William Gilman Thompson

“ It is disgraceful, and yet it happens constantly, that men are graduated by prominent medical schools or colleges in this country without ever having listened to an abnormal heart sound, seen a case of measles, or been present at a confinement. "But," it is asked, "why should the general public take any interest in medical education? Why not let doctors manage their own 'shops,' as they always have done, unaided by public support?"
The answer is that, so long as a medical college is dependent entirely upon the fees of its students for support, the highest educational good can not be attained. ”

“ The question concerns endowment. A review of a few facts and statistics will demonstrate this need.
The medical profession in the United States, like many branches of industry, is at present suffering severely from over-repletion. There are more doctors, in proportion to the population, than in any other country in the world. The laws of supply and demand tend to lead many men toward those schools where they can soonest secure their diplomas with least expenditure of time and money (and too often of energy) . The schools become overcrowded, and new ones spring up with alarming rapidity. ”

“ They go abroad, partly because it is the fashion, and gives them a sort of advertisement as having done the proper thing, and partly to learn a new and useful language, and study foreign methods of life. But the fundamental reason of their going is that, instead of sitting in a huge lecture-hall with two or three hundred other men, to take notes verbatim of a lecture which often might be read in a textbook at home, they can join small classes in which they practically demonstrate every fact for themselves, under the guidance of an instructor. ”

“ The germ-theory, too, has given a great impetus to popular medicine.
The germ appeals to the average mind: it is something tangible; it may be hunted down, captured, colored, and looked at through a microscope, and then, in all its varieties, it can be held directly responsible for so much damage. There is scarcely a farmer in the country who has not read of the germ-theory. ”

“ There are many demonstrations which can be better made, and many theories which can be more conveniently discussed, in a lecture; still, it is well to bring a student face to face with at least one patient before intrusting him with a diploma and license to practice at large. ”

“ The importance of a universal knowledge of, and attention to, the laws of physiology and hygiene is becoming more and more appreciated, [3] and the elements of these subjects are taught in the public and private schools. The mental training to be acquired through the observation of biological and physiological facts is recognized as being of the greatest importance, and laboratory courses of instruction in these studies are already introduced in many of our colleges and universities side by side with the classics. ”

“ Many students will leave for cheaper and easier colleges, and the fees are likely to fall off so much that professorships having no endowments to rely upon must be abandoned. Thus the lack of endowment is a virtual check upon all growth. Division of labor with a new assistant instructor means division of personal income with him. The expense of maintaining a new laboratory means a further reduction of the professor's income. ”

“ Our great need is a little more system and concentration of energy, or a diversion of some of the wide-spread public interest in general medical topics toward securing and demanding the most thorough medical education for every one who seeks to become a physician. ”

“ There is a growing dissatisfaction with the old system. The percentage of medical students who are graduates in letters or science is constantly increasing. At present they number nine per cent, and they have frequently had the advantage of a year or two of biological, physiological, and chemical practice before entering the professional school. The number of such students at the Medical College of the University of Pennsylvania has doubled in the past six years. The number of medical schools which require some sort of preliminary examination for admission is also increasing. ”

“ But there should also be separate State or National Boards of Examiners who alone should have the power of granting licenses to practice medicine, based upon proofs of practical laboratory and hospital work, and upon the diplomas of only first-class colleges, which latter should be raised to a uniform high standard of merit. ”

“ Strangely enough, in some instances the professors themselves object to the endowment of their chairs, because they fear a sacrifice of their independent methods, or because it seems impossible to secure endowments which would yield as fair incomes as they at present derive from the students' fees. ”

“ Such is the system in vogue to-day at a large number of our medical colleges. There are, fortunately, a few where a much higher standard is not only encouraged but required. No wonder that our students, immediately after graduating, go by the hundred to Paris, Berlin, Vienna, etc., where the Government encourages professional schools, laboratories, and scientific bureaus by substantial support and thorough system. ”

“ The success of these small voluntary classes (often conducted by men who are without any official connection with the colleges) in drawing students, who thus incur considerable additional expense, is in itself a severe commentary upon the poverty of the colleges which restricts them from making their own advantages all that they should be. ”

“ But practical work, at its commencement at least, means increased expense. There must be separate and well-appointed laboratories for chemical, physiological, anatomical, and pathological research, rooms for photography, germ-culture, delicate electrical apparatus, for hygienic and therapeutic demonstrations, for libraries, and for the reception and treatment of many classes of patients at clinics. Moreover, assistant instructors and demonstrators are needed, in order that each student may receive a fair share of personal attention. ”

“ All these activities, directed toward improving the public health and alleviating sickness and suffering, are most gratifying and commendable, and call for increasing thoroughness in methods of educating physicians, for, without the co-operation of the public with scientific men who devote their lives to the study of these subjects, much benevolent energy as well as time and expense are wasted or misapplied. ”

“ When men of distinction are ill, the conditions of their pulse, temperature, and respirations are telegraphed all over the civilized world, to be read at the breakfast-table in the morning newspaper. Their medicines and their doses are minutely described ”

“ The work accomplished in the past ten years by physicians themselves through their various societies and organizations in exposing quackery, injurious patent medicines, malpractice, and bargaining in diplomas for which no study has ever been expended, has revealed and corrected an enormous amount of abuse and crime, notwithstanding the very tardy legal and popular support which has attended these efforts. ”

“ Still, a great deal of this popular medical talk and instruction is the outcome of an earnest desire to learn to alleviate the growing evils of heredity and environment, especially in overcrowded cities. ”