Medical education

“ Hence the most profoundly ignorant of medicine, are often the oldest members of the profession, and those who have had the most extensive practice. A medical education, founded on a knowledge of anatomy, is, therefore, not only indispensable to prevent the most fatal errors, but to enable a person to obtain advantage from those sources of improvement which extensive practice may open to him. ”

“ My own belief is that if the Medical Council, instead of insisting upon that examination in general education which I am sorry to say I believe to be entirely futile, were to insist upon a knowledge of elementary physics, and chemistry, and biology, they would be taking one of the greatest steps which at present can be made for the improvement of medical education. And the improvement would be this. The great majority of the young men who are going into the profession have practically completed their general education--or they might very well have done so--by the age of sixteen or seventeen. ”

“ THERE is no branch of education which attracts so little public interest and support as proper medical instruction, yet no one would gainsay the necessity that, if there are to be physicians at all, the community should be guaranteed that they have been most thoroughly trained.
It is not so very long since an air of mystery, which no laymen would attempt to penetrate, enveloped the art of medicine. It required generations to separate medical practice from alchemy, astrology, and the search for the elixir of life. ”

“ The third great fact which is to be taken into consideration in dealing with medical education, is that the practical necessities of life do not, as a rule, allow aspirants to medical practice to give more than three, or it may be four years to their studies. Let us put it at four years, and then reflect that, in the course of this time, a young man fresh from school has to acquaint himself with medicine, surgery, obstetrics, therapeutics, pathology, hygiene, as well as with the anatomy and the physiology of the human body ”

“ On a medical certificate, a man may be taken from his home and from his business and confined in a lunatic asylum; surely, therefore, it is desirable that the medical practitioner should have some rational and clear conceptions as to the nature and symptoms of mental disease. Bearing in mind all these requirements of medical education, you will admit that the burden on the young aspirant for the medical profession is somewhat of the heaviest, and that it needs some care to prevent his intellectual back from being broken. ”

“ A medical education, too, would be an embellishment that every one could not boast of. I had the necessary time and means to take a course in medicine, having no one dependent upon me. If there had been family cares on my hands, the case would have been different. So I matriculated in a St. Louis medical college during the middle of a term and began the study of the healing art.
Now, reader, please do not be shocked too badly if, in this connection, I mention a few slightly uncanny things. ”

“ While the practice of medicine is so vast and extensive a field, that it has been found necessary to subdivide it amongst physicians, surgeons, accoucheurs, apothecaries, oculists, aurists, dentists, men for the gout and men for the gravel, one for the belly and another for the brain, these reformers seem to regard medical knowledge and medical practice as in a nutshell,—as already perfect and complete. ”

“ It is a well-known law in the history of medicine that, whenever medical schools are attached to universities in such a way that students who come to the medical department have been thoroughly trained by preliminary studies and have such standards of scholarship as obtain in genuine university work, then great progress in medicine and in medical education is accomplished. ”

“ A survey of the present condition of American medical education offers little hope for a higher intellectual status of the medical profession or of any fundamental tendency to turn medicine as a whole from a mélange of religious ritual, more or less accurate folk-lore, and commercial cunning, toward the rarer heights of the applied sciences. ”

“ In the school of physicians, there is not medicine but the learning of it, for if the art of healing were already mastered as it seems to be in the case of the professors, there would be no need of a medical school. ”

“ Some laymen might wish to end the discussion of a person's medical education at the moment he receives his medical diploma, but those who are in the practice of medicine know that this is the end of only the initial phase of professional education and that there are many things not taught in the school that must be learned in practice. ”

“ 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. ”

“ Of astronomy every one was expected to know much, of medicine we shall have considerable to say hereafter, but in the meantime it is well to recall that these mediaeval centuries maintained a high standard of medical education and brought some wonderful developments in the sciences allied to medicine and above all in their applications to therapeutics. Surgery never reached so high a plane of achievement down to our own time, as during the period when it was studied so faithfully and developed so marvellously at the mediaeval universities. ”

“ It is clear, therefore, that a university and its antecedent, the school, may best co-operate with the medical school by making due provision for the study of those branches of knowledge which lie at the foundation of medicine.
At present, young men come to the medical schools without a conception of even the elements of physical science; they learn, for the first time, that there are such sciences as physics, chemistry, and physiology, and are introduced to anatomy as a new thing. ”

“ And the importance of understanding the true conditions of health and disease—of knowing how to acquire and preserve that healthy habit of body which the most tedious and costly medical treatment so often fails to restore when once lost, should secure a place in general education for the principal maxims of hygiene, and some of those even of practical medicine. For those who aim at high intellectual cultivation, the study of physiology has still greater recommendations, and is, in the present state of advancement of the higher studies, a real necessity. ”

“ Lastly comes the question as to how the university may co-operate in advancing medical education. A medical school is strictly a technical school--a school in which a practical profession is taught--while a university ought to be a place in which knowledge is obtained without direct reference to professional purposes. ”

