Institute of Medicine, which conferred on him its seventh bachelor of medicine degree in 1790. Back to Cornish in his twenty-seventh year, he resumed practice and improved his standing by marrying a daughter of the community's leading citizen, General Jonathan Chase. 1 Smith was not content to become merely another practitioner of medicine. His active and constructive mind became agitated over the lack of 1 A f t e r two years Dr. Smith's w i f e died; he then married her sister. 186

DARTMOUTH COLLEGE

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o p p o r t u n i t i e s for the thorough study of m e d i c i n e in the country. A t the time the country supported only three medical schools—the University of Pennsylvania's, C o l u m b i a College's in N e w Y o r k , and Harvard's in Cambridge. N a t u r a l l y Dr. Smith's educational ambitions drove h i m into the friendly arms of President W h e e l o c k at H a n o v e r . W i t h Wheelock's support S m i t h proposed to Dartmouth's m a n a g i n g body the organizing of a medical department. T h e D a r t m o u t h fathers favored the proposal b u t tabled it, probably because of lack of funds a n d Smith's lack of training b e y o n d the bachelor's degree. Still ambitious a n d courageous, the would-be professor, w h o already had private pupils, promised to limit the proposed d e p a r t m e n t to one room and to prove his sincerity and determination of purpose he left his practice, at great financial loss to himself, and, armed w i t h letters from W h e e l o c k , went to Britain for nine months' study. T h e practical-minded frontiersman was more at home in L o n d o n , where the H u n t e r i a n school of experimental medicine prevailed, than in the theoretical atmosphere of E d i n b u r g h . In the fall of 1797 he returned home loaded d o w n with books a n d apparatus for the new school, w h i c h was not yet endorsed by the trustees. 2 In N o v e m b e r he began a series of lectures at the College, which marked his formal initiation as a professor in medicine. Before many months passed, the trustees actually established the M e d i c a l D e p a r t m e n t w i t h provision for instruction in three general fields: anatomy and surgery; chemistry and materia medica; and the theory a n d practice of physic. Lectures were to begin annually, on October 1, a n d continue for ten weeks. T h e fee for a term of attendance at the new medical school was set at fifty dollars, i n c l u d i n g all lectures. U p p e r classmen in the liberal arts department were admitted to the medical lectures on p a y m e n t of only twenty dollars. A s was customary under such loose academic relationships between aspiri n g medical professors and established colleges, the medical professor collected a n d kept the lecture fees as his compensation. T h e graduation fee of twenty dollars was to be divided between the president of the C o l l e g e a n d the professor of the Medical Department. 3 Dr. Smith, of course, was elected to the professorship over the medical subjects. T h e trustees also voted that he m i g h t employ, at his own expense, assistants in any of the subjects. U n t i l 1810, Smith's only assistant was his former student, L y m a n Spaulding. In 1808, A l e x a n d e r Ramsay, an eccentric personality, former p u p i l of W i l l i a m C r u i k s h a n k of L o n d o n , a n d peripatetic anatomist in America, was e m p l o y e d by Smith to give a series of lectures. It seems that Ramsay's work w i t h S m i t h was not for long, even 2 T h e best accounts of Smith's early life and his part in founding Dartmouth's Medical Department are: Samuel C. Harvey, " T h e Education of Nathan Smith," Yale Journal of Biology and Medicine, 1: 259-68, May, 1929; Leon B u r r Richardson, History of Dartmouth College, I, 228 ff.; and Emily A. Smith, The Life and Letters of Nathan Smith, M.B., M.D. Money for the equipment Smith purchased was said'to have been obtained by lottery before he went abroad. T h e legislature authorized a third lottery for Dartmouth in 1795, two previous lotteries having netted little for the relief of the distressed institution. 3 Baxter Perry Smith, The History of Dartmouth College, pp. 540-41. In 1801 the trustees conferred on Smith the doctorate of medicine.

i88

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

though L y m a n S p a u l d i n g carted anatomical subjects for his use across the state in barrels of rum, and Smith gracefully laughed him out of the fits of anger for w h i c h he was noted eveiywhere he went. 4 N a t h a n Smith resigned his connection with Dartmouth College in 1814. T w o years later he returned to give a special course of lectures, and in 1816 was reelected to the chair of surgery, but declined to accept. T h e trustees, in 1820, declared that the medical faculty should consist of four chairs, presided over by the president of the College. 5 Dr. R e u b e n D . Mussey, born in 1780, the son of a respectable New Hampshire physician, was N a t h a n Smith's successor at Hanover. He received the bachelor of medicine degree from Dartmouth in 1806 and the doctorate from the University of Pennsylvania in 1809. Settling in Salem, Massachusetts, he soon joined in partnership with Daniel Oliver, w h o was later a member of Dartmouth's medical faculty. Mussey and Oliver for a time conducted popular lectures in chemistry which were well received. Mussey's teaching connection with Dartmouth began in 1814 and continued until 1837, during which time he also held chairs and delivered lectures in several other N e w England and New York schools. In 1837 he became connected with the O h i o Medical College, Cincinnati, and subsequently was a leader in founding Miami Medical College in Ohio. D i x i Crosby, Mussey's successor, E d m u n d R a n d o l p h Peaslee, anatomist and physiologist, and A l p h e u s B e n n i n g Crosby, anatomist, all stand high in the records of Dartmouth's medical history. 6 T h e first medical lectures at Dartmouth are said to have been held in a small wooden structure. In 1798 Professor Smith moved his paraphernalia into a little room of D a r t m o u t h Hall, scarcely as large as a common living room. Nevertheless it served as lecture hall, dissecting room, chemical * James A. Spalding, " A l e x a n d e r Ramsay," Kelly and Burrage, Dictionary of American Medical Biography, pp. 1004-6. In 1810 Cyrus Perkins was elected to the chair of anatomy, and in 1812 R u f u s Graves was elected lecturer in chemistry, but lasted only three years because he was a poor manipulator. Smith was absent in 1814, his work and emoluments going to a Dr. Perkins. R e u b e n D. Mussey, a Dartmouth graduate of 1812, was made professor of chemistry in 1816. A f t e r Smith's final departure Mussey helped to carry the anatomy and surgery, being helped by James F. Dana who became a full professor of chemistry in 1820. Perkins resigned in 1819. 6 These chairs were filled as follows: surgery, obstetrics, and medical jurisprudence, Reuben D. Mussey; theory and practice and materia medica, Daniel Oliver of Salem, Massachusetts; chemistry and mineralogy, James F. Dana; and anatomy and physiology, Usher Parsons, w h o remained only two years. Dr. Mussey added Parsons' work to his own. A Dr. Hale followed Dana, continuing until 1835. John Delamater, of peripatetic fame, became professor of theory and practice; and O. P. Hubbard, professor of chemistry in 1836. In 1838 all professors resigned except Hubbard. T h e trustees then elected a staff as follows: Elisha Bartlett, Oliver Wendell Holmes, John Delamater, Oliver Payson Hubbard, D i x i Crosby, and Stephen W . Williams. Joseph Roby succeeded Bartlett in 1840 when the latter resigned. Delamater and Holmes also resigned about this time. In 1841 Edward Elisha Phelps, materia medica and therapeutics, and Edmund R . Peaslee, anatomy and physiology, began a long and useful connection with Dartmouth. Roby resigned in 1849 an< ^ w a s followed by Albert Smith. Subsequent changes came after the close of the period covered by this study. 6 Smith, op. cit., pp. 349-66.

DARTMOUTH COLLEGE

189

laboratory, and library for several years. In 1803 Smith received a grant of $600 from the New Hampshire legislature for additional apparatus. Six years later the state legislative body granted $3,450 for a substantial medical building. 7 T h e finished structure cost §4,600. Nathan Smith furnished the land and went security for the balance of building costs. In those early years when the trustees, as well as the sole professor, were striving to get the Medical Department firmly established, Smith was asked to give up his home in Cornish and move to Hanover. For this arrangement, whereby he could accept even more responsibility in the school, Dr. Smith was given a salary of two hundred dollars a year. President Wheelock exhibited a genuine interest in the Medical Department, as is illustrated by an anecdote usually noted by Smith's biographers and Dartmouth's chroniclers. Wheelock, fresh from Smith's lecture room one day, went to evening prayers in the old chapel where he prayed in substance: O Lordi we thank Thee for the Oxygen gas, we thank Thee for Hydrogen gas; and for all gases. We thank Thee for the Cerebrum; we thank Thee for the Cerebellum, and for the Medulla Oblongata.8 In 1820 the trustees accepted the friendly advances of the New Hampshire Medical Society, which invited the school to send delegates to the Society's annual examinations. In the same year ties between the Medical Department and the College were weakened by placing in the hands of the medical faculty all disciplinary problems involving medical students. Also, students enrolling in the medical classes thereafter were not required to present to the College evidence of good moral character. Such adjustments were in keeping with trends of the day in medical education, i.e., more independence for the medical department and less supervising by the mother institution. A t that saine time the preliminary education requirements for graduation were lessened. Students without a bachelor's degree were only required to have a knowledge of Latin and natural and experimental philosophy. 9 Much to the satisfaction of the candidates for the doctorate they were no longer required to defend their theses and take their final examinations in public. Dartmouth was essentially a country medical school. T h e weakening of its scholastic standards as early as 1820 is significant evidence that the competition between country schools and especially between city and country institutions was active. Nevertheless it is much to ' T h e r e a f t e r Dartmouth Medical Department was often called the New H a m p s h i r e Medical Institution. β Smith, Life of Dr. Xathan Smith; cited in Packard, op. cit., p. 4 6 1 . Packard gives no page for his citation. 0 T h e requirement before 1820 prescribed a preparatory examination before the president and professors in which the candidate demonstrated his ability to parse the English and Latin languages, construe Virgil and Cicero's orations, and e x h i b i t a good knowledge of common arithmetic, geometry, geography, and natural and m o r a l philosophy. T h e M. B . degree was the principal degree given before 1 8 1 2 , but in the latter year the M . D. (previously given only in course, three years after the M . B.) was the only degree given, after a three-year apprenticeship and two terms of lectures.

îgo

M E D I C A L E D U C A T I O N BEFORE T H E CIVIL W A R

D a r t m o u t h ' s credit that at least as late as 1850 the Annual Announcement listed a competent k n o w l e d g e of L a t i n a m o n g its requirements for candidacy. H o w well the rule was e n f o r c e d may be another question. By 1830 or earlier, the term was lengthened to fourteen weeks. 10 Even t h o u g h the medical school in H a n o v e r h a d an infirmary or clinic as early as 1826 or 1827, such clinical facilities cared only for ambulatory sick and d i d not give students the all-important bedside experience. 1 1 T o some extent the D a r t m o u t h M e d i c a l D e p a r t m e n t lacked the atmosphere favorable to investigation a n d scientific leadership. It was for this reason that James F. D a n a left the teaching staff in 1826 a n d settled in N e w Y o r k City. 1 2 Dartmouth's rural location a n d limited faculty kept N a t h a n Smith's school from turning out m o r e graduates in its earlier years. O n l y sixtyo n e degrees were conferred b e f o r e the College began conferring the doctorate of medicine in 1812. T h e r e a f t e r , w i t h a reasonably complete faculty most of the time, the M e d i c a l D e p a r t m e n t grew more rapidly. T h e finishi n g classes ranged from eight to eighteen until 1824, w h e n there were twenty-eight. T h r o u g h the thirties and forties the attendance held u p well, b u t began a decline d u r i n g the sixth decade. T h e attendance d u r i n g these decades usually amounted to a b o u t four or five times the size of the finishing group. A l t h o u g h D a r t m o u t h ' s M e d i c a l D e p a r t m e n t was never large as compared w i t h contemporary medical schools, it was no d o u b t the principal department of the C o l l e g e m u c h of the time. 1 3 In spite of occasional complaints about students' " d i g g i n g - u p " activities a n d the general conduct a n d morals of the medicos, both the c o m m u n i t y a n d state supported the medical school at Hanover. A f t e r 1820 the periodically appointed delegates to the State Society often included in the M e d i c a l Department Announcement or College Catalogue a portion of their report on the state of the school. T h e i r complimentary remarks in the 1850 Announcement reflected, t h o u g h not directly, the problems w i t h w h i c h a country school was c o n f r o n t e d at the m i d d l e of the century. I n view of "its pleasant location a n d freedom from temptations and demoralizing influences of a c i t y " the delegates felt justified in declaring: . . . few, if any, Institutions in the country offer greater facilities for the attainment of a thorough knowledge of Medical Science, or possess stronger claims to the patronage of the Medical Public generally. 14 T h e D a r t m o u t h Medical D e p a r t m e n t , t h o u g h never large or p r o f o u n d l y influential, h a d from time to time some excellent men in its faculty. It 10 Fifty-fourth Annual Announcement of the New Hampshire Medical Institution, pp. i f f .A Catalogue of the Officers and Students of Dartmouth College, p. 11. n j a m e s Thacher, American Medical Biography, p. 46. It is assumed that the pupils got some bedside observation while they were private pupils. 1 2 Richardson, op. cit., p. 37g f. is Of the 246 students in Dartmouth College in 1830, ninety-eight were in the Medical Department. Catalogue of . . . Dartmouth College, (1830), p. 18. 14 Fifty-fourth Annual Announcement of the New Hampshire Medical Institution, p. 8.

DARTMOUTH COLLEGE

served as a sort of connecting link between the city schools in Boston, New York, and Philadelphia and the schools farther west in Vermont, New York, and Ohio. This is shown by the presence on Dartmouth's faculty of men from the principal city schools and peripatetic professors who eventually gravitated westward. In this capacity, the school founded by Nathan Smith did well its part.

CHAPTER

17

THE MEDICAL INSTITUTION OF YALE COLLEGE THE practice of medicine in early colonial Connecticut, like medical practice in the mother colony to the north, was largely in the hands of eminent clergymen who had either professional training or a practical working knowledge of physic. Yale College, founded in 1701, had many alumni practising medicine, but few, in fact only two, according to William H. Welch, obtained medical degrees in course before the close of the eighteenth century. Practically all of the 224 Yale graduates, who Welch says practised medicine in the eighteenth century, were apprentice trained. 1 Representatives of this office-trained group and first of Yale's graduates to take up the practice of medicine was the Congregationalist Jared Eliot, class of 1706, last of the eminent clerical physicians of New England. He studied medicine under Reverend Joshua Hobart of Southold, Long Island, and rapidly rose to a place of distinction in the medical profession. Thacher rated him as the first physician in his day in Connecticut and the most prominent consultant in all New England. His prominence as a medical preceptor is amply justified by his remarkable approach to modernity in a time and place providing little intellectual stimulus. T h e following quotation from his writings does credit to his extraordinary scientific spirit: E n t e r i n g o n the b o r d e r s of terra i n c o g n i t a I can a d v a n c e n o t o n e step f o r w a r d , b u t as e x p e r i e n c e , m y o n l y pole-star, shall direct. I a m o b l i d g e d to w o r k as p o o r m e n live, f r o m h a n d to m o u t h , a n d as l i g h t springs u p b e f o r e me, as I a d v a n c e . . . . A s all t h e o r y n o t f o u n d e d u p o n m a t t e r of fact a n d that is n o t the result of e x p e r i e n c e , is v a g u e o r u n c e r t a i n , t h e r e f o r e it is w i t h great diffidence that I h a v e o f f e r e d a n y t h i n g in w a y of t h e o r y w h i c h is o n l y c o n j e c t u r a l a n d shall a l w a y s take it as a f a v o r to b e c o r r e c t e d a n d set right. 2

Such an approach to the problems of medical practice and education by Jared Eliot profoundly influenced the medical profession of Connecticut and helped to prepare the way for the organization of Connecticut's first medical school. T h e first formal proposal for the founding of such an in1 William H. Welch, " T h e Relations of Yale to Medicine," Yale Medical Journal 8: 129-30, 1901-02. T h e T o n e r Manuscript lists no Edinburgh medical graduates from Connecticut among the 122 Americans who were graduated from 1749 to 1800. Welch, op. cit., p. 128, concluded that the number of New England students "who resorted to the medical schools of Edinburgh, London, or I.eyden was extremely small, much smaller than that from the Middle and Southern colonies." 2 Quoted by Anson Phelps Stokes, Memorials of Eminent Yale Men, p. 10. 192

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stitution at Yale College was in 1777. In that year a committee of the General Assembly had under advisement suggestions for the expansion of Yale's scope of activity, among which was a suggestion for the establishment of a chair in medicine. Ezra Stiles, newly elected president of the College, was in harmony with the idea and incorporated "medical lectures" in his draft of a bigger and better Yale. For some reason not definitely known, probably economic in nature, these early proposals bore no fruit. 3 D u r i n g the administration of T i m o t h y Dwight, ardent expansionist, the Medical Department was actually established. O n all appropriate occasions President Dwight applied his vigorous powers to the enlargement of collegiate advantages. In 1802 he secured the appointment of Benjamin Silliman to the chair of chemistry and mineralogy, and then rushed him off to Philadelphia and later to Europe for special study. H e also attended lectures in medicine and anatomy in anticipation of his future connection with a medical school at Yale. O n his return Silliman set about vigorously organizing his department. A t about the same time (1806) the corporation of Yale College authorized the establishment of a medical professorship. In order to consummate the idea of a medical department President Dwight entered into negotiations with the Connecticut Medical Society, which was the authorized body in the state for examining and licensing physicians and conferring medical degrees. Dwight and Dr. Eli Ives of the Society eventually agreed upon certain articles of incorporation deemed essential to such an organization and jointly applied to the legislature for a grant of authority. 4 T h e desired bill was passed in October 1810, after several years of negotiations. T h e act made the Medical Institution a joint creature of Yale College and the State Society. T h e articles of incorporation were very specific in matters of detail. T h e r e were to be four chairs, an anatomic and materia medica museum, and a botanic garden. A joint committee of members from the Society and the College corporation was to nominate professors to be elected by the corporation. A similar joint committee w i t h membership drawn from the medical faculty and the Society was authorized to examine candidates for degrees and licensure. T h e r e a f t e r the Society could not grant honorary degrees but could recommend meritorious individuals to the president of the College Corporation for such honors. O n the recommendation of each county medical society one "meritorious and necessitous" individual would be accepted for free attendance one term. Graduation requirements recognized the value of proper preliminary education. College graduates were required to take only a two-year apprenticeship, but three years was required of others. A license could be 3 T h e early attempts by President Stiles to i n c o r p o r a t e medical lectures in Yale's c u r r i c u l u m are well covered in W a l t e r R . Steiner, " T h e E v o l u t i o n of M e d i c i n e in C o n n e c t i c u t , w i t h the Foundation of the Y a l e M e d i c a l School as Its N o t a b l e A c h i e v e m e n t . " Memorial on the Centennial of the Yale Medical School. * Ebenezer B a l d w i n , Annals

P- 175-

of Yale

College

from

Its Foundation

to the

Year

18ji.

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M E D I C A L E D U C A T I O N BEFORE T H E C I V I L W A R

obtained after one term of lectures, and the M. D. degree after two terms.' T h e statute governing the Medical Institution of Yale College was slightly revised in 1821. An amendatory act, approved in June 1829, authorized certain important changes. The number of professors was specified at not less than four or more than six, and the price of each professor's ticket was to be no more than twelve dollars and a half.6 This act stated more specifically the premedicai requirements in addition to "a good English education," as a "competent knowledge of the Latin language, and some acquaintance with the principles of Natural Philosophy." The fact that these requirements were to be satisfied before the student commenced his professional studies put Yale in a unique situation among the American medical schools of the day, many of which by that time were giving scant attention to standards of preliminary education.7 Schools which still held on to the Latin and natural philosophy requirement usually permitted the student to meet tHe deficiency in his educational background by taking the required studies along with his medical lectures. Indeed the circulars and announcements of some institutions suggested this manner of solution by declaring the lectures of the liberal arts department open to medical matriculants.8 The 1829 alterations also authorized the Institution to require one full course of lectures of candidates for a license and two for the doctorate. T h e student who attended a second term as in other American schools, merely repeated the material of his first term. The act further provided that students without a bachelor's degree be required to submit a certificate of a four-year apprenticeship in contrast to the conventional three-year term required of candidates holding a degree. The Annual Circular for the term of 1839-40 indicated that the requirements had by that time been somewhat modified to compete with the conventional system in certain points, i.e., college graduates were required to present a certificate of only two years of apprenticeship, and undergraduates three years, but both were required to take two complete courses of lectures. By that time the lecture courses had been lengthened to sixteen weeks. T h e entire Yale set-up was more rigid than the standards generally maintained elsewhere, and to that extent was a specific contribution to medical education.9 5

Ibid., pp. 176-79. β Previously the law limited the entire course to fifty dollars. ι The elevation of medical educational standards at Yale was brought about in order to conform with the recommendations of the convention of delegates representing various New England state medical societies which met at Northampton in 1827. β According to Baldwin, op. cit., p. 187, Yale opened her library and classical lectures to medical students about this time. Evidence that the policy was for the purpose of providing medical candidates with the opportunity for making up premedicai requirements while in course is lacking. As noted above, the 1829 charier amendment specified the completion of the requirements "previous to the commencement of professional studies." Hence the liberal policy can be regarded as a move to make even broader the cultural background of Yale graduates in medicine. 9 Of the total number of graduates from 1814 to 1820 (62), about thirty-two percent were holders of a liberal arts degree. During the third to sixth decades inclusive, the figures were: 229 (19.3%); 169 (26.6%); 152 (26.25%); and " 9 (20.2%).

YALE COLLEGE

'95

T h e cooperative arrangement between the Medicai Society and Yale College for the control of the Medical Institution continued for nearly three-quarters of a century. T h e elemental features of this union are of special interest to the student of medical education. Welch noted the fact that the initiative to create this profitable relationship came from the College and not from the Society. T h e arrangement was also advantageous in that the Institution, through the Society, secured the active support of the medical profession throughout the state. As noted so often throughout this study, medical schools usually existed as a result of a group of physicians associating themselves together in a professorial manner and then attaching themselves to some established college. President Dwight, though not a physician, is credited by Welch with originating and initiating the idea— a remarkable improvement over the contemporary method of establishing medical colleges. 10 In September 1 8 1 2 , the corporation selected its first medical faculty, five gentlemen of more than ordinary ability. T h e professorship of theory and practice of surgery and obstetrics went to none other than Nathan Smith, the founder and builder of Dartmouth Medical Department. B u t the appointment was not made until after the Corporation had scrutinized and approved of Smith's religious ideals. It seems that at one time Dr. Smith was profoundly impressed by the brand of free thought (Deism) popularized by T h o m a s Paine and Ethan Allen. T h a t Smith was more than touched by the invigorating skepticism of his day is evidenced by his reputation in New Haven as an infidel. Steiner quoted from certain documents in possession of the Yale corporation, showing that the Dartmouth professor underwent a sweeping change in spiritual outlook about this time. His unorthodox views were renounced in intimate conversations and before his class "in such terms of his past and present views as drew tears from both speaker and hearers." 1 1 Only a cynic could accuse Smith of hypocrisy in this event of his life. With characteristic enthusiasm and sincerity Nathan Smith served the Medical Institution of Yale College with energy until his death in 1829. His eulogizer, J o n a t h a n Knight, declared that he did more for the improvement of physic and surgery in New England than any other man. 1 2 It is fair to state that he was a greater teacher than scholar, but well known as both. H e contributed much to the moderate success of the Medical Institution during its first seventeen years. 1 3 Dr. Aeneas Munson was well advanced in years at the time of his appointment to the chair of materia medica and botany in 1 8 1 2 . His appoint10 Welch, op. cit., pp. 137-38. 11 Harvey, op. cit., pp. 260-62. 12 Baldwin, op. cit., pp. 185 f. is During his connection with Yale, Nathan Smith delivered one course of lectures at Dartmouth, one at Vermont University, and two at Bowdoin College. When he died in 182g, Thomas Hubbard, who held an honorary M.D. degree from the Connecticut State Society, succeeded to the chair of surgery and continued until 1838, at which time Jonathan Knight, professor of anatomy and physiology in the 1812 staff (he added obstetrics in i8«o) became professor of surgery and continued in that capacity until 1864.

I96

MEDICAL E D U C A T I O N BEFORE T H E CIVIL WAR

ment was a reward for his long and honorable service to the profession and a recognition of his enlightened and advanced views in the field of his special interest. Because of Munson's physical infirmities the adjunct professor, Eli Ives, carried the burden of the department. Especially was this true after 1820, when Munson was made professor of the institutes of medicine, a course incorporating physiology and histology. Munson died at the age of ninety-two in 1826.14 O n e of Dr. Ives's private pupils, William T u l l y , a recipient of one of Yale's honorary M. D. degrees (1819), accepted the chair of materia medica and botany in 1829. His extensive writings, in which he indulged in illconcealed sarcasm for physicians w h o accepted hearsay evidence as to the value of drugs, brought him both publicity and enemies. In 1826 he began his public teaching career as president of the Vermont Academy of Medicine, Castleton, Vermont, while living in Albany, New York. T u l l y retained his position at Castleton, including the "settee" of materia medica and theory and practice, when he went to Yale in 1829. His self-assumed superiority robbed him of peace and happiness, and chafed his colleagues. For several years he routinely submitted his resignation to the Yale authorities who, probably to T u l l y ' s surprise and chagrin, accepted it in 1841. Having also resigned at Castleton and turned down offers at Bowdoin College and in South Carolina, T u l l y suddenly found himself a chairless professor. He regarded his life and teaching as a failure, but his students and contemporaries placed a higher estimate on his pedantic contributions. 1 5 Benjamin Silliman, a member of the first medical faculty, as professor of chemistry, pharmacy, mineralogy, and geology, was active in the department (chemistry in particular) until 1853, and then continued as emeritus professor until 1864, while his son Benjamin succeeded him as active head of the department. T h e Sillimans held honorary M. D. degrees from Bowdoin College and the University of South Carolina respectively. Silliman is at times regarded as the founder of Yale's Medical Institution, but his actual contribution to the prestige and permanency of the school was less than that of his colleague, Nathan Smith. 16 T h e first course of lectures in the Institution began in November 1813. T h e embarrassment that often attends the opening of a new institution was present, being made more acute by the lack of sufficient means and apparatus. T h e following May a grant of $20,000 from the legislature, 1 4 D r . Ives b e c a m e professor of m a t e r i a m e d i c a a n d b o t a n y in 1820, professor of theory a n d p r a c t i c e in 1829, a n d later m o v e d to the d e p a r t m e n t of t h c r a p c u t i c s and m a t e r i a m e d i c a , r e t i r i n g f r o m the latter as e m e r i t u s professor in 1853. H e was succeeded by W o r t h i n g t o n H o o k e r , a H a r v a r d m e d i c a l g r a d u a t e of 1829, w h o served u n t i l 1867. ι» W i l l i a m T u l l y ' s life a n d w o r k is critically discussed by K a t e C a m p b e l l M e a d in K e l l y a n d B u r r a g e , Dictionary of American Medical Biography, p p . 1230-32. 1 · T i m o t h y P. Beers, h e a l t h officer of N e w H a v e n , was a p p o i n t e d to the chair of obstetrics in 1829. B a l d w i n , op. cit., p p . 181-86, discussed the f a c u l t y a p p o i n t m e n t s u p to 1829. T h e r e a f t e r , P a c k a r d , op. cit., p p . 762—66, is the p r i n c i p a l source besides circulars a n d catalogues. T h e Annual Circular f o r the term of 1839-40 listed C h a r l e s H o o k e r as professor in a n a t o m y a n d p h y s i o l o g y . T h e fees for a f u l l course in that year were seventysix dollars.

YALE COLLEGE

>97

secured through the efforts of Dr. Smith, enabled the corporation to purchase an extensive stone building on G r o v e Street with an adjoining tract, which were converted into a school building and a botanical garden. T h e s e quarters were occupied for forty-five years. 1 7 T h e close connection between the College a n d its Medical Department was interestingly evidenced by an attempt to introduce the academic practices of the former into the latter. T h e medical students assembled morning a n d evening for prayers, at which chapel hours the professors officiated. Other rigid rules of the academic administration were enforced until 1824, when law and theology departments were organized. Welch thought that Yale's early efforts to make medical students conform to the general regulations of the College were without parallel. 1 8 T h e Institution enjoyed moderate prosperity until about 1830. Attendance d u r i n g the first two decades averaged between seventy and eighty. T h e average attendance for the fourth, fifth, and sixth decades was fiftytwo, forty-seven, and thirty-six respectively. T h e number of graduates increased f r o m only three in 1 8 1 4 to thirty-six in 1829. T h e number in the finishing class dropped sharply to seventeen the following year and averaged even less for the next thirty years. T h e decline was equally noticeable in the attendance over the same period. 1 9 T h e sharp decline beginning in 1830 may have been precipitated by the death of N a t h a n Smith, who was unquestionably the most magnetic personality on Yale's early medical faculty. B u t even this loss was not sufficient to keep the Institution on the downward grade. Its reputation had been good. 2 0 W i t h the exception of the dissection riots of 1824, little had happened to detract from the dignity of the school. 2 1 Welch attributed the falling off in number of matriculants and graduates to the honorable effort of the faculty and corporation to maintain high scholastic standards of admission a n d graduation. T h i s is a logical deduction in view of the fact that the third, fourth, and fifth decades of the century witnessed an epidemic of establishing medical schools. T h e resulting competition popularized medicine as a profession and at the same time degraded standards of admission, instruction, graduation, and certification. It was the close relationship between the Institution and the College and State Society, T o facilitate the opening of the Institution the College Corporation advanced a few hundred dollars which was later returned. Some of the state money which was given was used for the purchase of a library and a collection in anatomy and materia medica, the last being regarded as the best at that time in this country. Walsh, op. cit., p. 156. is Ibid., loc. cit. 18 Catalogue of the Officers and Graduates of Yale University ιηοι-1924, pp. 486-93. See also Welch, loc. cit. 20 A Britisher who traveled in the United States in 1818 and 181g reported that the medical school in connection with Yale College "is of recent institution, but already bears an honorable reputation, as regards the course of study and the ability of the Professors." See John M. Duncan, Travels Through Part of the United States and Canada in 1818 and 181Ç, p. 141. Duncan also noted that the Medical Institution was under a bond to the state legislature "that no bodies shall be taken from the New Haven burying ground, for anatomical purposes." Ibid., p. 102. 21 Hannibal Hamlin, " T h e Dissection Riots of 1834 and the Connecticut Anatomical Law," Yale Journal of Biology and Medicine, 7: 275-89, March, 1935.

ig8

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

a relationship maintained with most remarkable harmony until 1884, without local competition to split the allegiance of the Connecticut medical profession, that made possible the peculiar history of the Medical Institution of Yale College. Further analysis produced other aspects of the Yale phenomenon. Even though the Institution's academic ties and professional backing were noticeably more secure and powerful than were the relationships enjoyed by the majority of the city schools, the Medical Institution of Yale was essentially a country school in several major respects. In a small town anatomical material was difficult to obtain, and transportation of specimens from a distance was both hazardous and expensive. T h e Institution also lacked throughout this entire period adequate clinical teaching facilities, particularly hospital beds. 22 Except for its very excellent connections the Institution would not have survived these stormy decades of American medical history. Its struggle to maintain certain classical standards in the face of strong competition is admirable; its lack of adequate anatomical and clinical facilities is regrettable. In spite of these handicaps Yale made an honorable contribution to medical education and practice. 22 T h e Medical Institution had a respectable collection of wet and dry anatomical preparations to supplement the use of fresh specimens. It also boasted a materia medica cabinet and a manikin. B a l d w i n , op. cit., p. 263.

CHAPTER

l8

MISCELLANEOUS TOWN AND RURAL MEDICAL SCHOOLS OF NEW ENGLAND BROWN

UNIVERSITY

MEDICAL

SCHOOL

EARLY in its history the General Assembly of R h o d e Island licensed physicians and at one time (1663) even conferred a degree of "Doctor of physick and chirurgery" on Captain John Cranston. 1 T h e majority of early R h o d e Island practitioners received their medical training by reading medicine under some practitioner. After receiving a certificate of proficiency they either entered practice or went abroad for formal training. However, T o n e r listed no R h o d e Island graduates in medicine at Edinburgh from 1749 to 1800. W i t h the founding of American medical schools, formal medical education was more available. Names of R h o d e Islanders began to appear on class rolls in Philadelphia, New York, and Cambridge. A sense of the growing need for more widespread opportunities for medical education was felt throughout the country during the opening decades of the nineteenth century. For this reason Nathan Smith was brought d o w n from the wilds of the upper Connecticut to help establish Yale's Medical Institution in 1812. For the same reason, one year earlier, B r o w n University of Providence, R h o d e Island, established its Medical School by the appointment of three professors. U p to that time Brown University had been pursuing an even course of academic training with about one hundred students. Since 1804 its president had been Asa Messer, w h o administered the institution under a liberal charter that authorized conferring "any and all the learned degrees which can or ought to be given and conferred in any of the colleges or universities in America." T h e University exercised this authority from time to time by the conferring of honorary M. D. degrees on eminent members of the medical fraternity. A t least seven such degrees had been conferred by 1814, w h e n the first two medical degrees in course were granted. 2 During its brief history of seventeen years the Brown University Medical School graduated about ninety physicians. Not a few honorary degrees were also given. 3 1 Supra, Part II, Chapter 3. T h e degree was probably little more than a license to practice. Rhode Island Colonial Records, II, 33. 2 Historical Catalogue of Brown University, 1164-1914, p. 585. Prior to 1804 the institution was k n o w n as R h o d e Island College. 3 Several of Brown's medical graduates became ornaments of the profession, such as A l d e n March and Elisha Bartlett. Ibid., pp. 585-89. 199

M E D I C A L E D U C A T I O N BEFORE T H E CIVIL

WAR

T h e first three professors were Solomon Drowne, materia medica and botany; William Ingalls, anatomy and surgery; and William C. Bowen, chemistry. Apparently this medical school was founded, as were many second-rate medical schools of the nineteenth century, on nothing but anticipated good will and students', fees. At least, the corporation records show no considerable increase in revenue prior to 1 8 1 1 and no mention of salaries for the medical professors before 1815. It is to the credit of Brown's corporation that the Medical School was born a department of Brown and not adopted at the request of a group of memorializing professors. In spite of its rather ideal conception, the Medical School was only loosely tied to the mother organization. 4 As judged by contemporary standards, the Medical School was open to severe criticism. T h e author of an anonymous pamphlet in 1815 sharply criticized the condition of the institution: O n the present plan, the medical professors d e p e n d f o r compensation entirely o n the fees of attendance. T h i s gives them a most precarious standing. R e p e a t e d l y has it been the lot of a professor, as the season f o r his lectures approached, to visit the college, i n q u i r e how m a n y attendants w o u l d be had, be i n f o r m e d that f o r this or that reason they w o u l d be very few, and return to his residence, l a m e n t i n g that he must w a i t a n o t h e r year, because an u n f o r t u n a t e arrangement has made the discharge of his duties d e p e n d e n t on the accidental finances and feelings of fifty o r sixty youth. T h i s state of things is too humiliating. It has already occasioned the loss of o n e distinguished professor. 5

A t that time (1815), only two students had completed the course and taken the degree. T w o years had passed since Professor Bowen resigned the chair of chemistry. T h e chair of theory and practice had not yet been filled. A contemporary critic, probably the one quoted above, was quoted by W. C. Bronson as pointedly inquiring, ". . . will medical students extensively resort to a school but half made up?" T h e same commentator proposed salaries for professors, and textbook studying and drilling by tutors as a supplement to lectures. This ardent "Alumnus Brunensis" anxious for the future of the Medical School did not even mention laboratory or clinical instruction as phases of Brown's medical shortcomings.® T h e frank criticism in 1 8 1 5 apparently was productive of good. Several men of more than ordinary ability were associated with the faculty during the next few years. Students were supplied with individual sets of bones and given "ample opportunities in Practical Anatomy," according to a * Charles William Parsons, The Medical School Formerly Existing in Brown University, . . . pp. 4 ff. Another account is that of Frederick C. Waite, "The Third Medical College in New England, That of Brown University (1811-1828)", New England Journal of Medicine, 207, 1: 30-33, July 7, 1932. Waite recognized Parsons as his principal source. 6 Quoted by Parsons, op. cit., p. 7. •Walter C. Bronson, The History of Brown University, p. 160. According to Parsons, op. cit., p. 12, other faculty appointments were as follows: 1817 John DeWolfe Jr., (not M. D.) chemistry; 1815, Levi Wheaton, theory and practice; 1815, John M. Eddy, adjunct in anatomy and surgery (died early in 1817); 1822, Usher Parsons, adjunct in anatomy and surgery, and after 1823 professor. Dr. Parsons maintained secret channels through which he obtained fresh anatomical specimens. Dr. Drowne held the chair of materia medica until 1834, but did no teaching after 1827.

OTHER

NEW

ENGLAND

201

SCHOOLS

circular of the early twenties. T h e requirements for graduation included Latin and natural philosophy, three-year apprenticeship, and two terms of lecture courses. A private final examination was held, but the dissertation was publicly defended in the college chapel. 7 T h e Brown University Medical School showed signs of decay soon after 1826. T w o years later it was extinct. T h e reasons for this sudden decline are rather plain. President Messer of the University resigned in December 1826. His successor, the Reverend Francis Wayland, Jr., of Boston, was inducted into office two months later. In March the corporation supported the new administration by passing a resolution which must have been calculated to destroy the Medical School. T h e new President seemed obsessed with a conviction that the University must carry on in a very close family spirit. At any rate it was decreed: . . . no salary or other compensation be paid to any Professor, officer, who shall not during the course of each and every term in one of the colleges (to be designated by the President), and vote himself to the preservation of order and the instruction of the performance of such other duty as may belong to his station.

T u t o r or other occupy a room assiduously dethe students, or

At its next meeting the corporation further ordered that all teachers devote their time during each term "exclusively" to instruction and discipline, occupying college rooms during study hours. These actions were communicated to the medical professors. T h e result was rather mutely announced in the 1828 to 1831 catalogues. An asterisk after the name of each medical professor in the 1828 Catalogue indicated that the gentlemen to whose names the asterisks were affixed were "not of the immediate government," and did not, at the time, "give any instruction in the University." T h e same appeared in 1829. Finis for Brown University Medical School was written in the 1830 and 1831 catalogues thus: " T h e gentlemen to whose names the asterisk is affixed give no instruction in the University and have no concern in its government. . . . " 8 Charles William Parsons in a charitable vein declared that the destruction of the Medical School at Brown was not the result of any hostile feeling on the part of President Wayland, but was an accidental result of his unswerving conviction and policy in regard to college government. He described this regrettable incident figuratively: President Wayland was driving a team of horses at quite a pace down the road. He checked the animals suddenly in order to negotiate a corner. Something, the loosest thing, was bound to be jolted from the wagon. It was the Medical School. Wayland may have improved the discipline of Brown University, but he killed the Medical School and contributed nothing to medical education in Rhode Island. His act was hardly justifiable. THE

MEDICAL

SCHOOL

OF

MAINE

OF

BOVVDOIN

COLLEGE

Soon after Maine entered the sisterhood of states its legislature, jealous for the health and happiness of its people, established the Medical School 7

Information cited by Bronson, op. cit., p. 163. β Parsons, op. cit., pp. 45-47.

202

MEDICAL

EDUCATION

BEFORE T H E C I V I L

WAR

of Maine (June 27, 1820) to be under the control of the Trustees and Overseers of Bowdoin College in Brunswick. Bowdoin College, established under a Massachusetts charter in 1794, had just come under the progressive leadership of President William Allen. Immediately after his accession to the presidency, the Reverend Mr. Allen addressed a communication to Nathan Smith, New England's grand old man of medicine, founder of Dartmouth's Medical Department, and at that time professor of theory and practice of medicine at Yale. Allen's inquiry about the wisdom of inaugurating medical lectures at Bowdoin elicited an enthusiastic response from the dean of medical professors in New England. His reply was typical: I think after what experience I have had, we could form a medical school that would, in point of real utility, equal any in the country. In a new state like Maine, where neither habit nor parties have laid their ruthless hands on the public institutions, and where the minds of men are free from their poisoning influence, everything is to be hoped for. Such a field would be very inviting to me; and such a place I take M a i n e to be. . . . 9

T h e legislative act of J u n e 27, 1820, not only established the Medical School of Maine but granted $1,500 for necessary books, plates, preparations, and apparatus, and authorized the annual payment of $1,000 for operating expenses. T h e fostering hand of the state thus exhibited afforded a most encouraging prospect for the institution. Unfortunately the benevolence of the commonwealth fathers was withdrawn in 1834. Before that misfortune overtook the department the small group of professors, with the state aid, succeeded in building up a medical library and apparatus which compared favorably with the equipment of almost any New England medical school, though four of them surpassed it in age. T h e School was first housed in Massachusetts Hall. Although considered as temporary quarters at first, the building came to be spoken of as the "Medical College." As such it served until 1862, when a state land grant yielded $5,500 which, with a generous gift of Seth Adams of Boston and an additional amount from the College, was used by the trustees to erect Adams Hall. 1 0 Three men comprised the first faculty of the Medical School of Maine, and lectures began in the spring of 1821. Nathan Smith lectured on the theory and practice of physic and surgery, Parker Cleaveland on chemistry and materia medica, and J o h n D. Wells on anatomy and physiology. 11 Smith withdrew from the School in 1825 because of his pressing duties in New Haven. From 1826 to 1861 seven different men occupied the chair of » Cited in General Catalogue of Bowdoin College and the Medical School of Maine, p. cii. Maine, Democratic-Republican in political sentiment, had just become a state, a fact pleasing to the Federalists of Massachusetts, whose security had been threatened by political elements in the wilderness and coast communities to the northeast before the separation of Maine. Smith, a pioneer in spirit, was intrigued by the freedom of the prospect in the new state. 10 Louis C. Hatch, The History of Bowdoin College, pp. 461-64. 11 T h e lectures were at first conducted in the summer as an accommodation to Smith, who lectured at Yale during the winter months. For an early contemporary account of the Brunswick school see Jaines T h a c h e r , American Medical Biography, p. 45.

OTHER NEW ENGLAND SCHOOLS

203

12

theory and practice of medicine or served as lecturers. T h e death of Wells in 1830 was a shock to the School. His skill as an operator, brilliancy as a lecturer, and wise expenditure of much of the original $ 1 , 5 0 0 grant contributed materially to the institution's early success. Four teachers succeeded Wells until 1857, when the professorship was split and the chair of surgery was created separate from anatomy and physiology, which were combined in one professorship. 13 A chair in obstetrics, founded in 1825, was first held by James McKeen of T o p s h a m until 1839. Materia medica and therapeutics were assigned to a separate chair in 1846, under Charles A l f r e d Lee, who continued until 1859. A lectureship in medical jurisprudence still further expanded the curriculum in 1849. J ° h n Searle T e n n y delivered the lectures until 1869. 14 Parker Cleaveland did not retire from chemistry until 1858. He was followed by Paul A. Chadbourne, 1859-65. In spite of its reasonably good, though small, teaching staff, satisfactory classroom, laboratory, and museum equipment, the medical department in Brunswick was lacking in clinical facilities. Although few schools at that time had access to hospitals for teaching purposes, medical educators were beginning to recognize the need of such facilities to carry on satisfactory medical education. In Maine the medical fraternity recognized soon after their State Society was organized in 1821 that the state had need of a general hospital to care for insane and surgical cases. T h e desirability of connecting such an institution with the Medical School was even more clear. T o such an end the legislature was persuaded, in 1826, to pass an act incorporating a hospital, but the solons of the state repeatedly refused to endow the proposed institution or even provide enough funds to warrant opening it, with the hope that private benevolence might keep it going. T h i s failure of the state to cooperate, and its subsequent discontinuance of the yearly allowance thwarted the progress of medical education in Maine. It may be assumed that the Bowdoin Medical School did not suffer so much from lack of fresh anatomical material as did some of the inland country schools, because of Brunswick's proximity to Portland and other port towns. Nathan Smith and his two colleagues began lectures to a class of twentyone. T h e next year forty-nine attended. T h e r e a f t e r the number of medical students averaged about eighty each year. A f t e r the first graduation (1821), 12 Henry Halsey Childs, lecturer, 1836; Daniel Oliver, 1827-28; John Delamater, 182932; William Sweetser, 1833-34; Henry Halsey Childs, lecturer, 1835-36; William Perry, 1836-37; Henry Halsey Childs, lecturer, 1837-38; James McKeen, lecturer, 1838-39; John Delamater, 1840-41; William Sweetser, 1842-61; Israel Thorndike Dana, 1861-69. General Catalogue . . . (1912) p. 48. 1» Wells's successors to 1863 were: Reuben D. Mussey, 1831-36; Jedediah Cobb, 1836-37; Joseph Roby, 1838-42; Edmund R . Peaslee, 1843-57; (surgery a separate chair); and David S. Conant, 1857-63. Peaslee occupied the chair of surgery from 1857 to i860 and Timothy Childs 1860-63. ι* In obstetrics. Dr. McKeen was followed by Ebenezer Wells, 1840-45; Fordyce Barker, 1845-46; and Amos Nourse 1846-66. In materia medica and therapeutics, Dr. Lee was succeeded by Israel Thorndike Dana, 1859-61; and William Chaffee Robinson, 1861-69.

