Medical Education

views updated

Medical Education

Schools. Prior to the Revolution, there were very few trained physicians in the United States, and what few there were had been educated in Europe, typically in Edinburgh, Scotland. In the United States only Philadelphia and New York had medical schools, both established in the 1760s. The post-Revolutionary War period saw a significant increase in the number of medical schools affiliated with prestigious institutions. Dartmouth Medical School was established in 1781, Harvard in 1782, the University of Maryland at Baltimore in 1807, and Yale and Columbia in 1813. At the same time state licensing boards established standards for medical practice. The medical schools and state boards fought over the right to license physicians; Harvard, for example, claimed that its medical-school graduates did not have to take the state exams, and eventually the state agreed. By about 1820 most states allowed medical schools to license physicians, and Americans began to take pride in their medical schools, reasoning that there was no need to train doctors in Europe. Unfortunately, it would be many decades before that belief would be justified.

Quality of Education . Despite the increase in the number of medical schools, nine out often “doctors” still had no formal training. Even the formal training was meager—medical schools would grant a license after only one year of study beyond the bachelor’s degree. Doctors mainly learned “on the job.” One particular problem in medical education was the difficulty in finding human cadavers, which would help prospective doctors learn human anatomy. The public had a deep revulsion to human dissection, and rarely would permission be given to dissect a body, or even to perform an autopsy. The only legal way to get human bodies was for physicians and doctors to wait for the execution of a criminal. Some medical students and doctors would rob graves to get corpses. There was even a club at Harvard called the Spunkers, who procured corpses of derelicts and criminals.

New York “Doctor’s Riot.” The most dramatic example of public disapproval of dissection was the “Doctor’s Riot” in 1788. A group of boys climbed a ladder to look into a window at New York Hospital. They saw four men dissecting a corpse. The public was already furious over a series of grave robberies, and when news of the dissections got out, an angry mob formed to punish these suspected graverobbers. The rioters entered and ransacked the hospital, and would have lynched the doctors had they not escaped. The militia was called in to disperse the mob, and the riot ended, but the basic conflict between the medical profession’s research needs and the individual’s right to a safe burial remained unsettled.

Midwifery. Since medieval times, midwives, rather than male physicians, had helped women deliver babies. Midwives tended to be unschooled, yet many of them had years of experience—and some medical historians claim that women were better off with a midwife than with some theorizing doctor. A few doctors believed that midwifery and professional medicine could be brought closer together. William Shippen, who had been trained in obstetrics in London, gave private lectures in midwifery in Philadelphia in 1782. He admitted midwives to these lectures—an unusual practice at the time. Like Samuel Bard in New York, he believed that midwives could handle most births, while physicians could be called in for emergencies. With the fading of the moral taboo over men’s involvement in childbirth, physicians began to displace the midwives, at least in the cities, and for those who could afford it. But in the rural areas midwifery continued to flourish, as seen in the case of Martha Ballard, who from 1785 to 1815 kept a detailed diary of her life in rural Maine. She bore nine children herself, and delivered 816 others. Midwives were often the equivalent of country doctors, using their practical knowledge, herbal medicines, and empathy to meet the health-care needs of their neighbors. Ballard “knew how to manufacture salves, syrups, pills, teas, and ointments, how to prepare an oil emulsion (she called it an ‘oil a mulge’), how to poultice wounds, dress burns, treat dysentery, sore throat, frostbite, measles, colic, ‘hooping Cough, ’ ‘Chin cough, ’ ‘St. Vitas dance, ’ ‘flying pains, ’ ‘the salt rhume, ’ and ‘the itch, ’ how to cut an infant’s tongue, administer a ‘clister’ (enema), lance an abscessed breast, apply a ‘blister’ or a ‘back plaster, ’ induce vomiting, assuage bleeding, reduce swelling, and relieve a toothache, as well as deliver babies.” By any standard Ballard was a remarkable woman, as capable as any country doctor, although women as yet had never attained the status of physicians. It was not until 1849 that Elizabeth Blackwell became the first woman to obtain an M.D. degree.

MEDICAL TRAINING AT HARVARD

Harvard Medical School got its start in 1783 when John Warren, a surgeon in the American Revolution, began giving lectures for the Boston Medical Society. These lectures were so popular that Harvard College (from which Warren had graduated in 1771) saw the opportunity to catch up with its rivals, the College of Philadelphia and King’s College (Columbia University), both of which had established medical schools.

When it was first established in 1783, the Medical Institution of Harvard College had little money, a few pieces of laboratory equipment, and a dingy classroom in the basement of Harvard Hall. Warren was appointed professor of anatomy and surgery, Benjamin Waterhouse (unpopular and pretentious, but the best-educated doctor in New England) professor of theory and practice of physic, and Aaron Dexter professor of chemistry. Students who could pay their fees were admitted; there were no entrance exams. Since some of the students could not write, the final qualifying exam was oral. To receive a bachelor of medicine degree, a student would attend college for two four-month terms and serve a six-month apprenticeship. Classroom lectures were delivered in the pompous, droning style favored by Waterhouse; students were given no opportunity to ask bothersome questions. Laboratory training was limited, and clinical experience could only be had several miles away at the “pest house” (the hospital where people with infectious diseases were quarantined) in Boston.

In 1810 the Harvard Medical School moved to Boston, and soon joined up with Massachusetts General Hospital, where students could get the clinical training they desperately needed. Yet even by 1860 there were still no entrance requirements, exams continued to be oral, and a student had to pass only five of the nine subject areas to graduate. After the Civil War, reforms instituted by Harvard president Charles William Eliot tightened entrance requirements and placed new emphasis on scientific discipline and academic rigor.

Source: John Langone, Harvard Med (New York: Crown, 1995).