A Book Excerpt
OK, moving away from controversial topics for a bit. I am going to post a section of my “book” (in my imagination it’s a book) in which I talk about the development of Harvard Medical School. I do so because changes are afoot in American medical education and it is interesting to see how major reforms occurred in the past. It’s a little rough, so don’t decide not to read the “book” (in my imagination it’s a book, as I’ve said) if you hate this chapter.
Freeman Allen graduated from Harvard Medical School (HMS) in 1899. The medical school had grown exponentially in the 50 years prior to Freeman’s graduation. The first person who had an idea for a medical school was John Warren, John Collin’s father. Because of the revolutionary war, the apprentice system for training doctors broke down, the doctors having joined the army or fled. Unable to go abroad to study, men were becoming doctors with essentially no training at all. Warren organized some lectures and demonstrations at the hospital (presumably the Continental General Established Hospital, at which he was superintending surgeon). He had tried to bring in a couple of other doctors to form a faculty, but they suspected Warren of trying to gain a pecuniary advantage, and refused. Warren’s lectures were open only to members of his own staff and certain med students he trusted, as dissection was illegal. The newly formed Boston Medical Society eventually decided to sponsor these lectures. In 1782 Harvard’s president Joseph Willard considered establishing a medical professorship and Warren was asked to outline a course of study that would supplement the apprentice system. In 1782 the medical school was created with three professors: Warren to teach anatomy and surgery, Dr. Benjamin Waterhouse to teach theory and practice, and Dr. Aaron Dexter to teach chemistry and materia medica.
By 1814 there were four medical schools in the US: University of Pennsylvania, Harvard, one in Baltimore, and one in Hanover, New Hampshire. Students were required to do two courses of lectures, two years of apprenticeship, a third unspecified year, then pass oral examinations in medicine, Latin, and experimental philosophy, and submit a dissertation. In 1849 Harvard medical school consisted of eight doctors and around 150 students. The school was located in a building on Mason street but was soon to relocate to a new building on North Grove Street on land donated by Dr. George Parkman, whose father had been present at the first successful anesthetic and who was to be found murdered in the chemistry lab in December of 1849. There was no requirement that students have an undergraduate degree. There were no pre-admission exams and essentially no entrance requirements. J. Mason Warren, son of the Warren who performed the first operation under anesthesia, never had more than 2 years at college. The requirement that medical students had to have an undergraduate degree was initially suggested in 1887. A degree wasn’t actually required yet when Freeman matriculated, and wouldn’t be until 1901.
Around 1850 lectures in medicine were given starting in November of every year and were four months long. The medical school of 1850 was really a school of medicine in it’s clinical aspect, but the alliance of science and medicine was neither acknowledged nor taught. The original purpose of medical schools, after all, was to supplement the existing apprenticeship system, not create a new entity. Lecture time was considered “extra”, hence the limit of four months. For hands-on clinical training the MGH charter provided that students from either the Massachusetts Medical College (as HMS was then known) or physicians’ private students could be admitted by ticket to see the practice of the hospital. Examinations for a medical degree were given twice a year at which three faculty were all that were required to be present, usually the faculty that taught the subject and who were paid for the classes by the students they were examining. They were oral exams and were informal and short. J. Collins Warren, a member of the prominent Warren family of surgeons, took one of his oral exams bouncing along in a buggy with his examiner Richard Hodges. Candidates to take the MD exam had to be 21 years old, have attended two “full courses of lectures” (four months each) at the college and have studied for three years with a physician (an increase of one clinical year since 1814). Candidates still had to show knowledge of “Latin and experimental philosophy”. If you did those things and passed the exam, you were a doctor. This is why young men of means went to Europe to study medicine, where the standards of admission of and of learning were much higher.
In 1869 Harvard acquired a new president, Charles William Eliot. The medical school had 13 faculty members. Eliot was to shake up those 13 men and the future of medical education. He advocated for changes in medical education including a progressive three year course including lectures, labs and hospital training, abolition of fees to individual professors, entrance requirements, and written examinations. The old guard, helmed by Dr. Bigelow, opposed all these changes but the young doctors who had recently gone through the system advocated strongly for reforms. Bigelow’s faction was eventually defeated, and quality of students and graduates began to rise soon after. The school outgrew the North Grove Street location and J. Collins Warren was secretary of the comittee charged with raising money for another new building for the medical school on Boylston street at the corner of Exeter street, in the newly-created Back Bay. This new building was opened in 1883.
At the time Allen graduated from the medical school in 1899 HMS had as many as 100 teachers and faculty and 710 students attending medical lectures. The duration of medical school was now the 4 years that has been standard ever since. In Allen’s first year of medical school he took Medical Chemistry along with two hours of lab every week. The Sears family had donated money to the school for new laboratory space, called Sears Laboratories. Some of the labs he took were likely located at MGH or the Boston City Hospital, where new lab facilities were making Boston a center for the study of pathology. In fact, laboratory or practical learning was beginning to take the place of extended lectures. He took Applied Physiology or Physiological Chemistry as it was re-named. He studied 16 of the most common surgical procedures in the form of “exercises” as well as a Surgical Landmarks course. Later in the year he repeated these surgical procedures under the supervision of an assistant. He had to complete 24 hours of such practice. He also had to care for and report on at least four cases of clinical medicine. Anatomy was taught over the first two years. In his fourth year he had the option of electives like histology, infectious diseases, embryology, and Clinical Microscopy. If he took any anesthesia course at all it would have been as part of a month-long surgical clerkship in his third year.