204

MEDICAL E D U C A T I O N BEFORE T H E CIVIL W A R

when only two medical degrees were conferred, the number of medical degrees granted yearly averaged above twenty. 15 T h e yearly fee for all medical lectures at Bowdoin was forty-five dollars until 1825, w h e n the obstetrics chair was established, at which time the fee was raised five dollars. T h i s amount was constant for many years. T h e term was three months in 1825. T h e Annual Announcement of 1850 stated that the term was fourteen weeks. It also stated that the number of lectures and the extent of courses were equal to the number and extent in other New England schools, and then rather independently added that the improvements recommended by the National Medical Association "will be adopted, should the example be set by the older institutions." Thus, by declining to reform, the Medical School of Maine contributed its share to the delinquency of medical education. Little more could be expected of Bowdoin, inasmuch as its affiliated medical school, though admirably ordained and maintained as a department of the College, was poorly financed and in competition with schools enjoying hospital affiliations. As it faced the current practical problems of medical education the Medical School of Maine was on essentially the same basis as the country schools of New England and elsewhere. CASTLETON

MEDICAL

COLLEGE

T h e New Englanders w h o made settlements on both slopes of the Green Mountains during the eighteenth century carried with them a strong hereditary love for religious and educational institutions. When a Vermont village became populous and flourishing, the townsfolk began to think of an academy or a grammar school. W h e n an acadcmy was well established, its trustees before long began to plan in terms of a college to do for Vermont what Harvard had done for Massachusetts and Yale for Connecticut. Fierce boundary disputes with N e w York and New Hampshire, and the vicissitudes of the Revolutionary W a r delayed the establishment of the University of Vermont until 1791. A n act of the legislature in 1800 established Middlebury College, which opened in November of that year as the second collegiate institution for Vermont's 154,000 population. 1 6 As early as 1810 the Middlebury trustees, in an effort to broaden the scope of the curriculum, began to consider the wisdom of establishing a medical department. A n effort to take from Dartmouth New England's most famous medical professor, Nathan Smith, ended in failure. By formal action a medical department was even established, a classroom and home for the department head was provided, but the plans failed before the department was ever organized. 1 7 General Catalogue of Bowdoin College, pp. 103-25. ie T h e University of Vermont, at Burlington, was chartered in 1791, but had made very little advancement by 1800. Addison County Grammar School, from which Middlebury College sprang, was first chartered in 1797. Semi-Centennial Celebration of Middlebury College, (1850), pp. 169-71. υ W. Storrs Lee, Father Went to College, p. 85. See also Frederick C. Waite, " T h r e e 15

O T H E R NEW E N G L A N D SCHOOLS

»05

W h i l e Middlebury's trustees were h o p i n g f o r a medical department, several successful practitioners in Castleton, thirty miles to the south, were accepting private pupils and planning on the establishment of a medical school. T h e first formal lecture courses in medicine in Vermont were given by three of these men, Selah Gridley, T h e o d o r e W o o d w a r d , and J o h n L . Cazier, A . M., beginning in late February 1 8 1 8 . Seven months later (October 29, 1 8 1 8 ) the Vermont General Assembly approved of their educational venture by chartering the Castleton Medical Academy. A faculty was promptly organized and lectures u n d e r the charter began on November 15, 1 8 1 8 . A n addition to the charter, on October 27, 1819, gave to the president, with consent of the professors, power to confer honors and degrees which were usually given in medical institutions. 1 8 A b o u t this time the medical gentlemen in Castleton realized the need of academic connections for their proprietary school. T h e y saw in a hook-up with Middlebury College an opportunity for personal prestige a n d the strengthening and enlarging of the Academy, which they had established " t o offer facilities and means so ample for the acquirement of a thorough knowledge of anatomy that country students shall not be compelled to resort to cities at an increased pecuniary expenditure and the exposure of health and morals." Besides, all other New E n g l a n d medical schools h a d collegiate connections. A petition from Drs. Gridley and W o o d w a r d for a " c o n n e x i o n " with M i d d l e b u r y was favorably received a n d acted upon by the trustees in August 1820 after the faculty recommended the merger. T h u s Castleton Medical Academy was taken over in toto by the trustees of Middlebury in 1820, before Castleton had even exercised its legislative privilege of conferring degrees. Less than a week elapsed after the formation of the union before M i d d l e b u r y granted its first two M . D. degrees. Medical lectures continued to be delivered at Castleton, but the degrees were conferred in Middlebury. T h e ties between Castleton and M i d d l e b u r y were not strong. T h e affiliation was one of the first of such connections in the country, a connection in which a proprietary medical school or an ambitious group of professors sought and obtained a formal acceptance or recognition from an established liberal arts college without becoming a very active organic part of the academic and administrative mechanism of the college. T h e arrangement lasted only until 1827. D u r i n g much of this time the medical school in Middlebury's charge was the largest medical school in New England. A l t h o u g h there were no J o h n Warrens, N a t h a n Smiths, or J a m e s Jacksons on the faculty, there were several men of extraordinary ability, chief of w h o m was Dr. Woodward. 1 0 Episodes in Medical Education at Middlebury College (1810-1837)," New England Journal of Medicine, CCVI, 14: 729-735. 18 History of Rutland County, Vermont, pp. 519-20; and Waite, loc. cit. 19 T h e professorial appointments up to and including 1826 were: Selah Gridley, theory and practice, and materia medica. 1818-20; Theodore Woodward, surgery and obstetrics, 1818-39; L- Leronte Cazier, A. M., chemistry, anatomy, and physiology, 1818-19; Thomas P. Matthews, A. M., chemistry, anatomy, and physiology, 1819-20; John P. Batchelder, anatomy and physiology, 1819-22; Selah Gridley, clinical practice and medical juris-

2O6

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

While under the Middlebury regime, the Academy lengthened its lecture term from twelve to fourteen weeks. T h e conventional graduation requirements, three years of apprenticeship and two terms of lectures, were in force. Candidates for the degree were imbued with a modicum of academic sanctity by having to defend their theses publicly in the College chapel at Middlebury. T h e moving of the public examinations and commencement exercises to Middlebury was not pleasing to the villagers of Castleton, for they looked with pride on the institution that was spreading the fame of their town throughout the country. Under the initial impetus of the Middlebury connection, funds were collected to provide satisfactory quarters in the place of the original dingy building converted from a store. T h e new structure, completed during the summer of 1 8 2 1 , had a lecture room in real amphitheatre style, a chemical laboratory, a dissecting room, and a museum. Indeed, this edifice with its imposing dometopped belfry was thought to have incorporated all the main features of modern architecture for medical schools. 20 Until 1835 lectures were given annually in one term of fourteen weeks. 2 1 In the years 1 8 3 5 - 3 7 , lecture terms were the same length but given twice yearly. T h e semi-annual term idea, regardless of what virtues it may have had, was a mercenary and competitive feature. Students were more easily attracted to a school where the required two terms of lectures could be taken in one year. Competing institutions obviously were not pleased to have their first-year students transfer to Castleton at the close of the winter term with the prospect of completing the required work for the degree before the close of the following summer. Hard times came upon the Academy in 1838 through the severe illness and incapacity of Dr. Woodward and the unexpected determination of two members of the faculty to join the staff of a rival school. T h i s severe shock, added to the regular problems of administration, was almost fatal. For two years the trustees were forced to suspend operations. In 1839 the Academy was reorganized and a faculty of five appointed in time to begin a spring term of fourteen weeks in March 1840. T h e efforts to revive the school were more than ordinarily successful. T h e building was remodeled and the museum collections were enlarged. 2 2 prudence, 1820-24; Thomas P. Matthews, chemistry, >820-21; Amos Eaton, botany, chemistry, natural philosophy, 1820-26; Joseph A. Gallup, theory and practice of materia medica, 1820-23; William Anderson, anatomy and physiology, 1822-24; Jonathan Allen, materia medica and pharmacy, 1822-29; William Tully, theory and practice and medical jurisprudence, 1824-39; Alden March, anatomy and physiology, 1825-35; Lewis C. Beck, botany and chemistry, 1826-32; and Amos Eaton, natural philosophy, 1826-28. See History of Rutland County, Vermont, p. 521. By an act of November 7, 1822, the name of the institution was changed to Vermont Academy of Medicine. 20 Lee, op. cit., pp. 85-86. 21 The Triennial Catalogue of the Officers and Students . . . 1829 listed a lecture course of fifteen weeks. 22 History of Rutland County, Vermont, p. 521, lists the following Castleton faculty 1828-58; Solomon Foote, natural philosophy, 1828-33; John D'Wolf, chemistry and natural philosophy, 1833-39; James H. Armsby, anatomy and physiology, 1835-39; Horace Green, theory and practice of physic, 1839-41; Joseph Perkins, materia medica and ob-

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207

Foremost a m o n g the professors in the year 1 8 4 1 - 4 2 , was the president, J a m e s M c C l i n t o c k , recently f r o m P h i l a d e l p h i a , the country's medical center. 2 3 M c C l i n t o c k , w h o was also professor of general, special, a n d surgical a n a t o m y , attacked the p r o b l e m of r e b u i l d i n g the reputation of the institution with p o w e r f u l enthusiasm. I n October 1 8 4 1 , the n a m e was c h a n g e d to Castleton Medical College, a n a m e more expressive of the institution's chartered privileges. R e a d i n g terms or private lectures a n d demonstrations were offered at the close of the regular lecture term. I n a d d i t i o n to increasing the professors' revenues these r e a d i n g terms answered in a measure the current d e m a n d s f o r longer tenus in medical education. I n 1 8 4 5 the Catalogue again a n n o u n c e d two lecture terms yearly, each to be f o l l o w e d by a two-month r e a d i n g term. E a c h lecture term was extended to f o u r months. I n lecture terms Castleton c o m p a r e d well with the m a j o r i t y of schools throughout the country. T h e double-term system, however, d i d not contribute to the b u i l d i n g u p of friendly relations between the schools of N e w E n g l a n d . I n spite of competition and the general decline in the p o p u l a r i t y and utility of country medical schools, Castleton M e d i c a l C o l l e g e c o n t i n u e d to prosper until about 1854. In that year President J o s e p h Perkins h a d some m i s u n d e r s t a n d i n g with the trustees a n d faculty, w h i c h led h i m to resign a n d accept an a p p o i n t m e n t with the University M e d i c a l School in B u r l i n g t o n . Perkins's action precipitated an u n p l e a s a n t controversy resulting in the loss of other professors a n d a d i m i n i s h i n g student body. B y 1 8 3 9 Castleton was s u r r o u n d e d by c o m p e t i n g medical schools, all w i t h i n one h u n d r e d miles. T h e University C o l l e g e of Medicine in Burlington a n d the V e r m o n t Medical College in Woodstock drew heavily f r o m the V e r m o n t territory originally served by Castleton. A l d e n March's school ( A l b a n y M e d i c a l College) served that portion of upstate N e w Y o r k w h i c h h a d previously patronized Castleton. T h e B e r k s h i r e M e d i c a l College in Pittsfteld, western Massachusetts, carved out its place in medical education by attracting the apprentices f r o m the western e n d of the bay state, southern V e r m o n t , a n d parts of N e w Y o r k . stetrics, 1839-?; J a m e s Hadley, chemistry and pharmacy, 1 8 3 9 - 4 1 ; Robert Nelson, anatomy and physiology, 1839-40; James Bryan, surgery and medical jurisprudence, 1 8 3 9 - 4 1 ; J a m e s McClintock, general, special, and surgical anatomy, 1841-?; Frank H. Hamilton, principles and practice of surgery, 1841-?; C. L . Mitchell, physiology, general pathology, a n d operative obstetrics, 1841; Daniel M . Ruse, theory and practice of medicine, 1841-?; William C. Wallace, ophthalmic anatomy a n d surgery, 1 8 4 1 - ? ; William Mather, chemistry and pharmacy, 1841-?; William Russel, medical jurisprudence, 1841-?; Alfred C. Post, ophthalmia surgery, 1842-?; and surgery, 1842-?; Ezra S. Carr, chemistry, physiology, and natural history, 184a-?; Samuel Parkman, descriptive and surgical anatomy, 1842-?; Middleton Goldsmith, principles and practice of surgery, 1845-?; T h o m a s M. Markoe, surgical anatomy, 1846-?; Solomon Foote, medical jurisprudence, 1844-?; William C. Kittridge, medical jurisprudence, 1846-?; Corydon L a F o r d , anatomy and physiology, 1849-?; George Hadley, chemistry and natural history, 1 8 5 3 - ; A d r i a n 'Γ. Woodward and Albert Smith are listed without chairs in 1857 and William P. Seymour and E. R . Sanborn in 1858. ¡¡a McClintock returned to Philadelphia after two or three years. Supra, "Schools of Pennsylvania."

208

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

T h e basic cause f o r the decline of Castleton also-operated to an extent in the decline of other country schools. A school without adequate anatomical facilities, hospital beds, or an out-patient department could not compete with the city schools that had such facilities and were beginning to make very practical use of them by the middle of the century. A survey of a representative group of Castleton's catalogues and announcements during its forty years of existence reveals the fact that Castleton, like other country schools and many city schools of the time, was devoted to didactic teaching at the expense of practical science. Dissection was glowingly advertised but opportunities were limited. Body snatching from the churchyard burying ground or private cemeteries was hazardous business. Imported specimens from Boston or New York were often in a condition almost unfit for use when they arrived. These conditions led the professors, especially in their introductory addresses, to minimize the more practical aspects of medical education by superfluous rhetorical emphasis on the cultural, theoretical, and bookish aspects of the healing art.- 4 Although Castleton Medical College was practically eliminated in 1855, it continued to exist in name until 1861. From 1818 to 1838 Castleton matriculated 2,014 students and graduated 547. From 1839 to 1854, 2,603 were registered and 804 graduated. These figures alone made Castleton worthy of a front-rank place among the schools of its day in New England. Of the country schools, Castleton was one of the most picturesque, with its shifting faculty, its bitter quarreling with other schools, especially the University of Vermont, and its persistent determination to live in spite of overwhelming odds. Because of its geographic position, its ever changing faculty, and the large number and activity of its alumni, Castleton Medical College was a p o w e r f u l agent in the teaching and molding of medical science well past the middle of the century. 25 UNIVERSITY

OF

VERMONT

MEDICAL

DEPARTMENT

Vermont was admitted to the Union in 1791. Its constitution provided f o r a university, and approval of a charter for it was one of the first acts of the legislators. Burlington, the proposed site of the institution, had few inhabitants. Without strong financial support from the state and a more populous community, neither of which existed at the time, the trustees were able to do little toward organizing the school. T h e first president, 24 Alfred C. Post, An Introductory Address to the Students of Castleton Medical College . . . 184}. Samuel Parkman, Introductory Lectures to the Spring Session of Lectures in Castleton Medical College, 1845. James McClintock, Annual Lectures; Introductory Lecture Delivered in the Castleton Medical College, March 8, 1842. 2» Castleton usually had from fifty to 100 students in attendance, and four to seven professors. High standards of preliminary education were encouraged at one time by offering college seniors tuition at six and one half dollars a year. Tuition ordinarily was about ten or twelve dollars for each subject. T h e Catalogue of 1845 announced dissecting subjects for fifteen dollars. A valuable discussion of the Castleton school is given by Frederick C. Waite, "Birth of the First Independent Proprietary Medical School in New England, at Castleton, Vermont, in 1818," Annals of Medical History, N. S., VIII, 3: 242-52, May, 1935. Waite regarded the Castleton school as the very first entirely independent medical school in the country.

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209

Reverend Daniel Clarke Sanders, D. D., was not elected until 1800. T h e idea of medical lectures was an early consideration. According to the General Catalogue of the University, Dr. J o h n Pomeroy was appointed to the chair of physic, anatomy, and surgery in 1809, the same year in which James Dean, the first professor in the academic department, was appointed. No other chairs of medical science were established until 1821, the year before the Medical Department was actually organized and two years before the first graduation. 26 T h e department's first staff was composed of Arthur Livermore Porter, Dartmouth, 1818, professor of chemistry and pharmacy, 1 8 2 1 - 2 5 ; William Paddock, Dartmouth, 1815, professor of botany and materia medica, 1821-24; and Nathan Ryno Smith, Yale, 1817, son of the celebrated Nathan Smith, anatomy and physiology. T h i s small school at Burlington was, then, essentially a New England product, being manned by Dartmouth and Yale graduates. Indeed, no chairs of medical science at the University were held by graduates of medical schools outside of New England before 1853, when Horatio Nelson of New York University took the chair of surgery. Thereafter several men from Philadelphia, New York, and elsewhere were employed from time to time, but the New England stock prevailed." T h e Burlington school graduated four students in 1823 and averaged better than twelve M. D. degrees yearly thereafter until 1 8 3 1 . T h e n the school experienced many lean years, averaging less than five graduates a year in the seven years in which degrees were conferred out of the next twenty-five years. Beginning with 1854 the Medical Department of the University showed definite signs of recovery in its attendance. Thereafter the future of the school seemed to be assured if the number of matriculants was indicative. An average of about nineteen were graduated annually from 1856 to 1861. 28 It is interesting to note that the decline in the University Medical Department beginning in 1830-31 was paralleled by prosperous years at 2« Elbert Vaughan Wills, The Growth of American Higher Education, p. 80, states that a lecturer on "Chirurgery and Anatomy" was appointed in 1804. T h e General Catalogue of the University of Vermont and State Agricultural College, p. 21, does not support Wills's statement. T h e chair established for Pomeroy was unfilled from 1 8 1 7 - 2 1 . 27 Faculty appointments from 1823 until the Civil War were: James Kent Piatt, surgery, 1823-24; William Sweetzer (Sweetser), theory and practice, 1825-32; J o h n Bell, anatomy and physiology, 1825; William Anderson, anatomy and physiology, 1825-28; Henry S. Waterhouse, surgery, 1825-27; Benjamin Lincoln, 1829-34; Joseph Marsh, theory and practice, 1835-41; Edward Elisha Phelps, anatomy and surgery, 1835-37; Samuel White Thayer, anatomy and physiology, 1853-56, surgery, 1854-55, anatomy, 1856-72; Walter Carpenter, materia medica and therapeutics, 1853-57; theory and practice, 1857-81; Edward Kane, theory and practice and pathology, 1853-57; O r r ' n Smith, obstetrics and obstetrical jurisprudence, 1853-58; Horatio Nelson, surgery, 1853-54; David Sloan Conant, surgery, 1855-65; John V. Lansing, physiology and pathology, 1856-57; medical jurisprudence and medical psychology, 1857-58; Joseph Perkins, materia medica, and therapeutics 1857-58, obstetrics, 1858-68; Richard Cresson Stiles, physiology and pathology, 1857-65; and Henry Martyn Seeley, chemistry and toxicology, 1860-67. 'bld., PP· 21-22. 2 « T h e seven years in which degrees were granted were 1831, six; 1832, ten; 1833, four; 1834, four; 1836, one; 1854, six; and 1855, three. Ibid., pp. 202-4.

210

MEDICAL EDUCATION

BEFORE T H E CIVIL W A R

Castleton and the rising activity at the Clinical School of Medicine (established 1827) at Woodstock, Vermont. Castleton's short recess in 1838-39 seemingly was not sufficient stimulus to revive the Burlington school, w h i c h was practically in a state of coma from 1836 to 1853, when it was reorganized. T h e definite decline of Castleton beginning in 1854 and its complete elimination in 1861 is accurately complemented by the splendid recovery of the University Medical School during the same years. Presumably economic difficulties were the primary cause for the suspension of the Medical Department at Burlington in 1836. T h i s of course was the result of curtailed revenue from student fees as well as a drying up of other sources of financial support. 29 Benjamin Lincoln, who joined the University medical faculty in 1829 as professor of anatomy and surgery, recognized the Castleton school as the chief competitor of his school, and Castleton's dean, T h e o d o r e Woodward, professor of surgery and obstetrics, as the traditional fly in his ointment. Dr. Lincoln was not the dean at Burlington but was a zealous defender of the University's Medical Department. W h e n four Canadians w h o had taken one term of medical lectures at M c G i l l University presented themselves for advanced standing at B u r l i n g t o n in 1831, Professor G. W. Benedict, the dean, delayed action in order to communicate with the M c G i l l faculty. Meanwhile the Canadians wrote to the Castleton school, which promptly took them in. T h e event occasioned a bitter quarrel between Lincoln and Woodward that assumed disgraceful proportions. A l l manner of invectives were indulged in. Woodward admitted soliciting students and inferred that Lincoln w o u l d have done likewise if he had been awake. T h e feud finally brought forth from Lincoln's pen, in 1833, an invective published in 110 pages, in which Woodward's "Deeds of Darkness" were laid bare. T h e value of the bulky pamphlet lay in Lincoln's analysis of the evils of the current system of medical education, particularly in New England. He made sane suggestions for higher scholastic standards of admission and graduation. H e admitted Burlington's as well as Castleton's inability to teach medicine clinically and proposed that the state legislature recognize the Woodstock school, which had some facilities for teaching medicine at the bedside. H e thought that Woodstock might become the finishing place for students w h o had studied the theory of medicine elsewhere in Vermont. 30 A l t h o u g h little information seems to be available on the early history of the University of Vermont Medical Department, the student of medical history can be sure that it was a typical country medical school, lacking in clinical teaching facilities and having only a limited amount of dissection material. T h e school, of necessity then, stressed the importance of the lecture system. It is equally plain that, with all the competition and 2 » T h e panic in 1837 probably added to the burdens of both the Burlington and Castleton schools. T h i s is attested to by the fact that both schools were suspended about this time. 3o Benjamin Lincoln, Hints on the Present State of Medical Education and the Influence of Medical Schools in New England. With an Appendix Containing a Review of a Letter by T. Woodward, . . . pp. 73-76. Lincoln referred to G. W. Benedict as dean of the Burlington school, but the University Catalogue does not mention him.

O T H E R NEW ENGLAND SCHOOLS

21 1

financial distress, the Burlington school, like other schools in similar and even better circumstances, minimized entrance requirements, even though its circulars very likely stressed " L a t i n and natural philosophy" standards. T h e University Medical Department was apparently a weaker school than Castleton Medical College, because it succumbed to the economic impact of the day long before Castleton. W h e n the B u r l i n g t o n school finally reestablished itself in 1853 it was at the expense of Castleton. T h u s the struggling institution, so violently defended by B e n j a m i n Lincoln, 1829-34, received a new and permanent lease on life. 3 1 T h e contribution of the University to medical education and practice before 1861 fell short of the contribution of Castleton. T h e greatest service of both schools was the training of a large number of men to provide reasonable medical care for towns a n d villages of New E n g l a n d and for the hardy pioneers w h o were moving westward through New York on into the O h i o Valley. W h i l e Castleton was graduating over 1,300, B u r l i n g t o n turned out less than 250 graduates. BERKSHIRE

MEDICAL

INSTITUTION

OF

MASSACHUSETTS

T h e advent of doctors to Berkshire County in western Massachusetts dates from about the middle of the eighteenth century. T h e s e early pioneer men of pill and scalpel were usually H a r v a r d or Yale arts graduates w h o had supplemented their academic training by reading medicine under some well-known practitioner. A f t e r attaining some degree of proficiency they went west to establish themselves in the communities just starting among the Berkshire hills. Later, trained physicians from Harvard, Dartmouth, Yale, and elsewhere joined the profession in the scattered villages in Berkshire County. 3 2 As early as 1762, settlers in the west end of the province petitioned the colonial legislators for a college at Hatfield, H a m p s h i r e County, in order to save their children from growing u p " b a r b a r o u s and uncivilized." W h e n a legislative act failed to pass both houses G o v e r n o r Sir Francis B e r n a r d issued a charter in the name of the K i n g . H a r v a r d supporters promptly terrorized the Governor into revoking the charter. T h i r t y years later citizens of Berkshire memorialized the government of the state for a college and succeeded in establishing Williams College at Williamstown, in 1793. A m o n g the graduates of Williams College (A. B., 1802 and A . M., 1805) was Henry Halsey Childs, born in Pittsfield, Berkshire County, the son of Dr. T i m o t h y Childs, a surgeon of the R e v o l u t i o n . Y o u n g Childs, true to traditional custom, read medicine under his father, with w h o m he became associated. In this way he grew into an excellent practice without ever 3i Tuition rates at Burlington were probably officially ten or twelve dollars for each lecture course. A Berkshire County Medical Society was formed in 1787. T h e fourteen charter members agreed that no member should introduce his pupils into the practice of medicine, unless they be first examined by the censors and recommended by them to the association for a certificate of their qualifications. History of Berkshire County, Massachusetts, p. 598.

MEDICAL EDUCATION BEFORE T H E CIVIL WAR receiving the M . D. degree. One day in 1 8 2 1 , Oliver S. Root, a student in the newly established Castleton Medical Academy of Vermont, came to Pittsfield with a message from his teacher, J o h n Putnam Batchelder, M. D. (Harvard, 1815), to Dr. Henry Childs. Batchelder, dissatisfied with his connections in Castleton, proposed to Dr. Childs that the time was ripe to establish a medical school in Pittsfield. A little encouragement was all that the energetic Childs needed. He presented the idea to the Berkshire District Medical Society, which he had recently helped to revive. 3 3 A petition for a charter and endowment was presented at the J u n e 1822 legislative session. T h e memorial was fortified with all of the conventional arguments of country medical school promoters and pointed out that Berkshire County had done its part in supporting other institutions throughout the state. After being printed in the Boston Sentinel and Pittsfield Sun the proposition came before the fall session. Again H a r v a r d sought to defend her traditional rights. T h e radicalism of Berkshire and especially Pittsfield was proverbial in Boston. Dr. Childs belonged to the political school which was anathema to standpat Federalists in Boston. With the aid of loyal friends in both houses the charter was finally granted, but no endowment was voted until 1823, when $5,000 in five yearly payments was authorized. T h e citizens of Pittsfield generously subscribed about $3,000, much of which was not paid for several years. T h e charter named Henry Hubbard, Samuel M. McKay, Henry H. Childs, and J . P. Batchelder as trustees of the Berkshire Medical Institution. T h e lack of degree-granting power in the charter was compensated for by a loose affiliation with Williams College, which adopted the Institution as its Medical Department. T h i s connection lasted until 1837, when the Berkshire school legally became recognized as an independent medical college with powers to grant degrees which would be recognized by the State Society. Previously Berkshire graduates were not admitted to the State Society without fee and examination. 3 4 T h r e e months before the Berkshire District Medical Society petitioned for a school charter Dr. Childs confidently purchased the old Pittsfield Hotel building. During that year an informal course of lectures was given to twenty-five students. T h e first regular course of lectures began in 1823 with about eighty students in attendance. T h e next year the trustees received permission to move the hotel stable to the lot east of the townhouse and remodel it f o r school purposes with the provision that the school keep the town house insured against fire. A f t e r some other buildings were erected the school had a fairly neat establishment. T h e old hotel was converted into a dormitory and boarding house. Following a destructive 33 This society, organized in 1807, had lapsed into desuetude. 3* Both Leverett Wilson Spring, A History of Williams College, p. 320, and Calvin Durfee, A History of Williams College, p. 194, make only slight reference to Williams' affiliation with the Berkshire Medical Institution. Castleton's loose connection with Middlebury probably served as a model for the Williams-Berkshire connection.

OTHER NEW ENGLAND SCHOOLS

213

fire in 1850, the legislature granted $10,000 and Berkshire citizens gave $5,000 for a new and commodious structure on South Street. T h e dormitory was discontinued and the building sold. 35 Berkshire's first faculty was formed by six men, a splendid start for a country school. T h e y were: Jerome V. C. Smith, anatomy and physiology; J . P. Batchelder, surgery, anatomy, and physiology as subservient to the theory and practice of medicine and surgery; Henry H . Childs, theory and practice of medicine; Asa Burbank, obstetrics; J o h n Delamater, materia medica and pharmacy; Chester Dewey, chemistry, botany, mineralogy, natural and experimental philosophy; and Stephen W. Williams, medical jurisprudence. 3 8 T h e first president of the Institution was Dr. J o n a h Goodhue of Hadley, one of New England's self-educated physicians. Dr. Zadoc Howe of Billerica followed Goodhue in 1829 and continued until 1837, when Dr. Childs succeeded to the presidency. Non-residency of the previous presidents had been a handicap to the school. Childs resigned his professorship when he reached the age of eighty in 1863 but retained the presidency until his death in 1868, the year before the Institution passed out of existence. 37 A p p r o v a l by the Pittsfield townspeople of the establishment of the Medical College was mingled with some apprehension. Before 1830 the Massachusetts law almost countenanced grave robbery by permitting physicians to have in their possession bodies for anatomical study without accounting for the way in which they were obtained. 3 8 In 1820 the body of one George Butler, J r . was stolen from its grave. T h e Pittsfield citizenry arose in holy rage to punish the offenders. T h e facts of this case were fresh in the minds of the leading citizens when the Berkshire Medical Institution was organized two years later. It was generally believed that scarcely a burying ground in the county had not had its nocturnal visits by the "resurrectionists." T o allay this fear the trustees in the first formal announcement of the school gave the public abundant assurance that the Institution's extensive anatomical preparations and its course in "comparative anatomy, or the dissection of brute animals" furnished " a n excellent substitute for human dissection." Dissection of human bodies was of course carried on, but the response of the townspeople in support of the school from year to year is some proof that the trustees and faculty proved ss History of Berkshire

County, pp. 391—97.

'«Ibid., p. 395. T h e trustees conferred an honorary degree on Childs in 1823. s? Many brilliant men served on the medical faculty at Pittsfield from time to time. Among them, in addition to those previously noted, who added luster to Berkshire's reputation were Drs. Pliny Erie, A. B. Palmer, Paul A. Chadbourne, William H. Thayer, Corydon La Ford, R . Cresson Stiles, William Warren Green, and H. M. Seeley. Thayer and Stiles intensified the local esprit de corps by publishing for only one year the Berkshire Medical Journal. All of these men worked vigorously for the success of the Pittsfield school, but sooner or later saw the hopelessness of their cause and abandoned the task for more promising fields. History of Èerkshire County, p. 397. s» An act passed in 1830 afforded protection for burial grounds and directed that the bodies of certain deceased criminals be made available for dissection. Thereafter bodies were more easily obtained.

214

MEDICAL EDUCATION BEFORE T H E CIVIL W A R

to some extent their "honest intentions" not to disturb the "repose of the d e a d . " 39 Besides the lecture courses, the school offered a regular course of instruction throughout the year by the resident professors. Much of the time was consumed by what was called the reading term. 40 T h r e e full years " i n this institution" was accepted in lieu of three years of apprenticeship under some practitioner. U n d e r such a plan men were graduated from Berkshire w h o received all of their medical education from the school. T h e Institution made the categorical requirement of a "usual and adequate knowledge of L a t i n " before graduation. Other graduation requirements were as usually stipulated elsewhere. T h e fees were comparable to the charges at Castleton and other country schools. In the earlier years of the school, board, washing, a n d lodging were offered for one dollar and seventy-five cents weekly, a rate calculated to attract poorer students w h o might otherwise have chosen a city school. 41 T h e Catalogue of 1 8 3 0 - 3 1 announced a lecture term of fifteen weeks. It was later advertised as thirteen weeks ( 1 8 4 1 ) and fourteen weeks (1844). Beginning in 1866 the lecture courses were given in the summer time, an indication that certain professors with winter lectures elsewhere were being favored. T h i s policy was an outward sign of Berkshire's decline a n d of the end that came three years later. T h e average attendance from 1823 t o 1 8 3 5 was about eighty-five. In 1836 it rose to one hundred and five, but fell to sixty-eight in 1837, an index of business in the panic year. T h e average to 1844 was about eighty. During the next five years Berkshire was one of the largest New E n g l a n d schools, with an average attendance of 135. T h e final decline, intercepted by temporary recoveries, began in 1849. forty-four years of its existence the Berkshire Medical College, as it was often called after 1837, graduated 1 , 1 3 8 doctors of medicine. Such a large group of men must have materially influenced the medical profession. Berkshire thrived during the decades of western migration from New England to the Ohio Valley. L i k e similarly located schools, the Berkshire Medical Institution's greatest contribution to society was its feeding into the successive waves of migration practitioners and professors of medicine to succor the founders of American civilization in the West. T h e medical school cradled and nurtured by Dr. Henry Childs was never a great asset to the growth of scientific medicine and the spirit of investigation. Its anatomical facilities were admittedly weak. It lacked in clinical opportunities; no college clinic was founded until 1854. With the so J. P. Batchelder, Berkshire Medical Institution, pp. 10, 11. In 1830, two bodies stolen in Franklin County were traced to two students in Pittsfield. A town meeting, resolutions of indignation, and much excitement resulted. •«»The Catalogue of 1830-31 a n n o u n c e d a reading term from the first Wednesday of February to the last Wednesday of August with three weeks vacation in May. Fees were usually advertised as: for all lectures, forty dollars; tuition for a year, exclusive of lectures, fifty dollars; matriculation, three; and graduation, twelve. In the forties these fees were raised slightly. Catalogue, (1824), pp. 29-30, 30-31; ibid., Í1841), ΡΡ· 44"47·

O T H E R N E W E N G L A N D SCHOOLS d e v e l o p m e n t of e n d o w e d a n d better e q u i p p e d schools farther west a n d the u s h e r i n g in of organized bedside teaching in the city schools, the College in Pittsfield was u n a b l e to compete, a n d passed out of existence w i t h little struggling, in 1869. 4 2 VERMONT MEDICAL

COLLEGE

P r o m i n e n t in Vermont's early medical a f f a i r s was Dr. J o s e p h A d a m s G a l l u p , a D a r t m o u t h medical graduate of 1 7 9 8 . T h e f o l l o w i n g year he began general practice at Woodstock, one of V e r m o n t ' s largest villages, located in a picturesque region on the O t t a u q u e c h e e R i v e r . Besides his practice, he conducted a d r u g business. D r . G a l l u p was active in the f o r m a t i o n of the V e r m o n t State M e d i c a l Society, incorporated in 1 8 1 3 , a n d was its president f r o m 1 8 1 8 to 1829. H e was professor of theory a n d practice at the Castleton A c a d e m y of M e d i c i n e f r o m 1 8 2 1 to 1 8 2 5 a n t ^ served as president of the corporation the last f o u r years of his professorship. I n the latter year he switched his allegiance to the U n i v e r s i t y of V e r m o n t M e d i c a l School a n d accepted the chair of materia m e d i c a at B u r l i n g t o n , w h e r e he r e m a i n e d only one year. 4 3 Dr. G a l l u p was obsessed with the idea of establishing a medical school in his o w n town, Woodstock. Soon the zealous professor f o u n d e d the C l i n i c a l School of Medicine, in 1827. T h e n a m e of the institution was indicative of its peculiarity. G a l l u p firmly b e l i e v e d that medical instruction s h o u l d be given at the bedside. H e m a y not h a v e been in a d v a n c e of some of his contemporaries in recognition of this f u n d a m e n t a l p r i n c i p l e of medical education, but he distinguished himself by taking steps actually to carry it out in his o w n school. In comparison w i t h city hospitals of the day G a l l u p ' s infirmary, established in 1827 in Woodstock, was of slight importance. Nevertheless it p r o v i d e d f o r m e d i c a l students in the C l i n i c a l School of M e d i c i n e a privilege not a f f o r d e d to medical students in a n y other country school of N e w E n g l a n d . In o r d e r to insure a variety of patients f o r students to observe, free treatment was offered at the i n f i r m a r y d u r i n g the lecture season. It is p r o b a b l e that in this one respect the little school at Woodstock c o m p a r e d f a v o r a b l y w i t h some of the city schools w h i c h h a d greater clinical teaching o p p o r t u n i t i e s but were not yet f u l l y a w a k e to the importance of this mode of m e d i c a l instruction. H o w m a n y beds were a v a i l a b l e f o r teaching purposes is not k n o w n , but it is reasonably certain that the institution was limited in scope a n d activity. G a l l u p was the C l i n i c a l School's first professor of the institutes of medicine, of materia medica, of clinical medicine, a n d of obstetrics. I n fact, G a l l u p seems to h a v e been practically the entire faculty. 4 4 A s m i g h t be expected, an effort was soon m a d e to establish some b o n d of connection w i t h a liberal arts college. T h e University at B u r l i n g t o n h a d its M e d i c a l Ί2 For attendance figures see History of Berkshire County, p. 395. « Charles S. Caverly, " J o s e p h Adams G a l l u p , " H . A. Kelly and W. I.. Burrage, Dictionary of American Medical Biography, pp. 445-46. 44 According to Waitc, loc. cit., G a l l u p had two y o u n g men, one an 1 8 1 9 H a r v a r d graduate, associated with him in teaching.

2i6

MEDICAL E D U C A T I O N BEFORE T H E CIVIL WAR

S c h o o l , a n d M i d d l e b u r y C o l l e g e , h a v i n g r e c e n t l y c u t its ties w i t h C a s t l e t o n , w a s n o t i n t e r e s t e d i n e m b a r k i n g o n a n o t h e r q u e s t i o n a b l e r e l a t i o n s h i p so soon. T h e B u r l i n g t o n a n d Castleton medical groups blocked G a l l u p in h i s e f f o r t t o o b t a i n a c h a r t e r f r o m t h e 1827 l e g i s l a t u r e . W i t h o u t degreeg r a n t i n g a u t h o r i t y t h e S c h o o l w a s c o m p e l l e d to s u s p e n d a c t i v e t e a c h i n g i n 1828. S u c h c i r c u m s t a n c e s l e d D r . G a l l u p to j u m p t w o state lines a n d m e m o r i a l i z e t h e trustees of W a t e r v i l l e C o l l e g e , o n e of M a i n e ' s earliest b a c k w a t e r c o l l e g e s , n o w k n o w n as C o l b y C o l l e g e . I n D e c e m b e r 1828 the W a t e r v i l l e trustees a p p r o v e d of D r . G a l l u p ' s p r o p o s a l t h a t the little M a i n e college, w i t h its less t h a n t h r e e s c o r e s t u d e n t s , a d o p t t h e C l i n i c a l S c h o o l t w o states a w a y in o r d e r t h a t G a l l u p ' s p u p i l s m i g h t r e c e i v e m e d i c a l degrees. 4 5 T h e i n t e r s t a t e c o n n e c t i o n b e t w e e n W a t e r v i l l e a n d the C l i n i c a l S c h o o l w a s s o o n e f f e c t e d b u t o n l y l a s t e d u n t i l 1832. A l t o g e t h e r , W a t e r v i l l e C o l l e g e c o n f e r r e d fifty-five M . D . d e g r e e s by v i r t u e of this loose liaison, e l e v e n i n 1830, s i x t e e n in 1831, a n d t w e n t y - e i g h t in 1832. T w e n t y - e i g h t s t u d e n t s a t t e n d e d l e c t u r e s in 1830. T w o c o u r s e s of l e c t u r e s a n d t h r e e years of p r i v a t e s t u d y w e r e r e q u i r e d f o r g r a d u a t i o n . C a n d i d a t e s f o r g r a d u a t i o n w e r e r e q u i r e d to b e t w e n t y - o n e years of a g e a n d a b l e t o e x h i b i t a c o m p e t e n t k n o w l e d g e of L a t i n . T h e s e s c h o l a s t i c s t a n d a r d s w e r e c o m p a r a b l e to r e q u i r e m e n t s in C a s t l e t o n , B u r l i n g t o n , a n d P i t t s f i e l d . T h e l e c t u r e courses, a c c o r d i n g t o the Catalogue f o r 1 8 3 0 - 3 1 , w e r e t h i r t e e n w e e k s in l e n g t h , a n d b e g a n i n M a r c h , indicati n g that the professors h a d w i n t e r appointments elsewhere. A reading t e r m c o m m e n c e d a w e e k a f t e r t h e close of the l e c t u r e courses a n d cont i n u e d t h r o u g h t h e y e a r . T h e n e x t Catalogue a n n o u n c e d three reading ' t e r m s of t w e l v e w e e k s e a c h , w i t h a w e e k o r m o r e v a c a t i o n b e t w e e n terms. T h e y e a r - r o u n d a c t i v i t y a t t h e W o o d s t o c k s c h o o l was m o r e t h e result of G a l l u p ' s zeal t h a n t h e e f f e c t o f the l o n g - d i s t a n c e c o l l e g i a t e i n f l u e n c e . " Professor G a l l u p ' s arrangement with Waterville College was roundly c r i t i c i z e d i n m e d i c a l c i r c l e s of V e r m o n t . B e n j a m i n L i n c o l n , B u r l i n g t o n ' s bitter critic of Castleton's T h e o d o r e W o o d w a r d , was no d o u b t referring to t h e W o o d s t o c k - W a t e r v i l l e c o n n e c t i o n w h e n h e said: " T h e r e a r e d i p l o m a s 45 Edwin Carey Whittemore, Colby College 1820-1925, pp. 44-45. Written approval had to be secured from several absent members of the Board of Trustees before the December 1828 action was finally reported to Dr. Gallup. T h e Waterville trustees appointed two censors to sit with Vermont Medical Society censors at examinations, and reserved the right to discontinue the affiliation at their will. 46 General Catalogue of Colby College, pp. 376-77. Catalogue of the Officers and Students of Waterville College and of the Clinical School of Medicine at Woodstock, Vt. Connected With the College, 1830-31 and Catalogue . . . 1831. Fee for a term of lectures was forty dollars, the examination twelve dollars, and matriculation five dollars. T h e three reading terms were offered at ten dollars each. T h e Catalogue for 1832 offered board and lodging from a dollar and a quarter to a dollar seventy-five weekly. T h e Catalogue of 1830-31 listed the following professors: Joseph A. Gallup, institutes of medicine and lecturer on clinical practice and obstetrics; Willard Parker, anatomy and lecturer on principles of surgery; David Palmer, lecturer on materia medica, pharmacy, and medical jurisprudence; and Frederick A . Willard, lecturer on chemical philosophy and botany. T h e Catalogue of 1831 listed Edward F. Sing as demonstrator of anatomy, and Lyman Bartlett and W. F. T i l t o n as assistant dissectors.

OTHER NEW ENGLAND SCHOOLS

217

e n o u g h i n t h e S t a t e of M a i n e y e t : — t h e y g r o w w i l d o n t h e b a n k s of Kennebeck,

above

Presumably

tidewater.

criticism

the

. . ."4T

in V e r m o n t

and

not

trustees b r o u g h t a b o u t t h e d i s s o l u t i o n . T h e

the action

of

w i l l i n g n e s s of

Waterville's Middlebury's

trustees t o a d o p t a m e d i c a l d e p a r t m e n t a g a i n m a y h a v e b e e n t h e d e c i d i n g f a c t o r . S u c h a n a r r a n g e m e n t w a s c o n s u m m a t e d in t i m e t o i n c l u d e a n ann o u n c e m e n t of it in t h e 1833 Catalogue.

U n d e r the n e w c o n n e c t i o n

ex-

a m i n a t i o n s w e r e a t t e n d e d b y a b o a r d of visitors a p p o i n t e d b y t h e p r e s i d e n t a n d f e l l o w s of M i d d l e b u r y C o l l e g e . D e g r e e s w e r e c o n f e r r e d at W o o d s t o c k , a r e v e r s a l of t h e p o l i c y p u r s u e d w i t h C a s t l e t o n . T h e fees a n d r e q u i r e m e n t s f o r g r a d u a t i o n w e r e essentially the same as u n d e r t h e W a t e r v i l l e T h e Catalogue

charter.

of 1835 m a d e first m e n t i o n of d e f e n d i n g a thesis as a re-

q u i r e m e n t . T h e Catalogue

of 1836 w a s s i l e n t o n t h e L a t i n

requirement.48

I n 1834, dissension in t h e f a c u l t y b e t w e e n D r . G a l l u p a n d a c o l l e a g u e , Dr. D a v i d

P a l m e r , r e s u l t e d in t h e w i t h d r a w a l

of D r .

Gallup

from

the

f a c u l t y . D r . H e n r y H . C h i l d s , f o u n d e r of t h e B e r k s h i r e M e d i c a l I n s t i t u t i o n , w a s e l e c t e d p r e s i d e n t of t h e c o r p o r a t i o n in 1835 a n d b e c a m e p r o f e s s o r of t h e o r y a n d p r a c t i c e of p h y s i c a n d obstetrics. A n act of t h e l e g i s l a t u r e , i n O c t o b e r 1835, c o n s t i t u t e d the V e r m o n t M e d i c a l C o l l e g e as a n i n d e p e n d e n t institution

with

degree-granting

authority.49

President

Joshua

Bates

M i d d l e b u r y h a d b e c o m e t i r e d of his c h a r g e b e c a u s e t h e t r o u b l e s in dlebury were enough two

institutions

had

to consume not

been

his e n e r g i e s .

active.

The

Fellowship

records

of

the

between

the

Middlebury

trustees d o n o t e v e n m a k e m e n t i o n of t h e e i g h t y g r a d u a t e s w h o their degrees f r o m M i d d l e b u r y

of

Mid-

received

College.50

B e g i n n i n g w i t h the i n d e p e n d e n t c h a r t e r of 1835 t h e C l i n i c a l S c h o o l of M e d i c i n e o p e r a t e d u n d e r the n e w n a m e , V e r m o n t M e d i c a l C o l l e g e , f o r ano t h e r q u a r t e r of a c e n t u r y . A t t e n d a n c e d e c l i n e d d u r i n g t h e p a n i c y e a r of 1837, b u t s i x t y - f i v e w e r e m a t r i c u l a t e d in 1838 a n d e i g h t y i n 1839. A n

at-

t e n d a n c e of n i n e t y w a s r e p o r t e d in 1850. L e c t u r e courses in t h e m e a n t i m e were lengthened

t o s i x t e e n weeks. T h e

subsequent

history

M e d i c a l C o l l e g e is h a z y . Statistics of t h e A m e r i c a n M e d i c a l

of

Vermont

Association

r e p o r t e d t h e s c h o o l as e x t i n c t in 1856. J. S. B i l l i n g s , w r i t i n g i n 1876, e s t a b lished

i 8 6 0 as t h e d a t e of cessation. A l t h o u g h

t h e d a t e of e x t i n c t i o n

u n c e r t a i n , o n e m a y be q u i t e sure t h a t t h e W o o d s t o c k c o l l e g e c a r r i e d f e e b l y d u r i n g its l a t t e r years. P o s s i b l y t h e r e v i v a l of t h e U n i v e r s i t y School

in

Burlington,

1853-54,

was

ruinous

to

continued

is on

Medical

activity

in

W o o d s t o c k as it w a s i n C a s t l e t o n . 6 1 T h a t t h e p r o v i s i o n f o r b e d s i d e i n s t r u c t i o n , a f e a t u r e of t h e s c h o o l i n its •»' L i n c o l n , op. cit., p. 75. 4 8 T h e teachers under the W a t e r v i l l e connection w i t h slight changes c o n t i n u e d on under the M i d d l e b u r y arrangement. R o b e r t W a t t s was a demonstrator in 1834. T h e 1834 Catalogue a d d e d the chair of medical j u r i s p r u d e n c e , m a k i n g a faculty of six i n c l u d i n g the demonstrator, W i l l i a m P. Russell. Catalogue of . . . Vermont Medical College . . . 18)8, p. 2. •0 Lee, op. cit., p. 117. A t t e n d a n c e d u r i n g the brief existence of the M i d d l e b u r y connection averaged a b o u t seventy per term. " J. S. Billings, et al., A Century of American Medicine, American Medical Directory, p. 87.

2I8

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

early years u n d e r D r . G a l l u p ' s d i r e c t i o n , w a s not sufficiently d e v e l o p e d o r e v e n m a i n t a i n e d is f a i r l y c e r t a i n . A f t e r the w i t h d r a w a l of G a l l u p in 1834, the c a t a l o g u e s w e r e s t r a n g e l y silent o n the p o i n t of special facilities f o r b e d s i d e i n s t r u c t i o n . A p p a r e n t l y w i t h o u t a d e q u a t e financial s u p p o r t a n d satisfactory facilities f o r c l i n i c a l t e a c h i n g , V e r m o n t M e d i c a l C o l l e g e was o v e r t a k e n by the same fate that closed the g r e a t m a j o r i t y of c o u n t r y schools that w e r e e s t a b l i s h e d b e f o r e the C i v i l W a r . H a d G a l l u p c o n t i n u e d to d i r e c t the f o r t u n e s of the s c h o o l instead of w i t h d r a w i n g , the history of the i n s t i t u t i o n m i g h t h a v e b e e n different, b u t the u l t i m a t e e x t i n c t i o n n o d o u b t w o u l d h a v e f o l l o w e d in course. T h e forces that c r u s h e d small b a c k w o o d s schools w e r e n o t c o n t r o l l e d by single m e n or boards of trustees. T h e o n w a r d m a r c h of m e d i c i n e so decreed. 6 2 MISCELLANEOUS

CONTRIBUTIONS IN

NEW

TO

MEDICAL

EDUCATION

ENGLAND

N e w E n g l a n d , l i k e N e w Y o r k , h a d its a m b i t i o u s free-lancers of m e d i c a l e d u c a t i o n a n d its w o u l d - b e m e d i c a l schools. A m o n g the f o r m e r was the c o l o r f u l a n d t e m p e r a m e n t a l A l e x a n d e r R a m s a y , a n Irish i m m i g r a n t w h o i n f l u e n c e d m e d i c a l e d u c a t i o n i n the U n i t e d States of his day all the w a y f r o m S o u t h C a r o l i n a to M a i n e . F o r years he s o u g h t to establish himself as a n a u t h o r i t y o n a n a t o m y . A s a professor in established schools his t e n u r e w a s u s u a l l y n o m o r e t h a n o n e term. H e was a d m i t t e d l y a g o o d teacher, but, as S p a u l d i n g said, " R a m s a y was b o r n a w a n d e r e r b e n e a t h the b a n d s o f O r i o n a n d c o u l d n o t rest q u i e t a n y w h e r e . " 53 O n l y a f e w years a f t e r his a r r i v a l i n A m e r i c a (1802) h e b e t o o k himself t o the solitary s e t t l e m e n t of F r y e b u r g , M a i n e , w h e r e he a t t e m p t e d to b u i l d u p a n i n s t i t u t i o n of a n a t o m y that w o u l d i n f l u e n c e A m e r i c a n m e d i c i n e . R a m s a y was at F r y e b u r g at i n t e r v a l s f o r m a n y years. A t times h e h a d small g r o u p s of s t u d e n t s w h o p a i d thirty d o l l a r s for his course in a n a t o m y . It is said that w h e n h e w a s at the p a t i e n t ' s bedside h e n e v e r f a i l e d to speak of f e l l o w p r a c t i t i o n e r s as " m u r d e r e r s a n d v i l e H o t t e n t o t s . " T h e F r y e b u r g i n s t i t u t i o n b e c a m e m o r e n o t e d f o r its t r e a t m e n t of fever t h a n as a center o f a n a t o m i c a l i n s t r u c t i o n . A t o n e t i m e R a m s a y p e t i t i o n e d the legislature of M a i n e f o r financial a i d i n e s t a b l i s h i n g the institute at F r y e b u r g . A t a n o t h e r t i m e h e m e m o r i a l i z e d N e w H a m p s h i r e ' s legislators to establish a n " I n s t i t u t i o n f o r A n a t o m y " at C o n w a y in that state. B o t h requests were i n vain. Unfortunately Dr. Ramsay's warped personality and inordinate « T h e teachers i n 1850 were: H e n r y H . C h i l d s , theory a n d p r a c t i c e of m e d i c i n e ; A l o n z o C l a r k , institutes of m e d i c i n e a n d p a t h o l o g i c a l a n a t o m y ; B e n j a m i n R . P a l m e r , g e n e r a l , d e s c r i p t i v e , a n d surgical a n a t o m y ; E l i s h a B a r t l e t t , m a t e r i a m e d i c a a n d obstetrics; E d w a r d M . M o o r , p r i n c i p l e s a n d p r a c t i c e of surgery; Chester D e w e y , chemistry a n d b o t a n y ; J o h n H . L u l l , d e m o n s t r a t o r . Catalogue, (1850), p p . 6 - 7 . B e n j a m i n R . P a l m e r succeeded C h i l d s as president a b o u t 1839. A n e w a n d c o m m o d i o u s b u i l d i n g was erected in t h a t year. A n a i d to students in the school's e a r l y years was a m o n t h l y m e d i c a l m a g a z i n e , Domestic Medical and Dietetical Monitor or Journal of Health. U n f o r t u n a t e l y it lasted only a year o r two. C a v e r l y , op. cit., p. 445. »8 J a m e s A . S p a u l d i n g , " A l e x a n d e r R a m s a y , " K e l l y a n d B u r r a g e , Dictionary ican Medical Biography, p p . 104-06.

of

Amer-

O T H E R NEW E N G L A N D SCHOOLS

«19

vanity, coupled with an uncontrollable temper, kept him from ever fitting into the scheme of American medicine a n d making more abundant use of his anatomical museum, valued at $ 1 4 , 0 0 0 . " Some N e w E n g l a n d physicians were successful in carrying on extramural instruction that developed into enterprises of more or less formal nature. T h e Boylston and T r e m o n t schools in Boston have been noted earlier in Part V because of their very close connection with Harvard. T y p i c a l of similar organizations which were not uncommon throughout New E n g l a n d was the situation described in an advertisement appearing in the Catalogue of Vermont Medical College for the year 1839, under the caption " M e d i c a l Instruction:" Drs. [Gillman] Kimball and [Elisha] Bardett, of Lowell, Mass., have associated themselves for the purpose of giving surgical and medical instruction. Their courses of instruction will consist in hearing recitations in Surgery and Medicine; and in superintending anatomical dissection through the winter. . . . They [students] will have daily access to the City Almshouse practice; also to all practice of the City Dispensary.55 Dr. Bartlett was a teacher at Woodstock a n d hence was in a position to draw on the Vermont Medical College student body for office pupils. T h e Kimball-Bartlett partnership offered a twelve-weeks' "winter term" which seems to have been a lecture course similar to lecture terms at regular schools. It did not conflict with lectures at the University of Vermont, where the term began in the spring. T h e instruction offered at Lowell was essentially the same as the " r e a d i n g courses" featured much of the time by New England's country schools, except that the work was done off the campus. T h e almshouse and dispensary practice at Lowell made Drs. K i m b a l l and Bartlett's offer more than ordinarily attractive. Norwich University in Vermont deserves passing notice as having made an unsuccessful effort to establish a medical department about the middle of the f o u r t h decade of the century. T h e how and why of this attempt to make medical science a part of the Norwich curriculum is uncertain. It is probably not amiss to ascribe to Norwich's trustees of that day a desire to keep pace with Dartmouth, Middlebury, a n d the University at Burlington. Again, it may have been merely a responsive gesture to the request of a group of physicians who wished shelter under the wing of an academic institution. W . A . Ellis, editor of a history of Norwich University, passes by the event rather lightly in three brief sentences: A board of Medical examiners was appointed with the power to examine and recommend to the trustees the persons for the degree of M. D. The only person to receive the degree was Joseph G. Tilden in 1837. This department did not prove practicable and was soon given up. . . . 5 e s* Ibid., p. 106. 55 Catalogue . . . Vermont Medical College, for the year 18)9, p. 12. Tuition for the year was fifty dollars, board and room two dollars and fifty cents per week, and office space, fire, and lights were furnished by the teachers. 56 William Arba Ellis, Norwich University, 1819-1911, Her History, Her Graduates, Her Roll of Honor, pp. 76-77.

