Ohio History Journal

THE PROFESSIONAL EDUCATION OF PIONEER

OHIO PHYSICIANS

 

By FREDERICK C. WAITE, PH.D.

 

The early location of physicians for practice in Ohio was

coincident with the establishment of settlements, and since these

settlements began on the Ohio River, it was in that region that

were found the first resident physicians late in the eighteenth cen-

tury. The northern part of the state was settled somewhat later,

the northwestern area last of all. In the Western Reserve of north-

eastern Ohio, the first resident physician came in 1800.

In 1800, Ohio, with a population of 45,365, ranked eighteenth,

but by 1840 the population had increased to 1,519,467, and the

rank advanced to third, being exceeded by only New York and

Pennsylvania. With this great increase in population there came

a proportional increase in physicians.

Whence came these physicians of Ohio before 1835, and how

were they professionally educated? In southern and central Ohio

they came chiefly from Virginia, Maryland, and Pennsylvania;

in northern Ohio mainly from New England and up-state New

York. The number graduated from Ohio medical schools before

1835 was small. The Medical College of Ohio graduated its first

class of seven members in 1821 and the total graduates up to and

including 1835 was 239. More than half of these graduated after

1830. There was no other regular medical school in Ohio that

had any graduates prior to 1836. The irregular (Botanic) Worth-

ington Medical School graduated about thirty men from 1831 to

1835 inclusive. Accurate statistics are lacking. There was no

medical school west of Ohio prior to 1840. A few graduates of

the Transylvania Medical School of Lexington, Kentucky, settled

in Ohio prior to 1835.

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The professional training of early Ohio physicians is related

to the growth of American medical schools. Up to and including

1800 there had been granted medical degrees in the United States

to a total of 312 individuals by three successive schools in Phila-

delphia, three in New York City, and one each in Cambridge,

Massachusetts, and Hanover, N.H. However, deducting the hon-

orary degrees to older men leaves about 250 men who graduated

under instruction. No record has been found that any of these

men came to pioneer Ohio. It is unlikely that they would do so,

since a medical degree then gave distinction and its holders would

be likely to remain in the older and more populous states.

The number of medical schools increased in the early nine-

teenth century. In the first decade three new schools, in the second

decade six schools, in the third decade eleven schools, and in the

first half of the fourth decade five more schools. Only four of

these twenty-five were south of Virginia, so that most of them

became potential, if not actual, sources of supply to the rapidly

growing state of Ohio.

What is more important is that nine of these twenty-five

schools were founded in small towns and known as country medical

schools. Several of them had large attendance and they drew

their students almost exclusively from country towns and rural

areas. The medical care of rapidly growing western states was

supplied far more by the country boys who had attended country

medical schools than by those who attended the schools in the

large cities. The country boys had grown up under pioneer con-

ditions and were willing to endure the hardships of a new country

which was scorned by city-bred boys.

The number of medical college graduates among practicing

physicians in the pioneer period of Ohio was far less than the

number of non-graduates. No statistics are available and only

conjecture can be offered. A conjecture is that in the first decade

considerably less than ten per cent of the practicing physicians

in Ohio held a medical degree. By 1835 this proportion had

probably risen to nearly twenty per cent.

The use of the term practicing physician excludes the Botanics,

or Thomsonians, who comprised a large proportion of those who

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PIONEER PHYSICIANS OF OHIO              191

were treating the sick in Ohio. This state was a stronghold of

Thomsonianism and in 1835 the followers of this cult claimed

that one-half of the people of Ohio relied upon their system of

practice, and men of the regular school conceded a proportion of

one-third.

The small proportion of medical graduates in early Ohio can

be illustrated by a few specific instances. A contemporary list of

all licensed physicians in Portage County, published by the county

medical society in 1831, contains thirty-six names. A checking

of these names against lists of graduates of all medical schools

up to that time identified only five as graduates.

The Willoughby Medical School was established in 1834. Its

first faculty consisted of ten men and only three of them held an

M.D. degree. Four of the others had attended a medical school for

one session, but had not continued to graduation, while three of

these ten had probably never attended a medical school. Seven of

these ten men were dismissed at the end of the first session. How-

ever, these figures show the difficulty of securing holders of a

medical degree in 1834, even for the faculty of a new country

medical school, in northern Ohio.

In the first directory of Cleveland, published in 1837, there

are listed twenty-four physicians and surgeons. I have been unable

to identify more than six of them as having a medical degree.

