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A History of the Medical Department of the University of Pennsylvania/Chapter IX

 

CHAPTER IX.

 

Separation of Obstetrics from the Chair of Anatomy—Estimation of this branch in Europe, and its elevation to an equal position with other branches in the Medical Schools—Dr. Shippen’s endeavors to improve its condition in America—Election of Dr. James to the Chair of Obstetrics in the University of Pennsylvania—The tardy admission of the subject to an equality with others—Mode of examining for degrees—New By-Laws for the regulation of the Medical Department—Rules for graduation.


In 1810 a separation was effected between the two branches of Anatomy and Obstetrics, which had continued in the hands of a single Professor from the origin of the School of Medicine —a long period of forty-five years. This was owing more to the ignorance of the community at large with respect to the utility of Obstetrics than to the want of appreciation of its importance on the part of the profession. “Indeed, the public had to be educated to the opinion that science and extensive medical knowledge were required to conduct ‘labor’ with safety and success, as much as surgical operations or the treatment of disease.”

In Europe, Obstetrics, as an art and science, was forced to disenthral itself from prejudice and disesteem. In consequence of the fastidiousness existing among women, it was little appealed to in aid of their sufferings. Delivery was assigned to, or rather permitted to be exercised by those entirely ignorant of its principles. Midwifery was in the hands of elderly women, who were usually conceited in proportion to their ignorance. To show that in the middle of the eighteenth century, midwifery was hardly regarded as belonging to the regular duties of the medical practitioner, it may be stated that Dr. Smellie, who afterwards contributed so much to improve and perfect it, at the commencement of his career “united the occupation of cloth merchant and practitioner of midwifery at Lanark.”[1]

Instruction in midwifery was first commenced in Edinburgh in 1726. The patrons of the University then founded a Professorship of this branch, to which was appointed Mr. Joseph Gibson. With respect to this the following statement is made by Mr. Bower: “At the time Mr. Gibson made his proposals to the Town Council, the practice of Midwifery in Scotland was completely engrossed by females. The profession of Accoucheur, little more than thirty years ago (from 1817), was esteemed very unbecoming a gentleman, and so strong was the current of vulgar prejudice against those who practised it, that it was only in the most extreme cases, and, in general, when they could be of little or no service, that modest women would permit them to be called in for advice or assistance. Mr. Gibson solely instructed the midwives, and he was not a member of the Senatus Academicus. On his death in 1737, Mr. Robert Smith was appointed his successor, and was the first who had the status of a member of the Senatus.”[2]

“Dr. Thomas Young, who in 1756 succeeded Mr. Smith, may truly be considered as the founder of this branch in the University of Edinburgh. He opened a class for students, instead of confining his attention to the education of females, and thus was the means of preventing midwifery from being engrossed by a very ignorant and credulous set of practitioners. He furthermore applied to the Managers of the Royal Infirmary for permission to fit up award for ‘Lying-in Women’ and was successful.”[3]

“Even among medical men, for a long time after the branch had been introduced into the studies of the University, the prejudice against it continued. In 1769 an act was passed by the College of Physicians of Edinburgh, declaring those who practised Surgery, or any of its branches, including Obstetrics, disqualified from being admitted Licentiates of the College; and this having been carried by the majority, a dissent from the determination was entered by Dr. Thomas Young. In this dissent he was supported by his Colleagues Drs. Cullen, Monro, Ramsay, Gregory, and Black, and by Dr. James Hay. In the progress of the discussion, which lasted until May, 1772, when the College reverted to their original resolution of prohibiting the practice of Surgery and its several departments, by Fellows of their own body, Dr. Cullen took, in a great measure, the lead at the meetings of the College. The following reasons were given in opposition to this act with reference to Obstetrics.”

“If the separation of Midwifery from Physic was the principal intention for passing this new act, it is certainly one of the most improper. Midwifery is a part of Surgery the most diversified that we know of, and the most requiring the general principles of physic. A judgment in physic is often inseparable from the practice of Midwifery, when it is not possible to have either the physician always at hand, or to render him useful unless he is exercised in the practice of it; therefore it is to the interest of mankind to have the two conjoined, if possible, in one person.”