MEDICAL EDUCATION BEFORE T H E CIVIL W A R Conflicting with a portion of the above quotation is William B. Atkinson's categorical statement that a gentleman, Edwin C. Cross, attended medical lectures at Woodstock and at Norwich University, receiving the M. D. degree from the latter institution in 1846. Granting that Norwich has a record of only two medical graduates does not give the institution any place of note in the annals of medical education. It is assumed that there was a regularly appointed faculty of medicine, but the sum total of its contributions must have been insignificant. 57 In 1856 Drs. Israel T . Dana, William C. Robinson, and Simon Fitch of Portland, Maine, entered into an agreement to accept office pupils on a cooperative basis. T h e first Announcement of the organization was circulated in March, under the name of "Portland Medical School for Preparatory Instruction." T h e organization was patterned after the Boylston Medical School of Boston. Dr. Dana and his associates felt that they were fulfilling the spirit of the American Medical Association resolution of 1854 which cordially approved the establishment of private schools. T h e second Announcement gave the name of the institution as "Portland School for Medical Instruction." In 1858 the school was incorporated and authorized to hold property to the extent of $20,000. T h e school gave no degrees and had few students, never more than a dozen until several years after the Civil War. Its students usually went to Bowdoin or other New England schools for degrees in medicine. 58 T h e medical schools of New England before the Civil W a r fall into two distinct classes, the city schools and the country schools. T h e Harvard Medical School, for nearly thirty years a country school, passed into the city-school class when it was moved to Boston in 1810, and was the only New England school which could be so classified before the civil strife beginning in 1861. Even though the Cambridge professors took their anatomical preparations and chemical apparatus to Boston in 1810, another decade passed before the Massachusetts General Hospital was completed and made available to Harvard's medical faculty and students. T h e medical departments at Dartmouth, Yale, and Brown all partook of the deficiencies common to backwoods schools of the day. T h e trustees of Yale and Brown in particular may have regarded their college towns as old and cosmopolitan communities, but they did not provide hospital beds to supplement the lecture system of medical education that prevailed among the medical professors. T h e rural schools of Maine, Vermont, and Massachusetts were distinctly weak in opportunities for clinical observation and first-hand anatomical study of fresh specimens. T h e emphasis placed on bedside instruction by Dr. Joseph G a l l u p at his Clinical School of Medicine in Woodstock, Vermont, is a refreshing page in New England's medical education records. « William B. Atkinson, editor, The Physicians and Surgeons of the United States, p. 493. se T h e instructors of the fifth year (1860-61) were: W. C. Robinson, surgery, midwifery, and diseases of women and children; Israel T . Dana, practice, materia medica, auscultation, and percussion; W. R . Richardson, anatomy and histology; and Charles H. Burbank, physiology. See Israel Thorndike Dana, History of the Portland School for Medical Instruction . . . , pp. 1-33·

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221

Unfortunately the Woodstock college, in this respect, appears to have degenerated to the level of its near-by competitors which depended upon the private patients of the professors and occasional "college clinics" to acquaint theory-filled students with the practical problems of practice. T h e passing of the Massachusetts Anatomical law in 1830 improved the situation somewhat, but body-snatching continued as mute evidence that the schools and preceptors were not satisfactorily supplied, and that certified bodies were all too few. A n examination of the faculty lists of the schools in Castleton, Burlington, Woodstock, Pittsfield, and the similar institutions in A l b a n y and the western district of New York reveals a continued shifting of teachers. Not a few of these men held several professorships at the same time. Lecture terms were shifted to comply with this contingency. Professors w h o stayed at home and attended to their practice and private pupils before and after the regular lecture season compensated themselves by organizing "reading courses" for which fees were charged. T h e student of medical history can hardly deny the charge of Dr. Benjamin Lincoln of Burlington, in 1833, that teachers of medicine in New England were engaged in a trade rather than a profession. 59 T h e Medical Institution of Yale seems to have maintained the highest standards of preliminary medical education, higher in that students were required to satisfy them before entering upon the study of medicine. Elsewhere in New England and the country at large the customary time for checking the "Latin and natural philosophy" requirement, if at all, was at the time of the final examination. How well Yale enforced its premedical requirement may be open to question, but its small enrollment and other outward signs of retarded progress are good evidence that quality rather than quantity was the prevailing standard at New Haven. In summarizing the legal status of the New England medical schools it is approximately correct to state that the medical departments at Harvard, Dartmouth, Yale, Brown, and Bowdoin were not proprietary in origin. T h e y came into existence primarily as the result of the initiative of the mother institution and not in response to a memorial of a group of medical professors seeking the protection of an established college. It must be added that such an origin did not preclude in most cases a rather independent existence, with financial support dependent solely or nearly so on student fees. Technically the University of Vermont Medical Department was not a proprietary school, but its precarious existence for the first decade, the subsequent decline and cessation, marked it as poorly supported. T h e schools at Castleton, Pittsfield, and Woodstock were purely proprietary in origin and their collegiate connections were ephemeral and without organic strength. A l l of the New England schools formally endorsed the requirement of L a t i n or natural philosophy, or both, but the honest enforcement of it is open to question. Lincoln, in his 1833 criticism of medical education, lamented that the intellectual background of many men studying medicine «· Lincoln, op. cit., pp. 14-20, passim.

222

MEDICAL E D U C A T I O N BEFORE T H E CIVIL W A R

was c o m p r e h e n d e d in an ability to " r e a d , write a n d c y p h e r . " H e f u r t h e r declared that u n d e r the p r e v a i l i n g system " i l l i t e r a t e m e n in great n u m bers, ( a n d i n some (not very rare) cases, grossly a n d criminally i g n o r a n t m e n ) — d o e n t e r the P r o f e s s i o n of M e d i c i n e . " 60 L i n c o l n died in 1834 b u t the c o n d i t i o n s w h i c h h e described, possibly exaggerated, lived on u n t i l the advent of the A m e r i c a n M e d i c a l Association, w h i c h was only g r a d u a l l y able to improve the s i t u a t i o n . N a t u r a l forces, e c o n o m i c a n d scientific, performed a g r e a t e r service by e l i m i n a t i n g most of the country schools. Standards of m e d i c a l e d u c a t i o n in N e w E n g l a n d were n o worse, and in some respects better, t h a n elsewhere. G e n e r a l l y s p e a k i n g , H a r v a r d , D a r t m o u t h , a n d Y a l e trained the teachers of m e d i c i n e w h o m a n n e d the country faculties. T h e s e professors of medicine t r a i n e d h u n d r e d s of physicians, m a n y of w h o m j o i n e d the caravans m o v i n g w e s t w a r d . T h u s N e w E n g l a n d ' s m e d i c a l schools m a d e their cont r i b u t i o n to the d r a m a of western e x p a n s i o n . •o/fcjd., p. 14.

PART

VI

THE SCHOOLS OF THE OLD

CHAPTER

SOUTH

IG

T H E COLLEGE OF MEDICINE OF MARYLAND, AND UNIVERSITY OF MARYLAND COLLEGE OF MEDICINE MEDICAL education in Maryland during the colonial period and early years of statehood consisted almost entirely in reading physic and chirurgery under the supervision of some practitioner. A few fortunate students were able to journey abroad to study in the schools of Europe. J . M. Toner's manuscript lists only eight Maryland students who received the M. D. degree at Edinburgh during the last half of the eighteenth century. 1 Many more students were able to spend a winter or two in Philadelphia attending lectures at the College of Philadelphia Medical Department, after its establishment in 1765. For several decades the Quaker city was the mecca of southern youth who sought a comprehensive medical training. Even after the establishment of southern medical schools Philadelphia continued to draw heavily from Maryland, Virginia, the Carolinas, and Georgia. Something of the moral and cultural standards upheld by the better preceptors of Baltimore is intimated in the following press notice that appeared under the date of May 15, 1788: "Wanted by a regular bred physician a youth of genteel connexions as a pupil. He must be well versed in the Latin tongue." 2 T h e first medical preceptor of prominence in Baltimore was Dr. Charles Frederick Wiesenthal, who came to America from Prussia in 1755. Just when Dr. Wiesenthal began teaching is not certain, but his educational activities assumed proportions extensive enough to demand the construction of a building at the rear of his residence for school purposes. When Wiesenthal died in 1789 his teaching program during the following winter was carried on by his son Andrew and Dr. George Buchanan, both Pennsylvania graduates with European postgraduate training. On September 11 these zealous young doctors were appointed to the staff of the 1 J . M. Toner, "Names of Americans who Graduated in Medicine from the University of Edinburgh Prior to the Close of the Year 1800." A manuscript in the T o n e r Collection of the Library of Congress. For the whole of New England T o n e r lists only three. 2 J . Thomas Scharf, History of Baltimore City and County, p. 732, footnote. Presumably the quotation is from a Baltimore paper but no reference was given.

283

MEDICAL EDUCATION BEFORE T H E CIVIL W A R Baltimore County Hospital, along with five other practitioners, several of w h o m had had many years of experience. O n the same day they publicly announced their forthcoming lecture courses to begin the following December. T h e announcement seems to have stimulated local professional zeal. Before two months passed (November 8) the Medical Society of Baltimore was formed, the "principle e n d " of which was "the promotion of medical knowledge." Wiesenthal lectured to a class of fifteen on anatomy, physiology, pathology, operative surgery, and the gravid uterus. His colleague, Buchanan, covered the diseases of women and children and the B r u n o n i a n system of medicine then in vogue, before a class of nine. On December 29, an observer referred to the lectures as an "attempt to establish a medical seminary in this state" and suggested that the legislature honor the enterprise by public patronage. In March 1790 a published testimonial by Buchanan's nine students further encouraged the project. Other doctors became interested, and before the end of the month the Maryland Journal carried an announcement of courses for the following winter, to be taught by five doctors: Wiesenthal, anatomy; Buchanan, midwifery; Samuel Coale, chemistry and materia medica; L y d e Goodwin, theory and practice of surgery; and George Brown, theory and practice of physic. Dr. Wiesenthal continued lecturing until his death in 1798. T h e extent of Buchanan's lecturing and that of the three associates is uncertain. Eugene F. Cordell credited Wiesenthal and B u c h a n a n with trying to start a school. Whatever their objective may have been, no school was established at that time. 3 In 1796, the year that Baltimore received its city charter, Dr. J o h n Beale Davidge, a Glasgow graduate of 1793, moved into town and opened an office. Although he is not listed among the original incorporators of a state medical society known as the Medical and Chirurgical Faculty, organized in 1799, this gifted lecturer and teacher had a part in the affairs of the society. 4 Dr. Davidge appears to have been associated with a recommendation placed before the Medical and Chirurgical Faculty in 1801 and 1802 advocating the formation of a medical school, the faculty of which was to take over the duties of the Medical Board of Examiners of the State of Maryland, a subsidiary of the state society. Nothing constructive seems to have resulted from this proposition, but at the next meeting, in 1803, Dr. Davidge and f o u r associates were appointed to digest a plan for establishing a college of physicians. Not until 1807 did the faculty fully realize the importance of lending its full support to the establishment of a medical school. 3 Scharf, op. cit., pp. 734-35; Eugene Fauntleroy Cordell, University of Maryland, 180JlQoy, p. 6; and Eugene Fauntleroy Cordell, The Medical Annals of Maryland, 1799-1899, pp. 1 7 - 1 8 . * T h e corporation was authorized to appoint a medical board of twelve members to function as a state examining and licensing board to "grant licenses to such medical and chirurgical gentlemen as they, either upon a full examination or upon the production of diplomas from some respectable college, may judge adequate to commence the practice of the medical and chirurgical arts." Gentlemen already in practice were exempt. Scharf, op. cit., p. 734.

COLLEGE OF MEDICINE OF MARYLAND

«5

Meanwhile Dr. Davidge was not waiting for formal endorsement by the profession. In response to repeated requests that he "engage in a course of lectures on the obstetric and chirurgical sciences," Davidge began such a course to a small group about December 1, 1802. It is said that only four attended at first and that the attendance was never greater than twelve. Details on the progress of Dr. Davidge's independent enterprise for the next few years are lacking, but in 1807 two other gentlemen of the profession became genuinely interested in the project. Dr. James Cocke, a Virginian, Pennsylvania medical graduate of 1804, and former pupil of Sir Astley Cooper at Guy's Hospital, London, joined with Davidge as a professional associate in February 1807. Soon afterward John Shaw, a former Pennsylvania and Edinburgh student, who had not received a degree, moved from Annapolis to Baltimore for the purpose of engaging in practice. 5 In the fall of 1807 Davidge, Cocke, and Shaw associated themselves together in the giving of medical instruction. T h e courses began about the first of November, Davidge devoting himself to anatomy, surgery, and midwifery, Shaw to chemistry, and Cocke to physiology. 6 T o accommodate his anatomy class Davidge had erected at his own expense a small building on the east side of Liberty Street, just south of Saratoga. A subject was procured and instruction of students commenced. When the populace learned that a subject had been introduced for dissection, trouble for the doctor promptly began. T h e presence of a few curious boys before the door of the "anatomy hall" was the beginning of a mob of irate citizens that demolished the building. Public opinion seemed to approve of the vulgar action. Only one protest appeared in the press, signed by "Celsus," who was probably John Crawford, a respected physician and resident of Baltimore after 1796. Dr. Davidge's loss and personal embarrassment did not overcome his determination to establish a school of physic. Steps to procure legal protection were discussed at a meeting in Davidge's home in early December, well attended by Baltimore members of the faculty, who felt drawn together by recent events. Dr. Shaw, a man of more than ordinary literary ability, was appointed to draw up a proposed charter. Before the close of the month both houses of the legislature passed a bill embodying the charter, and on December 28, 1807, the first meeting of the newly authorized board of regents was called. 7 T h e charter provided for a very close relationship between the new school, the College of Medicine of Maryland, and the Medical and Chirurgical Faculty of the state. T h e third section of the charter enacted that the 8 John Ruhräh, "John Shaw, A Medical Poet of Maryland," Annals of Medical History, 3: 252-62, September, 1921. 6 Cordell, University of Maryland, pp. 6-7, and Medical Annals of Baltimore, p. 54-55. Scharf, op. cit., footnote, pp. 735-36, cites Nathaniel Potter, Rise and Progress of the University of Maryland, as authority for the statement that Davidge began discussing the idea of a medical school soon after he (Potter) came to Baltimore in 1797. 1 An Act for Founding a Medical College in the City or Precincts of Baltimore, pp. 3 - 1 7 ; Cordell, loc. cit., says the bill was finally passed on December 18. Scharf, loc. cit., gives January 20, 1808, as the date. See Cordell, University of Maryland, p. 17, for the minutes of the first regents' meeting, on December 28, the birthday of the medical school, according to Cordell.

2s6

medical

e d u c a t i o n

b e f o r e

t h e

civil

w a r

president and professors of the college, with the members of the Board of Medical Examiners, should be the regents of the school. T h e fourteenth section provided that every licentiate of the state board should be entitled to a surgeon's certificate from the college after practising five years in the state. T h e Medical and Chirurgical Faculty were regarded as the patrons and visitors of the College, and the president of the Faculty as chancellor of the College, according to the eighteenth section. Since twelve of the eighteen or nineteen regents were members of the state board, it is clear that control of the institution, by a comfortable margin, was vested in the Medical and Chirurgical Faculty. This arrangement did not become permanent. 8 Section X V I of the charter named the initial faculty as follows: John B. Davidge and.James Cocke, joint professors of anatomy, surgery, and physiology; George Brown, practice and theory of medicine; John Shaw, chemistry; Thomas E. Bond, materia medica; and William Donaldson, institutes of medicine. Drs. Shaw, Bond, and Donaldson did not hold the M. D. degree. When the bill of charter was being read in the legislature a friend of one of the degreeless professors remarked that he could see no reason why the gentleman should not be an M. D. the same as the others. No objection was raised, so the degree was written in after the three names. Thus by act of the Assembly the members of the first faculty were placed on an equal basis. Thereafter the regents of the College exercised the authority of appointing professors. At the first meeting of the regents, on December 28, 1807, Dr. Brown resigned his professorship and accepted the presidency of the board. Dr. Davidge was appointed dean, and Nathaniel Potter to the vacated chair of practise and theory of medicine, but he did not lecture until December, 1808. Drs. Donaldson and Bond soon withdrew because of ill health. Responsibility for the chair of institutes of medicine was divided among the other chairs and the vacancy in materia medica was not filled until 1809, when Dr. Samuel Baker accepted the chair. Dr. Shaw died in the fall of 1808 and was succeeded by Dr. Elisha De Butts. A separate chair in obstetrics was created in 1812, and filled by the election of Dr. R . W. Hall. In the same year Dr. William Gibson, with a brilliant medical record in Edinburgh and London, returned to his home in Baltimore and was elected to the chair of surgery. 9 T h e lectures so rudely interrupted in the fall of 1807 were continued during the following winter. T h e course of instruction, however, was not complete because of the irregularities in appointment of faculty personnel. Practical anatomy was abandoned for a time because of the popular prejudice against it. T h e lectures were held at the residences of the professors until early in 1808, when a dilapidated old school building at "Ibid., pp. 8 - 1 5 . Gradually the Medical and Chirurgical Faculty lost its influence over the College, but in the celebrated case of "Regents of the University of Maryland vs. Trustees of the University of M a r y l a n d , " in 1839, the original rights of the faculty were reiterated and substantiated. β Ibid., p. 8; Cordeil, The Medical Annals of Maryland, pp. 57-59; and Scharf, op. cit.,

Ρ· 73®·

COLLEGE OF MEDICINE OF MARYLAND

227

the corner of Fayette Street and McClellan's Alley was occupied after some repairing. T h i s structure served as a medical school building until the completion of new quarters at Green and L o m b a r d streets in 1 8 1 3 . In spite of poor quarters and very limited and crude facilities for the teaching of chemistry and anatomy, the professors were enthusiastic and appreciated the added respect derived from the legal sanction by the state. W h e n Maryland's first institution for medical instruction opened in 1807, the city of Baltimore boasted a population of forty thousand, approximately half the size of New York or Philadelphia. In a special way Baltimore was an appropriate location for the organizing of a medical school. As the country's third Atlantic seaport in size, Baltimore had problems in public health which demanded the presence of well-trained physicians. In spite of public prejudice, bodies for dissection were plentiful in Baltimore as compared with the average American city of that time. Already it had three hospitals: the City and County Almshouse, the Marine Hospital, and the Baltimore or Maryland Hospital, founded in 1798. During the first year of the medical school's operation, 1807-8, clinical lectures were said to have been given at the Almshouse. If this is true, the founders of the College of Medicine of M a r y l a n d deserve honor for recognizing the importance of clinical instruction and taking advantage of the extraordinary opportunities available in the city. 10 According to the charter, lecture terms were to begin the first Monday in November each year and continue not less than four nor more than six months. As compared with the four contemporary medical schools of the country this requirement put the Baltimore school in a favorable light. Unfortunately the strength of this provision was weakened by Section X V I I , which permitted all students who matriculated at any time before J a n u a r y full credit for completion of the term if they continued through the remaining months. Both the bachelor of medicine and the doctor of medicine degrees were given. In general the requirements for these degrees were one and two years' attendance on lectures respectively and an examination both private and public. Candidates for the doctorate were required to write and publish in L a t i n or English, and defend their theses publicly on commencement day. Provision was made for giving advanced standing to students who had attended lectures in any other medical seminary of established reputation. 1 1 T h e beginning of the College was very modestly supported so f a r as 10 Cordell, The Medirá! Annals of Baltimore, pp. 57-59. T h e Baltimore or Maryland Hospital was limited to the treatment of the insane after 1838. T h e Baltimore Library, founded in 1796, contained at this time " n o inconsiderable collection of books upon medical science." n Cordell, University of Maryland, pp. 1 2 - 1 5 . T h e charter made no mention of preliminary educational requirements. T h e fact that the thesis was acceptable in Latin or English indicates that the L a t i n requirement may not have been stressed. Sections X I I I and X I V authorized the regents, at their discretion, to confer honorary M. D.'s on physicians who had practised for twenty years or more in the state. T h e honorary M. B . could be conferred on practitioners of ten years' standing, and the surgeon's certificate was available for all licentiates of the state board who had to their credit five years of practice within the state.

228

MEDICAL EDUCATION BEFORE T H E CIVIL W A R

number of matriculants was concerned. Attendance during the first three years was seven, ten, and eighteen respectively. T h e first graduating class, five in number, was in 1810. T e n finished the next year. For the next fifteen years the College steadily increased in enrollment. T h e expenses of the College were borne equally by members of the faculty for a time. T h e r e is no evidence that the Medical and Chirurgical Faculty gave any pecuniary assistance to the enterprise. Loans from banks and individuals, and encouragement from public-spirited citizens were of material assistance. A lottery for the benefit of the College was authorized by the legislature, on January 20, 1808, for the raising of a sum not to exceed $40,000. T h e commission of ten appointed to organize the scheme failed to make substantial progress. Dr. Cocke then, after receiving authority from the next legislative session, reorganized the enterprise on a basis that eventually yielded revenue for the College. Nothing, however, was derived from the lottery until 1821, after the College had become a university. 12 O n A p r i l 7, 1811, the cornerstone was laid for the new College building on Lombard Street. T h e exterior of the building, patterned after the old R o m a n Pantheon, occupied a commanding situation, over-looking the Patapsco River and Chesapeake Bay. Niles' Weekly Register described the anatomical theatre, with its necessary appendages, as extensive and appropriate as those of any of the European schools. T h e lecture room accommodated 1,200 persons, and the chemical hall immediately below, only 200 less. T h e "apparatus" was declared to be complete and "accommodated to the taste and views of the learned professors." T h e edifice was near enough completion to permit partial occupancy during the lecture term of 1812-13. 1 8 A b o u t the time of commencing the Lombard Street building the College professors conceived the idea of grafting on to the College three departments, i.e., divinity, law, and arts and sciences, thus making the institution a university. A memorial to the legislature from the president and professors of the College, with the approval and advice of the regents, proposed the establishment of a university bearing the name of the state. T h e act establishing the University of Maryland was passed on December 29, 1812. T h e College of Medicine of Maryland was authorized to "constitute, appoint and annex to itself" the other three colleges or faculties. N o mention was made in the act of the Medical and Chirurgical Faculty which literally had established and controlled the College. T h e r e appears to have been no formal relinquishment of rights on the part of the medical society, even though the new charter named the professors of the several faculties and the provost of the university as regents of the institution, and 12 Ibid., p. 31. T h e lottery was a p o p u l a r m e t h o d of f i n a n c i n g large enterprises u n t i l past the m i d d l e of the c e n t u r y . T h e legislative records of M a r y l a n d indicate that lottery acts f o r t h e benefit of the University of M a r y l a n d were passed in 1811, 1813, 1816, 181g, 1820, 1826, a n d 1827. In 1827 an act was passed p u t t i n g an e n d to lotteries f o r the U n i v e r sity a n d a u t h o r i z i n g t h e p a y i n g of the balance of the privileges f o r m e r l y g r a n t e d b u t n o t realized ($40,946), f r o m t h e state treasury in a n n u a l i n s t a l l m e n t s of $5,000. i ' Niles'

PP· 3*-35·

Weekly1 Register,

S e p t e m b e r 15, 1815, cited in C o r d e l l , University

of

Maryland

COLLEGE OF MEDICINE OF M A R Y L A N D

sïq

endowed each faculty with power to fill vacancies in its teaching staff. Neither does there appear to have been any opposition. It seems that control passed quietly from the hands of the original Board of Regents, which was dominated by the State Board of Medical Examiners, into the hands of the new regents, a self-perpetuating group. W h e n the control of the Medical Department came to an issue in 1838 the Maryland Court of Appeals declared that the act of 1807 was still in force and that the second charter did not invalidate the first. It was declared that the College of Medicine had not lost its identity by the 1812 charter. Nevertheless none but feeble and unsuccessful efforts were ever made to revive the original Board of Regents. 1 4 In harmony with the intent of the new act, on January 6, 1813, the faculty of physic of the University, with the advice of learned men of the several professions, "appointed and annexed" to itself the three faculties. T h e medical faculty functioning as the Board of Regents appointed a provost, secretary, and professors of the other three schools. T h e R o m a n Catholic archbishop, John Carroll, was elected provost but declined the honor. Robert Smith was then elected provost and Richard Wilmost Hall was named secretary of the regents. T h e University of Maryland, as a university, if it were then worthy of the dignity, was the eighth to be chartered in the country, not counting the early career of some colleges before they received the title of university. T h e idea of creating a university, using a medical department as a nucleus, was quite a departure from the traditional plan of university making in the country. Ordinarily academies became colleges of liberal arts and such colleges became universities. A further unique feature of the University of Maryland was that it was a proprietary institution. T h e professors were the regents and able to perpetuate themselves in office. T h e r e was literally no governing body over the faculty. Several years passed before the institution really expanded to the point where it deserved the title of university. 15 T h e main reason for the slow development of the University was the discouraging financial prospect, made even more acute by the W a r of 1812. T h e new building, not even complete in every respect, gradually assumed a state of gloomy dilapidation. By 1821 a debt of $38,000 was hanging over the University. T h e creditors were ready to divide the spoils when the state authorized a loan of $30,000, to be secured by a lottery. T h i s move saved the institution from extinction, but troubles were not at an end. It was charged that all the money of the University was being spent to ι* Ibid., pp. 36-43. 1» N'o instruction was offered in theology until 1819, when Reverend William E. Wyatt lectured on the evidences of Christianity and moral conduct. His audience seems to have been confined to medical students. Instruction in theology was never again attempted. Instruction in law was not attempted until 1823. Much later in the century the school actually attained university standing. T h e act of December 29, 1812, created the first really independent and proprietary medical school in the country. Some elements of independence had appeared elsewhere, but the so-called University of Maryland's Faculty of Physic was independent indeed.

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maintain the Medical Department. T h e regents had formally appointed a professor and six members in each of the associated departments, but there was little or no activity except in the Medical Department. T h e r e was also trouble within the medical faculty. Drs. Davidge and De Butts, popular private instructors, had their office practice well attended by students of the Medical Department. So many students had attached themselves to Davidge and De Butts by 1824 that it became necessary for the professors to engage Craig's schoolroom for conferences with their private pupils. Other members of the faculty became jealous, insisting that Davidge and De Butts charged double fees and taught branches not assigned to them, all of which was unauthorized by the regents and productive of strife. An appeal was made to the regents, which body ruled that no professor should, during the regular term, give lectures and receive fees for the same, "except officially ex cathedra." T h i s was a blow at the two professors, but they did not let the matter drop. Independent of the faculty and regents, Dr. De Butts and a group of sympathizers secured the passage of a bill through the legislature which authorized confiscation of the University in the name of, and for the good of, the state. A board of twenty-one trustees was set up, on whom were conferred all the powers formerly belonging to the regents, but the new charter did not release the medical professors or their successors from paying interest on the $30,000 loan of 1 8 2 1 . T h e act was passed on March 26, 1826, but the regents were already planning active opposition. As early as the seventeenth it was decided to seek the best legal counsel. T h e opinion of three nationally known lawyers was rendered on May 2 1 , in a statement that declared the act of 1826 to be a manifest violation of the rights created by the acts of 1807 and 1812, and an impairment of the obligation of contract as guaranteed by the United States Constitution. 1 ® Before the appointed day for the act to become effective, the regents reported the situation to the governor, requesting suspension of action until after the next legislative session or until after a judicial decision had been secured from the proper court. There was no reply from the governor. When the appointed day arrived the board of twenty-one trustees, none of whom were medical men, were unopposed as they took formal possession of the University. 1 7 T h e personnel of the medical faculty was subject to a gradual process of change. When Professor Cocke died in 1 8 1 3 , Davidge succeeded to the chair of anatomy. T h e chair of institutes, vacated by Davidge, was filled a year later by the appointment of Dr. Maxwell McDowell. William Gibson, appointed to the chair of surgery in 1812, continued until 1819 when he was called to the professorship of surgery at the University of Pennsylvania, where he sustained and increased his splendid reputation. 1 8 Davidge gave the surgery lectures along with his anatomy for a year until the Uni16 Cordell, University of Maryland, pp. 58-63. T h e legal counsel came from William Wirt, J o h n Purviance, and Daniel Webster. i? Loc. cit. is Dr. Gibson's lectures in B a l t i m o r e were largely didactic; he occasionally performed operations before the class at the M a r y l a n d Hospital or the Almshouse.

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versity secured the services of Granville Sharpe Pattison, formerly professor of anatomy, physiology, and surgery at the Andersonian Institution in Glasgow. He reputedly had come to the United States in 1 8 1 9 in consequence of some domestic difficulties. Failing to secure a professorship in Philadelphia, he was willing to accept the chair of surgery in Baltimore. Pattison remained until 182Ü, during which time the University Medical Department was noticeably revived, apparently infused with the energy of his dynamic personality. 19 Again Davidge added surgery to his duties with the aid of J o h n Buckler as adjunct professor in anatomy. This situation prevailed until the election of Dr. Nathan R. Smith, Jefferson's professor of anatomy, to surgery in 1827. T w o years later Dr. Davidge was stricken with a "fungus of the antrum" which proved fatal after a few months of excruciating pain. 20 His professorship was soon awarded to Dr. J o h n Wells, a Harvard graduate, who at the time held the chair of anatomy at the Berkshire Medical Institution in Pittsfield, Massachusetts. T h e University was shortly deprived of Wells's enthusiastic service by his untimely death in July 1830. He was followed by his friend Benjamin Lincoln, of the University of Vermont in Burlington. Dr. Lincoln's lectures were entirely satisfactory, but he preferred the simple New England life with a mere pittance "to all the honors and emoluments Baltimore could offer." In the spring of 1831, Thomas H. Wright, a local physician, was selected for the professorship from a list of six applicants. Dr. Wright recommended that Duncan Turnbull, Pattison's friend who had been demonstrator of anatomy, 1821-26, be offered the position of adjunct professor in anatomy. Turnbull was said to have wielded an unrivaled knife, but his academic education was defective. For this reason T u r n b u l l was rejected. Immediately Wright withdrew from the faculty. T h e death of Dr. De Butts about that time made a second vacancy in the staff. A n election was held resulting in the selection of Eli Geddings, of South Carolina, for anatomy, and Jules Timoleon Ducatel of Baltimore for chemistry. In 1833 Robley Dunglison succeeded Samuel Baker, who resigned the chair of materia medica." Maxwell McDowell resigned the professorship of institutes the same year, and his work was divided between the professors of anatomy and practice. Dr. Dunglison's superior reputation secured for him a better position in 1836, when he was offered the professorship of institutes at Jefferson Medical College in Philadelphia. His successor in Baltimore, Dr. Robert E. Griffith of Philadelphia, held the chair for only one year, resigning to acPattison went abroad in 1826 and received an appointment at the University of London. He later taught in Jefferson Medical College, Philadelphia, and in the Medical Department of New York University. 20 More than any other one man Davidge was responsible for the existence and continuance of the University of Maryland, Faculty of Physic. 21 Professor Dunglison was one of the country's most prolific writers. He edited the American Medical Library and Intelligencer, a monthly, from 1837 to 1842. T h e sale of Dunglison's principal writings amounted to more than 100,000 volumes by 1858. He received his M . D . degree at Erlanger in Germany and commenced practice in England. Ibid., p. 197.

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cept a rail to the University of Virginia. A t the close of the 1836-37 session Geddings and Ducatel both resigned.22 Any account of this decade of frequent changes in the University medical faculty must include a brief narrative of the principal contributing causes of such irregularities. T h e newly appointed trustees took, charge of the University in 1826, in spite of the combined protest of the four faculties. T h e trustees gave the professors of the faculty of physic fifteen days to decide whether they would apply for reappointment to their chairs under the new order. All of the medical professors applied, in spite of their wounded pride, and all were appointed. T h e professors were still further disturbed the next year when Dr. Horatio Gates Jameson, an alumnus of the school, was thwarted in a prospect of receiving an appointment on the medical faculty and became the leading spirit in the founding of a rival school in Baltimore, the Washington Medical College. 23 Davidge and De Butts, who helped to engineer the coup d'état in 1826 to regain their right of conducting private lectures, were sadly disappointed. Davidge's appeal to the new governing body, seconded by the students, was made in vain. With respect to private lecturing by members of the faculty the trustees adopted and adhered to the policy of their predecessors. Potter said that Davidge and De Butts both magnanimously acknowledged their error in supporting the act and repented in "sackcloth and ashes." In 1827 ^ faculty was again given cause to complain when the trustees abolished the graduation fee. Theretofore the professors had regarded this item of revenue as a special perquisite of their chairs and an inalienable right of their offices. T h e act of the trustees had some virtue as an innovation in policies of medical education. It was believed by certain men who wished to reform American medical education that professors, after examining candidates, would not be so willing to recommend them for the M. D. degree if they did not receive a fee from successful candidates.24 T h e fee was restored in 1833, but the irate professors had already lost 16,405, an amount not to be overlooked by teachers who were paying interest on a $30,000 loan. Early in the history of the school an infirmary was erected through the efforts and financial support of several of the professors. In hard times these professors were forced to borrow money personally to save the infirmary, the deed to which was in their names. When the University was taken over by the trustees they seized the infirmary building, despite the protest of these gentlemen, who were required to contribute their service gratis as attending physicians. T h e professors memorialized the legislature, which passed an act forcing the trustees to make settlement. A protracted examination brought forth the fact that the professors involved had a total investment of $15,474. It seems that a settlement was made in 1832, Ibid., pp. 133-S05, passim. 2» Dr. Jameson claimed he had been treated with great discourtesy by the University faculty. A committee of the medical faculty visited Annapolis in the winter of i8*5~s6 to try and have blocked the legislation giving a charter to Jameson, but it was not successful. See Benjamin Lincoln, Hints on the Present State of Medical Education . . . (1833). 12

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whereby the trustees paid off the mortgage, presumably an amount much smaller than the investment, and received the title to the p r o p e r t y . " According to Professor Potter, the source of much of Cordell's information, the infirmary management under the trustees was characterized by extravagance and inefficiency. T h e teachers were compelled to use their o w n instruments and were not furnished even with so necessary an article as leeches. When the salary of the "Superintendent," later known as the " G o v e r n o r " was raised from four hundred to eight hundred dollars a year, he was accused of ruling the institution with a high hand, handling all funds, purchasing inferior drugs, and admitting and dismissing patients at his will. 2 6 Dr. Potter was unrelenting in his criticism of the trustees. He went so f a r as to accuse certain members of the board of discreditable conduct. T h r e e of the members, judges of judicial districts in the state, Potter regarded as "true friends of the school." In order to get rid of these members, according to Potter, the trustees passed a resolution providing for the vacation of a seat after four successive absences. W h e n it was learned that the judges h a d been absent three successive times the next meeting was called for a day on which the judges were presiding in court. T h u s they were automatically expelled. 2 7 From 1826 until the late thirties there seemed to be constant friction between the trustees and medical faculty, as illustrated in the episodes just noted. Potter's narrative of these years of turmoil is biased in favor of the professors. It is difficult to conclude that the trustees were so disreputable a lot as the choleric Potter pictured them. One thing is certain: an open break between the trustees and medical faculty followed as the aftermath of years of disagreement and suppression. T h i s situation was intensified by the professors, who freely discussed their troubles with sympathetic students. T h e trustees were said to have retaliated by threatening to dismiss any professor who should speak disrespectfully of them in the presence of students. T o this challenge Potter replied that "if they would let him appear before the B o a r d he would give them the opportunity to resort to still more extreme acts of tyranny." 28 Early in 1837 'he faculty attempted to secure the passage of a legislative act giving the professors seats as trustees, each with power to vote only on questions of appointment or removal of provost and professors of other members of his department. T h e trustees memorialized against the act and succeeded in having its passage blocked. T h e r u p t u r e occurred during the summer of 1837. T h e trustees, contrary to the expressed wishes of the medical faculty, appointed Dr. Henry This conclusion is based on the statement of J . H. B. Latrobe, one of the regents, in a report made in 1852, and cited by Cordell, University of Maryland, p. 74. Cordell also quoted Professor Potter, The Rise and. Progress of the University of Maryland, who claimed that a suit for recovery of the debt was still ¡»ending in 1838. Probably this suit was brought by the professors to obtain a more satisfactory settlement. 26 Cordell, op. cit., pp. 74-75. " Ibid., pp. 75-76. 28 Ibid., p. 76.

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W. Baxley to the chair of anatomy instead of Dr. William N. Baker, a graduate of the class of 1832 and unanimous choice of the medical professors.29 Dr. Baxley was the demonstrator of anatomy, but he had become so offensive to his colleagues that they had determined not to remain on the faculty if the trustees should appoint him to the chair of anatomy. As soon as the professors were apprised of the obnoxious appointment they made good their threat and resigned. Drs. Potter and Hall—Dr. Hall was the dean—in resigning, expressly stated that they were retaining their appointments held from the regents under the charter of 1812. These two professors, as regents under the charter of 1 8 1 2 , immediately elected Professors Smith and Griffith to chairs corresponding to those just vacated. Dr. Hall was made dean and, as secretary of the old Board of Regents, he called a meeting of the members, a majority of whom were yet living. Legal counsel was secured which declared the faculty of the regents to be the legitimate faculty. T h e law faculty concurred in the opinion, and a committee with representatives from the faculties of medicine, law, and arts and sciences was appointed to manage a suit to recover the rights of the regents. On September 21, 1837, pending the legal outcome of the schism, the regents' faculty, through craftiness, took possesssion of the University buildings. T h e plant was held until the twenty-third, when the insurgent group decided to withdraw and let the law take its course. 30 T h e trustees, in possession of the buildings and enjoying the support of the state, determined to continue operating a medical school. A faculty, including Dr. Baxley, was appointed and school was started, with Dr. Baxley delivering the introductory address. T h e faculty of the regents secured quarters in the Indian Queen Hotel, where Dr. Baker delivered the opening address. As a result of the split in the University, attendance was not good in either of the schools. Potter remarked that the trustees' faculty opened their session "to a beggarly array of empty benches." T h e regents' school had a larger group, made up mainly by local patronage. Few students from elsewhere were willing to enter a school whose faculty was dissipating its energy on internal strife. 31 T h e faculty headed by Dr. Hall issued a circular in the fall of 1837, which the regents' faculty was disparagingly described as "strangers" whose 2e Dr. Baxley became demonstrator of anatomy in 1834, but bccause of an altercation with a student in which he exhibited a pompous attitude he had fallen into disfavor with his students and colleagues. Dr. Baker was the conductor of a private dissecting room on Cider Alley, just to the rear of the University. His splendid platform manners, social qualities, and erudition made him a favorite. 3° T h e janitor's house was within the confines of the high brick wall that surrounded the medical school building. T h e janitor, after the regents' faculty retired, reported finding in a room of his house three vessels that had contained liquor, and a coarse bowieknife made from a part of an old sword. T h e professors took some materials from the museum which they regarded as personal property. Seizing the property was said to have been done on advice of counsel. 3i T h e trustees' faculty was: H. W. Baxley, anatomy and physiology; Henry Howard, obstetrics and diseases of women and children; Robert E. Dorsey, materia medica and therapeutics; M. A. Finley, principles and practice of medicine; John F. May, principles and practice of surgery; William R . Fisher, chemistry; and Ellis Hughes, demonstrator. Cordell, op. cit., p. 82.

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35

chairs had been offered in vain to prominent medical men. T h e r e is n o reason to believe that the two faculties were not of about equal standing. D u r i n g the following winter the regents presented a memorial to the legislature, praying for the repeal of the act of 1826. T h e trustees promptly presented a counter memorial, in which they recognized the failure of the 1 8 3 7 - 3 8 session, but noted the character and talents of the faculty as justification for believing the University would fully resume its former standing. 3 2 T h e entire question was one of constitutionality of the act of 1826. T h e County Court, in which the case was decided rendered a decision in f a v o r of the trustees. T h e regents, unwilling to accept defeat as final, appealed the case to the C o u r t of Appeals, which reversed the action of the lower court in its famous decision of 1839. T h e higher court declared the act of 1826 unconstitutional in that it contravened the obligation of contract. T h e charter or franchise of 1 8 1 2 was a contract between the corporation, a private institution, and the state. T h e act of 1826 aimed to strip the regents of the rights conferred when the corporation was created. In brief, the legislature h a d no right, without assent of the corporation, to alter its charter or deprive it of property. J u s t though this decision may have been, it is not incontrovertible evidence that vesting corporate powers in the faculty of a college or university was a wise method of creating and perpetuating such institutions. T h e legislature, soon after the court decision, received a memorial f r o m the regents, requesting the state to direct its agents to surrender certain properties to the r i g h t f u l owners. A n act was passed with the proviso that the University regents could never, without consent of the M a r y l a n d General Assembly, dispose of or convert the property to any other use than that of medical science or the arts and sciences generally. Violation of this proviso was declared sufficient justification for the state to take possession a n d control of the property " f o r the purpose of promoting general science." A f t e r considerable debate the regents agreed to comply with the requirement, and issued a certificate to the treasurer of the state. 33 O n A p r i l g, 1839, a committee of the trustees completed the transfer of the University properties a n d holdings, free from all encumbrances a n d in good shape. T h u s ended the reign of state control over a private institution. T o the credit of the trustees it must be stated that they had conducted the University for thirteen years with energy and capacity. Never had the institution been in better financial condition than in 183g when it was returned to the control of the regents. A gradual diminution in the number of matriculants was b l a m e d on the trustees by the faculty. 3 4 T h e trustees cited the loss of Pattison f r o m the faculty, and the general increase of medical schools as the principal cause of this decline. B o t h were proba32 For two years the University of M a r y l a n d was split into two factions. In J a n u a r y , 1839, the trustees ordered the placing of watchmen to protect the buildings and premises, an indication that they may have a p p r e h e n d e d another seizing of property. 33 At the same session the Assembly passed an act making valid the medical diplomas of the school f r o m 1826-39 inclusive. 3Ί A b o u t three h u n d r e d were in attendance in 1825, a n d only eighteen in 1839.

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bly overdrawn statements of the causc. T h e history of the Faculty of Physic of the University after 1826 might have been more encouraging had the Maryland Assembly exercised the good j u d g m e n t of providing representation for the faculty and the medical profession at large on the Board of Trustees. T h e teachers, animated by Professor Potter's spirit of insubordination, could not reconcile themselves to the isolation imposed on them by the trustees, so far as governing the institution was concerned. Consequently the faculty was torn between two objectives, (1) conducting medical instruction, and (2) struggling to regain lost privileges and rights. Energy was expended achieving the second objective at the expense of the first. In the light of present-day standards the contention of the trustees that a governing body should be independent of all personal interests must be respected. O n the other hand, exclusion of medical representation from the Board of Trustees can hardly be regarded as fair or intelligent. Under a properly selected board, the University of Maryland Faculty of Physic could have been by 1837 a well-established and popular medical school. Unfortunately history decreed otherwise. Energized by the restoration of their "ancient rights," the faculty issued a Prospectus for the session, 1839-40, in which all features of the institu tion were highly advertised with a free use of superlatives. D u r i n g the next year the term of lectures was lengthened from four to six months. T h e efficacy of this innovation was minimized by the provision that attendance during the last four months of the term only was required. Since other schools did not adopt the plan, the faculty felt compelled to return to the four-months' term in 1844. In 1848 the faculty modestly expanded the term to four and a half months. Less difficulty was experienced in operating under this p o l i c y . " During the time of schism, July 1838, Professor Nathan Smith resigned and accepted the chair of practice at Transylvania University in Lexington, Kentucky. For a year the duties of the chair of surgery were discharged jointly by Professors Hall and William Baker. Smith then returned to Baltimore and was reelected to the professorship of surgery. In 1841 the school lost by death the Baker brothers, W i l l i a m Nelson and Samuel George, both of whom trod the primrose path and died at an early age. T h e i r respective places in materia medica and anatomy were filled by Samuel Chew and Alexander C. Robinson. 3 0 T h e venerable Dr. Potter, ardent defender of the regents' charter, died in his seventy-third year in 1843. Professor R o b y finished Potter's course in "practice" that year. Before the next term Dr. Richard S. Stewart was assigned to the chair, but he resigned in 1844, without lecturing, in favor of Elisha Bartlett, w h o had had a successful teaching experience in T r a n s y l v a n i a University and several New England schools. He lectured only one term at Baltimore and 8» Prospectus of the Faculty of Physic of the University of Maryland . . . 18)9-40, p. 5; Cordell, op. cit., p. 207. »β Robinson's appointment was only a lectureship. Professor Smith favored giving him the professorship, but others thought he lacked experience. Dr. Joseph Roby of Boston was elected.

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was succeeded by Dr. W i l l i a m Power. In 1843 the regents attempted to impeach Professor Hall on the grounds that both students and professors had lost confidence in his professional ability. T h e effort failed for the lack of one vote to obtain the necessary three-fourths for conviction. In spite of Hall's triumph the regents hired another professor, William H . Stokes, to lecture on his subjects. As a result, the University had two courses of lectures in obstetrics f r o m 1843 to 1846. When Dr. H a l l died in 1847, he a n d Stokes were succeeded in the chair of midwifery and diseases of women and children by Dr. R i c h a r d Henry T h o m a s of Baltimore. In 1854 a lectureship in " E x p e r i m e n t a l Physiology and Microscopy" was established under the direction of Dr. Christopher Johnston, a foreign-trained physiologist w h o was said to have " a great natural aptitude for the acquirement and communication of knowledge." 37 Numerous changes in the faculty were not indicative of a well-planned, smooth-functioning organization. It was to the credit of the regents a n d for the benefit of the students that shifts in faculty personnel became fewer as the years passed. 3 8 W h e n the Civil War· started, the University attendance promptly fell off, because the institution had been heavily patronized by southern students. T h e matriculation dropped about fifty per cent, the lowest point being in 1 8 6 2 - 6 3 when there were only 103 students a n d 37 graduates. D u r i n g these years of distress special attention was given to military surgery and hygiene. Early in this study it was noted that in its inception the College of Medicine of M a r y l a n d had available some clinical facilities. While clinical teaching for many years did not occupy its rightful prominence, the value of bedside instruction was rccognized to some extent. In 1823 a ninctynine-year lease was secured by Drs. Davidge, Potter, Hall, De Butts, Baker, McDowell, and Pattison on a lot bounded by L o m b a r d Street and Whiskey Alley, near Green Street. A n infirmary (later known as the University Hospital) was erected at a cost of $ 1 4 , 1 0 9 . T h e capacity of the building was probably about fifty beds. Of the four wards, one was reserved for cases in ophthalmic surgery, a prominent feature of the surgery lectures. T w o students served as residents; each paid $300 per year for the privilege, including his board, room, laundry, etc. T h e residents were required to accompany the professors on their rounds and read to them the histories they had written on patients admitted since the physicians' previous visits. T h e y were, of course, privileged to attend the four clinical lectures, two medical and two surgical, given weekly for the benefit of the students. A n operating theatre had galleries capable of accommodating several hun3' Ibid., pp. 209-24. 38 Faculty changes from 1852 to 1861 were: Samuel Chew, practice, 1852; George W. Miltenberger, demonstratorship to chair of anatomy, 1852, and to obstetrics in 1858; Charles 1 rick, materia medica, 1858; Nathan R. Smith gave anatomy lectures, 1859-60; William A. Hammond, anatomy and physiology, i860; and Edward Warren, materia medica, i860. Ibid., pp. 224-27. In 1847 a course of lectures in pathological anatomy was started by Dr. Miltenberger, demonstrator of anatomy, Ibid., p. 218.

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dred students. T h e Infirmary's Board of Trustees was headed by the governor and mayor and augmented by several prominent citizens. 39 A t the end of the first decade four more wards were added, making a capacity of ninety beds, sixty or seventy of which were filled on the average. T w o more student residents were added to the staff. In 1846 the office of Resident Physician was created, and a graduate physician, James Morison, of Massachusetts, became the first incumbent. A n extensive addition in 1852 raised the capacity to 150 and provided work for eight student residents. 40 T h i s institution was a financial liability to the professors much of the time, especially before the trustees purchased it in 1832 and after it was returned to the regents in 1839. Yet its value as a center of clinical teaching is worthy of emphasis. In 1848 a rule was passed requiring attendance on two sessions of clinical instruction. T h e Catalogue of 1849 described briefly the basis on which Professor Power conducted clinical instruction in the practice of medicine: M o d e r n medicine differs f r o m that which has preceded it, mainly in this, that while it esteems at their f u l l v a l u e the powers of art, it also regards and wisely regards the powers of nature, teaching the true wisdom of watching patiently, observing carefully, acting cautiously, so that, the operations of nature being clearly understood, the ministrations of art may be judiciously, efficiently a n d beneficially applied.41

Students attending the instruction in practice of surgery, under the direction of Professor Smith, who made hospital rounds before daybreak part of the year, were forced to be early risers. T h e inconvenience of early rising was well repaid if the Catalogue description of 1849 is reliable: Surgery is taught as a reality not as an abstraction. H a v i n g been engaged actively in the practice of surgery f o r nearly thirty years, the Professor has h a d large experience in the treatment of surgical diseases, a n d has had occasion to p e r f o r m repeatedly all the i m p o r t a n t operations. His instruction is therefore of necessity in great degree personal—the result of what he has seen and done, a n d not merely of what he has r e a d — a statement of facts a n d not merely opinions. . . . 4 2

It is difficult to place an accurate estimate on the use of the University Hospital for teaching purposes or to make a fair comparison between that institution and other city hospitals of the day with reference to their individual contributions to medical education. Dr. A. J . Lomas, in J a n u a r y 1938, presented to the Medical History Society of the University of Maryland an intensely interesting account of the early decades of the Hospital's 39 Ibid., pp. 157-58. T h e members of the Examining Board of the Medical and Chirurgical Faculty were ex-officio consulting physicians and surgeons. No surgery was performed without consultation. Student residents or interns were also employed at the Maryland Hospital. « At the time of this publication only six years had passed since the death of Professor Potter, with whom a favorite expression was: "If nature should come in at the door, she must be thrown out of the window." Both quotations from the Catalogue for 184g are cited in Cordell, op. cit., pp. 221-22.

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history entitled, " A s It Was In the B e g i n n i n g . " O n the basis of this study and other sources one is justified in classifying the University Hospital among the leading institutions of the day in which medical education was being fostered. T h e Catalogue for 1 8 5 0 - 5 1 highly commended the American Medical Association's disapproval of "college clinics" as a substitute for hospital clinical instruction, and then added rather boastfully: T h e Faculty feel that they have a right to speak freely u p o n this subject. For m a n y years they have sustained, unaided, the " B a l t i m o r e I n f i r m a r y " as a school f o r clinical instruction, have e x p e n d e d their private f u n d s in enlarging it a n d h a v e d e v o t e d their personal attention to its management. It belongs to the University: all its inmates are under the special control of the Faculty, and no one else has p o w e r to say who shall be admitted, or who excluded. T h e y can render it, therefore, literally a school of clinical medicine. . . . 4 3

Dissection was rudely interrupted by a moh in 1807, but was reestablished about 1 8 1 2 when the new building was occupied. It was not compulsory, however, until 1833, when the trustees passed a regulation making attendance on one dissection course prerequisite to graduation. In so doing the University was one of the first schools in the country to require students to take at least one ticket from the demonstrator. Strangely enough, the professors objected to this new ruling. T h e i r opposition seems to have been based upon the faculty's supreme dislike for the B o a r d of Trustees and its policies. T h e professors really brought the change on by previously requiring the demonstrator to pay one-seventh of the current school expense. T h e trustees were then justified in stipulating attendance on at least one course in dissection. With the trustees the innovation was a matter of administrative policy rather than an effort to strengthen the curriculum. Unfortunately, to the faculty the regulation was just one more effort of the trustees to show their authority. T h i s is demonstrated by the fact that the professors, after being reinvested with the power of regents (1839), did not adopt the requirement until 1848 and even then not until after " m u c h reflection." A b o u t the same time, pathological anatomy was made a required subject, and gas lights were installed in the laboratory at considerable expense, making possible night use of the laboratory. 4 4 Other facilities of the medical school included a library, the nucleus of which was the collection purchased from the widow of Dr. J o h n C r a w f o r d in 1 8 1 3 . T h e collection was never at any time large, but it served a useful purpose. D u r i n g the regime of the trustees, 1826-39, a branch was maintained at the University Hospital for the use of physicians and students. W h e n Professor Pattison joined the teaching staff in 1820 he brought with him a very splendid anatomical collection which he disposed of to the faculty in 1 8 2 1 for the sum of $8,000. Soon afterward. Practice Hall was erected for its accommodation. T h e museum so auspiciously inaugurated « Catalogue of the Trustees, Faculty and Students of the Medical Department of the University of Maryland, 1850-51, p. 13. ** It may have been that requiring dissection detracted some from other departments and thus diminished the income of certain professors. Cordell, op. cit., pp. 68, 89, 137, 220.

