University of Virginia Library

XXVIII. Professional Departments—Medicine

During many years following the close of the war between
the States, as we have seen, the medical school of
the University of Virginia was satisfied to restrict itself
to the methods of didactic teaching. The instructors,
outside the hall of the demonstrator of anatomy,
relied only on the lecture and text-book; and the
information thus acquired by the student during the
session was clarified and confirmed by written examinations
at its end. The reputation of the school rested
chiefly on the record made before army and navy boards,
whose touchstone of competence consisted alone of a
series of questions in writing. During that period, there
were no oral interrogatories, and no laboratory or hospital
tests.

By the beginning of the Ninth Period, 1904, a new
spirit had come to govern medical education everywhere.
Its influence was reflected (1) in the increase in the
amount of preparation required of prospective medical
students; (2) in the employment of the laboratory as a
method of imparting expert knowledge; and (3) in the
far greater prominence accorded to practical research.
For some years, this spirit had made little impression
upon the didactic system prevailing at the University of

Virginia, but, in time, it was strongly felt there also,
through the convictions of younger professors who had
been trained to more modern methods than their predecessors.
The earliest indications of this fact in practical
application were the use of out-patient clinics, the introduction
of classes in histology, embryology, bacteriology,
pathology, and clinical diagnosis, and the erection
of a hospital in part. The foremost upholders of these
new methods were Barringer, Christian, Dabney, Tuttle,
Flippin, and the younger Davis. The demonstrators of
anatomy, like the elder Davis and Towles, had, in their
department, long anticipated the coming revolution, and
in doing so, had won a reputation which extended far
beyond the precincts. But the teaching force and equipment
continued inadequate, and the University was, during
all this time, unable to meet all the needs of the situation.
Nevertheless, it had become imperative that the
institution should do so if it was to maintain a respectable
position in the profession. Instead of examining
boards being satisfied now, as formerly, to submit a series
of written questions, they called upon all applicants
to prove their knowledge to be practical; and this was
done by requiring them to answer oral questions or to
do test work in laboratory or hospital. It was
generally admitted that the deductive system by itself
left the student pitifully weak along practical lines.

When the Ninth Period began in 1904, the modern
aim of the department was only illustrated conspicuously,
though not exclusively, in those special branches
of work which we have enumerated, and which were all
too few as we have seen. Professor Barringer, in a
formal report to the President in 1904–05, said that
"there were but three strong points in favor of our
school of medicine: (1) its medical professors, removed

from the commercialism of city life, taught their subjects
like the professors of Latin, history, and so on; (2) the
faculty work is best done in an educational atmosphere,
—here we have it to perfection; (3) our hospital,
small as it is, is yet under our sole conduct, and close at
hand, and is usable to its full extent. Medicine is becoming
each year more of a science and less of an art.
While the art demands the clinical material of the city,
the science demands only the habits and spirits of investigation."

It was acknowledged, at this time, that the graduates
were particularly deficient in training in physical diagnosis,
in pathology, in clinical microscopy, and in materia
medical. The general need of reorganization along
more modern lines was fully grasped by the new President
very soon after his inauguration; and one of the
first great tasks which enlisted his attention was to bring
about its realization. The principal demands were for
(1) a more cultured preparation for the study of medicine;
(2) fully equipped laboratories in the fundamental
medical sciences, under the direction of thoroughly educated
instructors; (3) the creation of a larger teaching
hospital, in which students in their third and fourth
years would have an opportunity to observe in person
phenomena of disease. This was to be done at the bedside,
under the guidance of professors whose only duty
would be to instruct them.

Who was the man most competent to build up the department
along these broad, salient lines? The President's
choice fell upon Richard H. Whitehead, then
occupying a chair in the University of North Carolina.
He had graduated at the University of Virginia in 1886,
having preferred to enter its didactic school of medicine
rather than some school elsewhere, in which the tuition

was given by men engaged in actual practice. After assuming,
in 1905, general charge of the department, as the
dean of its faculty, his first important policy was to require
that, from the session beginning September, 1907,
no student should be admitted to the school who had not
received a year of laboratory training in the three fundamentals
of medicine in some institution of collegiate
rank. His second was to establish properly equipped
laboratories, under the direction of experts, who had been
appointed after a careful appraisement of their fitness.
His third was to reorganize the hospital for the purpose
of teaching students as its principal form of usefulness.

The history of the medical department during the
Ninth Period is a history of the development of this combination
of policies. We propose to treat each in turn
in its various ramifications. Let us consider first the requirements
for admission adopted from time to time.
In the interval between 1904 and 1906, the American
Medical Association undertook in earnest to elevate
the character and condition of medical education in the
United States. That body declared it to be essential
that there should be first an improvement in the preliminary
education of the prospective student of medicine.
This improvement,—in accord with the demand of the
Association,—was, in 1904, considered to be evidenced
by the completion of a four-year high school course,
and afterwards, in 1906, by an additional year of college
work in the basic sciences. The University of
Virginia, beginning with 1907–08, required that every
applicant for admission to the first year of its medical
department should submit the diploma of a recognized
institution of collegiate rank or a certificate of good
standing given by the like seat of learning; or the diploma
of a high school offering at least a three-year

course, or the certificate of an accredited school offering
an equivalent course. In addition, he must have completed
at the University the college courses in physics,
general chemistry, and biology, or the same courses in
some other institution of reputation.

