SURGERY
The end of the eighteenth century was made notable by one of the most remarkable and beneficent discoveries which has ever blessed the human race, the discovery of the means of preventing small-pox. On May 14, 1796, Dr. Edward Jenner inoculated James Phipps. When we remember that two million persons died in a single year in the Russian Empire from small-pox; that in 1707 in Iceland, out of a population of thirty thousand, sixty per cent., or eighteen thousand, died; that in Jenner’s time “an adult person who had not had small-pox was scarcely met with or heard of in the United Kingdom, and that owing to his discovery small-pox is now one of the rarest diseases,” the strong words I have used seem fully justified. But the eighteenth century was not to witness the end of progress in medicine. The advances in the nineteenth century have been even more startling and more beneficent. What these advances have been in the department of medicine has been related by Professor Osler. It is my province to speak only of surgery.
METHOD OF TEACHING
The first advance which should be mentioned is a fundamental one—namely, methods of medical teaching. At the beginning of the nineteenth century there were only three medical schools in the United States: the Medical Department of the University of Pennsylvania, established in 1765; the Medical Department of Harvard, established in 1783; and the Medical Department of Dartmouth, established in 1797. The last report of the Commissioner of Education gives a list of one hundred and fifty-five medical schools now in existence in this country, many of them still poorly equipped and struggling for existence, but a large number of them standing in the first rank, with excellent modern equipment, both in teachers, laboratories, hospitals, and other facilities. The medical curriculum then extended over only two years or less, and consisted of courses of lectures at the most by seven professors who, year after year, read the same course of lectures, without illustrations and with no practical teaching. The medical schools, even when connected with universities, were practically private corporations, the members of which took all the fees, spent what money they were compelled to spend in the maintenance of what we now should call the semblance of an education, and divided the profits. Until within about twenty years this method prevailed in all our medical schools. But the last two decades of the century have seen a remarkable awakening of the medical profession to the need of a broader and more liberal education, and that, as a prerequisite, the medical schools should be on the same basis as the department of arts in every well-regulated college. To accomplish this the boards of trustees have taken possession of the fees of students, have placed the faculties upon salaries, and have used such portion of the incomes of the institutions as was needed for a constant and yet rapid development along the most liberal lines.
COLLEGE HOSPITALS
The first step has been the establishment in connection with most schools of general hospitals in which the various teachers in the college should be the clinical instructors, and where the students would have the means not only of hearing theoretically what should be done to the sick, but of actually examining the patients under the supervision of their instructors, studying the cases so as to become skilled in reaching a diagnosis and indicating what in their opinion was necessary in the way either of hygiene, medicine, or surgical operation. More than that, in most of the advanced schools to-day the students assist the clinical faculties of the hospitals in the actual performance of operations, so that when they graduate they are skilled to a degree utterly unknown twenty years ago.
ESTABLISHMENT OF LABORATORIES
Another step which was equally important, and in some respects even more so, has been the establishment of laboratories connected with each branch of instruction. A laboratory of anatomy (the dissecting room) every medical school has always had, but all the other laboratories are recent additions. Among these may be named a laboratory of clinical medicine, a laboratory of therapeutics, in which the action of drugs is studied; a laboratory of chemistry, a laboratory of microscopy, a laboratory of pathology for the study of diseased tissues, a laboratory of embryology for the study of the development of the human body and of the embryos of animals, a laboratory of hygiene, a laboratory of bacteriology, a laboratory of pharmacy, a surgical laboratory, in which all the operations of surgery are done on the cadaver by each student, a laboratory of physiology, and in many colleges private rooms in which advanced work may be done for the discovery of new truths.