University of Virginia Library

III. The Medical Alumni

MOVEMENTS IN MEDICAL EDUCATION

By William Holland Wilmer, '85, M.D., LL.D., of Washington, D. C.

May I take the liberty of speaking briefly of only one phase of this
movement in Medical Education—a phase, however, that is uppermost in
the minds of every loving alumnus of the dear old Alma Mater?

When one of the very distinguished members of the Medical Faculty
of this great University courteously asked me to express my views at this
meeting concerning the question of removing the Medical Department to a
distant city, I wrote him the question had been so thoroughly discussed by
Dean Hough in his fine report that I could do very little more than to say
"Amen." But I wish to express my personal views even if they possess no
other value than that of a retrospect, as it has been thirty-six years since I
left these beloved portals. I have seen the following reasons advanced for
the advisability of taking this step: (1) The necessity of securing greater
clinical material; (2) to avoid separating the Richmond Medical, Dentistry,
and Pharmacy Schools; (3) economy; (4) athletics are a disadvantage to
medical students; (5) the medical students do not take part in general university
life; (6) the general student body does not receive any profit from the
older medical students.

The first three points are the only ones that require any serious consideration
for consenting to this radical and painful operation. The first
argument divides itself very naturally into two main lines—quantity and
quality. In the argument for removing the Medical Department, the
necessity of a quantity of clinical material has been emphasized. This
greatly emphasized quantity is not dependent upon city environment. It
can be obtained by enlarging the present hospital facilities of the University,
where there is already in existence a great teaching hospital of two hundred
beds and 3,500 patients annually under the control of the staff of the Medical
Department. A hospital is like an individual. When a reputation for work
of the highest type has been established, the numbers of patients seeking
treatment will be limited only by the capacity to care for them. Among
the most notable proofs of this fact are the Mayo Clinic, at Rochester,
Minnesota (a town of 6,000 people); Ann Arbor, Michigan; Iowa City,
Iowa; Madison, Wisconsin; the three latter being average university towns.
The hospital facilities of the great German universities were entirely out of
proportion in size to the small cities in which they were located. Dr. Edsall,
Dean of the Harvard Medical School, says in speaking of the University of
Virginia: "Of course clinical material is essential, but there is no doubt in
my mind that the clinical material can be obtained in a perfectly adequate
way just as Michigan and Iowa have done it." Ease of communication and
transportation brings the suburban and the rural districts constantly into
closer contact with hospital centers. With the annihilation of many of the
problems of time and distance by the fast trains, the automobiles and the
prospective airplanes, those hospital centers will be increasingly independent
in the future, in regard to their location. Even now in regard to transportation
the University of Virginia is excellently placed. While the
demand for quantity could certainly be adequately met, it is well to remember

that quality is even more important. For after all, valuable preparation
does not lie in the number of cases seen by the student, but in the great care
taken in the study of each case and in the acquiring of the proper method of
pursuing that study to the very best advantage. One case exhaustively and
efficiently studied is worth a dozen or more cases considered hastily or imperfectly—the
great temptation where the mass of clinical material is very
large. Furthermore, I wish to emphasize the point that it is the method that
must be studied and not merely the individual case. That great student of
medical teaching, Sir James MacKenzie, says: "It is far better to be trained
to understand a few matters thoroughly than to have a superficial knowledge
of a great many things."

In addition to these points of "quantity" and "quality" there is
another question about this suggested change that requires serious consideration—vocational
instruction versus the teaching given by the busy
practitioner of medicine in a large city. The practitioner is certainly
handicapped. He is often harassed by a number of serious and pressing
cases that demand his attention. At best, it is difficult for him to find the
time for regular didactic lectures or for clinical instruction—often to the
detriment of his students. In Outdoor Departments, the teaching is often
left to younger men who have not sufficiently broad experience to enable
them to give the student the best viewpoint in the most important study of
the beginnings of disease. In the fundamental branches there can be no
comparison between the advantage of the instruction under the professor
who is vocational, and the teaching by the practicing physician. This is
well illustrated by the teaching of anatomy at our Alma Mater. I know of
no other university in any land where anatomy has been so well and unforgetably
taught. This splendid instruction has been a very great and lasting
asset to every one of the medical graduates of the University. The achievements
of its alumni prove that the teaching there in the past has been
efficient in lines other than the so-called "fundamentals." The recent
graduates, too, have been most successful in competitive examinations for
hospital positions, where clinical and laboratory tests were required. For
the last five years, not a single one of the graduates has failed to pass the
examination of any State Board. I have known of instances in New York
where among all the men who took the examination for filling two hospital
vacancies, both of the coveted positions were won by graduates of the
University of Virginia.

