The restriction of the energies of trained students to narrow fields
in science, while not without its faults, has been the most important
single factor in the remarkable expansion of our knowledge. Against
the disadvantages in a loss of breadth and harmony there is the
compensatory benefit of a greater accuracy in the application of
knowledge in specialism, as is well illustrated in the cultivation of
special branches of practice. Diseases of the skin, of the eye, of the
ear, of the throat, of the teeth, diseases of women and of children,
are now studied and practised by men who devote all their time to one
limited field of work. While not without minor evils, this custom
has yielded some of the great triumphs of the profession. Dentistry,
ophthalmology, and gynæcology are branches which have been brought
to a state of comparative perfection, and very largely by the labors
of American physicians. In the last-named branch the blessings which
have been brought to suffering women are incalculable, not only as
regards the minor ailments of life, but in the graver and more critical
accidents to which the sex is liable.
One of the most remarkable and beneficial reforms of the century has
been in the attitude of the profession and the public to the subject of
insanity, and the gradual formation of a body of men in the profession
who labor to find out the cause and means of relief of this most
distressing of all human maladies. The reform movement inaugurated by
Tuke in England, by Rush in the United States, by Pinel and Esquirol in
France, and by Jacobi and Hasse in Germany, has spread to all civilized
countries, and has led not only to an amelioration and improvement in
the care of the insane, but to a scientific study of the subject which
has already been productive of much good. In this country, while the
treatment of the insane is careful and humanitarian, the unfortunate
affiliation of insanity with politics is still in many States a serious
hinderance to progress.
It may be interesting to take a glance at the state of medicine in
this country at the opening of the nineteenth century. There were
only three schools of medicine, the most important of which were the
University of Pennsylvania and the Harvard. There were only two
general hospitals. The medical education was chiefly in the hands of
the practitioners, who took students as apprentices for a certain
number of years. The well-to-do students and those wishing a better
class of education went to Edinburgh or London. There were only two or
three medical journals, and very few books had been published in the
country, and the profession was dependent entirely upon translations
from the French and upon English works. The only medical libraries
were in connection with the Pennsylvania Hospital and the New York
Hospital. The leading practitioners in the early years were Rush and
Physick, in Philadelphia; Hossack and Mitchill, in New York; and James
Jackson and John Collins Warren, in Boston. There were throughout the
country, in smaller places, men of great capabilities and energy, such
as Nathan Smith, the founder of the Medical Schools of Dartmouth and of
Yale, and Daniel Drake in Cincinnati. After 1830 a remarkable change
took place in the profession, owing to the leaven of French science
brought back from Paris by American students. Between 1840 and 1870
there was a great increase in the number of medical schools, but the
general standard of education was low—lower, indeed, than had ever
before been reached in the medical profession. The private schools
multiplied rapidly, diplomas were given on short two-year sessions, and
nothing contributed more to the degeneration of the profession than
this competition and rivalry between ill-equipped medical schools. The
reformation, which started at Harvard shortly after 1870, spread over
the entire country, and the rapid evolution of the medical school has
been one of the most striking phenomena in the history of medicine
in the century. University authorities began to appreciate the fact
that medicine was a great department of knowledge, to be cultivated
as a science and promoted as an art. Wealthy men felt that in no
better way could they contribute to the progress of the race than
by the establishment of laboratories for the study of disease and
hospitals for the care of the sick poor. The benefactions of Johns
Hopkins, of Sims, of Vanderbilt, of Pierpont Morgan, of Strathcona, of
Mount-Stephen, of Payne, and of Levi C. Lane and others have placed
scientific medicine on a firm basis.