withhold his vote. 2. To avail himself of either of the above Rules 8
and 9.
"Article 17. Change of By-Laws. No clause of these By-Laws shall
556 HARVARD MEDICAL SCHOOL
be altered or suspended, except at a meeting succeeding that on which
notice of such proposed suspension or alteration has been announced.
Article iS. All By-Laws or Regulations previously existing inconsist-
ent with this Code are hereby annulled.
"Passed 20th May, 1868. " Geo - C Shattuck. Dean."
The committee" appointed to consider the need of new
building for the Medical School reported in December, 1866.
Their report relates in detail the shortcomings of the exist-
ing site on account of the unwillingness of the Parkman heirs
to sell land adjoining the school building. The advisability
of applying to the Legislature for a lot of land near the
Technology Institute seemed to meet the views of a majority
of the Faculty. Finally, a committee consisting of H. J.
Bigelow, Holmes, and Shattuck was appointed to raise funds.
Some idea of the necessity for this building on a new site
can be seen from the fact that the capacity of the surgical
lecture room was 263, and the medical lecture room 384, in-
cluding the additional seats lately placed in the clinical room.
The attendance at the School was 216 in 1865; 301 in 1866;
386 in 1867; 308 in 1868; and 306 in 1869. The fees
were: Matriculation $5. For a whole year's instruction
$200; for a winter term $120; for a spring term and sum-
mer term $100; graduation $20; Dissecting Room $5.
The winter term extended from the first Wednesday in
November for seventeen weeks. Then there was a recess of
ten days, during which were held examinations for the De-
gree, and a Commencement for conferring Degrees. Instruc-
tion was then resumed, and was continued till the middle of
July, at which time there was a vacation of eight weeks, dur-
ing which there were hospital visits. Recitations were then
resumed, and continued until November first. A second ex-
amination for the Degree was held in July, in time for the
College Commencement.
* Clarke, Bowditch. and White.
MEN AND MANNERS 557
The establishment of a Dental School in connection with
the University was advocated by the Medical Faculty as early
as 1867. This request was granted by the Corporation July
17, 1867, when it was voted to establish a Dental School in
the University. The relationship of these two Schools of
Medicine and Dentistry will be considered later.
A new era was about to begin both at the College and
at the Medical School, — an era compared with which, for
growth, prosperity, and advancement, all previous periods
were insignificant. Coming events had been foreshadowed
in the report of President Hill for the year 1862-63. He
said :
" Our country produces men of as fine natural talent for every depart-
ment of learning and science as can be found among any people. But
that talent almost never attains any high degree of culture, without being
transplanted to Europe for a few years. It is now time that we should
begin to develop among ourselves the learning and science which we dif-
fuse among our people and apply to the arts of life. It is time that we
should have in our country at least one institution thoroughly organized
and amply endowed, at which it may be a principal aim to carry those
students who have the highest taients to the highest degree of cultu.e;
and also through its teachers, its pupils and graduates, to extend the
domain cf science and increase the fruits of learning. The most able of
our young graduates, and (he most studious of our younger instructors,
now feel compelled to go in person to the universities of Europe for the
learning and science which they expound, or which they are to apply to
practice hereafter. This dependency upon the older countries was honor-
able and beneficial in our childhood, but becomes disgraceful and injurious
in our manhood."
President Hill resigned on September 30, 1868, and the
College remained without a president until the election of
Charles W. Eliot, May 19, 1869. The report of the acting
president* for this year refers to the Medical School thus :
' The school has never occupied a higher position absolutely or rela-
tively than at this moment. But its extended reputation is in its present
* Andrew Preston Peabody.
558 HARVARD MEDICAL SCHOOL
condition, a source of embarrassment ; for its classes are outgrowing the
capacity of the lecture rooms, which have already been twice enlarged.
There are no proper laboratories for scientific and practical study and it
is impossible either to construct such apparatus within the present walls,
or to obtain additional land in the immediate vacinity for their extension."
We have now brought the history of the Medical School
from its modest beginnings down to the point where that insti-
tution was represented by a substantial structure requiring the
active cooperation of more than twenty teachers for its three
hundred or more students. The widely agitated question of
reform in medical education, already too long deferred, was
becoming increasingly urgent. Harvard would make the trial.
