School of medicine

“ 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. ”

“ 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. ”

“ Its professors often came from a distance and had travelled extensively for purposes of study; they attracted patients of high rank from nearly every part of Europe, and these were generous in their patronage of the school. Students came from all over, from Africa and Asia, as well as Europe, and when abuses of medical practice began to creep in, a series of laws were made creating a standard of medical education and regulating the practice of medicine, that are interesting anticipations of modern movements of the same kind. ”

“ College Physiology and Hygiene.—Some colleges offer courses in physiology which are dilute presentations of medical school work. Thus, in one course, the student may be taught something of human anatomy, physiology, hygiene and medical bacteriology, all of which may be useful for those who are not intending to study medicine. It is wholly undesirable for the medical student to take time from other college work for the sake of such courses. ”

“ Those physicians who enroll themselves as students in the Washington Post-Graduate Medical School and faithfully follow the course of instruction which is open to them, can not fail to return to their professional work with broader and more exact information on many subjects relating to scientific medicine, with increased skill in the diagnosis and treatment of disease and with greater confidence in the resources of the noble profession to which they have devoted their lives. ”

“ Medical students should therefore have studied zoology and botany before beginning the study of medicine, and should have acquired some skill in the use of the scalpel and the microscope. It is absurd that anybody should begin with the human body the practise of dissection or of surgery; and, furthermore, it is wholly irrational that any young man who means to be a physician should not have mastered the elements of biology, chemistry and physics years before he enters a medical school. ”

“ He does not appear to be attached to any particular school, but, as his Red Cross Notes biographer says, "has placed himself in the crowd 'who have been moving forward upon the substantial basis of scientific research, and who, if characterized by any distinctive name, should be called the New School of Scientific Medicine.' He holds that if our practice was in accordance with our knowledge many diseases would disappear; he sees no room for creeds or patents in medicine. ”

“ Flexner have obtained their medical education by a short course, they have had expert advice and their general point of view is sound. We need several university schools of medicine emphasizing research and demanding long preliminary preparation, the schools for the training of the great mass of practising physicians should require a training in science and the languages equal to two years of college, the schools in the south can not at present reach this standard, but should require a preparation equal to a four-year high school course. ”

“ The theory of medicine has of course been taught from the beginning of the Harvard Medical School and eminent men have lectured to its students, but outside hospital and clinic facilities had to be sought. In the first Harvard Medical School building there was no laboratory at all. ”

“ It is only a small proportion of the physicians of the country who can come directly in contact with the special fields of investigation in medicine, and so the chief available channel for keeping up with current progress is through medical literature. The Harvard Medical School possesses unusual facilities for the training of its students in the proper use of the literature of the science. ”

“ At the end of the first year the student is examined in osteology, myology and the elements of physiology; at the end of the second year, in anatomy and physiology in all their branches; at the end of the third year, in medicine and surgery; at the end of the fourth year, an examination is held over the whole field of study.
No one is allowed to enter on the study of medicine without passing the Artium examen of a secondary school. This is the equivalent of the German Abiturienten Examen of a classical gymnasium. ”

“ 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 ”

“ The entrance requirements were simple; a fair high school education, with Latin and Greek sufficient for the understanding of medical terms. For graduation, at least three years' study with a reputable physician was required; but this might include the two six-month courses of lectures which comprised the work of the Department. Even this very slender medical preparation was not required of college graduates, or of students who had already practised medicine four years, for whom one course was deemed sufficient. ”

“ In the first place, if he has never seen any plan of treatment put into practice, how is he to decide between the merits of different, and it may be, opposite plans recommended by different authors? These differences, in many cases, may be satisfactorily explained and reconciled; but to the student, brought into contact with disease for the first time, they must prove hopelessly embarrassing. In the second place, medicine is a progressive science. ”

