Thursday, May 27, 2010

Part 5: American Medical Training before the 20th Century

In an earlier blog entry, I suggested that I would try to determine if there was some number of physicians who were in private practice, not associated with a medical school and had earned an LLD. This task is proving to be huge. However, as I was looking at how one became a physician in the United States prior to 1900, I have pretty much concluded that very few private practice physicians prior to 1900 took the time to study for an LLD degree.

Upon learning how one became a physician before 1900, I realized that many of the medical practitioners had no formal training at universities and colleges. The physicians included in Walter Graeme Eliot’s book were associated with schools like Columbia University and the University of Pennsylvania. Thus, the opportunity to pursue an LLD degree was readily available.

In Part 4 of this series, I mentioned that during the American Revolution of the nearly 3500 medical practitioners about 400 had medical degrees. The approximately 3100 had become medical practitioners through an apprenticeship. The quotation that I included in Part 4 from William Smith’s book, The History of New York, from First Discovery to the Year MDCCXXXII (1732), complains about the lack of regulation and licensing of doctors. This complaint was repeatedly expressed throughout the 19th century as well.

Prior to 1765, if you wanted to become a doctor, you either went to Europe to study or you studied under a local practicing physician. Typically you apprenticed for two years and then your preceptor would create a certificate or affidavit stating that you had completed your study and were qualified to practice medicine. The course of training at the Medical College of Philadelphia and at King’s College Medical School did not do much to improve the quality of doctors.

To graduate with a bachelor degree in medicine, the student served 2 years under a preceptor and attended one course of lectures for the duration of four months. The lectures were from 7 to 8 hours in length each day and covered material medica, physic, anatomy and chemistry. To graduate with an MD, the student served 3 years under a preceptor and attended 2 courses of lectures for the duration of four months each one year apart. The second course of lectures was a duplicate of the first course.

Admission to American medical schools from 1765 into the 19th century was based on who could afford to pay. Students purchased tickets to the various lectures. At the Medical College of Philadelphia, these were called Matriculation Tickets. There were no tests, no labs and little to no clinical experience as most medical schools were not associated with a teaching hospital let alone a hospital.

By 1850, there were 37 medical schools in the United States. None were regulated. Without the need of laboratories and clinics and the lack of regulation, medical schools were easy to set up. If marketed well, a medical school was a cash cow for the physician who owned one. So it is no wonder that by 1876 another 33 medical schools were established. In the succeeding 25 years the number of medical schools more than doubled by the addition of 86 facilities. Of the 156 medical schools in existence in 1900, only 74 were departments of colleges or universities.

During the first half of the 19th century, several states attempted to regulate medical practices but by the 1830s the statutes were amended to the point of being ineffectual or abolished entirely. In 1850, only three states had laws concerning the licensing of physicians.

To be continued: Part 6: Regulation of Medical Schools in the United States.

Harvard Medical School History: Looking Back and Looking Forward.
The History of Medicine in the United States by Francis Randolph Packard, MD. Philadelphia: J. B. Lippincott Company, 1901.
The Standard Medical Directory of North American 1902Chicago: G. P. Englehard & Company, 1902.

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