R E P OR T 
OF THE 
COMMITTEE ON MEDICAL EDUCATION. 
BY 
CHRISTOPHER C. COX, 
SURGEON U. S. VOLUNTEERS, OF MARYLAND. 
REPRINTED FROM THE 
TRANSACTIONS OF THE AMERICAN MEDICAL ASSOCIATION. 
PHILADELPHIA: 
COLLINS, PRINTER, 705 JAYNE STREET. 
1863. REPORT OF THE COMMITTEE ON MEDICAL 
EDUCATION. 
Early in 1861 a communication was received from Dr. Joynes, 
of Richmond, declining to serve upon the Committee on Medical 
Education, of which he was chairman. As the second-named 
member, it became my office to prepare something, however imper- 
fect, in recognition of the assigned duty. The remarks which 
follow are the result of fragmentary portions of time gleaned from 
the pressure of constant and responsible official labors. 
The present period of our history is emphatically one of progress. 
Knowledge, in all its departments, has been stimulated into new life 
by the animating spirit of the age; additional facilities of study 
and research have been placed within the reach of its votaries, 
and new and important facts annually poured into its expanding 
archives. Nor is our art without a share in this general improve- 
ment. The advancement in Medical Science and the increased 
value of its practical results are no longer debatable problems. 
To the sublime art of Medicine, as at present understood and prac- 
tised, humanity owes much of the physical welfare it now enjoys; 
as well as the diminished severity of disease and its control by 
intelligent and judicious treatment. Review the medical manage- 
ment in the apoplexy of Charles II., as described by Macaulay, the 
historian, when all the renowned physicians of London were sum- 
moned to the royal chamber, and compare it with the humane, 
discreet, and enlightened treatment of the well-trained practitioner 
at the present day. Hot iron was applied to the king's head, after 
excessive depletion by the lancet; "a loathsome, volatile salt, 
extracted from human skulls, was forced into his mouth." In 
another place the same distinguished Englishman furnishes direct 
testimony to the progress of our art. "Every bricklayer," says 
Macaulay, " who falls from a scaffold, every sweeper of a crossing 4 
REPORT OF THE 
who is run over by a carriage, now may have his wounds dressed 
and his limbs set with a skill such as a hundred and sixty years 
ago all the wealth of a great lord like Ormond, or of a merchant 
prince like Clayton, could not have purchased." " Some frightful 
diseases," he continues, "have been extirpated by science, and 
some have been banished by police. The term of human life has 
been lengthened over the whole kingdom, and especially in the 
towns. The year 1685 was not accounted sickly; yet in the year 
1685 more than one in three of the inhabitants of the capital died. 
At present only one inhabitant of the capital in forty dies annu- 
ally. The difference in salubrity between the London of the nine- 
teenth century and the London of the seventeenth century is very 
far greater than the difference between London in an ordinary 
season and London in the cholera." 
And yet, valuable and gratifying as may be this and kindred 
testimony in favor of medical progress, it is undoubtedly true, 
that, regarding the antiquity of physic and its vast importance to 
human life and comfort, it can hardly be said to have advanced 
pari passu with other sciences. The profession nowhere has 
answered the full expectation of its early promise. It does not 
hold the proud position, especially in this country, to which, as the 
guardian of truth, it is really entitled. There is evidently abroad in 
the land a want of confidence in the profession and an indisposition 
to accord that dignity and importance which should attach to it, as, 
next to religion, most vital in its relations to humanity. Why is 
this, when at no period the improvements in medicine more 
strongly challenge public admiration and trust? 
It is primarily the object of the American Medical Association 
to seek out the causes of this professional depreciation, and, by 
stimulating healthy reforms, and elevating the standard of medical 
education, to contribute more successfully to the great object of 
human relief underlying all its effoits. In briefly attempting this 
duty, the Committee do not expect to offer anything new, or place 
in stronger attitude the plain truths so ably and eloquently en- 
forced in former reports. The importance of the subject will 
readily excuse a possible repetition of much already embraced in 
those admirable papers. 
And in the first place the reproach resting upon the art, and 
which it is our duty to remove; the growing distrust greeting our 
practice every where: the almost indiscriminate patronage of the 
various fashionable medical follies, homoeopathy, hydropathy, mes- COMMITTEE ON MEDICAL EDUCATION. 
5 
merism, chronothermalism, and others, to the neglect of true science, 
are due, it is to be feared, in a great measure, to disregard, on the 
part of the profession itself, of its own high purposes and aims ; 
and therefore the failure to adopt such measures for its own ad- 
vancement in all those essential mental and moral qualities as 
will command the largest confidence and prove a crown of honor 
to its disciples. 
To treat disease rationally and successfully ; to improve the 
faculties of the mind to an exalted degree, and appropriate to the 
greatest advantage the experience of others; to grapple with the 
facts of science; attain the largest information, and command the 
best resources of art, the physician must be soundly and symmetri- 
cally educated. The chief cause of the evils complained of is, un- 
questionably, deficient preliminary education. Let any one reflect 
upon the volumes to be perused and comprehended; the various 
departments of philosophy, collateral to medicine, which should be 
understood ; the vast annals of medical and surgical science to be 
scanned; the intimate physiological and pathological relations of 
the human body to be penetrated ; the endless circle of diseases 
and their various remedies; the reciprocal action of mind and body, 
and the mysterious morbid complications to be traced out by a 
clear intellect, and submitted to a strong and disciplined judg- 
ment; let him reflect upon all the difficulties which beset the path 
of the skilful physician, and the necessity of a comprehensive 
basis of sound and thorough preliminary education must be ad- 
mitted. 