»4o

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

had numerous anatomical, pathological, and mineralogical additions in the years following. At times, however, this feature of the school's facilities suffered from neglect. In addition to the dissection requirement, 1 8 3 3 - 3 9 and 1848, and attendance on two sessions of clinical instruction required first in 1848, the graduation requirements were essentially the same as in contemporary schools and as set forth in 1 8 1 2 . Unlike many schools, the University of Maryland continued giving the bachelor of medicine degree until 1848. In most institutions the doctorate only was given after the first decade of the century. During the earlier years of the University's history the students customarily took only four tickets—anatomy, surgery, chemistry, and practice—the first year, and all six tickets the second year. About 1833 the trustees acceded to a faculty request that students be required to take all the regular tickets both years. T h i s requirement continued in force until years later when a graded course was adopted. Until 1845 and for many years after, the candidate for a medical degree had only to receive a majority vote of the faculty to be successful. In that year it was announced that any candidate, on whose case the faculty was equally divided, was entitled to another examination. T h i s privilege could be invoked if the faculty again divided equally. T h e candidate could also withdraw his thesis to avoid having it declared rejected. 45 In 1845 ^ e e s were reduced from twenty dollars for each ticket and one hundred twenty dollars per term to fifteen and ninety dollars respectively. T h e matriculation and graduation fees remained at five and twenty dollars. T h e fees for clinical instruction and dissection were five and ten dollars. In 1850 a fee of five dollars for pathological anatomy was listed. These fees compared with the tuitions of the smaller schools in Philadelphia. T h e early trends in matriculation at the University Medical Department have been noted previously. T h e r e was a steady increase until 1825 when more than three hundred were in attendance. T h e change in management in 1826, with the subsequent feud between the trustees and faculty, brought on the crisis of 1837. T h e number of students, already on the decline, suddenly shrank to less than twenty by 1839. Thereafter the recovery was steady. A decade later (1849) sixty-eight degrees were granted. With its clinical and laboratory facilities made available so early in its history, the University of Maryland Medical Department was reputed as a center for clinical instruction as early as 1830. Many hundreds of students, mainly from the South, received at the University a good medical education. With a scattering of nationally known teachers and several others whose energy and zeal compensated for their deficiencies in academic training, the medical faculty of the University of Maryland, because of financial difficulties and internal strife, failed to establish the degree of excellence of which it was capable. T h e charter of 1 8 1 2 was a tragedy. T r y i n g to graft schools of theology, law, and the arts on to a faculty of physic with a proprietary charter could 45

Catalogue

of the Trustees

. . . Medical

Department

of the University

(1834), pp. 35, 44-45, 45-46, 50-51; Cordell, op. cit., pp. 160, 194, 220.

of

Maryland,

COLLEGE OF MEDICINE OF MARYLAND

*4i

hardly be expected to succeed. T h e medical school enjoyed varying degrees of success, but the associated faculties were feebly active or dead much of the time. T h e state performed a useful service and at the same time committed a crime when it deprived the professor-regents of their charter and vested the rights of the organization in a Board of Trustees, none of whom, unfortunately, were medical men. T h e subsequent friction between the trustees and the faculty again delayed sound and permanent progress. T h e restoration in 1839 was legal but not favorable to the best development of a University. T h e Medical Department enjoyed a healthful growth, but many years passed before the institution as a whole deserved the title of university. T h e charter of 1807, whereby the College of Medicine of Maryland was bound to the Medical and Chirurgical Faculty, had it been retained, would have been far more conducive to medical progress than the plan under which the professors chose to carry on. Abraham Flexner cited the University of Maryland's charter of 1812 as the dishonorable example, followed by other legislatures, which gave existence to numerous proprietary medical schools that were active agents in lowering the standards of medical education. 46 * e A b r a h a m Flexner, ¿Medical Education

in the United States and Canada, p. 5.

CHAPTER

20

WASHINGTON MEDICAL COLLEGE OF BALTIMORE (Washington

University

of

Baltimore)

IN 1826, the year that the University of Maryland's control passed from the regents to the trustees, the population of Baltimore was approaching the eighty thousand mark. More than three hundred medical students matriculated at the University that same year. T h e country as a whole was experiencing an extraordinary wave of prosperity. Such circumstances favored the founding of another medical school in Baltimore. Foremost among the physicians of Baltimore to recognize the possibilities of opening another school of medicine was Dr. Horatio Gates Jameson, a native of Pennsylvania and graduate of the College of Medicine of Maryland in 1811. T h r o u g h his service as surgeon in the War of 1812 and his later work as surgeon of the Baltimore Hospital, consulting physician to the Board of Health, and his numerous publications, Dr. Jameson became widely known and generally respected by the medical profession. Trouble arose when Jameson was thwarted in his ambition to obtain an appointment on the medical faculty of the University. He finally ceased to be friendly with the professors. Indeed, Dr. Jameson claimed that he had been treated with gross discourtesy by some of them. 1 T h e want of harmony in the University faculty in 1825-26 and the loss of control by the regents in the latter year was a signal to Dr. Jameson to launch his project. In spite of organized opposition from the University, the legislature granted a charter during the winter of 1825-26 to the new school which was opened in the fall of 1827, in a building on North Holliday Street, near Saratoga. T h e school was established under the patronage of Washington College, Washington, Pennsylvania. Such a remote connection was obviously of little or no benefit to Washington College and must have furnished Jameson's enemies with abundant reason for criticism. A b o u t that same time a group of New York City medical professors failed to establish a permanent relationship with Rutgers College in New Brunswick, New Jersey.2 This affair in New York may have had some influence 1 These hard feelings culminated in a defamation of character trial (1828) in which Jameson was the plaintiff and Dr. F. Ε. B. Hintze was the defendant. Hintze was fined and Jameson completely vindicated. 2 When the legality of their arrangement was questioned, the New York professors affiliated themselves with Geneva College in New York State. In 1827 a court ruled against this remote connection.

84s

WASHINGTON COLLEGE

»43

on the short lived union promoted by Professor Jameson. T h e frail tie was broken on March 4, 1832 when the Maryland legislature granted an independent charter to Washington Medical College of Baltimore. 3 Associated with Dr. Jameson, professor of surgery and surgical anatomy, in this enterprise were: Samuel K. Jennings, materia medica and therapeutics; William W. Handy, obstetrics and diseases of women and children; T h o m a s E. Bond, theory and practice of medicine; Samuel Annan, anatomy and physiology; and James B. Rogers, chemistry. According to the act of 1832 a Board of Visitors was created, the main function of which seemed to be participation in the conferring of degrees. Like the University of Maryland charter in 1812, the act established the professors as the corporate body, with power to elect a president, other officers, and the faculty. By the year 1838 all the professorships had changed, except two, and one had been added. Jameson resigned in 1835 to accept a chair in Cincinnati. 4 T h e conflict between the laymen trustees and the medical faculty of the University of Maryland during the thirties may have influenced the faculty of Washington Medical College, in 1837, to call special attention to the fact that their institution was administered by medical men and that there was no handicap in the form of an attachment to a university or medical society. 5 Nevertheless, in less than two years the operators of the College sought and obtained a university charter. On March 6, 1839, the legislature authorized the institution to annex unto itself facilities in law, divinity, the arts and sciences, and assume the name of Washington University of Baltimore. As a university the institution never existed, because the other departments were never added. It remained only a proprietary medical college. During its beginning years the College prospered to the point of outgrowing the plant on Holliday Street. T h e faculty purchased land on Broadway, some distance out, and began the erection of an extensive Gothic structure which was planned to incorporate college facilities, living quarters for fifty students, and a hospital with three to four hundred beds." It seems that the entire building was never completed. T h e Circular for 1837 mentioned the bed capacity of the hospital as three to four hundred "when completed." T h e same description was given in the Circular for 1841-42. T h e most highly advertised feature of the new edifice was the apartments for house students which were said to be "most agreeable and inviting to young gentlemen." T h e faculty felt that students who took u p 3 Laws of Maryland, Vol. 12, ch. 18g. * T h e faculty changes were: James H . Miller, anatomy and physiology; Samuel K . Jennings, materia medica, therapeutics, and legal medicine; William W. H a n d y , obstetrics and diseases of women and children; J o h n C. S. Monker, institutes and practice of medicine; E d w a r d Foreman, chemistry; J o h n R . W. Dunbar, surgery and surgical anatomy; Washington R . Handy, demonstrator. Circular, 1848. p. 3. 5 Circular of Washingon Medical College of Baltimore (1837), p. 6. β It was in the Washington University Hospital that E d g a r Allan Poe died on October 7, 1849.

244

MEDICAL EDUCATION

BEFORE T H E

CIVIL

WAR

residence in the school building would be free from the distractions of a private home and in close proximity to the wards and the dissection laboratory, the principal facilities for medical instruction. T h e fact that the Circulars never declared the number of beds occupied on an average is indication enough that the clinical facilities of the institution were not very remarkable. T h e faculty half apologetically declared the virtues of the institution in 1837: . . . T h e y [the Faculty] believe that it is not right to assert that their institution is equalled by n o one in the country; for such statements are uniformly calculated to do more injury than good: but still they feel constrained to say that it is believed this Institution, from the peculiarity of the plan, presents great and unusual advantages more specifically to those students who reside in the College Edifice. . . J

T h e next year the faculty declared in rather positive language the relative standing of the College: In furnishing an exposition of the advantages afforded by the

Washington

Medical College of Baltimore for the acquisition of medical and surgical education, the Faculty flatter themselves that it would be easy to show that no other institution in the United States can offer superior opportunities. . . .

T h e grandiose scheme for the plant on Broadway was not realized, presumably because of its distance from the center of the city. T h e faculty attempted to overcome its handicap by high-powered advertising, but eventually concluded to move closer in. 8 T o this end property was purchased on Lombard and Hanover streets, in 1848, and plans were announced to erect a building "which for size and convenience" would be "second to few, if any, in the country," and enable the University "to vie in usefulness with the best Medical Institutions of the country." 9 In September 1839, the school was moved to the new plant, known as the " N e w Assembly Rooms." T h e Hospital and student dormitory were still maintained at the Broadway plant, and omnibuses were depended upon for transportation between the University and the Hospital. Economically the institution was not able to maintain itself. Whether from the magnitude of the enterprise or from the misuse of funds by the managers, as was alleged, the Washington University School of Medicine collapsed during the session of 1851-52. Both buildings were sold to meet the faculty's obligations. A survey of the Circulars from year to year, especially after 1836, gives abundant proof that the school provided more than ordinary clinical facilities. T h e overflow from the United States Marine Hospital apparently was placed in the Washington University Hospital. T h e Circular, in 1848-49, ^ Circular of Washington Medical College of Baltimore, (1837), p. 3. β O v e r and over, the p u b l i c announcements emphasized the virtues of the College to an extent almost worthy of disgust. A strong invitation was e x t e n d e d to sons of the U n i t e d States congressmen on the strength of Baltimore's p r o x i m i t y to W a s h i n g t o n and the ease of c o m m u t i n g a n d c o m m u n i c a t i n g between the cities. Circular . . . 1837, p. 6. » Annual Circular of the Medical Faculty of the Washington University of Baltimore, Session 1848-49, p. 3.

WASHINGTON COLLEGE

245

mentioned a lying-in hospital among the new facilities which "authorized" the faculty to believe that " . . . a diligent student need not leave their halls unqualified to practice the Art, under the most difficult circumstances. . . . 10 T h e professors never failed to remind the public that the pupil's private chamber was but a few steps from the sick ward, under the tutelage of an attending physician who was also a professor. T h e students were thus enabled to check carefully the development of all cases "from the incipient stage" to the period when the case closed "in convalescence or death." Indeed, this was the practical way to study medicine. A f t e r liberally discounting Washington University's claim of accomplishment in this respect, there remains sufficient reason to praise the school for pioneer work in popularizing bedside instruction. 11 D u r i n g the decade of the forties the medical profession at large was agitated over the problems of raising the standards of medical education. In 1839 the professors labeled themselves as "co-workers to this great end" but did little to demonstrate their claim, beyond noting the opportunities for bedside instruction in their school. T h e lecture terms remained at about four months in length until 1848-49, when the term was extended two weeks, " i n obedience to the expressed wish, of the late National Convention . . ." A t the same time and in harmony with the recommendations of the convention, the subject of mental diseases was added to the chair of institutes and medical jurisprudence. 1 2 A t the first commencement of Washington College School of Medicine in 1828 there were twelve graduates. For some years the school flourished. U p to and including the academic year of 1837-38 a total of 181 students had attended the institution. T h e r e were 108 graduates, seven of whom were honorary. Few if any schools of the day had the honorable record of graduating more than half of its matriculants. J. T h o m a s Scharf reported that the institution throughout its history, including a period of revival, 1867-72, graduated about seven hundred. It would seem, then, that the University was reasonably well patronized u p until the time of its first suspension in 1851-52. 13 T h e requirements for graduation were essentially the same as at the University of Maryland, i.e., three years of apprenticeship, two years of lectures, defense of a dissertation, and a twenty-one-year age limit. T h e Circular of 1838 announced that students must register with the school before obtaining the professors' lecture tickets. T h i s regulation may have been to insure a check on preliminary education, but the Circular made no mention of Latin or natural philosophy. 10 Loc. cit. 11 Circular . . . . (1839), p. 4. 12 Annual Circular . . . , (1848-49), p. 4. T h e chair including mental diseases was given to a Dr. Stokes w h o was physician to a large insane asylum. 13 Scharf, op. cit., p. 738; Circular . . . Washington Medical College, (1838), p. 4. Washington University Medical School was revived in 1867 and continued for a decade. See Genevieve Miller, " A Nineteenth Century Medical School: . . . ," Bulletin of the History of Medicine, 14: 14-S9, June, 1943.

246

MEDICAL EDUCATION BEFORE T H E CIVIL W A R

Fees at Washington University fluctuated during the forties, indicating some competitive price cutting. In 1848-49, the entire course was offered for $105. Matriculation, graduation, and dissection fees were five, twenty, and ten dollars respectively. T h e dissection fee was optional and clinical attendance was free. 14 T h e chief fault of Baltimore's second medical school, both before and after the charter of 1839, was that it was a proprietary school, lacking a governing body whose members had no personal interest in the financial affairs of the institution. In this respect it was very similar to the University of Maryland before 1826 and after 1839. Both schools tended to be commercial enterprises. T h e financial blunders which brought about the termination of Washington University School of Medicine might have been averted under a detached management. Both schools made medical history by providing and stressing bedside study of medicine. Considering the wealth of anatomical material in Baltimore, both schools were neglectful of a manifest duty by delaying so long to establish dissection as a required feature of the curriculum. 1 5 MISCELLANEOUS

CONTRIBUTIONS IN

TO

MEDICAL

EDUCATION

BALTIMORE

Like other American cities which supported schools of medicine, Baltimore had its special schools and special courses. T h e Catalogue of the University of Maryland announced a "Baltimore Summer Course of Medical Lectures." Full and complete lecture courses were offered in the principal subjects, with the view of "affording to students of medicine every possible facility in the prosecution of their studies." T h e courses began the first Monday in April and continued until the middle of October, with the opportunity of six weeks' vacation in July and August. T h e charge was ten dollars for each course, and regular examinations were promised. T h i s summer course was, no doubt, similar to summer courses offered by Harvard's faculty. It probably served as a partial fulfillment of the requirement for three years of private study, and presumably was conducted by members of the University's medical faculty. 1 6 A distinctly independent private school was founded in 1839 by Dr. John R . Dunbar and continued for a number of years as a valuable adjunct to organized medical education in the two universities. His CÌTCUIÙT in 1840 listed the institution under the name of "Private Medical Institute of Baltimore." T h e object of the enterprise was to give students elementary medical training in a well-organized doctor's office. T h e Institute was in a large building adjoining the Dunbar residence and office. T h e building had large, airy, well-lighted rooms, balconies for exercise during inclement weather, secluded study rooms, and anatomical, surgical, and pathological " Annual Circular . . . 1848-49, p. 4. is Dissection tickets were required by the trustees of the University of Maryland, contrary to the faculty's desire, 1833-39, but omitted by the professors, 1839-48. It seems that Washington University had not made the requirement when it closed in 1851-52. 18 Catalogue . . . Medical Department of the University of Maryland, 18)4, p. 11.

WASHINGTON

COLLEGE

247

museums. T h e school possessed a "Solar Microscope magnifying more than three millions of times," a library of 1,500 volumes, and a set of the famous papier maché anatomical models of Professor Auzoux of Paris, the first to be brought to Baltimore. Only young men of dignity and responsibility were accepted. Although Dr. Dunbar was a member of the Washington University faculty, he left his office pupils free to select their own medical school after leaving his office. Presumably many of his private pupils were registered at the University of Maryland School of Medicine at the same time. T h e two-year course offered by Dunbar and his associates cost $200, paid in advance. One year was $100, and a winter session, $ 5 0 . " Another special school which provided students the opportunity of at least partially satisfying the three-year apprenticeship requirement was founded in 1847, under the direction of Drs. C. Frick, E. W. Theobald, D. Stewart, and C. Johnston, at the corner of Fayette Street and Elbow Alley. T h e founding of this institution, the Maryland Medical Institute, was said to have been in response to the recommendations of the American Medical Association. It is wrong to conclude that it recommended the establishment of more schools as a method of medical reform. Nevertheless the standard of office instruction was elevated by such organizations. These schools were often spoken of as preparatory medical schools. They were in no sense premedicai schools but educational institutions that systematically organized the activities of students who were fulfilling the requirement for private instruction. It is very possible that the lectures given in these private schools were too often a rehashing of what the teachers gave in their regular lecture courses at the University. There seems to have been no intelligent effort to grade the work of the preliminary school with reference to the collegiate work which was done simultaneously or later. 18 Although its two medical schools lacked the academic sanctity which comes from being the medical department of a well-organized university, Baltimore was regarded as one of the country's leading medical centers before i860. T h i s reputation was made possible largely by the development of the bedside method of teaching and the comparative abundance of fresh anatomical subjects which, unfortunately, were not made full use of. T h e debilitation resulting from professional jealousies and frequent changes in charter was compensated for, in some degree, by the zeal and energy of such men as Davidge, Smith, Potter, and Jameson. i? John R . Dunbar, Circular Private Medical Institute of Baltimore, (1840), pp. 1-8; and (Dunbar) Private Medical Institute of Baltimore, (1840), pp. 4-6. Dunbar's school gave special attention to auscultation and percussion, and taught obstetrics by manikin and machine and models of the foetus. is Cordell, The Medical Annals of Maryland, pp. 116, 130, 700, 808, 836.

CHAPTER

21

MEDICAL SCHOOLS IN THE DISTRICT OF COLUMBIA COLUMBIAN

COLLEGE

MEDICAL

(National Medical

DEPARTMENT

College)

MEDICAL quacks and charlatans early established themselves in Washington. T h e presence of irregulars was one of the main reasons for the founding of the Medical Society of the District of Columbia in 1817. 1 Certain members of the regular profession, who were thinking in terms of medical education, saw in the founding of a Baptist institution, Columbian College, in 1821, an opportunity to begin medical lectures under a collegiate charter. Some medical lectures by Dr. Thomas Sewall and Dr. James Staughton were started with the opening of the College in January 1822, but the Medical Department was not formally inaugurated until the spring of 1825.2 T h e College itself had an up-and-down existence apart from the Medical Department, which carried on essentially as an independent institution, receiving no financial aid from the College trustees. The spring session in 1825 w a s held in a poorly adapted building which served the purpose until the professors secured a lot and constructed a building at Tenth and E streets. This building was occupied in 1826. Another group of doctors and their supporters about that time attempted to establish a competing school. Thirty-eight memorialists, seven of whom were physicians and probably professors in waiting, prayed the Congress for a charter "to enable them to institute a Medical College . . ." They were "deeply impressed with a sense of the advantages to be derived from well regulated Medical Colleges" and believed that such an institution should be established in the city of Washington. The Memorial was punctuated with slightly sarcastic inferences showing the uncomplimentary regard the petitioners had for the Columbian Medical Department.3 Congress did not grant the petition of the memorialists. The Columbian school, staffed by Drs. Thomas Sewall, James M. Staughton, Thomas Henderson, Nicholas Worthington, Frederick May, and Richard Randall, was allowed to continue without competition, playing only a minor part in the medical affairs of the country. For five years, 1834-39, it passed out of existence but was then revived. The school, because of its location in Wash1 History of the Medical Society of the District of Columbia, 180J-1909, pp. 2 - 3 . 2 Wilhelmus Bogart Bryan, A History of the National Capital, 2: 199-200. 3 Memorial of Sundry Citizens of the District of Columbia, Praying that a Charter may be Granted by Congress to enable them to Institute a Medical College, . . .

848

DISTRICT OF COLUMBIA SCHOOLS

249

ington, came to be known as the National Medical College, but its degrees were always conferred by authority of Columbian College under its Congressional charter. 4 By the middle of the century the National Medical College had materially bettered its facilities and standing. There were seven professors besides a demonstrator. 5 A commodious building, 250 feet long, housed a hospital and other educational facilities, including lecture rooms and chemistry, anatomy, and pathology laboratories. 6 According to the Annual Announcement for the 1850-51 session, the hospital was kept well filled with patients "presenting every variety of disease, both acute and chronic." T h e faculty was deeply impressed with "the importance of Clinical instruction" which it offered in contrast to the "ordinary and common College Clinic." T h e circular did not mention practical demonstrations in obstetrics, but it did stress opportunities in practical surgery in the hospital and with cadavers. An abundant supply of fresh anatomical material was supplied at "a mere trifle," thus giving to the student "advantages seldom to be met with." 7 T h e requisites for graduation were as usually required, although no mention was made of the apprenticeship. Presumably this conventional requirement was taken for granted. T h e cost of the professors' tickets amounted to ninety dollars. An additional charge of ten dollars was made for practical anatomy, one term of which was required; five dollars for matriculation, and twenty-five dollars for graduation. Apparently hospital observation was not required or charged for. T h e lecture term was only four months. 8 T h e class finishing in the spring of 1850 brought the number of medical alumni of Columbian College up to 186, an average of only about nine graduates each year for the twenty years the Medical Department operated after its first graduation in 1826. With all of its highly advertised teaching facilities the College had only twelve medical graduates in 185ο. 9 T h e National Medical College continued for many years on a rather medi* Circular of the National Medical College, Washington, D.C. A short-lived school established by Dr. Thomas Miller and six associates in 1830 may have been the outcome of the 1826 memorial. It was called the Washington Medical Institute, was probably never chartered by Congress, and seems to have lasted for only a few years. See Daniel Smith Lamb, "Thomas Miller," Kelly and Burrage, op. cit., p. 846. s T h e faculty as listed in the 1850 Circular, p. 5, were: Thomas Miller, anatomy and physiology; William P. Johnson, obstetrics and diseases of women and children; Joshua Riley, materia medica, therapeutics, and hygiene; John Fred May, principles and practice of surgery; Grafton Tyler, pathology and practice of medicine; Robert King Stone, adjunct professor in anatomy and physiology; Edward Foreman, chemistry and pharmacy; and James E. Morgan, prosector and demonstrator. 8 T h e building was provided by Congress in the early forties as a hospital. When Congress took no steps as to the actual operation of the institution, the professors requested that they be put in charge (1844). T h e request was granted and the Medical Department was moved to the same building. Other members of the profession objected to the monopoly enjoyed by the professors, but the policy continued. ι Ibid., pp. 7 - 1 3 . β Ibid., p. 14. 8 Ibid., pp. 15-20.

25o

MEDICAL EDUCATION BEFORE THE CIVIL WAR

ocre level. Nevertheless its professed emphasis on clinical and anatomical studies at a time when the American Medical Association was emphasizing such things is worthy of record. But it is not to the College's credit that it retained a four-months' term in face of recommendations from the same source urging a lengthening to six. GEORGETOWN

C O L L E G E SCHOOL O F

MEDICINE

Georgetown College, Washington, D. C., was established by members of the Society of Jesus in 1789 but was not formally incorporated by act of Congress until 1844. 10 Under this authority the institution began to expand. A School of Medicine was established in 1851 and graduated its first class the next year. T h e classes were small, only eight graduating in 1861. T h e School was small and meagerly equipped. 1 1 T h e Annual Announcement for the session of 1 8 5 1 - 5 2 listed a teaching staff of six and gave a competent description of each professorship and the teaching methods employed. T h e cultural advantages available to one residing in the national capital were emphasized. T h e dissection rooms were opened as early in the fall as weather would permit work with cadavers, the supply of which was "at all times as abundant and cheap as elsewhere." A school building, at the corner of Twelfth and F streets, contained a lecture hall, anatomical theatre, museum, and laboratory with "extensive light and well ventilated rooms for dissection." The philosophical and chemical apparatus of Georgetown College were at the disposal of the professor of chemistry in the School of Medicine. T h e College conducted a "clinique" in order to provide clinical material for teaching purposes. Later a hospital, T h e Central Infirmary, gave the students o p portunity to practice auscultation and percussion at the bedside. 12 T h e announced fees for the session of 1854-55 were ninety-five dollars for all lecture courses, ten dollars for a dissection ticket and five dollars for matriculation. A twenty-five-dollar diploma fee was returnable to students who failed to qualify for graduation. T h e graduation requirements were in harmony with the conventional standards. 13 A Catalogue published in 1861 listed only twenty-nine medical students enrolled from September 3, i860, to July 2, 1861. 1 4 Not until long after the Civil \ s 5 · 47· ' 5 . 26· P r e s u m a b l y t h e C o l l e g e received financial a i d f r o m t h e state. C h a r l e s C a l d w e l l , in an a p p e a l to t h e K e n t u c k y L e g i s l a t u r e o n behalf of T r a n s y l v a n i a U n i v e r s i t y i n 1836, d e c l a r e d t h a t t h e M e d i c a l C o l l e g e of O h i o h a d received " n e a r f o r t y t h o u s a n d d o l l a r s a n d is still in receipt of s i x t e e n h u n d r e d d o l l a r s a year." C h a r l e s C a l d w e l l , A Report Made to the Legislature of Kentucky, on the Medical Department of Transylvania University, February i)th, JSJÓ, p . 30. J u e t t n e r , op. cit., p p . 204-05. »0 S h o t w e l l ' s policy was to b e c o m e m o r e a n d m o r e i n d e p e n d e n t of t h e legislature. 28

OHIO SCHOOLS

315

d o c t o r s a s k i n g t h a t the e n t i r e f a c u l t y b e dismissed. T h i s w a s d o n e a n d r e o r g a n i z a t i o n was a t t e m p t e d . W i t h i n t w e l v e m o n t h s a f t e r the b e g i n n i n g of t h e 1 8 4 9 - 5 0 session there w e r e twenty-five c h a n g e s in the f a c u l t y res u l t i n g f r o m r e s i g n a t i o n s , dismissals, a p p o i n t m e n t s , a n d r e a r r a n g e m e n t s . A f t e r t h e d e a t h of S h o t w e l l in 1849 ' h e fight c e n t e r e d b e t w e e n D r . M . B . W r i g h t , w h o h a d the s u p p o r t of t h r e e m e m b e r s of the b o a r d , a n d a trustee, D r . J o h n L . V a t t i e r , w h o w a s p r a c t i c a l l y the d i c t a t o r of b o t h b o a r d a n d f a c u l t y . P a m p h l e t s of v i r u l e n t d i a t r i b e w e r e issued b y b o t h sides. T h e p u b l i c e n j o y e d t a k i n g sides, b u t the C o l l e g e r e c e i v e d n o t t h e slightest b e n e f i t . T h e c o n d i t i o n of the C o l l e g e in 1850 w a s s u c h t h a t e x t i n c t i o n of the school was e x p e c t e d b y all. T h e n it w a s that V a t t i e r t h r e w the w e i g h t of his p o l i t i c a l p o w e r i n t o t h e m o v e m e n t f o r a n e w b u i l d i n g . It was a p r o j e c t in w h i c h all c o u l d t a k e p a r t . A s s u c h it a b s o r b e d energies that o t h e r w i s e w o u l d h a v e b e e n d e v o t e d to f e u d i n g . A n i m p o s i n g s t r u c t u r e c o s t i n g §50,000 a n d r e g a r d e d as t h e m o s t p r a c t i c a l of its k i n d in the c o u n t r y was e r e c t e d in 1851. It h a d t w o l a r g e a m p h i t h e a t r e s e a c h w i t h a s e a t i n g c a p a c i t y of five o r six h u n d r e d , besides all the c o n v e n t i o n a l facilities, i n c l u d i n g p r i v a t e q u a r t e r s f o r t h e professors. 3 1 F o r t y - f o u r m e m b e r s of the C i n c i n n a t i p r o f e s s i o n in 1852 s h o w e d t h e i r d e t e r m i n a t i o n to s u p p o r t the f a c u l t y in its n e w q u a r t e r s b y p r a y i n g t h e trustees to dismiss t w o of its m e m b e r s w h o h a d s u b m i t t e d to t h e legislat u r e a n a c r i m o n i o u s m i n o r i t y r e p o r t o n the C o l l e g e . A l t h o u g h t h e b o a r d d i s r e g a r d e d t h e request, the discord d e c l i n e d . It a p p e a r e d t h a t the C o l l e g e was o n the t h r e s h o l d of peace a n d p r o s p e r i t y . E v e n the f o u n d i n g of t w o r i v a l schools in C i n c i n n a t i — C i n c i n n a t i C o l l e g e of M e d i c i n e a n d S u r g e r y ( 1 8 5 1 ) a n d M i a m i M e d i c a l C o l l e g e ( 1 8 5 2 ) — h a d a s t i m u l a t i n g effect u p o n the C o l l e g e . O n e o r t w o r e s i g n a t i o n s p u n c t u a t e d the close of e a c h t e r m d u r i n g t h e fifties, b u t the g e n e r a l tone of the i n s t i t u t i o n w a s m u c h imp r o v e d . T h e F a c u l t y e x h i b i t e d c o n s i d e r a b l e esprit de corps a f t e r t h e m i d d l e of the d e c a d e , w h e n G e o r g e C . B l a c k m a n a n d J a m e s G r a h a m j o i n e d the f a c u l t y . I n a d d i t i o n to b e i n g r e p u t a b l e m e n in t h e i r c h o s e n fields (surgery a n d m e d i c i n e ) , B l a c k m a n was a t r o u b l e m a k e r a n d G r a h a m w a s a first-class c o n c i l i a t o r . E a r l y in the d e c a d e (1853) the C o l l e g e C l i n i c w a s e s t a b l i s h e d a n d s u b s e q u e n t l y b e c a m e o n e of the m a i n f e a t u r e s of m e d i c a l e d u c a t i o n in C i n c i n n a t i . A n o t h e r i n d i c a t i o n of progress was the a b s o r p t i o n of M i a m i M e d i c a l C o l l e g e b y the O h i o school in 1857, i n c l u d i n g f o u r o f the M i a m i professors. 3 2 T h e f o u r t h d e c a d e of the school's existence was c o m p a r a t i v e l y p e a c e f u l e x c e p t at its e n d . B l a c k m a n , i m p u l s i v e a n d fiery t e m p e r e d , in a m o m e n t o f m o r b i d e x c i t e m e n t d u r i n g the session of 1859-60 s p o k e e v i l of his f e l l o w professors b e f o r e his class. W h e n the f a c u l t y d e m a n d e d a n a p o l o g y B l a c k m a n w a s a d a m a n t . In protest C . G . C o m e g y s , J. A . M u r p h y , G e o r g e M e n d e n h a l l , L . M . L a w s o n , B . F. R i c h a r d s o n , H . E. F o o t e , a n d Jesse P. J u d k i n s r e s i g n e d f r o m the f a c u l t y . G r a h a m also r e s i g n e d i n d i s a p p r o v a l o f B l a c k Ibid., pp. 206-10. 32 Ibid., pp. 210-11.

31

gi6

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

man's conduct, but was able to maintain his friendship with the troublemaker, who alone remained on the faculty. 3 3 When a new faculty was organized, a rule was adopted prohibiting any professor from speaking ill of another. In order to insure peace with the professors who resigned and were then invited to accept their professorships back again, chairs in clinical medicine and surgery were created for G r a h a m and Blackman. T h i s arrangement was a scheme to keep Blackman's duties centered at the Hospital and away from the College. Only G r a h a m and Blackman accepted chairs. By this time the trustees resigned in disgust, but the governor reappointed them. T h e y promptly appointed Blackman to surgery, Graham to medicine, M . B. Wright to obstetrics, and a Mr. Charles O'Leary, not a physician, to chemistry. 34 These four were empowered to fill the remaining chairs. T h e y elected J . F. Hibberd of Richmond, Indiana, to physiology and pathology, J o h n C. Reeve of Dayton, Ohio, to materia medica, L. M. Lawson to theory and practice, Jesse P. Judkins to anatomy, and J o h n B. Billings, demonstrator. 35 With some imported talent to infuse a new spirit into the school, the faculty managed to hold steady for the next four or five years, that is, with the exception of a quarrel in the Hospital. 3 6 T h e Civil War, with all its sorrow and tragedy, contributed to this brief period of peace by diverting the emotional energies of the profession into other channels. It is interesting to note that following the Civil W a r the College entered a period of prosperity continuing over a period of twenty-five or thirty years. Juettner, who is the source of most of this information, had little to say about the scholastic standards of the school with reference to admission or graduation. He inferred that two terms of five months were required for the doctorate in the fifties. Perhaps shorter terms were customary a few years earlier. 37 Attendance during the College's fourth decade was better than previously reported. On this point Juettner claimed that the Medical College of Ohio, like some other schools, reported its enrollment greater than the actual number of names entered on the registry. T h e purpose of such a questionable practice was to make a favorable impression on the public, especially prospective students. In 1859 the enrollment was boosted slightly when the trustees decided to accept one gratuitous student from each congressional district. 38 T h e tuition fee in 1850 was eighty-four dollars. It was to the credit of Ohio College that it did not cut its fees as other Western schools were 33 Ibid., p. z u . O'Leary had studied medicine at Long Island Medical College but was not a graduate. At the time oí his appointment he was lecturing on chemistry at Mt. St. Mary's Seminary, a Catholic school in Cincinnati. 35 Ibid., p. 247. Billings soon entered the army medical service and W. W. Dawson took his place. 36 T h e outcome of this row was that the Hospital was opened to all medical students in Cincinnati. 37 Thirteen out of twenty-six diplomas given in 1855 were honorary, i.e., given to men who had not attended lectures. s» Ibid., p. 2 1 1 .

OHIO SCHOOLS doing at that time. R u s h Medical College in Chicago had, reputedly f o r philanthropic reasons, reduced its fee to thirty-five dollars for one term. Evansville Medical College in Indiana, in the heat of temperance enthusiasm, had offered to credit any student with half his fee if he w o u l d take the temperance pledge. A few years later (1857) the Cincinnati College of Medicine and Surgery offered free tuition as a competitive measure. It seems that the Medical College of O h i o should have been beset with less trouble after it lost its independent status in 1825 became a statecontrolled and, in a measure, a state-supported institution. Certainly such was not the result. Perhaps no medical school in the country that existed during the period covered by this study h a d as much internal strife or was so effectively attacked from without as was Ohio's first medical college. Much of the impedimenta which disturbed the progress of the College can be traced to the charter provision which stipulated that the trustees were to be elected by the legislature every three years. Such a system made the trusteeships political jobs and a part of the political patronage of the state. As a result there was a scramble for the appointments. 3 9 M e n poorly qualified and with little interest in the College were often appointed. A m o n g trustees of this caliber there was often a tendency to dictate to the faculty a n d meddle with matters that were not board problems. T h e trustees frequently took sides in the quarrels between professors. T h i s action usually complicated an already difficult situation. With such potent personalities as Drake, Moorhead, Shotwell, and Blackman on the teaching staff there was bound to be friction. Fuel was always added to the fire by the public, which delighted in following the press reports of the wrangles and reading the calumnious pamphlets through which the professors defended themselves. T h e confusion was made complete by the attacks f r o m the outside by discharged professors and trustees and physicians w h o craved professional appointments. It is not to the credit of Daniel D r a k e that he dissipated so much of his own energy trying to annihilate the College. A t times the students made their contribution to the turmoil and bewilderment. In spite of all the jumble and disarray in the management of the College, it d i d graduate many physicians during the four decades before the Civil W a r . Because many of the professors during this time were wellschooled and talented teachers, it follows that the alumni of the school were reasonably well trained. T h i s conclusion is further justified by the fact that the Commercial Hospital was available for teaching purposes from the first. Later the Marine Hospital and the College Clinic emphasized the practical aspect of the College. Weird tales of students' nightly graveyard excursions and the ghastly trade of the resurrectionists in the vicinity of Cincinnati is evidence that the fast-growing river port, Cincinnati, did not provide enough legitimate bodies. 40 Even so, students of the Medical College of Ohio probably had as good facilities for prac39 Ibid., p. 206. A more satisfactory situation would have obtained if the trustees had been appointed by the governor in a rotating fashion. 40 Ibid., pp. 392-97.

3 I8

MEDICAL E D U C A T I O N BEFORE T H E CIVIL W A R

tical anatomy as any Western school, with the possible exception of the schools of New Orleans. T h e influence of the College in Western medicine is not easily estimated. T h a t it enjoyed both good and bad reputations is certain, in view of its fluctuating career. Few students could have attended two terms of lectures at any time from 1820 to 1861 without witnessing the participation of their professors in some wrangle. T o such an influence might be traced to some extent the professional feuds that accompanied the establishment of many smaller schools in the West after 1840. T h e College supplied Transappalachia with hundreds of graduate physicians w h o played their unsung yet heroic role in the winning of the West. T h e disgusting quarrels which characterized so much of the school's history were symptomatic of an uncontrolled profession in an immature democratic society where the inalienable rights of the individual and personal honor were guarded religiously. THE MEDICAL DEPARTMENT OF CINCINNATI

COLLEGE

Cincinnati College originated in 1811 as the Lancasterian Seminary, founded by a Presbyterian clergyman, Joshua L. Wilson. It happened that Drake was in Cincinnati at the time and took an active interest in the project. T h e Lancasterian feature of the school was soon dropped. In 181g the institution was chartered as a college or university and came to be known as Cincinnati College. Its first president was Elijah Slack, w h o was associated with Drake in founding the Medical College of Ohio. College work in the institution was suspended in 1825 a n d partially revived in 1834.41 T h e n it was (1834) that Daniel Drake considered the time ripe for organizing a school to drive the Medical College of O h i o out of business. News of Drake's intentions brought a storm of protest from the friends of O h i o Medical College. T h e attack was led by A l b a n Goldsmith, professor of surgery in the O h i o College. Drake defended himself and the new school through the columns of his Western Journal of the Medical and Physical Sciences. T h e attack on the school and against Drake's character and ability helped the enterprise along rather than destroying it. In addition to Drake's personal qualities, the most important factor in the success of the Medical Department of Cincinnati College was the capacity of the professors whom Drake secured. His brother-in-law, Joseph Nash McDowell, a nephew of the famous Ephraim McDowell, had taught at Jefferson and Transylvania. He joined heartily in Drake's "War of Extermination" while serving as professor of anatomy. Samuel D. Gross, pathology, physiology, and jurisprudence, was just beginning his career as a superior surgeon and an excellent teacher. He had stupendous capacity for work, which signalized his subsequent career as a leading m e n b e r of the American profession. T h e chair of surgery was held by H o n t i o B. •ι A Catalogue of the Officers and Students in the Medical Cincinnati College: First Session 18)5-36, pp. 10-11.

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Jameson, one of the founders of Washington Medical College, Baltimore, 1827. D r . Jameson resigned after one year. H e was succeeded by Willard Parker, a H a r v a r d graduate who later held the chair of surgery in the College of Physicians and Surgeons of New York for thirty years. Drake offered the professorship of obstetrics and diseases of women and children to L a n d o n C . Rives, an honor graduate of Pennsylvania in 1 8 2 1 , and a gentleman of polished manners. J o h n P. Harrison, who became professor of materia medica, was in 1834 on the verge of leaving Kentucky to apply for a teaching position in Philadelphia when Drake called him to the new school in Cincinnati. Chemistry and pharmacy went to a master of chemical lore, J a m e s B. Rogers, who as an orator was even superior to Drake and McDowell. Rogers was assisted for one year by J o h n L e o n a r d Riddell, who later held the chair of chemistry for twenty-nine years in the Medical Department of the University of Louisville. Drake himself occupied the chair of practice. 42 Drake's biographer, Otto Juettner, ranked this group of professors as the ablest faculty under the roof of a western medical school, a n d the school they operated as "the greatest medical school the West has ever seen." 43 Regardless of whether this opinion was an overestimate of the facts, it was a most talented coterie of teachers that Drake organized for the express purpose of annihilating the Medical College of Ohio. Besides coming dangerously near to accomplishing his pernicious purpose, Drake and his professors conducted for four years a very much respected Medical Department—except in the opinion of Moorhead and the professors of the older school. T h e trustees of Cincinnati College announced the establishment of the department in J u n e 1835. T h e first session opened in the fall. For four years there was a most bitter rivalry between the two schools. Barred from the Commercial Hospital, which was under the legal control of the Medical College of Ohio, Drake and his associates opened a small infirmary opposite the College and called it the Cincinnati Hospital. This, with Drake's Eye Infirmary (1827), served the clinical needs of the school. A f t e r f o u r years of effort Drake broke the monopoly on the Commercial Hospital by securing a legislative act authorizing the T o w n s h i p Trustees to issue an order permitting Cincinnati College medical students to attend the Hospital and adding some of its professors to the staff. T h i s support came too late; Drake's faculty was already beginning to break up. Without any financial help, except a few modest gifts from citizens, the professors had begun to despair of success. According to S. D. Gross, a member of this famous faculty, the break came in the summer of 1839, v h e n Dr. Parker accepted a call to New York. One by one the other professors followed suit, leaving Drake the last professor to withdraw. 4 4 Dur.ng the last year of the school's activity a committee of the legislaIbi¿., p. 188. **Ibil., p. 187.

3

2θ

MEDICAL

EDUCATION

BEFORE

THE

CIVIL

WAR

ture investigated the two medical colleges and submitted two reports, each signed by two members of the committee of five members. One sustained the Medical College of Ohio and the other favored the Medical Department of Cincinnati College, suggesting that the older school turn all its properties to Cincinnati College and make of its Medical Department a state institution. T h e one committee member who did not vote, had he favored Drake's school, perhaps could have been the instrument of satisfying the greatest desire of Drake's career. But this is only historical speculation. T h e fact is that Drake failed. His school became extinct. 45 T h e catalogue of the Medical Department listed the enrollment for the first three years as sixty-six, eighty-five, and 125. In the first class were representatives from Canada and twelve states, including New York, Maryland, and Virginia. Thirteen of the first graduating class of eighteen had been students of the Medical College of Ohio. T h e current practice of padding matriculation reports was condemned by the faculty in the Catalogue of its first session: T h e reader is i n f o r m e d that the M e d i c a l F a c u l t y of this Institution r e p o r t n o n e b u t p u p i l s w h o are e n g a g e d in the study of M e d i c i n e w i t h a v i e w of

becoming

physicians, a n d such graduates as m a t r i c u l a t e for the p u r p o s e of revising

their

studies, by an a t t e n d a n c e o n lectures; c o n s e q u e n t l y visiting physicians, druggists, dentists, teachers, p o r t r a i t painters, a n d a m a t e u r s are not e m b r a c e d

in

their

catalogue.48

T h e term in Drake's school was about four months long. Seven tickets cost $105. Practical anatomy tickets, one of which was required of graduates, were ten dollars. 47 Subjects were available at eight dollars, and the dissecting room was open a month before lectures commenced. 48 T h e requirements for graduation met the conventional standards. Four years of practice were accepted in lieu of one lecture term, a rather common policy in Western schools after Transylvania started it some years before. A thesis was required in English, Latin, or French. 49 T h e faculty offered a summer session known as the Summer Institute. It began on the first day of April and continued until late in September, excluding July as a vacation month. T h e term aggregated some three hundred lectures and cost sixty dollars. 50 This short-lived medical college was the crowning effort of Daniel Drake's career. It was an heroic effort to vindicate his position in the medical profession of Cincinnati and reestablish himself at the head of a medical school. Temporarily he was able to do this, but he did not succeed in crushing the Medical College of Ohio. Although he failed in the end, Drake demonstrated his genius at organization and leadership by calling « Ibid., p p . 186-87. 46 A Catalogue of the Officers and Students in the Medical Cincinnati College: First Session, 1S35-16, p. 6. 47 M a t r i c u l a t i o n was two, a n d g r a d u a t i o n twenty dollars. 48 Catalogue . . . i8j;-)6, p. 8. Loc. cit. so Ibid., loc. cit.

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3*1

together a brilliant g r o u p of professors. J u e t t n e r classed Drake's faculty, the medical professors of R u t g e r s College a decade earlier, a n d the f a c u l t y of P e n n s y l v a n i a at the b e g i n n i n g of the century, as the three greatest combinations of medical professors the country h a d ever seen. 5 1 CINCINNATI

COLLEGE

OF

MEDICINE

AND

SURGERY

I n 1850, A l v a H . Baker, f o r m e r schoolmaster a n d J e f f e r s o n graduate of 1 8 3 2 , was conducting quiz courses in C i n c i n n a t i . T h e next year the legislature of O h i o issued a charter creating B a k e r a n d twelve associates as the body politic a n d corporate of an institution to be k n o w n as the C i n c i n n a t i M e d i c a l a n d Surgical College. 5 2 L i k e D r a k e , A l v a B a k e r had a c o n s u m i n g desire to become the f o u n d e r of a medical school and the occupant of one of its chairs. It w o u l d be u n j u s t to D r a k e to carry the parallel any f a r t h e r . B a k e r lacked a sense of professional ethics a n d saw in a medical school u n d e r his control an o p p o r t u n i t y to g l o r i f y himself and create a personal f o r t u n e . T o satisfy his greed it was necessary f o r h i m completely to dominate the school. T h i s he set out to do. H e assumed the deanship and chair of surgery, a n d fitted u p a b u i l d i n g w i t h hospital wards on C e n t r a l A v e n u e . T h i s college b u i l d e r then secured the services of six professors. 5 3 B a k e r was severe in his m a n a g e m e n t of the school. H e was w i l l i n g to share the glory with his colleagues, b u t c l u n g tightly to most of the proceeds. Such a policy gave the school a poor reputation a n d contributed to frequent changes in personnel. N o t until a f t e r B a k e r ' s death did the College clear itself of this i n f a m y . O n e of B a k e r ' s professors, R o b e r t R . M c l l v a i n e , w h o taught physiology for a brief period, was not c o m p l i m e n t a r y in his estimation of the school: T h e Cincinnati College of Medicine and Surgery was conceived in sin and born in iniquity. T h e best that can be said of it is that it is a normal school for medical teachers. No one goes there to teach but those who are ambitious to learn how to teach in a better school.54 In a fast-growing city like C i n c i n n a t i there were in the profession not a few y o u n g m e n w h o were w i l l i n g to teach f o r B a k e r just to h a v e the experience. A m o n g them were a few excellent teachers such as J a m e s Grah a m , w h o taught materia medica for a short time. E l i j a h Slack held the c h a i r of chemistry one session ( 1 8 5 2 - 5 3 ) . « Juettner, op. cit., p. 188. 52 Baker's associates were: C. S. K a u f f m a n , Peter Outcalt, J a c o b G r a f f , Joseph K. Smith, Joseph Draper, William Cameron, William B . Dodds, Cornelius Moor, Martin T i l b e r t , Stanley Matthews, O. M. Spencer, and Robert Moor. J u e t t n e r , op. cit., p. 289. 5 3 Baker's professors were: Benjamin S. Lawson, registrar and professor of practice; R . A. Spencer, anatomy; Charles W. Wright, chemistry; J a m e s G r a h a m , materia medica; J . Sidney Skinner, pathology; and Edward Mead, obstetrics and diseases of women and children. G r a h a m later became famous as a teacher. Strangely, Baker's school went into operation as the Cincinnati College of Medicine and Surgery instead of "Cincinnati Medical and Surgical College," as the charter read. Forty years later this discrepancy was discovered by accident and rectified. Ibid., p. 2 9 1 .

3 22

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

Baker demanded access to the Commercial Hospital for his students. T h i s was granted on the strength of the decision won by Drake in 1839, but Baker did not receive an appointment to the staff. When his pupils attended the Hospital it was a constant reminder to them that their school was deficient. For this reason Baker finally refused to permit his pupils to buy hospital tickets. T h e n he began a long and bitter controversy with the Hospital management which helped no one, not even himself. In 1852 he attempted to operate two terms in one year, a scheme which had been unsuccessfully attempted in a few other schools. Obviously the purpose was to increase his revenue by attracting students who were anxious to complete training within one year. Apparently the scheme was abandoned before long. Baker then resorted to another extreme as a competitive measure. He began reducing fees until, in 1857, to kill his competitors he made a free school out of his College. By this policy he succeeded in driving the Miami Medical College (1852-57) into the arms of the Medical College of Ohio. T h e two schools were merged that same year. 65 Fees in the school were first fixed at ten dollars per ticket, five dollars matriculation, ten dollars practical anatomy, five dollars hospital, and twenty-five dollars graduation. T h e comparatively high graduation fee may account in a measure for the giving of thirteen honorary degrees in 1855. Although detailed information is lacking, Baker probably established the conventional scholastic standards. From these he may have departed when adherence to them contravened his personal policies. 56 Dr. Baker died in 1865. T h e character of his school is said to have improved after that date. Not every author deals so harshly with Baker as does Juettner. Alexander G. Drury mentioned his energy and charm of personality, but added that he lacked polish as a teacher. He edited the first issue of the Cincinnati Medical News, 1858, and presided over the Medical Convention of Ohio in 1847. One thing is certain; Alva H. Baker contributed his share to the general confusion of the 1850's. MIAMI

MEDICAL

COLLEGE

In 1850 a group of ambitious doctors who were conducting special courses issued a pretentious announcement under the title Cincinnati Medical Institute,5T T h e Medical College of Ohio cooperated with the Institute by making its lecture rooms available and opening to it the wards of the Commercial Hospital. Just at that time the seventy-two-year-old Reuben D. Mussey resigned from the Ohio College faculty because of friction with his colleagues. During his thirteen years of service at the College, Mussey had risen to the top of his profession and was an acknowledged leader among western surgeons. T h e teachers in the Institute persuaded Mussey that the time had come to establish another school in Cincinnati 5

® Ibid., pp. 291, 293. Ibid., pp. 290, 294. After the Civil War a term of lectures ranged from twenty to forty dollars besides other fees. 57 T h e "Institute" offered a sixteen-weeks course beginning in March. 56

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a n d that he was the chosen leader. T h e a g e d surgeon submitted to the will of his admirers a n d took the lead in securing a charter f r o m the Commissioners of H a m i l t o n C o u n t y . T h e n a m e of the institution was M i a m i Medical College, b u t it h a d no connection w i t h the M i a m i University u n d e r whose charter D r a k e h a d attempted to f o u n d a Medical D e p a r t m e n t in 1831." T h e interested professors met at the h o m e of J o h n F. W h i t e , on J u l y 22, 1852, to organize the faculty. Jesse P. J u d k i n s was elected dean a n d professor of surgical a n a t o m y and pathology, a n d Dr. Mussey professor of surgery. Seven other a p p o i n t m e n t s were made, m a k i n g a faculty of nine in all. 5 9 A r e m o d e l e d b u i l d i n g at F i f t h Street a n d C e n t r a l A v e n u e became the school's first home. Because the O h i o professors m a d e u p the staff of the C o m m e r c i a l Hospital, M i a m i students h a d to listen to the clinical lectures of professors in the r i v a l school. M i a m i professors gave clinical lectures at St. J o h n ' s Hotel f o r I n v a l i d s at T h i r d a n d P l u m , a n d a dispensary was opened in the College. T h e s e facilities, however, d i d not take the place of instruction at the bedside of hospital patients. 6 0 I n spite of these handicaps, the g r a d u a t i n g classes f r o m 1 8 5 3 to 1857 were: seven, seventeen, seventeen, eighteen, a n d thirty-one. T h e n u m b e r of m a t r i c u l a n t s the last year (1857) was three times as great as the first year. 8 1 T h r o u g h o u t these years the M i a m i professors sought by every means possible to break the m o n o p o l y of the O h i o professors over the Commercial H o s p i t a l Staff. T h e y succeeded only in w e a r y i n g the O h i o trustees, w h o finally suggested c o m b i n i n g the two colleges. T h e M i a m i professors at first scorned the idea, but w i t h i n a y e a r they began considering the proposition. T w o conditions hastened the c o n s u m m a t i o n of the merger. First, Dr. Mussey desired to retire, thus r o b b i n g the College of its most f a m o u s personality. Second, A l v a H . B a k e r , the arch enemy of both schools, was m a k i n g his C i n c i n n a t i College of M e d i c i n e a n d Surgery a free school w i t h the intention of crushing his rivals. T h e O h i o trustees in a reorganization elected f o u r M i a m i p r o f e s s o r s — J u d k i n s , Comegys, Foote, a n d Mend e n h a l l — t o its faculty. W i t h this move M i a m i M e d i c a l College ceased to exist. 6 2 T h e M i a m i College seems to have been a proprietary school, yet it h a d five years of vigorous existence w i t h o u t the violent internal strife that »8 A short time before this event, the legislature had passed an act authorizing county commissioners to grant charters when a sufficient amount of stock had been subscribed. se The other appointees were: Charles L. Avery, descriptive anatomy; John Davis, adjunct in anatomy; John F. White, practice; George Mendenhall, obstetrics and diseases of women and children; John A. Murphy, materia medica, therapeutics, and jurisprudence; C. G. Comegys, institutes of medicine (physiology); and John Locke, Jr., chemistry. Dr. Locke did not accept, and his place was taken by H. E. Foote. Juettner, op. cit., pp. 320-21. eo In 1855 Elkanah Williams, a noted ophthalmologist, opened an eye clinic at the College. ei Ibid., pp. 321-22. 82 Miami Medical College was revived in 1865 and maintained its identity until 1908.

