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should spend four years in a medical school, one year in a hospital, and one year in a medical school in Europe-making ten years in all. Dr. P. S. Connor, of Cincinnati, argued that it would be unjust to insist upon all students that they should first be in possession of the A. B. degree, and then possibly have to practico at some country crossroads where the people around were unable to speak a single sentence correctly.
However, to prescribe a course of training is one thing; to have it followel is another. To make it a requirement of all medical students that they shonld take the course mentioned above, requiring ten years for completion and only to be finished after 30 years of age, would be to demand what is impracticable. Not only would many students be prevented from taking such a course from financial reasons, and others claim that their prospective income in rural districts would not justify it, but there are also some educators who hold that there should be a better adjustment of the collegiate and professional courses—that the collegiate student should havo better opportunities for electing studies preparatory to his professional work, or that his professional course should lielp constituto the requirements for an academic degree. The latter plan has been adopted by a fow institutions. But in objection to this the question may be asked, What special reason is thero why the practitioner of medicine should receive an 'academic degree at all if he can not obtain it in the regular way? If he is not to receive the training and knowledge which the collogiate course is designed to give, then the degree would be misleading and deceptive and therefore objectionable; although it may be said that his medical training develops his mental faculties in the samo way as collegiate studies, it is answered that ho receives the M. D. degreo for the completion of the medical course and that it sliould not entitle him to double distinction. If so, why should not the medical student take an extended course in purely medical education and then receive the three degrees, A. B., Ph. D., and M. D.? There would be ono advantage in this: he would not spend one-half his life preparing for the other half. He could completo his secondary course at 18 or 19 years of age, his medical course at 25 or 26, and still be able to enter upon the practice of his profession with honors leaped upon him.
Another plan has also been adopted by some institutions to enable medical students to enter earlier upon the practice of their profession. In about one-fourth the medical schools of the United States students who are gradnates in arts or science are allowed to enter upon the second year of the medical course, thus completing the course one year earlier than nongraduates.
“ The average age of students who enter the Harvard academic department has been gradually rising during the whole of this century, until it has reached nearly 19 years. The student who enters the medical school, therefore, finds himself just beginning the preparation of the real work of his life at an age when many of his contemporaries are already engaged in the productive work of their professions. In Germany the best class of students begin their professional studies at a little earlier age than that at which our young men enter Harvard ('ollege. As the course of study lealling to the degree of doctor of medicine lasts five years, it follows that the German physician is ready to begin practice before he is 231 years old.”!
Says President Eliot in his report of 1892-93:
“The professional schools are demanding longer and longer periods of study; and this demand, coupled with the improvement in the secondary schools, makes it more and more natural, and for young men of small means even necessary, to go direct from secondary schools to professional schools."
Here it seems that the young men, when they find it necessary to curtail the time required, have omitted or abbreviated the college course, holding that their early training should be full and accurate, a good foundation, but that as their professional attainment will form the basis of their lifework and determine its success, it should be the last to be abridged.
I Dr. J. C. Warren.
In considering the subject of medical eclucation it is well to remember that all students can not be expected to pursue the same stereotyped course of study; in some cases the limitations of age or of tinances wonld compel the student to seek the nearest entrance to the practice of inedicine, while in other cases the student would be able and desire to obtain first a full general cuncation and then to spare neither time nor money in obtaining a thorongh and accurate medical tra ng, so that he would be able to practice his profession with that satisfaction to himself which only skillful training can furnish. There must of necessity be two standards of medical education; a minimum standard, to which all students are required to attain, and a maximum or ideal standard, to which all students should desire to attain if possible.
