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to say that the association constitutes an interested and efficient ally of the chain of bureaus.
The enumeration of topics, with the scope shown by the laws crearing the different bureaus of the United States, covers a wide range of investigations, affecting all the conditions of the people. It is my belief that this range will grow wider and wider, and that the men who are in charge of these bureaus, as a body, are thoroughly alive to the necessity of keeping that range within the province of practical work. They are not theorists, but, as a rule, practical men, who are doing excellent service in the cause of humanity. It is the duty, as it is the privilege, of this association to aid them, not only by bringing their work prominently before the people of the country, but by counsel and suggestion. We discuss matters here when the ideas underlying them are in embryo. We throw out suggestions of lines of work, and we discuss propositions which it is the privilege of the bureaus to crystallize into well-directed investigations. With all this, statistical science is making rapid progress in this country. It is apparent from this brief outline that the bureaus an
are engaged in a grand mission. Their integrity in this mission is unassailable, and the results they are bringing out constitute a most valuable series of contributions to social science. The popular education of the masses in the elementary facts of political and economic sciences is the greatest educational end of the day. The bureaus of statistics of labor are in the line of facilitating this grand work by their faithful investigations into all the conditions where facts should be known, and into all causes of bad conditions of whatever nature, and by their fearless promulgation of the results of such investigations. To attempt to turn such a sphere of labor to base purposes is a crime not easily punishable by law, but which can be punished by an unwritten law which reaches the violator through a decree more to be dreaded than any merely judicial order or sentence,- the sentence public opinion passes upon the man who prostitutes the cause of humanity.
II. PAPERS AND DEBATES OF THE DEPART
MENT OF HEALTH.
SARATOGA, SEPT. 5, 1888. The Department of Health was called to order at 9.30 A.m. by H. HOLBROOK CURTIS, M.D., the CHAIRMAN, who proceeded to make
AN ADDRESS ON “ THE NECESSITY OF ADDITIONAL REQUIREMENTS FOR OBTAINING A MEDI
While much has been accomplished during the past three years in the general advancement of medicine as a practical science, there is yet such scope for improvement in the manner in which the science is dispensed, and so urgent a need of legislative interference to prevent the medical schools from flooding the country with an uneducated rabble of incompetent pretenders, that it seems proper for this Department of the American Social Science Association to consider carefully the resolution of 1887, offered by President Scovel, of the Wooster University in Ohio, and to take the voice of the Association on another resolution which will be offered.
The following resolution was offered Sept. 7, 1887, by President SCOVEL, and adopted by this Association :
Resolved, That, in view of the peculiar relations which must always exist between the physician and the community, the Department of Health of the American Social Science Association be requested to inquire into the antecedent general and collegiate education of the students in the medical schools of our country, and to consider the expediency of agitation for additional requirements in this regard, by these institutions themselves, and for public legislation to establish at least a reasonable minimum.
In no country in our world has there been such vast wealth accumulated from the sale of nostrums as in the United States, nor are we able to find a people elsewhere who are as susceptible to the blandishments of the quack or the seductive influences of the “mind-cure lady” and the Christian scientist. Is this state of affairs due to national peculiarities and traits, to the lack of education among our people, or directly to the physicians themselves, and not to the community? Another question may be asked, What do the incorporated medical schools offer as a guarantee of the intrinsic value of their diplomas? Upon investigation, we find that, in sixty per cent of these institutions of the United States, applicants are taken as students, with no questions asked as to their ability to comprehend the teaching they are to receive. Consequently, a large proportion of these students are graduated after two school sessions with but a superficial smattering of the seven subjects in which they are examined ; and, as the examinations are often conducted orally, it is possible for men to receive a license to practise with but the crudest apology for an education in the elementary English branches. So long as our medical colleges are run as strictly business ventures, one bidding against another to obtain the greatest number of students, or holding out a shortened session or a lowered fee as an additional allurement, so long will our system of medical education be held up to ridicule abroad, and the laxity of our methods be a lasting reproach and mortification to every conscientious practitioner at home.