The neglect of this important prerequisite to suitable medical 
attainment attaches first to the private practitioner, who enters the 
pupil upon the office register without inquiring of, or caring for his 
educational fitness for a calling which demands the highest order 
of intellect and the most varied study and acquirement. He is 
often destitute of the moral independence or conscience, or both, 
to reject an applicant he has reason to regard as unfit for the pur- 
suits he has espoused. 
In a communication from II. L. Haskill, Acting Surgeon- 
General, in reply to a letter addressed by a committee of this 
Association to the Surgeon General U. S. A., in 1846, the propor- 
tion of those who pass the Army Board is stated at one-fourth, 
lie says : " The most striking causes of failure, on the part of candi- 
dates, are insufficient preparatory education ; a hurried course of 6 
REPORT OF THE 
professional pupilage; want of proficiency in practical anatomy or 
pathology and in clinical medicine." 
In the Transactions of the meeting of this body in New York in 
1847, is the report of a committee on preliminary education, ap- 
pointed at the session of the previous year. The responses to a 
circular, addressed by the Committee to distinguished practitioners 
in all the States and Territories, establish the fact " not only that 
there is no uniform standard of preparatory education exacted of 
medical students throughout the United States, but that there is 
no general rule adopted in any particular State or district which 
has been authorized or recommended by medical societies or other 
official bodies, or established by common consent and custom. The 
whole subject is left to private preceptors, many of whom recom- 
mend, and a few exact, an elevated standard, while others leave it 
to the discretion of the students themselves or their parents." In 
the resolutions appended to the report, the Committee advised cer- 
tain conditions of admission into a preceptor's office, to wit, " a 
good moral character; a good English education ; a knowledge of 
natural philosophy and the elementary mathematical sciences, in- 
cluding geometry and algebra, and such an acquaintance at least 
with the Latin and Greek languages as will enable the student to 
appreciate the technical language of medicine and read and write 
prescriptions." It must be conceded that the recommendations of 
the Committee, excellent as they are, are exceedingly moderate in 
the degree of attainment required. Still, as a step in the right 
direction, the report deserves to be commended. How far the sug- 
gestions have been complied with, or even seriously entertained 
by physicians, it is impossible to determine, but it is to be feared 
that few have been influenced by an emanation from the national 
faculty so fruitful of good results. A sufficient knowledge of the 
classics to improve the tone and vigor of the mind, elevate the 
taste, and facilitate the acquisition of learning would seem to be an 
essential preliminary to the study of so comprehensive and intricate 
a science as medicine; to which should be added a clear apprehen- 
sion of natural philosophy, the principles of which are so frequently 
applied to the anatomy and physiology of the body; as well as such 
of the natural sciences, botany, geology, and mineralogy, as are 
intimately associated with the Materia Medica from which medical 
agents are derived for the cure of disease. The acquirement of the 
practical part of the healing art seems to be the sole object of the 
aspirant for medical honors, forgetting that more than mere lec- COMMITTEE ON MEDICAL EDUCATION. 
7 
tares and cliniques are necessary to constitute the accomplished 
physician. It is not enough to pay the preceptor's fee-to ascertain 
the position of this or that artery-the relation of this or that nerve, 
the sensible qualities of a particular drug and the maladies for 
which it is employed. These may constitute a routinist, but will not 
make the rational, thinking, investigating, prudent practitioner, 
the result of rigid mental discipline and early scholastic training. 
"One of our great men has said," remarks M. Serres, at the open- 
ing of the Medical Congress, in Paris, 1845, "I know nothing 
more contemptible than a cowardly soldier, or than an ignorant 
medical man; the first is contemptible because he compromises the 
fate of his country in the day of danger; the second because he 
compromises hourly the life and welfare of his fellow creatures. 
Thanks be to heaven, there is no cowardly soldier in France, and 
government is under the obligations to society to employ all its 
power to render it impossible that there should be such a person 
as an ignorant medical practitioner." 
But the private practitioner is not solely to blame in this con- 
nection. The professors of colleges, who should sustain the rela- 
tion of faithful custodians to the temple of science, admitting no- 
thing unworthy within its sacred portals, are chiefly deserving of 
censure. A dishonorable rivalry exists between schools, at the 
expense of science, while an unworthy jealousy of opposing teachers 
not unfrequently refuses recognition of improvements which origi- 
nate within the walls of an antagonist institution. Nor is this all. 
The successful scramble for students of every grade of qualification 
and disqualification, results in the graduation, annually, of large 
classes of young men in the cities, who, it is not too much to affirm, 
are, for the most part, poorly furnished for the responsible duties 
awaiting them in the future. The irregular attendance upon two 
courses of lectures; no small quantity of cramming during the last 
days of college term; an hour of pretended examination in the 
green room, and the ribboned diplomas are distributed before a 
crowd of exultant sweethearts and gratified parents and guardians. 
Each roll of parchment indorses its possessor as " vir ornatissimus," 
and he goes forth amid the sound of martial music and rich bou- 
quets showered upon him by the hands of fair ones, an accredited 
agent for life or death, endowed with all the paraphernalia of a 
"Doctor of Medicine," but destitute of the brains. These remarks 
may seem ungenerous and needlessly severe. They are not so in- 
tended, but arc prompted by a stern sense of duty to the profession. 8 
REPORT OF THE 
Nor do they, I am proud to say, apply to all the medical schools of 
the country, although, it is to be feared, a very small number of 
them deserves exemption from censure. "It is a fact," observes Dr. 