324

MEDICAL EDUCATION

BEFORE T H E

CIVIL

WAR

blighted the development of all medical institutions in Cincinnati at that time. T h e respect of the faculty, most of whom were young, for the venerable D r . Mussey no doubt made possible this brief period of tranquillity. Private medical instruction in Cincinnati was thriving during the forties and fifties. It was customary for a doctor who was ambitious to bccome a professor to establish a private lecture course in which he covered one or more fields of medicine. 8 3 Several such men, discovering their mutual interest, would often form an association with the idea of systematically covering the entire field of medicine. It was but a stèp or two further to secure a charter or the sponsorship of an established college and then issue a circular announcing a new college. A. H. Baker's quiz courses of 1850 became the Cincinnati College of Medicine and Surgery in 1851 after the institution enjoyed the support of a proprietary charter. T h e Medical Institute of Cincinnati of 1850 was crystallized into the M i a m i Medical College in 1852, after being chartered by the trustees of Hamilton County. 6 4 In 1844 George Mendenhall, Charles Woodward, and their associates opened a dispensary and gave courses. Somewhat later Charles L . Avery, Ε . K. Chamberlain, and several others opened and conducted a rather pretentious private school. As early as 1837 a summer school was conducted by several young men who h a d no connection with either college. T h e year 1842 marked the opening of a summer session which apparently was the project of the Medical College of Ohio faculty. T w o sessions were offered in one summer, one from the first Monday in A p r i l to the end of J u n e , and the other in September and October. T h e fees for the two courses were fifteen and ten dollars respectively, and the matriculation fee to the College winter term covered the use of the library and admission to the Commercial Hospital during the summer. T h e circulars of this summer session stressed the advantages of witnessing surgery and post mortems at the Hospital and the rational balance maintained between the theoretical and the practical aspects of medical study. 66 In 1850 the Wesleyan University (Methodist) of Delaware, Ohio, attempted to open a medical department in Cincinnati. T h e plans never materialized because of the failure of its promoters to get joint control of the Commercial Hospital with the Ohio College. It was then suggested that the Medical College of Ohio become the Medical Department of Wesleyan University. T h e movement ceased when its chief promoter, Dr. T . O. Edwards, was given the chair of materia medica in the Ohio College. 0 " As a medical center in the pre-war West, Cincinnati was conspicuous. Its supply of anatomical material was not liberal but certainly more plentif u l than the meager number of subjects obtained by teachers and students in the backwoods schools of the West. In this respect the Medical College es Thomas Wood gave private dissecting courses in the Ohio Dental College to both medical and dental students. «4 Ibid., p. 208. β» Annual Announcement of the Cincinnati Summer School of Medicine, Session of 1844, pp. 5, 7; Ibid., 1845, p. 4. " Juettner, op. cit., p. «07.

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of O h i o must have been distinctly superior to the M e d i c a l D e p a r t m e n t of T r a n s y l v a n i a University in K e n t u c k y . T h e latter e x p e r i e n c e d a p e r e n n i a l dearth of specimens f o r dissection. C i n c i n n a t i also had clinical facilities f r o m the first. C o n t e m p o r a r y with the o p e n i n g of Drake's M e d i c a l C o l l e g e of O h i o in 1820 the C o m m e r c i a l H o s p i t a l was established. 6 7 Its usefulness as a teaching institution was limited because of m a n y professional f e u d s in w h i c h its control and m a n a g e m e n t were r o u n d l y disputed. Several m i n o r attempts at establishing hospitals m a r k e d the medical history of C i n c i n n a t i b e f o r e the C i v i l W a r , but the C o m m e r c i a l H o s p i t a l w a s the only teaching hospital of importance. 8 8 As a medical center C i n c i n n a t i was notorious f o r its lack of p r o f e s s i o n a l unity and f o r the a b u n d a n c e of prejudice a n d jealousy between f a c t i o n s i n t o w h i c h the profession was always divided. Besides feuds w i t h i n the r e g u l a r g r o u p , there were bitter controversies between the regulars, eclectics, a n d homeopaths. In 1832 and 1849 cholera u n m e r c i f u l l y r a v a g e d the city. D u r i n g the latter year many leading physicians took time o u t f r o m their losing battle against the Asiatic pest to write c a l u m n i o u s letters to editors a n d manifestoes to the public, h o l d i n g u p to ridicule the therapeutic methods e m p l o y e d by their professional enemies. It was b o t h pathetic a n d ludicrous that trained physicians, i n c l u d i n g D a n i e l D r a k e , R . D . Mussey, J o h n T . Shotwell, J o h n P. H a r r i s o n , a n d A l v a Curtis s h o u l d h a v e e n g a g e d in such a controversy w h e n the entire O h i o V a l l e y so g r e a t l y n e e d e d the cooperative efforts of the entire profession. T h e same spirit of stubborn i n d i v i d u a l i s m characterized medical education d u r i n g this forty-year period. N o school f o r any a p p r e c i a b l e p e r i o d of time was free from the b a l e f u l influence of professors' w r a n g l i n g a n d trustees' m e d d l i n g . It is convenient now to cross the state n o r t h w a r d to the shores of L a k e E r i e a n d survey the beginnings of medical education in the W e s t e r n R e serve. WILLOUGHBY

MEDICAL

COLLEGE

E a r l y in the nineteenth century N e w E n g l a n d e r s began settling in that p o r t i o n of northwestern O h i o k n o w n as the Western Reserve. 8 9 T h e trail of most of these hardy N e w E n g l a n d e r s led westward through the M o h a w k V a l l e y o f ' N e w Y o r k . C l e v e l a n d , w i t h i n a f e w years, became the p r i n c i p a l settlement in this region of Ohio. A N e w Y o r k e r of Massachusetts descent, D a v i d L o n g , physician and schoolmaster, was the first doctor in C l e v e l a n d . H e received a n M . D. degree f r o m one of the N e w Y o r k C i t y schools in 1 8 1 0 a n d soon l e f t f o r the Western Reserve. e? T h e Commercial Hospital had a bed capacity of 150 in 1832. »8 The Sisters of the Poor of St. Francis opened St. Mary's Hospital in 1859. so By its charter of 1662 Connecticut laid claim to lands from ocean to ocean. In 1786 Connecticut yielded all but the territory between 41° and 42° 1' extending westward 120 miles from the Pennsylvania border. In 1795-96 Connecticut sold much of this to a firm of forty-eight men, who set about to survey it and encourage settlement in this "Western Reserve."

386

MEDICAL EDUCATION BEFORE T H E CIVIL W A R

Other physicians came with the trains of emigrants who trekked through western N e w York to B u f f a l o and thence along the shores of L a k e Erie to the promised land. Close to the route of these travelers through the Mohawk Valley was the famous College of Physicians and Surgeons of the Western District of the State of New York, at Fairfield. From time to time teachers and graduates of this thriving school were influenced to join the caravans going west. Several of these physicians settled in or near a village called Chagrin, located on the shore of L a k e Erie. In 1834 these gentlemen from Fairfield were successful in having the town's name changed to Willoughby, in honor of their former colleague and professor, Westel Willoughby, a favorite professor at the College of Physicians and Surgeons of the Western District. Another patriotic move of Willoughby's admirers was the organization of a medical school named after their New York friend. Willoughby Medical College was technically the Medical Department of Willoughby University of L a k e Erie—an institution of higher learning that has left little or no record except for its Medical Department. Frederick C. Waite reported that there is evidence that the founders had the medical school principally in mind when the University was chartered. T h e subsequent history of the institution did not justify use of the term "University," but the trustees were enthusiastic from the first. A newspaper article published on November 14, 1834, during the first week of school, declared that the school's facilities were " e q u a l to any other college in the U n i o n . " Another press comment on the second of the following January listed Willoughby University as the only de facto university among the twelve chartered higher institutions in the state. In support of this statement the writer added that the various departments were fully organized and the Medical College had commenced. T h e other eleven institutions were rated as "only colleges with no collateral departments." During the second session the University opened its arts department, a school for young ladies which soon closed. 70 Dr. Willoughby was invited to come West and head the University, but he did not accept the honor. Meanwhile the College was patterned after Willoughby's school at Fairfield and enjoyed moderate success for a country school. 71 T h e school at Willoughby lasted little more than a decade, during which time it had on its faculty several men of more than ordinary and even of national reputation. T h e r e were at first ten faculty members, including three adjunct professors. 72 7 ° Frederick C. Waite, An Historical Sketch of the Willoughby Medical Colltge, 18)447. PP· 5 - 1 0 . This was the first instance in the United States of a medical school being named for an individual. Subsequently there appeared Rush, Beaumont, Starling, Toland, and others. " Henry Howe, Historical Collections of Ohio in Two Volumes, II, 34. 72 All of the professors in the first faculty were practitioners. Eight were Ohic residents and two were from Michigan. According to Waite it is very probable that seven lut of the ten did not hold the M. D. degree when the faculty was organized. T h e ten Avere: Horace A. Ackley, pathological and surgical anatomy; John Cook Bennett, midwifery; T . W.

OHIO SCHOOLS

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Perhaps the best-known teacher to deliver lectures on Chagrin Creek was Dr. John Delamater, professor of theory and practice of physic, pathological anatomy, and obstetrics (1837-43). During the same time he held chairs at Fairfield (1837-40), D a r t m o u t h (1837-40), Cincinnati (1838-39), Franklin Medical College, St. Charles, Illinois (1843-44), a n d a t Geneva, New York (1840-43). As an inspirational teacher Delamater was said to be without a peer. Altogether in his lifetime he held professorships in eight or nine different schools. 73 Doctor John C. Bennett, a practitioner from Stark County, was the first executive head of the school. W i t h a faculty made u p largely of inexperienced teichers and having the qualities of a promoter rather than an educator President Bennett soon f o u n d himself unfitted for his task. Furthermore there was dissension in the organization before the close of the first tent. Bennett, w h o was referred to as the "puff-master general," and two other professors were dismissed after the close of the first session, which ended or. March 3, 1835. E l i j a h F. Willey, a clergyman, was next elected president. T h e second year, w i t i a full complement of teachers, was more successful than the first. Another change in the presidency came in 1836. R a l p h Granger, a Yale graduate and man of affairs in northeastern Ohio, served until the close of the i8j2~43 session. D u r i n g his time a structure sixty by sixty and three stories h.gh was built and occupied. It made ample provisions for classrooms, liboratories, museums, and a library. T h e faculty was further improved aid the good reputation of the school spread throughout O h i o and the counxy. Disseniion over standards of medical education appeared in the faculty d u r i n g tie session of 1841-42. T h e r e was also some public disapproval of the schod because of its use of questionable methods of securing anatomical mateiials. Controversy increased until the close of the 1842-43 session, at w h i c h time President Granger resigned. T h e faculty by this time had dwindlec to five, and four of these followed the example set by Granger. O n e of tie issues of the quarrel was the question of m o v i n g the school to Cle^velanl or Columbus. W h e n the break came, John Delamater, Jared P. K i r t l a n d H. A . Ackley, and J. L . Lang, four seceding teachers, established the Cleveland Medical College under the charter of Western Reserve College. T h e sile remaining professor, Amasa Trowbridge, w h o resided four humdredmiles distant in New York, was appointed president. Vacancies in t h e fa:ulty were filled with men less experienced than Delamater and Kirttland A few more additions to the faculty during the next two years D o n a v a n , nstitutes; George Jones, anatomy and physiology; William M. Smith, materia mediica; Fancis W . Walsh, surgery; Samuel Underhill, chemistry; George W . Card, adjuinct ininstitutes; Hosmer G r a h a m , adjunct in midwifery; and Storm Rosa, adjunct in miateriamedica. ™ Fredeick C. Waite, "John Delamater, Educator and Physician," Bulletin of the Academy c Medicine of Cleveland, X I V , 5: 18, May, 1930. For a good discussion of early Westtern leserve Medicine see Howard Dittrick, compiler, Pioneer Medicine in the Westtern Bserve.

3 Í8

MEDICAL E D U C A T I O N BEFORE T H E CIVIL WAR

w e r e p r o f e s s o r s f r o m F a i r f i e l d M e d i c a l C o l l e g e , a n d Pittsfield, M a s s a c h u setts. 7 4 M e a n w h i l e W i l l o u g h b y M e d i c a l C o l l e g e s u f f e r e d a slight d r o p in enr o l l m e n t b u t s o o n m o r e t h a n d o u b l e d it, g r o w i n g f r o m fifty in 1844-45 to 126 t h e f o l l o w i n g y e a r . A l l t h e t i m e there w a s intense j e a l o u s y b e t w e e n the s c h o o l at W i l l o u g h b y a n d t h e s c h o o l in C l e v e l a n d . W i t h s u c h a s p l e n d i d p a t r o n a g e , W i l l o u g h b y b o a s t e d of h a v i n g , n e x t t o G e n e v a M e d i c a l Instit u t i o n in N e w Y o r k , t h e l a r g e s t e n r o l l m e n t of a n y c o u n t r y s c h o o l in t h e l a n d . T h e s e facts, d e c l a r e d t h e Annual Catalogue in 1846, m u s t satisfy the p r o f e s s i o n a n d t h e p u b l i c " t h a t a c o u n t r y M e d i c a l S c h o o l m a y be f u l l y s u s t a i n e d a n d t h a t t h e p l a c e w h e r e i n s t r u c t i o n is g i v e n , has less to d o w i t h success, t h a n m a n y s u p p o s e . " D u r i n g the year 1845-46 the m a t r i c u l a t i o n r e a c h e d 164. 7 5 I n all, W i l l o u g h b y M e d i c a l C o l l e g e g r a n t e d 200 degrees, f o r t y of w h i c h w e r e h o n o r a r y . 7 6 T h e t e r m at W i l l o u g h b y w a s s i x t e e n weeks. A l l the l e c t u r e tickets in 1846 w e r e fifty-five d o l l a r s . T h e five-dollar dissection ticket w a s o p t i o n a l . M a t r i c u l a t i o n a n d g r a d u a t i o n tickets w e r e t h r e e a n d e i g h t e e n d o l l a r s , res p e c t i v e l y . T h e f a c u l t y e v i d e n t l y o f f e r e d office p r a c t i c e to g r o u p s of stud e n t s o u t s i d e of t h e t i m e of l e c t u r e courses. I n this c o u n t r y v i l l a g e b o a r d w a s a v a i l a b l e as l o w as o n e d o l l a r a n d a q u a r t e r w e e k l y d u r i n g the summ e r . A Catalogue p u b l i s h e d i n 1846 c a l c u l a t e d the total cost to a s t u d e n t w h o m i g h t c h o o s e to t a k e h i s l e c t u r e s a n d p r i v a t e i n s t r u c t i o n , a l l in W i l l o u g h b y , at $347, l i t t l e m o r e t h a n " a r e s i d e n c e f o r a single w i n t e r in o n e o f t h e l a r g e c i t i e s . " 77 I n s p i t e of m o d e r a t e e x p e n s e s a n d o t h e r a d v a n t a g e s c l a i m e d by t h e M e d i c a l D e p a r t m e n t o f W i l l o u g h b y U n i v e r s i t y , as it was l a b e l e d in t h e Catalogue of 1846, the D e p a r t m e n t w a s m o v e d to C o l u m b u s in 1847, a f t e r a r e o r g a n i z a t i o n of t h e trustees. T h i s m o v e was a u t h o r i z e d by a l e g i s l a t i v e act, o n J a n u a r y 14, 1847, w h i c h d e s i g n a t e d the n a m e of the i n s t i t u t i o n as " W i l l o u g h b y M e d i c a l C o l l e g e at C o l u m b u s . " O n l y three of the f a c u l t y of e i g h t t r a n s f e r r e d to C o l u m b u s , b u t most of the s t u d e n t s f o l l o w e d . STARLING

MEDICAL

COLLEGE

T h e 1 8 4 7 - 4 8 session of W i l l o u g h b y M e d i c a l C o l l e g e o p e n e d in C o l u m b u s i n i n a d e q u a t e q u a r t e r s a n d w i t h l i m i t e d e q u i p m e n t . B e f o r e the t e r m w a s o v e r M r . L y n e S t a r l i n g , a C o l u m b u s a t t o r n e y a n d o n e of the o r i g i n a l « Frederick C. Waite, An Historical Sketch of the Willoughby Medical College 18344J, loc. cit. From 1834 to 1848 twenty-nine professors and adjuncts served on the Willoughby medical staff. 75 Annual Catalogue and Circular of the Willoughby University: Medical Department, . . . (1846), p. 4. T h e faculty in this year was as follows: Amasa Trowbridge, president, surgery; Henry H. Childs, obstetrics and diseases of women and children; George McCook, principles of surgery; Robert H . Paddock, dean, secretary, and anatomy and physiology; John Butterfield, pathology and practice of medicine; T . Rush Spencer, materia medica and pharmacy; Abner H. Brown, chemistry and bacteriology; Isaac J. Allen, medical jurisprudence; J. Waldo Brown, demonstrator. 7 8 Waite, op. cit., p. sg. 77 Annual Catalogue . . . (1846), loc. cit.

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proprietors of the site of Columbus, offered to give $30,000, soon raised to $35,000, for the erection of a medical school and hospital building. Some years passed before completion (1855) of the building, which cost $55,000 in all. T h e professors and citizens paid the balance of $20,000. T h e structure was of brick and ornamental cut stone, having a length of 135 feet. Its outward appearance, according to a writer in 1858, was admired by the "lovers of modern art." 78 An entirely new charter was secured for the medical school, which, out of gratitude to the donor, was called Starling Medical College. T h e trustees of Willoughby Medical College in Columbus resigned in January 1848, and the graduates at the end of the 1847-48 session received diplomas of Starling Medical College. Therefore Willoughby Medical College in Columbus operated less than one term and had no graduates. Although the majority of trustees, faculty, and students connected with Willoughby went over to Starling, Starling Medical College was not the legal successor of Willoughby Medical College. This is, however, a distinction without much difference. 79 A faculty of seven was named on January 29, 1848, several of whom had been with the Willoughby College in the Western Reserve. 80 During the first year under this Faculty there was an attendance of 160, thirty-two of whom qualified for the M. D. degree. Honorary degrees were conferred on six at the same time. By 1858, approximately twelve hundred students had been in attendance at this institution. 81 In 1873 it was estimated that Starling Medical College had graduated about one thousand physicians. 82 Located as it was about midway between Cincinnati and Cleveland, Starling Medical College had a definite field of its own and made a specific contribution to the medical needs of central Ohio in particular and to the West in general. CLEVELAND

MEDICAL

COLLEGE;

WESTERN

RESERVE

MEDICAL

DEPARTMENT,

COLLEGE

Dr. J o h n Delamater, the leading member of the Willoughby Medical College faculty, moved from Willoughby to Cleveland in 1842. Perhaps this peripatetic professor at that time had in mind to organize a medical college in Cleveland, then a thriving little city of six to eight thousand inhabitants. Certainly it presented better opportunities than the village at Willoughby, nineteen miles distant, where he was yet a member of the College faculty. '8 William T . Martin, History of Franklin County: . . . , pp. 400-1. Waite, op. cit., pp. 6, 7. so T h e professors were: Henry H. Childs, John Butterfield, Richard L. Howard, Jesse P. Judkins, Samuel M. Smith, Fredderick Merrick, and Francis Carter. See Jacob Studer, Columbus Ohio, pp. 263-64. si Perhaps about 350 of this number graduated. Martin, op. cit., p. 400. 82 Studer, op. cit., p. 265. Scholastically, Starling Medical College appears to have followed the beaten paths of convention. Its fees, too, were perhaps comparable to its neighboring competitors.

33°

MEDICAL EDUCATION BEFORE THE CIVIL WAR

A n opportunity to sever his connection with Willoughby soon presented itself. Dr. Delamater and his colleague, J . P. Kirtland, could not bring themselves to approve of the standards of medical education which were advocated by a minority in the Faculty. T w o younger men, Horace A. Ackley and J o h n L . L a n g , joined with Delamater and Kirtland in resigning from Willoughby and organizing the Cleveland Medical College in 1843. 83 T h e new College was organized under the auspices of Western Reserve College, Hudson, Ohio, a village twenty-four miles from Cleveland. Within a few months the relationship between the medical faculty and the trustees was so adjusted that the Cleveland Medical College came to be the Medical Department of Western Reserve College. 84 Associated with these four insurgent professors from Willoughby were: Erastus Cushing, a former pupil of Delamater; Samuel St. John, a Yale graduate; J . J . Delamater, son of J o h n Delamater, and recent graduate of New York University; and N o a h Worcester, a graduate of both Harvard and Dartmouth, just returned from three years study in Paris. T h e brilliance of this group of men under the aggressive leadership of Delamater did much to insure the success of the Medical Department of Western Reserve College. 8 5 T h e first session in Cleveland opened in November 1843. T h e rates (1843-44) were reasonable, all lecture tickets being available for a sum of seventy-two dollars. T h e graduation fee was twenty dollars. Board and lodging at one-fifty to two dollars a week was comparable to country rates. 86 In the absence of a hospital, the faculty performed gratuitous surgical operations before the class to fulfill the demand for clinical instruction. A t best this plan was only a partial substitute for full hospital practice. " F u l l provision" was promised for the "prosecution of Practical Anatomy on the most liberal terms." Students were advised to provide themselves with medical lexicons and a text for each branch of medicine studied. Drs. Kirtland, Ackley, Cassels, and the two Delamaters offered a summer course from May first to September first. T h e fee was thirty dollars. 87 Sixty-six students attended the first session, 1843-44, a n d eighteen earned degrees. Matriculation increased steadily during the next decade. During the year 1849-50 there was an enrollment of 256. 83

Frederick C. Waite, op. cit., T h e trustees of Western Reserve College considered establishing a medical school at Hudson, the first location of the College, as early as 183435. Frederick C. Waite, "Significant Dates in the History of the School of Medicine, Western Reserve University," reprinted from The Clinical Bulletin of the University Hospitals of Cleveland, p. 2, January, 1938. 84 Waite, An Historical Sketch . . . , loc. cit. See also Harvey Cushing, Consecratio Medici and Other Papers, pp. 200-22. T h e Medical Department was at times called Hudson Medical College because of the location of Western Reserve College. 85 Ibid., p. 18. 86 Catalogue . . . Western Reserve College . . . Medical Department, (1843-44), PP· 8-9. T h e next year lecture tickets were reduced to fifty dollars and the graduation fee raised to twenty-five dollars. In May 1844, ground was broken at the southeast corner of St. Clair and Erie (East Ninth) Streets for the school building, a four and a half story "edifice" costing approximately $20,000. Waite, "Significant Dates . . . ," loc. cit. e? Catalogue . . . Western Reserve College . . . Medical Department, (1843-44), p. 9.

OHIO SCHOOLS

331

J o h n Delamater continued as dean and professor of physiology and diseases of women and children until his retirement in i860. Western Reserve College conferred on him the L . L . D. degree in honor of his scholarship and long years of service. Of the Medical Department in the decade of the fifties it is necessary to report that it was not all smooth sailing. T h e advent of Hahnemannism started a quarrel in the Cleveland profession which quickly spread to the faculty. Many years passed before the resulting breach was closed. Still another infirmity beset the school of Delamater's building. T h e r e was no hospital worthy of the name in Cleveland until the establishment of St. Vincent's Hospital about 1863, and its wards were used for teaching purposes, not by the Western Reserve Medical professors but by a rival school, Charity Hospital Medical College, established the same year. Somehow Delamater's school withstood the tempest of war and lived on. 88 es Cushing, op. cit., pp. 121 ff. For an explanation of Hahnemannism see Chapter 41.

CHAPTER

28

THE SCHOOLS OF INDIANA LAPORTE UNIVERSITY MEDICAL

DEPARTMENT

A s EARLY as 1816 the settlers in Indiana were sufficiently conscious of the place of medicine in frontier society to influence the legislature to pass an act regulating the practice of physic and surgery. T h i s act provided for a district medical society in each of Indiana's congressional districts. Each society was to appoint a board of censors to examine and license candidates w h o wished to practise medicine in the state. T h e next year a district society was formed at Vincennes, the first in the state. In 1820 delegates from the districts formed the State Medical Society. 1 T w e n t y years passed after the f o r m i n g of the State Society before any medical preceptors ventured to establish a medical college in Indiana. D u r i n g this time the d e m a n d for physicians was b e i n g supplied by the schools of Kentucky, O h i o , and the A t l a n t i c states, especially from western New York. O n e such practitioner, Daniel Meeker, a N e w Y o r k e r by birth, had taken his first course of lectures in the school at Fairfield, N e w York. H e then t r e k k e d westward to W i l l o u g h b y , O h i o , on L a k e Erie, where he attended a second term and graduated. Still adventurous, Meeker continued westw a r d and settled in LaPorte, Indiana, in 1835. Six years later in this little village, w h i c h had g r o w n to one thousand or fifteen h u n d r e d inhabitants, D r . Meeker began g i v i n g private instruction in medicine. Associated w i t h h i m was an attorney, W i l l i a m P. Andrews, w h o also h a d office pupils. In true western fashion these two gentlemen soon conceived of themselves as the future heads of university departments. T h e road to realization was short. T h e y were j o i n e d by others and secured, in 1841, a charter for LaPorte University. T h e L a w D e p a r t m e n t was opened promptly, but the M e d i c a l Department did not open until 1842. A preliminary course was g i v e n to nine students in the spring of 1842. T h e first regular course opened to thirty pupils in the fall of the same year. T h e r e was one graduate in the s p r i n g of 1843. 2 T h e first medical faculty in L a P o r t e University was composed of Meeker, professor of anatomy and surgery, a n d four local physicians, two of w h o m p r o b a b l y had no medical degrees. 3 T h e faculty was reorganized in 1844-45, 1 G. W . H. Kemper, A Medical History of the State of Indiana, pp. 48-49. 2 Ibid., p. 52. » Meeker's first colleagues were: Franklin H u n t , materia medica and botany; Jacob P. A n d r e w , obstetrics and diseases of women and children; Gustavus C. Rose, theory and practice of medicine; and John B. Niles, chemistry. George H. Weaver, Beginnings of Medical Education in and Near Chicago, p. 9.

332

INDIANA

SCHOOLS

333

several out-of-town men being added and several local men being dropped. George W. Richards, St. Charles, Illinois; Moses L. Knapp, Chicago; Nichols Hard, Aurora, Illinois; Daniel E. Brown, Schoolcraft, Michigan; and J o h n L. Torrey, Elgin, Illinois, were added to the faculty in the following chairs: anatomy, materia medica, obstetrics and related subjects, theory and practice of medicine, and demonstration of anatomy. Daniel Meeker retained surgery, and John Niles continued in the chair of chemistry. Except for the withdrawal of Brown and the addition of A. B. Shipman of Cortlandville, New York, there were no changes in personnel until 1847. 4 With the exception of Nichols Hard all of the Illinois professors withdrew at the end of 1847. From 1847 t 0 remnant of the faculty continued to serve with the aid of occasional additions. 6 T h e attendance on medical lectures at the Medical Department of LaPorte University reached its peak in 1847-48, when 101 students were enrolled. During the next two years the enrollment was ninety-three and sixty-five. Lecture tickets were priced at ten dollars, optional dissection tickets were five (later ten) dollars, and one ticket was required in 1848-49 for graduation. Matriculation and graduation fees were five and ten dollars. 8 For a time it seemed that this medical school in the Indiana wilderness would prosper and become permanent. T h e Circular for 1844-45 m a d e an announcement designed to appeal to young men: A F e m a l e S e m i n a r y is a b o u t b e i n g o r g a n i z e d a n d t h e t o w n of L a p o r t e p r o m i s e s to b e c o m e t h e A t h e n s , as it is n o w the E d e n , of t h e N o r t h w e s t . 7

T h e Catalogue of 1846-47 announced the construction of a new college building, large enough to accommodatc three hundred students and with all the necessary facilities to make it "one of the best arranged and most convenient College buildings in the Western Country." 8 Its courses were sixteen weeks in length. About this time a charter amendment was secured, changing the name of the school to Indiana Medical College. 9 One of Daniel Meeker's principal difficulties from the first was in securing satisfactory teachers. LaPorte was too much of a village to support an entire teaching staff in private practice. As a result, Dr. Meeker reached out into the near-by states and secured men to man his faculty. 10 By 1850 another element figured strongly in the situation. Schools in fast-growing cities such as St. Louis, Louisville, Cincinnati, Cleveland, and Chicago * Ibid., pp. 9 - 1 0 . Shipman took surgery; Richards assumed theory and practice; and Meeker transferred to anatomy and physiology. s T h e additions were: E. Demming, LaFayette, Indiana, materia medica (1847-48); T . Higday, LaPorte, physiology and pathology (1847-48); J. Adams Allen, Kalamazoo, Michigan, materia medica and medical jurisprudence; and George W . Lee, Whitewater, Wisconsin, demonstrator (1848-49). β Annual Circular and Catalogue of the Officers and Students of the LaPorte University, Session 1844-45, P· 3· Ibid., 1848-49, pp. 1-2. 7 Annual Circular and Catalogue . . . 1844-45> P· 3· β Annual Catalogue of Indiana Medical College, 1848-49. 8 Kemper, op. cit., p. 55. 10 Meeker leaned heavily on Drs. Richards, K n a p p , Hard, Torrey, and Shipman.

334

MEDICAL EDUCATION BEFORE THE CIVIL WAR

were able to offer students a m u c h better program in practical anatomy a n d bedside study. T h e faculty recognized its p r o b l e m and closed the school at the end of the 1849-50 term. T h e tendency to pull away from L a P o r t e was noticed in February 1847, w h e n the spring course of Indiana Medical C o l l e g e was a n n o u n c e d to be h e l d in St. Charles, Illinois, under the direction of G . W . Richards. T h i s session was u n d o u b t e d l y a part of the program of Dr. Richards' personal project called Franklin Medical College, w h i c h was carried o n in St. Charles, 1842-49. Doctor Elizur D e m m i n g is said to have been responsible for offering the College's last spring term in LaFayette in an unsuccessful effort to interest the town in b i d d i n g for the College to move there. 1 1 L i k e several other country schools of the West, L a P o r t e M e d i c a l College sprang u p to meet certain demands. It played its part well and disappeared quite as rapidly as it rose. A l t h o u g h L a P o r t e was n o " A t h e n s " of the Northwest, as suggested by the trustees, the medical school located there probably m a i n t a i n e d the c o m m o n scholastic standards. Its graduates were certainly superior to many of the quacks and poorly trained practitioners w h o swarmed throughout the West. D u r i n g its eight years of operation the C o l l e g e gave instruction to 565 students, of w h o m 127 graduated. M a n y of these men became p r o m i n e n t practitioners in the West. W i l l i a m W . Mayo, father of the famous brother surgeons of Rochester, graduated in 1850 a n d later settled in Minnesota. T h r e e of them held professorships: W e l l s R . Marsh, chemistry at K e o k u k , I o w a ; S. S. T o d d , theory and practice, Kansas City Medical College; a n d T . Higday, physiology, general pathology, and anatomy, I n d i a n a M e d i c a l College. 1 2 INDIANA

CENTRAL

MEDICAL

COLLEGE

A medical school called Indiana Central Medical College was established in Indianapolis in 1849, under the auspices of the charter of Asbury University (Methodist) at Greencastle, Indiana. T h e first faculty was made u p of J o h n S. Bobbs, anatomy; A . H . Baker, surgery; L . D u n l a p , theory a n d practice; Charles G . D o w n e y , chemistry; a n d James Harrison, materia medica and therapeutics. A p p a r e n t l y not even Indianapolis c o u l d make u p one respectable teaching staff, since t w o of these professors, Baker a n d D o w n e y , were from C i n c i n n a t i a n d Greencastle. A f t e r the first session two more out-of-town professors were added to the staff. T h e school at L a P o r t e h a d just closed, leaving several teachers witho u t professorships. T h e Central Medical C o l l e g e offered a new chair of institutes of medicine a n d general pathology to Elizur D e m m i n g and anato m y to Daniel Meeker. B a k e r h a d just resigned surgery and Bobbs h a d transferred to that chair. 1 3 In its Announcement for 1850-51 the faculty 11 According to Helen Clapesattle in The Doctors Mayo, p. 30, Drs. Elizur Demming, William W. Mayo, and William H. Byford attempted to reopen the school in 1852. Destruction of the building and equipment by fire during the first term disheartened the promoters, who abandoned the enterprise. 1 2 Weaver, op. cit., p. 9; Kemper, op. cit., pp. 54-55. 1 3 Kemper, op. cit., pp. 69-70.

INDIANA

SCHOOLS

335

expressed its "aim to give a thorough, efficient, and practical course of instruction, to embrace every subject usually taught in well conducted Medical Colleges.'' T h i s statement can be accepted at face value, but a succeeding remark is open to doubt: M a t e r i a l for the prosecution of A n a t o m i c a l investigation will be p r o v i d e d liberally a n d cheaply f r o m the o p e n i n g to the close of the session . . .

In this same Circular students were reminded that the Indiana Constitutional Convention and Legislature would be in session the following winter, which would give students the opportunity of meeting gentlemen from all parts of the state with the idea of discovering openings for commencing practice. 1 1 T h e fees for all professors (seven) dropped from seventy to fifty-six dollars in 1851. Matriculation and graduation fees were five and twenty dollars, respectively. T h e dissection ticket was five dollars, one being required for graduation. Other graduation requirements were as usual, and the term was four months. Board, including lights and fuel, was available at two dollars weekly. 16 In 1851-52 the trustees of Asbury University, the patron institution of Central Medical College, attempted to impose some scheme of reorganization on the Medical school in Indianapolis. T h e details of the plan are not known, but the attempt destroyed Central Medical College, after only three years of operation. John Shaw Billings, in an effort to secure information on the history of Indiana's first two medical schools, wrote L . D. Waterman of Indianapolis in 1876 and James F. Hibberd of Richmond, Indiana, in 1882. W a t e r m a n replied that he was unable to secure copies of the Catalogue or Prospectus of Central Medical College but did have access to the Secretary's Book. From this source he gave the number of graduates for the three years, 1849-50, 1850-51, and 1851-52, as nine, eighteen, and twelve, not including honorary or ad eundem degrees. Doctor Hibberd replied that he was personally unable to give Billings any information. He added that he had inquired of a Dr. Israel Terris, who "was practising in the County from 1840 to i860 . . . but he never heard of either college." 10 N o other attempts were made to found a medical school in Indiana until 1869. Indianapolis in 1850 was a small town without hospital facilities and unable to lift Central Medical College out of the country school class. Its university connection no doubt hastened its demise, but it was in line for extinction almost before it started, because of changing circumstances in the West. 1 * Annual Announcement of the Indiana Central Medical College for tl>e Session of 1850-51 and Catalogue for 1849-50, p. 3. it Annual Announcement . . . 1851-52, and Catalogue . . . 1850-51, p. 3. Plans for the erection of a college building were announced in the Announcement for 1851-52. T h i s building was probably never erected. 1 6 L. D. Waterman to J. S. Billings, Indianapolis, Indiana, May 1, 1876; James F. Hibberd to J. S. Billings, Richmond, Indiana, August 5, 1882, Ms. T h e author of this study found both of these manuscripts folded in a school bulletin in the pamphlet section of the Army Medical Library.

336

MEDICAL EDUCATION BEFORE THE CIVIL WAR MEDICAL COLLEGE OF

EVANSVILLE

T h e Medical College of Evansville was apparently founded in 1849, inasmuch as its first public commencement was held on February 23, 1850, at which time six candidates received the doctor's degree in medicine. Thirty-nine students were enrolled during the 1849-50 term. 17 The Annual Announcement for the session of 1850-51 proudly declared "to the public and especially to the Medical profession, that the success of this Institution, no longer remains an untried experiment." A faculty of eight was listed, including a janitor, Eugene Gallagher. The Announcement proudly reported that several members of its first graduating class, who had taken their first year in leading schools of the country, assured the faculty that the school's facilities were "fully equal, and in some respects superior to those they had formerly enjoyed." T h e geographical location of Evansville, in close proximity to anatomical material from the South, friendliness of Evansville's citizenry, and an "indefatigable Faculty" were cited as advantages of the College. 18 Fees were reasonable: matriculation, five dollars; each professor's ticket, ten dollars; dissecting (required of candidates for the degree), five dollars; and graduation, twenty dollars. "Good boarding and fuel was available at one and a half to two dollars weekly." Graduates, students who had attended two sessions, and ministers of the Gospel were admitted gratis to lectures. T h e conventional graduation requirements prevailed. 19 No mention was made in the 1850-51 Announcement of clinic or hospital tickets. Presumably there were no such facilities. The Third Annual Announcement, 1851-52, admitted the lack of clinical facilities, but announced that the United States Government Marine Hospital, soon to be erected in Evansville, would give the College advantages unsurpassed in the West.20 For reasons unknown to the author the Medical College of Evansville ceased to exist after operating four or five years. It is very likely that the proximity of Louisville and St. Louis with their successful schools made impracticable the maintenance of a medical school in Evansville, a town of only about five thousand population. 21 17

Annual Announcement, Medical College of Evansville, 1850-51, pp. 13, 14. is Ibid., pp. 4-6. The faculty were: Charles S. Weever, surgical anatomy and physiology; C. A. Foster, A.M., chemistry; John R . Wilcox, materia medica; Madison J . Bray, principles and practice of surgery; Levi L. Laycock, dean, theory and practice of medicine; George B. Walker, obstetrics and diseases of women and children; Mark Trafton, demonstrator of anatomy, ι» Ibid., p. il. 20 Annual Announcement . . . , /S5/-52, p. 5. The Medical College of Evansville was reopened in 1871.

C H A P T E R

2 9

T H E SCHOOLS OF ILLINOIS FRANKLIN

MEDICAL

COLLEGE

w h o taught for a time in the Medical Department of L a P o r t e University, was an 1828 graduate of the famous school in Fairfield, western New York. For a few years he practised in Onondaga County, N e w York. When he went West is not certain, but it is known that he was in St. Charles, forty miles west of Chicago, for a time in 1839. 1 He located permanently there in 1 8 4 1 . Nichols Hard, an 1841 graduate of Ohio Medical College, came to the same town the next year. Both of these men engaged in the preceptorial training of physicians. 2 In 1842 Richards organized in St. Charles what was known as the Franklin Medical College. Nichols H a r d soon joined Richards in this project. In a letter which H a r d wrote from St. Charles, on November 5, 1842, he commented favorably on the prospects for the school and added: " W e shall have to get a charter f r o m the Legislature this winter and can not be appointed Professors until we get a charter." Hard also expressed his belief that the school would eventually be located in Chicago "which is a pleasant city and offers every advantage of Society." 3 Weaver was unable to determine if the Franklin Medical College ever received a charter. W h i l e searching for evidence he discovered that in 1843 a charter was issued to the " L i t e r a r y and Medical College of the State of Illinois, to be located in the town of St. Charles." 4 He also discovered that a charter was granted in 1845 t o " F r a n k l i n Literary and Medical College of Illinois, to be located in the city of G a l e n a . " 5 T h e trustees of these two chartered schools were different. Neither corresponded to the trustees for Franklin Medical College. T h e two schools which were chartered seem to have left no history. B o t h of them may have been abortive efforts to block the development of R i c h a r d s ' school in St. Charles. A t any rate the Franklin Medical College did have a brief history." GEORGE W . RICHARDS,

1 W. G. Todd, a student at the first session of Rush Medical College, 1843-44, s a ' d that Richards came to St. Charles in 183g, with a cadaver for teaching purposes. Presumably he remained long enough to deliver a few lectures, which were attended by Todd and others. Bulletin of the Alumni Association of Rush Medical College, VII, 3: 1, cited by Weaver, Beginnings of Medical Education in and near Chicago, p. 79. 2 Ibid., pp. 13, 63, 79. 3 Weaver, op. cit., p. 13. Weaver's information came from a letter from Mrs. H. G. Wright, daughter of Doctor Nichols Hard. * Laws of Illinois, 1843, p. 69, cited by Weaver, op. cit., p. 14. 5 Laws of Illinois, 1845, p. 218, cited by Weaver, loc. cit. β Some of the men connected with the Galena school later tried to secure a charter for a school at Rock Island, and failing, had to operate it under the charter of a Wisconsin school.

337

338

MEDICAL EDUCATION BEFORE T H E CIVIL W A R

T h e first faculty in the St. Charles school was: George W. Richards, dean, anatomy and physiology; J o h n Thomas, chemistry and pharmacy, and president of the College; J o h n Delamater, surgery; Edward Mead, materia medica, therapeutics, and pathologic anatomy; Nichols Hard, obstetrics and diseases of women and children; and Samuel Denton, theory and practice of medicine. 7 Richards and Hard continued with the school until its extinction in 1849, but it is uncertain how long the others remained. 8 T h e r e are no extant circulars of Franklin Medical College, and no record of the number of matriculants or graduates. Possibly no degrees were granted. Several men on the faculty later distinguished themselves in other schools. T h e school was not strictly proprietary, because none of the professors were on the Board of Trustees. T h e classes were conducted in quarters above a store and in the offices of the professors. T h e unfortunate incident that closed the College in 1849 hastened the eclipse that was inevitable because of the increasing number of successful city schools. It seems that a recent grave in the neighboring town of Sycamore had been robbed. When the loss was discovered the St. Charles students were blamed. A mob gathered, on April 19, 1849, at the door of Richards' office and demanded the body. T h e family fled over a wall at the rear of the house, but Richards and a student, J o h n Rood, credited with having secured the body, stayed by. T h e professor was not able to convince the crowd that the body was not in the house. When they rushed the door he closed and locked it and braced himself against it. Several shots were fired. One passed through Richards' shoulder, leaving his right arm paralyzed as long as he lived. T h e student was mortally wounded and died soon after. Franklin Medical College never reopened. 9 MEDICAL

DEPARTMENT

OF

ILLINOIS

COLLEGE

Physicians first settled in Morgan County, Illinois, about 1820. Illinois College was organized in Jacksonville in 1829. I n l he language of the time it was commonly known as the "siminery." 1 0 A f t e r another decade the local medical profession began to lay plans for the establishment of a medical department in the collegiate institution. Jacksonville then had a population of about twenty-five hundred. Plans were completed and the first course began on November 1, 1843. A building called "Medical H a l l " was constructed in 1844. It was a very modest two-story frame structure with laboratory, clinic, and dissecting rooms on the first floor, and lecture and faculty rooms on the second floor. T h e chapel of the College was also used for medical lectures. 1 1 7 Western Lancet, 2: 95, June, 1843, cited by Weaver, op. cit., p. 13. 8 T h e Catalogue of the Medical Department of LaPorte University for 1846-47 listed Richards and Hard as preceptors to seventeen of its students. It is probable that much of the lecture work in St. Charles was before or after the LaPorte lectures during the time Richards and Hard served both places. » Weaver, op. cit., pp. 1 4 - 1 5 . 10 C. M. Earaes, Historic Morgan and Classic Jacksonville, pp. 56, 57. 11 Weaver, op. cit., pp. 1 6 - 1 7 .

ILLINOIS

SCHOOLS

339

T h e first f a c u l t y h a d o n l y f o u r m e m b e r s . D a v i d P r i n c e , a n 1839 g r a d u a t e of the M e d i c a l C o l l e g e of O h i o , a n d a p o p u l a r s u r g e o n , w a s the p r o f e s s o r o f a n a t o m y u n t i l 1845 a n d surgery u n t i l 1848. A n 1836 m e d i c a l g r a d u a t e of B o w d o i n C o l l e g e , S a m u e l A d a m s , t a u g h t in the arts a n d sciences of the C o l l e g e as w e l l as o c c u p y i n g the c h a i r of c h e m i s t r y in the M e d i c a l D e p a r t m e n t , 1843-45. A N e w Y o r k e r , s c h o o l e d in m e d i c i n e at the B e r k s h i r e M e d i c a l I n s t i t u t i o n , c a m e W e s t in 1831 a n d t a u g h t obstetrics in I l l i n o i s C o l l e g e , 1843-48. T h e f o u r t h m e m b e r , D a n i e l Stahl, t r a i n e d in E u r o p e a n d g i v e n a d e g r e e b y W e s t e r n R e s e r v e C o l l e g e in O h i o , was professor of t h e o r y a n d p r a c t i c e of m e d i c i n e . H e w i t h d r e w f r o m the C o l l e g e a f t e r the first year. J o h n J a m e s t o o k his p l a c e . E d w a r d M e a d s u c c e e d e d A d a m s in m a t e r i a m e d i c a , 1845-46, a n d H e n r y W i n g f o l l o w e d in 1847-48. 1 2 D u r i n g the five years of the D e p a r t m e n t ' s e x i s t e n c e (1843-44 to 1847-48) m o r e than o n e h u n d r e d s t u d e n t s r e c e i v e d i n s t r u c t i o n . Six r e c e i v e d the deg r e e at the e n d of the first term, a n d thirty-seven t h e r e a f t e r . 1 3 It is p r o b a b l e that the d i d a c t i c w o r k of the C o l l e g e was w e l l d o n e . A k n o w l e d g e o f L a t i n was listed as a r e q u i r e m e n t the first year. T h e school's w e a k n e s s w a s v e r y o b v i o u s l y the lack of a n a t o m i c a l a n d c l i n i c a l facilities. It was the " a n a t o m i c a l q u e s t i o n " m o r e t h a n any o t h e r f e a t u r e of the s c h o o l that c a u s e d its d o w n f a l l . L i k e o t h e r c o u n t r y schools, I l l i n i o s C o l l e g e had difficulty in m a i n t a i n i n g a n a d e q u a t e s u p p l y of subjects. D r . P r i n c e w o u l d not teach a n a t o m y w i t h o u t o f f e r i n g p r a c t i c a l o p p o r t u n i t i e s t o h i s pupils. N o d o u b t there w e r e n o c t u r n a l e x c u r s i o n s u n d e r the k n o w l e d g e if n o t the d i r e c t i o n of the a n a t o m y professor. A t least P r i n c e w a s b l a m e d f o r c e r t a i n u n e x p l a i n e d i n c i d e n t s . A f t e r o n e i n c i d e n t a n irate m o b s u r r o u n d e d the m e d i c a l b u i l d i n g a n d a c c u s e d the P r o f e s s o r a n d his p u p i l s o f e x h u m i n g the b o d y of the late G o v e r n o r J o s e p h D u n c a n . D r . A d a m s ass u a g e d the w r a t h of the f a m i l y a n d p u b l i c a n d thus a v e r t e d a c a t a s t r o p h e . S u c h h a p p e n i n g s h a s t e n e d the close of the M e d i c a l D e p a r t m e n t in 1848. J a c k s o n v i l l e , a s t r o n g l y r e l i g i o u s c o m m u n i t y , p r o b a b l y f o u n d g r e a t diffic u l t y in j u s t i f y i n g dissection as a necessary t o o l of m e d i c a l l e a r n i n g . T h e h a n d i c i p u n d e r w h i c h c o u n t r y schools w o r k e d w a s u s u a l l y g r e a t e r t h a n t h e y could b e a r . RUSH M E D I C A L

COLLEGE

T h e m e d i c a l history of C h i c a g o b e g a n i n 1820, w h e n the site of the city w a s still k n o w n as F o r t D e a r b o r n . T h e g o v e r n m e n t I n d i a n a g e n t , A l e x a n d e r W o l c o t t , w h o a r r i v e d that year, w a s a p h y s i c i a n . I n a d d i t i o n t o his o f f i c i a l duties D r . W o l c o t t p r a c t i s e d a m o n g the f e w residents of the settlem e n t . T h e first r e g u l a r p r a c t i s i n g p h y s i c i a n at the F o r t was E l i j a h D e w e y H a r m o n , a N e w E n g l a n d e r , a p p r e n t i c e - t r a i n e d in V e r m o n t . H e a r r i v e d i n 1829, j i s t a year b e f o r e the I n d i a n a g e n t d i e d . M e a n w h i l e t h e v i l l a g e w a s s h o w i n g signs of d e v e l o p m e n t . B y 1835 it h a d o n e t h o u s a n d settlers, a m o n g w h o i n vere several r e s p e c t a b l e p h y s i c i a n s . 1 4 12 Tbic., p. 17. 13 Loc cit. " Fraicis Packard, History of Medicine in the United States, 2: 850-52.

