Kans.; Louisiana Chautauqua, Ruston, La.; Marthas Vineyard Summer Institute, CHAPTER VII. MEDICAL EDUCATION.1 RAISING THE STANDARD. Medical education in this country is now making one of the longest strides forward that has occurred in its history. This step is the lengthening of the course to three and four years of eight or nine months, instead of the old course of two years of four or five months. We say this step is now being taken, for while many schools have already lengthened their courses during the last eight years, there are others which have arranged to do so soon, and still others which are certain to follow along afterwards. So the work of higher medical education is still in a progressive state, in that many medical schools have not as yet entered upon their full course of instruction, but it is probable that nearly all of the colleges will have completed this extension during the next four or five years. When they have done so, and one can take a retrospective glance and see that every medical school has added one or two years to its course, and has lengthened the annual session to eight or nine months, the question will naturally arise, What was the moving cause of this extension? Why was it that the medical colleges, which for decades had been contented with a course of two years of four or five months each, began to adopt courses of three or four years of eight or nine months each? In fact, this question has already been answered by several writers, but the explanations must have come from different standpoints, as they arrive at different conclusions. It is said by some that the Illinois State board of health, of which Dr. John H. Rauch was secretary, was the prime canse, when it announced that no school having a course of less than three years would be considered in good standing and that its graduates could not practice in Illinois without first undergoing an examination. Others say that the medical practice acts adopted in several States during the last five or six years began the work; others attribute it to the resolutions of the American Medical College Association in favor of higher education; others claim that "it was inaugurated by the American Institute of Homeopathy in 1888, when it was ordered that 'After the college sessions of 1890-91 each and all of the homeopathic schools of America will require of their candidates for graduation at least three years of medical study, including three full courses of didactic and clinical instruction of at least six months each."" It is probable that many of the leading medical institutions had for some time been in favor of extending the course, but were deterred from fear that their students would leave for competing colleges where less time was required. But when some By A. Erskine Miller. The Association of American Medical Colleges, at its meeting in San Francisco, June 7, 1894, "Resolved, That students graduating in 1899 or subsequent classes be required to pursue the study of medicine four years and to have attended four annual courses of lectures of not less than six months' duration each." of the institutions which constituted departments in heavily endowed universities became less dependent upon tuition fees, they were able to adopt longer courses without considering its effect upon attendance. Besides, about this time the number of medical students was becoming unusually large, so that some schools did not really desire an attendance larger than they could well accommodate. By adopting a longer course they would still have as many students as desired, and they would send out graduates better prepared to gain credit for themselves and for the institution. Many of the State boards of health now announce that they will not recognize any institution unless it exacts a full three years' course of study and complies with all other standard requirements of education. One of the results likely to follow from this elevation of the course is that there will be fewer new colleges coming into existence, for unless an institution has a good standing with the State boards of health or examining bedies, it can not reasonably expect to meet with much success. But as the present number of medical colleges will be ample for many years to come, no complaint will be made because others can not come into existence. In fact, medical education would be advanced if some institutions already existing were consolidated with others in the same locality. "The chief difficulty in making a high standard universal lies in the number of the medical colleges. It is, indeed, a sorry admission that the medical schools in this country are the greatest enemy to medical progress, not in themselves but in their number. The remedy lies in their amalgamation. Let the absurdity cease of small towns having three, four, or six of these struggling institutions, no one of which can have a vigorous life. # "There is now all over the country a growing disposition for the universities to take charge of medical teaching and to develop their medical departments with all the zeal they give to the others. We see it in Michigan; we see it in California and Colorado; we see it in Louisiana and Texas as strikingly as in our Eastern States. There is nothing but good in this. The power, the means, the spirit of the university go out to its branch; the university in turn gains by the reputation of its medical faculty, and by the recognition that medicine is an essential part of the new learning which leads on to the highest attainable civilization."2 EFFECT ON ATTENDANCE OF LENGTHENING THE COURSE. The question may be asked, How has the attendance of students been affected by the requirement of another year of study? Adding one year to the course means not only increasing the amount of time required, but also an increase in the financial outlay. It would therefore naturally be expected that many young men would be led to seek other lines of employment. In order to determine this question somewhat definitely the statistics for the last five years have been collected of medical, dental, pharmaceutical, and law students, as all of these have had lengthened courses. Instead of any decrease, however, we find the number of students to have grown steadily larger. In 1888-89 the number of medical students was 15,029; since that time the number has goue steadily forward to 19,752 in 1892-93. As yet even the number of graduates has suffered no special loss, except in the dental schools, where the number of graduates in 1891-92 was 1,282 and fell to 507 in 1892-93, when the graduating class first encountered the three-year regulation. Athough the actual number of students in attendance during the last five years has regularly increased, it is still very probable that many have been kept out by 'Since the above was written the regulations have been made still more stringent. In Oregon, Montana, and Minnesota after 1898 an attendance upon four courses of lectures will be required. "The Regents of the State University [of New York] have voted to confer the university degree M. D. only after one year's postgraduate study subsequent to receiving the degree of bachelor or doctor of medicine from some registered medical school, and only on candidates who have spent not less than four years total study in accredited medical schools."-N. Y. Med. Record, July 20, 1895. 2 Dr. J. M. Da Costa, of Philadelphia. the lengthened course. It should be borne in mind that the same students are now kept in attendance a longer time, and therefore help to swell the enrollment for another year. a Decrease due in part to failure of one important school to report. b Decrease due to its being the first graduating class affected by the change to a three years' course. LEGAL CONTROL OF THE PRACTICE OF MEDICINE. Unless it be the American Medical College Association, probably nothing has contributed so much to the advancement of medical education in the United States as the establishment of State licensing boards, frequently called boards of health on account of a union of their functions. Here we see how far-reaching and important a little clause sometimes becomes, in a law which directs the licensing boards to register all graduates "of colleges in good standing." Probably no one of the legislators who first voted for the bill containing these words, now found in the law of several States, had any idea of what a powerful leverage they would become in the hands of State licensing boards for stimulating medical colleges to lengthen their course of study and raise the requirements for entrance and graduation. But when the Illinois State board announced that no medical school would be regarded in good standing which did not require three courses of lectures, the institutions immediately began to fall into line in lengthening their courses, for in truth many schools had favored such an extension before, but were deterred from taking the step because their competitors did not adopt it. Now, however, they recognized the fact that all schools would soon be compelled to advance their standards. This valuable work of State licensing boards was soon recognized in other States, and now we find such boards in thirty-five States and Territories, all of them contributing to a large extent in placing medical education upon a plane where it will reflect honor upon its followers. It was not many years ago when, in almost any State in the Union, anyone could hang out his sign as a medical practitioner and charge as high fees as the best qualified physician in the town. Why, then, should one spend several years in preparing for his work and deplete his purse with the hope of being able to refill it again? It might be said that the meritorious physician would be able eventually to show beyond doubt his qualifications, while the half-educated doctor would be unable to hide his mistakes. That is true to some extent, but the latter generally is able to |