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devote his life to scholarship, is not the man who craves $25,000 a year. What he craves is leave to follow his scientific pursuits; and he is satisfied to live comfortably, if he may extend his researches in the direction which he may choose. In France and Germany, the ablest men, the renowned specialists, who are known as good teachers, are not always wealthy physicians. Their entire time is taken up in hospitals and clinics. But they get the largest fees when they are called in consultation. They will receive sometimes as much as a thousand dollars for going a short distance. There is some recompense in this. Many a man is willing to devote his life to microscopy for five or six thousand dollars a year. The best fiddler is not always the best teacher of the fiddle. I think it is the same in medicine.
Mr. F. J. KINGSBURY.— I have been thinking that perhaps something in the way of reminiscence, if not instructive, would be encouraging. The memory of individuals here runs back almost to the time when the only method of medical education in this country was for the pupil to go and reside in the family of some physician. Almost every country physician had one or two such pupils. They took care of his horse, built the fires in the morning, milked the cow, cut and brought in the wood, and assisted in taking care of the children. After they got a little experience, they were allowed to use the lancet on the veins of cabbage leaves, and to unset, for the sake of setting, the legs of cats and chickens. That is truly the way in which our physicians of sixty or seventy years ago were educated, and it is greatly to their credit that this made some of the best physicians the world has ever known. There is no man whose name, I think, stands higher on the medical roll than that of Nathan Smith, one of the first prosessors in the Medical School of Yale; and that is the way he got his training. There has never been a lecturer more appreciated in the United States than Jonathan Knight, who was his successor; and that is the way, to a certain extent, in which he was educated. When we compare that method with the methods of to-day, there is reason to feel greatly encouraged at the progress of the medical profession. There are great difficulties about this as a practical question. The whole matter of endowments, of public assistance, is an entirely different problem here from what it is in Europe. There, the government has been looked to to do that sort of work, and has done it to a great extent. Here, we have no government which has the power, or which would be permitted to fill that position. We have got to look to some different source, to corporations or men of private fortunes.
Then there are other difficulties which the medical profession has to contend against. One is the natural tendency of the human mind to superstition. I presume people could still be found who have an abiding faith that the seventh son of a seventh son is a born doctor, that he has some special power. There is perhaps no branch of science so filled with superstition as the science or art of healing. There are various reasons for this. It has been so throughout all history, and we find it in sacred history quite as much as elsewhere. It is a very slow process to replace superstition by science, but that has to be done before substantial progress can be made in medicine. It is needful to train the whole community in methods of thought, belief, and action; and we must not expect to get on too rapidly. There has never been a time when there was such immense progress in the knowledge of the human frame and the nature of disease and remedies therefor as within the last five years, to say nothing of the last ten. The question of economics, which has already been alluded to, has been practically disposed of by Dr. Curtis. It is the young men, fresh from the best schools, who are really the best prepared as instructors. They are too modest to expect large pay. They are looking to the future, and are willing to do their work magnificently for a small sum. What we want to do is to thank God and take courage.
Mr. F. B. SANBORN.— As the city of Waterbury has been represented by several speakers, I almost think Boston should be heard from,- a small village in the eastern section of the country. Although, by some accident, I have never been appointed a member of the Corporation of Harvard College, I may allude to what has
I been going on there. You referred, Mr. Chairman, to the very sensible remarks of President Eliot, with regard to the endowment of medical schools. Something has been done in this way for the Harvard Medical School. As Mr. Kingsbury observed, the study of medicine has entirely changed, as well in character as in form. It now involves a knowledge of sciences which scarcely existed fifty years ago. Every ten years develops some new special science which is found to have peculiar value for the study and practice of medicine. That feature of education which at this time, in this country, most occupies the public mind, and which draws most fully upon the resources of private wealth, is the study of the various branches of science. You cannot appeal to the American public with a greater certainty of success than in reminding them that the progress of some science needs to be encouraged. It seems to me that, if we would leave a little the narrower curriculum of medical schools, and would call upon those gentlemen (one of whom I see before me) who so liberally endow institutions of learning, to provide means for the study of those branches of science which bear on the art of medicine, we should reach a result sooner and better than by directing attention exclusively to medical schools. The researches of Pasteur cannot have escaped the notice of any intelligent person. A scientific revolution has been produced by his experiments and his investigations, and by those of others following that line of inquiry. Although such investigations have been started in this country, and there are several universities where they are professedly pursuing them, I am not aware that there are in any of the universities medical schools where thorough research in the line which Pasteur has originated (being in part supported by the government and in part by himself) can be prosecuted with any hope of successful result by means of proper endowments. I think that in Johns Hopkins University a foundation has been laid. But the revenues there have been so diminished by unfortunate investments that I suppose the pursuit of research will be crippled. If there are any persons in this audience or elsewhere who propose to endow institutions of learning for the promotion of science, it seems to me they can do no better than to endow chairs for such special research. When that has been done, young men and older men will be drawn to the centres of scientific inquiry, and this question of attaining a large income by instructing students in medicine will become of trifling importance. The American people are understood to be specially devoted to the acquisition of an annual income, but I believe there is hardly any other nation where there are so many persons who would throw away considerations of gain if they could promote the interests of science or religion or whatever' subject most occupies their attention and makes an appeal to their conscience. There is no country where more people are willing to set aside for a few years the accumulating of property for the sake of devoting themselves to the work for which they are naturally fitted. It seems to me that in this direction rather than by legislative proscriptions or restrictions we can best help medical science.
