CHAPTER XXIX.

MEDICAL SCHOOLS OF THE UNITED STATES.1

The Report of the Commissioner of Education for 1892-93 (pp. 601-613) contains a summary of a report on medical education in the United States by Dr. Marcel Baudouin, delegate from the French Government to the Chicago Exposition and specially commissioned to study the system of medical instruction, conditions of professional life, etc., in our country. Dr. Baudouin visited the chief medical schools, hospitals, etc., of the country, and his report contains, in addition to the summary referred to, extended descriptions of individual institutions. To reproduce these in full would require more space than can be allowed for the subject, but it seems desirable to present at least extracts relating to typical schools and in a few instances even to give in full Dr. Baudouin's account of individual institutions.

JOHNS HOPKINS UNIVERSITY.

"Of this university for higher scientific education," says Dr. Baudouin, "it is necessary to give more than simple mention. Here, however, I can only describe its magnificent institute of physics, the largest in the United States, directed by Prof. Henry A. Rowland; its chemical laboratories, which Prof. Ira Remsen courteously showed me, and its geological collections (so important ordinarily in all the large American universities on account of the development given to studies relative to the mineral wealth of an almost virgin soil). Apparently the chief purpose of this university is the training of engineers (mining, mechanical, etc.), and specialists in chemistry, but it is also celebrated for the works of pure science which come from its laboratories. Here are to be found men of undoubted ability; here are illustrious mathematicians, savants of the highest order, whom rival universities seek as professors. This is, in fact, one of the principal centers of higher education in North America and would well repay close study. It differs essentially from our French faculties and also from the German universities.

"In 1889 the Medical Weekly stated that the medical department of Johns Hop. kins University, announced prematurely, was not in actual operation, but I was informed that the medical faculty of the famous university of Baltimore would open its doors in October, 1893. This department will, without doubt, have the same importance as the other faculties of this institution, and has promise of a brilliant future. In the hospital I am about to describe this school will possess fine appointments, and since the cultivation of pure science is not neglected in this intellectual center it can not fail to draw the most distinguished professors to its circle. Those men who have already taken the course of study at the hospital and who will certainly form a part of the personnel of its future faculty are men well known in the intellectual world.

JOHNS HOPKINS HOSPITAL.

"This hospital is as well known in the medical as is the university of the same name in the scientific world, but, judging from its register, few Frenchmen have visited it. I know of only one hospital in Europe, the Urban Spital at Berlin, that can at all compare with this one founded by Johns Hopkins. Our French hospitals are built on a very different plan, which their antiquity readily explains. Those that have been recently constructed, whether at Paris or in the provinces, may be as good and as interesting as the two mentioned, but certainly they do not compare with them either in extent or in perfect hygienic resources, or in the perfect, harmonious arrangement of all the parts. One who has not seen these two hospitals (which, be it said, admit only 300 or 400 patients, while Tenon at Paris admits double

From report of Dr. Marcel Baudouin, delegate from the French Government to the Chicago Exposition.

that number) can not form an idea of the results which may be attained at this age of the world in the construction of a great hospital when the resources are unlimited. "The Johns Hopkins Hospital, like the university, was built from funds left by Johns Hopkins, a merchant of Baltimore. Many plans for this institute were submitted to the executive committee, both by physicians and architects, but that accepted is due to Dr. John S. Billings, whose name I have already had occasion to mention. In order to perfect his designs Dr. Billings spent several years in Europe, and visited the principal hospitals of France and Germany. From these studies resulted plans so admirable that they were adopted without opposition. The immense buildings intended for those attacked by acute diseases are situated on a point of land elevated above the city. They comprise numerous separate pavilions divided into three grand sections-medicine, surgery, and gynecology. There is no section of accouchement. These departments are each under a physician in chief. The hospital is free to patients resident of Baltimore and its environs, and to those victims of accidents who are natives of Maryland. There are also separate pay wards for men and for women, and common wards where all patients may be admitted who are not able to pay the usual charges of $5 a week.

"There are also laboratories of bacteriology and pathologic anatomy admirably equipped (pertaining to the school of medicine), an excellent dispensary, and a training school for nurses with a nurses' home.

"I do not intend to give here a full description of the Johns Hopkins Hospital, which was finished only in 1889, nor to enter into all the details of its work. Those who desire more particular technical information will read with greater profit the magnificent publication of Dr. Billings. I prefer to dwell only on such parts as I have seen myself, and of which my report will naturally be shorter and less minute.

"The wards. My first visit was to the surgical department, which occupies a separate and finely appointed division. As I have said before, the wards are small and accommodate each only about a dozen beds. The largest ward is circular, or, rather, octagonal, a form which more than any other facilitates a constant watch on the patients.

"I noticed here portable screens of pine wood which are used to separate the beds of the patients during an operation or while a painful wound is dressed. Sometimes three of these screens are used, forming a sort of box, and thus much agony is kept from the sight of the patients. Some surgical operations which I witnessed interested me much, two in particular. A large aneurism of the aorta, and especially an operation at which, in the course of a hysterectomy, the ureter was cut, and at which Dr. Howard A. Kelly, professor of gynecology, successfully effected a suture of that conduit by means of a lateral anastomosis.