With a wise and fearless leader success might be expected.
While there were honest misgivings among many within his
own council, against the opposition of conservatism, and with
no precedent to guide him. President Eliot won the tentative
support of a bare majority of the Faculty. In the Faculty the
President was fortunate in having a Dean willing to cooperate
with him. Together with President Eliot, Calvin Ellis de-
serves a large share of credit for the reformation of medical
teaching in this country, begun at the Harvard Medical School
in 1870.
In the remaining chapters of our story, men and things
will be viewed in a perspective different from that followed
in the previous pages. Even in a history, it is difficult
to deal impartially with the living. If in his endeavor to
tell fairly the story of the Harvard School the writer should
seem to be over critical at times, it will be only because
he is striving for the frank narration of facts. He is never
forgetful of the laborious and faithful lives of Harvard's
great medical teachers, living and dead. While the Harvard
School flourishes, let us believe the names of Cheever, White,
H. P. Bowditch, C. J. Blake, Draper, C. B. Porter, Williams,
J. O. Green, J. Collins Warren, Fitz, Dwight, Putnam, Baker,
Knight, Wadsworth. Fdes, Wood, F. C. Shattuck, Bradford,
MEN AND MANNERS 559
Rotch, Minot, Councilman, W. L. Richardson, M. H. Rich-
ardson, Burrell, Ernst and Smith (I mention full professors
only) will be as intimately associated with the history of her
Medical School as are those of John Warren, John C. Warren,
W r aterhouse, Dexter, Jackson, Ware, Bigelow, Gorham, Hay-
ward, Holmes, Wyman, Ellis, Storer, Channing, Clarke, Rey-
nolds, Buckingham and Bacon.
So let us pass on (in volume III) to the tale of events
which gives the generation of living men a claim to our grate-
ful recognition.
APPENDIX, CHAPTER XXII.
JACKSON FUND.
" Original terms of Subscription to the Jackson Fund.
" Upon a representation that the Medical Faculty of Harvard University
have incurred a debt or are under a liability to pay to that Corporation
an amount of money about $16,000 which was necessarily expended upon
the building in Grove St. in the city of Boston which is used by said
Faculty for the delivery of their Lectures to Medical Students — that the
members of said Faculty have for a long time past devoted and yet apply
their time, learning and skill to the advancement of the department of
science in said College almost gratuitously for the establishment of a
Medical School, which if it does not surpass, should at least equal similar
institutions of other colleges in the United States, and offer as strong
inducements to students seeking instruction.
" We the Subscribers agree to pay to the Medical Faculty, or to a
commiltee appointed by that body, the several sums of money set against
our respective names to relieve said Faculty or its members from the
pecuniary and professional burdens they are under for the erection and
maintenance of said School to this time, and to provide in part the means
of preserving the said building in a proper state of repair, and of defray-
ing such current expenses and of furnishing such equipment as shall be
requisite to place said School in the most favorable condition.
"We however stipulate as the conditions upon which we give this aid —
" 1st. That said obligations incurred by the members of the Faculty
shall be satisfied and cancelled.
"2. That any balance remaining shall be invested at interest, cither
with the funds of the Corporation of Harvard College by the Treasurer
560 HARVARD MEDICAL SCHOOL
or in such other manner as the Medical Faculty hy a vote of a majority
shall decide to be more expedient.
" 3. That the income and produce of the sums so invested shall from
time to time as it is received be subject to and be paid upon the order
of said Faculty.
'' 4. That said Faculty for the time being, shall with fidelity apply such
income to the support of said School and use their best endeavors to
prevent its diversion to any other purpose or object.
" Wm. Sturgis $5000.
*' Jno. P. dishing by Wm. Sturgis Atty 5000.
" Thomas Lee 5000.
" Jonathan Phillips 5000.
" Nathl Thayer 5000.
" Robert M. Mason for S E. Mason 2500.
" N. I. Bowditch for Miss Bowditch 2500.
" Josiah Quincy 500.
" Mary Pratt 1000.
