MEDICAL 
EDUCATION 
IN THE 
/ 
UNITED STATES. 
BY / 
R. A. F. PENROSE. MEDICAL EDUCATION IN THE UNITED STATES. 
A great deal of discussion has recently taken place on the subject of 
medical education in the United States. To a foreigner, or one not ac- 
quainted with the influences that have led to, and have kept up this dis- 
cussion, it might seem to be the result of a spontaneous outburst of popular 
feeling, earnestly demanding much-needed progress. Really, however, the 
very reverse is the case; and the revolutionists are those whose hind and 
sympathetic interest in the welfare of the community is prompted solely 
by selfish considerations. The changes urged by these self condemning 
philanthropists are not demanded by the medical profession nor by the 
public; neither have they been, nor will they be, sustained by both or by 
either. This assertion is clearly proved by the experience of the University 
of Pennsylvania. In 1846 the American Medical Association recommended 
to all medical colleges certain changes and improvements in their courses 
of instruction. In consequence of this recommendation the University of 
Pennsylvania extended its session to six months : not a single medical college 
in the country followed its progressive lead, and after continuing the experi- 
ment for six years, at great pecuniary loss, it was reluctantly obliged to 
retrace its steps, and to return to the old standard as to length of session. 
During the period of this advance the classes of the University fell off 
greatly, and the classes of other medical schools correspondingly increased. 
Even medical men sent their sons to other medical schools, to save the time 
and money necessary for the longer course. Indeed, medical men, as a rule, 
have sought to evade the restrictions as to length of time of study, etc., 
more than any other class ; and the statement, that the “ student usually 
dates his medical studies from the time he buys his first Chemistry,” applies 
more frequently to the sons of physicians than to any others. Hence, I 
declare that these proposed changes are not demanded by the medical pro- 
fession nor by the public. 
The writer of a recent article in Lippincott’s Magazine (Dr. H. C. 
Wood) on “ Medical Education in the United States” seems to have been so 
lost in admiration at the methods of instruction followed in European medical 
colleges, as to be utterly blind to the good in the system of medical education 
as it exists in this country—a system, the necessary result of our political, 
social, financial and territorial conditions; a system, which, though in the 
abstract, may not be the best, is certainly, judging from its results, the best 
possible under our peculiar circumstances. This much-abused system of 
medical education (only greatly improved in its extent and thoroughness— 
improvements developed by the constant advances in knowledge) is the same 4 
system which has produced the great medical men of the United States 
during the past seventy-five years—medical practitioners, whose success has 
been surpassed by none in Europe; surgeons, whose skill has been, and is, 
world-wide in reputation; authors, whose works arc standard authorities 
everywhere. It is the same system of medical instruction—I quote verbatim 
(italics mine) from this article that holds it up to scorn—which “ accom- 
plished such splendid results during the late rebellion.” The writer says : 
“ The great resources of the medical profession were proved during the civil 
war, when there was created in a few months a service which for magnitude 
and efficiency has rarely if ever been equaled. Indeed, military medicine 
was raised by it to a point never reached before that time in Europe, and the 
results achieved have, in many points, worked a revolution in science.” After 
this frank declaration of the inestimable value and glorious results of 
American medical education, the writer draws the logical (?) sequence that 
it (American medical education) is responsible for a case of most heart- 
rending malpractice, which he relates, compared to which the. Japanese 
hari-kari were merciful mildness, and approaching more nearly the tortures 
by crucifixion as administered by this same kind-hearted people. With 
about as much reason and justice might he conclude that the American 
system of Sunday-school education is lamentably inferior to that of Great 
Britain, because (?) Jesse Pomeroy was a possibility in that most respectable 
town of Boston. 
Dr. Wood alludes to the ignorance of the American medical student, 
and makes a statement “ not founded on the authority of official publication,’’ 
in which he endeavors to show that from “ six to ten per cent.” of American 
medical students have an ignorance of vulgar fractions and rudimentary 
astronomy, that would exclude them from an ordinary infant-school. Every 
one familiar with the students attending our first-class American medical 
colleges knows, perfectly well, that in origin and in culture they compare 
favorably with the young men engaged in the study of law and divinity, or 
with those entering upon mercantile or manufacturing pursuits. True, there 
are some imperfectly educated, but certainly not “ six or ten per cent.” 
destitute of that knowledge taught even in American infant-schools, and 
without knowing, and without the statement “ being founded on the 
authority of any official publication,” I infer that in Europe, owing to their 
“ better methods,” similar knowledge is communicated to the average Euro- 
pean child many months before its birth. 
Next follows a comment on the poverty of the American student. Dr. 