“We are persuaded that the public will think it for their interest, in cases which are attended sometimes with so great and sudden danger that physicians of the first rank should undertake the profession of Midwifery, and that the Legislature will not suffer the College of Edinburgh to put a mark of contempt upon such physicians by excluding them from their Society.”

Before Dr. Cullen died this act was repealed, and practitioners of midwifery admitted as Fellows of the College.[4]

The elevation of Midwifery to its true position in England is due mainly to the writings of Dr. Smellie, Dr. William Hunter, and his pupil Dr. Denman; while Mauriceau and Baudelocque were, by their clear and philosophical exposition of its principles, mainly instrumental in establishing its importance on the Continent.[5]

It has been seen that Dr. Shippen, while in Europe, cultivated obstetrical science. Upon establishing himself in business, he endeavored, by teaching its principles, to ameliorate the evils which came from the assumption of its duties by persons destitute of competent skill or knowledge. In the “Pennsylvania Gazette,” Jan. 1, 1765, we find this curious advertisement:—

“Dr. Shippen, Jr., having been lately called to the assistance of a number of women in the country, in difficult labors, most of which were made so by the unskilful old women about them; the poor women having suffered extremely, and their innocent little ones being entirely destroyed, whose lives might have been easily saved by proper management; and being informed of several desperate cases in the different neighborhoods which had proved fatal to the mothers as well as to their infants, and were attended with the most painful circumstances, too dismal to be related! He thought it his duty immediately to begin his intended courses in Midwifery, and has prepared a proper apparatus for that purpose, in order to instruct those women who have virtue enough to own their ignorance and apply for instruction, as well as those young gentlemen now engaged in the study of that useful and necessary branch of surgery, who are taking pains to qualify themselves to practise in different parts of the country, with safety and advantage to their fellow citizens.”

After giving an outline of the contemplated course, the advertisement goes on to state that, “in order to make the course more perfect, a convenient lodging is provided for the accommodation of a few poor women, who otherwise might suffer for want of the common necessaries oil these occasions, to be under the care of a sober, honest matron, well acquainted with lying-in women, employed by the Doctor for that purpose.” This is the first attempt in this country to establish a practical school or hospital for lying-in women. By his exertions in this direction, Dr. Shippen succeeded in popularizing “Man Midwifery,” and acquired a respectable share of practice. We are informed by Dr. Wistar, that prior to the Revolution, Dr. Shippen “seems to have had a distinct class of students in the branch of Obstetrics; after that he delivered a short course to his general class,” and adds: “I believe there was no lecture in which he shone so much as in his Introductory one to Midwifery, upon the subject of dress and deportment.”

The union of Anatomy and Midwifery, after Dr. Shippen’s death, did not continue without remonstrance upon the part of the Professor, Dr. Wistar. From the Minutes of the Board of Trustees, Jan. 9, 1809, immediately after his election, we find that he directed a letter to that body, “requesting, for reasons therein stated, that the Professorship of Anatomy and Midwifery be abolished, and that two distinct Professorships be established in this Seminary.” The movement which ensued from this proposition led to the passage of the following resolution, April 11, 1810:—

“That the present establishment of a Professor of Anatomy and Midwifery be divided, and that hereafter there shall be a Professorship of Anatomy, and a Professorship of Midwifery, but that it shall not be necessary in order to obtain the Degree of Doctor of Medicine, that the student shall attend the Professor of Midwifery.”

On the 29th of June, 1810, Dr. Thomas Chalkley James was elected Professor of Midwifery. To no one could the duties of this chair have been more appropriately committed than to this amiable, gentle, and accomplished gentleman.

But with the act of calling Dr. James to the newly-created chair of Obstetrics, it must not be concealed that a grudging assent was given to the propriety of elevating the subject to a condition of independence, and that its equality with others as a branch of medical science was denied, from the fact that attendance upon the lectures of the Professor was not made obligatory for a degree. For three successive years it modestly remained subordinate. In 1813 it assumed its legitimate footing, when attendance upon the lectures and an examination upon it became requisite for graduation.

