In the 35 years following down to the com pletion of the first hundred years of our his tory in 47 new medical schools were created, not including five or six abortive at tempts so transient as to leave a record diffi cult to trace. This made 80 altogether estab lished during the first 100 years, 16 of which had been discontinued, leaving 64 medical col leges in active operation in the United States. Of these Maine had two • New Hampshire one; Vermont three ; Massachusetts one; Connecti cut one ; New York nine ; Pennsylvania four; Maryland three; Virginia two; South Carolina one; Georgia three; Alabama one; Louisiana two; Texas one; Tennessee one; Kentucky three; Missouri three; California two ; Oregon one; Iowa two Illinois three; Indiana three; Ohio seven; Michigan two; and the District of Columbia three; leaving 13 States without any medical college. Of these, four, two in New York City, one in Philadelphia and one in Chicago, were devoted to the education of women in medicine. The whole number of students attending the five medical colleges in 1810, for Yale though chartered was not yet receiving students, was about 650, of whom about 100 were graduated that year. The population of the United States was about 7,250,000. In 1840, with the population two and a half times as numerous the medical students numbered 2,500, nearly four times as many, and about 800 graduated that year, eight times as many. In 1875-76 the .opulation of the United States was over 40,111,000. It had mul tiplied once more two and a half times, but the medical students now numbered 6,650, having again increased faster than the population, and that year 2,200 were graduated. With this great increase of medical colleges far beyond the medical needs of the population, the inevitable struggle for existence led to the lowering of standards. The temptation to concentrate the teaching into as brief a space as possible, partly because of competition for students but mainly to secure more profit for and less call upon the time of professors who were engaged in active practice, gradually compressed the time re quired for study. At the same time preliminary requirements lessened and anyone who could write his name, and he did not have to write it very plainly, could take up the study of medi cine. Thepreceptor was practically superseded and the college terms shortened to four months each with the lectures not graded, the students listening to the same course two years in suc cession. The degeneration of medical education was brought about by the faculty using the medical schools for money-making purposes, neglecting scientific development. Even when the medical schools bore the names of well known universities, as Harvard, Pennsylvania or Columbia, the university administration had practically nothing to do with the medical school curriculum or management and the fees were di vided among the historic septenate of pro fessors who became firmly entrenched every where and refused to permit of reforms until their hands were actually forced by certain reforming elements, mainly younger members of the medical profession.
There were vigorous protests against this unfortunate degradation of medical education which all could not but acknowledge and the American Medical Association was organized on the initiative of the New York State Medi cal Society with one of its main purposes the reform of medical education. An attempt was made to sidetrack the organizing convention by the delegates from the faculty of the Medical Department of New York University in whose halls the preliminary meeting was held. This failed and the national organization became a fact, hut was able to accomplish little in the reform of medical education for a generation.
Numerous discussions were of no avail. All were ready to admit that medical students should have better preliminary education and that the lecture courses should be graded and that there should be a systematic division of the branches taught into groups appropriate for each year of study, and that there should be at least three terms of six or better still eight or nine months, each year. The faculty of each school frankly acknowledged the defects of the system in vogue, but "each waited for the other to move first lest by placing higher requirements upon the time and resources of the student it should cause its own halls to be deserted for those of its less exacting neighbor') (Davis). Some very praiseworthy attempts were made, how ever, to get away from the current unfortunate state of affairs. The New York Medical Col lege was established in 1850 with a three-year graded course and the beginnings of clinical in struction. Unfortunately the Civil War proved fatal to it, but not before it had demonstrated the possibility of raising standards in medical education. In 1859 the Chicago Medical Col lege was organized for the express purpose of testing the practicability of establishing a school with a thoroughly graded and consecutive sys tem of instruction. In 1871 Harvard through the influence of President Eliot adopted a fully graded system of instruction, dividing her classes and extending the courses throughout the collegiate year. The new medical school of Syracuse University adopted the same policy about the same time.
In the 35 years after 1876 the number of medical schools doubled. The great majority of the new schools were of the same low stand ards as so many of their precedessors and in deed were founded with the idea not of foster ing medicine but of producing revenue for the professors directly or indirectly. In the mean time in 1878 Dr. Francis Delafield established the first laboratory in this country in connection with the College of Physicians and Surgeons in New York. Later that same year Dr. Wil liam H. Welch opened•the pathological labora tory of Bellevue. By degrees the better schools followed these examples and many other schools found themselves compelled to take up this de velopment of medical education or lose in at tendance. It was not until 1893 that a definite advance in medical education was made by the foundation of Johns Hopkins Medical School, Baltimore. This required a bachelor's degree from every student and required four years medical study. The better known schools were now stimulated to follow the example of Hop kins. Above all the special feature of clinical instruction worked out there gradually spread to the great benefit of medical education.
At the beginning of the 20th century the Council on Education of the American Medi cal Association began its work of registering medical schools after examination according to the grades which they deserved. In order to secure a class A rating the medical school had to have six full time professors, at least $100, 000 investment, be provided with laboratories properly equipped, require four years of medi cal study and at least one year of preliminary college work. It was not long then before the number of medical colleges began to drop off. At the end of the first decade of the century the investigation of medical education in the United States by the Carnegie Foundation for the Advancement of Teaching revealed the de fects in many existing schools and called at tention to what should be the absolute require ments for medical teaching in our day.