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.
Sources:
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 1902. Chicago: G. P. Englehard & Company, 1902.
I made an javascript:void(0)error in my last post. Maryland was not the location of one of the first four medical colleges in the United States.
The Medical College of Philadelphia (now the medical school of the University of Pennsylvania) was established in 1765. King's College (now Columbia University) in New York City established a medical school in 1768. Philadelphia and New York for many years were the centers of medicine in the American colonies.
Harvard College added a medical curriculum in 1782 followed by Dartmouth Medical College in 1797. The creation of medical schools in the United States in the first 75 years of the 19th century was rather slow. Between 1801 and 1825 only 12 more medical colleges were established. Over the next 25 years 22 more schools were established followed by 33 between 1851 and 1875. However, the pace accelerated in the last 25 years of the 19th century with the addition of 86 new medical colleges. According to page 13 of The Standard Medical Directory of North America 1902, as of 1899, there were 156 medical schools in the US with 24,119 students enrolled.
This book, as well as others, claimed that during the Revolutionary War, nearly 3500 people were medical practitioners but only about 400 had medical degrees. So with only four medical schools founded between 1765 and 1797, how were most medical practitioners trained?
A few went to Europe to study. Dr. Francis Packard writes in his book that from 1758 through 1788, 63 Americans graduated with a medical degree from the University of Edinburgh in Scotland (page 156). During this period, if you had the funds, you went abroad to study in London, Edinburgh, Paris and Leiden. Unfortunately, most colonists did not have the means, thus most medical practitioners were trained through an apprenticeship.
I found that there were no standards regarding what constituted proper medical training. The following quotations taken from or about the time clearly illustrates the point:
God heals and the doctor takes the fee. - Benjamin Franklin
Few physicians amongst us are eminent for their skill. Quacks abound like locusts in Egypt, and too many have recommended themselves to a full practice and profitable subsistence. This is the less to be wondered at, as the profession is under no kind of regulation. - William Smith (1732)
The Chicago Medical College (Northwestern University) by 1859 had introduced a more rigorous curriculum and graded courses, compulsory clinical and laboratory work and lengthened the duration of the program. In 1871, Harvard Medical School adopted a similar program followed by Syracuse Medical School. However, the problem continued throughout the greater part of the 19th century at which time medical societies such as the American Institute of Homeopathy (organized 1844), Association of American Medical Colleges (1890), National Confederation of Eclectic Medical Colleges (1871) and the Southern Medical College Association (1892) pushed for the establishments of higher standards.
To be continued in my next blog: American Medical Training before the 20th Century.
Sources:
History of New York, from the First Discovery to the Year MDCCXXXII by William Smith. Albany, NY: Printed by Ryer Schermerhorn, 1814.
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 1902. Chicago: G. P. Englehard & Company, 1902.