“ The only branches of medical science, for the teaching of which special departments have not yet been established, are pharmacology (action of drugs) and public health.
“As regards the third part of the medical curriculum, viz., instruction in the practice of medicine, the University had adopted the principle that the two or three years which its students must devote to their purely professional studies must be spent where the existence of great hospitals affords opportunities for seeing medical and surgical practice in all its branches. ”

“ 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. ”

“ The only difference between the schools is in the remedies employed, the size of dose administered, and the results attained. These are insufficient grounds for bitter sectarianism. We are all fellow laborers in the same field. Before us lies a boundless expanse for exploration. There are new conditions of disease to be learned, new remedies to be discovered, and new properties of old ones to be examined.
We do not deplore the fact, that there are different schools in medicine, for this science has not reached perfection, and they tend to stimulate investigation. ”

“ 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. ”

“ Since the students cannot be expected to learn medical science unless they have previously been grounded in logic, we further decree that no one be permitted to take up the study of medical science without beforehand having devoted at least three full years to the study of logic. [19] After three years devoted to these studies he (the student) may, if he will, proceed to the study of medicine, provided always that during the prescribed time he devotes himself also to surgery, which is a part of medicine. ”

“ The fourth lecture will be a survey of present-day methods and problems, and the fifth lecture will be a discussion of the position of medical research in America, its facilities, needs and opportunities, with special reference to medical research as a function of the university.
Of medicine in the earliest stages of its development we have no knowledge. Not until we arrive at a period of civilization as highly developed as that of the Assyrians and Egyptians do we find references to the practise—the studied practise—of medicine as a healing art. ”

“ 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 . ”

“ 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. ”

“ In Europe, the shortest period of study required for a physician's degree is four years, and at least ten months of each year must be spent in attendance upon the course of instruction. This course comprises not only lectures on the different branches of medicine, but thorough practical study of chemistry, botany, anatomy, etc., in the laboratory, gardens, museums, etc. Attendance on the hospitals is also required, where, for several years, the student is occupied with subordinate medical and surgical duty. ”

“ 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. ”

“ The students of Medicine, who almost exclusively support the Professorship of Chemistry, are induced to do so in consequence of its application to Pharmacy and the different branches of Medicine, viz., Physiology, Pathology, Therapeutics, Materia Medica, and the Practice of Physic. ”

“ The main task of the medical schools will always be to train physicians. It does not fall within the scope of this address to define what this training should be, and I shall not attempt it, excepting in so far as it bears upon laboratory instruction. I believe that the medical school should make the future physician absorb as much as possible of the best medical science of the day and give him a certain initial skill and dexterity in carrying out the fundamental operations of the medical art. ”

“ The great extent of medical science, which comprehends under it so many different branches, makes it impossible to learn it thoroughly without we follow a certain order. Whilst we neglect this, all our ideas are but crude conceptions, a rope of sand, without any firm connection. Should the student, as chance or whim might direst, sometimes apply himself to one branch, sometimes to another; or read indiscriminately even the best authors on the different parts of Medicine ”

“ When the medical sciences are taken seriously, when thorough preparation is demanded before their study may be taken up, when four or five years of attention to theoretic and practical medicine are required for graduation, and when the professors are writing textbooks that are to attract attention for generations afterwards, then, there is always a thoroughly scientific temper m the university itself. Medicine is likely to suffer, first, whenever there is neglect of science. ”

“ In the latter, clinical medicine or medical practise seeks to lay hold of the acquisitions of experimental science and to utilize them in the interpretation of symptoms. The clinical or hospital laboratory approaches medical problems from the professional side and is thus an extension of medical practise into a territory where science and practise meet and shade into one another. Here the future physician should receive most careful training when he begins to direct his studies toward some branch of medicine. ”

“ Likewise in the clinic the ideal teacher, with a few notable exceptions, was the busy consultant who devoted only a few hours of oratorical effort to clinical instruction and who disdained investigation as beneath the notice of a practical physician—an ideal which still holds in many of the more conservative schools and is responsible for the slow progress in the development of a science of clinical medicine. ”