From Quackery to Bacteriology, Document 10

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Medical Education

The poor quality of medical training offered in the United States was one reason for the slow development of the medical profession and the rapid growth of quackery in the 19th century. Medical schools were proprietary, had few entrance requirements, and provided no clinical training. Most doctors learned their trade through apprenticeships with practicing physicians, which provided the doctors with needed extra income and cheap labor. Hence the profession was unwilling to replace the proprietary schools and apprenticeship system with more appropriate education. Medical training—and medicine—suffered as a result.

Medical schools developed slowly in the first decade of the century. But the extreme shortage of doctors and large profits possible from operating medical schools led to a rapid expansion: 26 new schools opened between 1810 and 1840, and 47 more between 1840 and 1875.

This rapid expansion degraded the quality of education. Opening a medical school required only a hall and a group of physicians willing to lecture. Students bought tickets for the lectures, producing hefty supplemental incomes for physicians who earned little from patient care. Most schools had no admission requirements. Medical students were unruly and undisciplined, and often illiterate. No clinical practice, aside from apprenticeships, was offered to augment lectures.

Learning by dissection was difficult since most states prohibited dissecting human corpses, and students either had to bring their own cadavers or colleges employed body snatchers to steal corpses. Massachusetts was the first state to legalize the donation of bodies to medical schools, and this did not occur until 1830. Other states were slow to follow. New Orleans became a center of medical education because of the large number of unclaimed corpses of poor transients available for dissection from Charity Hospital.

Students dissecting corpses at the Toledo Medical College, ca. 1900.

The proprietary nature of medical schools made improvements in the quality of education difficult. Fierce competition for students resulted in lowering standards. When a school tightened its admissions standards and toughened its curriculum, enrollment dropped as students left for easier schools. Because the schools emphasized profit, medical education was separate from the university system and those schools affiliated with universities were affiliated in name only.

In an effort to improve standards, state medical societies fought colleges for the right to license physicians through examinations. But most were forced to accept either passing an examination or a diploma from a college as proof of ability, and as states did away with licensing in the middle of the century, even these criteria were dropped.

Poor training and the resulting poor quality of care did little to bring respect to physicians. Patients paid less than five dollars for common procedures, and often bartered for medical services. As Americans rebelled against the horrors of heroic medicine and were swept up by Jacksonian democracy, they became increasingly skeptical of aristocratic doctors who did little to relieve their suffering or cure disease.

In 1847, the newly formed American Medical Association established a committee to study medical training. The committee recommended tightening requirements, lengthening the academic year, and establishing a minimum of seven faculty members with different specialties to open a medical college.

Medical education improved slightly in the second half of the century, as the exploding knowledge base of the profession finally forced colleges to improve. Harvard president Charles Eliot seized the opportunity in 1869 to extend the medical college's school year from four months to nine, require both written and oral examinations, and establish a three-year curriculum. But it was not until Johns Hopkins University opened in 1876 that medical education improved significantly because founder Daniel Coit Gilman required clinical practice as an integral part of training. The apprenticeship system was ending.

Such changes were slow to be enacted nationwide. In 1890, the National Association of Medical Colleges approved strict membership rules, including a three-year curriculum. The National Confederation of State Medical Examiners and Licensing Boards supported this requirement in 1891. In 1910, a pivotal study conducted by Abraham Flexner for the AMA reported on the standards of specific colleges. Those with the best programs were rewarded with large grants. Schools found lacking eventually closed, including the Toledo Medical College, affiliated with the University of Toledo.

The operating amphitheater at the Toledo Medical College, ca. 1900.

Flexner, Abraham. Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching. Boston: The Merrymount Press, 1910.

Photographs, Schedule of property, Board of Trustees minutes, Correspondence, and 1892 Annual Report, Toledo Medical College, Toledo Medical College Collection, UM 68, University of Toledo.

Announcement of classes offered at the Toledo Medical College, 1900.

Selected Bibliography

For more information on medicine in the 19th century, consult the following works:

Caplan, Ruth B. Psychiatry and the Community in Nineteenth-Century America. New York, Basic Books, Inc., 1969.

Duffy, John. From Humors to Medical Science: A History of American Medicine. Urbana: University of Illinois Press, 1993.

Gillet, Mary C. The Army Medical Department, 1818-1865. Washington: Center for Military History, United State Army, 1987.

Gordon, Linda. Woman's Body, Woman's Right: Birth Control in America. New York: Penguin Books, 1975.

Green, Harvey. Fit for America: Health, Fitness, Sport, and American Society. Baltimore: The Johns Hopkins University Press, 1986.

King, Lester S. Transformations in American Medicine: From Benjamin Rush to William Osler. Baltimore: The Johns Hopkins University Press, 1991.

Shyrock, Richard Harrison. Medicine in America: Historical Essays. Baltimore: The Johns Hopkins University Press, 1966.

Sicherman, Barbara. The Quest for Mental Health in America, 1880-1917. New York: Arno Press, 1980

Wertz, Richard W. and Dorothy C. Lying-In: A History of Childbirth in America. New Haven: Yale University Press, 1989.

Wrobel, Arthur, ed. Pseudo-Science and Society in Nineteenth-Century America. Lexington: The University Press of Kentucky, 1987.

Young, James Harvey. The Toadstool Millionaires: A Social History of Patent Medicines in America before Federal Regulation. Princeton, New Jersey: Princeton University Press, 1961.

Barbara Floyd, University Archivist, University of Toledo

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Last Updated: 7/1/19