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People & Events: The Rise of Professional Medicine

Harvard Medical College The nineteenth century, in which George Parkman and John Webster learned medicine, was a pivotal time for the transformation of medicine into a modern science. Parkman and Webster's education at the beginning of the century consisted mainly of theoretical lectures about the human body and diagnosis. By the end of the century, medical education focused on the hard sciences of histology, pathology, and chemistry, and on hands-on lab and hospital experience. The century opened on doctors as tradesmen, and closed on them as professionals.

Doctors as Tradesmen
In the middle of the nineteenth century, when John Webster was teaching chemistry at Harvard Medical College, most ill Americans still received about the same treatment they would have received a hundred -- or even two hundred -- years earlier. People needing medical attention would not necessarily turn to an actual physician. They may have preferred to be treated by a homeopathic healer, a patent medicine-maker, or a midwife. Doctors were simply tradesmen competing for clients against other tradesmen. Many doctors considered it part of their jobs to keep up a sophisticated social calendar and attract the kind of patients who could pay good money for their services.

Standards Varied
In 1850 there were 52 medical schools in the United States, as opposed to only three in France. Yet this did not indicate superiority in the level of American medical education. American medical schools of the early and mid-nineteenth century were generally doctor-owned institutions that varied widely in their standards and methods of education. Even Harvard Medical College, with ties to that well-known institution, was left largely on its own. Harvard medical professors were required to pay for their own teaching supplies. When professors insisted they needed a new medical school, one was built in 1846 only with the agreement that the professors would personally pay back the money required for the project.

Training and Apprenticeship
men sitting with skeleton In the 1830s, aspiring doctor Nathan Davis spent two years in New York, training in medicine, and then served a four-year apprenticeship, for which he paid by tending cows. Davis's career path was typical for medical students of the early to mid-nineteenth century. But doctors could get licensed with the apprenticeship only. If they did attend school, they may have entered with only a high school diploma, and they may have had no laboratory experience. Medical schools hesitated to make their programs longer or more rigorous for fear of losing students and tuition. Davis saw a need to raise the level of medicine to that of an organized profession.

Professional Standards
Nathan Davis believed that medicine, so crucial to society, must rise above these inconsistencies and become a standardized, respected profession. He devoted his career to this goal, and institutions such as Harvard and Johns Hopkins helped him. He proposed that medical standards should transcend state boundaries. In 1846 Davis spearheaded a national medical convention with four aims: to create a national medical association, to create elevated, uniform standards for an M.D. degree, to require standard preliminary education, to define a national code of medical ethics. The American Medical Association was founded a year later, but the rest of Davis's reforms took decades to implement.

Urgent Need for Improvement
From 1861 to 1865, the bloody Civil War created an urgent national demand for more medical personnel and hospitals. Doctors witnessed a dire need for improved medical treatment and turned their attention to medical education. Harvard was the first major school to adopt reform. Harvard president Charles Eliot said, "The ignorance and general incompetency of the average graduate of American medical schools at the time when he receives the degree which turns him loose upon the community, is something horrible to contemplate. The whole system of medical education in this country needs thorough reformation." Harvard lengthened medical education from two to three or four years, and shifted its focus to laboratory work rather than lectures. The curriculum was redefined to focus on the practical sciences of histology, pathology and chemistry.

More Rigorous Requirements
Johns Hopkins University joined Harvard at the vanguard of the reform movement. Johns Hopkins was created as an experiment: the first medical school to require a prior college degree, and to employ full-time medical professors. It was also the first American school to add required hands-on hospital training to its curriculum. Innovations at Harvard and Johns Hopkins prompted other medical schools to raise their standards, and the modern medical education system was born. In 1890, teaching institutions formed the Association of American Medical Colleges. Its members, including one-third of all U.S. medical schools, adopted a standard course of study: three years focused on histology, pathology and chemistry. By 1893 most U.S. medical schools conformed to these standards, and the more marginal schools folded.

Licenses and Publications
As the twentieth century approached, only a couple of Nathan Davis's goals for professional medicine remained to be fulfilled. The necessity of professional licensing boards had began to be realized with the birth of Texas' state board in the 1870s. By 1898, all states had their own medical licensing boards. Davis's American Medical Association almost perished in the 1870s, but was permanently revived with the birth of the Journal of the American Medical Association. JAMA's first issue was published on July 14, 1883, with Davis as its editor. The journal remains today the foremost American publication on medical standards and innovations.

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