WORCESTER MEDICINE
From the Archive Medical Education and our Worcester District Dale Magee, MD, WDMS Curator
E
ducation
and
credentialing
are
foundational for the Worcester District Medical Society. When 41 physicians met at the U. S. Arms Hotel on Main Street in Worcester on December 18, 1794 it was out of concern that education was not standardized, lectures not readily available and experience varied depending on who was a student’s preceptor. The minutes of that first meeting state: “Since the business of the Physician is of such importance to mankind and since the science of Physick with the best opportunities for improvement can never be perfectly attained by any individual in the short compass of human life, it becomes the duty of every practitioner of this Divine Art to adopt the best methods for his own improvement and also to make his knowledge as useful as possible. Confident of this truth and influenced by motives of friendship and philanthropy, we, whose names are subjoined, agree to form ourselves into a fraternity by the title of the Worcester Medical Society…” The Society at that time sought to credential physicians by having censors examine them on a list of topics. There was a list of what would be examined as well as suggested books. The credentialing issue (with a charter from the State providing authority) was at the heart of a decade long conflict with the Massachusetts Medical Society. The MMS wanted all of the authority for the state (even though they had limited their membership to 70…) and Worcester wanted local authority. This was resolved in 1804 with the merger of the two Societies with Worcester becoming a District with authority west of Framingham. A career in medicine was basically training by apprenticeship. Keep in mind that this was when the only medical school in the state was what would later be called the Harvard Medical School. Over a decade after its founding it had graduated less than a dozen doctors. Nonetheless, the founders of the WDMS did encourage attendance at the medical school to those seeking admittance to the Society. But, until the mid 19th century most physicians had not graduated from medical school. States had not adopted licensing requirements (Massachusetts would establish the Board of Registration in Medicine in 1894). Those who attended medical school
routinely graduated without laying eyes on a patient! It seems that one either apprenticed without academic training or went to medical school without clinical exposure. Courses were often taken one at a time with cards issued certifying completion. Instructors were paid when their pupils passed. Pupils often were not literate and exams were oral. Those who chose would commonly go to Europe to further their training. Although education was poor by today’s standards, medicine itself was not considered a science. Prior to the mid 19th century there was no knowledge of infections, appreciation for the benefits of hygiene, ability to perform any but the most crude operations (without anesthesia!) and medicines were not standardized. Some felt that the theories that were being taught may have done more harm than good. Besides credentialing physicians, and having the certificate acting as a defacto license, the Society became a prime source for books with the library being the central function well into the twentieth century. As the mid 19th century approached, medicine began to change. John Snow’s revelations regarding epidemiology and hygiene, the discovery of anesthesia, Pasteur’s exposure of the world of infectious disease and Lister’s development of antiseptic technique all advanced the potential of medicine. Now there was something important to be gained with a good education. Although there were numerous breakthroughs in advancing medical education in this time span, I will quickly review a few. Elizabeth Blackwell is best known for being the first female graduate of a medical school in the U.S. Less well known is the fact that she felt that medical education was not only not accessible to women, but that medical education in general was deficient. She and her sister Emily instituted a Women’s Medical College of the N.Y. Infirmary for Women and Children in 1868. Besides actually having some educational requirements for entering students, they expanded the curriculum from 2 years to 3, provided a graduated curriculum (prior to this courses were simply repeated from 1 year to the next) and connected the medical school to their hospital to provide clinical experience. At about the same time, at Harvard, Dean Charles Eliot advocated for a 3 year graded curriculum, expansion of the year from 4 to 9 months and written exams. He was warned by faculty that given the low literacy among students that this would be a disaster for the school. He persisted and, in 1870, Harvard instituted the new structure…with 40% fewer students. Possibly the most significant breakthrough in medical education in the 19th century came with the design and opening of Johns Hopkins. Beginning with Daniel Coit Gilman in 1876, adding John Shaw Billings (who had previously founded what later became the National Library of Medicine), a faculty was recruited from the best in the country. This included: William Osler in Medicine, Howard Kelly in Gynecology, John Whitridge Williams in Obstetrics, William Halsted in Surgery and William Welch in Pathology. Designed with the intent of revolutionizing medical education it instituted a requirement for a bachelor’s degree for admission, and a medical school curriculum including 2 years of basic science training and 2 years of clinical training at a hospital designed to be part of the educational system. The school opened in 1893. The influence of Johns Hopkins cannot be overstated. As concern grew that the science of medicine was advancing but degree mills were SEPT / OCT 2021
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