Manly, "and one too pregnant with disastrous consequences to pass 
without the unqualified censure of the whole profession, that some 
of the medical schools in their annual circulars, invite, nay almost 
entreat the public for their patronage; they present inducements to 
the half educated, and even the wholly uneducated youth of the 
country to become physicians, promising facilities of study and full 
courses of instruction on easy terms; and on their arrival, accept 
promises to pay at remote periods, instead of their fees; thus offer- 
ing bounties to the ignorant and illiterate, to crowd the ranks of a 
profession whose duties and responsibilities require higher attain- 
ments, a more elevated moral character, greater industry, and a 
more severe and constant application to study than any other pro- 
fession in the whole catalogue of human sciences." 
Thus, in the disgraceful scramble for students, exalted motives of 
action have no place. The country is flooded with incompetent, 
physicians; the reproach resting upon the profession gathers 
strength, and quackery and empiricism acquire increasing public 
confidence. The late searching examinations of army medical ex- 
amining boards for the purpose of testing the qualifications of ap- 
plicants for military position, as well as of such already in service 
in the field or hospital, as are, from time to time, cited before them 
upon the charge of incompetency, reveal the ignorance resulting 
from the carelessness and neglect of schools. In one of the most 
prominent of our colleges, all the candidates for graduation, last 
March, were successful in procuring their diplomas, and almost im- 
mediately after a number of these applicants, for medical positions 
in the army, were rejected by the Army Board, before whom they 
presented themselves for examination. It is notorious that few of 
the college graduates undergo creditably the searching, but just, 
scrutiny to which they are subjected by army boards. 
Much of the difficulty, upon which we have discoursed, grows out 
of the inefficient organization of Faculties of Medicine, and the in- 
adequacy of the plan of instruction to the ends proposed. In the 
first place, the professors are often wholly unfitted for the duties 
they assume as public teachers, and the claims of many better men 
are overlooked in their selection. A gentleman is not unfrequently 
chosen for a given chair from numerous candidates of superior 
merit, because he has it in his power to subserve some particular COMMITTEE ON MEDICAL EDUCATION. 
9 
purpose, or conciliate some influential social or professional clique. 
The European system of concours would vastly enhance the intel- 
lectual status of our professorial corps in the various institutions 
of instruction. 
The schools, moreover, as already intimated, are too crowded. 
Of those who attend a demonstration in the theatre; follow the 
lecturer through the clinical wards; or rush to the operating room 
to witness some case of capital surgery, few are favored by even a 
sight of the professor or subject, much less benefited by the re- 
marks of the speaker. Besides, the whole system of instruction is 
essentially defective. In the first-course student the difficulties be- 
come insuperable. Just from the office of the preceptor, where a few 
weeks or months have been passed, with no proper direction given 
to his studies; without having acquired the first principles of 
physiology or therapeutics, he is required to attend five or six lec- 
tures a day, hurrying from one lecture hall to another without 
pause for reflection or review. Endless varieties of facts and 
reasonings are presented to his bewildered intellect which are 
rarely comprehended, never digested, and which leave the mind 
more confused at the close than at the opening of the session. The 
professor indicates little or no interest in the student out of the 
lecture room, and confines his examinations, which occupy but a 
small fragment of the hour, to the few who collect immediately 
around him on the advanced benches. So that, between the mul- 
titude of abstruse topics, he is expected to grapple in a given time, 
and the carelessness and neglect of the professor, he reaches the 
end of his course with a precious modicum of sound information in 
regard to the subjects upon which he has been for so many months 
engaged. 
The examination for degree, also, it must be conceded, is entirely 
too trifling in extent and thoroughness, and loudly demands cor- 
rection, if we expect to wipe out the charge of ignorance and in- 
competency so often applied to the profession. 
How, then, are the mischiefs to which I have alluded to be 
corrected ? 
I. A certificate of suitable preliminary education should be ex- 
acted of every young man admitted to office instruction, and a 
failure on the part of any medical practitioner to comply with this 
reasonable demand should be deemed unprofessional ; a violation 
of the esprit du corps, and expose him, if a member of any medical 10 
REPORT OF THE 
society, State or county, to censure by, or expulsion from the same 
A similar test should be required at the door of the university, 
and no student should be suffered to matriculate until he shall 
have furnished satisfactory evidence to the Dean that he has been 
qualified by a course of preparatory study in the classics and Eng- 
lish branches of belles lettres and science, including a sufficient 
knowledge of chemistry and physiology. 
II. The entire system of medical instruction in the colleges of 
the country requires reform. 
1. The number of professors should, if necessary, be increased, 
so that each department of the science may receive its due atten- 
tion and be thoroughly taught. 
2. These should always be elected by a Board of Regents or 
Trustees (a certain proportion of whom should be medical men), 
the Faculty of the college having no precedence in the nomination 
of candidates or any influence, other than outsiders, in their selec- 
tion. In the greater part of Europe the professors are chosen with- 
out regard to the wishes of the Faculty, and paid by the govern- 
ment, instead of deriving fees from the sale of tickets. 
3. There should be not less than three courses of lectures of six 
months each in duration; the first to comprise anatomy, physio- 
logy, chemistry, and the principles of medicine, and the remaining 
courses to embrace the usual branches taught in the schools, in- 
cluding hygiene, medical jurisprudence, and toxicology. 