The following is the Resolution on the Minutes of the Board of Trustees, Oct. 11, 1813: “Resolved, that hereafter the Professor of Midwifery shall be a member of the Medical Faculty, and that no person shall be admitted as a Candidate for the Degree of Doctor of Medicine in this University, unless he shall have regularly attended the lectures of said Professor for two years, provided, &c.” On this event, Dr. Hodge, in the Life of Dr. James, thus forcibly comments:—

“This triumph of Truth and humanity over ignorance and prejudice may be considered as complete. Obstetrics was confessedly equal to the other branches of medical science, and its practitioners and teachers were authoritatively pronounced on a par with Surgery and the Practice of Medicine. The battle had been fairly fought and won, and Dr. James, who contributed so much to the happy issue, received now the reward so eminently due to modest worth, superior talents and attainments united with persevering industry.”

At the time of his election in 1810, Dr. James had Dr. Chapman associated with him, which connection continued until the bestowal upon the Chair of its full dignity and privileges, when the latter gentleman assumed new functions in the School.

The mode of examination for Degrees, from the foundation of the Medical Department, had been to subject the student, in the first instance, to a private investigation of his qualifications by the Professors, and then, by public demonstration before the Trustees, to exhibit his fitness for the honor of the Doctorate. The latter process was technically termed “defending his Thesis.” The first ordeal was the most important. It in reality determined the fate of the applicant, as the Professors took care not to expose incompetent persons to the mortification of failure in the public exercises, and were, moreover, well informed by it of the preparation of the candidate for a second examination. At the examination of 1810, a modification of the first step in the proceedings was adopted, which has given rise to the conventional term for examination, even still employed, “The Green Box.” With respect to its origin, we quote the Minutes of March 20: “This day, from certain difficulties having arisen, the Professors commenced the practice of examining the candidates behind a screen. Mr. Naudain was the first candidate examined in this manner.”[6] In this way the individual was only known to the Dean. The custom of examining in the “Green Box” was formally abolished by the Faculty in 1821. The examination upon the Thesis was not always satisfactory, as cases are on record of failure in this part of the exercises.

On the 1st of January, 1811, the Trustees appointed a committee of their body to “revise the Bye-Laws and Ordinances that have been made in this Institution, and to report such a set of Bye-Laws and Ordinances as to them shall appear proper and consistent with the Constitution of the Seminary for the regulation thereof.”

On the 21st of January the following rules were enacted with reference to the Medical Department:—

“In the Medical Department there shall be a Professorship of Anatomy; of Surgery; of the Institutes and Practice and Clinical Medicine; of Materia Medica; of Chemistry; of Natural History and Botany; of Midwifery; of Natural Philosophy.

“The Medical Schools shall be under the immediate government of the Medical Professors, subject to the Rules and Statutes of the Board of Trustees.

“The Medical Professors shall hold meetings from time to time for the purpose of arranging and conducting the business of this department, and establishing rules and regulations for the preservation of order and decorum among the medical students, and they shall keep regular minutes of their proceedings.

“All questions (those excepted which relate to the passing of a Candidate for a Medical Degree) shall be decided by a majority.

“Each student, and every other person attending a course of medical lectures, shall pay to the Treasurer of the University four dollars at the beginning of every session, and no Professor shall deliver a Ticket of admission to his lectures, unless at the time of application thereof, the treasurer’s certificate of the payment of that sum be produced by the applicant.

“The Medical Professors shall, each in rotation, act as Dean for one year, and it shall be the duty of the Dean to arrange and conduct the business of examining the candidates for medical degrees.

“The Professor of Natural Philosophy in the Medical Department shall not be considered as a member of the Faculty, nor entitled to a vote at the meetings of the Medical Professors; nor shall he comprehend within the plan of his lectures any branch of natural knowledge for which there is a professorship especially appointed in the Medical department. He shall provide apparatus for his own use, and he shall have authority to make regulations for the government of his school, subject to the Rules and Statutes of the University.[7]

Rules for Graduation.

“1. No person shall be admitted as a Candidate for the Degree of Doctor of Medicine until he shall have attained the age of twenty-one years, nor unless he shall have applied himself to the study of Medicine three years, two of which shall have been in this University; nor unless he shall have attended the Pennsylvania Hospital during one session at least, and also have attended the practice and been the private pupil of some respectable practitioner.

