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In the absence of President Scovel, whose paper is here printed, though it was not read, Dr. GRACE PECKHAM, of New York, Secretary of the Health Department, said :
Most of the points having already been touched upon, it only remains to emphasize a few. Dr. Scovel has presented the idea of a liberal education antecedent to the study of medicine. He says a higher education is now demanded in every department of science and in all professions. Ours is no exception to this. The Women's Medical College of the New York Infirmary was among the first colleges in the country to insist upon entrance examinations and to require a three years' course. The New York College of Physicians and Surgeons for the first time this year requires an entrance examination. The numbers at the Women's College of New York have been very small because of the high standard it has required; but, in spite of this, the managers, the trustees, and the faculty have maintained the requirements. Every year they raise the standard, valuing quality rather than quantity. A very interesting editorial bearing on this question appeared in a recent Medical Record of New York, relating to the overcrowding of the medical profession, from which, with your permission, I will read :
It is generally admitted that the number of physicians in this country is much greater than is needed to attend to the wants of the people, and far too great to be compatible with the best interests of the medical profession. In his annual address at the Cincinnati meeting of the American Medical Association, the late Dr. Garnett referred to this overcrowding, and used it as one of the arguments in favor of a higher medical education. “That the professions of law and medicine are overcrowded in this country," he said, “ no man of common observation will deny. The ratio of professional men in the United States to the population exceeds that of any other country in the civilized world, so that any legitimate means of checking this evil, which can be devised and carried into practical effect, must be hailed by the medical world, as well as the general public, as an inestimable boon.” The speaker estimated that the ratio of practising physicians in the United States to the population was about as I to 580. The general belief seems to be that this ratio is not decreasing, but that, notwithstanding the rapid increase in population, the proportion of the latter to each physician is constantly growing less. It is gratifying, therefore, to learn from the report of proceedings of the quarterly meeting of the Illinois State Board of Health, held in Chicago in June last, that this is not the case.
Dr. Rauch, the Secretary of the Board, referring to Dr. Garnett's address, shows that there is not so great cause for alarm, but that the tide has apparently begun to turn. Quoting from the forthcoming report on Medical Education, he says that, notwithstanding the growth of population, the total number of medical students has never yet reached the proportions attained in 1882–83. The sessions of that winter were attended by 13,088 students; of 188384 by 12,763 students; of 1884-85 by 11,975 students ; of 188586 by 12,321 students; and of 1886-87 by 12,948 students. Although there was a gain last year of 627 studenis over the attendance in 1885-86, the aggregate in 1886-87 was still 140 less than in 1882–83. Not only is the absolute number of students growing smaller, but what is of perhaps even more importance, as indicating a better quality of the finished product, is the fact that the percentage of graduates to the total number of students is steadily diminishing. In 1882–83, out of every 1,000 matriculates 322 were graduated, taking both the United States and Canada and all schools of practice into account. In 1886–87, only 294 out of every 1,000 matriculates were graduated. In the United States alone, in 1882–83, out of every 1,000 matriculates 331 were graduated, while in 1886–87, only 305 out of every 1,000 matriculates were graduated. Thus it is seen that, while the population increases - according to the census authorities - at the rate of two per cent. per annum (exclusive of the increment by immigration), the number of new graduates entering the profession was nearly eight per cent. less in 1886–87 than it was in 1882–83.
The causes which are working to produce this good result are chiefly two. In the first place, it is getting to be more commonly understood by the laity that the physician's calling is not an easy nor a lucrative one, and that a young man whose ambition it is to acquire a fortune cannot choose a less certain means of attaining this end. But the second and more active cause is the gradual evolution of the medical school from a business college to an institution for scientific training. The effects of a demand for a preliminary education, of a graded course of studies, and of a higher standard of qualifications for graduation are beginning to be felt. The number of graduates is less, and the proportion of well-educated men among them is greater. The example of the leading medical schools of the country, and the influence of an awakened professional opinion, will doubtless be able to raise still higher, rather than to lower, the educational standards now in force. But it must in justice be admitted that to the work of the Illinois State Board of Health, and of its able and untiring secretary, Dr. Rauch, much of the credit is due for the improvement now being made in the methods of medical study throughout the country.
You see, then, that there is cause for congratulation ; that we are improving instead of retrograding in medical education.
With regard to the proposed law, I would say that law is only the
expression of public opinion; and as soon as public opinion raises the standard of requirement for physicians, then the standard of physicians in colleges will be raised. I read not long since of a quack who had come to grief in some of his ministrations to the sick, and was called before the courts, when, to the surprise of every one, he produced a diploma obtained from a regular college ten years previous. When asked why he had never let it be known that he possessed such a diploma, he said that he began to practise medicine as a regular physician, made a failure of it, and turned his attention to other business. While following that business, one or two of his neighbors were taken ill, and he prescribed for them. His success was so great that they recommended him to others, until finally he had a large and flourishing practice, - what he was unable to obtain as a regular physician.