" H. H. Hunnewell 500.
" Moses Williams 500.
" Mary Wigglesworth 500.
"John T. Heard (D. H. Storer) 100.
" Henry Cabot (O. W. Holmes) 100.
"Henry Lee " " " 100.
"Gardner Brewer " " " 100."
(The original manuscript is deposited with the Treasurer of Harvard
College.)
PARKMAN DONATION.
1846. Extract from letter of Medical Faculty to Corporation, Feb. 22, 1846.
" Through the liberality of Dr. George Parkman, the Faculty have
received the offer of a donation of a lot of land, principally flats measuring
100 feet by 60, with provision for light and air, situated near the north
end of Grove Street and fronting the estate of the Massachusetts General
Hospital, to be appropriated for the site of a new Medical College. The
Faculty are of opinion, that if the donation be accepted by the Corpora-
tion and the estate belonging to the Corporation in Mason Street, be sold,
the balance of money necessary to complete the new building might be
provided for without expense to the University."
1847.
" Subscriptions for new building — (North Grove Street) :
" Nathaniel Appleton 100
" Samuel Appleton 500
" William Appleton 500
" Martin Bremmer 100
MEN AND MANNERS 561
" Francis C. Gray 200
"John C. Gray 100
" Abbott Lawrence 500
" William Lawrence 100
" Thomas Lee 100
" Francis C. Lowell 100
' John A. Lowell 500
" Charles Lyman ioo
" Thomas H. Perkins 500
" David Sears 500
" George C. Shattuck 500
" Thomas A. Wales 200
" $4600 "
CLINICAL ADVANTAGES AT HARVARD.
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CLINICAL ADVANTAGES AT HARVARD 565
CHAPTER XXIII.
CLINICAL ADVANTAGES AT HARVARD.
Harvard has never owned and properly controlled a hospital.
That has always been a regret, and at times a disadvantage.
The disadvantage has been twofold. First, there is the well
recognized necessity which all medical schools feel for clin-
ical facilities. This necessity was early recognized by the
government of Harvard College, when in 1784 they peti-
tioned the Overseers of the Poor of Boston to> allow the med-
ical teachers to care for the sick in the Boston Alms House.
From the time (1810) when this request was granted down
to the present, the Medical School has never wanted for clin-
ical material. There is a second phase of the question; as
one follows the development of the school, — and this holds
true of the other medical schools in this country with two or
three notable exceptions, — one is impressed with the fact that
vacancies in clinical professorships and lectureships are filled
from the ranks of those who have succeeded in obtaining hos-
pital, dispensary and asylum appointments. Those institutions
are managed by independent trustees, often by boards without
a single representative of the medical profession. They select
their staffs without regard to the teaching abilities of the can-
di dates. It is undoubtedly true that many boards of trustees
are willing tc cooperate with the faculties of medical schools to
improve the standard of medical instruction ; but such coopera-
tion carries with it no rights for the teachers. Mostly, they
teach and lead about their students on sufferance. So the field
of selection of teachers for the medical schools is restricted,
and university governors cannot reward suitably their teachers
566 HARVARD MEDICAL SCHOOL
with proper clinical facilities, nor can they appoint instructors,
however able as teachers, who do not hold hospital positions.
Harvard has suffered from this. She has often secured
great teachers, but her progress has been in spite of the sys-
tem pursued in selecting them, and not as a result of the
system. Within a few years, visions of better things have
become clear, and today she is within sight of the goal of
her long deferred hope. Harvard's transition from the Col-
lege School to the Medical University seems almost complete,
and we hope that one of the pillars of strength in the new.
scheme will be a University Hospital.
Let us leave the consideration of that for later chapters,
and here pay some regard to the means which, through nearly
one hundred years, have been employed with some measure
of success.
At the opening of the nineteenth century the only hospitals
in Boston were the Alms House and the Dispensary. Both
of these were in the hands of the teaching corps of the Medi-
cal School. But the classes of medical students were grow-
ing, and Philadelphia and New York were offering clinical
advantages far in excess of those available in Boston. James
Jackson, John C. Warren, and Gorham were three examples
of Boston medical students who had been obliged to seek
hospital experience in Europe. So a practical, business-like
question was before the medical teachers : either Harvard must
procure hospital facilities for her students, or the students
would seek clinical experience under private tutors, or at
some better equipped school. Jackson and Warren acted.
