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The most gruesome diploma in history was issued in 1782. It read:
"These may certify that Israel Keith Esq, has diligently attended an entire course of my Anatomical Lectures & Demonstrations; together with Physiological & Surgical disertations at the dissecting Theatre in the American Hospital, Boston: whereby he has had an opportunity of acquiring an accurate knowledge in the structure of the human body. John Warren, M.D. March 28, 1872."
At the top of the medical certificate was a likeness of the balding, bearded Dr. Warren. At either side was a grotesque dangling skeleton. At the bottom was a drawing of a surgeon, performing some sort of abdominal dissection upon a corpse with instruments faintly similar to oyster knives. The slashed end of a hemp rope dangled from the edge of the table. The other end of the rope was still fastened in a noose about the corpse's neck.
This was the first diploma awarded by the man who had sold the Boston Medical Society on the idea of anatomical dissection as a practical teaching method. Warren became the first professor of the Harvard Medical School the following year.
Respectability of diplomas has not been the only change down through 166 years of the Medical School's constantly expanding and sometimes turbulent existence. The school is now larger, its staff is more experienced, its equipment is of higher quality, and its problems more numerous than ever.
The present physical plant of Harvard Medical looks like M.I.T. set up on a small hill. Heavy Greek architecture and columns feature the massive, U-shaped external view. In the center is the Administration Building, Building A, which houses the Dean's Offices of the Medical School and the School of Dental Medicine, the Alumni Office, the Office of Graduate Courses, the Business Office, the joint library of the Medical School and the School of Public Health, and the Warren Museum, which has, among other displays, large tanks full of specimens of human hands.
The joint library is on the second floor, and contains nearly 100,000 volumes, plus 205,000 pamphlets and 900 periodicals. The 4000-volumes, 1500-pamphlet School of Dental Medicine library is further down Longwood Avenue. In addition, the other buildings hold well-stocked departmental libraries.
The remaining buildings are denoted merely by letter. Building B holds the Department of Anatomy, Histology, and Embryology. Opposite is Building C, containing the Departments of Physiology, Physical Chemistry, Biochemistry, and Experimental Surgery. Building D is occupied by the Departments of Bacteriology, Biophysics, Pathology, Preventive Medicine, and the laboratories of the Department of Medicine (internal). Finally, Building E houses Pharmacology, Legal Medicine, and Comparative Pathology and Tropical Medicine. The vast, almost monastic interiors of the buildings smell like a cross between a hospital and a chemistry laboratory--essentially what they are.
But as impressive as their own physical plant is, its administration is even more proud of the extent of the Medical School's hospital affiliation.
The very essence of the teaching method in the Medical School is clinical diagnosis. The student spends his first-year-and-a-half on normal required courses at the School. But the last two-and-a-half years he puts more and more of his time into working in hospitals in the clinical facilities at the School's disposal.
During this period the student is graded largely on his hospital and diagnosis efficiency. He works as part of the hospital team. The work he does and the diagnosis he makes are carefully checked by someone over him, who is checked in turn.
Although this is certainly not an unusual method of medical instruction, Harvard Medical students have an almost unrivalled opportunity to secure a well-organized clinical experience and knowledge of disease. A large number of cases in four major hospitals are available for student work--Massachusetts General, Boston City, Peter Bent Brigham, and Beth Israel. In addition, cases are used for teaching in nine specialist hospitals.
An active service is maintained to aid graduates in securing suitable hospital appointments as interns. These affiliated hospitals make about 100 such appointments each year.
These affiliations and appointments are two of the most desirable aspects of the Medical School, and a primary reason why it has to turn down nine out of every ten applicants. Harvard College annually gains the highest number of admissions, averaging between 30 and 40. The remainder are scattered about the country, although the Medical School seems to be following the unintentional College trend of taking a higher and higher percentage from the New England area.
The Committee on Admissions is conscious of the fact that many men who apply to a medical school are interest primarily in the money, or have been brow-beaten into the profession by socially-conscious parents.
While they must be consciously on the watch for applicants not interested in medicine per se, members of the committee admit that many a brow-beaten or financially-minded youth has, in four years, developed a fanatic devotion to the profession. At the same time, they state from experience that quite often it is not the most brilliant college men who do the best work in the School.
The students themselves have about as desirable living conditions as those of any school or graduate school in the country. About 325 of the 544 men live across the street from the School in the comfortable Vanderbilt Hall, donated by Harold Vanderbilt '07. The 800 faculty members and 31 women students have to provide their own quarters.
The Administration is currently seeking two objectives:
(1) To make the hall crystallize as the center of the students' social lives, and (2) to make these distant relatives of the Cantabridgians feel more a part of the University. In pursuance of the latter objective, Provost Buck and President Conant have often been invited to address the student body. And a surprising number of men travel into Cambridge on fall weekends to cheer for the College football team.
For the former objective, the administration encourages the social fraternities, which include about half of the students (but almost everyone is invited to join), dances and parties at Vanderbilt, and informal athletics. The only formal athletic group is a Class C squash team that almost always loses.
Vanderbilt has a few double rooms, but most of the men live in singles. Parietal rules are not strenuous (1 a.m. permissions on weekends) and parties become almost as raucous as College ones. In fact, there is far more of a collegiate spirit and air about Vanderbilt than would be expected of a home of sober young medical men.
Despite popular opinion, most Medical School men do not think that they work very hard. Class attendance is not compulsory, but nearness to the lecture halls makes it relatively habitual. No grades are given until after the National Board exams after graduation, and a very small fraction of men is ever informed that its work is unsatisfactory. Time and duration of work in laboratories is left more or less to the disgression of the individual.