"Certain usages which I had never seen in Europe surprised me; for instance, the custom of taking the temperature in the mouth by means of a very convenient little thermometer. This instrument is placed in the buccal cavity, and the lips of the patient tightly closed for a few moments. In this way results are obtained compa rable to those obtained by taking the temperature at the rectum and vagina. This method is a little less exact; as it is rapid it is employed in ordinary cases or where time presses. When the malady is serious recourse is had to the rectal temperature. Contagion is easily avoided by washing these little instruments in antiseptics. The wards for the sick deserve more than passing mention, but I can only touch upon their irreproachable cleanliness, upon the care with which all hygienic precautions are observed, upon the use of the telephone, the little libraries, the flowering plants, the aquariums, and the cages of birds. I must emphasize the importance and regularity of the services rendered by the American nurses who occupy the same position as the 'infirmières' and 'surveillants' of our own hospitals.

"The nurses.-There are 60 nurses at Johns Hopkins Hospital, whose shining white uniforms, delicate manners, good nature, respect for the sick, and professional knowledge aroused in me a most lively interest. If the reader will bear in mind that I am a member of the corps of instruction in a training school for nurses connected with a similar hospital in Paris he will easily comprehend how painful were the comparisons which were forced upon me.

"The comparison that I made between the uncertain remuneration of French lay nurses and the liberal salaries received by American nurses, especially those of Johns Hopkins Hospital, and also between the intellectual culture of the two, is not favorable to the French.

"The Nurses' Home of Johns Hopkins Hospital is superb, in reality a little hotel, almost a palace, whose soft carpets and white marble staircase are in strong contrast with the ragged straw matting and wooden ladders of the dormitories of the Pitié or of the Salpêtrière. This building is four stories high. The basement contains a dining room which will accommodate 40 persons, a pantry, four storerooms, a study hall, a lecture room, bathrooms, water-closets, and an elevator, besides a kitchen where the nurses have practical lessons in cookery.

"The first story opens from a large hall on a terraced walk. It contains a parlor

for the nurses, two rooms for the superintendent, a library, six rooms for the head nurses, two others for sick nurses, and water-closets and bathrooms. This story is reserved for the graduate nurses.

"The second and third stories are identical and have seventeen rooms heated by steam (a manner of heating very common in America), four rooms with fireplaces for sick nurses, a laundry, and bathrooms and water-closets. As a matter of simple information I believe it useful to describe the nurses' parlor, which is furnished with a view to comfort rather than luxury. This room is heated by hot water although one of its few luxuries is a fireplace, a rarity in modern American houses. The waxed floor is covered with soft rugs; easy wicker chairs, stuffed chairs, and the traditional rocking chair of America supply inviting seats. The clean white walls are bare of pictures and the windows are without curtains or draperies. I will add only one word more. We not only have nothing in France to be compared with institutions of this kind in the United States, but there is nothing in our country which can truly be called an autonomous and complete lay school for nurses. What has been done at Paris can not be compared with the institutions of this sort in the United States.

"The new hall for surgical operations is reserved for the practice of gynecology and surgery, and is profusely lighted by electricity.

"The surgical amphitheater, in the form of a half circle, is provided with rows of seats rising one above another. At the rear is the entrance for students. Not far from this room is a smaller room for operations on the wounded, or patients requiring antiseptics. This is lighted from the two sides, while the large hall receives its light from above.

At the outer edge of the hall is an anesthetic room, which serves for both operating rooms, an arrangement somewhat objectionable. There is a dark room for ophthalmology, a room for the surgeon, a room for watchers, a room for those who have undergone an operation, and a small hall for the sick. Situated at the side of the office through which all the wounded must be brought who require immediate operation is a bathroom and a room for gynecological examinations. The wounded do not enter the operating room by the same passage as the hospital patients, and the students have still another entrance. I pass over the dispensary building (a description of which would greatly astonish French physicians), to say a word about the isolating ward. In the basement of this building are the usual arrangements for heating, and from the roof project the usual ventilating chimneys. So numerous are these that one could well describe the Johns Hopkins Hospital as the hospital of little chimneys and hot-water coils.

"Above the basement there is a single story a little more than 10 meters in height. It contains twenty alcoves which open on a central hall. A single bed is in each. In three of the alcoves the floor is perforated in order to insure perfect cleanliness and to admit extra heat from the coils immediately beneath. There are also two rooms for nurses, with two beds in each room, a laundry, a bathroom, and a special kitchen.

“Heating and ventilation.—I can not say enough in praise of the system of ventilation and heating which has been adopted by Dr. Billings. I should certainly fail in my duty if I did not make special mention of this feature, which distinguishes Johns Hopkins Hospital from all other American hospitals as well as from those of Europe. "Machinery.—The basement of this establishment should also be seen in detail. Here is machinery unlike any to be seen in France and which can be equaled only in Berlin. Unfortunately it is impossible to describe it in a few lines. Therefore I shall only mention its principal points. Acoustic tubes are placed in all the halls and corridors and communicate with the different buildings. The separated buildings are connected by telephone with the office and through this with the city. Almost every room is supplied with an electric register of temperature.

