Medicine – Teacher and Student Part 1

TRULY it may be said today that in the methods of teaching medicine the old order changeth, giving place to new, and to this revolution let me briefly refer, since it has an immediate bearing on the main point I wish to make in the first portion of my address. The medical schools of the country have been either independent, University, or State Institutions. The first class, by far the most numerous, have in title University affiliations, but are actually devoid of organic union with seats of learning. Necessary as these bodies have been in the past, it is a cause for sincere congratulation that the number is steadily diminishing. Admirable in certain respects—adorned too in many instances by the names of men who bore the burden and heat of the day of small things, and have passed to their rest amid our honoured dead—the truth must be acknowledged that the lamentable state of medical education in this country twenty years ago was the direct result of the inherent viciousness of a system they fostered. Something in the scheme gradually deadened in the professors all sense of the responsibility until they professed to teach (mark the word), in less than two years, one of the most difficult arts in the world to acquire. Fellow teachers in medicine, believe me that when fifty or sixty years hence some historian traces the development of the profession in this country, he will dwell on the notable achievements, on the great discoveries, and on the unwearied devotion of its members, but he will pass judgment—yes, severe judgment —on the absence of the sense of responsibility which permitted a criminal laxity in medical education unknown before in our annals. But an awakening has come, and there is sounding the knell of doom for the medical college, responsible neither to the public nor the profession.

The schools with close university connexions have been the most progressive and thorough in this country. The revolution referred to began some twenty years ago with the appearance of the President of a well-known University at a meeting of its medical faculty with a peremptory command to set their house in order.’ Universities which teach only the Liberal Arts remain today, as in the middle ages, Scholae minores, lacking the technical faculties which make the Scholae majores. The advantages of this most natural union are manifold and reciprocal. The professors in a University medical school have not that independence of which I have spoken, but are under an influence which tends constantly to keep them at a high level: they are urged by emulation with the other faculties to improve the standard of work, and so are given a strong stimulus to further development.

To anyone who has watched the growth of the new ideas in education it is evident that the most solid advances in methods of teaching, the improved equipment, clinical and laboratory, and the kindlier spirit of generous rivalry-which has replaced the former debased method of counting heads as a test of merit—all these advantages have come from a tightening of the bonds between the medical school and the University.

And lastly there are the State schools, of which this college is one of the few examples. It has been a characteristic of American Institutions to foster private industries and to permit private corporations to meet any demands on the part of the public. This idea carried to extreme allowed the unrestricted manufacture—note the term—of doctors, quite regardless of the qualifications usually thought necessary in civilized communities—of physicians who may never have been inside a hospital ward, and who had, after graduation, to learn medicine somewhat in the fashion of the Chinese doctors who recognized the course of the arteries of the body, by noting just where the blood spurted when the acupuncture needle was inserted. So far as I know, State authorities have never interfered with any legally instituted medical school, however poorly equipped for its work, however lax the qualifications for license. Not only has this policy of non-intervention been carried to excess, but in many States a few physicians in any town could get a charter for a school without giving guarantees that laboratory or clinical facilities would be available. This anomalous condition is rapidly changing, owing partly to a revival of loyalty to higher ideals within the medical profession, and partly to a growing appreciation in the public of the value of physicians thoroughly educated in modern methods. A practical acknowledgment of this is found in the recognition in three States at least of medicine as one of the technical branches to be taught in the University supported by the people at large.

But it is a secondary matter, after all, whether a school is under State or University control, whether the endowments are great or small, the equipments palatial or humble; the fate of an institution rests not on these; the inherent, vital element, which transcends all material interests, which may give to a school glory and renown in their absence, and lacking which, all the “pride, pomp and circumstance” are vain—this vitalizing element, I say, lies in the men who work in its halls, and in the ideals which they cherish and teach. There is a passage in one of John Henry Newman’s Historical Sketches which expresses this feeling in terse and beautiful language: “I say then, that the personal influence of the teacher is able in some sort to dispense with an academical system, but that system cannot in any way dispense with personal influence. With influence there is life, without it there is none; if influence is deprived of its due position, it will not by those means be got rid of, it will only break out irregularly, dangerously. An academical system without the personal influence of teachers upon pupils, is an Arctic winter; it will create an ice-bound, petrified, cast-iron University, and nothing else.”

Naturally from this standpoint the selection of teachers is the function of highest importance in the Regents of a University. Owing to local conditions the choice of men for certain of the chairs is restricted to residents in the University town, as the salaries in most schools of this country have to be supplemented by outside work. But in all departments this principle should be acknowledged and acted upon by trustees and faculties, and supported by public opinion—that the very best men available should receive appointments. It is gratifying to note the broad liberality displayed by American colleges in welcoming from all parts teachers who may have shown any special fitness, emulating in this respect the liberality of the Athenians, in whose porticoes and lecture halls the stranger was greeted as a citizen and judged by his mental gifts alone. Not the least by any means of the object lessons taught by a great University is that literature and science know no country, and, as has been well said, acknowledge “no sovereignty but that of the mind, and no nobility but that of genius.” But it is difficult in this matter to guide public opinion, and the Regents have often to combat a provincialism which is as fatal to the highest development of a University as is the shibboleth of a sectarian institution.