CHAPTER XXIX.
THE LOW STANDARD OF PROFESSIONAL ACQUIREMENTS.
The low standard of medical education in the United States makes the profession too easy of access, and often allows incompetent individuals to enter its ranks. The present state of medical literature requires a longer term of pupilage, and a more thorough course of clinical instruction, than has hitherto been fixed upon by our American medical institutions. Public sentiment requires a higher standard; a standard that would place the profession infinitely above all low pretenders,—upon a summit to which empiricism might look with envy, but could never approach. The distinction between men learned and skilled in the profession, and ignorant pretenders, should be made wider and more apparent. Men who obtain diplomas without more than a smattering of medical knowledge are easily induced to abandon the profession altogether, or to embrace some variety of quackery.
I believe that in all parts of Europe the requisites for a degree far exceed any in the United States. In Great Britain and France a more thorough preliminary education is required before the candidate is allowed to commence his pupilage. He is then to study four years, and six months of each year must be passed at some regular medical college. He must become thoroughly acquainted with hospital practice and clinical surgery. He must also have an experimental knowledge of chemical pharmacy, and be able to pass a rigid examination in all the collateral sciences. In Austria and Prussia the standard is still higher;—a liberal education is an indispensable prerequisite, after which five years of study and instruction are required, during which time the candidate for a degree must undergo a thorough examination every six months. There are, it is true, some quacks in all these countries, but they are always of a low order, and never held in much estimation by intelligent people.
The case is very different here. In many places in the United States, public opinion has elevated quack practitioners above regular physicians. Perhaps no city in the world affords better means for clinical instruction than the city of New York. In her numerous hospitals, diseases of all kinds, in all their various forms and stages, can be seen and studied ad libitum under as competent teachers as are found in any part of the world; but the brief period allotted to the common student does not give him time to enjoy the full benefit of these institutions j and often a pecuniary inability opposes its stern barriers and wholly deprives the student of any participation in these advantages. In this land of boasted liberty, public opinion is opposed to arbitrary rules, and the right of every man to medicate whomsoever he pleases is everywhere conceded. Whether he study little or much, with or without a diploma, he is under no restraint, and our State governments always appear disposed to allow quackery its largest liberty. I know that these are mortifying reflections: but they are nevertheless true. Still, however, some allowance should be made for the newness of our institutions and the unsettled state of public opinion. And it is confidently to be hoped that the time is not far distant, when the profession of medicine shall be allowed to occupy the same rank in America that it does in Europe, and no young American shall think of going to Edinburgh, Paris or Vienna, to complete his medical education, any more than he would think of going to Egypt to finish a study of theology.
I know it will be said that if the term of pupilage is lengthened, and a more thorough acquaintance with clinical and hospital practice required, the expenses will be increased to such an extent as to render it impossible for young men of small means to obtain medical degrees. To this I answer, that neither the public nor the young men with small means would suffer if it should so operate. If physicians were more thoroughly educated, and better qualified for the duties of their calling, the public would certainly gain by it, and the profession itself would enjoy a higher degree of public confidence. And if by such means some meritorious young men should be hindered from entering into the profession, it would be a favor to them, for they had much better stay out of it than starve in it. Throughout the United States, the profession is everywhere crowded; physicians are quite too numerous, and under existing circumstances a prudent young man had much better select some other more reliable occupation than to embark in the precarious business of medicine. No other class of men are so poorly paid for their services as physicians. Reckoning the cost of a medical education, the same amount of capital invested in almost any respectable business would prove more profitable.
It is said that when a young man inquired of the Hon. Daniel Webster as to the prospects in the profession of law, Mr. Webster replied, "The profession is quite full down here, but there is room enough up yonder." It is always so in medicine; the lower ranks of the profession are ever quite full, but there is always "room enough up yonder." In the present condition of things, no young man should select the profession of medicine as the business of his life, unless he intends to surpass the common ranks, and take his position "up yonder." Every young man who contemplates entering into any profession, should aim above mediocrity, and endeavor, by his industry and fidelity, to obtain an honorable position in the profession of his choice. Neither the honor of the profession nor the good of society requires any large increase in the number of medical graduates; but both are deeply interested in the thorough qualification of all who are allowed to assume the responsibilities of the profession.