The first simply requires that the student shall liave received a full secondary or high school education, then an attendance upon three full courses of lectures, and the passing of an examination in each branch of study. This course will be taken by those whoso age or financial condition prevents the possibility of a more extended training
The ideal course is the one mentioned on a preceiling page, a full secondary education by 19 years of ago, the completion of a regular four years' collegiate course by 23, tlien four years in a medical college and one or two years in a hospital, the student not beginning practice until 30 years of age. Of course many students can not take this ideal course, but there aro many who will, and especially will those who espect to scek practice in the large cities endeavor to comply with it. Those schools whose graduates go mainly to rural districts and villages will probably receive the larger number of students taking a short course, while other schools possessing large endowment funds, and independent of tuition fees, especially those schools which constitute departinents in the old and well-established universities where can be found every appliance for complete laboratory investigation, will be sought by those students desiring to receive the fullest medical training; while thie large boily of medical students will seek an intermediate plane between the two extremes, but each year approaching nearer to the liighest standard. Of course the number of students pursuing the extensive course above mentioned is not large at present, but as the country becomes more densely populated and as the candidates for professional honors are increasing rapidly, only those who have received full preparation can long expect to compete successfully for medical practice.
WOMEN IN TIIE PRACTICE OF MEDICINE.
It is well known that in America woman has a wider, more independent, and more remunerative sphere of work than in any other part of the globe. In fact, there are but few callings here in which she has not at least a few representatives. Although there is a greater demand here for “woman's rights” and probably more conventions are held to secure them than in any other part of the world, still it is to America that they ever look for the nearest approach to the ideal condition of woman. The greater freedom has whetted the appetite for still wider fields. But when we consider that some of the most skillful and eminent authorities on medical subjects have been wonen, we need not be surprised that they are still engaged in the work. When a Lachapelle and a Boivin have gone before, their followers are sure to be coming after. During tho year 1892-93 there were 1,302 women enrolled as students in the various medical schools of the l'nited States, including of students not reported in time to bo tabulated. Women were enrolled in 61 medical schools as follows:
78 330 10 57
There are in the United States 7 schools for the medical education of women exclusively. One of these, the Woman's Medical College of Pennsylvania, has an enrollment of 210 students. There were also 161 women studying the cognate subjects pharmacy (98) and dentistry (63), not mentioning the 42 engaged in the study of law.
Taking three years as the average length of time required for graduation, and making some allowance for students dropping out, there would be about 300 medical students in the graduating classes, or 3,000 women in the last ten years licensed to practice. According to the Census bulletin giving the statistics of occupations in 1890, there were in the United States 4,555 women physicians and surgeous, out of a total number of 104,803 physicians and surgeons.
A French compiler, M. Marcel Baudouin, furnishes a résumé of the legal status of women in the medical profession in various countries, in which, singularly enough, he omits all but the merest mention of the gentler sex in France. According to M Baudouin, women are rigidly excluded from the advantages of a university education in Germany, and consequently may not become candidates in any medical examination. “ It naturally follows that no medical woman can be the possessor of a certificate carrying with it the slightest value in Gerinany,” since a State license upon examination is necessary to practice in that country. In Austria-llungary the situation is even worse; there the admission of women to biglier grade instruction is formally forbidden by law. Spain is quite as bad; in fact, the difficulties are said to be even greater in the Iberian Peninsula than in Germany and Austria. In England, Ireland, and Scotland the universities-through which lies the registration necessary to the right to practice-are now all thrown open to women, Scotland hav. ing been the last to yield to the new order of ideas. In Ireland, however, while a woman is afforded every facility for obtaining a medical qualification, she may not fill any public office under the State. Similarly in Sweden, Norway, and Denmark the medical career is open to all without distinction of sex, save in the matter of State appointments. In Belgium, Ilolland, and Roumania the broadest views prevail regarding the medical rights of women; they may do and be, as plıysicians, all that men can and are, cæteris paribus, which they are not. The right of women to practice is fully recognized in Italy, and a woman occupies the chair of histology in the medical faculty of Bologna.
