10 



SCIENCE 



[N. S. Vol. XXVII. No. 679 



any I'esponsible outside control whatever, 

 empowered by the state to usurp the uni- 

 versity's right of conferring the doctor's 

 degree and at liberty to set whatever 

 standards it chose for obtaining this degree, 

 which carried with it the license to prac- 

 tise, is a phenomenon unique in the history 

 of education and a contribution to systems 

 of education for which America is entitled 

 to the sole credit. This is the type of 

 medical school which prevailed in this 

 country during the greater part of the 

 nineteenth century, and familiarity has 

 made it difficult for us fully to realize how 

 anomalous and monstrous it really is. 

 Even in the ease of those schools which 

 were united with a college or university 

 the connection became in most instances so 

 loosened as to be merely nominal and to 

 secure practical autonomy to the medical 

 school. In the common type of these 

 schools there was no requirement of pre- 

 liminary study worthy of the name, the 

 only practical training was in the dissect- 

 ing room and an occasional amphitheater 

 clinic, and the degree and license to prac- 

 tise followed the passing of an easy exami- 

 nation after attendance on two annual 

 courses of lectures lasting five or six months 

 each, sometimes an even shorter period, the 

 student hearing the same lectures each 

 year. 



It is needless to say that such conditions 

 brought great reproach to American medi- 

 cine and introduced evils from which we 

 are not yet wholly free. Nevertheless the 

 system', bad as it was, can be painted in 

 too dark colors. The rapid multiplication 

 of medical schools which followed the 

 second decade of the last century was, 

 although excessive, in response to the needs 

 of a rapidly developing country pushing 

 the boundaries of civilization ever west- 

 ward. Still it would be difficult to find a 

 sound argument for increasing the hard- 



ships of frontier settlements and struggling 

 communities by a supply of poor doctors. 



The main relief to the picture is that the 

 results were not so bad as the system. 

 Many of the teachers were devoted, able 

 men who imparted sound professional 

 traditions and whose personality in a meas- 

 ure remedied the defects of the system. 

 The native force, ability and zeal of many 

 students enabled them to overcome serious 

 obstacles and to acquire in the course of 

 time, in spite of adverse circumstances, a 

 mastery of their calling, perhaps a re- 

 sourcefulness engendered by these circum- 

 stances, for even under the best conditions 

 education does not end with the modicum 

 of knowledge imparted in school and col- 

 lege. Some were so fortunate as to be able 

 to supplement their inadequate training by 

 European study. But among those with- 

 out foreign training who were entirely the 

 products of American conditions not a few 

 were the peers of their European con- 

 temporaries, such as Daniel Drake, Jacob 

 Bigelow, John D. Godman, William Beau- 

 mont, Nathan Smith Davis, Samuel D. 

 Gross, Austin Flint, Marion Sims and 

 others who have left names illustrious in 

 the annals of our profession. Native vigor 

 and resourcefulness enabled such men to 

 surmount defects of an educational en- 

 vironment to which the average man must 

 succumb. 



Most gratifying is the rapidity with 

 which medical education has risen during 

 the last two decades from the low estate to 

 which it had sunk during the greater part 

 of the past century in this country. 

 Among the more important causes con- 

 tributing to this result may be mentioned 

 the operation of laws transferring and, in 

 fact, restoring the licensure to practise 

 from the medical schools to state boards of 

 examiners, whereby worthless medical 

 schools are crowded to the wall and out 

 of existence and others have been com- 



