Preparation for medical school

After William Alexander Graham returned home from his trip to Kanahawa, he faced the decision of deciding what his future career was going to be. Graham’s father had practiced as a lawyer in Kanawha, but once he moved to Lexington, he taught astronomy and chemistry at Washington College.  In considering a future profession, Graham’s “mind vibrated between law and medicine” as a career (p.11). He ultimately chose to become a doctor because he suffered from “Pulmonary Consumption” and felt he should avoid “engaging a profession requiring any great exertion of the chest” which a lawyer might endure in courtroom arguments. After “deliberating and consulting for some time”, he convinced himself that becoming a physician was the right path from him to take, and thus, his future was set.

There were no official entrance requirements for medical school until the late nineteenth century.  In Graham’s day, students were only expected to have the ability to pay the fees and express a desire to learn and have some preliminary education by means of an apprenticeship (4).  Students were often notified of upcoming classes in local newspapers and if they were interested, they could attend the lectures without any application process more complicated than paying the fees(6).   

As in European medical schools, students were expected to earn a liberal arts education before applying to medical school (7).  The academic challenges of medical school were not unknown to aspiring physicians. For instance, Solomon Mordecai of Petersburg, Virginia,  was aware that medical school would require him to be “latined” and educated in both the classics and sciences, and so he prepared himself by learning these subjects at the Warrenton Male Academy. He then studied under Dr. Nelson as an apprentice before continuing to Philadelphia to study medicine(9).

Like Solomon Mordecai, Graham was aware that he would need a pre-medical education before going to Philadelphia and enough money to pay for the lectures.  His education at Washington College supplied him with a foundation good enough to teach “the Latin Languages and the sciences,” although he described his knowledge of classic literature as something he had “very imperfectly studied during his colligate course” (p.20).

For an apprenticeship before medical school, Graham studied under Dr. Robert McClewer, a Lexington-based physician married to a cousin of Graham. He was permitted to use Dr. McClewer’s books and supplies, in exchange for which he would look after the Apothecary and serve as a partner (p.12). Graham had a well-rounded apprenticeship with Dr. McClewer, making pills, preparing medications, and performing minor medical procedures like bloodletting and purging. Graham found this experience “dull and irksome to him in the highest degree” but he refused to give up or “utter one syllable of dissatisfaction at the choice he had made” to be a doctor (p.13). This experience allowed Graham to observe McClewer’s work and helped him to understand more of the medical field.  Even though Graham conveyed a certain displeasure toward Dr. McClewer he recognized that the doctor had a “generous kindness and the warmest friendship” while giving Graham some first-hand experience in medicine, botany, and apothecary arts (p.14).

But Graham felt that he was not learning the scientific premises in medicine.  “All the subjects which he attempted to understand in the science—were like the faint and indistinct shadows of surrounding objects in a dark and gloomy night, no bright way of science to illumine them.”  In addition, his father’s salary at the small college meant that he had to worry about being able to afford the fees for medical school.  And so, he decided that a change was in order. Graham’s solution in order to “acquire the means of defraying the expenses necessary, in attending a course of medical lectures in Philadelphia” was to teach in Abingdon for pay (p14).

While teaching Latin and science in Abingdon, Graham took  up another apprenticeship with Dr. John Johnston (p.19).   Graham long remembered the “enthusiasm he felt when rambling over the river hills” while studying botany with Dr. Johnston every Saturday. They studied plants in great detail and learned how to recognize and name the trillium, bloodroot and Linnea borealis (p.22-23).

But the subject that had the greatest impact on him was anatomy.  First he studied Osteology, and “a skeleton was his constant companion, kept under his bed, which he might consult at any time” (p.22).  He learned in detail about the human body and spent much of his free time outside of teaching “investigating the structure of bones” (p.22).  Dr. Johnston also taught Graham through comparative anatomy by using the eyes, hearts, and lungs of farm animals.   This approach to teaching appealed to Graham and he “began to feel some interest in medicine as a science” as opposed to the deterrence of the subject he had felt while working with Dr. McClewer.

Graham’s internship with Dr. Johnston exceeded the typical expectations for an apprenticeship. Most doctors suggested their students learn anatomy through textbooks (5) but Graham and Johnston brought their apprenticeship to an entirely new level and took part in a dissection of a human body.  The dissection was “viewed with more horror than the foulest murder” (p.25) by the residents of Abingdon. This reaction was due to the fact that the body was taken from a cemetery.  Both Graham and Johnston were consequently accused of having “invaded the sanctuary of the grave” and “disturbed the repose of the dead” (p.25).  Graham and his preceptor were asked to “come before [the] court of Washington County” to defend their actions (p.29). This case prevented Graham from teaching his lectures in Abingdon and so was threatened with being dismissed without pay (p.41-58).

While an apprenticeship was enough to prepare some people for a medical career, Graham chose to also attend a medical school.  By 1818, there were some ten medical institutions open – mainly in the northeast of America – that recruited the most esteemed professors and lecturers in the nation.  There was social and political pressure for southern students to study in medical institutions in the south, but there were clear advantages to attending a northern school.  Philadelphia boasted a high-quality education, a chance to mingle with the upper class, and a unique atmosphere.  It was there that Graham chose to complete his medical education.

By:  Laura Wiseman

References

  1. Graham, W.A. A Narrative of Graham’s Journeys, Medical Training and Career 1816-1819 in Lexington, Va., Abingdon, Va., and Philadelphia. Washington and Lee Library, Special Collections: Lexington, 1827; pp. 11-12.
  2. Kilbride, D. Southern Students in Philadelphia, 1800-1861: Science and Sociability in the “Republic of Medicine”; The Journal of Southern History: Houston, 1999; Vol.65, pp. 697-700.
  3. Upstate Medical University Health Sciences Library: The Earliest North American Medical Schools: Chronological List of Founding Dates. http://upstate.edu/library/history/research/medschoolfoundingdates.php (accessed May 14, 2012).
  4. Ludemerer, K.M. Learning to Heal: The Development of American Medical Education; Basic Books: New York, 1985; pp. 113-115
  5. Kaufman, M. American Medical Education: The Formative Years, 1765-1910; Greenwood Press: Westport, 1976; pp7-8.
  6. Poulson, Z. Poulson’s American Daily Advertiser, Philadelphia, Sept. 3, 1818.
  7. Bonner, T.N. Becoming a Physician: Medical Education in Britain, France, Germany, and the United States, 1750-1945; 2nd ed.; The Johns Hopkins University Press: Baltimore, 2000; pp. 35-36.
  8. Ludemerer, K.M. Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care; Oxford University Press: Oxford, 1999; pp. 403-404.
  9. Barlow, B.; Powell, D.O. A Dedicated Medical Student: Solomon Mordecai, 1819-1822; University of Pennsylvania Press: Philadelphia, 1987; pp. 377-381.
  10. Freidman, M.S. The Inflation Calculator. http://www.westegg.com/inflation/ (accessed May 16, 2012).

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