4. The applicant for matriculation should be not less than 19 
years of age, and must have completed at least six months' study 
in the office of a respectable preceptor prior to attendance upon 
college lectures. 
5. Examinations upon the preceding lecture should be held daily 
by the Professor, the class being interrogated by divisions, so that 
no student may be omitted in the review. 
6. Clinical instruction should also be so arranged as to confer 
equal advantages upon all. 
7. It should be obligatory upon the student to attend every lec- 
ture and clinique, unless sick or unavoidably detained. Monitors 
should be present to note such as are absent or delayed beyond the 
hour of the exercise, and the list of delinquencies forwarded every 
week to the Dean of the Faculty. Premiums should be accorded 
to unusual merit, and penalties meted out to wilful neglect of study 
or gross immorality. COMMITTEE ON MEDICAL EDUCATION. 
11 
8. A corps of teachers should be organized in connection with 
the Faculty, to direct, under suitable regulations, the studies of the 
pupils, during the recess of the lectures-the tuition to consist of 
oral explanations and examinations, chemical manipulation, phar- 
macy, pathology, clinical medicine and surgery, and conversaziones 
or discussions upon medical topics. 
9. The final examination for degree should be conducted by a 
Board of Examiners, selected from the first medical talent of the 
State, without the presence of the Faculty. To avoid possible par- 
tiality or the influence of improper motive, the members of the Board 
should be liberally remunerated for their services, not only to in- 
demnify them for interruptions and consequent losses to private busi- 
ness for the time neglected, but also to place them above the remote 
possibility of suspicion. The examinations should not be hurried 
or superficial. Every branch should receive its proper attention, 
and, whenever practicable, the candidate required to test his skill 
on the cadaver, and to diagnose disease at the bedside of the sick. 
These views are not extravagant. The general ignorance of the 
profession, and the diminishing public confidence consequent there- 
upon, demand sound and healthy reform in the modes of medical in- 
struction. It is time the educated mind of the country should be 
animated by a lofty independence in its dealing with a subject so 
important to science and humanity, and that, as the guardian of 
truth, it should devote its energies steadily and fearlessly to the 
great work before it. 
It may be objected that the necessity of suitable preliminary 
education might exclude many deserving young men, who, without 
early advantages, possess those qualities of mental acumen and 
industry which cannot fail to constitute them ornaments of the pro- 
fession and benefactors of the race. The obvious answer is that 
the application of no general rule, looking to aggregate good, 
should be diverted from its proper purpose from regard to excep- 
tions. 
No man can be more sensible than is the writer of this report of 
the admiration due those men of extraordinary intellect, but limited 
means of early cultivation, who reflect lustre upon the profession 
of their choice. To all these the most respectful homage should 
be generously accorded. But to such minds what conditions of 
preliminary education would be insurmountable ? The ambitious 
but poor student would, by perseverance and the countenance 
and encouragement of liberal patrons of letters, control all opposing 12 
REPORT OF THE 
difficulties, and make his way, pari passu, with the more favored 
into the arena of college competition. 
It may be also urged against the plea to extend the cause of 
instruction that the country is in its infancy; that men are called 
to assume responsibilities early, and that time cannot be spared in 
protracted preparation for the duties of life. If this were really 
so, it cannot be weighed against the inestimable advantage of sending 
out from our schools qualified practitioners instead of routinists 
and quacks. The argument of expense also falls to the ground for 
the same reason. 
In every other country than the United States preliminary 
education is invariably required of the student of medicine, while 
the duration and thoroughness of college instruction greatly exceed 
our own. 
In Edinburgh five years is the term of study, six months of each 
year being passed in the university. After continued attendance 
upon lectures and other instruction, besides, for six months of 
each year of the period of study, he presents himself for the doc- 
torate. The conditions annexed to this final examination are a 
complete statement of his studies, as well in literature and philo- 
sophy as in medicine, accompanied with proper certificates; a the- 
sis, either in Latin or English, subject to the searching criticism of 
one of the college professors; a competent knowledge of the Latin 
language, and a thorough acquaintance (tested by written or oral 
questions) of anatomy, chemistry, botany, institutes of medicine, 
zoology, materia medica, therapeutics, pathology, practice of physic, 
surgery, theoretical and operative midwifery, medical jurisprudence, 
and toxicology. If found unqualified, he is required to study one 
or two years longer before he can be admitted to a second exami- 
nation. After appearing, in compliance with the Senatus Academi- 
cus, to defend a thesis, he is admitted to his degree. This offers a 
mere outline of the course of medical instruction in one of the 
principal cities of Europe. 
In Paris the number of professors amounts to twenty-eight, be- 
sides assistant or adjunct professors. The instruction is embraced 
in eighteen courses of lectures, two a year, comprising anatomy, 
medical chemistry, legal medicine, surgical pathology and thera- 
peutics, pathological anatomy, operative surgery, clinical medicine 
and clinical midwifery, medical physics, hygiene, medical natural 
history, accouchements, physiology, surgical pathology, pharmacy 
and organic chemistry, therapeutics, and pathological anatomy. COMMITTEE ON MEDICAL EDUCATION. 
13 
Before matriculating, he presents certificates of moral character and 
a Baccalaureate diploma; or, should he not have graduated in let- 
ters, he is obliged to submit to an examination of one hour's dura- 
tion in the French, Greek and Latin, general history and geography. 
