Εικόνες σελίδας
PDF
Ηλεκτρ. έκδοση

There are in the United States 7 schools for the medical education of women exclusively. One of these, the Woman's Medical College of Pennsylvania, has an enrollment of 210 students. There were also 161 women studying the cognate subjects pharmacy (98) and dentistry (63), not mentioning the 42 engaged in the study of law.

Taking three years as the average length of time required for graduation, and making some allowance for students dropping out, there would be about 300 medical students in the graduating classes, or 3,000 women in the last ten years licensed to practice. According to the Census bulletin giving the statistics of occupations in 1890, there were in the United States 4,555 women physicians and surgeons, out of a total number of 104,803 physicians and surgeons.

A French compiler, M. Marcel Baudouin, furnishes a résumé of the legal status of women in the medical profession in various countries, in which, singularly enough, he omits all but the merest mention of the gentler sex in France. According to M. Baudouin, women are rigidly excluded from the advantages of a university education in Germany, and consequently may not become candidates in any medical examination. It naturally follows that no medical woman can be the possessor of a certificate carrying with it the slightest value in Germany," since a State license upon examination is necessary to practice in that country. In Austria-Hungary the situation is even worse; there the admission of women to higher grade instruction is formally forbidden by law. Spain is quite as bad; in fact, the difficulties are said to be even greater in the Iberian Peninsula than in Germany and Austria. In England, Ireland, and Scotland the universities-through which lies the registration necessary to the right to practice-are now all thrown open to women, Scotland having been the last to yield to the new order of ideas. In Ireland, however, while a woman is afforded every facility for obtaining a medical qualification, she may not fill any public office under the State. Similarly in Sweden, Norway, and Denmark the medical career is open to all without distinction of sex, save in the matter of State appointments. In Belgium, Holland, and Roumania the broadest views prevail regarding the medical rights of women; they may do and be, as physicians, all that men can and are, cæteris paribus, which they are not. The right of women to practice is fully recognized in Italy, and a woman occupies the chair of histology in the medical faculty of Bologna.

In 1893 there were 308 women attending medical lectures in Zurich, Geneva, Berne, Basle, and Lausanne, but there are only 10 women practicing in Switzerland. After graduating the students return to their own countries to practice, principally in Russia. In this latter country, Russia, there were 546 women practitioners in 1893, and women are there allowed by law to become assistant surgeons in all railway administrations; in 1890 a special medical school for women, after the American model, was established in Moscow. Universities in many of the English colonies have been open to women since 1875, and in France women first obtained foothold in a university in 1863, but five years later there were only 4 female students in l'École de Medecine of Paris; the more beautiful women of a most beautiful country do not seem to take kindly to the practice of physic, notwithstanding the illustrious examples of Mesdames Lachappelle, Bourgeois, and Boivin, concerning whom it has been said that "if their mantle could be made to fall on the shoulders of their sisters of the present generation, female delicacy would be saved many a rude shock and the cause of science would in no sense suffer." M. Baudouin concludes with the following tribute to this country:

"Only a moment's consideration of the following statistics is necessary to convince an inquirer that he must proceed to the United States of North America if he wants to study effectually the question of medical women. According to a statistical report drawn up by M. Louis Frank, of Brussels, there were in 1893 on the other side of the Atlantic fully 2,000 women practicing medicine in one or other of its forms, and inclusive of 130 homeopaths The majority were general practitioners, but there were also 70 hospital physicians or surgeons; 95 professors in the schools; 610 specialists for the diseases of women; 70 alienists; 65 orthopedists; 40 oculists and aurists; and, finally, 30 electro-therapeutists. In Canada there is but 1 medical school exclusively for women, but in 1893 there were 10 such in the United States."1

1 Journal of the American Medical Association, July 28, 1894.

HIGHER MEDICAL EDUCATION.

By Dr. WILLIAM H. WELCH, professor of pathology in Johns Hopkins University.

[From Western Reserve Medical Journal.]

The time has come when the need of medical education should be brought forcibly before the general public in this country. Medicine can no longer be taught with the simple appliances of former times. The proper teaching of medicine now requires hospitals, many laboratories with an expensive equipment, and a large force of teachers, some of whom must be paid enough to enable them to devote their whole time to teaching and investigating. These things require large endowments of money, and can not be adequately secured simply from the fees of students. If the public desires good physicians it must help to make them.

*

In this country, for the most part, we can not look to the State for endowment of medical education, but we must appeal to private beneficence. A few public-spirited and generous men and women have already given practical proof of their appreciation of these facts. With more general and fuller realization of the needs and present condition of medical education, and of the results which can be secured by its liberal endowment, there is every reason to believe that these benefactions will be largely and rapidly increased, and that thereby the condition of medical education in this country shall cease to be a reproach to us. During the last few years our methods and standards of medical teaching have shown remarkable improvement. What preparation should a student bring to the study of medicine? It is highly desirable, in my judgment, that he should be liberally educated; that is, that he should possess a degree in arts or science which shall be an index of that knowledge and culture which, apart from any immediate bearing upon professional studies, are recognized as entitling their possessor to be ranked among liberally educated men. Scientific studies have acquired the right to rank with classical studies in affording this liberal culture, but the humanities should have a fair share of attention at this period of education.