Among the most prominent physicians in the state in 1835,

as indicated by their efforts in the beginning of organized medicine

in Ohio, and in holding of office in the medical conventions, were

men who were not graduates of a medical school, although some

of them received honorary degrees later. Among them may be

mentioned David Long, Cleveland's first physician, Peter Allen

of Kinsman, William M. Awl of Columbus, and Samuel P. Hil-

dreth of Marietta. Hildreth had attended one session at Harvard

Medical School.

Since it is evident that so small a proportion of Ohio physi-

cians prior to 1835 held medical degrees, the question arises as to

how the majority of physicians secured their medical education.

It was by the preceptor system solely, or, in a minority of cases,

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with the addition of attendance at one session of lectures in a

medical school.

In colonial America the apprentice system was used in medi-

cine with the traditional seven-year period, but after the Revolu-

tionary War there came a change by which the time was reduced

to three years, the instruction limited to medical subjects, and the

terms master and apprentice changed to preceptor and student.

This became practically universal by 1800.

Under this reduction in the length of the program the boy

was expected to secure his general education before coming to

the preceptor. This consisted on the average of completion of

the course in one of the typical village academies. Often it was

less, and occasionally more, extending even to college graduation.

There were two varieties of "reading medicine with a doctor."

In one type the youth lived in the family of the preceptor, and

his duties included anything that a son would be expected to do,

such as some manual labor, and chores of various types. In such

case no fee was paid the preceptor, or only a small fee.

In the other type the student lived with his parents or rela-

tives, or boarded and attended the preceptor during the day, and

perhaps part of the night. A fee was charged, usually of one

hundred dollars a year. This type gradually replaced the first.

In this second type, the duties of the student were limited to

things connected with medicine, but this included the care of his

preceptor's conveyances, including the horses, saddles, and harness,

and chaise or buggy, and driving the doctor. Long drives gave time

and opportunity for much personal instruction. He also had care

of orderliness and cleanliness in the office. He was called upon to

grind with mortar and pestle the crude drugs from which the

physician compounded his medicines, and in time to help compound

these medicines, make pills, and put up powders.

The preceptor furnished the text-books and usually a skeleton

for the study of osteology, which was much emphasized. The

student had the use of the preceptor's meager library. The pre-

ceptor assigned lessons and heard daily recitations, except Sunday,

usually early in the morning, or in the course of driving to see

patients. If recitations were missed by reason of excessive pro-

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PIONEER PHYSICIANS OF OHIO              193

 

fessional duties or illness, or absence, of either preceptor or student,

the preceptor was expected to extend the standard three-year

course to compensate for these omissions.

After a time the student was permitted to be present at the

treatment of patients calling at the office and to assist in dressing

wounds and doing independently minor operations such as lancing

abscesses and extracting teeth.

Sometime in the early part of the course, and in the cold

weather, a cadaver was obtained by resurrection in some quiet

country churchyard, and in the preceptor's barn loft he and the

student dissected it. The student would clean the skeleton and

keep it as the first item in the equipment of his future office. Later

in the course a second cadaver was obtained and a series of surgical

operations, mostly amputations at various levels, were carried out.

These phases of instructing the student permitted the preceptor

himself to revive his knowledge.

After about a year and a half the student was permitted to

enter the sick room with his preceptor and see examinations and

treatment, and on the ride to the next patient the preceptor would

discuss the case and give his reasons for what he had done. These

sick room visits were restricted to men and children patients. The

entry of the student into the sick room of an adolescent or adult

woman was unusual. Only very rarely did the student see an

obstetrical delivery. Such privilege was restricted to delivery of

negro women. As a result the student, on completion of his course,

was woefully deficient in knowledge of diseases of women and in

obstetrics. Toward the end of his courses the student made calls

independently upon convalescing patients.

The standard length of preceptorship was three years without

vacations, i.e., thirty-six months of private instruction--actually

more months of instruction than our present-day medical schools

require. When that was completed, if the work of the student

had been reasonably satisfactory, the preceptor would issue a

certificate of proficiency and on registration of this with civil

authorities the former student became "a legal practitioner." There

was usually agreement that the student should not begin inde-

pendent practice in the immediate neighborhood of his preceptor.

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194   OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

The young practitioner might apply to a district medical society

for examination by the censors of the society and if passed, a

certificate was issued which was called a license and the holder

became a "licensed practitioner."

The next step was to seek membership in a medical society

and if granted he became a "society member." There were then,

in public opinion, three grades of physicians who did not hold a

medical degree, namely, legal practitioners, licensed physicians, and

society members.