Under the operation of the various entrance requirements,
during a period of four years, the enrolment
shrank from one hundred and thirty-six students to
seventy-eight; but, in the meanwhile, as we shall see, the
means of restoring the balance were being created by the
establishment of new laboratories, the appointment of expert
teachers, and the extension of hospital facilities.
How necessary for the high character of the Medical
School these admission requirements were, is demonstrated
by the report of the dean for 1906–07,—the year
before they went into effect. "A little more than fifty
per cent. of the medical classes this year," he said, "had
devoted from one to four years to collegiate education
before beginning medicine. The class contains all degrees
of quality, from mature, intelligent, trained men, at
one extreme, to raw, untrained boys, at the other." It
was expected that pupils of the latter type would be unable
to obtain entrance at the beginning of the next session;
and this anticipation, as already stated, proved to
be correct. It was to equip the raw and untrained that
the college course especially was laid off with such care
and discrimination. Not less than thirty-five per cent.
of the students in the medical department in 1908–09
had won the degree of master of arts or bachelor of
arts. The rule was based on two facts: (I) it was impossible
to impart a proper knowledge of modern medicine
to an unripe and undisciplined mind; and (2) it had
been observed that the young men who had received instruction
in those naturalistic sciences which were fundamental

to medicine exhibited the most interest, and were
the most successful, in the medical course.

By March, 1915, Dean Whitehead concluded that the
department had won such a high position that it would be
safe to increase the entrance requirements to two years of
college work. He based his recommendation on two
reasons: (I) the average student found it difficult to
acquire in one year the necessary training in chemistry,
physics, and biology, and in those modern languages
which had been added to the course; and (2) the laws
of numerous States already prescribed two years. By
1916–17, the requirements for admission called for proof
of two years of college work, covering, among other subjects,
always English, mathematics, inorganic chemistry,
physics, biology, and either the German or the French
tongue. This work was to follow the completion of a
four-year course in a high school. The student who was
able, on entering the medical department, to secure an
advanced standing, was enrolled in the classes of the
second, third, or fourth year. To accomplish this, he
had, not only to show that he had satisfied all the general
requirements for entrance into the department, but also
to submit a certificate from an accredited school of medicine
in proof that he had done work equivalent to the
grade of at least eighty per cent. in each subject for which
he was asking credit. The like privilege for one year was
allowed the holder of the degree of bachelor of arts or
science whose academic course had included medical subjects
equal in quality and volume to those of the first year
in the medical course. This regulation was already
in operation in 1905–06; and seems to have continued in
force during succeeding sessions.

In 1904–05, the medical courses which had to be completed
by the candidate for the degree of doctor of medicine

extended over four years. He was only exempted,
as already stated, from so prolonged a stay if he had been
successful in obtaining advanced standing by the required
testimonials which relieved him of the first, second, or
third year, as the case might be.

The division of studies in force in 1905–06 was as
follows: during the first session, instruction was given in
elementary biology, chemistry, practical physics, practical
chemistry, medical biology,—which embraced physiological
anatomy, normal histology and embryology,—
and descriptive anatomy; during the second session, in
physiology, bacteriology, general pathology, special pathology,
descriptive anatomy and regional anatomy; during
the third session, in obstetrics, materia medica, surgery,
clinical diagnosis, and dispensary clinics; and during the
fourth session, in practice of medicine, therapeutics,
hygiene, clinical surgery, derminology, diseases of eye,
ear, and nose, gynecology, medical jurisprudence, diseases
of children, and dispensary and hospital clinic.

The largest proportion of the course of the first year
was accompanied, at this time, by practical work in the
laboratory. This condition was true, in almost equal
measure, of the course of the second year. During the
third year,—and especially during the fourth,—the attention
of the student was very much occupied with
practical clinical instruction. Some account of the character
of this supplementary work will be given on a later
page.

By 1906–07, the dean of the department was able to
say in his annual report that "an excellent beginning
had been made towards the full realization of a well-rounded
modern school." "We only lack now," he
added, sufficient motive power,—money." During this
session, the chair of anatomy was separated from the

chair of surgery, and the chair of practice of medicine
from the chair of pathology. With the subsequent introduction
of a course in pharmacology, Professor
Whitehead declared that the department had been completely
reorganized in the sense "that all the more important
branches of medical science were represented in
its courses on a basis that permitted of their going forward,
should the condition of the future be favorable
to them."

By 1907–08, the division of subjects was as follows:
during the first session, the instruction was limited to
normal histology and embryology, anatomy, anatomy of
the nervous system, and physiological chemistry; during
the second, to physiology, bacteriology, pathology,
anatomy, pharmacology, and physical diagnosis; during
the third, to obstetrics, materia medica, practice of medicine,
surgery, gynecology, clinical diagnosis, and clinics;
and during the fourth to neurology, pediatrics, therapeutics,
hygiene, surgery, dermatology, gynecology,
medical jurisprudence, diseases of eye, ear, nose, and
throat, and clinics. This division and assignment to
successive sessions followed a logical scheme: the first and
second years were occupied with the study of those
sciences which were fundamental to the subjects of the remaining
two years. These latter subjects were the
strictly professional ones. They had been begun in the
second year. Both in the third and fourth years, particular
attention was still given to clinical instruction.

In March, 1909, as the result of a movement which
had been inaugurated by the President of the University
in the previous autumn, at the suggestion of Dr. Rawley
Martin, a distinguished physician of the city of Lynchburg,
the Board of Visitors authorized the establishment
of a series of courses for the practical teaching and

demonstration of sanitary engineering, the science of
public health, and other topics which related to the
training of public health officers. The first series of
lectures formed a part of the summer course in 1909, and
embraced the subjects of sewerage, filth disease, malaria,
ventilation, plumbing, vital statistics, and the like. An
advanced course in physiology was now added for the
benefit of the fourth-year students who had completed
the lower courses and wished to specialize in the science.