They sent the following circular letter broadcast, asking aid
for the establishment of a hospital to meet the requirements
of the case. Grateful as every student of the Harvard Med-
ical School must be for the privileges and benefits of the great
hospital that resulted from that letter, it has always been a
source of regret that the hospital was not made an integral
CLINICAL ADVANTAGES AT HARVARD 567
part of Harvard University. Here is the appeal which has
been appropriately called the "Corner-stone of the Massachu-
setts General Hospital" :
" Boston, August 20, 1810.
" Sir, — It has appeared very desirable to a number of respectable gen-
tlemen, that a hospital for the reception of lunatics and other sick persons
should be established in this town. By the appointment of a number of
these gentlemen, we are directed to adopt such methods as shall appear
best calculated to promote such an establishment. We therefore beg
leave to submit for your consideration proposals for the institution of a
hospital, and to state to you some of the reasons in favour of such an
establishment.
'" It is necessary to urge the propriety and even obligation of succouring
the poor in sickness. The wealthy inhabitants of the town of Boston have
always evinced that they consider themselves as ' treasurers of God's
bounty ' ; and in Christian countries, in countries where Christianity is
practised, it must always be considered the first of duties to visit and to heal
the sick. When in distress, every man becomes our neighbor, not only if
he be of the household of faith, but even though his misfortunes have
been induced by transgressing the rules both of reason and religion. It is
unnecessary to urge the truth and importance of these sentiments to those
who are already in the habit of cherishing them, — to those who indulge
in the true luxery of wealth, the pleasures of charity. The questions which
first suggest themselves on this subject are, whether the relief afforded by
hospitals is better than can be given in any other way ; and whether there
are, in fact, so many poor among us as to require an establishment of
this sort.
" The relief to be afforded to the poor, in a country so rich as ours,
should perhaps be measured only by their necessities. We have, then,
to inquire into the situation of the poor in sickness, and to learn what are
their wants. In this inquiry, we shall be led to answer both the questions
above stated.
" There are some who are able to acquire a competence in health, and
to provide so far against any ordinary sickness as that they shall not
then be deprived of a comfortable habitation, nor of food for themselves
and their families; while they arc not able to defray the expenses of
medicine and medical assistance. Persons of this description never suffer
among us. The Dispensary gives relief to hundreds every year; and the
individuals who practise medicine gratuitously attend many more of this
description. But there are many others among the poor, who have, if we
may so express it, the form of the necessaries of life, without the sub-
stance. A man may have a lodging; but it is deficient in all those advan-
tages which are requisite to the sick. It is a garret or a cellar, without
568 HARVARD MEDICAL SCHOOL
light or due ventilation, or open to the storms of an inclement winter. In
this miserable habitation, he may obtain liberty to remain during an ill-
ness; but, if honest, he is harrassed with the idea of his accumulating rent,
which must be paid out of his future labours. In this wretched situation,
the sick man is destitute of all those common conveniences, without which
most of us would consider it impossible to live, even in health. Whole-
some food and sufficient fuel are wanting ; and his own sufferings are
aggravated by the cries of hungry children. Above all, he suffers from
the want of that first requisite in sickness, a kind and skillful nurse.
" But it may be said, that instances are rare among us, where a man.
who labours, with even moderate industry, when in health, endures such
privations in sickness as are here described. They are not, however, rare
among those who are not industrious ; and who, nevertheless, when labour-
ing under sickness, must be considered as having claims to assistance. In
cases of long-protracted disease, instances of such a description do occur
amongst those of the most industrious class. Such instances are still less
rare among those women who are either widowed, or worse than widowed.