As at Edinburgh, the course of study is four years. To secure a 
diploma five examinations must be submitted to at intervals during 
the course of study-the first comprising chemistry, physics, and 
medical natural history; the second, anatomy and physiology; the 
third, internal and external pathology; the fourth, hygiene, legal 
medicine, pharmacy, materia medica, and therapeutics. The fifth, 
a practical, clinical lecture at the bedside. The theses must be 
publicly defended. 
At Berlin the number of professors and assistant professors is 
sixty seven, and the branches taught consist of psychology, natural 
philosophy, logic, metaphysics and anthropology, natural sciences, 
physics, climatology, theoretical and practical chemistry, botany, 
zoology and mineralogy, anatomy, physiology, history of medicine, 
institutes of medicine, pharmacology, dietetics, pathology and the- 
rapeutics, mental diseases, surgery, ophthalmology, bandages and 
instruments, midwifery, medical jurisprudence, clinical surgery, 
clinical medicine,clinical midwifery, clinical ophthalmology, and dis- 
pensary practice. The examinations are made semi annually, and no 
one is allowed to enter upon a second course without satisfactory evi- 
dence of his proficiency. The examination, preliminary to admission 
into the medical department, is exceedingly thorough, consisting of 
physics, chemistry,botany, natural sciences, the classics, mathematics, 
history, and philosophy. From four to six years are required to 
complete the course of study, during which the student is subject, 
under the laws of Prussia, to three distinct examinations, entitled 
respectively Examen Philosophicum, Tentamen medicum, and Examen 
rigorosum. The last is, as its title implies, very strict, and the final 
test of qualification. Anatomy is demonstrated upon the dead 
subject, or extemporary descriptions of the parts of the osseous, 
vascular, and organic systems. Materia medica, by deciding upon 
medicines submitted unlabelled for inspection, and writing pre- 
scriptions of variable preparations and combinations. The know- 
ledge of the student is tested in surgery by operations upon the 
cadaver, and the application of bandages and other surgical appli- 
ances to the living subject; while the diagnosis of disease is to be 
made and explained at the bedside. The same extended and 
thorough course of instruction, and the same rigid scrutiny into 14 
REPORT OF THE 
the qualifications and requirements of candidates for the doctorate, 
exist, with little variation, in the different medical universities of 
Europe. 
These facts, which have been more carefully collected and more 
strongly and comprehensively presented in former reports, are sug- 
gestive of the estimate placed upon the importance of medicine in 
other countries. In Europe an educated physician is presumed to 
be an accomplished belles lettres and professional scholar. In this 
country, owing to causes already described, a doctor has no special 
prominence, and, because a graduate, is not therefore regarded as 
educated or learned. 
The members of the Association are so generally informed 
in regard to the police regulations and modes of tuition of the 
various colleges of the United States, that it is unnecessary I should 
even allude to them. They are thus prepared to institute a com- 
parison between our meagre plans of teaching and those recognized 
in the colleges of other countries. 
These remarks are offered in no captious fault-finding temper, 
but with that regard for the general good of the profession and the 
advancement of medical science which should animate every mem- 
ber of the Association. It is to be regretted that the colleges have 
not responded as generally or as cordially to the recommendations 
of the Association, in reference to medical education, as was de- 
sirable. Still, the reform is not the less imperative, and the well 
intended efforts of this body should not cease until the great object 
be achieved, and both colleges and preceptors, throughout the 
country, induced to admit its paramount importance. In the lan- 
guage of a late issue of one of our prominent journals, in allusion 
to the present meeting, " The Association should not fail to main- 
tain its jurisdiction in all matters pertaining to medical education. 
Let it reassert the propositions which it adopted at its last session, 
and enforce compliance with them." 
In the examination before the Army and Navy Boards, a proper 
regard has always been had to the qualifications of those proposing 
to enter either branch of the science. Few comparatively of the 
candidates are finally accepted, although graduates of colleges in 
respectable standing. Each department has a series of regulations 
and requirements which are invariably enforced. In the army the 
Board of Examiners is expected, in execution of the duty assigned 
them, rigidly to scrutinize the pretensions of each candidate; taking 
into careful consideration his physical qualifications and moral COMMITTEE ON MEDICAL EDUCATION. 
15 
habits, as well as his professional attainments, and to report favor- 
ably upon no case admitting of a reasonable doubt. "The Board 
will report the positive merit of the candidates in the several 
branches on which they may be examined, and their relative merit 
from the whole examination; agreeably to which they will receive 
their appointment and take rank in the department." If the can- 
didate fail, he may be admitted to a second examination two years 
after, but if then unsuccessful, his name is finally dropped. If 
accepted, he becomes Assistant Surgeon in the army, but in five 
years is again examined for the post of Surgeon, when, if unsuc- 
cessful, his connection with the service is at once ended. 
The certificate issued by the existing medical bureau of the 
army, and to which every applicant for examination must first sub- 
scribe, is as follows :- 
I, , a candidate for the appointment of 
Assistant Surgeon of the United States Army, do hereby declare 
that I was years of age on the day of last; that 
I labor under no mental or physical infirmity, nor disability of any 
kind, which can in any way interfere with the most efficient dis- 
charge of my duties in any climate ; and- 
1st. That I have the degree of A. M. or A. B. from the , 
dated 
2d. That I have the degree of M. D. from the , dated 
3d. That I have attended the clinical course of instruction at the 
Hospital. 
4th. That I have been resident physician in Hospital for 
months. 
