“It was the month of October when Graham arrived in this regular & beautiful city of Penn” (8, p.60). After arriving in Philadelphia, twenty-two year old William Alexander Graham found lodgings on Market Street where he and other medical students would board while studying medicine at one of the most prestigious schools in the country— the University of Pennsylvania. As a native Virginian, Graham had travelled approximately 520 miles from the comforts of the Shenandoah Valley in order to obtain a formal medical education. Unlike some of his peers, Graham had a basic knowledge in medicine. His first exposure to medicine, particularly apothecary, came in Lexington, Virginia where he worked with Dr. McClewer (8, p. 12).He also served as an apprentice to a rural physician, Dr. Johnston, in Abingdon, Virginia, 175 miles south of his home in Lexington (8, p. 21). Apprenticeships were the most common path to becoming a doctor in early colonial America, and even after Morgan and Shippen established the first medical school in the United States in 1765, an apprenticeship was the encouraged prerequisite (1, 2). As an apprentice, Graham observed physician-patient interactions, learned the importance of bones and structure, copied medical textbooks, and studied comparative anatomy and botany (8, p. 21-24). Yet for Graham, this informal education was not enough for his ambition and determination to be the best physician: “he had in him a native spark of ambition, which was always stimulating him to some exertion” (8, p. 131). Thus, he became a school teacher in order to collect the necessary funds to travel to Philadelphia and become a better physician (8, p.14).
With its reputation and innovative techniques, many men in the 1800s opted to move to Philadelphia in order to study medicine. Philadelphia offered dissection opportunities, comprehensive anatomy lectures, and other medical courses from the leading physicians at the time. Moreover, learning surgery through observation at the surgical amphitheater was an experience available to those in Philadelphia. The Pennsylvania Hospital was the first to build a surgical amphitheater for the purpose of student and public observation (3). Besides quality lectures, the medical students had access to clinical experiences during their medical education in Philadelphia. Many students took advantage of hands-on experiences and multiple cadaver dissections during the summer months (1). Furthermore, students enriched their medical education by actually treating patients in the hospitals, clinics, and the Almshouse (4). In fact, eight medical students paid for the privilege of serving as physicians to the Almshouse which cared for chronically ill, dying, and impoverished patients (4). Graham may have been one of those eight students, since “after the lectures were over his time was principally occupied in attending the practice in the Alms-House and Hospital” (8, p. 121).
Not only did the University of Pennsylvania provide Graham with well-prepared lectures on anatomy, midwifery, chemical experimentation, and patient care, but it also provided him with the opportunity to attend lectures and cutting-edge surgeries performed by the famous Dr. Physick in the surgical amphitheater. When describing Dr. Physick, Graham states that Dr. Physick “never open[ed] his lips without uttering something which may be of practical utility,” and because of Dr Physick’s popularity, Graham soon learned that obtaining a ticket to attend such lectures was a lesson in itself (8, p. 61). Dr. Physick strived to teach his students both quality medicine and professionalism (7). He emphasized the importance of time and precision in all aspects of his life. Thus, he did not miss the opportunity to instruct Graham on tardiness when Graham tried to purchase a ticket to one of Dr. Physick’s surgeries: “Looking at his watch, ‘my dear Sir you are precisely ten minutes too late; we are obliged to learn the value of time here…’” (8, p. 61). Through interactions with Dr. Physick and other lessons learned from his Philadelphia education and previous apprenticeship, Graham was able to learn how to interact with people and patients. These interactions shaped his future medical practice and experiences.
Medical students of the 1800s went to Philadelphia for more than just receiving the best medical education and clinical experiences offered in the United States. Philadelphia offered students an accepting atmosphere and the chance to obtain social clout that otherwise would have been denied to many men if they had remained at home to study medicine (6). Attending Philadelphia medical school allowed ambitious men to not only obtain a MD, but also to become a gentleman. While in Philadelphia, many medical students attended social events in order to enjoy and increase their societal rank. Graham particularly took pleasure in attending Shakespeare plays at the local theater whenever the chance presented itself (8, p. 68-83). As Graham and other medical students learned, their social standing was critical to their future success. Thus, being cultured was a particularly valued aspect of Philadelphian society (6). The social opportunities resulted in an increasing number of students, particularly southern students, enrolling at the Philadelphia Medical School each year (6). Though feelings of attachment to home were strong for many students, they were willing to make a sacrifice in order to attend Philadelphia. They were confident that opportunities and experiences in Philadelphia were unparallel to any other city and medical institute. John Dabney states, “‘I must sacrifice my inclination to my interest…as I shall have a much greater opportunity here for acquiring information than I could have in Virginia.’” (6). Not even through an apprenticeship could young men experience everything that Philadelphia offered its medical students.