The second argument, that it is necessary to associate with the Medical
School the departments of Dentistry and Pharmacy, as now exist in Richmond,
is easily met. These two departments can function, as they do in
other cities, apart from a Medical School; and, at present there are needs
more urgent than the addition of these departments here. In due time this

can be brought about. I personally feel that Dentistry is becoming such an
important part of the Medical Science that a Dentistry Department should
be instituted later at the University of Virginia and I am sure that it could
be accomplished without difficulty. The atmosphere of university life would
be of inestimable value to the dental student. There is no reason why a
practical clinical department of Pharmacy and Therapeutics should not be
established also. In this connection it may be interesting to quote what
Sir James MacKenzie says in regard to medical education: "Each time a
drug is given, the teacher must give the reason for presenting it, and the
student must be set to watch the effects it is supposed to produce." This
sound and practical advice can only be followed in a faculty-controlled
hospital. By this means the student may have the opportunity of seeing
remedies prescribed on grounds of reason and not of credulity. These
suggestions for two new departments are made, because, in my mind's eye
I see a well rounded, evenly balanced, vitalized University in the future,
and not one shorn of its glory. Even the division of the four year course is
detrimental to the highest medical education.

There is much dissatisfaction in the minds of the broadest thinkers
upon the subject of medical education. It is a cause of thankfulness that
they do not apply to the University of Virginia as now conducted. The
objections are that anatomy, for instance, "is often but an intelligent
description of facts, so that the student is burdened with an accumulation of
many trivial details." Sir James MacKenzie in regard to medical education
says that "Physiology is such a broad subject that it is difficult to determine
how much is necessary to impart to the medical student." This
criticism is true of the other so-called medical sciences. However, in a
medical department, with buildings clustered around the campus, the
teachers of the fundamentals come into closer contact with their fellow
professors of clinical work and laboratory investigation than could possibly
be the case in a large city away from the Mother University. In this way
they have a closer insight into the practical problems necessary for the
student.

The third argument for removing the Medical Department is economy.
"Efficiency and not retrenchment is true economy," wrote that sagacious
statesman, Disraeli. This is a saying for all time. The education that is
the most economic is not the one that costs the fewest dollars, but the one
that is the best, the most efficient and broadening, for the least relative
financial outlay. Dr. Flexner wisely says: "It is easier and cheaper to
bring patients to Charlottesville than to reproduce the University laboratories,
workers, libraries, and spirit anywhere else."

A University like our beloved Alma Mater, with its beautiful and
healthy situation, its charming social advantages and its broad cultural

opportunities, will always attract the best type of instructors; but separation
from the life of a great university and the associations of colleagues,
together with the higher cost of living in the city, would have the reverse
effect.

The disadvantage of athletics to medical students forms the fourth
argument. Quite to the contrary, athletics, which have become such an
integral part of college life—and justly so—are benefited by the participation
of medical men. The instances where medical students have led in all
types of athletic sports are too numerous to mention. It is equally true that
medical students are vastly helped by athletics. Quick and accurate response
of brain and muscle to each stimulus is thereby inculcated. The
medical student above all others should have a "sound mind in a sound
body."

Whatever may be the case at other universities, the fifth and sixth
arguments that the medical students do not take part in general university
life, and that the general student body does not receive any benefit from the
older medical students, are not at all applicable to the charming life at our
dear old University. As far as my own personal experience goes, my dear
friend and roommate of my first year at the University was a student in the
academic department and he is now a very distinguished Episcopal minister.
In my second year, my roommate was a brilliant student of law and the
judge of the "moot court" the following year. The third year my room on
East Lawn was in the midst of men who have since become leaders in their
respective walks of life—distinguished scientists, senators, judges. As class
commander of 1885, some of the most delightful letters received have been
from classmates who had not been in the Medical Department. To illustrate
the close cultural relations between the students in the different departments,
I have only to recall to my collegemates of long ago some of the
episodes of our college life. I can remember as if yesterday the eloquent
lecture of Professor Smith upon "Gravity"—not to be erased by the theories
of Relativity. Notable too was the fascinating lecture upon "Opium" by
Dr. Davis. There were many such occasions when the lectures were so interesting,
so charming, so impressive that they drew students from all
departments.

The very association with the great men who were teachers in those
days was a liberal education in itself. This has been equally true in years
since then.

Who in the eighties could forget the gentle tap upon the door and in
response to "come in," the entrance of Dr. John Staige Davis. After an
apology for interruption he sat down for a chat for fifteen or twenty minutes.
The medical student was left charmed and energized and returned to even
his fundamentals with renewed zest. Or, who could forget the kindness and

helpfulness of that commanding figure, Dr. Cabell? Dr. Towles taught
anatomy in such a way that he made it as delightful as it is indelible. These
men had the true vision—not to pitch the greatest number of students, but
to set a high standard and to elevate the men to that standard, and thus to
secure the greatest number of well-trained men for service.

William James, in his interesting brochure, "On Vital Reserves," emphasizes
the fact that all men "energize" far below their normal maximum.
Athletes are familiar with this fact of "second wind." The successful and
most useful men push farther and farther away the barrier of fatigue. This
is an evident fact that the busiest men are those who still take time for outside
activities. The student in contact with the multifarious activities of
university life will "energize" at a higher level than those segregated into a
class—which too often occurs when one department is located in a large
city away from the parent university. It has been well said that "The
most important factor is university contact, ideals and activities." On
the whole, the body thus isolated will be inferior to a similar body "run at a
higher pressure." Can the State of Virginia afford to take away from the
medical students within its gates, those great stimuli that "awaken the
energies of loyalty, courage, endurance or devotion?"