In 1893 there were 308 women attending medical lectures in Zurich, Geneva, Berne, Basle, and Lausanne, but there are only 10 women practicing in Switzerland. Alter graduating the students return to their own countries to practice, principally in Russia. In this latter country, Russia, there were 516 women practitioners in 1893, and women are there allowed by law to become assistant surgeons in all railway administrations; in 1890 a special medical school for women, after the American model, was established in Moscow. Universities in many of the English colonies have been open to women since 1875, and in France women first obtained foothold in a university in 1863, but five years later there were only 4 female students in l'École de Medecine of Paris; the more beautiful women of a most beautiful country do not seem to take kindly to the practice of physic, notwithstanding the illustrious examples of Mesdames Lachiappelle, Bourgeois, and Boivin, concerning whom it has been said that “if their mantle could be made to fall on the shoulders of their sisters of the present generation, female delicacy would be saved many a rude shock and the cause of science would in no sense suffer.” M. Baudouin concludes with the following tribute to this country:
"Only a moment's consideration of the following statistics is necessary to convince an inquirer that he must proceed to the United States of North America if he wants to study effectually the question of medical women. According to a statistical report drawn up by M. Lonis Frank, of Brussels, there were in 1893 on the other side of the Atlantic fully 2,000 women practicing medicine in one or other of its forms, and inclusive of 130 homeopaths The majority were general practitioners, but there were also 70 hospital physicians or surgeons; 95 professors in the schools; 610 specialists for the diseases of women; 70 alienists; 65 orthopelists: 40 oculists anul aurists; and, finally, 30 electro-therapeutists. In Canada there is but 1 medical school exclusively for women, but in 1893 there were 10 such in the United States."!
1 Journal of the American Medical Association, July 28, 1894.
HIGHER MEDICAL EDUCATION,
By Dr. WILLIAM H. WELCH, professor of pathology in Johns Hopkins University.
[From Western Reserve Medical Journal.] The time has come when the need of medical education should be brought forcibly before the general public in this country. Medicine can no longer be taught with the simple appliances of former times. The proper teaching of medicine now requires hospitals, many laboratories with an expensive equipment, and a large force of teachers, some of whom must be paid enough to enable them to devote their whole time to teaching and investigating. These things require largo endowments of money, and can not be adequately secured simply from the fees of students. If the public desires good physicians it must help to make them.
In this country, for the most part, we can not look to the State for endowment of melical education, but we must appeal to private beneficence. A few public-spirited and generous men and women have already given practical proof of their appreciation of these facts. With inore general and fuller realization of the needs and present condition of medical education, and of the results which can be secured by its liberal endowment, there is every reason to believe that these benefactions will be largely and rapidly increased, and that thereby the condition of medical education in this country shall cease to be a reproach to us. During the last few years our methods and standards of medical teaching have shown remarkable improvement. What preparation should a student bring to the study of medicine? It is highly desirable, in my judgment, that he should le liberally educated; that is, that he should possess a degree in arts or science which shall bo an index of that kuowledge and culture which, apart from any immediate bearing upon professional studies, are recognized as entitling their possessor to be ranked among liberally educated inen. Scientific studies have acquired the right to rank with classical studies in affording this liberal culture, but the humanities should have a fair share of attention at this period of education.
The question has been discussed whether or not during the period of collegiate education the student who intends to study medicine should be required to pursue any special subjects, and especially such as bear a direct relation to his future professional studies. The answer to this question seems to me to depend upon the character of collegiate training on the one hand and of medical training on the other. The primary purpose of collegiate education is to furnish a broad basis of mental discipline and liberal culture independently of direct relation to professional work. Where, as in the old-fashioned college in this country and in the gymnasia and lycées of Germany and France, the student enters college at the age of 15 or 16 and is graduated at 19 or 20, it is not necessary or even desirable that the undergraduate student should specialize his work with reference to his future profession. Under these circumstances, which obtain in most foreign universities, at least the first year of medical study is devoted mainly to physics, chemistry, and zoology, including comparative anatomy.
These are not, however, the conditions which prevail in this country at the present time, where on the one hand the average age of graduation from our best colleges is at least two years later than in Germany and France, and on the other hand the medical schools do not furnish adequate training in physics, general chemistry, and biology, whereas these sciences are now generally included in the curricula of our colleges. When we consider the fundamental importance of these sciences for the study of medicine, the axlvanced age of graduation from college, and the special conditions of collegiate and medical education in this country, it seeins to me clear that during the period of collegiate study the student intending to study medicine should acquire a fair knowledge of chemistry, physics, and general biology, and to these sciences should be added the study of French and German. Inability to read French and German deprives the physician of personal acqnaintance with a large part of the most valuable literature of his profession, and makes it impossible for him to keep thoroughly abreast with the progress of medical science and art.
There are certain points which should be clearly understood as regards the requirement that the preliminary education of a medical student should be a liberal one, iudicated by a degree in arts or science, and should be made to include a specified amount and kind of knowledge of physics, chemistry, and biology, with a reading knowledge of French and German. "The justification for the latter requirement is that inasmuch as students are kept at college in this country two years longer than in most foreign countries they should be permitted to pursue during at least the last two years of their course subjects which bear upon the study of medicine, but which, although included in the medical curriculum in foreign universities, are strictly liberal studies independent of their professional bearing. These sciences, preliminary to medical study, can be studied and taught better in the college than
in the medical school, and, indeed, in foreign universities they are more often pursued by medical students in the philosophical than in the medical faculty. It would be a waste of energy and money to make provision for them in both the medical and the academical departments.
It can not be truthfully said that the plan indicated need to divert the preliminary education from a liberal to a technical and specializeil one, for the degree in arts or science will presumably indicate that the student has a liberal education and the special subjects need not be taken up lefore the last two years of the course. The scheme presupposes that the student will have inade up his mind to study medicine in time to include these special subjects in his undergraduate studies. If he has not done so, or if he chooses to esclude them from his collegiate work, he will le obliged to devote at least a year to them after graduation and before beginning the study of medicine. The college authorities should, however, direct attention at the proper period of the course to the importance of these subjects for those who intend to study medicine.
This plan, moreover, adjusts medical education to existing conditions of collegiate eclucation in this country without any essential changes in the curriculum of the latter.
The advance age of graduation from college is a serious embarrassment to higlier medical education in this country, and has led to the unfortunate result that with the increase in the time required for the study of medicine there bas been a falling off in the number of medical students with a college degree in at least one of our leading medical schools, although it can not be doubted that the average amount of preliminary education has increased among our medical students.
Various suggestions have been made, especially by the medical faculties of our universities, to remedy this anomalous condition of collegiate education, or to adapt it to the needs of medical eclucation. I think that we may assume that the college course is not likely to be shortened, or that the college will relinquish that part of its development which has made it something between the old college and a university. There is good reason to believe that there are serious defects in our systems of primary and secondary education, and that without lowering the standard of admis. sion, better inet lods of teaching will enable students to enter college at least a year younger than is now the case,
The plan has been adopted in some of our colleges of permitting students to begin their medical studies in the medical departinent at the beginning of the senior year. This is a plan which is applicable only where there is a medical school in connection with the college, and involves certain sufficiently apparent difficulties. I think, however, there is much to be said in favor of this arrangement, which permits the student to take up the study of human anatomy, physiology, and physiological chemistry in his senior year in college, provided he has suficient preliminary training in the fundamental sciences which have been mentioned. It may, however, be questioned whether the time available for the study of physics, chemistry, and yeneral biology in college is any too long for this purpose, and will permit the addition of human anatomy with dissections and other subjects which must be a part of the regular medical curriculum. Unless the student has completed the work of one year of the medical course I do not see the justification of permitting him to shorten by one year the reguar medical course because he has a college degree.
It should be understood that if il medical school requires for admission a year's collegiate training in physics, chemistry, and biology, subjects which are incinded in the medical curriculum of European universities, its period of medical study is, according to European standards, lengtheneil by one year, the first year being relegatel to the collegiate period.
The only medical school in this country where a liberal degree is required for admission is that of Jolins Hopkins University. Here it is also required, for reasons which have been stated, that the candidate for admission shall be able to read French and German, and shall have had a year's collegiate training with laboratory work in physies, chemistry, and biology. It is, of course, impossible for unendowed medical schools to demand anything approaching these conditions for admission. I do not undertake to say that even were other medical schools so situated that they could demand them it would be wise for them to do so under present conditions, but it seems to me that there is room in this country for at least a few medical schools with such a standard. Exactly what is feasible to require as a general standard for admission to medical schools in this conutry at the present time is a sulijeet which, as already said, I do not consider at this time.
It is true that without a liberal education a man may become a competent physician, and may attain even a high standard of excellence in his profession, but with such education he is better adapted for the study of medicine, he is more likely to succeed in his profession, his social position will be better, and his life will be fuller.
How long should be the period of undergraduate study in a medical school? In Europe it is nowhere less than four years, and in most European countries it is