340

MEDICAL EDUCATION

BEFORE T H E

CIVIL

WAR

Chief among them was Daniel Brainard, a New Yorker who had studied medicine at Fairfield but had gone to Jefferson in Philadelphia to get his degree in 1834. T w o years later he settled in Chicago, which was to be the principal arena of his future medical career. T h e idea of establishing a medical school in Chicago must have occurred to Brainard as soon as he sized up the fast-growing town and contemplated its future possibilities. Nineteen years later, while in a reminiscent mood, Brainard declared that the idea of establishing a medical college in Chicago dated back to 1836. In the fall of that year he and J . C. Goodhue drafted articles of incorporation which were presented to the legislature in Vandalia during the following winter. A charter was granted on March 2, 1837. A plan to organize Rush Medical College was practically ready for execution when the blighting depression of 1837 halted both public and private enterprises. Friends of the project who had funds with which to endow the institution suddenly found themselves stripped of all liquid capital. Therefore the plan was dropped and no action was instituted under authority of the charter until the summer of 1843. 1 5 T h e act of incorporation named seventeen of Chicago's most active and able citizens. Eight were lawyers, four of whom became judges, and one governor of Illinois. Of the remaining nine, three were physicians, two clergymen, and four business men. T h e group presented a splendid array of culture and business acumen. Few medical colleges of the day, without university ties, had governing bodies equal to that group of public-spirited leaders. T h e chief motive in securing a charter seems to have been a desire to train adequate physicians for Chicago and the West. 16 T h e reason for the name of the College has been questioned. T h e only answer is one suggested by the widow of A. W. Davisson, demonstrator in the first Rush faculty. In a private letter she said that it was decided to name the institution after the celebrated physician, Benjamin Rush, then deceased, with the hope that his heirs might "handsomely" remember it. T h e net result of this bit of strategy was merely a letter of thanks. It seems that Brainard himself was not enthusiastic over the name. In several contributions to French journals Brainard advertised himself as a professor in the "collège médical de L'Illinois, à Chicago," (1854); and "Collège medicale de Chicago (Illinois)" (1853). In his introductory address of 1855, he spoke of " T h e Medical College of Chicago." T h e name Rush, however, clung to the institution until its end. 17 Brainard made good use of the time, 1839-41, by pursuing post-graduate studies in Paris, bearing in mind the task ahead of him of establishing Rush Medical College. After his return to the United States he was appointed, in May 1842, to the chair of anatomy in St. Louis University. He delivered two courses of lectures in St. Louis, but gave much thought to his chosen project in Chicago. 15 North-Western p. 19.

Medical and Surgical Journal, 12: 537, 1855, cited by Weaver, op. cit.,

ie Weaver, op. cit., p. 20. T h e three physicians were: Josiah C. Goodhue, Edmund S. Kimberly, and John T . Temple. 17 Ibid., pp. 19-20.

ILLINOIS SCHOOLS

34»

T h e issuing of circulars by the country medical schools of I n d i a n a a n d I l l i n o i s d u r i n g the s u m m e r of 1843 stirred Professor B r a i n a r d to action. T o J o h n M c L e a n he wrote, o n October 1 0 , 1843: I think it urgent there should be a commencement made this season. By commencing at present a number of students might be prevented from going from this region to other places and thus give .advantages to other schools. 18 T h e f a c u l t y h a d already been named. A s a result of B r a i n a r d ' s enthusiasm, lectures were started on D e c e m b e r 4, less than two months a f t e r he wrote to D r . M c L e a n , the professor of medicine. B r a i n a r d was assigned to a n a t o m y a n d surgery. J a m e s V. Z. B l a n e y , a P e n n s y l v a n i a graduate (1842) met B r a i n a r d in St. L o u i s w h e r e he was attached to J e f f e r s o n barracks. H e assumed the c h a i r of chemistry a n d materia medica. Moses L . K n a p p , a J e f f e r s o n g r a d u a t e , h a d been in successful practice in several places since 1 8 3 1 . H e accepted the chair of obstetrics. A . W . Davisson was demonstrator. 1 9 D u r i n g the i n t e r i m between the first a n d second terms, the faculty h a d time to take stock a n d effect i m p r o v e m e n t s which were m u c h needed. T h e first lectures w e r e g i v e n in the " s a l o o n " b u i l d i n g at C l a r k a n d L a k e Streets. Plans f o r a new b u i l d i n g b e g a n materially when three gentlemen interested in N o r t h Side real estate gave the trustees sufficient l a n d on N o r t h D e a r b o r n a n d a purse of $ 5 0 0 toward the b u i l d i n g . Friends a n d faculty subscribed l i b e r a l l y t o w a r d the new b u i l d i n g , which cost only about $3,500. T h e second term was conducted u n d e r pleasanter circumstances. 2 0 I n 1850, R u s h M e d i c a l C o l l e g e f o u n d itself in a very satisfactory situation. T h e c o u n t r y schools of I n d i a n a a n d Illinois were either dead or dying. C h i c a g o h a d a p o p u l a t i o n of 28,269. B r a i n a r d ' s school was in a position to secure a r e a s o n a b l e a m o u n t of anatomical material, a n d the prospects f o r hospital instruction were cheering, since the Illinois G e n e r a l H o s p i t a l of the L a k e s was o p e n e d that year. U p to that time the Cdllege h a d o p e r a t e d seven years, g i v i n g instruction to 532 a n d the doctorate to 1 3 2 . 2 1 N . S. Davis, w h o j o i n e d the f a c u l t y in 184g was already a national figure. H e h a d led o u t in the c a l l i n g of the N a t i o n a l M e d i c a l Association in 1846, w h i c h in 1847 became the A m e r i c a n M e d i c a l Association. T h e p r i n c i p a l b u r d e n of the Association f r o m the first was to r e f o r m medical education. A n d N . S. D a v i s h a d very specific ideas of w h a t reforms were necessary. H e took a d v a n t a g e of his first introductory address at R u s h to analyze the A m e r i c a n system of m e d i c a l education. F o u r faults he pointed out as c o n t r i b u t i n g to the u n c e r t a i n t y of medical science; first, the A m e r i c a n 18

Ibid., p. 20. Ibid., pp. 2 1 , 48, 55, 7 1 , 74. B e f o r e the second course, 1844-45, Moses L . K n a p p was dropped. G r a h a m N. Fitch, Logansport, Indiana; Austin Flint, B u f f a l o , New York; and William B . Herrick were appointed to obstetrics and diseases of women and children, medicine, and anatomy. T h e next year, J o h n Evans of Attica, Indiana, joined, and in 1849 T h o m a s Spencer and N . S. Davis added luster to the teaching statf. 20 Ibid., p p . 2 1 - 2 2 . " Ibid., p. 83. 19

342

MEDICAL E D U C A T I O N B E F O R E T H E CIVIL W A R

trait exhibited by an urge to rush everything in a hurry; second, the almost universal neglect of proper preliminary education; third, the defective organization of most of the numerous medical schools; and fourth, the inordinate expense of a medical education. 2 2 T h e new R u s h professor dilated at length on the evils of the fourthmentioned fault. He advocated the establishment of free medical schools, operated at state expense. T o show its faith in the theory advanced by Davis, the faculty had previously conceded him the privilege of announcing that three of the professors' tickets for the term then beginning would be offered free. T h a t left the tuition for the year at forty dollars, little more than half what it previously was. Matriculation and graduation fees were five and twenty dollars, respectively. T o encourage f u r t h e r attendance, approved notes were to be accepted in payment of tickets, and a cash discount of ten per cent was offered students w h o could pay for tickets in advance. 2 3 Such a policy was projected under the sanctity of reform, but other western schools, especially the small country institutions, could see in this move little more than a clever scheme to eliminate competition. Davis openly stated that the existing system compelled many to resort "to those country schools, where lecture fees and board are cheapest, yet facilities for imparting practical instruction are ever so limited." 24 His interest was unquestionably in the profession at large, but he hewed to the line and let the chips fall where they would. A t the time of the change in fees, another innovation, sponsored probably by Brainard, was instituted. T h e College announced that a demonstrator in anatomy would be selected on a merit basis. Each applicant was required to demonstrate his skill before the faculty and present personal recommendations. Weaver felt that this was the first instance of the use of such a system of choosing a medical teacher in the United States. 25 Irr spite of some difficulties, it was comparatively easy for the R u s h trustees to build up a good staff of teachers in a progressive and rapidly growing city. J o s e p h W a r r e n Freer, a R u s h alumnus of 1848, became professor of anatomy in 1855. He was an able operator and excelled in anatomy and microscopy. W h e n the faculty was reorganized in 1859, Freer transferred to the chair of physiology and microscopic anatomy. 2 0 A graduate of the Medical College of Ohio (1845), William Heath Byford, accepted the chair of obstetrics and diseases of women in 1857. H e became one of the country's leading gynecologists and an ardent advocate of medical education for women. 2 7 N . S. Davis, with all of his individualism and schemes for reform, could 22

N. S. Davis, Address on Free Medical Schools, Introductory to the Session of 184^50, Rush Medical College, pp. 4-7. 23 Ibid., pp. 9-12, and the back cover of the pamphlet. Ibid., p. 9. 25 Weaver, op. cit., p. 24. 26 Davina Waterson, "Joseph Warren Freer," Kelly and Burrage, Dictionary of American Medical Biography, p. 435. 2 "· Kelly and Burrage, op. cit., pp. 185-86.

ILLINOIS SCHOOLS

343

n o t l o n g t o l e r a t e his s e c o n d a r y p o s i t i o n in t h e R u s h f a c u l t y . F o r some t i m e h e insisted t h a t e s t a b l i s h i n g a g r a d e d c o u r s e of i n s t r u c t i o n w a s the o n l y w a y to e l e v a t e m e d i c a l t r a i n i n g to its p r o p e r l e v e l . B r a i n a r d c o n t e n d e d t h a t such a r e v o l u t i o n a r y m o v e w a s u n n e c e s s a r y . F r i c t i o n o v e r this cont e n t i o n b r o u g h t t h e f a c u l t y to a crisis in 1859. Drs. D a v i s a n d B y f o r d , foll o w e d by s e v e r a l o t h e r s , r e s i g n e d a n d i m m e d i a t e l y p r o c e e d e d to e s t a b l i s h a n o t h e r s c h o o l — t h e t y p i c a l A m e r i c a n p l a n of s e t t l i n g strife b e t w e e n m e d i c a l professors. R e p l a c e m e n t s o n the f a c u l t y of R u s h w e r e m a d e b y the a p p o i n t m e n t of the f o l l o w i n g : J o n a t h a n A d a m s A l l e n , U n i v e r s i t y of M i c h i g a n p r o f e s s o r of p h y s i o l o g y a n d p a t h o l o g y , to the c h a i r o f m e d i c i n e . D e L a s k i e M i l l e r t o o k obstetrics a n d diseases of w o m e n , v a c a t e d b y B y f o r d . R o b e r t L . R e a a n d E p h r a i m I n g a l s s u c c e e d e d to a n a t o m y a n d m a t e r i a m e d i c a a n d jurisprudence.28 T h e I l l i n o i s G e n e r a l H o s p i t a l of the L a k e s , e s t a b l i s h e d in 1850, l a r g e l y as a result of D a v i s ' e n t h u s i a s m f o r c l i n i c a l t e a c h i n g , w a s d u r i n g the foll o w i n g year p u t i n t o the h a n d s of the Sisters of M e r c y , w h o o b t a i n e d a c h a r t e r d e s i g n a t i n g the i n s t i t u t i o n by the n a m e of M e r c y H o s p i t a l . W h e n D a v i s arid his c o l l e a g u e s seceded they m a n a g e d t o t a k e w i t h t h e m c o n t r o l of t h e a t t e n d i n g staff b y o f f e r i n g free m e d i c a l a t t e n d a n c e in e x c h a n g e f o r t h e p r i v i l e g e of g i v i n g c l i n i c a l i n s t r u c t i o n . T h i s loss l e f t R u s h w i t h l i t t l e m o r e than its free dispensary, w h i c h h a d b e e n o p e n e d o n D e c e m b e r 24, 1846, t o p r o v i d e o p p o r t u n i t i e s f o r c l i n i c a l i n s t r u c t i o n . 2 9 I n 1846 t h e c a b i n e t s of m o r b i d a n d g e n e r a l a n a t o m y , m a t e r i a m e d i c a , a n d m i n e r a l o g y w e r e m a t e r i a l l y a d d e d to, a n d a l i b r a r y of six h u n d r e d v o l u m e s w a s p r o v i d e d f o r the s t u d e n t s ' use. A b o u t 1855 the C o l l e g e b u i l d i n g was r e m o d e l e d a n d several r o o m s w e r e a d d e d for m u s e u m a n d a u t o p s y purpose!. 3 0 E v e n h o u g h R u s h h a d w e l l - c h o s e n trustees, the e x p e n s e of i m p r o v e m e n t s w i s a l w a y s s u s t a i n e d by the professors. T h e r e m o d e l i n g of 1855 cost $15,000 i n d w a s b o r n e by the f a c u l t y . D r . J. A . A l l e n , c o m m e n t i n g o n t h e r o l e of t h e professors in financing m u c h of the school's e x p e n s e , remarked: . . - privleged to pay all expenses, after the manner of Mr. Pickwick and Messieurs Smdgrass, T u p m a n and Winkle, and, like them, have been subject to acri mon) and animadversion as a reward for their expenditure. 9 1 Y e t R u s i ' s first d e c a d e s w e r e t r a n q u i l years c o m p a r e d w i t h the c o n t e n t i o u s h i s o r y o f t h e M e d i c a l C o l l e g e of O h i o a n d s o m e o t h e r schools. T h e a t a l o g u e s of R u s h i n d i c a t e d a r a p i d g r o w t h d u r i n g its first five 28 P a c k a d , op. cit., p . 857. 2β· Ibid.,pp. 873-74; A . T . A n d r e a s , History of Cook County, Illinois, p. 293. A c c o r d i n g to tlhe Hitory of Medicine and Surgery and Physicians and Surgeons of Chicago, the Unitted St;tes M a r i n e H o s p i t a l N u m b e r 5 was o p e n e d in C h i c a g o in 1852, a p o o r h o u s e in 1 8 5 5 , a s m a l l p o x h o s p i t a l in 1855, a n d t h e Illinois C h a r i t a b l e E y e and E a r I n f i r m a r y in 1 8 5 8 . I a p p e a r s t h a t none of these institutions was used to any e x t e n t for t e a c h i n g p u r p o s e s lefore t h e C i v i l W a r .

30 Andras, loc. cit. 31 Ibid.,p.

294.

344

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

years. Beginning with the year 1847-48, when the enrollment reached 140, the attendance leveled off on a plateau, remaining between 100 and 150 during the next ten years. U p to the close of 1858 there were 437 graduates. 32 Rush's independent Board of Trustees kept it from falling into the proprietary classification. Its lack of any affiliation with an academic institution was not to its credit but may have saved it from unnecessary wrangling. Rush was not in its first two decades a large school as compared with Pennsylvania and Louisville, but it sent over five hundred trained physicians into the towns and hamlets of the West before the outbreak of civil strife. It is also worthy of record that R u s h helped to hasten the demise of the inadequate courses offered in the country schools. 33 MEDICAL

DEPARTMENT,

LIND

UNIVERSITY

When N. S. Davis and his colleagues broke with Daniel B r a i n a r d in 1859 it was coincidental that L i n d University was then seeking to establish a medical school in Chicago. It did not take the representatives of the two groups long to arrange a basis on which the Davis group became the medical faculty of L i n d University. Lectures in the Medical Department began in October 1859. T h e r e was a four-point basis for this affiliation which was so soon arranged: one, the University agreed to furnish temporary quarters for three years and then provide a permanent suitable building; two, the faculty had the right to organize, arrange the curriculum, and nominate to the trustees candidates for vacant chairs; three, the income of the Department was to be turned back into the Department for the first three years, during which time the professors would labor gratuitously; and four, the medical degree should be given only on recommendation of the medical faculty. A curriculum of thirteen subjects was planned, with the idea of splitting it into three groups to cover the three years of pupilage. For the time it was deemed prudent to split it two ways, providing for two five-month terms. Students in the first year and a half of pupilage were to attend the junior courses, and students in their last year and a half of apprenticeship were to attend the senior lectures. Roughly, the pre-clinical subjects were grouped in the first term, and the clinical subjects and bedside experience composed the second term. 34 This first term of regularly graded medical instruction, conducted in two well-lighted lecture rooms, a laboratory, museum, library, and dissecting room, was attended by nineteen juniors and fourteen seniors. Mercy Hospital, which passed from the control of R u s h to the new school, a college clinic, and an orphan asylum furnished more than ordinary clini32

Sixteenth Annual Catalogue of Rush Medical College for 1858-59. T h e real reason was that the schools in LaPorte, St. Charles, Evansville, and Jacksonville could not supply sufficient dissection material or support any hospital beds f o r clinical teaching. Chicago by 1850 was providing reasonably well both of these necessities. 34 A. H . Wilde, Northwestern University, pp. 297, 305. 33

ILLINOIS SCHOOLS

345

cal opportunities. T h e first term closed on March 5, i860, with the conferring of nine degrees in course plus two ad eunde.m degrees. A summer course followed which was entirely free except for the materials used. T h e faculty which Davis organized consisted of twelve doctors, including one emeritus professor. 35 This was probably the largest personnel combined in any one medical faculty in the country at that time. 39 In 1864 Lind University's chief supporter, Sylvester Lind, met with financial reverses because of the war and was unable to back the institution further. T h e name was changed to Lake Forest University and its trustees abrogated the contract with the Medical Department. Thereupon the professors organized the Chicago Medical College, which five years later became the Medical Department of Northwestern University. Davis had barely two years to try his plan before the outbreak of civil hostilities in the country. T h e Medical Department of Lind University was a noble experiment which definitely pointed the way out of the morass in which medical educators found themselves. « T h e L i n d professors were: T i t u s Deville, descriptive anatomy; J o h n H. Hollister, physiology a n d histology; F. M a h l e , chemistry a n d toxicology; Hosmer A. Johnson, materia medica and therapeutics; M. A. T a y l o r , general pathology; R a l p h N. Isham, surgical anatomy; E d m u n d Andrews, principles and practice of surgery; N. S. Davis, principles and practice of medicine; William H. B y f o r d , obstetrics and diseases of women; Henry G . Spofford, Esq., medical jurisprudence; David R u t t e r , emeritus in obstetrics; and Horace W a r d n e r , demonstrator. Andreas, op. cit., p. 425. se T h e second, third, and f o u r t h terms were attended by fifty-one, sixty-three, and seventy-nine pupils.

CHAPTER

30

OTHER SCHOOLS IN T H E OLD NORTHWEST WISCONSIN

MEDICAL

COLLEGE

WISCONSIN was organized as a separate territory on A p r i l 20, 1836. T h e Territory of Wisconsin at first included Iowa, which became a separate territory in 1838, and Minnesota, which was not so organized until 1849. A short time before Wisconsin discarded its territorial swaddling clothes, the governor, on March 2, 1848, approved a bill incorporating " The Wisconsin Medical College" which was to be "located in or near the city of Milwaukee." T h e object of the incorporation was "to promote the general interests of medical education and to qualify young men to engage usefully and honorably in the practise of medicine and surgery." Nothing seems to have resulted from this effort. Not even the names of the petitioners are known. 1 Congress approved of Wisconsin's statehood on May 29, 1848. T h e constitution of the new state provided for the establishment of a university. O n July 26, 1848, Governor Nelson Dewey approved an act establishing the University of Wisconsin with four departments, one of which was to be medicine. T h e Medical Society of Wisconsin (organized 1842) at its January meeting, in 1850, was agitated over the fact that the University had not yet established a school of medicine. Some conferences were held between Society representatives and University authorities. In the following June the committee on medical education reported progress and asked for more time. According to William Snow Miller, the Transactions of the Society indicated that the committee finally reported against the immediate organization of the department. 2 It so happened that a member of this committee, Ε. B. Wolcott of Milwaukee, in A p r i l 1850, organized a medical school under the State University charter. 3 T h r e e officers were selected and several meetings were held, but nothing was accomplished and the attempt was abandoned. T h e regents of the University created a Department of Medicine in 1854, but it never advanced beyond the paper stage. Many years passed be1 W i l l i a m Snow Miller, "Medical Schools in Wisconsin; Past and Present," Wisconsin Medical Journal, reprinted from June, 1936, p. 1. 2 Ibid., p p . 6-7. • L . F. Frank, Medical History of Milwaukee, p. 215. T h e officers and faculty were: Ε. B. Wolcott, president, surgery; A . D. Smith, secretary, medical jurisprudence; E l i p h a l e t Cramer, treasurer; and J. P. Whitney, institutes of medicine.

346

SCHOOLS IN T H E OLD NORTHWEST

347

fore a medical department was actually established under the charter of the University of Wisconsin. MADISON

MEDICAL

COLLEGE

Over in Madison, meantime, another effort had been made to start a school of medicine. On August 2, 1848, Madison Medical College was incorporated. T h e charter named six men, George W. Richards, Moses L . Knapp, Chandler B. Chapman, John Y. Smith, Richard S. Molony, and Nathaniel W. Dean, and their associates and successors, as a body corporate and politic "for the purpose of giving instruction in the science of medicine, surgery, and chemistry and all the various sciences connected with the healing art . . ." T h e school was to be located in or near Madison, and to have the authority to create a branch. T h e corporation was given unlimited proprietary privileges within the limits of federal and state laws.4 T h e first three of these incorporators became members of the first faculty. It was not the first teaching venture for Richards and Knapp, who had just withdrawn from Indiana Medical College at LaPorte. Knapp had also been on the first teaching staff at Rush. It seems that Richards and Knapp, who took the lead in the institution, had desired to open a school in Illinois but had met with legal obstacles. They then turned to the callow legislature in Wisconsin. T h e provision in the act for "power to create a branch of the same" was a betrayal of the inccrporators' intentions. ROCK

ISLAND

MEDICAL

COLLEGE

N o session of the Madison College was ever held in Madison. On the strength of the "branch" clause a school was opened on November 7, 1848, in Rock Island, Illinois, under the name of "Rock Island Medical College." T h e sesaon was short, ending February 20, 1849, a t which time twenty-one students were graduated. An announcement of the Rock Island school in the Macison Wisconsin Argus, September 26, 1848, advertised the lecture tickets it ten dollars each, practical anatomy fee (optional) five dollars, a n d graluation fee twenty dollars. T h e notice, signed by M. L. Knapp, promise! " f u l l and perfect" instruction, and degrees for practitioners after atiendance for one term. 5 Dean Knapp promised in his introductory lecture, given on the opening day, tha Madison Medical College, under which the school was operating, possessel "as full and ample powers for conferring degrees in the Profession of Viedicine as any institution in the United States." He explained that the school's locating in Rock Island was purely a matter of finding a central position and not intended to offer interference with any other school, " h e speaker declared the faculty's intention to give lectures in both Roick Isand and Madison as soon as there was sufficient demand. There * Millei op. cit., p. 2. Property of the College was not to exceed $100,000. 5 Wiscoisin Argus, September 26, 1848. When Knapp gave his address on November 7 he stated hat one practical anatomy ticket was required.

348

MEDICAL EDUCATION BEFORE T H E CIVIL W A R

was a slight mercenary note in Professor Knapp's remark that the professors formed a majority of the trustees and would thus continue to control the College." Some of Knapp's adulatory introductory remarks exhibited his rhetorical skill and doubtless profoundly impressed the aggregation of rustics who crowded the lecture hall on the bank of the Mississippi: . . . No honor could be more congenial to my feelings for since enduring some fifteen years of toil in the Profession in Illinois, to find myself at last in this El Dorado of the flow'ry West, on the banks of a lovlier than the "Blue Moselle," presiding as accoucheur at the birth of a new institution of Medical Learning, pure, promising, and undefiled by perfidy, comely in every feature, and limb, matchless, indeed, at her birth, is, to me, a source of more unalloyed happiness than I could enjoy were I elected to the Chief Magistracy of a State.7 K n a p p emphasized that the College was in harmony with the spirit of the reforms advocated by the American Medical Association, but could not adopt some features—such as three months steadily devoted to dissection and examinations by persons having no pecuniary interest in the school— until neighboring schools were ready to do likewise. He also indicated that the school would not lengthen the term to six months. According to the speaker the instructors were judiciously selected and students were expected from different quarters of the West. Easterners, he predicted, would come for their second term as soon as railroads made the transportation practicable. COLLEGE

OF

PHYSICIANS UPPER

AND

SURGEONS

OF

THE

MISSISSIPPI

In spite of Knapp's spoken confidence in Rock Island as an ideal site for the College, it remained there only one term. For some reason not very clear, possibly the anatomical problem, the trustees sought and secured an Iowa charter. 8 T h e next term was given at Davenport, across the river in Iowa. Drs. Pierce and Goudy dropped out in this year. Chapman assumed anatomy. Sanford took on the extra burden of surgery, and Everts accepted chemistry and pharmacy. J. D. Fisher was the new demonstrator and A. S. Hudson the prosector in surgery. Under the Iowa charter the College was named College of Physicians and Surgeons of the Upper Mississippi. 9 β M. L. Knapp, An Address Delivered at the Opening of the Rock Island Medical School, November 7, 1848, p. 6. T h e first professors were: George W . Richards, theory and practice of medicine; M. L. Knapp, materia medica and therapeutics; C. B. Chapman, surgery; W . S. Pierce, anatomy; John F. Sanford, midwifery and diseases of women and children; Calvin Goudy, chemistry and pharmacy; S. G. Armor, physiology, pathology, and jurisprudence; and Orpheus Everts, demonstrator. 7 Ibid., p. 5. » T h e announcement of the second session, College of Physicians and Surgeons of the Upper Mississippi 1849-^0, p. 6, gave as a reason for moving the offer of ample buildings constructed for use of the College and the urging of solicitous citizens. Weaver, op. cit., p. 26, suggested that the anatomical difficulties that beset St. Charles may have been felt in Rock Island. » Loc. cit.

SCHOOLS IN T H E OLD N O R T H W E S T COLLEGE

OF

PHYSICIANS IOWA

AND

SURGEONS

OF

349 THE

UNIVERSITY

Davenport also proved to be a mere place of hesitation. In the spring of 1850 the College became an integral part of the State University of I o w a and was moved to Keokuk. T h e Catalogue for 1849-50 announced the new arrangement and declared that Keokuk, with its population of several thousand souls, was especially desirable with reference to anatomy and clinical medicine. T h e f u l l course was advertised at seventy dollars plus matriculation five, a n d diploma twenty. T h e r e was to be no charge for hospital attendance. B o a r d and room could be had at one-fifty to two dollars weekly. 1 0 A t this point it is necessary to get the Iowa background to the history of this transient medical college. On December 7, 1848, Dr. J . M . Vaughan and an attorney named Stephen Whicher, representing a medical convention recently held in Iowa City, presented to the University of Iowa trustees a statement entitled "Conditions and Wants of the Medical Faculty of the State of I o w a . " A t the same time they requested that their voluntary professional society be recognized as the medical department of the University. A sort of tacit recognition followed, an arrangement by which the trustees accepted no obligation and permitted no claim against the funds of the institution. 1 1 In the following J a n u a r y a square of land in Iowa City, known as the College Green, was donated by the legislature to this rather imaginary medical department, with the provision that a building costing no less than $1,000 should be erected within two years. 1 E v e n before that time the trustees felt that steps should be taken to show evidence that there really was a medical department in the University of Iowa. T h e board took action creating seven branches in which medical instruction was to be given. Teachers were assigned to all the chairs except one. Collectively they were regarded as the faculty and were empowered to fill vacancies and manage administrative details. T h e first course of lectures was authorized to begin in November 184g. As a faculty the professors were to be entirely responsible for all expenses incurred in the operation of the school. 1 3 T h u s the department was essentially an independent medical school. Clarence R a y A u r n e r left the impression in his History of Education in Iowa that this department as such never actually functioned. On February 22, 1850, the Davenport school entered the picture by presenting through Stephen W h i c h e r a memorial requesting that the College of Physicians a n d Surgeons of the U p p e r Mississippi be recognized as the medical department of the University. Partial recognition was accorded but the school was not 10 College of Physicians and Surgeons of the Iowa University Located in Keokuk, Iowa; Annual Catalogue of the College, Session 1849-50, pp. 6-η. 11 Clarence R . Aurner, History of Education in Iowa, IV, 131. 12 Loc. cit. 13 Ibid., p. 132. T h e trustees reserved the right to demand reports from the school at any time.

350

MEDICAL EDUCATION BEFORE T H E CIVIL W A R

legally "recognized and established" as a part of the University until 1851. Meanwhile the 1849-50 Catalogue was published, part of the title being " C o l l e g e of Physicians and Surgeons of the Iowa University." T h e Catalogue also announced removal of the College to Keokuk. Presumably there was some collusion between the Iowa City and the Davenport-Keokuk projects. Several of the doctors who received professorial appointments at Keokuk had been appointed previously to the faculty in Iowa City. T h e r e appears to have been no contention between the two enterprises. T h e recognition of 1851 was strengthened in 1855 by a statute placing the College under the University trustees. Vacancies in the teaching staff were filled by the faculty, subject to the approval of the board of the University. In 1851 $5,000 from the sale of state salt lands was given to the school. During the legislative session of 1858 a loan of $15,000 from the common school f u n d was secured. A l t h o u g h the connection between Keokuk and Iowa City was only nominal, no general funds of the University being available for the medical department, the relationship was generally accepted and recognized in legislative acts from time to time. W h e n the physicians of Iowa City petitioned both the trustees and the General Assembly in 1858 for aid to found a medical college in connection with the University, the faculty at Keokuk requested a legal interpretation of its relationship with the University under the new constitution. 1 4 Nominal recognition continued inasmuch as the new constitution made no provision for severing the relationship. 15 Weaver regarded the College in Keokuk as a very respectable seat of medical learning, having several very able teachers, particularly Richards, Sanford, and Armor. T h e reputation of the school was further enhanced by the graduation of many excellent practitioners, a few of whom attained prominence in the medical profession of the West. 16 UNIVERSITY

OF

MICHIGAN

MEDICAL

SCHOOL

Physicians began settling in Michigan early in the nineteenth century. Some of the first to enter the area later designated as Michigan were surgeons attached to the army. As soon as Michigan became a state, in 1837, the State University at A n n Arbor was chartered. In that first year of its existence, President John D. Pierce, in making a report on the organization of the University, recommended the establishment of schools of medicine and law at the earliest practicable moment. 1 7 A member of the first Board of Regents of the University was Dr. Zina T h e General Assembly in 1858 was framing a new constitution. « Ibid., pp. 133-36. ie Weaver, op. cit., pp. 27-28. T h e Keokuk school merged with Drake University at Des Moines in 1908, and the product of this merger united with the State University of Iowa College of Medicine in 1913. Dr. Chapman, a member of the Davenport and Keokuk faculties, conducted a private summer school in Madison, Wisconsin. 17 History of Washtenaw County, Michigan, p. 309. 14

S C H O O L S IN T H E O L D

NORTHWEST

35

P i t c h e r . H e was e a r l y interested in Pierce's r e c o m m e n d a t i o n f o r a m e d i c a l d e p a r t m e n t a n d took i n t o his c o n f i d e n c e Drs. A b r a m Sager, Silas H . D o u g las, a n d Moses G u n n . P i t c h e r b e c a m e a m e m b e r of a c o m m i t t e e a p p o i n t e d by the regents to s t u d y the p r o b l e m of e s t a b l i s h i n g a m e d i c a l d e p a r t m e n t . T h i s c o m m i t t e e m a d e a f a v o r a b l e r e p o r t in 184g. T h e U n i v e r s i t y Catalogue f o r 1848-49 a n n o u n c e d t h a t a r r a n g e m e n t s w e r e b e i n g m a d e t o c o m m e n c e m e d i c a l i n s t r u c t i o n in the fall of 1849. ^ w a s a ' s o a n n o u n c e d t h a t o n l y o n e term, a n d that to e x t e n d t h r o u g h the a c a d e m i c year, w o u l d b e r e q u i r e d f o r g r a d u a t i o n . B o t h of these a n n o u n c e m e n t s w e r e p r e m a t u r e . Courses w e r e not o f f e r e d u n t i l the t e r m of 1 8 5 0 - 5 1 . T h e of that year set f o r t h the f o l l o w i n g s t a n d a r d s f o r a d m i s s i o n :

Catalogue

A good English education, the knowledge of Natural Philosophy, the Elementary Mathematical Sciences, and such an acquaintance with the Latin and Greek languages as will enable the student to appreciate the technical language of medicine, and read and write prescriptions. 1 * In these respects the M e d i c a l S c h o o l of the U n i v e r s i t y of M i c h i g a n w a s a d h e r i n g to the r e c o m m e n d a t i o n of the A m e r i c a n M e d i c a l A s s o c i a t i o n . T o be a d m i t t e d to the d o c t o r a t e , the c a n d i d a t e m u s t h a v e s t u d i e d m e d i c i n e for three years a n d a t t e n d e d lectures f o r t w o terms. A l s o , he was req u i r e d to be t w e n t y - o n e years of age a n d pass the e x a m i n a t i o n s . I n a n e f f o r t t o grade the course, c a n d i d a t e s w e r e r e q u i r e d to t a k e e x a m i n a t i o n s i n a n a t o m y , m a t e r i a m e d i c a , a n d c h e m i s t r y at the close of the first t e r m o r b e g i n n i n g of the s e c o n d . T h e t e r m was a f u l l six m o n t h s f r o m the first W e d n e s d a y of O c t o b e r to the t h i r d W e d n e s d a y of A p r i l . 1 9 T h e M e d i c a l S c h o o l was u n i q u e in that it b r a v e l y set h i g h s t a n d a r d s at t h e frst. N o school in the W e s t at the t i m e a n n o u n c e d s u c h r i g i d r e q u i r e m e n t . F e w in the East w e r e e n f o r c i n g c o m p a r a b l e r e g u l a t i o n s . T h i s n e w school was u n i q u e in yet a n o t h e r respect. T h e professors w e r e o n a salary basis, the same as professors in t h e arts a n d sciences. T h u s t h e teachers w e r e n o t possessed w i t h a c o m p e l l i n g d r i v e to h a v e l a r g e classes a n d graduate e v e r y c a n d i d a t e . T i e f a c u l t y was filled w i t h m e n fired w i t h a zeal t o m a k e t h e M e d i c a l S c l i o ) l succeed. D r . A b r a m Sager, p r o f e s s o r of obstetrics a n d diseases of w o m ? n , h e a d e d the school as d e a n . H i s associates w e r e : M o s e s G u n n , a n a t o m y a n d surgery; S a m u e l D e n t o n , t h e o r y a n d p r a c t i c e of m e d i c i n e ; J. A . A l l e n , p h y s i o l o g y a n d p a t h o l o g y ; a n d Silas D o u g l a s , chemistry. 2 0 T i e g r e a t difficulty of the S c h o o l was its l a c k of p r o p e r c l i n i c a l facilities. N o hospital was c o n n e c t e d w i t h the i n s t i t u t i o n u n t i l 1877. I n spite of its h i g h scholastic s t a n d a r d a n d the h a n d i c a p o f h a v i n g n o h o s p t a l at a t i m e w h e n c l i n i c a l i n s t r u c t i o n w a s b e i n g stressed, the e n r o l l 1 β hid., p. 310. T h e m o r a l character r e q u i r e m e n t was, of course, also specified. b-eliminary Announcement, p. 9. - 0 I i c k a r d , op. cit., p p . 890-91. C o r y d o n L . F o r d , a G e n e v a g r a d u a t e , j o i n e d the Miichi;an f a c u l t y in a n a t o m y and p h y s i o l o g y in 1854 a n d c o n t i n u e d forty years. A l o n z o Β . Pallmcr, a Fairfield g r a d u a t e , became professor of m a t e r i a m e d i c a , t h e r a p e u t i c s , a n d disieas-s of w o m e n and c h i l d r e n in 1854. H e transferred to p a t h o l o g y a n d practice of m e ; d i c n e in i860 a n d c o n t i n u e d u n t i l 1887.

35a

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

ment began in 1850 with ninety-five and steadily increased. In the year 1 8 5 1 - 5 2 a total of 159 students were enrolled in medicine as compared with only fifty-seven in literature, science, and the arts. T h e opening of the Civil W a r rapidly increased the number of matriculants. Nearly five hundred registered when a new building was occupied at the opening of the session in the autumn of 1864. 21 Michigan's adherence to certain high scholastic standards and paying of salaries to her medical professors rather than making them directly responsible for sustenance from "ticket" sales were very excellent contributions to come from a beginning western institution. A n n Arbor was a prolific source of trained physicians. 21 The number of graduates by the year from 1851 to 1862 were: 6, 27, 34, 41, 23, 30, 27,

29, 24, 22, 44, 41. University of Michigan

General Catalogue, 1912, pp. 2gi-g8.

CHAPTER

3 1

T H E SCHOOLS OF MISSOURI THE

MEDICAL

DEPARTMENT

OF

KEMPER

COLLEGE

PHYSICIANS are known to have established themselves in the vicinity of St. Louis soon after the middle of the eighteenth century. T h e s e early Missouri doctors were usually European-trained Frenchmen. St. Louis, which began as a French trading post in 1764 and was incorporated as a town in 1809, six years after Jefferson's historic purchase of Louisiana, obtained its medical care largely from such men as Antoine François Saugrain, a bourgeois physician-explorer w h o died in 182ο. 1 American dominance in the region was accelerated by the advent of steamship transportation on the Mississippi and its tributaries. With the flow of population to the Southwest began the speedy development of St. Louis, which soon had its quota of American doctors, both trained and untrained. Joseph Nash McDowell, nephew of the celebrated ovariotomist, E p h r a i m McDowell, was the first to organize a group of St. Louis physicians into a teaching faculty. McDowell was an 1825 graduate of the West's first medical school, Transylvania University, Lexington, Kentucky. W h e n he arrived in St. Louis in 1839 he had already had teaching experience in T r a n s y l v a n i a , Jefferson Medical College, and Cincinnati Medical College. 2 McDowell at once put himself to the task of organizing a medical college in which he might have the opportunity to teach. T h e problem of securing proper authority to organize a school was solved by obtaining nominal authorization from an Episcopal institution known as K e m p e r College. 3 As the Medical Department of Kemper College, McDowell and f o u r colleagues during the winter of 1840-41 gave the first course of medical lectures to be given west of the Mississippi. 4 A building was erected at the corner of N i n t h and Cerre streets. McDowell, w h o was a natural orator of extraordinary ability, delivered an address at the laying of the cornerstone of the new building. With an eloquence perhaps never before heard in that little city of about twenty thousand so fully given over to trade a n d commerce, Professor McDowell pictured to his audience the trek of the "Scythian stock" through successive and compelling waves of migration 1 All the early period of Missouri medicine is well covered by E. J . Goodwin, A History of Medicine in Missouri. T h e first medical society, St. Louis Medical Society, was formed in 1836. See J . Thomas Scharf, History of St. Louis City and County, II, 1542. 2 Kelly and Burrage, Dictionary of American Medical Biography, pp. 783-85. 3 Goodwin, op. cit., p. 129. • McDowell taught anatomy and divided the other subjects among his associates, J o h n S. Moore, Josephus W. Hall, John D. Wolf, and Hiram L . Prout. 353

354

MEDICAL EDUCATION BEFORE THE CIVIL W A R

until its crest reached the American frontier. He then centered attention upon the new-born institution by resort to an appeal to provincialism: W e are the center o£ the mass of poulation of the great south-west, and those who wish to be educated well can as readily obtain their learning here as elsewhere. Shall we decline the contest and leave the palm to other cities, and own our inferiority. This may suit the spirits of other climes, but it is not the spirit of those who have embarked in the enterprise—it is not the spirit of the sons of the Mississippi valley. . . . T h e n like a patriot he fired the zeal of all friends of the new venture: Our motto must be—peace, and to our posts. People, Trustees, and Professors, each to your respective duties, and the wind of persecution may howl a hurricane, and the lightning of malice may fall upon us, but if our good ship be light and free, our gallant mast may be bent but not broken. And like the proud eagle soaring aloft, she will ride the billow to its tip of foam, and glory in the strength that overcomes the storm. By 1847 Kemper College had failed owing to a lack of financial support. Arrangements were then made whereby McDowell's College, as the school was popularly known, became the Medical Department of the State University. 5 MEDICAL

DEPARTMENT

(Missouri

OF

MISSOURI

Medical

STATE

UNIVERSITY

College)

A f t e r McDowell's College bçcame attached to the State University it was often called Missouri Medical College. A b o u t the time of the transfer the Annual Circular announced completion of a new building with complete facilities for six professors. T h e structure was a formidable octagon-shaped edifice built on the lines of a fortress. Across the street was McDowell's home, which had also been planned to resist assault.® Howard Kelly and Walter Burrage suggested that the reason for such strange forms of construction are traceable to McDowell's Catholic phobia. In 1841-42 the Jesuit Fathers of St. Louis University were active in forming a medical department. Seeing the possibility of a strong competitor, McDowell took to the platform and delivered several acrid lectures aimed directly at Jesuitism. After his mind was unburdened he was obsessed w i t h a constant fear of danger. T h e r e a f t e r he wore a brass breastplate, carried arms, and had his home and school constructed to afford the maximum of protection. 7 5 Loc. cit. β Annual Circular of the Medical Department of the University of the State of Missouri, Session 1847-48, p. 4. ? Kelly and Burrage, op. cit., p. 784. McDowell's adventurous state of mind led him to conceive of a plan to cross the plains with a group of men and wrest Upper California from Mexico. For that purpose lie bought 1,400 obsolete muskets from the Federal Government at two and a half dollars each. He also purchased quantities of brass to m a k e cannon. It is said that he interested several hundred, including students and graduates, in the project. Apparently other pathfinders beat McDowell to the job. At least his expedition never materialized.

MISSOURI SCHOOLS

355

T h e faculty of Missouri Medical College in 1847-48 comprised the following professors and chairs: J . N. McDowell, anatomy; J o h n S. Moor, practice of medicine; R i c h a r d Barrett, physiology and materia medica; T h o m a s B a r b o u r , obstetrics and diseases of women and children; J o h n B . J o h n s o n , pathology and clinical medicine; and E d w a r d H . Leffingwell, chemistry a n d pharmacy. 8 G r a d u a t i o n requirements in that year were quite the same as elsewhere throughout the West, i.e., three years of private study, two terms of lectures, etc. T h e City Hospital, first opened to patients in 1846, was open daily to students without charge. Lecture fees for one term were $ 1 1 0 including matriculation. T h e dissection ticket was ten dollars, a n d the diploma or graduation fee twenty dollars. 9 MEDICAL

DEPARTMENT

OF T H E

MISSOURI

INSTITUTE

OF

SCIENCE

A b o u t 1856 the Medical Department of Missouri State University received a separate charter under which the College operated independently as the Medical Department of the Missouri Institute of Science. It was still commonly known as the Missouri Medical College or just McDowell's College. A leading member of the faculty just before and during the Civil W a r was J o h n T h o m p s o n Hodgen, a Kentuckian by birth and an alumnus of McDowell's College. He graduated in 1848 and began his teaching career as demonstrator during the next year. Hodgen succeeded to the chair of anatomy in 1854 and added physiology in 1858. It was he w h o attempted to hold the school together after the impact of the Civil W a r a n d McDowell's departure for the South. T h e building of the Missouri Medical College was seized by the Federal Government and converted into a military prison. Dr. Hodgen then transferred his allegiance to St. L o u i s Medical College. 1 0 T h e first medical school in St. Louis was well called McDowell's College. It was he w h o founded and nurtured it throughout its first existence, which covered a period of almost a quarter of a century. During that time McDowell a n d his faculty had connections with three different organizations, t h e last being independently chartered. In spite of its affiliation with K e m p e r College (1840-47) and the State University (1847-56), the medical schiocl appears to have been more or less a proprietary school throughout its history. T h e powerful personality of McDowell held the organization together. A Daniel Drake or a Charles Caldwell as a member of his teachi n g staff perhaps would have broken up the school. Joseph Nash McDowell, β Arnual

Circular

. . . 1847-48, p. 4.

β Ibd., pp. 8-10. A Sisters of Charity Hospital was opened in St. Louis as early as 1828. Wilth iiis dislike tor Catholics there is 110 reason to believe that McDowell ever made any uie of this institution for teaching purposes. Drs. W. L. Barret and John S. Moore opened the "Hotel for Invalids" on the upper floors of Paul House in the summer of 184$. Scharf, op. cit., p. 1545. l'Oli 1874 the Missouri Medical College was reorganized as a stock company in close association with the St. Louis Polyclinic College. In 1899, along with St. Louis Medical Collleg, it was merged into the Washington University Medical Department. Goodwin, op. cit, p. 12g.

356

MEDICAL EDUCATION BEFORE T H E CIVIL

WAR

a remarkable teacher with a unique individuality, was the greatest personality in medicine of the Southwest before the Civil W a r . 1 1 MEDICAL

DEPARTMENT

OF

ST.

LOUIS

UNIVERSITY

In 1836, after several conferences between the St. Louis Medical Society and the trustees of St. Louis University (Jesuit), an agreement was formed as a basis on which to organize a medical school in the University. T h e Medical Society named a faculty, and a prospectus of the Medical Department was published annually along with that of the other departments of the University, but no lectures were given until 1842. Meanwhile McDowell had established his school as the Medical Department of Kemper College, and railed against the Jesuits for seeking to establish a medical department. 12 In spite of McDowell's storming, and other difficulties which inhibited progress, the board and faculty of St. Louis University enacted a constitution for a medical department on October 14, 1841. T h e organization was perfected and lectures were started a year later, on October 8, 1842, after the trustees had approved of the faculty already appointed by the University. 13 Dr. James Vance Prather was the first dean. He and his four associates began lecturing in a small house belonging to the Dean and located on Washington Avenue, near T e n t h Street. Six received the doctorate at the end of the first term. 14 In 1847 ^ r . M. L. Linton was elected dean. During the two years that he served, the department outgrew its quarters on Washington Avenue. A new school building was provided by Colonel J o h n O'Fallon at Seventh and Myrtle streets. T h e new building, a rather conspicuous edifice, had two large lecture rooms, two anatomical rooms, and other appropriate quarters. Charles Pope became dean of the faculty in 1849. His influence was strongly felt both in and out of the school. T h e department came to be known as Pope's College. Rivalry between Pope's College and McDowell's College was a regular feature of St. Louis history during the decade of the fifties. Pope and his faculty were determined to make their school excel: T h e y [the professors] are resolved to spare no effort which will advance the best interests of medical education, extend the usefulness of their Institution, and mak St. Louis the medical as she is the commercial metropolis of the West. 11 Robert E. Schlueter, "Joseph Nash McDowell (1805-1868)," a reprint from The Washington University Medical Alumni Quarterly, October, 1937, is the only extensive sketch of the life of McDowell. Dr. McDowell died of lobar pneumonia in 1868, after receiving, strangely enough, the blessing of a Jesuit father. 12 Schaif, op. cit., p. 1545. T h e faculty which never functioned was as follows: Drs. J . C. Carpenter, J . Johnson, William Beaumont, E. H. McCabe, H. I.ane, and H. King. 13 T h e original faculty consisted of: Drs. Josephus Wells Hall, Hiram Augustus Prout, James Vance Prather, Daniel Brainard (of Chicago), and Moses L. Linton of Springfield, Kentucky. " Prout and Brainard left before the second term. Their places were filled by Drs. Abram Litton of Nashville, Tennessee, Joseph Granville Norwood of Madison, Iowa, and Charles Alexander Pope. Moses M. Pallen joined the faculty the next year.

MISSOURI

SCHOOLS

357

L i n k e d as the school is with the rise and progress of a great flourishing city, its success, already both permanent and complete, must and will increase with each revolving year. Like St. Louis, its destiny is to a higher and useful future. 1 5 P o p e ' s C o l l e g e w a s m a k i n g a r e s p e c t a b l e r e c o r d . Its s e v e n t h term, 1848-49, w a s a t t e n d e d by 102 s t u d e n t s , t w e n t y - f o u r of w h o m g r a d u a t e d . T h e r e w e r e 1 1 2 in a t t e n d a n c e t h e n e x t year. T h e l e c t u r e fees w e r e the s a m e as in M c D o w e l l ' s C o l l e g e , 105 d o l l a r s , p l u s five d o l l a r s m a t r i c u l a t i o n , ten dollars dissection, a n d twenty dollars graduation. Board, including l o d g i n g , lights, a n d f u e l w a s a v a i l a b l e w i t h r e s p e c t a b l e f a m i l i e s at t w o to three dollars weekly. G r a d u a t i o n r e q u i r e m e n t s in t h e M e d i c a l D e p a r t m e n t of St. L o u i s U n i versity w e r e in h a r m o n y w i t h the c o n v e n t i o n a l standards, i n c l u d i n g o n e d i s s e c t i o n t i c k e t . T h e Annual Announcement f o r 1849-50 c l a i m e d that n o s c h o o l in t h e c o u n t r y d e v o t e d m o r e t i m e to c l i n i c a l i n s t r u c t i o n t h a n P o p e ' s C o l l e g e . S o m e o n e of the f a c u l t y was o n the C i t y H o s p i t a l staff d u r i n g the e n t i r e y e a r , a n d the St. L o u i s H o s p i t a l ( o r i g i n a l l y f o u n d e d by Sisters of C h a r i t y in 1828) w a s u n d e r t h e e x c l u s i v e c o n t r o l of the f a c u l t y a l l the year. C o n s i d e r i n g these o p p o r t u n i t i e s a n d the a v a i l a b i l i t y of dissecting m a t e r i a l in a r i v e r city, it is a f a i r c o n c l u s i o n that a c o m p a r a t i v e l y h i g h g r a d e of w o r k w a s d o n e in P o p e ' s C o l l e g e , in spite of the fact that most of the professors w e r e p r a c t i t i o n e r s u n k n o w n o u t s i d e the c o m m u n i t i e s in w h i c h they h a d p r a c t i s e d . 1 8 T h i s d e c a d e of the f o r t i e s w a s a t i m e w h e n a n t i - C a t h o l i c s e n t i m e n t was easily a r o u s e d in A m e r i c a . T h e a c t i v i t i e s of C a t h o l i c societies such as the Jesuits w e r e p o p u l a r l y c o n t r a s t e d w i t h A m e r i c a n i s m by g r o u p s k n o w n as n a t i o n a l i s t s . M c D o w e l l h a d a t t e m p t e d to c a p i t a l i z e o n this p o p u l a r sentim e n t in his d r i v e to k e e p St. L o u i s U n i v e r s i t y f r o m o r g a n i z i n g a m e d i c a l faculty. I n O c t o b e r 1848, the M e d i c a l D e p a r t m e n t r e q u e s t e d t h a t the trustees diss o l v e its c o n n e c t i o n w i t h t h e U n i v e r s i t y , o n the g r o u n d s t h a t the r e l i g i o u s p r e j u d i c e t h e n p r e v a l e n t w o u l d m i l i t a t e a g a i n s t the success of the d e p a r t m e n t . T h i s r e q u e s t w a s d e n i e d a n d t h e n r e p e a t e d o n J a n u a r y 24, 1849. A g a i n the trustees d e c l i n e d t o p e r m i t t h e s e p a r a t i o n . 1 7 ST. LOUIS M E D I C A L

COLLEGE

W i t h the rise of t h e " K n o w - N o t h i n g " e x c i t e m e n t in 1 8 5 4 - 5 5 the m e d i c a l professors of St. L o u i s U n i v e r s i t y a g a i n insisted o n a s e p a r a t i o n f r o m the is Annual Announcement of the Medical Department of tlte St. Louis University, Session 1849-50, p. 4. 16 T h e m e d i c a l f a c u l t y of St. L o u i s U n i v e r s i t y in 1849-50 c o m p r i s e d the f o l l o w i n g : M . L . L i n t o n , p r a c t i c e a n d p r i n c i p l e s of m e d i c i n e ; C h a r l e s A . P o p e , p r i n c i p l e s a n d practice of s u r g e r y , clinical s u r g e r y , a n d d e a n ; A . L i t t o n , chemistry a n d p h a r m a c y ; M . M . P a l l e n , obstetrics a n d diseases of w o m e n a n d c h i l d r e n ; J a m e s B l a k e , g e n e r a l a n d descriptive surgical a n a t o m y ; T h o m a s R e y b u r n , m a t e r i a m e d i c a and therapeutics; R . S. H o l m e s , physiology a n d m e d i c a l j u r i s p r u d e n c e ; W . M . M c P h e e t e r s , clinical m e d i c i n e a n d p a t h o l o g i c a l a n a t o m y ; C h a r l e s W . Stevens, d e m o n s t r a t o r ; F. S. Cozens, j a n i t o r . Annual Announcement 1849-50, p. 3. Cozens was raised to t h e r a n k of c u r a t o r in 1850-51. π Scharf, op. cit., I, 863.

