the following year. The schools had not noticed at all when the vital features of the apprentice system dropped out. They continued along the old channel, their ancient methods aggravated by rapid growth in the number of students and by the lowering in the general level of their education and intelligence. Didactic lectures were given in huge, badly lighted amphitheaters, and in these discourses the instruction almost wholly consisted. Personal contact between teacher and student, between student and patient, was lost. No consistent effort was made to adapt medical training to changed circumstances. Many of the schools had no clinical facilities whatsoever, and the absence of adequate clinical facilities is to this day not prohibitive. The school session had indeed been lengthened to two sessions; but they were of only sixteen to twenty weeks each. Moreover, the course was not graded and the two classes were not separated. The student had two chances to hear one set of lectures—and for the privilege paid two sets of fees. To this traffic many of the ablest practitioners in the country were parties, and with little or no realization of its enormity at that! "It is safe to say," said Henry J. Bigelow, professor of surgery at Harvard in 1871, "that no successful school has thought proper to risk large existing classes and large receipts in attempting a more thorough education."[1] A minority successfully wrung a measure of good from the vicious system which they were powerless to destroy. They contrived to reach and to inspire the most capable of their hearers. The best products of the system are thus hard to reconcile with the system itself. Competent and humane physicians the country came to have,—at whose and at what cost, one shudders to reflect; for the early patients of the rapidly made doctors must have played an unduly large part in their practical training. An annual and increasing exodus to Europe also did much to repair the deficiencies of students who would not have neglected better opportunities at home. The Edinburgh and London tradition, maintained by John Bell, Abernethy, and Sir Astley Cooper, persisted well into the century. In the thirties, Paris became the medical student's Mecca, and the statistical and analytical study of disease, which is the discriminating mark of modern scientific medicine, was thence introduced into America by the pupils of Louis,[2]—the younger Jackson, "dead ere his prime," Gerhard, and their successors. With the generation succeeding the civil war, the tide turned decisively towards Germany, and thither continues to set. These men subsequently became teachers in the colleges at Philadelphia, New York, Boston, Charleston, and elsewhere; and from them the really capable and energetic students got much. One of the latter, who in recent years has wielded perhaps the greatest single influence in the country towards the reconstruction of medical education, says of his own school, the College of Physicians and Surgeons of New York, in the early seventies: "One can decry the system of those days, the inadequate preliminary requirements, the short courses, the dominance of the didactic lecture, the meager appliances for
Page:Carnegie Flexner Report.djvu/27
HISTORICAL AND GENERAL
9