5th. That I have attended courses of lectures on Military 
Surgery and Hygiene. 
Signature: 
Date: 
Place of Residence: 
Note.-The 1st and 4th of the numbered requirements are not essential prere- 
quisites for examination, but will be taken into consideration in making up the 
finding. 
In the requirements the character and extent of the examinations 
are clearly stated. 
The candidates are examined on the branches usually taught in 16 
REPORT OF THE 
our medical schools; also on their literary and scientific attain- 
ments, embracing a grammatical knowledge of the English lan- 
guage, Latin, and natural philosophy (or physics), which are deemed 
important branches to those entering on the study of a liberal 
profession. Each candidate is required, as introductory to his 
examination, to prepare, in writing, a brief, extemporaneous 
description of the causes, symptoms, pathology, treatment, &c. of 
such disease as may be assigned by the Board, together with one 
or more prescriptions proper in the case, written out in form for 
the apothecary. 
"In the several branches enumerated, the candidate is required to 
be well grounded. The examinations are conducted with the view 
of ascertaining the measure of his natural endowments, his general 
professional intelligence, as well as his exact knowledge, his prac- 
tical ability and strength of judgment." 
The medical department of the army has been always active in 
promoting the cause of science, and much credit is due for the use- 
ful contributions embraced in the published statistics, especially 
those upon medical topography and meteorology. From Jan., 
1819, to Jan., 1839, reports were regularly made to the Medical 
Bureau of the Army, "thus affording the means, in connection with 
the returns in the Adjutant-General's office, not only to investigate 
morbid action by the numerical method, but to, show its relation 
with climate. As these diversified facts admit of classification 
according to certain geographical limits, the results, it is hoped, 
will furnish some general laws towards a basis of a system of medi- 
cal geography." From 1839 to 1855 the report was under the 
direction of Surgeon R. II. Coolidge, a highly distinguished mem- 
ber of the corps, as also the volume of statistics from 1855 to 1860. 
They form a most valuable body of papers upon the sanitary con- 
dition of the various army posts, the natural history of the differ- 
ent sections of the frontier country, an important consolidated 
summary of observations on mind and matter, temperature and 
rain tables, and other useful meteorological data. Special reference 
is made in the army regulations for the medical department, to the 
important duties of Surgeons and Assistant Surgeons in connection 
with their important branches of science, "connected," observes the 
last paragraph, " with meteorology and many interesting subjects of 
inquiry, which can only be elucidated by wide-spread, simultaneous 
observations. rI he medical officers of the army are, therefore, con- 
fidently directed to co operate in the collection of data tending to 17 
COMMITTEE ON MEDICAL EDUCATION. 
advance the interests of science. In the accuracy of these observa- 
tions (quoted as they will be both at home and abroad), it is hardly 
necessary to say the reputation of the department is pledged." 
At no period in our national history has the medical department 
of the army been more thoroughly penetrated by a spirit of improve- 
ment and progress; and while the war now being waged, to crush 
out a most unholy rebellion against a most beneficent government, 
may leave many bleeding hearts at its close, it will have resulted, 
in untold compensating advantages, not the least of which will be 
the onward impulse communicated to American medicine and sur- 
gery. To the distinguished and enterprising chief of the Army Med- 
ical Bureau, Surgeon-General William A. Hammond, is due the 
credit of having inaugurated many wholesome reforms and stimu- 
lated a spirit of improvement unexcelled in its former history. 
While superintending the vast practical machinery of the depart- 
ment over which he presides, he has not been insensible to the 
medico-literary claims upon his position. Early in the present 
national struggle, he projected a surgical history of the war, to be 
composed of contributions from the entire medical staff of the army 
and edited by an able member of the corps. 
The extent of this collation of valuable surgical materiel, and its 
immense importance to the profession at large, cannot be adequately 
appreciated. 
Simultaneously with this movement a request was communicated 
to the medical officers of the regular and volunteer corps, to prepare 
and forward such specimens as they might be possessed of, to a 
proposed army medical and surgical museum located at the Surgeon- 
General's office in Washington. The specimens were divisible 
into two classes:- 
1. Specimens illustrative of surgical injuries and affections; such 
as- 
Fractures, compound and simple-fracture of the cranium. 
Excised portions of bone. 
Diseased bones and joints. 
Exfoliations, especially those occurring in stumps. 
Specimens illustrative of the structure of stumps (obliterated 
arteries, bulbous nerves, rounded bones, etc.). 
Integumental wounds of entrance and of exit, from both the round 
and conoidal ball. 
Wounds of vessels and nerves. 18 
REPORT OF THE 
Vessels obtained subsequent to ligation and to secondary hemor- 
rhage. 
Wounded viscera. 
Photographic representations of extraordinary injuries, portray- 
ing the results of injuries, operations, or peculiar amputations. 
Models of novel surgical appliances, and photographic views of 
new plans of dressing. 
2. Specimens of disease:- 
Specimens illustrating morbid processes of every kind; especial 
consideration being paid, however, to the degree in which the mor- 
bid condition will probably be demonstrable in the preparation 
when preserved. All unnecessary or extraneous appendages to be 
dissected away. In addition to specimens of diseased organs, mal- 
formations, parasites, concretions and calculi are desirable. Micro- 
scopical specimens should, for uniformity's sake, be mounted on 
slips of glass three inches by one inch. 
To Surgeon J. H. Brinton, U.S. Vol., was committed the special 
charge of this collection, which, under his active and judicious 
management, consists of thirteen hundred and forty-nine objects. 