"Altogether this hospital presents exquisite cleanliness and admirable organization and is constructed with that view to convenience that is met with only in a country where time is money and where in order to work well and profitably it is necessary to work quickly. It is a unique hospital which should be seen and studied.”

WOMAN'S MEDICAL COLLEGE OF PENNSYLVANIA.

"As everyone knows, in America there are several colleges devoted exclusively to women. I have examined in all its details the most important of these, The Woman's Medical College of Pennsylvania, situated in Philadelphia. It was organized in 1850, and is the oldest and most celebrated of the existing woman's colleges.

first college of this class, founded in Boston in 1848, is no longer in existence.

The

"The school of medicine is under the direction of a board composed of men and women (the latter six in number). The president is a woman (Mrs. Mary E. Munford), as is also the dean (Mrs. Clara Marshall). There are, besides, teachers,

demonstrators, assistants, and prosectors, many of whom are women. the American universities, it has a woman librarian.

Like most of "The examination for entrance into this college is not difficult. In order to show the plane upon which medical colleges stand I add that the applicants for admission are required to know a little orthography, arithmetic, physics, and Latin (the corjugation of the verbs is sufficient); nothing more is required. The professors, evidently, are content with very little. In the United States it is necessary not to be too severe if one intends to have pupils, a fortiori if they are women." (Here follows a synopsis of the curriculum.)

"I went through the building, even to the roof, and found that, as in almost all American colleges, the dissecting room was in the top story. The room in this case is lighted by electricity, and each table is supplied with a small light that can be moved to accommodate the operator. I wondered at the location of the operating room, but it is probably so placed to prevent the odor from getting to all the rooms of the building and for freer admission of air into the room."

(Brief descriptions are also given of a few other rooms.)

THE UNIVERSITY OF PENNSYLVANIA.

"In spite of the importance of Jefferson College, in spite of the relative éclat, at least, of the Woman's College, the place of honor among the medical schools of the metropolis of Pennsylvania must be accorded to the medical department of the University of Pennsylvania. It is situated some distance from the center of the city, on the left bank of the Schuylkill River, not far from the Drexel Institute. The campus of the university covers five squares, on which are located the immense buildings separated by grass plats. The first block inclosed by a railing is in the form of a trapezoid, on which stands the college hall of the university; that is to say, the offices of the directors and the halls of the faculty of philosophy, of the faculty of medicine, the laboratories for dental clinics, the library, the mechanical laboratories, and the machine shops. Behind these are the hospital of the university, the nurses' home, the maternity hospital, and the morgue, with a mortuary chapel. A little farther away in a triangular park are the veterinary hospital, the veterinary school, a hospital for dogs, and the school of biology (faculty of natural sciences). Finally, there is in course of construction an immense building, which will receive the name of the Wistar Institute of Anatomy and Biology.

"The school of medicine connected with this university is one of the oldest in the United States and one of the most important. Organized in 1765, it conferred its first diploma in 1768. Owing largely to the influence of Benjamin Franklin and William Smith, its early development was rapid. The course of study in this school is for three years only, but most of its professors are men of great distinction, and some of them, as, for instance, J. W. White, L. A. Duhring, J. Ashhurst, J. S. Billings, and J. Marshall, have a European reputation. The corps of teachers comprises 22 professors, 4 assistant professors, 1 demonstrator, 7 teachers, and 20 prosectors and instructors in anatomy. The dean, Mr. Marshall, still quite a young man, is only an assistant professor. The total number of students for the present scholastic year (1892-93) is 847, of whom 1 is French, 1 African, 1 Haitian, 1 Japanese, 2 Germans, and 2 natives of the West Indies. It was with great interest that I went through the laboratories of this university, especially the two for chemistry, each of which accommodates more than 200 pupils. The dissecting room, like that at the Woman's College, is in the top story, and is lighted by electricity and supplied with lavatories. I saw also the old museum of anatomy, which contains one or two curious specimens, and the museum of geology.

“School of dentistry.-I was much struck by the location of this department. One room is in the lower story of the chemical laboratory, and is reserved for clinic exercises and for operations by the pupils. This immense hall contains a succession of dentists' chairs, in which, at the time of my visit, were seated a large number of patients, upon whom the students were operating. This department is, moreover, much appreciated. It has 8 professors, 3 assistant professors, 9 instructors, and 17 demonstrators. The course of study is for three years. In the years 1892 and 1893 there were 153 pupils, of whom 72 were in the first year, 60 in the second, 17 in the third, and 17 more taking special studies. Among them were 1 French and 2 German pupils.

"The operating room is one of the largest I visited in the United States. It measures 140 feet long by 40 feet wide. It is lighted from all sides by large bay windows. Before each of these windows, where the light is very strong, is placed a Morrison chair and all the instruments necessary in dentistry. The mechanical laboratory has been supplied with all the modern appliances and with electric lights. In 1891-92 8,536 persons were treated in the operating room. From this it will be seen that the patronage is large and the students active.

1 Since this article was written this school and many others have adopted courses of four years.