Wood says : “ Even worse than this, however, is the fact that the summer 
between the winter courses is often not spent in study, but in idleness, or, 
not rarely, in acquiring in the school-room or harvest-field the pecuniary 
means of spending the subsequent winter in the city.” Alas! this is too 
true. Providence seems to have ordained that our young American doctors 5 
are not always reared in the lap of luxury and wealth as the fittest prepa- 
ration for the trials, hardships and self-denials of their future lives. Jt is 
also true that some other young American professional men have been com- 
pelled “ in the school-room or harvest-field ” to acquire the means to prose- 
cute their professional studies. Daniel Webster, the son of a New England 
farmer, taught school at Fryeburg, Maine, “ upon a salary of about one 
dollar per diem.” His salary was all saved ... as a fund for his own ■pro- 
fessional education, and to help his brother through college.” “ During his 
residence at Fryeburg, Mr. Webster borrowed (he was too poor to buy) 
Blackstone’s Commentaries” Mr. Webster’s great rival, Henry Clay, 
also was compelled to resort to the “ school-room and harvest-field to ob- 
tain the pecuniary means,” etc., etc., etc. The son of the poor widow with 
seven children “ applied himself to the labor of the field with alacrity and 
diligence; ” “and there yet live th®se who remember to have seen him 
oftentimes riding his sorry horse, with a rope bridle, no saddle, and a bag of 
grain.” “ By the familiar name of the Mill-boy of the Slashes do these men 
. . . perpetuate the remembrance of his lowly yet dutiful and unrepining 
employments.” American biography is so filled with similar instances, 
showing how the great characters of her great men acquired their develop- 
ment and strength in the stern gymnasium of poverty, even in “ the school- 
room and harvest field,” that I could fill volumes with the glowing records. 
The youngest American school-boy recognizes Abraham Lincoln and Henrv 
Wilson in this American galaxy. Whose heart has not been stirred by the 
life-story of the great Hugh Miller? The stone-cutter’s pick earning for him 
humble means, thereby enabling him to acquire that learning which made 
his name a household word even in America. Truth, then, as I have 
remarked, obliges me to admit that we have in our medical colleges some 
young men who labor “in harvest-fields and school-rooms” in order that 
they ftiay honorably pay their way, rather than eat the bread or accept the 
gratuities of pauperism. 
Last March there graduated at the medical department of the Uni- 
versity of Pennsylvania one of these self-supporting young men. He was 
the son of a missionary clergyman : the father was poor in pocket, but 
the son was not poor in spirit. During the interval between his winter 
courses of lectures, rather than be a burden to his father, rather than accept 
gratuitous instruction from the school, he went into the coal regions of 
Pennsylvania and worked in a coal-mine, as a common miner, to procure 
funds to enable him to complete his professional studies; and, strange as it 
may seem, this young miner passed an excellent examination, and received 
the unanimous vote of the medical faculty for his degree. I mention this 
case, but every year there are several similar; and we always find that the 
school-teachers and miners are by no means at the foot of the graduating 
class. 6 
Concerning clinical teaching, we have the following statement: “ The 
clinical teaching in an American hospital is comprised in the following 
routine: Once or twice a week, from one to five hundred men being congre- 
gated in an amphitheatre, the professor lectures upon a case brought into the 
arena, perhaps operates, and when the hour has expired the class is dismissed. 
Evidently, under such circumstances there cannot be the training of the 
senses, the acquiring of a knowledge of the hourly play of symptoms of 
disease and of familiarity with the proper handling of the sick and wounded, 
which is of such vital importance, and which can be the outcome only of 
daily contact with patients.” What can the writer of this sentence mean? 
Certainly, no one knows better than he does that such ts not the practice 
in the hospital of the University of Pennsylvania, in Bellevue, and in 
many other large hospitals, where clinics and dispensary services are held 
for several hours daily throughout the year, and where the student has 
furnished him abundant opportunities for “acquiring a knowledge of the 
. . . symptoms of disease, ... of handling the sick and wounded,” etc., etc. 
That the American medical student protits by these opportunities, and learns 
his clinic lessons well, is proved by the unexpected, and evidently unintended, 
testimony which occurs toward the close of the article, where Ur. Wood 
says, “ The great resources of the medical profession in America were 
proved during the civil war, when t!here was created in a few months a 
service which for magnitude and efficiency has rarely if ever been equaled. 
Indeed, military medicine was raised by it to a point never reached before 
that time in Europe, and the results achieved have in many points worked a 
revolution in science.” The italics in this quotation are mine, as they also 
are in those which follow. 
But (says the article under review) “the largest proportion of our 
prominent physicians have educated themselves after graduation.” As if 
this were an extraordinary or unusual circumstance ! Certainly, they have ; 
and so have all prominent men in all professions and all pursuits of life, in 
every age and every country, not even excepting the much-lauded men of 
Great Britain and the continent of Europe. What young lawyer is en- 
trusted with an important cause immediately after admission to the Bar ? 