"Of these," Dr. Brinton informs us, in his published report, "nine 
hundred and eighty-five are surgical specimens, one hundred and 
six are medical, and one hundred and thirty-three are missiles, 
which, for the most part, have been extracted from the body. This 
latter class includes round and conical bullets, shot, grape, canister, 
fragments of shell, arrows, arrowheads, etc. Every object in the 
museum has been appropriately and permanently mounted-the 
dried preparations on stands, and the wet ones in glass anatomical 
jars, of the most approved patterns, and constructed for the purpose. 
Every specimen bears a label, on which is inscribed its catalogue 
number, and the name and rank of the medical officer from whom 
received." 
This museum is still receiving additions, and must become, at 
no distant period, the most extensive, interesting, and instructive 
collection of the kind in the world. 
lhe Surgeon-General has, moreover, exhibited extraordinary 
activity in banishing charlatanism and quackery from the army, 
and elevating the standard of ability in the corps. Medical exa- 
mining boards have been organized in all parts of the country, 
before whom are summoned those against whom charges may have 
been preferred of immorality or incompetency. Their qualifica- COMMITTEE ON MEDICAL EDUCATION. 
19 
tions are thoroughly sifted, and should they fall below the pre- 
scribed standard, they are at once dropped from the service. 
But the most important act of Dr. Hammond's administration is 
the organization of a national military college, for the purpose of 
educating more thoroughly candidates for the responsible position 
of Army Surgeon. The plan is nearly perfected; it is the inten- 
tion to procure suitable buildings and open the institution early 
in October, proximo. The subjects to be taught are Military 
History and Physiology, Military Surgery, Hygiene, and Medi- 
cal Jurisprudence and Toxicology. The chairs, four in number, 
have been already filled by surgeons of the army, whose acknow- 
ledged erudition and ability furnish the strongest guarantee that 
the instruction will be commensurate with the fullest requirements 
of the day. Connected with the College will be the extensive 
museum, already referred to, and extensive medical and surgical 
cliniques, which, at this time, are especially suggestive and im- 
proving. Medical cadets are required to attend the lectures, and 
medical officers of higher grade may do so at their option. Civilians 
admitted to matriculation must exhibit evidence of having gradu- 
ated at some respectable medical school, and must, further, subscribe 
the intention to unite with the army. The college is not designed, 
of course, to compete or conflict with any of the other medical in- 
stitutions of the country, but will be complemental to them. 
In the naval Medical Bureau a similar regard is had to the quali- 
fications of candidates, and the strictness of the examination is 
shown by the number rejected. A valuable statement may be 
found in the first volume of the Transactions of the American Medi- 
cal Association, drawn up by two very distinguished surgeons of 
the-navy, Drs. Wood and Pinkney. This paper states distinctly 
the conditions and requirements of examination for the medical 
branch of the navy. "The attention of the Board," declares the 
precept by which they are convened, " will be directed to moral 
character as well as to scientific and other attainments; and it will 
be its duty to make the examination full, minute, and rigid. The 
circular to candidates is as follows:- 
"For the information of the Board, you will state in your own 
handwriting, the place of your birth, your age, the State of which 
you are a citizen, and the names of the institutions in which your 
general education has been acquired. If a graduate of arts, please 
state from what college you received your diploma. Besides En- 20 
REPORT OF THE 
glish, what languages have you studied ? If you have studied 
Natural History, please state what branches. 
"State the name of your medical preceptor, and the time devoted 
by you to the study of medicine. If a graduate, of what institu- 
tion ? What period of time have you devoted to practical anatomy 
or dissection? What opportunities have you had to witness the 
practice of medicine and surgery ? What opportunity, if any, 
have you had to become acquainted with pharmacy and the physi- 
cal properties of drugs? 
"You will state, on your honor, whether you are obnoxious to 
any hereditary disease whatever; especially, whether any of your 
immediate family has suffered from pulmonary disease, epilepsy, 
insanity, or paralysis : and you will also state whether your general 
health is good, and whether you are free from constitutional disease 
and local affection, such as hernia, &c. You will furnish satisfactory 
evidence that your moral and social habits and character are good." 
In connection with the subject of medical education, it is proper 
I should notice the neglect of two departments of medical science 
the importance of which cannot be overrated. I mean Hygiene and 
Medical Jurisprudence. In many of the schools these branches are 
not taught, and in others very imperfectly. It is creditable to the 
Association that, at its first regular session, a standing committee 
was appointed on Public Hygiene. The various reports upon this 
subject, ably prepared, embody much information of value. Hy- 
giene, in the variety of its subdivisions, is illimitable. As yet, the 
field of investigation has hardly been entered by the curious ex- 
plorer. Its intimate relation to the preservation of human life, 
individual and in the aggregate, renders it of vast interest to him 
whose mission is to prevent disease as well as cure it. A know- 
ledge of hygiene implies an intimate acquaintance with etiology. 
We must understand the morbid influences which affect the body 
before we can deduce the principles of hygiene designed to arrest 
them, lhe relation of hygiene to endemic and epidemic disorders 
opens a wide scope of investigation as to their varieties, the agen- 
cies which produce them, their characteristics, and the peculiar 
laws by which they are governed. While its sanitary importance, 
in the construction and ventilation of private dwellings, hospitals, 
and public buildings; the qualities of water; d rainage; public 
nuisances and their correction; disinfectants and their influence 
on the spread of contagion; with a multitude of other equally im- 
portant topics, renders it not only one of the most interesting but COMMITTEE ON MEDICAL EDUCATION. 