Though hospital and clinical experiences in Philadelphia were outstanding for medical students, many critics expressed concern that acquiring a medical education away from home was deleterious to a physician. These critics argued that lessons learned in an urban setting at the advanced facilities of Pennsylvania Hospital could not be applied to the practice of medicine in a rural setting. They believed that treatments taught by Philadelphia physicians were contingent upon environmental factors that did not apply to other parts of the country (6). As a result, Philadelphia educated doctors were forced to learn medicine as they went rather than have applicable clinical experience obtained from an apprenticeship with a rural physician (6). In support of these critics, some professors even acknowledged the discrepancy between Northern and Southern medicine. One New Orleans physician insisted that “[t]here is a distinction between Northern and Southern medicine as surely as there is a distinction between foreign and American medicine” (6). The professors of Graham, however, did not agree with this regional medicine argument. Dr. Chapman told Graham and his fellow students that “In whatever climate or under whatever circumstance you meet with a full strong and vigorous pulse, whether amid the snows of the polar region, or under the scorching rays of the tropics: there the lancet is called for in language loud and unequivocal! This is the flag which nature holds out for success…” (8, p. 100).
Counter to the regional medicine argument, Graham’s Philadelphia education enhanced his medical practice by providing him hands on clinical experiences and unique surgical observations. Moreover, his clinical experiences and surgical observations helped him gain respect in his future medical practice rather than hamper his ability as a physician. For example, Dr. Clements, a rural physician, was willing to cut off the entire arm of a patient. Graham was able to draw on his time spent in the surgery amphitheater at the Pennsylvania Hospital to know that this surgery was unnecessary. Dr. Physick was adamant that his patients should not suffer unnecessarily, and this belief influenced his surgical decisions (7). Following Dr. Physick’s example, Graham was able to convince Dr. Clements as well as the patient that an amputation of only the finger would suffice as a treatment. He argued “that if it did not [work,] they could then resort to the other remedy” (8, p. 121). Thus, Graham used his Philadelphia education to develop a well-respected medical practice in Abington, Virginia.
William Alexander Graham was typical of many young and ambitious gentlemen in the early 1800s that desired to pursue a career in medicine. He left his home in Virginia and headed to Philadelphia in order to learn from the leading physicians at the time. With the establishment of University of Pennsylvania, medical education became more formalized. At medical school, students would “review anatomy through dissection, medicine and material medica through practice lectures, and surgery, medicine and midwifery by observing a variety of cases at a local hospital” (1). Experiencing all of these areas of medicine was nearly impossible through an apprenticeship (1). And as hospitals became more established and expanded their services, the opportunity for clinical experiences likewise increased. Philadelphia offered these young students not only a top of the line education, but also the chance to participate in clinical experiences prior to starting their own practice. In no other city could medical students observe specialized surgeries in a surgical amphitheatre on a daily basis or treat patients at the local Almshouse. The chance for medical students to treat patients did not become the common practice until the rise of teaching hospitals decades later (5). Finally, Philadelphia encouraged medical students to take an active role in their medical studies; thereby, helping to initiate a medical education reform that led to the current model of teaching hospitals. It is no wonder William Alexander Graham joined countless other determined young men in Philadelphia to learn medicine.
By: Heather Deisher
- Kaufman, Martin. American Medical Education. In The Education of American Physicians. Cal Press, 1980. pp 7-28.
- History of Pennsylvania Hospital: Historical Timeline. http://www.uphs.upenn.edu/paharc/timeline/ (accessed 5/14/12). Part of Penn Medicine.
- Surgical Amphitheatre. http://www.uphs.upenn.edu/paharc/tour/tour5.html (accessed 5/14/12). History of Pennsylvania Hospital: Virtual Tour. Part of Penn Medicine.
- Barlow, William; Powell, David. A Dedicated Medical Student: Solomon Mordecai, 1819-1822. Journal of the Early Republic. 1987, 7.4, 377-397.
- Cassedy, James H. Medicine in America: A Short History. The Johns Hopkins University Press: Baltimore, 1991.
- Kilbride, Daniel. Southern Medical Students in Philadelphia, 1800-1861: Science and Sociability in the “Republic of Medicine.” The Journal of Southern History. 1999, 65.4, 697-732.
- Simpson, Henry. The Lives of the Eminent Philadelphians, Now Deceased. William Brotherhead: Philadelphia, 1859.
- William Alexander Graham, “A Narrative  of Graham’s Journeys, Medical Training and Career 1816-1819 in Lexington, Va., Abingdon, Va., and Philadelphia,” Washington and Lee University Library, Special Collections.