And, as the young doctor (according to the aforesaid showing) “ gains his 
first practical knowledge while serving as a hospital resident, under the 
supervision of experienced men,” so the young lawyer, even in Great Britain, 
must gain his first practical knowledge by constant attention at the courts, 
and by diligently following the proceedings of his preceptor’s and other 
offices. Even the young clergyman, whose business it is to save souls, has to 
do very much as the young doctor does, and, like him, is often “ thrown at 
once on his own resources, gaining his experience without supervision, and 
at the expense of the poorer classes, who naturally fall to his charge, and 
whose ignorance precludes them from an even approximately correct estimate 7 
of “ his fitness.” “ It is one of the saddest features of our system that the 
famed skill of our best ” (clergymen) “ should so often be acquired at such a 
cost.” 
What can be more unphilosophical and illogical than to compare the 
young doctor, or any other young professional man, to a new piece of 
machinery, fresh from the manufactory, complete and perfect in all its parts ? 
And yet, something like this is attempted in the article before us. Even as 
Minerva sprang from the brain of Jove the complete and perfect goddess of 
learning, so would our Utopian writer have the young doctors to come from 
the brains of their medical professors complete and perfect; only, if his idea 
be correct, their medical professors have so little brains, that, the annual 
graduating medical classes of the United States would be immediately 
reduced, from the frightful army of three thousand “ legalized murderers,” 
to the comparatively small, and easily counted, number of one graduate (of 
course, springing from one head). No; the young doctor, at graduation, 
cannot be compared to a new, complete and perfect machine fresh from the 
manufactory; rather, let him be compared to the young marsupial creature, 
at birth, extremely rudimentary, whose natural, and hence fittest, place is the 
parental pouch, but which, in due time, becomes the vigorous and well- 
developed specimen. I suppose, if I compare the young doctor to the young 
marsupial, I should also say that his protecting parental pouch, in which he 
acquires growth and vigor, is the hospital where he goes after graduation, or 
the practice which he sees under his preceptor’s supervision. 
The article continues: “ The remarks which follow do not apply to the 
medical department of Harvard College, or to one or two other schools” (the 
italics are mine); and further on, it continues: “In other words, Harvard 
has copied the European plan of medical teaching in some of its essential 
features, and as a consequence its medical diploma is the only one issued by 
any prominent medical American college which is a guarantee that its pos- 
sessor has been well educated in the science and practice of medicine.” 
Where can we find meekness and modesty like this?—modesty, as becoming, 
as it is unexpected and surprising, seeing that the writer fills two professor- 
ships in the University of Pennsylvania Does he hang his head so low in his 
—I was about to say singular—self-abasement (but considering the two pro- 
fessorships, I suppose I should say double self-abasement) that he cannot 
see ? or are his eyes so blinded by the effulgence of “ Harvard ” and 
“ European ” plans, that he fails to recognize and appreciate the immense 
advantages offered by his own home institutions? I do not propose to make 
any invidious remarks concerning Harvard, but I maintain that an honest and 
just comparison of the schools, of their requirements, of the character of 
their teachings, and the facilities they furnish their students, must show that 
modesty alone prevented Professor “ H. C. Wood, Jr., M. D.,” also excepting 
from his sweeping denunciations the two great schools of Philadelphia, 8 
though I only speak for and defend the medical department of the University 
of Pennsylvania from an attack unjust, uncalled for, and untrue. 
R. A. F. PENROSE. 
In the January, 187G, No. of the American Journal of the Medical 
Sciences, and in a most excellent article, styled ‘‘A Century of American 
Medicine,” “by Edward II. Clarke, late Professor of Materia Medica in 
Harvard University,” on page 135 will be found a singularly appropriate 
endorsement of the views contained in this paper I quote a few lines; 
although the whole article might be given as strongly sustaining my propo- 
sitions. 
“ The fact that the European schools are founded and controlled by the 
State, and are to a large extent responsible to it, and that American schools 
are independent institutions, self-supporting, and responsible only to public 
opinion, necessarily impresses a distinctive character upon the medical schools 
of the two continents. The atmosphere of each is different; each leads a 
different life; and each will produce a different result. Admitting such to 
he the case, it does not follow that the medical schools of the United States 
are necessarily of an inferior character, or that the physicians who graduate 
from them are imperfectly educated.” 
“ Indeed it may be affirmed that those who, like the apothecary of 
England and the Secundar Arzt of Germany, are charged with the medical 
care of the mass of the community in Europe, are not better equipped for 
the practical work of their profession than their average American contem- 
porary. We do not mean to assert by this that the scientific training of our 
schools is equal to that of Vienna, Berlin, or Paris. But we do assert that 
if the necessities and different conditions of Europe and America are 
impartially compared, we shall lind that the American method of medical 
education yields as good a practical result to the nation as the European 
method of medical education does to Europe. And we further assert, that 
the flexibility of the American method permits of change, growth, and 
development, in correspondence with the demands of each succeeding age, 
more easily and more rapidly than is possible with the conservative organi- 
zations of Europe. Hence we are not ashamed to present our medical 
schools, with all their short-comings and imperfections, as substantial contri- 
butions to the practical medicine of the century. And, moreover, we can 
justly point to graduates of these schools, some of whom have, and others of 
whom have not, been fortunate enough to add to their American a European 
education, as in every way the peers of European physicians or surgeons.”