The tendency of medical science is towards prevention and not cure.
The advance in surgery is marvelous beyond expression, but it is a confession
in each case of the failure of prevention. It should be resorted to
only when there is no possibility of relief in other ways. If this applies to the
individual, how much more does it apply to the growing, vigorous University
of Virginia, where dismemberment by amputation of one of its most essential
parts seems as abhorrent as it is unwise?

Even at the risk of repetition, the words of men like Dr. Edsall and Dr.
Flexner should be emphasized at this critical juncture in the affairs of the
University. The former feels so strongly the importance of intimate contact
with the general university that he says: "I should be very glad indeed
if the mere three or four miles that separate the Harvard Medical School
from Harvard University could be wiped out."

After calling attention to the fact that "the independent medical school
has practically disappeared in the last ten years," and that "the universities
have simply had to take charge of medical education because they alone
have the correct point of view of spirit," Dr. Flexner, one of the greatest
authorities on medical education, goes so far as to say: "It is my conviction
—a conviction born of observation over a very wide area—that Virginia
will hardly be able to develop a school of the highest grade except as an
immediate part of the State University in Charlottesville."

Thus it will be seen that the specialists in Medical Education are
against this transfer. Four college presidents, eight deans of medical schools

and fifty professors have registered their opposition. The Medical Faculty
of the University of Virginia is against it; and I do not personally know a
single one of the medical alumni who has not protested against this step.
Moreover, there is no precedent for the transfer of a medical school that has
been functioning efficiently for a hundred years. Those who are pressing
favorably this transfer must bear the burden of proof. If, in the face of the
opposition of the Medical Faculty, the alumni body, and the experts in
medical education from all sections of the country, they carry through this
unfortunate policy the burden of responsibility for the unnecessary handicap
fastened upon the future graduates of the Medical School, will be theirs.

From a broad philosophic point of view no doubt can arise concerning
the great wisdom of keeping intact the present structure of our beloved
Mother University. Sir James MacKenzie says that "We are all creatures
whose mode of thought is influenced by tradition and environment. Teaching
and particularly medical teaching, is more affected by tradition than
almost any other subject." When the tradition is as noble as it is here, and
the environment as inspiring, it would be indeed unfortunate to lose them.
There is an old text that "Wisdom is the principal thing; therefore get
wisdom: and with all thy getting get understanding." The man who has
the deepest understanding, the broadest point of view and the widest vision
is the man who will give the greatest service to humanity. President Alderman
has said: "Scholarship and knowledge fulfill themselves only in
service to men."

While close association with men of diverse trains of thought is a most
potent factor in producing the wise psychiatral point of view so essential
to the highest success in every form of life's activity, environment is an equal
force in man's development. Who could spend a portion of the plastic period
of youth in this ideal spot, with its beauty of hills and valleys, its inspiring
architecture, its splendid ideals and ennobling traditions without being
better fitted for service to his state, his country and to his fellowman?

This Centennial Celebration of our Alma Mater has been a memorable
and happy occasion. Her sons have returned to her in goodly numbers.
Her sister universities and scientific and educational bodies have striven to
do her honor. Speakers of rare eloquence have expressed in glowing phrases
their conviction that her vigorous and inspiring past is but an earnest of her
splendid future. The far-seeing Rector with pointed epigram and eloquent
appeal has shown us the way of duty and of lofty ideals. He has extolled
her vital essence, and shown that it was her spirit, breathed into those
valiant youths while in these sacred precincts, that enabled them to fight
for the cause of freedom, and to make the supreme sacrifice for the right.
Shall we who have not been called upon to lay down our lives, be less true
than they to the inspiration of this beloved Mother? They have glorified

her in their sacrifices; shall not we add to her strength and beauty until
another generation can take from our hands the privilege of loving upbuilding?
But even while all honor is being paid to her and her praises sung by
all, a shadow falls across the hearts of many of her devoted sons at the
thought of the dismemberment that is purposed for this nurturing mother.

In the mind of Thomas Jefferson there was a true university with all
of the schools that we have now—and more in addition. He did not seek to
found an academy or a college, but a university of glorious proportion.
Shall this beautiful dream be turned into an unrestful nightmare? What
excuse can we offer the "Master-Builder" if we do not strive to avert this
work of disintegration of the fabric that he wrought so lovingly?

The medical student is as true a son to Alma Mater as any other son.
Is he therefore to be denied his rightful inheritance? If so, then other sons
will ultimately be deprived of their portions, once this vicious process has
begun. Do not take from the medical student his precious heritage inspired
by the brilliant genius of Thomas Jefferson—this beautiful creation called
the University of Virginia. Leave him where he can exclaim with his
brethren of the other schools, as they look from the beauty of architecture
to the mountains of blue: "I will lift up mine eyes unto the hills from whence
cometh my help."