“ That is his business in life, and if he has not a thorough and practical knowledge of the conditions of health, of the causes which tend to the establishment of disease, of the meaning of symptoms, and of the uses of medicines and operative appliances, he is incompetent, even if he were the best anatomist, or physiologist, or chemist, that ever took a gold medal or won a prize certificate. This is one great truth respecting medical education. Another is, that all practice in medicine is based upon theory of some sort or other ”

“ For about 1871 anyone who wished might enter an American medical school practically anywhere in the country, without any preliminary education, and having taken two terms of ungraded lectures, that is, having listened to the same set of lectures two years in succession, might receive his degree of doctor of medicine. ”

“ The hospital education of the present day is mere craftsmanship, and should only be permitted in conjunction with a liberal university training. The man who knows medicine and surgery only, however well he may know both, has only half learned the business of a doctor. ”

“ In the same way the student must be taught to apply the knowledge gained in the lecture-room, and from books, to the practical duties of the physician. She must be taught how to practice medicine; and the care of the sick under supervision should be an essential part of the future physician's training. (Of course I include in the term medicine, the prevention of disease; the knowledge and application of hygienic law is essential to the education of a woman physician.) ”

“ I am quite sure that a very considerable number of young men spend a very large portion of their first session in simply learning how to learn subjects which are entirely new to them. And yet recollect that in this period of four years they have to acquire a knowledge of all the branches of a great and responsible practical calling of medicine, surgery, obstetrics, general pathology, medical jurisprudence, and so forth. ”

“ With the power and authority , under the direction and sanction of the regents , to teach the science and practice of medicine in all its branches by lecture, experiments , demonstrations , clinical instructions and examinations , and to recommend for graduation therein such students as may attain the requisite proficiency in the knowledge and practice of medicine . ”

“ The greatest and most important needs of medical students who leave their homes or the offices of their preceptors to obtain them are clinical instructions and opportunities to pursue the study of practical anatomy , with every available convenience in the way of material and surroundings . ”

“ It was realized that this would make the teaching of medicine more serious and keep the practical side of medicine from obscuring too much the scientific and cultural aspects of the medical training. In modern times in America we made the mistake of having our medical schools independent of universities, but with the advance in education and culture we have come to imitate the custom of the thirteenth and the fourteenth century in this regard. ”

“ Fortunately, during this period the practical character of the clinical instruction given in the better colleges fitted the graduates in some measure for the actual necessities of practice, while the good traditions of medicine as a learned profession stimulated those who adopted it as a career, so that in the main the body of practitioners deserved and held the confidence and respect of the community. ”

“ Within the scope of medicine are included the basic sciences of physiology and pathology; and the instruction and training of every child and young person in elementary hygiene, including dietetics, necessarily come also within the range of our subject.
There are still agnostics, usually of exclusively classical and mathematical education, even among men holding official sanitary administrative positions, who doubt the value of the application of medical knowledge to the extent indicated ”

“ The instruction in the College of Therapeutics, is thoroughly demonstrative, leaving no room for doubt, and it gives a species of knowledge which ought to be a part of every one’s education—a knowledge of the constitution of man, not obtainable to-day in any medical or literary college, nor in our mammoth libraries. ”

“ So strong, however, has been the growth of American public opinion that a four-years course of medical training has become the standard in medical schools, and in the majority this is in addition to one or two years' training in the natural sciences. ”

“ To accomplish this demands the brightest talents, a liberal education and great experience. We cannot suppose then that a Student of ordinary parts can, by any means of himself, acquire sufficient skill in medicine to take charge properly of the lives of mankind. ”

“ He aimed at securing for the medical student a good preliminary and a high professional education, and uniform and searching examinations by all universities and medical and surgical colleges. He also advocated the separation of apothecary's work from medicine and surgery as far as practicable. ”

“ It is our recognition of them which lowers us without elevating them . Call ing such men 'Doctors ' and counselling with them de grades us . They are not capable of imparting or receiv ing.knowledge . * * * “ The one great medicine ( to remedy these evils ) we would employ , almost the only one having any power , is medical education . Our medical colleges must be edu cated up to a proper realization of their duties . They must produce better results . As a rule their work has been by far too carelessly performed . ”

“ Every piece of advice given to a pupil that can be followed up should be followed up and the result recorded. No system of medical inspection in schools can be complete and permanently successful which does not eventually educate the parent and child to a sympathetic and coöperative relationship with the system. Medical inspection is a force working for a better general education in personal hygiene and should coördinate with the class room instruction. ”

“ It has done, and is doing, much to place the science of medicine on a firm basis. To the text-books of this school, every student who would qualify himself for medical practice must resort, to gain that knowledge upon which depends his future success. ”

“ With such gifts and training his Institutes of Medicine, published in 1707, in which all the teachings in anatomy, in physiology, and in pathology up to his time were, after the severest personal scrutiny, made the foundation of the theory and treament of disease, rapidly became the text-book of Europe and of the East, and long remained in the hands of his pupils the basis of medical teaching. Yet there were so-called "practical men" in those days who received the work with scant favor. They boasted that they read nothing; that all available knowledge was the product of experience only. ”