It happens too frequently that modest and worthy women are united to
men who are profligate and intemperate, by whom they are left to endure
disease and poverty under the most aggravated forms. Among the chil-
dren of such families also, instances are not rare of real suffering in'
sickness. To all such as have been described, a hospital would supply
every thing which is needful, if not all they could wish. In a well-regu-
lated hospital, they would find a comfortable lodging in a duly attempered
atmosphere; would receive the food best suited to their various conditions;
and would be attended by kind and discrete nurses, under the directions of
a physician. In such a situation, the poor man's chance for relief would
be equal perhaps to that of the most affluent, when affected by the same
disease.
' There are other persons, also, who are of great importance in society,
to whom the relief afforded by a hospital is exceedingly appropriate. Such
are generally those of good and industrious habits, who are affected with
sickness, just as they are entering into active life, and who have not had
time to provide for this calamity. Cases of this sort are frequently occur-
ring. Disease is often produced by the very anxiety and exertions which
belong to this period of life ; and the best are most liable to suffer. Of
such a description, cases are often seen among journeymen mechanics and
among servants.
" Journeymen mechanics commonly live in small boarding-houses, where
they have accommodations which are sufficient, but nothing more than
sufficient, in health. When sick, they are necessarily placed in small,
confined apartments, or in rooms crowded with their fellow-workmen.
They are sheltered from the weather, and have food of some sort ; and
these must, in many c?ses, be the extent of their accommodations. Per-
CLINICAL ADVANTAGES AT HARVARD 569
sons of this description would do well to enter a hospital, even if they
had to pay the expense of their own maintenance. In most cases, they
would suffer less, and recover sooner, by so doing. When, as sometimes
happens, they have not the means of payment, they become objects of
charity ; and the welfare of such persons should be considered among the
strong motives in favour of establishing a hospital.
" Servants generally undergo great inconveniences, at least when afflicted
with sickness, and oftentimes much more than inconveniences. With so
much difficulty is the care of them attended in private families, that many
gentlemen would pay the board of their servants at a hospital, in prefer-
ence to having them sick in their own houses. In some cases, however,
neither the master nor servant can afford the expense of proper care in
sickness. Not uncommonly, a young girl is taken sick in a large family,
where she is the only servant. She lodges in the most remote corner of
the house, in a room without a fireplace. The mistress is sufficiently
occupied with the unusual labours which are thrown on her at a time
perhaps when she is least fitted to perform them. Under such circum-
stances, how can the servant receive those attentions which are due to the
sick? Of what use is it that the physician leaves a prescription to be put
up at the Dispensary? He goes the next day, and finds that there has
not been time even to procure the remedies which he had ordered ; mean-
while, the period in which they would have been useful has passed by, and
the incipient disease of yesterday has now become confirmed.
" Persons of these descriptions would not be disposed to resort to a
hospital on every trivial occasion. But, when afflicted with serious indis-
position, they would find in such an institution an alleviation of their
sufferings, which it must gladden the heart of the most frigid to con-
template.
" There is one class of sufferers who peculiarly claim all that benevo-
lence can bestow, and for whom a hospital is most especially required.
The virtuous and industrious are liable to become objects of public charity,
in consequence of disease of the mind. When those who are unfortunate
in this respect are left without proper care, a calamity, which might have
been transient, is prolonged through life. The number of such persons,
who are rendered unable to provide for themselves, is probably greater
than the public imagine; and, of these, a large proportion claim the assist-
ance of the affluent. The expense which is attached to the care of the
insane in private families is extremely great ; and such as to ruin a whole
family that is possessed of a competancc under ordinary circumstances,
when called upon to support one of its members in this situation. Even
those who can pay the necessary expenses would perhaps find an institu-
tion, such as is proposed, the best situation in which they could place their
unfortunate friends. It is worthy of the opulent men of this town, and
consistent with their general character, to provide an asylum for the insane
570 HARVARD MEDICAL SCHOOL
from every part of the Commonwealth. But if funds are raised for the
purpose proposed, it is probable that the Legislature will grant some assist-
ance, with a view to such an extension of its benefits.
" Of another class, whose necessities would be removed by the establish-
ment of a hospital, are women who are unable to provide for their own
welfare and safety in one of nature's most trying hours. Houses for
lying-in women have been found extremely useful in the large cities of
Europe ; and, although abuses may have arisen in consequence, these are