The question has been discussed whether or not during the period of collegiate education the student who intends to study medicine should be required to pursue any special subjects, and especially such as bear a direct relation to his future professional studies. The answer to this question seems to me to depend upon the character of collegiate training on the one hand and of medical training on the other. The primary purpose of collegiate education is to furnish a broad basis of mental discipline and liberal culture independently of direct relation to professional work. Where, as in the old-fashioned college in this country and in the gymnasia and lycées of Germany and France, the student enters college at the age of 15 or 16 and is graduated at 19 or 20, it is not necessary or even desirable that the undergraduate student should specialize his work with reference to his future profession. Under these circumstances, which obtain in most foreign universities, at least the first year of medical study is devoted mainly to physics, chemistry, and zoology, including comparative anatomy.

These are not, however, the conditions which prevail in this country at the present time, where on the one hand the average age of graduation from our best colleges is at least two years later than in Germany and France, and on the other hand the medical schools do not furnish adequate training in physics, general chemistry, and biology, whereas these sciences are now generally included in the curricula of our colleges. When we consider the fundamental importance of these sciences for the study of medicine, the advanced age of graduation from college, and the special conditions of collegiate and medical education in this country, it seems to me clear that during the period of collegiate study the student intending to study medicine should acquire a fair knowledge of chemistry, physics, and general biology, and to these sciences should be added the study of French and German. Inability to read French and German deprives the physician of personal acquaintance with a large part of the most valuable literature of his profession, and makes it impossible for him to keep thoroughly abreast with the progress of medical science and art.

*

There are certain points which should be clearly understood as regards the requirement that the preliminary education of a medical student should be a liberal one, indicated by a degree in arts or science, and should be made to include a specified amount and kind of knowledge of physics, chemistry, and biology, with a reading knowledge of French and German. The justification for the latter requirement is that inasmuch as students are kept at college in this country two years longer than in most foreign countries they should be permitted to pursue during at least the last two years of their course subjects which bear upon the study of medicine, but which, although included in the medical curriculum in foreign universities, are strictly liberal studies independent of their professional bearing. These sciences, preliminary to medical study, can be studied and taught better in the college than

in the medical school, and, indeed, in foreign universities they are more often pursued by medical students in the philosophical than in the medical faculty. It would be a waste of energy and money to make provision for them in both the medical and the academical departments.

It can not be truthfully said that the plan indicated need to divert the preliminary education from a liberal to a technical and specialized one, for the degree in arts or science will presumably indicate that the student has a liberal education and the special subjects need not be taken up before the last two years of the course. The scheme presupposes that the student will have made up his mind to study medicine in time to include these special subjects in his undergraduate studies. If he has not done so, or if he chooses to exclude them from his collegiate work, he will be obliged to devote at least a year to them after graduation and before beginning the study of medicine. The college authorities should, however, direct attention at the proper period of the course to the importance of these subjects for those who intend to study medicine.

This plan, moreover, adjusts medical education to existing conditions of collegiate education in this country without any essential changes in the curriculum of the latter.

The advanced age of graduation from college is a serious embarrassment to higher medical education in this country, and has led to the unfortunate result that with the increase in the time required for the study of medicine there has been a falling off in the number of medical students with a college degree in at least one of our leading medical schools, although it can not be doubted that the average amount of preliminary education has increased among our medical students.

Various suggestions have been made, especially by the medical faculties of our universities, to remedy this anomalous condition of collegiate education, or to adapt it to the needs of medical education. I think that we may assume that the college course is not likely to be shortened, or that the college will relinquish that part of its development which has made it something between the old college and a university. There is good reason to believe that there are serious defects in our systems of primary and secondary education, and that without lowering the standard of admission, better methods of teaching will enable students to enter college at least a year younger than is now the case.

The plan has been adopted in some of our colleges of permitting students to begin their medical studies in the medical department at the beginning of the senior year. This is a plan which is applicable only where there is a medical school in connection with the college, and involves certain sufficiently apparent difficulties. I think, however, there is much to be said in favor of this arrangement, which permits the student to take up the study of human anatomy, physiology, and physiological chemistry in his senior year in college, provided he has suficient preliminary training in the fundamental sciences which have been mentioned. It may, however, be questioned whether the time available for the study of physics, chemistry, and general biology in college is any too long for this purpose, and will permit the addition of human anatomy with dissections and other subjects which must be a part of the regular medical curriculum. Unless the student has completed the work of one year of the medical course I do not see the justification of permitting him to shorten by one year the regular medical course because he has a college degree.

It should be understood that if a medical school requires for admission a year's collegiate training in physics, chemistry, and biology, subjects which are included in the medical curriculum of European universities, its period of medical study is, according to European standards, lengthened by one year, the first year being relegated to the collegiate period.