“2. No person shall be admitted as a candidate for said Degree unless he shall have regularly attended the lectures of the following Professors: of Anatomy, Surgery, Institutes, Practice and Clinical Medicine, Materia Medica, and of Chemistry.[8]

“3. Each person intending to offer himself as a Candidate for the Degree of Doctor of Medicine, shall, on or before the 10th day of March of the year in which he offers himself as a Candidate, signify such intention in writing to the Dean, and shall, one week at least before the time appointed for his examination, deliver to the Dean a Thesis on some Medical Subject, which subject shall have been approved by the Professors. The Candidate shall then be examined privately by the Professors upon the various branches of Medicine, and upon his Thesis in the presence of such of the Trustees as may choose to attend, notice of the time of examination having previously been given to them. If he be found qualified for the Degree, he shall be so reported by the Dean to the Provost, who shall communicate such report to the Trustees, in order that if approved by them, their Mandamus may be issued for conferring the Degree, at such time as they may judge expedient.

“4. The Thesis may be published, if the Candidate desire it; the permission of the Professor by whom he was examined thereon having been first obtained, but no alteration shall be made therein after such permission shall have been given; and a copy of the Thesis shall be deposited in every case in the University Library before the degree be conferred.[9]

“5. Each graduate in Medicine shall pay to the Provost three dollars as an honorarium, and to the Vice-Provost two dollars as an honorarium, at the time of placing their signatures to the Diploma.”

The fee for graduation had been regulated in 1809, by requiring of the graduate the sum of five dollars to each Professor. In the arrangements subsequently made between the Trustees and the Professors, the specific fees of the Provost and Vice-Provost have been commuted for an addition to their salaries. The pecuniary understanding between the Board and the Faculty has undergone many modifications, arising from an outlay of capital in providing accommodations for teaching. The whole fee for graduation was fixed at forty dollars, which continued to be the regulation until 1837, when the matriculation fee was fixed at five dollars, to be paid but once, and the fee for the diploma reduced to thirty dollars.

  1. Life of Cullen, by Dr. J. Thomson, vol. i. p. 10.
  2. Bower’s History of the University of Edinburgh, vol. ii. p. 254.
  3. Ibid., vol. iii. p. 516.
  4. Life of Cullen, vol. ii. pp. 89-697. Continued by Dr. Craigie.
  5. Dr. John Maubray is considered by Dr. Denman as the first public teacher of Midwifery in England, and in 1724 published a syllabus of his lectures. His course consisted of twenty lectures, twelve of which were anatomical and physiological, and eight practical.

    Dr. Edmond Chapman was the second public teacher of this branch in London about the year 1730. “He was a practitioner in the country, and came to the metropolis once a year to deliver his lectures; but his pupils were only instructed in the theory, as he had no machine; nor were they allowed to attend labors, for Smellie first introduced these two great improvements. Dr. Chapman first described the forceps.” This instrument had been invented by Paul Chamberlain.—Sketch of Medicine and Midwifery in Denman's Treatise on Midwifery.

  6. Dr. Arnold Naudain, of Delaware, afterwards a distinguished citizen of that State, and Senator of the United States.
  7. This Professorship was instituted at the same time as the Chair of Midwifery, as a part of the organization of the Medical Faculty. It was filled June 29, 1810, by the election of Mr. Robert Hare, who does not appear to have performed any duty, and resigned October, 1812. It was subsequently filled by the appointment of Dr. Robert M. Patterson, until the transfer of that gentleman to the Chair of Natural Philosophy and Mathematics in the Department of Arts, in 1814.
  8. Midwifery was omitted as a branch necessary for graduation, and did not rank on an equality with the other branches until 1813. See ante.
  9. It had been enacted in 1802, “That the Dean inform each Candidate upon his application, that if it should appear upon inspection of his Thesis that he was not well acquainted with Orthography he will not be regarded as qualified for a Degree.” In 1806 the candidate was relieved of the necessity of publishing his Thesis, and it was made optional with him to print it or not, as in the regulation above.