We have owed, as Mr. Sanborn says, in this country the endowment of our educational institutions to the benevolence of private individuals; but there is no more important claim that should come under the notice of the Government than the health and welfare of its citizens. It is found that whatever scientific work is supported by Government advances more rapidly, more thoroughly, and more successfully than in any other way. Take the work done by the Government for astronomy, for instance. Since the United States has taken under its protection the observatories, our researches have taken rank with the foremost in the world. I have thought that there should be also Government aid for scientific research in that which pertains to the health of the people. The endowments of private individuals, though of great assistance, leave much to be desired. Those men who are best capable of scientific investigation are usually least capable of earning money or dealing with the practical necessities of life. If they were assured of a regular income, and their time were given them for scientific work on such matters as microscopic study of tuberculosis, cholera, etc., which requires constant endeavor, minute research, and the entire time of a scientific person, I think the result would be of the greatest benefit to the country.
FURTHER DISCUSSION OF MEDICAL EDUCATION,
Mrs. C. H. Dall, of Washington, D.C.— One word about the Mormons, to whom Mr. Purrington referred. When I was in Salt Lake City, I had the privilege of reading the private papers of
Brigham Young; and I never read papers of such interest. They show his wonderful astuteness. He found the grossest superstition about medical practice when he came into power, and was obliged to call in “ Gentile” physicians. He then selected persons to be medically educated, and he was sensible enough to see that they must be liberally educated. At the bottom of one of the pages of his manuscript, on which he had recorded a discussion upon inspiration, he wrote, “Inspiration is common sense." Inspiration in his
. view was common sense, and he carried it into all practical affairs. He sent both men and women to learn medicine; and three Mormon women have taken degrees in Philadelphia, and passed creditable examinations. He himself meanwhile studied medicine, and made himself a practical accoucheur and surgeon.
Mr. PURRINGTON.- I had myself the pleasure of spending six months with one of the sons of the Prophet, and of staying with the physician who treated his wife. The argument that I use is that the same theory which would justify a system of irregular practice would justify what I think is the legal practice among the Mormons. Their law, I think, contemplates the “anointing with oil and the prayers of the saints for the healing the sick”; but Brigham Young, with that wonderful common sense of his, had a revelation by which this prescription of the Book of Mormon was evaded. It is to their credit that they have a divine book with a provision for amendment by revelation. I do not think legislation will ever destroy Mormonism; I think the French milliner will do it.
HENRY D. SMITH, of Connecticut.— I do not believe that the existence of quacks in a community is an unmitigated evil. There is a large balance of common sense on the part of the laity, that in the main will keep them from a class of people who do not understand their profession. Is not the important question, after all, What can a medical man do? I think we can let people settle that point. You tell me that quacks are doing a great amount of evil, and I do not doubt it; nor do I doubt that the regular profession is doing a great deal of evil, especially the younger men. It is a choice between two evils, at best. You tell me that men cannot cure by Christian Science. I do not know that they can. But we have had some mighty examples of their doing it. Facts are stronger things than theories. A neighbor of mine had an organic disease which the physicians told him would last as long as he lived; and that person was cured by Christian Science, to the joy of all good men. Yet the profession said, That is quackery. If they can do all these things, we laymen shall find it out. I have another neighbor who is so fixed in his habit of employing nothing but an orthodox physician that he said that he would rather die in the orthodox way than employ a physician out of the regular profession. I have no apology to make for quacks, but I am here to say that all the virtue does not lie inside the regular profession.
Dr. F. BONNEY.-A few words in explanation and addition to what I said before. It did take ten years of effort to get an act regulating the practice of pharmacy through the legislature of Massachusetts, although its purpose was to protect the people from either incompetency or casual mistakes. When the bill was first introduced, it was laughed down, not because it had not merits, but because pharmacists themselves generally did not favor it, while the people were suspicious that it was favoring physicians in some way. All legislation of this character must not only look to the interests of the public, but they must so understand it; and it must be kept, as far as possible, away from the idea that any particular individuals or classes are to be favored. There is great sensitiveness upon this point. I am old enough to remember some of the circumstances mentioned by Mr. Kingsbury, and can see the progress since made, which should certainly give us courage in thinking of the future. Most, if not all, of the reputable schools of medicine in this country have already raised their standard of qualification for admission to their classes; and they will undoubtedly place it still higher hereafter. I am very certain that none of them would, at this day, admit students with so imperfect preparation as was formerly (sometimes) done. And this is so well understood that few, if any, such persons would now attempt to gain entrance to them. Great progress is still to be looked for. The allied sciences of chemistry, physiology, and pathology, and other collateral studies, have immense influence in this matter, as was remarked. The earlier physicians were unfortunate in not sharing our opportunities, for they lived when these sciences were imperfectly known. The younger men of America, with their greater facilities and broader fields for study, must give us progress in medicine; and the public must co-operate before we can accomplish much by legislation. But there is reason to expect that we shall have proper laws enacted, which will result in raising the standard of the medical profession, while protecting the public.