358

MEDICAL EDUCATION BEFORE T H E CIVIL W A R

institution. T h i s time, by mutual consent, the separation was effected and the Medical Department, by virtue of an independent charter, became St. Louis Medical C o l l e g e . " T h i s institution survived the Civil W a r and in 1891 became the Medical Department of Washington University. It happened eight years later (1899) that Missouri Medical College was absorbed by Washington University. T h u s the lineal descendants of McDowell's College and Pope's College were welded together into one institut i o n — a n event that must have irked the restless spirits of those deceased early promoters of medical education in St. Louis. MEDICAL

DEPARTMENT LITERARY

OF

FRANKLIN

COLLEGE

OF

ST.

MEDICAL

AND

LOUIS

O n March 12, 1849, General Assembly of Missouri incorporated the above-named institution. It was the aim of the trustees in naming the faculty to secure as far as was practicable professional skill and ability of the highest order, drawn from different portions of the Great Valley of the West. T h e object of this policy was to lay claim to a patronage from all the West and to build a general and not a sectional institution. 19 Neither E. J. Goodwin, J. T h o m a s Scharf, nor Francis Packard made any reference to this school. T h a t such a college was planned and organized is substantiated by the testimony of a surviving copy of its first Annual Announcement, published in 1849. A crude etching on the cover of the circular pictured the "Franklin Medical College" as occupying the two upper floors of a building in which "Wheaton and Co., Importing Druggists" did business on the ground floor—a close association suggestive of some benefit to the drug firm. It is probable that this school attempted to ride the crest of antiCatholic feeling which was current in the country at the time. T h e Annual Announcement invited the "attention and scrutiny of Western physicians" to the College's offer to Free Masons and O d d Fellows to nominate one student of each order for free schooling from each congressional district in which the lodges were organized. T h e faculty specified the generally established scholastic standards. Material for practical anatomy was said to be plentiful, but the dissection ticket, which cost ten dollars, was optional. T h e other fees, matriculation, lecture tickets, and graduation, were the same as in other St. Louis schools, five, one hundred five, and twenty dollars respectively. N o mention was made of clinical teaching facilities. T h e term was announced for October 15 to the last of February. 20 A faculty of seven r the number recommended by the American Medical Association, was listed. Not one of them, however, is among the biographies in Scharf. T h i s may be explained by a statement in the Announceis Goodwin, op. cit., p. 131-32. ι» Annual Announcement of the Medical Department College of St. Louis, (1849), p. 6. 2° Ibid., loc. cit.

of Franklin Medical and

Literary

MISSOURI SCHOOLS

359

ment that.they were drawn from "different portions of the Great Valley." Even at that, Packard's index of personal names omits all seven. 21 One is forced to the conclusion that the Medical Department of Franklin Medical and Literary College of St. Louis had an ephemeral existence if indeed it ever advanced beyond the embryonic stage. It was at least a symptom of the trend of the uncontrolled American medical profession in the West. ST.

LOUIS

COLLEGE

OF

MEDICAL

AND

NATURAL

SCIENCES

Dr. Adam Hammer, a native of the G r a n d Duchy of Baden, was a medical graduate of Heidelberg University. T h e fortunes of the 1848 revolution in Germany forced him to seek an asylum elsewhere. Like C a r l Schurz and other liberal patriots in revolutionary Europe, Dr. Hammer sought refuge in the United States. He arrived in St. Louis in October 1848. T w o years later, on request, Dr. Hammer joined the St. Louis Medical Society. It is not strange that a medical graduate of Heidelberg, where standards of medical education were relatively high, recognized gross deficiencies in the American plan of medical instruction. In an effort to correct some of the defects in the current system of training doctors, Hammer, in 1855, was aided in establishing a medical school by eleven public-spirited citizens who secured a state charter for the St. Louis College of Medical and Natural Sciences. T h e charter provided for a graded curriculum to be covered in four four-rLonth terms, two of which were to be given each year. T h i s was a very distinct improvement over the conventional American plan of requiring a medic to take the same courses in each of the two four-month terms required. A Circular published by the trustees sharply criticized the generally accepted plan as "simply impossible." Unlortunately the three distinguished European professors whom Hammer expected to join him in the enterprise did not come. T h e school closed in 1856. T h e r e were, of course, no graduates. T h e contribution of the College to medical education was obviously little more than a setting forth of current defects. Had the foreign professors become connected with the in;titution there is a very reasonable doubt that the faculty could have survived while maintaining such standards. Other institutions had made similar attempts previous to this time and had failed. 22 21 Members of the Franklin faculty were: John Barnes, Henry Murray, Edward H. Roe, James H. Johnson, Henry King, Albion T . Crow, and John H. Boardman, the dean. 22 Su J u n e 24. >9>6.) N.p., n.n., n.d. 10 p p . R a u c h , J o h n H., Medical Education, Medical Colleges, and the Regulation of the Practice of the Medicine in the United States and Canada, 1765-1891. (Illinois State Board of Health.) Springfield, 111.: H . W . Rokker, 1891, 222 pp. R e d e n b a u g h , Mary Young, The Biography of Ephraim McDowell. New York: Charles L. Webster a n d Company, 1890. 558 p p . Refutation of the Misstatements Contained in a Pamphlet Recently Issued by W. Danach, M. D., and John Wiltbank, M. D. in Reference to the Medical Department of Pennsylvania College, A. Philadelphia: Merrihew a n d T h o m p s o n , 1855. 64 p p . Regulations of the Library of the Massachusetts Medical College. N.p., n.n., 1816. 4 PP· Reply to a Pamphlet Entitled "A Statement of the Facts Connected with the Late Re-organization of the Faculty of the Medical Department of Pennsylvania College, together With a Documentary History of Said Department, from its Origin to the Present Time." Philadelphia: King a n d Baird, 1855. 68 p p . Reply to a Pamphlet Purporting to Be an Answer to a Letter Addressed to a Republican Member of the House of Representatives on the Subject of a Petition for a Neiu Encorporation, to Be Entitled a College of Physicians. Boston: n.n., February 1812. 15 p p . Report of the Select Committee of the House of Representatives on So Much of the Governor's Speech, at the June Session, 1830, as Related to Legalizing the Study of Anatomy. . . . Boston: D u t t o n a n d W e n t w o r t h , 1831. 118 pp. Revere, J o h n , An Introductory Lecture on the Comparative State of the Profession of Medicine, and of Medical Education, in the United States and Europe, Session MDCCCXLVI-VII. (University of the City of N e w York.) New York: H e r a l d J o b Office, 1846-47. 18 p p . Review of the Memorial of Doctor John Bell, to the Trustees of the University of Pennsylvania, A. Philadelphia: B. Mifflin, 1850. 24 pp. Rhees, B. Rush, An Address Delivered March 8, 1825, in the Hall of the Medical Faculty of Jefferson College, Located in Philadelphia. Philadelphia: Stavely a n d Bringhurst, 1825. 30 p p . Richardson, L e o n Burr, History of Dartmouth College, 2 vols. Hanover, N. H.: D a r t m o u t h College Publication, 1932. 854 p p .

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462

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

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GENERAL INDEX Académie Royale de Chirurgie de Paris, 2 Addison County Grammar School, 204 Ad eundem degrees and students, 61, 79, 80, 269, 280, 335 Alabama legislature, 376 Albany Medical College (see Albany Medical School), 136, 159-63, 207, 387, 389, 394. 395 Medical School (see Albany Medical College), 160, 221 University, 163 " A l b u m , " 392 Almshouse: Boston, 174; Charleston, S. C., 253, 257; R i c h m o n d , 270 American Academy of Arts and Sciences, 172 Antiquarian Society, 132 Eclectic Medical Association, 419 Medical Association, 98, 99, 140, 217, 222, 239, 247, 272, 274, 278, 301, 341, 348, 35·. 358, 376, 377. 395. 422. 427· 428. 432. 433 medical degrees: at end of eighteenth century, 60; types of granted in eighteenth century, 61 American Medical Library and Intelligencer, 231 Medical Recorder, 86 Practice of Medicine, The, 419 River, 377 system of medical education, criticisms of, 341, 342, 364, 365, 373, 374, 377, 379· 3 8 5- 3 8 6. 39°. 3 9 ' . 4° 6 · 422-28 textbook writers, 397 Americans versus Frenchmen in New Orleans, 364 Anatomic museum of Alexander Ramsay, 166 Anatomical laws: Massachusetts, 177, 400; New York, 400; Congress, 400; New Jersey, 400; Missouri, 400 lectures and dissection, early: Giles Firmen, 11, 37; W i l l i a m Hunter, 40; Order of General Court, 38; W i l l i a m Shippen, 6, 40-42, 63; Lambert Wilson, l i , 37; T h o m a s Wood, 40; see Dissection riots and Resurrectionists lectures, tickets for: 392; not required, 400 "Anatomie," criminals' bodies for, 400 Andersonian Institution, Glasgow, 231

Anglican C h u r c h , 1 A n n a n , Samuel, 288 Announcement of Augustus L. Warner to receive private pupils, 270 Ante bellum days, 281 Anti-Catholic sentiment, 354, 357, 361 Apprentice system of medical education: 32-38, 380, 381; duties of apprentice, 32; examples of, 34-36; fee rate of, 33; for degree, 404, 405; in hospital, 48; seven-year term, 32: three-year term, 32; see "Preceptorship" Apprenticeship, 380-86 Armory (Richmond), 270 Army Hospital (Boston), 173 Asbury University (Methodist), Greencastle, Ind., 334 Atlanta Medical College, 280, 281 Attendance on two terms, a graduation requirement, 404 A u b u r n Medical School, 154-56 Prison, unclaimed bodies from, 123, '54 Augusta, Ga.: City Council of, 277, 389; Medical Society of, 276 Augusta Aradcmy, 2G0 "Autocrat of the Dissecting T a b l e , " 178 Bachelor of Medicine degree: abolition of, 403; abolition in College of Philadelphia, 78; course of study prerequisite to, 65, 66; requirements for, 403 Baltimore, Md.: County Court of, 235; County Hospital of, 224; Marine Hospital of, 227, 244; Medical Society of, 31, 224 Baltimore Hospital, 227, 238, 242 Summer course of Medical Lectures, 246 Baptist Church, First, Buffalo, N. Y., 165 institution, 248 Barber-Surgeon Company, 60 Beachites, 419 Bedside instruction, 215, 220, 244, 245, 305, 334, 368,.370, 393, 394, 401, 422, 431 Belles-Lettres, Society of, 2 Bellevue Hospital Medical College, 143, 145-47, '66, 393, 394 Hospital of New York, 52, 53, 122, 463

'4547

464

MEDICAL EDUCATION BEFORE THE CIVIL WAR

Berkshire District Medical Society, 212 Medical College (see Berkshire Medical Institute), 207, 214 Medical Institution (see Williams College and Berkshire Medical College), 98, 156, 2 1 1 - 1 5 , 231, 339,363, 387, 389,420 Berkshire Medical Journal, 213 Best endowed medical school, 292 "Blackballing" students, 80 Blockley, 48-50, 86, 95, 106, 412 Board and room, cost of, 395 Boston Medical Society, 31 Female Medical School, 408, 409 Boston Medical and Surgical Journal, The, 412 Boston University School of Medicine, 408 Botanic and eclectic schools in New York, •47 Botanical garden, 396 Botanico-Medicai College of Memphis, 419 College of Ohio, 418 School in Cleveland, 41g "Botanies," 417-21 Botany and n a t u r a l history in curriculum, 396 Bowdoin College, 153, 196, 221, 308, 339, 387, 393, 423; proposal of reform by, 423 Boylston School (Boston), 184, 219, 394 Brief Guide in the Smallpox and Measles, A, 13 Brown University (see R h o d e Island College), 1, 160, 199-204, 221 Brunonian system of medicine, 224, 287 Buffalo Medical College (see University of Buffalo), 370 Cabal, the Conway, 59 Caldwell-Cross quarrel, 295-97 California: McDowell's plan to invade, 354; medical education in, 377; public hospitals in, 377; quacks and medical crooks in, 377; State Medical Society of, 377 Calvinist clergyman, 289 Canals, railroads, and turnpikes, influence of, 284 Care of sick and children, inheritance of women, 407 Carpenter's, Mrs., School of Midwives (St. Louis), 360 Castleton Medical Academy (see Castleton Medical College and Vermont Academy of Medicine), 205, 212, 383, 385, 430 Medical College (see Vermont Academy of Medicine), 98, 160, 161, 204-11 Castleton-Middlebury liaison, 205 Catholic societies, 357 Cayuga County Medical Society, 154

"Celsus," press notice signed by, 225 Central Medical College (see Indiana Central Medical College), 334, 335 Medical College of New York (Syracuse), 419-20 Centre College, 296 Charity Hospital (New Orleans), 54, 55, 363. 366. 3 6 8 · 369 Hospital (Philadelphia), 106 Hospital Medical College, 331 Charleston, S. C.: City Council of, 255, 282; Marine Hospital of, 253, 257; Medical Society of, 252 Charlottesville, Va., Bank of, 264 Charter relationships, 431 Chartered medical schools in U. S., 281, 431 Chase's Medical Students Guide, 96, 102 Chemistry lectures, ticket for, 392 Chicago, 111.: Marine Hospital Number 5 of, 343; Mercy Hospital, 343, 344 Chicago Medical College, 345, 432 Children's Hospital (Philadelphia), 106 Cholera, 362, 363 Christian education, 156 Cincinnati, Ohio: Board of Trustees of the T o w n s h i p of, 3 1 1 ; Central Avenue hospital wards, 321; Marine Hospital of, 317; Medical Association of, 308 Cincinnati College (Cincinnati Medical College), 306, 312, 318-21, 333, 353, 392 College of Medicine and Surgery, 315, 317, 321-24, 392 Eclectic Institute, 314, 334 Hospital, 319 Medical a n d Surgical College (see Cincinnati College of Medicine and Surgery), 321 Medical Institute, 322, 324 Cincinnati Medical News, 322 Summer School of Medicine, 324 City Almshouse (Bettering House) of Philadelphia, 48 Dispensary (Medical College of Georgia), 278 —•— and County Almshouse (Baltimore), 227 Hospital (Richmond), 270 Hospital (St. Louis), 355, 357 Civil War, 124, 143, 145, 148, 162, 164, 165, 218, 220, 237, 250, 256, 262, 264, 267, 268, 274, 275, 278-80, 282-84, 295, 301, 316, 317, 322, 325, 343, 344, 352, 355, 356, 358, 360, 368, 371, 373, 375, 376, 381, 415, 417, 421, 427, 431, 432 Clergymen, medical education of, 11, 12 Cleveland, Ohio, quarrels in, 331 Cleveland Medical College (Western Reserve College), 327, 330

GENERAL INDEX Clinical fee, 393 instruction, difficulty in securing material for, 400-2 lectures, first in medical school, 65 School of Medicine (see Vermont Medical College), 210, 215-17, 220, 383 subjects, 396 Colby College, 156, 383 College Clinic (Ohio Medical College), 317 "College Clinics," 55, 239, 249, 250 College of Charleston, 251, 252 of Medicine of Maryland, 223-42, 383, 384, 388, 430 of New Jersey, 71 of Philadelphia (see also University of Pennsylvania and University of the State of Pennsylvania), 1-8, 61, 63-79, 171, 223, 25 >. 259· 3 8 ' . 3 8 2, 39 6 · 397- 401. 430 of Physicians (Philadelphia), 31; library of, 398 of Physicians and Surgeons (see Columbia College and King's College), 11325, 128, 131, 135, 136, 138, 145, 155, 156, 260, 319, 381, 383, 387-89, 396, 400, 405, 419, 430, 432 of Physicians and Surgeons in the Iowa University, 349, 350 of Physicians and Surgeons of the Upper Mississippi, 348 of Physicians and Surgeons of the Western District of the State of New York (see Fairfield Medical College), 15053, 326, 392 of Physicians of the Valley of Virginia at Winchester, 261, 262 Colonial medical literature, 21, 22, 381 practice, 22-28; general practitioners, 23; influence of European medicine on, 26; in New England; obstetricians, 23-26; vital statistics, 24 practitioners, 7-20; Connecticut, 15, 192; Delaware, 17; foreign trained, 27; Maryland, 19; Massachusetts, 11-14; New Hampshire, 15; New Jersey, 17, 18; New York, 16; Pennsylvania, 18, 19; the Carolinas, 19, 251; Virginia, 9, 10 preceptors, heterogeneity of, 380 women as midwives, 407 C o l u m b i a College or University (see College of Physicians and Surgeons and King's College), 61, 109-25, 135, 187 C o l u m b i a n College Medical Department (National Medical College); 248-50, 310, 395 Columbus, O h i o , plan of reform, 423, 424 Commercial Hospital and L u n a t i c Asylum for the State of O h i o , 305, 306, 313, 314, S ' 6 , 317, 322, 323, 325

465

C o m m e n ç a i spirit in medical education, 321 Committee on Medical Education of Α . Μ . Α., 401 Comparison of Harvard Medical Institution with New York Schools, 131 Confederate Army, 264 Connecticut, Medical Society of, 31, 193,425 Constitution of the United States, 230 Continental Journal and Weekly Advertiser, 172 Cornell University, 415 Country versus city medical schools, 264, 265 schools, death of in Indiana and Illinois, 341 C u m b e r l a n d College (see University of Nashville), 373 Curriculum, 396, 397 D a r t m o u t h College (see New Hampshire Medical Institution), 1, 61, 152, 153, 18691, 202, 204, 2og, 211, 215, 219, 221, 222, 327. 330. 3 ® 3 8 7 - 388, 430 Decree of Allejandro O ' R e i l l y , 362 Degree granted Daniel T u r n e r by Yale College, 60 granted John Cranston by R h o d e Island Assembly, 60 Degrees: B.M. and M.D., 403 (see Bachelor of Medicine and Doctor of Medicine degrees); honorary medical degrees, 328 Delaware, Medical Society of, 31, 425 Democracy and freedom, experiment in, 284, 318 Demonstrator of anatomy, 393; selected on merit basis, 342 Depreciated currency, 295, 298 De Puopoiese, thesis of John Morgan, 1 " D i g g i n g u p " activities, 190 Diseases of the Interior Valley of North America, The, 287 Dispensary of Drs. Mendenhall, Woodward, et al., 324 of Miami Medical College, 323 Dissection activities, mobs, and riots: College of Medicine of Maryland, 225, 23g, 339; Criminals, 109; Dartmouth College, 190; "Doctors' M o b , " 399; Franklin Medical College, 338; Missouri Medical College. 339; public sentiment, 393, 398-400; Shippen's course, 399; Worthington College, 7; Yale Medical Institution, 197, 399 "Distracting Clinics," 265 District of C o l u m b i a : medical schools in, 248-50; Medical Society of, 248 Doctor of Medicine degree, requirements for, 403-6

466

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

"Doctor of physick and chirurgery" degree conferred on Captain J o h n Cranston, >99 "Doctors' M o b " riot of 1788, 5 1 Domestic Medical and Dietetical Monitor or Journal of Health, 218 Drake-Moorhead feud, 306 Drake University, 350 Drake's dramatic dismissal, 307, 308 Drunken orgy, 296 Dudley-Richardson duel, 293 Dutch Reformed Church, 125 Eclectic Institute (Lexington), 303 Medical Institute, 419 medical schools, 4 1 5 , 417 Eclectics, 419, 433 Ely Resolutions, 424 Emancipation of women, 407, 408, 415 Empire-building, 284 English language as premedicai requirement, 266 Episcopal church, 289 institution, 353, 41g Erie Canal, 149, 163 Essay on the Means of Improving Medical Education and Elevating Medical Character, An, 158, 159 Ether, demonstration of, 54; Morton and Long, 286 European medicine: in seventeenth century, 26, 429; in eighteenth century, 26, 27, 1 7 1 , 429; influence of, 362, 374, 380, 381, 429 Evansville, Ind., Marine Hospital of, 336 Medical College (see Medical College of Evansville), 3 1 7 , 393 Examination for the doctorate, 406 or graduation fee, 390, 394 Excelsior Medical College, 147 Experimental philosophy, a premedicai requirement, 403, 404 Experiments and Observations on the Gastric Juice and the Physiology of Digestion, 286 Eye clinic at Miami Medical College, 323 Infirmary (Cincinnati), 3 1 4 Faculty feuds, 432 "Faculty of Physic" (South Carolina), 251 Faculties, control of, 382-86 origin of, 382-86; as "integral part," 382; by "grafting," 382, 383; by original university plan, 383; organized by professional societies, 383; proprietary, 384 Fairfield Academy, 150, 152 Medical College (see College of Physicians and Surgeons of the Western Dis-

trict of the State of New York), 150-53, • 56, 157. 159. 164, 327, 328, 332, 337, 379 Federal Government, 355 Fee, one to cover all expenses, 393 rates, 298; for graduation, 406 Female Medical College of Pennsylvania, 392, 4 1 2 - 1 4 Medical Education Society in Boston, 408, 409 Seminary (La Porte, Ind.), 333 Financial Support of Medical Schools, 38791 First effort at medical education in colonies, 11 graduate of American medical college to cross Rockies, 153 independent and proprietary medical faculty in America (University of Maryland), 228, 229, 241 inoculation in America, 13 instance of medical college (Willoughby) named for an individual, 326 medical course west of Mississippi, 353 national medical convention called, failure of, 424, 425 — — medical student of Cincinnati, 287 Foreign medical texts, 397 Fort Augusta, 57 Fort Dearborn, 339 Fort Mackinac, 286 Franklin Literary and Medical College of Illinois (Galena, 111.), 337 Medical and Literary College of St. Louis, 358, 359, 395 Medical College (Philadelphia), 100, 392, 410, 4 1 2 Medical College (St. Charles, 111.), 327, 334. 337. 338 Free Academy, 394 dispensary, first American, 74 — Masons, 358, 395 tuition, 317, 322, 342, 358, 393, 394, 395 French Canadian voyageur, 286 School of Medicine (Paris), 134 Friendly Botanic Societies, 418 Geneva Academy, 156 College (see Hobart College), 1 2 1 , 132, 155-59. 327 Medical College, 153, 155-59, 164, 165, 328, 4 1 1 , 412 Georgetown College School of Medicine, 250 Georgia, legislature of, 277 Medical College (see Medical College of Georgia), 423; plan for reform, 423

GENERAL INDEX Georgia Medical Society, 276, 425 Godey's Lady's Book, 408, 409 Gold rush of 1849, 377 Graded course of instruction, 343, 405 Graduation fee, 406 Grammatical errors and bad spelling, 262 Gratis students, 281, 394, 395 Gratuitous operations, 330 Grave robbing, 291; see dissection activities Great Valley of the West, 358 "Green B o x " examination, 80 Gulf plains, 284 Guy's Hospital (London), 146, 225, 368

Hahnemann Academy of Medicine (N. Y. City), 417 Medical College of Chicago, 417 school in N. Y . City, failure to f o u n d in 1849 and 1853, 417 Hahnemannism, 331 H a m i l t o n College (see Oneida Academy), >53 County, Ohio, commissioners of, 323, 324 Hampden-Sidney College, 135, 260, 267-74, 282, 383, 387, 393 Harvard College (see Harvard University, Harvard Medical Institution, Massachusetts Medical College), 1, 13, 53, 61, 156, 167-85, 187, 204, 2 U , 212, 220-22, 231, 272. 3°9> 3>9- 33°> 373. 3 8 1 ' 387· 389- 392. 394· 39 6 ' 4°2. 405. 412 Corporation, 170, 180, 430 Medical Institution (see Harvard Coli g e ) . 43. »7«. »73 University (see Harvard College), l 6 7-85. 433 Heidelberg University, 359 Herb doctor, 418 Herkimer County, N. Y., Medical Society of, 152 Historical Society (N. Y.), 124 H o b a r t College (see Geneva College), 158 Homeopathic Medical College of Pennsylvania, 41Θ, 417 Medical College of the State of New York in New York City, 417 Homeopathy, 408, 415-17, 433 Honorary medical degrees, 328 Hospital-college system of instruction, start of, 143, 146, 166 Hospital instruction, bedside clinics, ward walks, etc., 65, 81, 401; required attendance on, 55 or clinical fee, 393 Hospitals, early American; as teaching

467

facilities, 44-56; see separate names of hospitals " H o t e l for Invalids" (St. Louis), 355 Howard Hospital (Philadelphia), 106 H u m b o l d t Institute, 360, 361 Medical College, 360, 361 Hydropathy, 417, 418 Illinois: General Hospital, 341, 343; legislature, 337, 340, 417; medical schools in, 337-45, 379; State Medical Society, 414, 425 Illinois Charitable Eye and Ear Infirmary (Chicago), 344 College, 338, 339 Inalienable rights, effect of on medicine, 288 Independent Medical School of Pennsylvania, 106 T h o m s o n i a n Botanic Society, 418-21 Individualism, 42g Indiana: district medical societies of, 332; legislature of, 332; medical schools in, 332-36, 379; State Medical Society of, 332, 425 Indiana Central Medical College, 334, 335 Medical College, 334, 347 Infants Hospital (N. Y.), 146 Infirmary (Medical College of Georgia), 278 (University of Maryland Hospital), 232. 233, 237-39 Inoculation, first in America, 13 "Institution of Anatomy," 218 Institution of Medical Schools in America, A Discourse Upon, by John Morgan, 3 Inverted microscope, John L. Smith, inventor of, 264 Iowa General Assembly, 350 Ishmaelite, 419 Jamestown Colony, g, 10 Jefferson College, Canonsburg, Pa., 87 Medical Association of Danbridge (Tenn.), 375 Medical College, 86-93, I0 7> >3^, 164, 231, 256, 259, 269, 275, 282, 310, 318, 340, 34>> 353. 392, 393- 400, 405, 410, 433 Jeffersonian Republicans, 174 Jefferson's, T h o m a s , concept of a university curriculum, 262 Jeremiahs of reform, 422 Jesuit Fathers, 354, 356, 357 Jesuitism, 354 John Brown's raid, 282, 371 Juettner's estimate of three greatest medical faculties, 321 Junto, 2

468

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

Kansas City Medical College, 334 Kemper College (McDowell's College), 353, 354 "Kentuckee," 289 Kentucky: legislature of, 294, 314; medical schools in, 289-303, 332 "Kentucky Academy," 289 Kentucky School of Medicine, 288, 298, 30'3 University, 294 Kimball-Bartlett partnership, 219 King's College, 1, 9, 26, 36, 50, 61, 109-12, '24. 3 8 ' · 397' 430 Lake Forest University, 345 Lancaster School, 304 Lancasterian Seminary, 318 Laparotomy, 285 LaPorte University, 332-34, 337, 338 Largest faculty (Lind University), 345 Latin American medicine, influence of, 362 Latin, a premedicai requirement, 65-67, 403, 404 Lazarettos, 44 Lecture course, average cost of, 392 Lectures as adjunct to preceptorship, 396 Letter of John Morgan to Governor William Denny of Pennsylvania, 57 Leyden University, 26, 46, 92, 259, 381, 430 Library Society (Charleston), 251 Licensure, 406 Lincoln-Woodward quarrel, 210 Lind University, 344, 345, 379 Lister's antisepsis, 286 Literary and Botanico-Medicai Institute of Ohio, 418 and Medical College of the State of Illinois (St. Charles, 111.), 337 Fund of Virginia, 261, 388 London Medical Repository, 263 Long Island College Hospital, 143-46, 166, 316, 389, 393, 394 Lottery grants or benefits, 228, 292, 387, 388. 390 Louisiana: early practice in, 362; legislature of, 365 Louisiana Purchase, 284, 353 Louisville, Ky„ Marine Hospital of, 300, 302 Louisville Medical Institute, 297, 299, 314, 390 Lunatic Asylum (N. Y.), 146 Lyceum of Natural History, N. Y„ 131 I.ying-in Hospital (Washington University), 245 Hospital (New York), 1 1 3 McDowell's College, 353, 354, 358

McDowell's plan to invade Upper California, 354 McGill University, 210 Madison Medical College, 347 Mail order medical practice, 73 Maine: legislature of, 387; Medical Society of, 203 Manhattan College, 147 Man-midwifery exposed, 408 Marine and Naval Hospital (New Orleans), 363

Hospital (Baltimore), 227, 244 Hospital (Charleston, S. C.), 253, 257 Hospital (Cincinnati), 317 Hospital (Evansville, Ind.), 336 Hospital (Louisville), 300, 302 Hospital Number 5 (Chicago), 343 Maryland: Assembly of, 225, 226, 235, 236, 243; Court of Appeals of, 235; Hospital, 227, 238, 242; Medical and Chirurgical Society of, 425; Medical Board of Examiners, 224, 226, 229 Maryland Medical Institute, 247 Maryland's claim to Dr. Russell, 10 Masonic University, 298, 302 Massachusetts: anatomical law (1830) of, 221; Board of Medical Examiners, 224, 226, 229; General Assembly, 172, 175, 176, 182; Historical Society, 12, 172; Humane Society, 172; Medical Society, 31, 33, 174, 176, 212, 425 Massachusetts College of Physicians, 175 General Hospital, 53, 54, 172, 17g, 181, 182 Hall (Bowdoin), 202 Medical College of Harvard University (see Harvard College), 183, 185 Mathematics, a premedicai requirement, 403 Matriculation fee, 392 Medical Academy of Georgia, 276 and Chirurgical Faculty (Maryland), 224, 225, 228, 384 Medical and Philosophical Register, 115 Medical college in a cave, 303 College of Alabama, 376 College of Chicago, The, 340 College of Cincinnati, 153 College of Evansville, 336 College of Georgia, 276-79, 282, 38g, 423 College of Georgia Infirmary, 278 College of Louisiana, 362-68, 292 College of New York City, 147 College of Ohio, 121, 188, 293, 299, 304-19, 322, 339, 342, 343, 379, 388, 393 College of Philadelphia, 105, 106

GENERAL Medical College of South Carolina (see Medical College of the State of South Carolina), 251-58, 276, 389 College of the Slate of South Carolina (see Medical College of South Carolina), «55-58. 394 College of Transylvania (see Transylvania University), 289 College of Virginia, 264, 273-75, 282, 370, 383, 392; Board of Visitors of, 274 degrees granted in eighteenth century, 430 Department of Continental Army, 58, 59, 72, 168 and Chirurgical Society of Maryland, 4*5 department integral part of university structure, 267 education costs in Philadelphia, 102 education for women, 342 education in eighteenth century, 6« graduation, first American, 68, 69 History Society, University of Maryland, 238, 239 Institute of Georgia, 276 "Medical Institution of the State of New York," 1*8 Instruction," 219 Medical jurisprudence, 396 journalism, 31, 178 legislation, 29-31; New York, 29; New Jersey, 30; professional societies' influence on, 30 library of Transylvania University, 294 libraries, 398 literature from England and Continent, 398 men of Revolution, 58 Medical Repository, 31, 114, 145 Medical School of Maine of Bowdoin College, 201-4 secession in South Carolina, 253-56 societies, founding of, 30, 31 training, cost of, 392-95 Medico-laymen, 149 Memphis Institute, 373 Medical College, 372, 373, 392 Medical Institute, 296, 373 Mental diseases added to curriculum, 245 Mercy Hospital (Chicago), 343, 344 Seat, Va., 269 "Meritorious and necessitious" students, 394. 395 Mesmerism, 393, 408 Methodist University of the Pacific, 378 Mexican War, 156 Miami Medical College, 188, 315, 322-25, 393

INDEX

469

Miami University, 310-17 Microscope as teaching aid, 396; binocular, 367; inverted, 264 Middlebury College, 204, 205, 216, 217, 219, 383 Midwives, 407 Military medicine, effect of on medical education, 57, 59, 380, 429, 430 Ministers of the Gospel, 336 Miscellaneous medical education efforts in New York state, 166 medical schools in New York City and Brooklyn, 139-48 Mississippi, Medical Society of, 425 Missouri: early doctors in, 353; General Assembly of, 358; medical schools in, 35371 Missouri Institute of Science, 355, 356 Medical College, 354, 355, 399 State University (Missouri Medical College), 354, 355 Modern clinical teaching pioneered, 370 Morbid-minded youth attracted to medicine, 408, 409 Morgan-Shippen feud, 6, 7, 58, 59, 75-78, 171 Morrison College, 291 Mt. St. Mary's Seminary, 316 Multiple duties of pioneer physicians, 284, 285 "Mutual Admiration Society," 141 Nashville Journal of Medicine and Surgery, SOS National Board of Health, 264 domain, 284 Medical Convention (Association), 204, 245, 256, 282, 341, 386, 425, 427 Medical College (see Columbian College), 249, 393 Sanitary Aid Association, 415 Nationalism, influence of, on medical education, 76 Natural philosophy, a premedicai requirement, 403, 404 New Dictionary of Medical Science and Literature, by Robley Dunglison, 263 New England Botanico-Medicai College (Worcester Botanico-Medicai College), 420 Confederation, 167 New England Eclectic and Guide to Health, 420 New England Female Medical College, 419 medicine, 167 pioneers, 186, 325 New England's medical contribution to westward expansion, 222, 379

MEDICAL EDUCATION BEFORE THE CIVIL WAR

470

New Hampshire: legislature, 189, 387; Medical Society of, 31, 189, 190, 422, 424, 4*5 New Hampshire Medical Institution (see D a r t m o u t h College), 190 plan of reform, 424 New Jersey Medical Society, 30, 425 New Orleans, La.: City Council of, 366; medical schools in, 362-71, 373 New Orleans Medical and Surgical Journal, 367 Medical News and Hospital Gazette, 369-7« New Orleans School of Medicine, 368-71, 401 New York City: City and County Medical Society, 31, 113, 119, 127, 139, 383, 397; H i g h School Society of, 121; House of Correction, 52 New York Almshouse Department becomes Bellevue Hospital, 136, 145 Dispensary, 110, 113 Homeopathic Hospital, 147 Hospital, 50-52, 113, 131 Hospital School of Medicine, 139, 140 Infirmary for W o m e n and Children, 4'4> 415 New York Journal of Medicine Collateral Sciences, 122, 139 Lancet, 137 New York

and

the

Medical College, 140-45, 370,

394 Medical College and Charity Hospital (see New York Medical College), 141 Medical College and Hospital for W o m e n , 415 New York Mercury, announcement in, 110 New York Metropolitan Medical College,

>47 School of Medicine, 139 State: legislature of, 29, 123, 137, 154, 385, 415; Medical Society of, 114, 118, 142, 152, 395, 423-25; upstate, 149; western district of, 149, 221 University (see University of the City of N e w York), 122, 134-38, 209, 256, 269, 33°. 389, 395. 4*5 North American Academy of Homeopathic Medicine, 416 North American Medico-Chirurgical Review, 371 Northampton conference on reform, 422, 423 Medical Convention, 194 Northern Dispensary (New York City), 121 Medical Association (Philadelphia), 106

Northwestern University, 345, 433 Norwich University, 219, 220 Obstetrics, chair of, 397 Odd Fellows, 358, 395 O'Fallon Dispensary (St. Louis), 360 Preparatory School of Medicine (St. Louis), 360 Office of doctor as teaching facility, 56 Office study, cost of, 394 Oglethorpe Medical College, 281, 282 Ohio: first medical convention in, 307; General Assembly, 305, 307, 314, 319, 320, 321, 328; medical schools in, 304-31 Ohio Dental College, 324 Ohio Medical and Surgical Journal, 412 Ohio Medical College (see Medical College of Ohio), 188, 337 Ohio's first Medical Convention, 307 Old South Church, Boston, 13 Omnibuses for student transportation, 244 Oneida Academy (see Hamilton College), '53 Outdoor obstetrical service (Medical College of Georgia), 278 Ovariotomy by Ephraim McDowell, 285, 286 by Nathan Smith, 285 Oxford University, 259 Padding matriculation reports, 320 Pamphleteering, 317 Panic of 1837, 163 Papier-mâché anatomical models, 247 Pathological anatomy course: fee for, 393; required subject at University of Maryland, 239 Society (Philadelphia), 106 Paul House (St. Louis), 355 Penitentiary (Virginia), 270 Penn Medical University of Philadelphia, 101 Penn's "holy experiment," 1 Pennsylvania: independent medical schools of, 106; legislature of, 385; Medical Society of, 425 Pennsylvania (Gettysburg) College, Medical Department of, 94-97, 392, 393, 425 Pennsylvania Gazette announcement of founding of College of Philadelphia, 63 Pennsylvania Hospital, 5, 36, 42, 44-48, 71, 79, 95, 106; library of, 398, 403 Peripatetic anatomist, Alexander Ramsay, 187 professor, John Delamater, 327, 329 Petition for medical college charter in District of Columbia, 248

GENERAL INDEX P h i l a d e l p h i a , Pa.: C o u n t y M e d i c a l Society of, 106; G e n e r a l H o s p i t a l , 48-50, 86, 95, 106, 412 Philadelphia Academy, 1 Association for M e d i c a l Instruction, 104, 105 College (see College of Philadelphia), 397. 403 College of M e d i c i n e , 97-99, 410 Lying-in Hospital, 106 Medical Institute, 105 Medical Society, 31 Polyclinic and College for Graduates in Medicine, 103 School of A n a t o m y , 97, 103 Phrenology, 293, 366, 412 Physiological e x p e r i m e n t s of B e a u m o n t , 286 Physiology and a n a t o m y , separate chairs in, 279 Physio-Medical College, 314 Physio-Medicals, 419 Physiopathists, 41g Pillbox and lancet, 284 Plain Remarks on Wounds and Fractures, 58, 109 Polyclinic Hospital (Medical College of Georgia), 278 Poorhouse (Chicago), 343 Poorhouses, 44 Pope's College, 356-58 Portland Medical School for Preparatory I n s t r u c t i o n , 220

School for M e d i c a l Instruction, 220 Post surgeon, 286 Practical anatomy, special fee for, 393 Prayer of President W h e e l o c k of Dartmouth College, 189 Preceptorship, 32-38 Preclinical subjects, 396 Practical anatomy, 432; lack of, 422 Premedicai requirements, 403, 404, 422 Prince E d w a r d M e d i c a l Institute (see R a n d o l p h - M a c o n College), 268 Princeton University, 1 Private hospital (New Orleans), 363 Medical Institute of B a l t i m o r e , 246, 394 school of Dr. C h a m b e r l a i n et al., 324 tutelage, a g r a d u a t i o n requirement, 404, 405 Professorship subject to two-thirds vote of faculty, 306 Professorships combined, 396, 397; customary, 396 Professors' income based on n u m b e r of matriculants and graduates, 422 Proprietary medical schools, 431

47»

Protestant E p i s c o p a l H o s p i t a l (Philadelphia), 106 Evangelicals, 288 Provincialism, 354 Prussia, 223 Public W o r k h o u s e a n d H o u s e of Correction of the City of N e w Y o r k , 5g " P u f f - m a s t e r g e n e r a l , " 327 Quakers, 1 Q u a r r e l in C l e v e l a n d profession, 331 Queen's C o l l e g e (see R u t g e r s College), 1, 61, 125-29, 430 R a n d o l p h - M a c o n C o l l e g e , 267-69 R e f o r m in m e d i c a l e d u c a t i o n , 232, 253, 257, 272. 277. 3 5 ' . 370. 374. 403. 404 m o v e m e n t s , 422-28 suggestions: B o w d o i n C o l l e g e , 423; C o l u m b u s , O h i o , 423, 424; G e o r g i a Medical C o l l e g e , 423; N e w H a m p s h i r e , 424; N o r t h a m p t o n , 422, 423; O n o n d a g a C o u n ty M e d i c a l Society, 424 R e f o r m e d M e d i c a l C o l l e g e of the City of N e w Y o r k , 419 M e d i c a l School of C i n c i n n a t i (Eclectic M e d i c a l Institute), 419 M e d i c a l Society of the U n i t e d States, 419 " R e f o r m e d School," 419 S y s t e m " (see Friendly B o t a n i c Societies), 418 Regents of the University of N e w Y o r k , 112, 114, 181, 125, 130, 150, 383, 385 R e l a t i o n s h i p b e t w e e n Y a l e M e d i c a l Institution a n d State Society, 197, 198 Request for Pennsylvania State to c u r b irregulars, 80 Resident physicians i n hospitals, 237, 238 Rest homes for seamen, 44 "Resurrectionists," 213, 306, 399, 432; see A n a t o m i c a l lectures a n d Dissection R e v o l u t i o n a r y W a r , 30, 57-60, 168-70, 174. 204, 2 1 1 , 251, 267 R h o d e Island: G e n e r a l Assembly o f , 199; M e d i c a l Society of, 425 R h o d e Island C o l l e g e (see B r o w n U n i v e r sity), 19g R i c h m o n d M e d i c a l School, 270, 271 Rock Island M e d i c a l College, 347, 348 R o m a n P a n t h e o n , college b u i l d i n g patterned a f t e r , 228 R o y a l Society, 2 R u s h M e d i c a l College, 156, 317, 337, 33944. 347. 393- 4 M R u t g e r s C o l l e g e , 120, 121, 129-32, 242, 39» M e d i c a l Faculty of G e n e v a College, 133. 159. 242, 321

47«

MEDICAL EDUCATION

St. John's Hospital (Nashville), 375 Hotel for Invalids (Cincinnati), 323 St. Joseph's Hospital (Philadelphia), 106 St. Louis College of Medical and Natural Sciences, 359 Hospital (Sisters of Charity), 357 Medical College, 357, 358 Medical Society, 353, 359 University (Pope's College), 340, 354, 356. 357- 378. 401 St. Paneras Hospital (London), 178 St. T h o m a s ' Hospital (London), 146 St. Vincent's Hospital (Cleveland), 331 Salary for medical professor, 263, 283, 351, 379. 382 Savannah Medical College, 279-82 Medical Institute, 279 Poor House and Hospital, 279, 280 Scholarships, 84 School of Anatomy, Joseph M . Allen's, 410 teacher and doctor with early settlers, '49 Schools of Transappalachia, 284-379 Scientific Medical and Eclectic Institute of Virginia, 419, 420 Second Continental Congress, 7» Sectarian schools, 416-21 Shelby Medical College of the Central University of the General Conference of the Methodist Episcopal Church, South, 375 Shortness of term, 422 Similia similibus curantur, 416 "Siminery," 338 "Simples," 417 Sing Sing Prison, unclaimed bodies from, 123 Sisters of Charity Hospital: Buffalo, N . Y., 165; St. Louis, Mo., 355, 357 Six-month term urged, 277 Smallpox, 267, 362 hospital (Chicago), 343 South Carolina: legislature of, 252, 254; medical schools in, 251-58; Medical Society of, 31, 258; State Medical Society of, 251-53 South Carolina College, 251 South: schools of the old, 223-83; students from, 240, 274, 278, 279, 282, 375; students sent abroad from, 251, 259 Southern Botanico-Medicai College, 419 Medical College of Atlanta, 281 medical schools, estimate of, 283, 375 Southerners, patriotic motive of, 282 Special facilities for medical education in Philadelphia, 101-5 Starling Medical College, 328, 329 State Hospital (Tenn.), 375

BEFORE T H E CIVIL

WAR

State Medical Convention (Ohio), 307 societies, "visitors" or "delegates" of, 385 University of Iowa, College of Medicine, 350 Steam navigation on O h i o and Mississippi, 291, 300 Stethoscope, 273 and Virginia Medical Gazette, 272 Struggle between rival schools in Philadelphia, 74 Student residence in hospital, 243 Student's Guide, 393, 394 Stuyvesant Institute, 137, 389 Summer Institute (Cincinnati), 320 schools, 324 Superior Court of Chatham County, Ga., 279 Surgeon-General's Library, 398 Surgeon's Hall, 83 mate, 286 Surgery lectures, ticket for, 392 Sutter's mill, 377 Syllabus of a Course of Lectures on

Chemis-

t r y-

73 Syracuse Medical College, 415 University College of Medicine, 150, 156, 158 "Scythian stock," 353 Telescope, The, 419 Temperance pledge, 317 Tennessee: legislature of, 375; medical schools in, 372-75; Medical Society of, 372. 425 T e r m , length of, 402 Textbooks, 397, 398; students' purchase of, 398 The Medical Student; or Aids to the Study of Medicine, 398 Theory and practice of medicine, first American course in, 64 Therapeutic Institute of Philadelphia, 103, 104 Thesis, requirement of doctorate, 403, 404, 406 " T h i r t y Years' W a r , " 306 Thomsonian Record, 418 Thomsonianism, 313, 415, 418-21, 433 Thomsonians, true, 41g Thoughts on the Impolicy of Multiplying Schools of Medicine, 295 Ticket system of handling fees, 392 Trivoli Theatre, 87 T o l a n d Medical College, 378 Toner's, J. M., manuscript, 27, 223, 251, 259 Training of pioneer Ohio physicians, 304

GENERAL INDEX Transylvania Journal of Medicine and Associated Sciences, »94 Transylvania Medical College (see Transylvania University), 292 Transylvania Medical Journal, 294 Transylvania Seminary, 289 University, 61, 236, 256, 261, 289-98, 304, 308, 309, 3 1 1 , 314, 318, 320, 325, 353, 379· 3 8 9 · 39*. 398. 4 3 ° Treaty of Paris (1763), 186 T r e m o n i Street School (Boston), 183, 219, 394 Trinity College, Dublin, 109 T r u e Thomsonians, 419 Transactions of the American Medical Association, 427 Twenty-one-year age limit, 404, 406 T w o lecture terms requirement, 405 T w o year attendance regulations, 81 Union Army, 262 hospital (Nashville), 375 University, 163 United States Navy, 156 United States Pharmacopoeia, 398 United States Thomsonian Society, 418-21 Unethical conduct of teachers, 422 University of Buffalo, 159, 163-65, 370, 392 of California, 378 of Edinburgh, 2, 10, 27, 40, 46, 50, 7 1 , 72, 92, 1 1 0 - 1 2 , 1 1 7 , 223, 225, 259, 284, 308, 379· 3 8 · . 4 3 ° of Friedburg, 416 of Georgia Medical Department, 278 of Glasgow, 224 of Iowa, 349 of Louisiana (Medical College of Louisiana), 367, 368 of Louisville, 269, 293, 299-303, 31g, 378. 379. S89. 39° of Maryland, 223-41, 243, 245, 246, 267, 306, 363, 384. 387, 388, 392-94, 403. 405. 4 3 ° of Maryland Hospital (see Infirmary), «37-39 of Maryland, regents of, 226, 228, 229, 234, 235. 264 of Maryland, trustees of, 226, 228, 229, 234. 235. «39 of Michigan, 343, 350-52, 379, 381, 389 of Mississippi, 261 of Nashville, 293. 373-75 of New York, regents of, 1 1 2 , 114, 1 2 1 , 125, 130, 150, 383, 385 of Pennsylvania, 1, 61, 63-85, 8 7 , 9 1 . 93, 107, 108, 133, 187, 188, 223, 225, 230, 256, 259, »64, 268, 2 7 1 , 275, 277, 278, 282, »89, 3 1 3 , 319, 3 2 1 , 341, 343, 363, 379, 381.