21 
useful of the sciences. The necessities and results of the present 
war have especially invoked the aid of hygienic principles in the 
management of large bodies of troops with a view to health, and 
the proper regulation of camps and hospitals. The late printed 
certificate, which every candidate for admission into the medical 
staff of the army is expected to subscribe before admitted to exam- 
ination, demands that he shall have attended so many courses of lec- 
tures on hygiene. This will necessitate the establishment of a chair 
for instruction in this important branch of medicine, in connection 
with all the schools, since no graduate can hope to enter the army 
who has not been publicly taught in its principles. But one 
text-book of any value has been known to the profession for a 
series of years. I refer to the admirable but limited treatise of 
Professor Dunglison. A more comprehensive work, embracing 
all the recent additions to hygienic science is now passing through 
the press, which cannot fail to attract the attention of the profes- 
sion. It is the emanation of a mature intellect full of resources 
upon the subject of which it treats, and will constitute an additional 
proof of the surprising industry and ability of the present chief 
of the Medical Bureau of the army. 
The principles of Medical Jurisprudence are so frequently tested 
in the most public manner that attention to this important part of 
our science is really most desirable. Ignorance upon this subject 
often brings the physician into disgrace and the profession into dis- 
repute. 
There is one feature connected with medical testimony in the 
courts, to which I here allude, although not perhaps strictly ger- 
mane to the object of this essay. I refer to the mode by which 
the value of medical opinions is weighed and tested in courts of 
justice. A half dozen physicians, of variant ability, are summoned 
as experts, in a case involving intricate propositions in science, 
which educated persons only are competent to solve, and not un- 
frequently a human life depends upon the decision. And who, it 
may be asked, are the judges? A jury of twelve men, taken from 
less than the average minds of community. In the opinion of 
such individuals one doctor is quite as good as another, and the 
verdict is accordingly determined by the numerical preponderance 
of the witnesses, and not from their comparative intelligence and 
acquirements. Of these qualities they cannot indeed be considered 
competent judges. There is in all this a double injustice. It fails 
to protect the man of true merit, exalting the pretentious quack, 22 
REPORT OF THE 
while the ends of law and justice are unanswered or perverted. 
It is quite time some measure had been taken to remedy a growing 
evil, involving, in an eminent degree, the dignity, honor, and 
respectability of the profession. 
In concluding this report, hastily thrown together, I cannot too 
strongly urge the necessity of association as one of the most pow- 
erful means by which at last it may accomplish a more thorough 
system of instruction and a more wide spread zeal for the advance- 
ment of the science. Medical societies, both State and county, 
should be liberally encouraged and fostered. They bring together 
resources and facilities impossible of accomplishment by the indi- 
vidual, and exercise a healthy influence and wholesome restraint 
upon medical institutions and modes of practice within the circle of 
their operation. To the members themselves, such societies are 
invaluable. The attrition of mind with mind in stated discussions 
upon medical topics; the use of books and periodicals not other- 
wise accessible; these and other advantages cannot fail to promote 
the cause of medical education ; while, in the light of social inter- 
course, men in the same vicinage learn to know and appreciate 
each other's worth, thus extending the courtesies and amenities, 
which should ever characterize our noble profession. Compara- 
tively few practitioners acquire much from books, after graduation, 
without some extraordinary stimulus to rouse them from thejnertia 
and idleness into which they so often glide almost insensibly. This 
is so with those who move smoothly along in the routine of city 
practice, year after year, depending rather upon the superior attain- 
ments and convenient judgment of professional colleagues than 
upon individual application and habits of thought. But in country 
practice it is emphatically the case. The desire for advancement 
rarely survives long. If the necessary interruptions of business, 
and the non-appreciation of learning by a rustic population, do 
not destroy or prevent habits of study, the temptations to dissipa- 
tion, gossip, cards, politics, &c., so difficult to resist in the country, 
soon exert their paralyzing effects upon the mind. To all these 
the Medical Society comes as a healthy stimulus to exertion, and a 
blessed remedy for all the irregularities of the erratic practitioner. 
The principle of combination, well sustained and extensively dif- 
fused, is of vital moment to the moral influence of this great Asso- 
ciation, to which all others are subordinate. It is the only mode 
by which public institutions for teaching medicine, refusing to co- 
operate with us cordially in the plans of education proposed, shall COMMITTEE ON MEDICAL EDUCATION. 
23 
at length be compelled to yield to the moral pressure of organized 
associations in different portions of the land. 
The following resolutions for the consideration of the Associa- 
tion, conclude the report:- 
Resolved, That a thorough preliminary education in Latin, 
mathematics, and physics constitutes an essential prerequisite to 
the admission of a student of medicine into the office of a medical 
preceptor, or as a matriculant of a respectable medical college. 
Resolved, That the advancement of medical education demands 
a more extended and symmetrical course of instruction in the col- 
leges, and a more thorough and impartial examination for the 
degree of Doctor of Medicine than at present prevails. 
Resolved, That medical jurisprudence and hygiene are highly 
important branches of medical science, deserving the careful con- 
sideration of all medical teachers and schools. 
Resolved, That societies for medical improvement, State, district, 
and county, are important auxiliaries to the advancement and pro- 
motion of science, and are therefore highly recommended by this 
body as valuable levers in the cause of medical education. 
Respectfully submitted, 
CHRISTOPHER C. COX.