In 1859 the Chicago Medical College, now the medical department of Northwestern Uni versity, was established to test the practicability of a thorough graded system of instruction. Students were divided into three classes, and each class was examined at the close of the year. Each of the three courses was six months in duration. Attendance on hospital clinical in struction and practical work in the chemical, anatomic and microscopic, or histologic labora tories were required for graduation. In 1871 the Harvard Medical School adopted a similar plan. The Syracuse Medical School followed, and to-day the graded system of consecutive lectures is the rule. In 1896 President Eliot wrote substantially as follows: Within 25 years the whole method of teaching medicine has been revolutionized throughout the United States. The old medical teaching was largely exposi tion; it gave information at long range about things and processes which were not within reach or sight at the moment. The main means of instruction were lectures, surgical exhibitions in large rooms, appropriately called theatres, rude dissecting rooms with scanty supervision, and clinical visits in large groups. The lectures were repeated year after year with little change, and no graded course was laid down. There was little opportunity for laboratory work. The new medical education aims at imparting manual and ocular skill, and cultivating the mental powers of close attention through pro longed investigations at close quarters with the facts and of just reasoning on the evidence. The subjects of instruction are arranged, as at the Harvard Medical School, in a carefully graded course, which carries the student for ward in an orderly and logical way from year to year. Laboratory work in anatomy, medi cal chemistry, physiology, histology, embryology, pathology and bacteriology demands a large part of the student's attention. In clinical teaching, also, the change is great. Formerly a large group of students accompanied a visiting physi cian on his rounds, and saw what they could under very disadvantageous conditions. Now instruction has become, in many clinical depart ments, absolutely individual, the instructor deal ing with one student at a time, and personally showing him how to see, hear and touch for himself in all sorts of difficult observation and manipulation. Much instruction is given to small groups of students, three or four at a time — no more than can actually see and touch for themselves.
In 1918 there were, excluding graduate schools, 95 medical schools in the United States with 13,630 students. The growth in medical students in 32 years up to 1910 was 333 per cent. In the last 15 years, however, there has been a radical change in medical education in the United States which has had the effect, as will be shown in the following table, of improv ing the quality of the education, while at the same time reducing the number of those granted medical degrees. Acting upon the rec ommendation of the American Medical Asso ciation, a committee has made a division of medical schools into three classes, A, B and C, the first containing those medical schools which fulfilled the highest requirements. The an nexed table shows the results of the reconstruc tion which followed the classification: While the actual number of physicians graduated is half that of 1904, the number per thousand of population is still twice as great as it is in Europe. The diminution in number
of medical students was not affected by the European War nor was the actual number of medical students and teachers affected by the selective draft, for the Medical Officers' Re serve Corps and the Enlisted Medical Reserve Corps provided against that contingency.
Class A colleges require a four-year high school course and two years of work in a col lege of arts and sciences approved by the council on education of the American Medical Association. The council also specifies what is required in the studies both in high school and college, and also what is to be expected of the medical schools themselves, both in supervision, equipment, teachers, clinical facilities [includ ing, for instance, daily dispensary cases, at least six maternity cases for each senior stu dent and 30 necropsies for each senior class of 100 students or less], medical library, museum, dissect material, etc. In 1918 there were 69 medical colleges of Class A in the United States and two in Canada.
Medical schools of Class B are those which under the present organization give promise of being made acceptable by general improve ments. Of these there are 14 in the United States and six in Canada. Class C contains those which require complete reorganization, do not keep satisfactory records, or enforce entrance requirements or give a major portion of their instruction after 4 P.M., or are privately owned and conducted for profit. Of these there are 12 in the United States.
The comparative value of the work done now and 14 years ago is realized when it is known that in 1904 only 2.5 per cent of medi cal schools required college work as an en trance requirement, while in 1918 92.2 per cent did, and that in 1904 only 6.2 per cent of the medical students of the country were in the high grade medical schools, while in 1918 there were 95.3 per cent in the better schools, and that in 1904 but 6.4 per cent of the graduates in medicine came from the high grade colleges, while in 1918 the latter graduated. 90.3 per cent.
In 1915 a national board of medical examin ers was inaugurated with funds from the Car negie Foundation. The board consists of six representatives from the government [two from the army, two from the navy and two from the public health service], three members of State licensing boards and seven other physi cians appointed at large.
Of the 82 medical colleges in the United States in 1914-15 the most highly endowed had an income of $411,570, and the lowest $6,080.
About 1903 a rapid improvement in medical education began in the United States, result ing in a very great decrease in the number of medical colleges and it was thought that a dearth of physicians would follow. Fears were also expressed that the medical education, the cost of which was thus greatly increased, would be the privilege of the rich, and that it would undemocratically exclude the poor boy, a fear which has not been justified. Appre hensions' were also felt that the raising of the standard of medical education would have the effect of decreasing the supply of physicians for rural communities. This, however, has been obviated by the improvement of facilities in communication — automobiles, better roads, etc.