Students have ample time for social life. Many are married, and some go with feminine acquaintances of long standing. Some take out nurses, and many invade local colleges for women--with Wellesley the general favorite.
While the men take their courses and careers seriously, ther is a certain amount of joking connected with the medical profession which grows more perverted with each succeeding year of study. In anatomy classes the cadavers--one to each four men--are sometimes tagged with pet names and often are fondly discussed in the midst of an otherwise normal social conversation. A favorite name for a corpse is "Ernest," so that a student can inform his friends that he is "working in dead Ernest."
While the students' sense of humor is easing their minor struggle through one of the nation's finest professional educations, the administration has done little joking in the past few years.
Since the last war, almost all of the nation's 77 accredited medical schools have been facing a financial crisis. The cost of educating a man at Harvard Medical is figured at roughly three times the relatively large amount ($800) tuition he pays for that education.
Obviously, however, Harvard would never let its Medical School get too far into financial trouble, and the school faces rather another problem--that of keeping up the highest standards of education while trying to do its part in meeting the annual need for more and more doctors.
The men with the problems in their laps are a Princeton man, Dr. George P. Berry, Dean of the Medical School since 1949, and Dr. Reginald Fitz '05, assistant dean of the Faculty of Medicine.
Dr. Berry is a firm believer that the medical student needs to take a long-range view of the patient, in which he is seen in relation to his family, the community, and his share of the tax dollar. Of current attempts to increase medical services in the U. S., he has pointed out that there is no great need to build hospitals if there is an inadequate production of properly trained doctors.
In this Dr. Berry echoes the sentiments of the Association of American Medical Colleges, of which he is currently president elect. There has been a three-cornered battle waged in recent years over aid to medical schools and their students between the A.A.M.C., the American Medical Association, and the Federal Security Administration.
So far the AMA has swept the early rounds. Early this year, when President Truman found his omnibus health bill blocked by the AMA lobby (financially the nation's strongest), he attempted to push through a bill giving scholarships to students of medicine and aid to their schools.
A.A.M.C. found only a few things wrong with the Truman plan. It objected to the originally presented "indenture clause", (that the holders of federal scholarships be obliged to serve for a period of time after their graduation in a government agency or in a shortage are designated by the government). Most of the A.A.M.C. also did not press to increase enrollments but thought that government aid should be extended to these students already in medical schools.
The A.M.A., however, opposed the whole bill as "the first step toward the nationalization of the medical profession." In Washington the A.M.A.'s voice was the loudest. The bill died in the House.
While admitting that the bill may rise again, Dr. Fitz believes that debating about it at present is somewhat on the order of heating a dead horse--or at least a horse that is completely anesthetized for some time.
As concerned as Dr. Berry with what seems to be an imminent doctor shortage, Dr. Fitz has disclosed that the Faculty of Medicine is now actually considering the possibility of expansion, presumably to allow an increase in enrollment (technically the school can admit only 110 students annually at present).
As yet in the talking stage, specific details for expansion are a meet point. Where the money would come from is a very mute point. "The U.S. Public Health Service is crying for more doctors," Dr. Fitz points out, "but we must not expand and lose quality."
In the present crisis, as throughout the history of the profession in America, other institutions look to Harvard Medical for leadership. The School has stood first in the ranks of medical progress for more than a century and a half.
From its comparatively humble beginning to its present grandeur and ideal situation, the school has occupied three sites; and has offered the best in educational facilities from the earliest practical training in "Midwifery" to the latest clinical practice methods in Psychoanalysis.
The first three Medical School professors (Anatomy and Surgery, Theory and Practice of Physic, and Chemistry and Materia Medica) did their teaching and demonstrating in the basement of Harvard Hall and Holden Chapel.
Adding the name and prestige of Harvard to Dr. Warren's methods of "practical demonstration" did not make everything as rosy and acceptable as might be expected. Among the problems to arise in the earlier days of the institution was the necessity for, and subsequent ban upon, body-snatching.
At first the professors themselves would wander the graveyard paths by stealth and by night to find specimens good enough to last out a term or a course. Later one professor wrote that the students themselves were becoming very helpful in digging up good subjects. But grave-robbing was obviously a crime, and mutilation of bodies was believed by many to be sacreligious. Harvard had to fight to keep her medical men out of trouble.
When finally in 1811 a state ban was put on the "illegal procurement" of human bodies, the School authorities were forced to look for a more agreeable solution. The one they eventually hit upon is the one used today--procurement, upon agreement, of the bodies of wards of state institutions.
In order to be close to whatever hospital facilities might develop in a large and growing city, the Medical School moved to Boston in 1810. It occupied several different buildings over a period of years, generally in the area of Boylston Street, between Arlington Street and Massachusetts Avenue. Although women were not admitted to the School until 1945, the controversy over coeducation in this institution started in the later years of the 19th century, but was squelched by the Corporation.
It Moves Again
In 1904, under President Charles William Eliot, another great expansion was prepared and plans were drawn up for the present buildings on Longwood Avenue at the head of Avenue Louis Pasteur. The cost of land, construction, furnishing, and providing a suitable endowment for the four laboratory buildings and one administration hall was estimated at $5,000,000. Money poured in generously, with large donations from John D. Rockefeller, J.P. Morgan, David Spears '74, Collis P. Huntington, and other individuals and groups.
In September 1906 the Medical School moved in.
In general, no one feels that the present School is number one in the nation or the world more strongly than a Harvard Medical student. As one man puts it, "We come here realizing that the School is very good. After we're here long enough we start to feel that this is the best."
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