473

University, 392-94, 397, 400, 403-5, 417, 423, 430. 433 of South Carolina, 196 of Tennessee, 375 of the City of New York (see New York University), 134, 135, 387, 433 of the Pacific, 377, 395 of the State of Pennsylvania, 61, 76-79 of Transylvania (see Transylvania University), 388 of Vermont, 153, 204, 2 0 7 - 1 1 , 215, 217, 219, 231 of Virginia, 232, 260-67, «69. «7 1 · 283, 286, 373, 383, 388, 389, 393, 402, 405 of Wisconsin, 346 Vanderbilt University, 375 Vapor baths, 418 Vegetable remedies, 41g Vermont: General Assembly, 205; State Medical Society of, 215, 422, 425; T h i r d Medical Society of, 286 Vermont Academy of Medicine (see Castleton Medical College), 160, 196, 206, 215 Medical College (see Clinical School of Medicine), 207, 2 1 5 - 1 9 , 221 Virginia: Assembly, 261, 273, 289; medical schools in, 25g-75 Virginia Medical College, 383; see Medical College of Virginia Vocational therapy, 46 War of 1 8 1 2 , 268, 286 " W a r of Extermination," 318 Ward's Island, 146 Washington and Lee University, 261 College, 242 College of Chestertown, Md., 61 College School of Medicine (Washington Medical College of Baltimore), 242, 243. 394 Medical College of Baltimore, 232, 242-45, 268, 282, 31g Medical Institute, 24g University Hospital, 243-45 University of Baltimore (see Washington Medical College of Baltimore), 243-45. 393 University ( St. Louis), 358 Waterville College (see Clinical School of Medicine), 216, 383 Wesleyan University, 324 West in medicine, the, 284-88 Western doctors, training of, 288 Hospital (see Geneva Medical College), 159 Western Journal of the Medical and Physical Sciences, 309, 310, 318

474

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

Western Medical Gazette, the, 309 Medical Reformer, 419 Western Reserve College, 153, 339-31, 339, 414 Westward expansion, 284, 285, 318, 326, 378. 379 Wheaton and Co., 358 W h i g campaign of Henry Clay, 296 William and Mary College, 1, 61, 259-61, 43° Williams College, 211, 212 Willoughby Medical College, 325-28 Medical College at Columbus (see Starling Medical College), 328, 395 University of Lake Erie, Medical Department of (see Willoughby Medical College), 326, 328 Wills Hospital (Philadelphia), 106 Winchester Medical College of Virginia, 261, 262, 388, 392, 402 Wisconsin Medical Society, 346 Medical College, 346, 347 Women and medical education, 407-15

Women's Education Association, 407 Hospital of Philadelphia, 413 Medical College cf New York Infirmary, 414, 415 Medical College of Pennsylvania (Female Medical College), 412-14 Woodstock Clinical School of Medicine (see Vermont Medical College), 393 Worcester Botanico-Medicai College, 420 Medical Institution, 420 Medical School, 420 Worthington College, 419 Worthy, poor students, 394, 395 Yale College Corporation, 193 College, Medical Institution of, 1, 60, 6 i , 192-99, 202, 204, 209, 211, 221, 222, 266, 286, 373, 393, 394, 400, 404 graduates practising medicine, early, 192 Year of practice accepted in lieu of one lecture term, 320 Yellow fever, 362

INDEX OF PERSONAL NAMES Abernethy, John, 118, 120 Ackley, Horace Α., 326, 327, 330 Adams, Herbert B., 263, 376 , Samuel, 33g , Seth, 202 , William, 33, 34 Addoms, Jonas Smith, 127, 128 Aesculapius, 411 Agassig, Louis, 258 Agnew, D. Hayes, 49, 103 Alexander, Henry, 255 Allen, B. W., 264 , C. C., 141 , Ethan, 186, 195 , Isaac, 328 , J. Addams. 333, 343, 351 , J. R., 292 , Jonathan M., 96, 103, 206 , Joseph Eve, 277 , Joseph M., 410 , William H., g8, 202 Anderson, William, 206, 20g , W . H „ 376 Andreas, Α. 'Γ., 343 , Don, 54 Andrew, Jacob P., 332 Andrews, Edmund, 345 , William P., 332 Annan, Samuel, 243, 288, 292, 301, 302 Antony, Milton, 276, 277, 418 Archer, John, 69 Aretacus, 12 Armor, S. G., 348, 350 Armsby, James H., 161, 162, 206 Armstrong, James, 42 Arnold, R . D., 279, 280 , Richard, 425 Astor, John J., 146 Atlee, Washington, 95, 96 Auzoux, 247 Avery, Charles L., 323, 324 Axson, A. Forster, 369 Bache, Franklin, 91 Bacon, John, 180 Bagnali, Anthony, 10 Baker, Alva H., 321 -24, 334, 393 , Samuel, 226, 231, 236, 237 , William N., 234, 236 Balling, W . M „ 292 Bancroft, George, 134

Bankston, Lanier, 41g Barbour, Thomas, 355 Bard, John, 21, 36, 3g, 55, 109, 110 , Samuel, 36, 50, 51, 110-12, 117, 118, 430 Barker, B. Fordyce, 141, 146, 203 Barnaby, R u t h , 24 Barnard, Daniel, 161 Barnes, Albert, 412 Barret, W. L., 355 Barrett, Richard, 355 Barrow, Alexander, i g Barston, George, 378 Bartlett, Elisha, 122, 135, 188, 189, 19g, 218, 219, 236, 292, 293 , John, 301 , Joseph, 168, 170, 173, 174 , Josiah, 173, 402 , Lyman, 216 , Moses, 15, 122 Barton, Benjamin Smith, 78, 7g, 82, 105 , Edward H., 365, 367 , William P. C „ 86, 89, 103-5 Bartram, William, 76 Basey, Samuel, 250 Batchelder, John P., 205, 212-14 Bates, Joshua, 217 Baumgarten, G. H. F., 360 Baxley, Henry W., 234 Bayard, Robert, 129 Bayley, Richard, 118 Bayless, George W., 314 Beach, Abraham; 126, 127 , Wooster, 40g, 418, 41g Beakley, Jacob, 417 Beale, James, 270 Beard, Cornelius C., 369, 370 Beattie, F. S., 49, 87, 89 Beatty, Louis H., g9 Beaumont, William, 286, 287, 356 Beck, John Brodhead, 22, 44, 120, 122 , Lewis C., 160, 162, 206 , Paul, 100 , T . Romeyne, 150, 153, 162, 398 Bedford, G u n n i n g S., 121, 122, 135, 136, 161, 162, 255 Beebe, Gaylord D., 417 Beecher, Mrs., 24 , Catherine, 407, 408 Beers, T i m o t h y , ig6 Behr, Α., 360

4/6

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

Belcamp, van, 17 Bell, John, 209, 425 Bellinger, John, 255 Bellingham, Samuel, 13 Benedict, G. W., 210 Bennett, John Cook, 326, 327 Berkley, Lord, 17 Bernard, Claude, 164 , Sir Francis, 211 Bernays, G., 360 Biddle, John Barclay B., 96, 100 Bigelow, Jacob, 118, 176, 177, 180-83, l 8 5 Billings, J . S., 31, 84, 91. 217, 281, 335, 373 , John B., 316 , Peter, 23 Bird, Robert M., 94 Black, Joseph, 70 Blackman, George C., 315-17 Blackwell, Elizabeth, 158, 409-15 , Emily, 414, 415 Blair, Hugh Α., 281 Blake, James, 357 Blaney, V. Z., 341 Blount, William, 127 Blythe, James, 289, 290, 292 Boardman, Andrew, 158, 159 , John H., 359 , Η. K., 417 Bobbs, John S., 334 Boerhaave, 27, 71, 73, 287, 397 Bohannan, Richard L., 271 Bohrer, Benjamin S„ 305-8 Bohun, Lawrence, 10 Bolton, James, 273 Bond, Phineas, 19, 35, 36, 45 , Thomas E., 35, 36, 42, 44-50, 64, 65, 69, 77, 226, 243 Boring, Jess, 280 Bowen, Ephraim, 15 , Pardon, 15 , Richard, 15 , William C., 15, 200 Bowling, W. K„ 303, 374, 375 Boylston, Thomas, 13, 53 , Zabdial, 13, 23 Bradford, William Α., i l , 261 Bradley, Mrs., 24 Brainard, Daniel, 153, 340-43, 356 Bray, Madeson J., 336 Brickell, D. Warren, 369, 371 Briggs, Robert, 270 , William T., 375 Brighton, John H., 49 Broadwcll, Mary, 24 Bronson, John O., 143 Brower, Abraham, 115 Brown, John, 28 -, Abner H., 328

Brown, Daniel E., 333 . George, 224-26 , H. W., 280 , J . Waldo, 328 , R. K., 143 , Samuel, 289, 292, 305, 306 Brown-Sequard, Charles Edward, »74 Bruce, Archibald, 115, 128 , J . M., 292 Bryan, Dr., 142 , James, 207 Buchanan, A. H., 375 . George, 43, 223, 224 , Joseph, 290, 29», 375 Buck, Gurdon, 140 Buckler, John, 231 Buckman, E. D., 101 Budd, Berr L., 142, 143 , Charles Α., 143 Bulkeley, Gershom, 15 Bull, William, 19 Bullitt, Henry M., 292, 301 Bullock, W. G„ 279 Burbank, Asa, 213 , Charles H., 220 Burden, Jesse R., 98 Burnham, Walter, 101, 420 Bush, J . M., 292-94, 301 Butler, George, Jr., 213 Butterfield, John, 328, 329 Byford, William H., 334, 343 45 Byrd, H. L., 279, 281 Cabell, James Lawrence, 264, 266 ·, Robert G., 273 Cadwalader, John, 19, 36 , Thomas, 35, 39, 40, 45, 109 Caldwell, Charles, 36, ¿8, 74, 292-303, 314, 355. 374. 379- S»» Cameron, William, 321 Campbell, H. F., 277 Canby, Joseph, 307 Canfield, Jabez, 127 Card, George W., 327 Carman, B. R., 378 Camochan, John M., 141, 143 Carpenter, J . C., 356 , Walter M., 20g, 367 Carpentier, Mrs., 360 Carr, Ezra, 162, 207 Carroll, Hermanus, 39 , John, 229 Carter, Francis, 329 Carteret, Sir George, 17 Cassels, John L., 330 Cazier, John L., 205 Celsus, 12, 225

INDEX OF PERSONAL NAMES C e n a s , A u g u s t u s H., 364, 366, 367 C h a d b o u r n e , P a u l Α . , Î03, 213 C h a i l l é , S t a n f o r d . 363, 368 C h a l m e r s , L i o n e l , 22 C h a l o n e r , A . D . , 412 C h a m b e r l a i n , Ε . K . , 324 C h a m b e r l a y n e , L e w i s W e b b , 270, 273 C h a n g , 142 C h a n n i n g , W a l t e r , 180 C h i p l e y , W . S., 292 C h a p m a n , C h a n d l e r , Β . , 347-350 , N a t h a n i e l , 82, 83, 107, 397 C h a r l e s I I , 17 C h a s e , H e b e r , 92, 102, 394 , J o n a t h a n , 186 C h e a t h a m , W . Α . , 374 C h e r t s e r , d e M a r e o , 17 C h e s e l d e n , W i l l i a m , 39 C h e w , S a m u e l , 236, 237 C h i l d s , H e n r y Halsey, 203, 211-18, 328, 32g , T i m o t h y , 146, 203, 211 C h i p l e y , W . S., 292 C h i s e l d e n , 397 C h o p i n , S a m u e l , 369, 370 C h o v e t , A b r a h a m , 43 C h u r c h , B e n j a m i n , 58, 168 C l a p , R o g e r , 24 C l a r k , A l o n z o , 123, 218 , J o h n , 15 , W i l l i a m , 34 C l a r k e , E d w a r d H . , 26, 31 , J. H e n r y , 18 C l a y , H e n r y , 296 C l a y t o n , J o h n , 21 C l e a v e l a n d , P a r k e r , 202, 203 C l e v e l a n d , E l i z a b e t h H o r t o n , 413 Clossy, S a m u e l , 109, 110 C l y m e r , M e r e d i t h , 100, 272 C o a l e , S a m u e l , 224 Coates, R e y n e l l , 105 C o b b , J e d e d i a h , 203, 299, 308, 3 1 1 , 313, 3'4> 390 C o c k , T h o m a s , 123, 128 C o c k e , J a m e s , 225, 226, 228, 230 Coe, C a n f i e l d , 154 C o l d e n , C a d w a l l a d e r , 16, 21, 3 1 , 39, 51 C o l e , D r . , 154 , R . B e v e r l y , 378 C o l e m a n , A n s o n , 157 C o l h o u n , S a m u e l , 89, 90, 94 C o l z e y , E. F., 281 C o m e g y s , C . G . , 315, 323 C o n a n t , D a v i d Sloan, 142, 143, 203, 20g C o n a u t , 366 C o n r a d , D a n i e l , 261 C o n w a y , J a m e s H., 274 C o o k e , E s t e n , 314 , J o h n E s t e n , 261, 292-94, 297, 299

C o o k e , Josiah Parsons, 180, 230 , N i c h o l a s F., 417 C o o p e r , Sir Astley, 118, 176, 225 , D . M., 359 , Elias S a m u e l , 378 , T h o m a s , 252, 263, 290 C o t t o n , J o h n , 25 C o u p e r , J., 425 C o v e n t r y , C h a r l e s B., 157, 164 C o well, B e n j a m i n , 69 C o w p e r , W i l l i a m , 32 C o x , A b r a h a m , 141 , D a n i e l , 18 , C . C., 98 , H . G . , 141, 142 C o x e , J o h n R e d m a n , 82, 142 Cozens, F. S., 357 Cozzens, Issacher, 131 C r a i g , B e n j a m i n F., 250 C r a i k , James, 10 C r a m e r , E l i p h a l e t , 346 C r a n s t o n , C a p t a i n J o h n , 15, 60, 19g C r a w c o u r , I. L., 36g C r a w f o r d , Mrs. Jane T o d d , 285 , J o h n , 225, 23g , Mrs. J o h n , 23g Crosby, A l p h e u s B e n n i n g , 188 , D i x i , 188 , Joshua, 45 Cross, E d w i n C., 220 , J. C „ 292-gg, 312, 313, 373 C r o w , A l b i o n T . , 35g C r u i k s h a n k , W i l l i a m C., 43, 187 C u l l e n , J o h n , 271 , W i l l i a m , 2, 27, 67, 68, 71, 73,

477

110,

397 C u l p e p e r , N i c h o l a s , 21 C u n n i n g h a m , J o h n , 273 C u r r i e , James, 75 C u r t i s , A l v a , 314, 325, 418 C u s h i n g , Erastus, 330 C u t b r u s h , E d w a r d , 156, 157 C u t t e r , J o h n , 13

D a l l , C a r o l i n e H . , 407 D a l l a m , W i l l i a m , 73, 74 D a l t o n , J o h n C., 124, 144, 164 D a n a , Israel T h o r n d i k e , 203, 220 , James F., 120, 188, 190 D a n f o r t h , S a m u e l , 172 D a r r a c h , 95, 96, 410, 412 D a v i d g e , J o h n B e a l e , 224-26, 230-32, 237, 247. 383 Davis, C h a r l e s , 255 , E d w i n H a m i l t o n , 141 , J o h n Staige, 264, 266, 323

478

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

D a v i s , N . S., 9, 379. 390-9". 428. 433 Davissen, Mrs. Dawson, John

2 1 , 22, 87, 5 7 , 79, 153, 3 4 · " 4 5 . 393- 395- 4°3- 4 ° 5 · 4«4. 425. A . W . , 340, 341 B., 366

, W . W., 316 D ' A l v i g n y , N . , 281 D e a n , A m o s , 162 , J a m e s , 209 , N a t h a n i e l W . , 347 D e B u t t s , E l i s h a , 226, 230-32, D e H u i s e , D r . , 16 D e l a f i e l d , E d w a r d , 120, 1 2 1 , D e l a m a t e r , J o h n , 150, 152, 203, 213, 327, 3 2 9 - 3 1 , 338,

237 123, 425 1 5 3 , 156, 188, 433

. J· J·. 3 3 ° D e m m i n g , E., 3 3 3 , 3 3 4 D e n n y , W i l l i a m , 57 D e n t o n , S a m u e l , 338 D e t m a l d , W i l l i a m , 124 Detwiller, H e n r y , 416 D e v i l l e , T i t u s , 345 D e w e e s , W . P., 83, 397, 398 Dewey, Chester, 213, 218 , E l i j a h , 339 , N i l s o n , 346 D e W i t t , B e n j a m i n , 115 D ' W o l f , J o h n , 200, 206 D e x t e r , A a r o n , 170-75, 179 D i c k , A l e x a n d e r , 71 D i c k e r s o n , M . W . , 98 Dickeson, W . W., 412 D i c k i n s o n , J o n a t h a n , 15, 18 D i c k s o n , S a m u e l H . , 101, 2 5 1 , 252, 256-58

D u n g l i s o n , R o b l e y , 89-91, 231, 261, 264, 286, 397, 398, 404, 405 D u n h a m , L e w i s , 126 D u n l a p , L., 334 D u n s t e r , H e n r y , 167 D u n t o n , J o h n , 24 D u p u y , J o h n , 25 D w i g h t , T i m o t h y , 193, 195 D y e r , M a r y , 25

263,

E a s t e r b y , J . H . , 252 E a s t m a n , S a n f o r d , 164 E a t o n , A m o s , 206 E b e r l e , J a m e s , 397 , J o h n , 86-89, 97, 293, 297, 310, 3 1 1 ,

254,

D i n e l y , " F a t h e r g o n e , " 12 , W i l l i a m , 12 D o c k , G e o r g e , 99 D o d d s , W i l l i a m B., 3 2 1 D o n a l d s o n , W i l l i a m , 226 D o n a v a n , T . W . , 326 D o r e m u s , K . O g d e n , 1 4 1 , 143, 144, 146 D o r s e y , J o h n Syne, 82, 83, 86, 397 , R o b e r t E., 234 D o u g l a s , J a m e s , 154 , Silas H . , 351 D o u g l a s s , W i l l i a m , 22, 23, 31 D o v e , J o h n , 273 D o w l e r , B e n n e t t , 428 D o w n e y , C h a r l e s G., 334 D r a k e , D a n i e l , 89, 153, 287-325, 355, 379, 420, 422, 4 3 3 , Isaac, 306 D r a p e r , J o s e p h , 321 , J o h n W i l l i a m , 135, 137, 146 , S i m e o n , 146 D r o w n e , S o l o m o n , 200 D r u r y , A l e x a n d e r G., 322

D u b o s e , J . E., 280 D u c a t e l , J u l e s T i m o l e o n , 2 3 1 , 232 D u d l e y , B e n j a m i n W . , 290, 292-97, 3 0 1 - 3 3 , E t h e l b e r t L., 292, 294, 301 , W i l l i a m , 144, 379, 389 D u f f i e l d , B e n j a m i n , 43 , S a m u e l , 69 D u g a s , L . Α., 277 D u k e of Y o r k , 17 D u m m e r , J e r e m i a h , 60 D u n b a r , J o h n R . , 243, 246, 247, 394 D u n c a n , J o s e p h , 339

313. 390. 397 E d d y , J o h n M . , 200 E d m i s t o n , D r . , 307 E d w a r d s , T . O . , 324 E l d e r , W i l l i a m , 410 E l i o t , J a r e d , 15, 185, 192 , J o h n , 12, 37 , J o h n s o n , 250 E l l i o t , G . T . , 146 E l l i o t t , S t e p h e n , 253 E l m e r , J o n a t h a n , 69 E m e t , J o h n P a t t e n , 263, 264 E m m e t , T h o m a s A d d i s , 132 E m m o n s , E b e n e z e r , 1 6 1 , 162 E n d i c o t t , J o h n , 11, 14 E n g , 142 E n o s , D . C., 144 E p h r a i m , D r . , 15 Erie, Pliny, 213 E u s t i s , G e o r g e , 366 E v a n s , C a d w a l a d e r , 35, 36, 48 , J o h n , 341 E v e , J o s e p h Α., 276, 278, 423 , P a u l F., 277, 375 E v e r t s , O r p h e u s , 348 E w e l l , T h o m a s , 409 E w i n g , J o h n , 77, 79, 172, 179 I'eay, W . T . , 281 F e n n e r , E . D., 369-71 F e r g u s o n , R i c h a r d , 298

INDEX OF PERSONAL NAMES Fillmore, Millard, 164 Finley, Μ. Α., 234 Firmen, Giles, 12, 37 Fishback, James, 290 Fisher, J. D „ 348 , William R., 234 Fiske, Phineas, 15 Fitch, G r a h a m N., 341 , Simon, 220 Flint, Austin, 141, 144, 146, 163, 164, 341, 37" ——, Austin Jr., 146, 370 , J o s h u a B., 299, 301 Foote, Η . E„ 315, 323 , J o h n P., 306 , Solomon, 206, 207 , T h o m a s M., 163 Ford, Corydon L., 351 , L. D., 277 -, Lewis, 276 Foreman, Edward, 243, 249 F ormen to, 366 Forry, Samuel, 12a Fortin, 366 Foster, C. Α., 336 Fothergill, J o h n , 4, 5, 46, 47, 70, 170, 171 Foulke, J o h n , 43 Francis, J o h n W „ 117-20, 130 33, 139 Franklin, B e n j a m i n , 1, 2, 4, 44-46, 50, 65,

479

7 ' · 77 Freedly, Samuel, 417 Freer, Joseph Warren, 343 Frelinghuysen, Frederick, 126 Frick, Charles, 237, 247 Frost, H . R., 251, 252, 257, 258 Fuller, Mrs. Bridget, 24, 407 , Samuel, 11, 24 Fullerton, H u m p h r e y , 69

Goddard, Paul B., 100 G o d m a n , J o h n D., 130, 306, 307 Goebel, D-, 360 Goforth, William, 287 Goldsmith, Alban, 312, 313, 318 , Middleton, 207 , Oliver, 72 Goodhue, Jonah, 213 , Josiah C., 186, 340 Goodman, J o h n D., 130, 131 Goodwin, Lyde, 224 Gordon, Charles, 17 , F. E„ 376 G o r h a m , J o h n , 172, 175, 179 Goudy, Calvin, 348 Gouley, J. W. S., 146 Graff, Jacob, 321 G r a h a m , 315, 316, 321, 327 Gram, J o h a n n e s B., 416 Granger, R a l p h , 327 Grant, William, 95 Graves, Ruf us, 188 Green, Henry, 160, 161 , Horace, 141, 206 , Jacob, 87, 90, 91 , Samuel Sweet, 131, 182 , William Warren, 213 Gregory, George, 408, 409 , Samuel, 408, 409 Gridley, Selah, 205 Griffith, Robert E., 231, 234, 264 Griffitts, Samuel, 78, 79, 82 Griggs, A. W., 281 Griscom, J o h n , 128, 130, 131, 139, 140 Gross, S. D., 90, 135, 285, 287-90, 293, 312, 314, 318, 319, 371 G u n n , Jaspher, 15 , Moses, 351

Gale, B e n j a m i n , 15 Galen, 12 Gallagher, Eugene, 336 Gallup, Joseph Α., 2o6, 215-20 Gait, W. T . , 298 Garden, Alexander, ig Gardiner, William Α., 417 Garvin, I. P., 277 Gasset, Helen M., 409 Gaulding, J e m i m a h , 267 Geddings, Eli, 231, 232, 253, 257, 258 Gibbons, Henry, 98 Gibson, Charles Bell, 272 , William, 82, 83, 226, 230, 397 Gilbert, David, 95, 96 Gilman, Chandler, 121, 122, 124 Gleason, C. W., 412 Gobrecht, W. H „ 97, 99

Hadley, George, 207 , James, 150, 156, 164 H a h n e m a n n , Samuel F., 331, 416 Hale, Enoch, 188 , Sarah J., 408 Flail, A. P., 376 , Josephus W „ 353, 356 , N a t h a n K., 163 ——·, Richard Wilmost, 226, 228, 234, 236, 237 Hallar, Albrecht, 32, 397 Halsey, W. S., 97, gg Hamerick, J., 359 H a m i l t o n , Frank, 146, 155-57, l 6 3- l 6 4 · 2 ° 7 , James, 3, 144, 150, 155, 157, 164 H a m m e r , Adam, 359, 360 Hammersley, William, 117 H a m m o n d , Edward, 171 • -, William Α., 237

48ο

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

Hancock, J o h n , 170 H a n d y , W a s h i n g t o n , 243 , W i l l i a m W . , »43 H a r d . Nicholas, 333, 337, 338 H a r d e n . E. J., 281 H a r d i e , B e n j a m i n W h i t e , «8* H a r e , R o b e r t , 82, 83 H a r l a n , J a m e s , 297, 30s , R i c h a r d , 49 Harlow, Lewis, 97 H a r m o n , E l i j a h Dewey, 339 H a r r i n g t o n , T . F., 38g Harris, T h o m a s , 105 , W i l l i a m , 105 Harrison, G. T . , 360 , J a m e s , 334 , J o h n , 362-68 • , J o h n P., 319, 325 H a r t s h o r n e , H e n r y , 97, 99 H a r t t , George, 298 H a r t w e l l , Ε. M., 399 Harvey, W i l l i a m , 26 H a u c k , Fred, 359 Hawes, C. N., 360 Hawkins, J a n e , 25 H a x a l l , R o b e r t W „ 270, 273, 427 H a y w a r d , George, 177, 268 H a z a r d , Samuel, 17 Hazel, A n d r e w , 183, 255 H e n d e r s o n , T h o m a s , 248 Henry, J o h n F., 310, 3 1 1 H e r i n g , C o n s u m i n e , 416, 417 Herrick, W i l l i a m Β., 341 Hersey, Ezekiel, 168 Heustis, J . F., 376 H e u s t o n , George, 9g Hewson, T h o m a s T . , 105 H i b b e r d , J a m e s F., 316, 335 Higday, T . . 333. 334 Higginson, J o h n , 24 H i l g a r d , T . C., 360 Hintze, F. E. B., 242 Hippocrates, 12, 294 H o a r , L e o n a r d , 13 H o b a r t , J o h n H e n r y , 156 , J o s h u a , 192 Hodge, H u g h L „ 49, 83 H o d g e n , J o h n T h o m p s o n , 355 H o f f m a n , Josiah O g d e n , 132 Höge, Moses, 273 H o l b r o o k , J o h n E d w a r d , 252, 258 Holcombe, Frederick, 143 Hollister, J o h n H., 345 Holmes, Oliver W e n d e l l , 12-15, 91, 1 1 7 1 , 172, 177-79, 183, 184, 188 , R . S., 357 Holyoke, E d w a r d , 3 1 , 169 H o o k e r , Charles, 196

H o o k e r , W o r t h i n g t o n , 196 H o r n e r , W . E., 277, 397, 410, 423 , W i l l i a m , 49, 82-85 H o r s f o r d , Ε. N., 180 Hosack, David, 33, 115-120, 129-34. 13g, '55. 156, 422. 433 H o w a r d , Flodoardo, 250 , H e n r y , 234, 264 , J. G „ 279 , R i c h a r d L., 329 H o w e , Zadoc, 2 1 3 H u b b a r d , H e n r y , 212 , J a c o b u s , 34 , J a m e s , 34 ——, Oliver Payson, 188 , T h o m a s , 86, 195 H u d s o n , A. S„ 348 H u g h e s , Ellis, 234 , J o h n J o s e p h , 146 H u m e , W i l l i a m , 255 H u m p h r e y , Friend, 161 H u n , T h o m a s , 1 6 1 , 162 H u n t , F r a n k l i n , 332, 417 , Sanford Β., 164 , T h o m a s , 362-66, 368 H u n t e r , J a m e s , 95 , J o h n , 2, 27, 40, 79, 381 , W i l l i a m , 2, 4, 26, 27, 40, 72, 109, 3 8 1 , 397 H u s t o n , R . M., 90, 91 H u t c h i n s o n , Anne, 24, 25, 407 , James, 77-79, 82 , J o s e p h C., 144 Ingalls, T h o m a s R., 364, 366 , W i l l i a m , 200 Ingals, E p h r a i m , 343 I s h a m , R a l p h N., 345 Ives, Eli, 193, 196

ι,

Jackson, Charles F., 286 , David, 69 ——, J. B. S„ 179, 181 • . James, 53, 172, 177-79, l 8 5 · *°5 , J a m e s , Jr., 179 , Samuel, 49, 50, 410 , W a r r e n , 177 Jacobi, A b r a h a m , 1 4 1 , 143, 409 , Mary P u t n a m , 415 Jacques, J o h n D „ 1 1 7 James, E d w i n , 160 , J o h n , 160, 339 , T h o m a s Chalkley, 82, 168 J a m e s o n , H o r a t i o B., 3 1 9 , H o r a t i o Gates, 232, 242, 243, 247 J a n e k e , H a n n s , 17 Jaynes, Leven S., 100 Jeans, J a c o b , 417

I N D E X OF P E R S O N A L Jefferson, Thomas, 90, 260, 262-65, 3®3 Jegli, J o h n B„ 500 Jenner, Edward, 27 Jennings, Samuel K„ 243 Johnson, Carter Page, 272 , Hosraer, 345 . J - 356 , James H., 359 , John B., 355 , Samuel, 78 , Thomas, 263, 271 , Walter, 94 , William P., 249 Johnston, Christopher, 237, 247 , James C., 298 Jones, B. L., 280, 281 , Edward, 19 — , George, 327 — , J. W„ 280 , James, 367 , John, 22, 51, 58, 109, 137 , Theodore, 134 Joseph, Francis, 268 Joyes, Dr., 74 Judkins, Jesse P., 315, 316, 323, 329, 397 Kane, Edward, 209 Kauffman, C. S., 321 Kearsley, John, 31, 36 Kellogg, J. L., 417 Kennedy, A. L., 98 Kent, James, 116, 117 , j . E., 101 Ketchum, George Α., 376 Kidder, C. W. B„ 420 Kieft, William, 16 Kierstedt, Hans, 16 Kimball, Gilman, 219 Kimberly, E d m u n d S., 340 King, A. T., 99 , H., 356, 359 Kinnersley, Ebenezer, 65 Kirby, Stephen W., 417 Kirkland, M. P., 313, 325 Kirtland, Jard P., 327, 330 Kissam, Samuel, 111, 129 Kittridge, William C., 207 Klapp, Joseph, 87 Knapp, Moses L„ 333, 341, 347, 348 Knight, Jonathan, 195, 425 Kollock, P. M„ 279 Kuhn, Adam, 67, 68, 74, 77-79, 82 Labalut, Dr., 366 LaFord, Corydon, 207, 213 Lamb, Daniel Smith, 249 Lambert, Dr., 366

NAMES

481

LaMontagne, Johannes, 16 Lane, H., 356 , Levi Cooper, 378 Lang, J . L., 327, 330 Lansing, John V., 209 Lathrop, Joshua R., 164 Latrobe, J. H. B., 233 LaValliere, Madame, 408 Lavoisier, Antoine-Laurent, 27 Lawrence, John, 69 Lawson, Benjamin S., 321 , L. M., 292, 315, 316 Laycock, Levi L., 336 Lecky, William H., 1 LeConte, John, 122 LeDran, Henri-François, 109 Lee, Charles Α., 203, 411 , Charles E., 135, 164 , George W„ 333 Leech, C. Α., ιοί Leeuwenhoek, 26 Leffingwell, Edward H., 355 LeHardy, J. C., 281 Leidy, Joseph, 83, 100 Leighton, David, 9 Lemomier, J. Y., 366, 367 Letcher, S. M., 292 Lettsonj, John Coakley, 47, 171 Levret, Andre, 26 Lewis, R. Α., 274 , William, 47, 3 g 7 Lincoln, Abraham, 417 , Benjamin, 209-11, 216, 217, 22». 222, 231, 232 Lind, Sylvester, 345 Lindsley, J. Berrien, 373-75 -, Philip, 373, 374 Lining, John, 19, 21 Linn, William, 126 Linnaeus, 19, 67 Linton, Moses L., 356, 357 Lister, Lord Joseph, 286 Litten, Abram, 356, 357 Livezey, Abraham, 101 Livingston, John H., 128 Lloyd, James, 26 Locke. John, Jr., 313, 314, 323 Lockhart, Dr., 16 Logan, James, 39 , Joseph P., 281 Lomas, A. J., 238 Long, Crawford, 286 , David, 325 Longshore, J. S., 101 , Joseph P., 412 Lord, Thomas, 15 Louis, Jean, 54 Lozier, Clemece Sopha, 415

48s

MEDICAL EDUCATION BEFORE T H E CIVIL WAR

Ludlam, Reuben, 417 Lukens, Isaiah, 101 Lull, John H„ 218 Luzenburg, Charles Α., 364, 366 Lyle, Charles L., 359 McCabe, Ε. H., 356 McCaw, James B., 265, 274 McClellan, George, 86-99, 3 l ° , Samuel, 90 McClintock, James, 97-99, 103, 142, 207, 208 McCloskey, J . H., 98 , James F. X., 412 McClurg, James, 260 McCook, George, 328 McCready, W. B., 135, 146 McDowell, Ephraim, 285, 286, 318, 353 , Joseph Nash, 310, 318, 319, 353-57, 379 , Maxwell, 230, 231, 237 McGill (Magill) Thruston, 261, 264 McGuire, Hugh Holmes, 261 , Hunter, 261 Mcllvaine, Robert R., 321 Mack, Theophilus, 164 McKay, Samuel, 212 McKeen, James, 203 McKenzie, Dr., 40 Mackie, J . Monroe, 264, 267 McLean, John, 341 McNaughton, James, 150, 161, 162 Macneven, William J., 120, 129, 130, 139 McPheeters, W. M., 357 Magrier, Dr., 409 Mahle, F., 345 Mallett, J . W„ 376 Malpighi, Marcello, 26 Mansfield, Edward D., 288 Marcy, William L., 119 Markoe, Thomas M., 135, 207 Manley, Dr., 152 March, Alden, 159-63, 199, 206, 207, 389, 425 Marsh, Joseph, 209 , Well R., 334 Marshall, A. K., 292 , John, 43 Martin, E. H., 279 Mather, Cotton, 2, 13, 14 , William, 207 Matthews, Caleb R., 417 , Stanley, 321 , Thomas P., 205, 206 Maupin, Socrates, 264, 271 May, Frederick, 248 , John Fred, 249 Mayo, William W., 334

Mead, Edward, 321, 338, 339 , Kate Campbell, 196 , Richard, 168 Meade, William, 261 Means, Alexander, 277, 280 Meeker, Daniel, 153, 332-34 Megapolensis, Samuel, 16 Meigs, Charles D., 91, 97, 105, 106, 398 , James Α., 99 Mendenhall, George, 315, 323, 324 Mercer, Hugh, 10 Merrick, Frederick, 329 Messer, Asa, 199, 201 Metcalf, T . J., 135 Mettauer, Francis Joseph, 267, 268 , Henry Archer, 268 , John Peter, 267-69 Middleton, Peter, 39, 51, 109, n o Milledoler, Philip, 130 Miller, De Laskie, 343 , Edward, 31, 1 1 3 - 1 5 , Henry, 299 , James H., 243 , Sylvester, 150 , Thomas, 249 Millington, John, 260 Miltenberger, George W., 237 Mitchell, C. L., 207 , J . K„ 91 , John, 10, 21 -, Jonathan, 167 , Samuel Latham, 31, 113, 114, 117, 120, 127, 129, 398 , Thomas D., 98, 292, 294, 297, 299, 310-12 Molony, Richard S., 347 Monker, John C. S., 243 Monro, Drs., 27, 40, 397 Montaigne, D. L., 417 Moor, Cornelius, 321 , Edward M., 164, 218 , Robert, 321 Moore, Anne, 12 , Sir Henry, 50, 51, 127 , James, 289 , John S., 353, 355 , William, 127, 129 Moorhead, John, 308-14, 317 Morehead, John, 306 Morgagni, Giovanni, 27 Morgan, James E., 249, 250 , John, 2-9, 22, 31, 35, 43, 44, 55. 57-59, 63-67, 70, 71, 74-78, 82, 85, 87, 154-57. 1 7 ' · 176, 382,402,403,430 Morison, James, 238 , Samuel Eliot, 168 Morly, Robert, 11 Morrison, J., 378

INDEX OF PERSONAL NAMES Morrison, James, 292 Morrow, T . V., 419 Morse, John F., 377 Morton, Samuel G., 49 , W. T . G., 54, 177 Mosely, N. R., 412 Molt, Valentine, 117-20, 129, 131-35, 137» •39

Moultrie, James, 19, 25, 255, 257, 258 , John, 25 Mulligan, G., 366 Munson, Aeneas, 195, 196 Murphy, J . Α., 315, 323 Murray, Henry, 359 . J - 397 Mussey, Reuben D., 150, 188, 203, 313, 314, 322-25, 379 Mutter, Thomas Dent, 91

Neil, J o h n , 96 Neill, Henry, 49 Nelson, Horatio, 209 , Robert, 207 N'ewcomb, Daniel, 79 Newton, Calvin, 420 , George M., 277 Nightingale, Florence, 16 Niles, J o h n B., 332, 333 Noeggenath, Emil O., 143 Norwood, Joseph Granville, 356 Nott, Josiah C., 376 Nourse, Amos, 203 Numi, Richard J., 281 O'Fallen, John, 356 O'Leary, Charles, 316 Oliver, Daniel, 188, 203 O'Reilly, Alejandro, 362 Osborne, J o h n C., 1 1 7 Orvis, Horatio, 150 Osier, William, 287 Outcalt, Peter, 321 Overton, James, 290, 292 Ovid, 73 Owen, Garonwy, 376 , Griffith, 18, 286 Paddock, Robert H., 328 , William, 209 Paine, Martyn, 135, 425 , Thomas, 72, 195 Pallen, Moses M., 356, 357, 360 Palmer, Alonzo Β., 213, 351 , Benjamin R., 164, 218 , David, 216, 217 Pancoast, Joseph, go, g ì , 410 , S., 101 Pankhurst, Joseph, 105, 410

483

Pardon, Dr., 15 Parker, Judge Joel, 141 , William, 156, 157 , Willard, 121, 122, 124, 216, 319 Parkman, George, 177, 179, 181, 183, 185 , Samuel, 207, 208 Parrish, Joseph, 99 Parsons, Joseph, 99 , Usher, 89, 188, 200 Paterson, T . V., 141-43 Patterson, Henry S., 95 Pattison, Granville Sharpe, 8g, 91-93, 135, 136, 231, 235. 237, 239 Payne, Dr., 137 , William E., 417 Payson, George, 417 Peaslee, Edmund Randolph, 141, 188, 203 Peers, Benjamin, 203 Pemberton, James, 46 Peniston, Anthony Α., 36g, 370 , Thomas, 36g Penn, Thomas, 2, 5, 45, 70 , William, 18 Pennypacker, Isaac, g9 Pepper, William, 42, 74, 80 Percey, S. R., 143 Perkins, Cyrus, 188 , Elisha, 416 , Joseph, 206, 207, 209 Perry, William, 203 Peter, Robert, 55, 56, 289, 290, 2g2, 297, 301-3, 389, 398 Peters, John C., 118 , Richard, 3 Petit, Jen-Louis, 109 Peticolas, Α. E „ 272 Phelps, Edward Elisha, 188, 209 Phillips, Elizabeth, 24, 407 , William, 53 Physick, Philip Syng, 7g, 82, 85, 86, 105, 268 Pickwick, Mr., 343 Picton, John M. W., 369 Pierce, John D., 350, 351 , W. S„ 348 Pierson, A. L., 33 • , C. E „ 3og-u Piertersen, Jan, 17 Pinchard, 2g7 Pitcher, Zina, 351, 382 Pitney, Dr., 154 Planner, J., 35g Platt, James Kent, 209 Poe, Edgar Allan, 243 Pomeroy, John, 209 Pope, Charles Alexander, 356, 357 Porter, Arthur Dartmouth, 209 ·, Charles H „ 162 , Robert M., 375

484

MEDICAL EDUCATION BEFORE THE CIVIL WAR

Post, Alfred C., j8, 39, 207, 208 , Wright, 118, 140

Pott, John, 10

, Perrival, 43, 109, 397 Poitenger, John, 360 Potter, Mrs., 24 , N a t h a n i e l , 115, 225, 226, 231-38, 247

Potts, Jonathan, 69, 71, 76 Powel, Samuel, 4 Powell, Llewellyn, 301 , Thomas S., 280 , W. Byrd, 366 Power, William, 237, 238 Prather, James Vance, 356 Pratt, Mr., 11 Preston, Ann, 413 Priestley, Joseph, 82 Prince, David, 153, 339 Prioleau, Thomas G., 252, 258 Prout, Hiram L„ 353 ——, Hiram Augustus, 356 Purviance, John, 230 Pylarini, 13 Quackenbush, John V. P., 16» Quinan, John R., 19

Rafinesque, C. S., 294, 418 , Samuel, 294 Ramsay, Alexander, 166, 187, 188, 218 , David, 19, 74, »51 , James, 251-53 , Samuel, 309 Rand, Howard, 97, 99 Randall, Richard, 248 Randolph, Jacob, 49 Raphael, B. I., 143 Rau, C„ 3 5 9 Ravenal, St. Julian, 258 Ravenel, Edmund, 252 Rea, Robert L., 343 Read, J. Bond, 279 Redman, John, 2, 4, 19, 35, 36, 45, 70, 71, 75 Reese, D. M., 161, 428 , L. Meredith, 143 -——, J o h n S., 97 Reeve, John C., 316 Revere, John, 89, 135, 136, 138 , Paul, 89 Reyburn, Thomas, 357 Reynolds, Edward, 183 Rhees, Benjamin Rush, 86, 88, 89 Rhinelander, John R., 120, 255 Richards, George W„ 153, 333, 334, 337, S3 8 · 547· 348. 35°. 379 Richardson, B. F., 315 . T . J., 97

Richardson, W. H., 290, 292, 293 , W. R„ 220 Riddell, John L., 319, 367 Ridgley, Frederick, 289, 290 Rientord, Francis, 127 , John Baptist, 127 Riley, Joshua, 249 River, Charles, 179 Rives, Landon C., 319 Roberts, J. J., 280 Robinson, Alexander, 236 , John, 11 , William Chaffee, 203, 220, 236 Roby, Joseph, 188, 203, 236 Rochester, Thomas F., 164 Rodman, William W„ 417 Roe, Edward H., 359 Roesch, C., 360 Rogers, Charles Chauncy, 13 , Coleman, 290, 304-7

, David L., 157, 158 , James B., 83, 100, 243, 31g , Robert E„ 83, 264 Rolfe, Enoch C„ 408 Romayne, Nicholas, 52, 112-17, 125, 129, >34. 389. 433 Rood, John, 338 Roosa, D. B. St. John, 52 Root, Oliver S., 212 Roper, Thomas, 257 Rosa, Storm, 327 Rose, Gustavus, 332 Ross, F. C., 376 Roward, T. G., 101 Rowell, Isaac, 378 Royeyne, T., 162 Ruse, Daniel M., 207 Rush, Benjamin, 19, 23, 28, 35, 58, 59, 6779, 82-85, 94, 95, 105, 1 7 1 , 268, 287, 288, 3 2 8 . 340, 397, 4 3 3

, James, 74 , William, 94 Russel, William, 207, 217 Russell, Walter, 9, 10, 19 Rutgers, Henry, 130 Rutter, David, 345 Sabin, Dr., 140 Sager, Abram, 351 St. John, Samuel, 122, 124, 330 St. Martin, Alexis, 286 Saltonstall, Henry, 13 Sanborn, E. R., 207 Sanders, Daniel Clark, 209 Sanford, John, 250, 348 Saugrain, Antoine, 353 Savory, C. Α., g8

INDEX OF PERSONAL NAMES Sayre, L. Α., 146 Schiel, J., 359 Schmoele, William, 101 Schreiner, Olive, 407 Schult, Gerritt, ι 6 Schurz, Carl, 359 S c h u u r m a n , Colonel, 126 Scott, Dr., 33 , Martin P., 273, 274 Seaman, Valentine, 53, 128, 145 Seeley, Henry Martyn, 20g, 213 Semple, Matthew, 417 Sewall, J u d g e Samuel, 14 , Thomas, 248 Seward, William H., 154 Seymour, William P., 207 Sharp, Dr., 397 Shattuck, George Cheyne, 179, 181 Shaw, J o h n , 225, 226 Sheldon, J o h n , 43 Shepard, 12, 37 , C. U., 258 Shipman, A. B., 333 , George E., 417 Shippen, William, Jr., 4-7, 26, 35, 36, 39-46, 5 8 · 59- 63-65, 69, 70-85, 171, 268, 398, 403, 430 , William, Sr., 36, 83 Short, C. W., 292, 294, 297, 299, 300 Shotwell, J o h n T . , 3 1 3 - 1 7 , 325 Siccary, Dr., 10 Silliman, Benjamin, 193, 196, 286 , Benjamin, Jr., 196, 397 Simons, T . U., 254 Sims, Francis, 268, 417 Sing, Edward F., 216 Sites, J o h n , Jr., 287 Skillman, H . L., 292 Skinner, Alexander, 298 , J. Sidney, 321 Slack, Elijah, 304-10, 318, 321 Slaughter, M. G., 280 Slaughton, James, 248 Small, Alvin E., 417 , Ε. Α., 417 Smelile, William, 26, 397 Smith, A. D., 346 , Alban G., 1 2 1 , 122 , Albert, 207 , A r t h u r , 23 , Augustine, 120 , Bathsheba, 39g , Baxter Perry, 187 , David S., 417 , Ε. Η., s i • , Edwin Β., 364 , Emily, 187 , Edwin R. ( 365

485

Smith, Elihu, 1 1 3 , Francis G., 97 , Henry, 83, 89 , Howard, 369 , Ira Η., 154 , J . Phillip, 261 , James, 109 , Jedediah, 154 , J e r o m e V. C., 213 , Jesse, 305-10 , J o h n , 186 89 ——, Captain J o h n , 9, 10, 19, 23 , J o h n Augustine, 114, 117, 118, 120, 260, 261 , J o h n Lawrence, 264 , J o h n Y., 347 , Judge, 116 , Mary, 23 , N a t h a n , 60, 152, 186, 188, 18g, 191, >95. '97· »99-*>5. *°9. »38. 285. 387, 390, 43°. 433 , N a t h a n Ryno, 209, 231, 234, 236-38, 245, 247. 292 , O r r i n , 209 , R o b e r t , 229 , Samuel, 146, 329 Snodgrass, Mr., 343 Snyder, J. M., 250 Sparks, W. H., 366 Spaulding, Lyman, 150, 152, 187, 188, 397 Spencer, Judge, 116 , Ο. M., 321 , R . Α., 321 , T . Rush, 328 , Thomas, 154-57, 34" Spoffard, Henry G., 345 Staats, A b r a h a m , 16 , Samuel, 16 Stafford, Ed., 14 Stahl, Daniel, 339 Starling, Lyne, 328 Staughton, James M., 248, 3 1 0 - 1 2 Stearne, J o h n , 150 Steele, Holmes, 281 , T h e o p h i l u s , 360 Stevens, Alexander H., 120, 122, 123, 427 , Charles W „ 357 , Samuel, 161 , T h a d d e u s , 94 Stewart, D., 247 ——, Richard S., 236 Stidden, T i m o n , 17 Stieren, H., 360 Stiles, Ezra, 193 , Richard Cresson, 209, 2 1 3 Stillé, Alfred, 50, 96, 105, 107, 425 Stokes, William H., 237-45 Stone, Robert King, 249

486

MEDICAL EDUCATION BEFORE THE CIVIL WAR

Stone, Warren, 362-67 Storer, D. H „ 180, 183 Strahan, William, 47 Straith, J . H., 261 Stringer, 33, 34 Stringham, James, 1 1 7 Studdiford, Peter, 126 Studer, Jacob, 329 Sweet, Dr., 140 Sweetser, William, 156, 203, 209 Swett, John Α., 135 Sydenham, Thomas, 26, 28, 71, 397 Taggert, W. H., 97, 99 Taliaferro, V. H., 281 Tallmadge, James, 1 1 9 T a r r , A. DeKalb, 101 Taylor, Bushrod, 261 , I. E., 146 , J . E „ 146 , John, 161 , Μ. Α., 345 Teats, Sylvester, 146 Temple, John T., 340 Tennant, John V. B., 26, 109 Tenny, John Searle, 203 Terris, Israel, 335 Thacher, James, 1 0 1 4 , 109, 1 3 1 , 190, 202 , Thomas, 13, 21, 25, 26, 192 Thayer, Samuel White, 209 , William H., 213 Theobald, E. W., 247 Thomas, A. R., 101 , John, 338 , Richard Henry, 237 Thomson, Samuel, 416, 418, 41g Thornsby, Philip, 301 Tidd, Jacob, 418 Tilbert, Martin, 321 Tilden, Ε. M., 99 , Joseph G., 219 Tilton, James, 69, 76 , W. F., 216 Timoni, 13 Todd, S. S., 334, 337 Toland, H. H., 378 Torrey, John L., 122, 333 Toulmin, Harry, 289 Townsend, Howard, 162 Trafton, Mark, 336 Trash, J . D., 144 Treat, Samuel, 35, 36 Trimble, Cary Α., 319 Tricou, Dr., 366 Trowbridge, Amasa, 327, 328 Tucker, David H., 100, 272 , Robert, 1 1 1 Tully, William, 160, 196, 206

Tupman, Mr., 343 Turnball, Duncan, 231 Turner, Daniel, 60 , William, 18 Tuttle, Erastus D., 154 Tyler, Grafton, 249 Tyneman, Peter, 17 Tyson, James L., 99 Underhill, Samuel, 327 Van Belcamp, Dr., 17 Van Buren, John, 52 , W. H., 135 Van de Bogaerdet, Myderts, 16 Van Dyke, Rush, 98 Van Kluck, James Livingston, 12g Van Reneselaer, Stephen, 119, 130 Van Solengen, Henry, 127, 128 Van Stevern, Jackson, 98 Van Wyck, C. C., 100 Vattier, John L., 315 Vaughan, J . M., 349 Viets, Henry R., 53, 54, 168, 173 Wagner, John, 252, 253, 255 Walker, George B., 336 Wallace, William C., 207 Walls, J . William, 261 Walsh, Francis W., 327 Ward, Isaac M., 417 Wardner, Horace, 345 Ware, John, 179 Warfieid, Walter, 290 Waring, William R., 276, 277 Warner, Augustus L., 264, 269-71, 294, 299, 300 Warren, Edward, 177, 237 , John, 10, 43, 53, 55, 168, 170 7g, 183, 185, 205, 272, 402, 430, 433 , John Collins, 168, 170-78, 433 , Joseph, 168, 169, 183, 433 Washington, George, 10, 1 1 , 59, 75, 175 Waterhouse, Benjamin, 170-75, 209, 418 Waterman, L. D., 335 Watson, Dr., 4 , John M „ 375 -, L „ 140, 292 Watts, John, 120, 122, 124, 128 , Robert, 217 \Vay, Nicholas, 6g Wayland, Francis, Jr., 201 Webster, Daniel, 230 , James, 157, 164, 411 , John White, 130, 1 3 1 , 157, 17g. 182 Wedderburn, A. J., 367 Weeks, Carnes, 251 Weever, Charles S., 336

INDEX OF PERSONAL NAMES Wellford, Beverly R., 274 Wells, Ebenerer, 203 , John D., 202, 203, 231 Welsh, James, 395 West, Benjamin, 72 , C. W „ 279 Westmoreland, J . G., 280, 281 , W. F., 280 Wheaton, Levi, 200 Wheelock, Eleazar, 186-89 Whicher, Stephen, 349 White, Delos, 150 , James C., 181 , James P., 163, 164 , John F., 323 , Joseph, 118, 150, 152 Whitman, Josiah, 308-10 , Marcus, 153 Whitmore, Mrs. Thomas, 407 Whitney, J . P., 346 Whittemore, Edwin Carey, 216 Wiat, Mrs., 407 Widderburn, A. J., 367 Wiesenthal, Andrew, 43, 223, 224 , Charles Frederick, 19, 43, 223 Wilburn, G. T., 280 Wilcox, John R., 336 Wilkins, Sarah, 24 Willard, Frederick, 169, 216 Willey, Elijah, 327 William, Stephen W., 188 Williams, Elkarak, 323 , Nathaniel, 13 , Roger, 15 , Stephen W„ 188, 213 Williamson, Walter, 417 Willoughby, Westel, 150, 152, 326 Wills, Daniel, 19 Wilson, George Α., 273 ·, Goodridge, 273 , Joshua L., 318 , Lambert, 1 1 , 12, 37 , Samuel, 19

487

Wiltbank, John, 95, 96 Wing, Henry, 339 Winslow, Edward, 14 Winston, C. K., 375 Winterbotham, William, 17 Winthrop, John, 14, 15, 24, 25 , John, Jr., 14 Wirt, William, S30 Wistar, Caspar, 78-80, 82, 83, 85, 105, 268, 397 Wolcott, Alex, 339 , Ε. B.. 346 Wolf, John D., 353 Wood, J . R „ 146 • , Thomas, 40, 324 Woodbridge, Timothy, 60 Woodhouse, James, 82 Woodward, Adrian, 207 , Charles, 324 , Theodore, 160, 205, 206, 210, 216 Woodwille, William, 178 Worcester, Noah, 330 Worthington, Nicholas, 248 Wottom, Thomas, 10, 16 Wright, Charles W., 321 , Mrs. H. G., 337 , Μ. Β., 3 1 3 1 6 , Thomas Η., 231 , Thomas R., 277 Wyatt, William E., 229 Wyman, Jeffries, 271 , Morrill, 179 Wynkoop, William T., 95 Wynne, Thomas, 18 Yandell, Lunsford P., 292-94, 297-303, 314, 372. 373. 389. 390 Young, Alexander X., 250 , Noble, 250 Zachary, Lloyd, ig, 36, 45 Zakrzewske, Marie Elizabeth, 408, 414