While I am not an advocate of trusts in general, no greater good could accrue to the advancement of medical science than that the medical schools combine, and make the requirements of admission the same for all. This would quickly close
institutions whose almost criminal methods make us blush for our legislation, and drag the noble name of physician in the mire. To show that the desire obtains in some directions of improving the present standard, let me quote from an able paper by Dr. F. R. Sturgis, of New York, read before our State Medical Society in February, 1882 :
Another hindrance to a good medical education arises out of the dependence of the medical schools upon the students' fees. With but one exception, perhaps, no medical school in this country can say to a student: We do not care about your fees. Your acquirements are not up to our standard. We will not accept you as a student. Most medical schools saying that would at once lose their students; and, in this connection, the friends of educational reform in medicine are invited to ponder the action of the Bellevue Hospital Medical College. In 1879, this school, amid loud trumpeting and posing before the medical public as the friend of educational reform in medicine, announced that, after the regular term of 1879-80, the preliminary term should be abolished, and the regular winter course be prolonged to six months instead of three, that a preliminary examination should be held prior to the matriculation, that attendance upon three winter terms should be obligatory, that the students should be obliged to pass annual examinations independent of the final one for the degree of M.D., and that the course of study should be a graded one. Amen, said the friends of reform. This is an excellent beginning. The reputation and position of the men connected with the Faculty of the Bellevue Hospital Medical College is a guarantee, if not of success, at least of a fair and thorough trial of this new and desirable system. We wish them Godspeed. What has the result been? Six months after the trial of the new method, the Faculty issued another circular, announcing that, “after the present session of 1880–81, attendance upon a third session will be optional, and not obligatory”; that the school will return to the two years' rule, and abandon the attempt to give an extended curriculum, because “ to persist in the requirement of attendance during these courses will be to incur a risk, as regards the interest of the college, which they do not feel justified in assuming," and, furthermore, because “ the profession is not prepared to sustain the movement.” Was ever conclusion more lame and impotent, was ever retrograde movement more hasty and indecent? After all their pretensions in behalf of reform in medical education, these worthy and excellent teachers are frightened at the result. They are losing too much money. They cannot stand the pressure, and they execute their somersault into their old place, amid the jeers of both friend and foe. Well may the friends of advance in medical education exclaim : We want no assistance against our foes.
We can manage them, but God save us from our friends.
Another defect is the careless and slipshod way in which charters can be obtained for educational and other purposes. All that is requisite in this State is that not less than “five persons of full age, citizens of the United States, a majority of whom shall be citizens of and residents within this State, . .. may make, sign, and acknowledge before any person authorized to take the acknowledgment of deeds in this State, and file in the office of the Secretary of the State and also in the office of the clerk of the courts, in which the business of such society is to be conducted, certificates in writing, in which shall be stated the name or title by which such society shall be known in law, the particular business and objects of such society, the number of trustees, directors, or managers of such society for the first year of its existence," etc. There is nothing making the educational candidate for a charter show just cause for its existence, nor anything binding it to give good and proper instruction. Hence, as soon as its charter is obtained, it may do as it pleases,— teach or not, as it likes, or, if it prefers, it may sell its diplomas.
So much for Bellevue. The Medical School of Yale College shortly afterward attempted the same thing, to find that the students commenced to disappear like dew before the rising sun. However, the Faculty did not have the courage of the Bellevue professors to resume the ways of darkness and save unto themselves the men and their shekels; but they kept on setting a noble example, while the ratio of students to professors is becoming painfully equalized. Yale College would never regret having that good old school, where have shone the noblest and most brilliant types of New England practitioners, die in martyrdom for the cause of scientific advancement.
It is evident that, unless the speculative instinct can be entirely eradicated from the minds of our instructors, no instruction can be wholesome and good. It is evident, without argument, that a man cannot be an accomplished instructor who has to devote eight hours a day to a general practice and his leisure, so to speak, to his professorial duties. To-day, with the advances in microscopy, the practitioner must be also a good pathologist, and to become a good pathologist requires an education, not granted but in the medical schools one can count on the fingers of one hand.
The medical school of the future must demand, on admission, a thorough knowledge of physics and elementary, inorganic, and physiological chemistry; for these branches require prolonged laboratory work, which is incompatible with attendance upon lectures. Either do this or add a third year to the time of study, and include the above branches with botany, comparative anatomy, and biology, as a first year's work. An ideal preparation for medical study, in my opinion, is the medical course of the Sheffield Scientific School of New Haven. We all know what we need. The question, then, is where and how to get it.
To make a school, we must first make our professors. They cannot be made from our busy practitioners. A Pasteur or a Koch does not evolve from a man who must needs consider his house-rent in the midst of his researches, or be called to a baby's belly-ache from the study of a bacillus. To elevate the standard, we must let the sincerity of our motives and the excellence of our scholarship be the desideratum, which condition can only be attained by properly endowing our institutions, thus placing the instructors without the pale of competition and beyond the necessity of considering their individual relationships with the community.
President Eliot, of Harvard University, said in his report for 1880-81: