months or more, and the introduction of graded courses instead of a repetition of the same lectures every year. The improvement thus begun became marked during the decade 1890-1900, amounting almost to a revolution in the rapidity with which the course of instruction was amplified. Many factors co-operated to produce this result: the general development of scientific instruction in the colleges and secondary schools, the influence of the large number of medical graduates who completed their training by study in European schools, the adoption by many states of stringent regulations regarding the licence to practise within their borders, the good examples set by many leading schools in voluntarily raising their requirements for entrance and graduation, and, perhaps above all in its general effect, the agitation continually maintained by several national or state associations which in a measure have exerted the general regulating control that in other countries has been enforced by national legislation. Among the most influential of these associations are the American Medical Association, the American Academy of Medicine, the Association of American Medical Colleges, the Illinois State Board of Health, and the University of the State of New York.
The different states make their own general regulations as to the practice of medicine within their borders. Certain states recognize the medical diplomas granted by other states having equivalent standards of examination. Such certificates, are generally required to be (a) of graduation from a “reputable medical school,” (b) certificates of moral character, (c) the applicant must be at least twenty-one years of age. These enable the candidate to present himself before the state board for the state examination. In many states the applicant must satisfy the board not only as to his professional, but as to his general education. The standing of the various medical schools is usually left to the state boards, each one determining the matter for its own state, consequently a school may confer a degree recognized as reputable in several states but not in others. Only three or four states regulate the chartering of institutions. In other states any body of men may secure articles of incorporation of a college or school by paying the necessary state fee, without question as to the ability of the incorporator to furnish an education. So strong, however, has been the growth of American public opinion that a four-years course of medical training has become the standard in medical schools, and in the majority this is in addition to one or two years' training in the natural sciences. There are some sixty-five state boards, and many have adopted strong medical practice acts.
The standard of preliminary requirements for entrance to the medical schools is being gradually raised, and a large number of the states demand a certificate of a high school education, while the colleges comprising the Association of Medical Colleges, which numbers more than half the American medical schools, accept as an entrance standard a certificate of at least one year's study at a high school. In the report for 1908 of the United States bureau of education of 71 schools, which report the number of their students having an arts degree, it is stated that a degree was held by only 15% of the candidates in medicine. These students were mostly distributed between the Johns Hopkins Medical School (which from the date of its foundation in 1893 has only admitted college graduates, and has in addition stipulated that candidates shall have a knowledge of French and German and have already completed a year's training in the natural sciences), Harvard Medical School and Columbia University, and the medical departments of the universities of California, Michigan and Chicago (Rush Medical College) require on entrance the equivalent of a two-years' college course, which must include French and German, together with physics, chemistry and biology. This tendency is in accordance with the recommended standard of medical education suggested by the Council of Medical Education and adopted by the House of Delgates of the American Medical Association, of which the following is a summary:—
1. (a) The preliminary of a four-years' high school education or an examination such as would admit to a recognized university.
(b) In addition a year of not less than nine months devoted to chemistry, physics and biology and one language (preferably French or German) to be taken at a college of the liberal arts.
2. Previous to entering a medical college every student should receive from the state board a “medical student's entrance certificate” to be given on the production of credentials of training as above.
3. Four years of study in a medical college having a minimum of a 30-weeks' course each year, with not less than 30 hours' work per week.
4. Graduation from college to entitle a candidate to present himself for examination before a state board.
5. A satisfactory examination to be passed before the state board.
Practically all medical schools admit women, but there are three separate schools of medicine for women: The Women's Medical College of Philadelphia, Pennsylvania; Women's Medical College, Baltimore, Maryland; New York Medical College and Hospital for Women—the last being one of the eighteen homoeopathic colleges of the United States.
Authorities.—J. M. Tower, Contributions to the Annals of Medical Progress and Medical Education in the United States, before and during the War of Independence (Washington Government Printing Office, 1874); N. S. Davis, History of Medical Education and Institutions in the United States (Chicago, 1851); Contributions to the History of Medical Education and Medical Institutions in the United States (Washington, Government Printing Office, 1877); J. B. Beck, An Historical Sketch of the State of Medicine in the American Colonies (Albany, 1850); Bulletins of the American Academy of Medicine (The Chemical Publishing Company, Easton, Pa.); H. L. Taylor, “Professional Education in the United States,” College Department, University of the State of New York, Bulletin 5, 1899, and Bulletin 8, 1900; “Courses of Study in Medical Schools,” Report of the Commissioners of Education (Washington, 1908); F. R. Packard, M.D., The History of Medicine in the United States (1901); Journal of American Medical Association (Aug. 14, 1909); A. Flexner, Medical Education in the U.S. and Canada (1910). (W. H. H.; H. L. H.)
MEDICAL JURISPRUDENCE, or Forensic Medicine, that branch of state medicine which treats of the application of medical knowledge to certain questions of civil and criminal law. The term “medical jurisprudence,” though sanctioned by long usage, is not really appropriate, since the subject is strictly a branch of medicine rather than of jurisprudence; it does not properly include sanitation or hygiene, both this and medical jurisprudence proper being distinct branches of state medicine. The connexion between medicine and the law was perceived long before medical jurisprudence was recognized, or had obtained a distinct appellation. It first took its rise in Germany, and more tardily received recognition in Great Britain. Forensic medicine, or medical jurisprudence proper as distinguished from hygiene, embraces all questions which bring the medical man into contact with the law, and embraces (1) questions affecting the civil rights of individuals, and (2) injuries to the person.
I.—Questions affecting the Civil or Social Rights of Individuals
1. Development of the Human Frame.—The development of the physical and mental powers of the human being is a factor of great consequence in determining criminal responsibility, civil responsibility, or the power of giving validity to civil contracts, and in determining the personal identity of a living person or of a corpse. Human life is usually divided into the five periods of infancy, childhood, youth, manhood and old age. Some writers increase the number of these unnecessarily to seven periods.
Infancy is the period from birth till the first or milk set of teeth begin to be shed—usually about the seventh year. During this period the body increases in size and stature more, relatively, than at any other period of existence; and the mental faculties undergo great development. The milk teeth, twenty in number, are evolved in a definite order, beginning with the central incisors at about six months, and ending with the second molars about the termination of the second year. From the size and stature of the body, the development of the teeth, and the more or less advanced state of ossification or solidification of the bony skeleton, conclusions may be drawn as to the probable age of the infant.
Childhood extends from the commencement of the shedding of the milk teeth to the age of puberty—usually from the seventh to the fourteenth or fifteenth year. During this period the body expands, as well as the bony structures, without any clearly marked difference in structure being observable between the sexes except as regards the genitals, so that it is impossible to distinguish absolutely between the male and the female skeleton during this period. The milk teeth are shed, and are replaced by the second or permanent set, thirty-two in number, though these do not usually all make their appearance during childhood. Marked differences between the proclivities of the sexes are noticeable even at an early period of childhood, and long before the characteristic functions begin to be developed.