But I am not so sceptical about what may be done through legislation. Many attempts fail because they are undertaken with great flourish of trumpets, and certain persons are put in the forefront who are sure to incur the hostility of the people whom they are seeking to benefit. In Massachusetts, a bill was lately introduced similar to that which was rejected by Connecticut, and with a like result. But nearly ten years ago a very sweeping change in analogous matters was made there in regard to the medical certificate of insanity by physicians. We passed a law providing that all insane persons who should be committed for treatment should be so committed on the certificate of two physicians; but these physicians must have had a degree from some regularly established medical school or college, and have practised in the State for three years. There was not at the time the slightest opposition to that regulation, nor has there been a single demand for the modification of that restriction. There has been a demand for further restricting the number of physicians who may certify to insanity, and this will probably be granted. In all legislation, those measures are most easily carried which appeal to the plain common sense of the people, and which are not put forward as likely to benefit or injure any particular class of persons, but simply appeal to the people as something which must inure to their benefit. It cannot be for the benefit of any person in Massachusetts that his insanity should be passed on by a physician who has no qualifications. So in medicine. When you can make the people understand that they are the sufferers, and they are to profit by any change that may take place, that such change is not to be for the benefit of special classes and not to swell professional gain or pride, you will get such legislation as you desire. Attempts at this legislation have often been made with a certain professional spirit and claim of superiority which from the first almost secured their defeat. If such efforts should be made in the plain and simple interest of the public, — and the legislature should aim at that alone,- and if the institutions of learning should be so endowed that special inquiries may be carried on without depending upon the fees of the students in those branches of science which concern medicine, I believe we should reach the desired result, not immediately, but after “a time, times and a half” as the Scriptures say.
Mr. W. A. PURRINGTON.- There was once upon a time a veterinary surgeon with a pupil whom he used to instruct after the fashion of the old doctors to whom Mr. Kingsbury has referred. This surgeon sent his student one day to administer a large bolus to a sick horse, telling him to open the horse's mouth and make him swallow it. When the student came back, the doctor said, “What success?” “No success at all, sir,” was the reply: “the horse bit my elbow.” The doctor then gave him a powder, saying, "Put this powder in a tube and blow it down the horse's throat." Again the student returned. “What success?” “No success at all, sir: the horse blew first.” Unfortunately, Mr. Sanborn has blown first. It is one of the merits of your rather unscientific method of having the debate precede the paper; however, that has given me one or two ideas, which is a piece of good fortune, as I had very few before. It has also emphasized what is the effect when schools are afflicted with what I might call diplomā-nia. So long as a diploma constituted a license to practise law in this State, it seemed as if some sort of contractual obligation might be almost inferred between the school and the scholar who had paid out $150 for his education. The matriculant felt that he was entitled to that parchment: it seemed very cruel to him that a man who had paid out that amount of money and spent anywhere from three to six months of his valuable life in studying a profession should not be allowed to follow that profession. The Bar took the matter in hand, and it was enacted by statute and regulation of court that no man should go to the bar in New York who had not first passed certain preliminary examinations in matters which he ought to know. After that examination there was to be a General Term examination, and the diplomas of the Law School were no longer ipso facto licenses to practise. thought by the School that this step would be a terrible blow to them, and that the students' fees would fall off. But the attendance is larger now than ever before, the standard higher, and the advertisement of the course of the college for this year states that for the first time Columbia Law School will require a three years' course for the degree of B.L. So much has been done by taking from the school the licensing power. I will now read my paper.
HOW FAR CAN LEGISLATION AID IN MAINTAIN-
BY W. A. PURRINGTON, OF NEW YORK CITY.
READ BEFORE THE AMERICAN SOCIAL SCIENCE ASSOCIATION, SEPT. 5, 1888.
Mr. President, Ladies and Gentlemen : - I desire, first of all, to express my indebtedness to those gentlemen in the different States and Territories of this country and in the British Provinces to whose courteous replies to a circular letter of inquiry upon the general topic of Medical Legislation, sent to them in the early part of the summer, it is due that the conclusions of this paper may be said with fairness, I think, to represent not only the opinion of others besides myself, but prevailing opinions among those whose chief interest in medical legislation is that it shall confine the practice of medicine to educated persons, regardless of any particular views they may entertain as to questions of therapeutics.
It is not intended to present statistics here. My correspondence has not yielded any from which I should care to deduce conclusions, nor are they needed to substantiate what I hope may prove fair reasoning and sound deduction.
This paper must be, therefore, a statement of what I conceive to be general principles and fair inferences from an experience of some years, as counsel of the medical societies of the State and of the county of New York, in drafting and securing the enactment of the present by no means perfect medical statute of that State, and enforcing in the county of New York obedience to its provisions.
It may be said, however, as the general result of the inquiries, which were made in every State and Territory of this country, and also in the British Provinces, that almost every reply to the circulars expressed approval of some system of regulating by statute the practice of medicine; and the opinion was also strongly expressed that such legislation as has been already, crude and imperfect though it is, has perceptibly improved the standard of medical education.