ity ity in its favor. It is pleasant to record that the indefatigable man was not daunted. He continued from time to time to found schools and to fill professorships—at Lexington, at Philadelphia, at Oxford in Ohio, at Louisville, and finally again in that beloved Cincinnati, where he had been so hardly served. In the course of a busy and fruitful career, he had occupied eleven different chairs in six different schools, several of which he had himself founded; and he had besides traversed the whole country, as it then was, from Canada and the Great Lakes to the Gulf, and as far westward as Iowa, collecting material for his great work, historically a classic, The Diseases of the Interior Valley of North America.
In the wave of commercial exploitation which swept the entire profession so far as medical education is concerned, the original university departments were practically torn from their moorings. The medical schools of Harvard, Yale, Pennsylvania, became, as they expanded, virtually independent of the institutions with which they were legally united, and have had in our own day to be painfully won back to their former status.[1] For years they managed their own affairs, disposing of professorships by common agreement, segregating and dividing fees, along proprietary lines. In general, these indiscriminate and irresponsible conditions continued at their worst until well into the eighties. To this day it is as easy to establish a medical school as a business college,[2] though the inducement and tendency to do so have greatly weakened. Meanwhile, the entire situation had fundamentally altered. The preceptorial system, soon moribund, had become nominal. The student registered in the office of a physician whom he never saw again. He no longer read his master's books, submitted to his quizzing, or rode with him the countryside in the enjoyment of valuable bedside opportunities. All the training that a young doctor got before beginning his practice had now to be procured within the medical school. The school was no longer a supplement; it was everything. Meanwhile, the practice of medicine was itself becoming quite another thing. Progress in chemical, biological, and physical science was increasing the physician's resources, both diagnostic and remedial. Medicine, hitherto empirical, was beginning to develop a scientific basis and method. The medical schools had thus a different function to perform: it took them upwards of half a century to wake up to the fact. The stethoscope had been in use for over thirty years before, as Dr. Cabot notes,[3] its first mention in the catalogue of the Harvard Medical School in 1868-9; the microscope is first mentioned
- ↑ The first step towards depriving the medical school of virtual autonomy was taken when the university undertook to collect the fees and thenceforward to administer the finances of the department by means of an annual budget. This took place at Harvard in 1871, at Yale in 1880, at the University of Pennsylvania in 1896. The scope of the medical faculty has gradually shrunk since. Columbia, which gave up its medical department to the College of Physicians and Surgeons in 1814, contracted a nominal relation with that school in 1860; in 1891 the connection became organic.
- ↑ In New York, however, the chartering of educational institutions is in the hands of the Regents, who have large powers. Nevertheless, they have recently given a limited charter to the Brooklyn Postgraduate School, a corporation practically without resources and relying on hospital and student fee income (the latter thus far small) to carry it through.
- ↑ Cabot,loc. cit., p. 673.
