Education: How Old The New

by James J. Walsh

UNIVERSITY MEDICAL SCHOOLS [Footnote 25]

[Footnote 25: Address to the graduates of St. Louis University Medical and Dental Schools, May 31, 1910, at the Odeon, St. Louis.]

It affords me great pleasure to accept the invitation of your Faculty to address the graduates of a university medical school here in the Middle West. I wondered, of course, what I should talk to you about, and have come to the conclusion that as an historian of medicine any message I may have for you is likely to come from my own subject. It so happens that we are just beginning to realize that the history of medicine may have much greater significance for us than we have usually been accustomed to think, and, above all, that it may mean much in furnishing incentive for the maintaining and raising of standards in medical education. In recent years there has come a very decided improvement in medical education in the United States. It is not hard to understand that the foreigner lifts his eyebrows in surprise when he is told that most of our medical schools a generation ago required but two terms of four months each, and that there was then just beginning to be a demand for a little more complete course and better facilities. There was a large number of medical schools, turning out graduates every year with the degree [{378}] of doctor of medicine, which was a license to practise in every state in the Union, for there were no state or federal laws regulating the practice of medicine. As for preliminary requirements the less said the better. If a man could write his name and, indeed, he did not have to write it very plainly, he found it easy to matriculate in a medical school and to be graduated at the end of two scant terms of four months each. He might come from the mines, or from the farm, or from before the mast, or from the smithy, or the carpenter shop; he need know nothing of chemistry, nor physics, nor of botany, nor of English and, above all, of English grammar, and he was at once admitted to what was called a professional school and graduated when he had served his time. Practically no one was plucked. The desire of the faculty for numbers of students forbade that in most cases. The two terms in medicine were not even successive courses. The second-year student listened, as a rule, to the same lectures that he might have heard the preceding year.

We all know the reason now for this extremely low standard of medical education. Proprietary medical schools made it their one business in life to make just as much out of medical education as possible and the historic septennate of professors, or sometimes the Dean, pocketed the fees (I came near saying spoils) every year, and robbed medical American education of [{379}] whatever possibilities it might have for the real training of young men in the science and art and practice of medicine. Perhaps the most interesting feature of this maintenance of extremely low standards in medical education, however, is the fact that in spite of it, men, or at least some of them, succeeded in obtaining a good foundation in medicine and then by personal work afterwards came to be excellent practitioners of medicine. Professor Welch said not long since: "One can decry the system of those days, the inadequate preliminary requirements, the short courses, the dominance of the didactic lecture, the meagre appliances for demonstrative and practical instruction, but the results were better than the system. Our teachers were men of fine character devoted to their duties; they inspired us with enthusiasm, interest in our studies and hard work, and they imparted to us sound traditions of our profession."

Nothing that I know is a better compliment to American enterprise and power of overcoming the difficulties of the situation than the life stories of some of the men who came from these completely inadequate schools. If with the maimed training and incomplete education given a generation ago American medicine not only succeeded in maintaining the dignity of the profession to a noteworthy degree, but also developed many men who made distinct contributions to world medicine, what will we not do now that [{380}] our medical education is gradually being lifted up out of the slough of despond in which it was and the preliminary education for medical studies set at a standard where real work of thoroughly scientific character can be looked for, from the very beginning of the medical course?

Is it any wonder, then, that those of us who have the best interests of American medicine at heart are watching with careful solicitude the movement that is now reforming medical education in this country? The one hope of medical education is, and always has been, organic connection with a university. Real University Medical Schools, that is medical schools as the genuine Post-Graduate Departments of Universities with the fine training that they give, have opened our eyes to what is needed in medical education in this country. Some of the old-time medical schools here in the United States had been connected by name with universities but this was more apparent than real, and the medical faculty ruled absolutely in its own department and throttled medical education and divided the income of the college among themselves, devoting as little as possible to equipment, to laboratories, to all that was needed for medical education.

Now has come the epoch of university medical schools in this country. I came near saying America, but we must not forget that the Spanish-American countries, having adopted their educational systems from the mother Latin country, [{381}] have always maintained the organic connection of the medical school with their universities, and as a consequence a good preliminary education, the equivalent of three years of college work with us, is required and has always been, and then some four years in the medical school and, indeed, in most of the countries five or six years and in one at least seven years of medical study required. I have thought, however, that this story of medical education in connection with universities and real university work will be especially interesting to the graduates of this thorough Western university, whose work in medicine is acknowledged as up to some of the best standards of professional attainment and whose organic connection with a great university assures not only the continuance, but the future development of medical education here along lines that shall place this among the serious progressive medical schools of the world.

The first university medical school that well deserves that name is the one that came into existence in connection with the University of Alexandria. I have been at some pains, because it is so delightfully amusing, to point out how closely the University of Alexandria resembles our modern universities in most particulars. It was founded by a great conqueror, who had gone forth to conquer the world, and having attained almost universal dominion sighed for more worlds to conquer. Then he set about the foundation of [{382}] a great city that was to be the capital of his empire, and endowed a great institution of learning in that capital that was to attract students from all over the world. When he died prematurely the Ptolemys, who inherited the African portion of his vast dominions, carried out his wishes. Money was no object at Alexandria: they put up magnificent buildings, founded a great library, bought a lot of first editions of books in the shape of author's original manuscripts, stole the archives at Athens, used Alexander's collection (made for Aristotle) as the foundation of what we would call a museum, paid professors better salaries than they received at that time anywhere else and housed them in palaces. What a strangely familiar sound all this has! Then Alexandria proceeded to do scientific work.

Euclid wrote his geometry, and, unchanged, it has come down to us and we still use it as a text-book in our colleges. Archimedes, following up Euclid's work, laid the foundation, of mechanics in his study of the lever and the screw, and of hydrostatics and of optics in his studies of specific gravity and burning mirrors and lenses. He made a series of marvellous inventions showing that he was a practical as well as a theoretic genius, who would be gladly welcomed, nay, eagerly sought for, as a member of the faculty even of a university of the highest rank or largest income in our modern times. Ptolemy elaborated the system of astronomy that had been so ably [{383}] developed by teachers at Alexandria before his time, and Heron invented his engines, which we have had as toys in our laboratories for centuries. We realized the true significance of one of them only when the turbine engine was invented and we found that the principle of it was in the toy engine of this old natural philosopher of Alexandria. They even did their literature scientifically at the University of Alexandria. We have no great original works from them in literature, but they invented comparative literature; for this making the Septuagint translation of the Holy Scriptures and doing the same for many other religious documents of the surrounding nations for comparative study.

It is rather easy to understand, then, that a medical school arose in connection with this scientific university, and that it did excellent work. The collections of Aristotle contained many illustrations which served as the basis for zoology, botany, comparative anatomy and probably even comparative physiology. The Ptolemys were very liberal and allowed dissection of the human body, so that human anatomy developed from a definite scientific standpoint better then ever before. The number of strangers in the town and the rather unhealthy climate of Egypt left many unclaimed bodies. It has always been the difficulty of obtaining bodies much more than prejudice against the violation of the human body on any general principle, that has been the reason [{384}] for the absence of human dissection in many periods of the world's history. We object to having the bodies of friends cut up, but we do not mind much if the bodies of those who are unknown to us are treated in that way. So long as men did not travel much there were few unclaimed bodies. With the advent of travel came abundant material for dissection and the Ptolemys allowed the medical school to use it.