Then & Now
Education & Training
The Civil War provided intensive, on-the-job training for thousands of physicians and other caregivers. Many doctors performed surgical procedures for the first time during the war. They also devised new approaches to diseases and conditions and developed follow-up treatment for patients, including the recording of detailed medical histories. Their wartime experiences paved the way for later developments in medical education.
In the mid-1800s, European cities, especially Paris, Berlin and Vienna, were centers for medical education, and a number of Americans studied medicine abroad. By 1860, there were 40 medical schools in the United States. The four institutions in Pennsylvania were all located in Philadelphia, including the country’s first medical school, the Medical Department of the University of Pennsylvania. At these four Philadelphia schools, there were 30 faculty members for a total of about 1,200 students.
Medical school curricula and requirements varied, but the course of study was shorter than it is today. Students took courses for a year, then repeated the same courses the following year.
Except for practical anatomy, the teaching was entirely by lecture, with a strong emphasis on the memorization of facts. Textbooks were central to medical education, as there was very little clinical or laboratory coursework.
However, students also studied collections of specimens, such as the many organs and bones preserved in the Mütter Museum of the College of Physicians of Philadelphia. They frequently supplemented their training with private courses, especially in anatomy. Independent anatomy schools, including the Philadelphia School of Anatomy founded by Dr. W. W. Keen, provided demonstrations, lectures and hands-on dissecting practice. After finishing their coursework, most medical students gained practical medical experience by working as anatomy demonstrators or preceptors for a year or two, or by serving as apprentices with established doctors or in hospitals. There were no standardized medical exams and no regulations of the profession. To become Union military surgeons, however, doctors had to pass extensive written and oral examinations. Some were even required to examine patients and to operate on cadavers to demonstrate their surgical skills.
Medical science of the era consisted of gross anatomy (the body’s basic structures), physiology (the body’s functions), pathology (the effects of disease on the body), and materia medica (substances used for healing, now called pharmacology). Several alternative systems of medicine also flourished during the 1800s, including homeopathy, which uses diluted substances to treat diseases. The country’s first homeopathic medical school was founded in Philadelphia in 1848. Eclectic medicine, which combined botanical remedies with physical therapy, was also popular for a time.
There were large gaps in medical knowledge in the mid-1800s. Doctors did not know that germs (microscopic organisms such as bacteria, viruses, fungi and protozoa) caused many diseases. Most physicians believed that diseases were spread by poisonous air, called miasma after the Greek word for pollution. Therefore, they did not follow antiseptic practices such as disinfecting wounds and cleaning instruments.
At the same time, however, medicine was becoming increasingly scientific. Physicians began to rely on observed evidence rather than ancient theories. Microscopy was frequently used for the examination and study of pathological tissues, leading to greater understanding of the effects of disease on the body. Later in the century, medicine began to become a modern profession, with examinations, licensing, codes of ethics and increasing specialization. Professional organizations such as the College of Physicians of Philadelphia contributed to these developments.
Information for this section was contributed by The College of Physicians of Philadelphia, in particular Jane E. Boyd, Ph.D., Wood Institute Research Associate, and Robert D. Hicks, Ph.D., Measey Chair for the History of Medicine and Director of the Mütter Museum & Historical Medical Library. For more information about The College of Physicians and the Mütter Museum, visit www.collphyphil.org.
Image: Anatomical and pathological study collections, Mütter Museum of The College of Physicians of Philadelphia. Photograph, after 1863. Courtesy of the Historical Medical Library of The College of Physicians of Philadelphia.
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