The only medical school in this country where a liberal degree is required for admission is that of Johns Hopkins University. Here it is also required, for reasons which have been stated, that the candidate for admission shall be able to read French and German, and shall have had a year's collegiate training with laboratory work in physics, chemistry, and biology. It is, of course, impossible for unendowed medical schools to demand anything approaching these conditions for admission. I do not undertake to say that even were other medical schools so situated that they could demand them it would be wise for them to do so under present conditions, but it seems to me that there is room in this country for at least a few medical schools with such a standard. Exactly what is feasible to require as a general standard for admission to medical schools in this country at the present time is a subject which, as already said, I do not consider at this time.

It is true that without a liberal education a man may become a competent physician, and may attain even a high standard of excellence in his profession, but with such education he is better adapted for the study of medicine, he is more likely to succeed in his profession, his social position will be better, and his life will be fuller.

#

[ocr errors]

How long should be the period of undergraduate study in a medical school? In Europe it is nowhere less than four years, and in most European countries it is

longer. In Sweden it is nine or ten years; in Spain, seven years; in Italy and Holland, six years; in Austria, Russia, Portugal, and several universities of Great Britain, five years; in Germany, four and a half years. In Canada the required period is four years.

#

[ocr errors]

The required period of study at the medical department of the Johns Hopkins University, where a full year of collegiate training with laboratory work in physics, chemistry, and biology is required for admission, is, according to European standards, at least five years.

Four years of undergraduate medical study in a medical school, each year being the usual academic year of about eight months, are as much as can reasonably be demanded in this country at the present time. This length of time is sufficient if the student enters with a satisfactory preliminary training, especially if, as is often the case, he supplements the undergraduate course with a year or a year and a half in a hospital or a year of special graduate study.

Only those medical schools which have good laboratory and hospital facilities are warranted in establishing a four years' obligatory course. It would be absurd for some medical schools, with their pathetically meager outfit, to require the student to remain with them four years.

AMERICAN AND GERMAN MEDICAL STUDENTS.

Dr. F. B. MALLORY in Boston Medical and Surgical Journal, July 5, 1894. The latter, after about nine years of hard drill in the gymnasium, which covers most of the ground of the American preparatory school and college, is ready at the age of about 19 years to enter the university, the most democratic institution of the Old World, for every professor and privat docent is wholly independent, and may give such instruction as he will. The German State system of universities has many advantages over the independent institutions in our own country. The requirements of all are the same, and they are run interchangeably, so that the students form a vast floating population in the university towns. They can hear the best men in the various subjects or in the same subject. They can spend their winters in the large cities like Berlin and Vienna, and their summers in towns like Heidelberg or Freiberg, where the surrounding mountains and forests offer opportunities for delightful tramps. Thus they see more of the world and obtain broader views than they can from living in one place all the time, for no one university can get the best men in every subject. They can also clect the university at which they will take their examination.

THE AMERICAN AND GERMAN GRADUATE IN MEDICINE,

Doctors of medicine in Germany are, as a body, better educated than our men at home. They have all been through the gymnasium, and have spent at least five years in the study of medicine. They are ready to enter practice (if they do not go into hospital work) at about the age of 24. Our men at home who have been through Harvard College and then four years in the medical school have undoubtedly received a broader training than the men here, but they are not ready to enter practice until about the age of 27.

The reason our college men enter the medical school about four years later (at the age of 23) than the men here is probably due in part to the following causes: They cover more ground than is gone over in the gymnasium. Their education previous to entering college has consumed more time than was necessary. American independence shows itself at a disadvantage at present in her educational institutions. There is a lack of harmony and of uniformity between them, even between the colleges and universities. Each has its own ideas, aims, and standards. The public schools especially are run with too little reference to the requirements of the higher educational institutions of the country. They seek to furnish in themselves a complete education of a certain degree. The desire or the possibility of attending college is often realized for the first time when this early education is nearly completed, and valuable time has been lost in learning what was unnecessary for this or that college, and more time must be spent in getting up the extra work required.

The proposition is being at present agitated in Germany of allowing students who are going into medicine to study French, English, and the natural sciences in the gymnasium, instead of the classics as heretofore, a step similar to the broader one already taken at Harvard.

Of the four and a half years that a German student spends in the study of medicine the first two years are devoted to six subjects-chemistry, physics, botany, zoology, anatomy, and physiology. That leaves three years for the rest of his medical education, the same length of time devoted in the Harvard Medical School to

the same branches, namely, pathology, clinical medicine, etc. It is proposed, however, to make the course for M. D. in the German universities six years instead of five (the last year to be devoted to practical work), in order to raise the age of the medical graduates.

With regard to the study of medicine the German universities possess the great advantage that both the universities and the hospitals are State institutions. Consequently the medical department and the hospital are very closely identified and work in perfect harmony. The visiting staff of the hospital are the clinical instructors of the medical school. The pathological institute likewise stands in the closest relationship to the hospital; indeed, forms a very important part of it. Its duty is to solve all problems that are doubtful clinically, to correct errors of diagnosis, and to render clear the cause and nature of every diseased process, so that it may be treated intelligently. The pathological department of a hospital thus conducted becomes of inestimable advantage, alike to the patients and to those whose mission it is to heal them.

« ΠροηγούμενηΣυνέχεια »