The man who held a medical degree always displayed it on

his office sign. When drug stores came in he signed all his prescrip-

tions with M.D. after his name. In registering at a medical meet-

ing, he signed M.D. after his name to differentiate himself from

those individuals who could only place Dr. before their names.

The editor of the local paper knew that in news items he should

put M.D. after the name of any holder of the degree. The high

regard in which the degree was held by physicians is shown by

the fact that the initials M.D. are found on the tombstones of all

holders of the degree who died prior to about 1870.

There was variation of this program of study under a pre-

ceptor in which the student attended a medical school during one

session of lectures. The time attending lectures was counted as

part of the standard three years service under the preceptor.

It was recognized that attendance on one session of lectures

was highly desirable, but cost and distance of schools, when there

were few schools, prevented most students from attending lectures

until medical schools were established in Ohio.

If the student attended a second set of lectures at the same

school or another school and was reasonably diligent and passed

the examination, he would receive a medical degree.

The preceptor system had its advantages and its disadvantages.

Its major advantage was in the acquiring of the art of medicine

and contact with patients.

The great disadvantage of the preceptor system was the wide

variability in the proficiency of the preceptors, both as to knowledge

of medicine and facility in teaching. Some physicians acquired a

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PIONEER PHYSICIANS OF OHIO              195

 

reputation as capable preceptors and had more applications from

boys who wished to study medicine than they could accept, but

many men served as preceptors whose general and professional

education was grossly deficient and who had no facility or experi-

ence in teaching.

The preceptorial system was less efficient in a pioneer country

than in the states that were older. The better educated men tended

to stay in the older states. When the less well-educated men reached

the pioneer area they had less contact with superior physicians and

so continued to degrade. They bought fewer medical books and

fewer of them took the few medical journals of that era. There

were fewer medical societies. In the older states many physicians

each year visited a medical school for a week or two and listened

to lectures. In Ohio the greater distances and fewer schools pre-

cluded this. Moreover, in a pioneer country a physician's profes-

sional duties were more burdensome and time-consuming, and he

had less energy and time to devote to a student for whom he was

a preceptor. Hence, on the average, a preceptor in Ohio gave

less efficient training to his students than did a preceptor in Ver-

mont or Massachusetts or eastern Pennsylvania. This differential

became cumulative in succeeding generations of men educated en-

tirely under the preceptorial system, but as pioneer conditions dis-

appeared, the efficiency of preceptorial education gradually im-

proved under the influence of medical societies.

It was appreciation of these conditions that led the abler

physicians of Ohio early to organize district medical societies and

later the state medical convention. In these the improvement of

preceptorial teaching was a frequent topic of discussion. This ap-

preciation also led them to encourage the founding of medical

schools in Ohio and to welcome the establishment of medical

journals.

In the first two decades of the nineteenth century the practi-

tioners of Ohio were practically all men who had come from

eastern states where the great majority had studied medicine

solely under a preceptor. The influx from eastern states continued

with the growth of the population until the middle of the century,

to supplement those who were locally educated.

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196   OHIO ARCHAEOLOGICAL AND HISTORICAL QUARTERLY

In the first decade of the nineteenth century the Ohio boys

who were growing up began to study under physicians in Ohio.

This initiated medical education within the bounds of Ohio. It

was not until later that there was any noticeable going of boys

from Ohio to eastern medical schools. The schools in their student

lists gave the state from which the student came, so that these

can be identified.

Gradually the number from Ohio increased, but at no time to

large numbers. At no time prior to 1835 were as many as forty

residents of Ohio registered in all eastern medical schools in any

one year.

There was a fairly definite geographical division in Ohio

of the choice of eastern schools for those few boys who did go.

From central and southern Ohio the students tended to go to Phila-

delphia. Twenty residents of Ohio graduated at Jefferson before

1840 and more at the University of Pennsylvania. A considerable

number went to the Transylvania Medical School in Lexington,

Kentucky. Five Ohio residents graduated at the University of

Maryland prior to 1835. The registration of Ohio residents in

Philadelphia schools begins about 1810. From northern Ohio regis-

tration in eastern medical schools begins about 1825. The majority

went to one of the country schools in up-state New York, Ver-

mont, or Massachusetts, and a few to Yale. It is noticeable that

scarcely any Ohio residents were registered in the New York City

schools before 1835 and none at Harvard.

There were, as indicated, two groups of practicing physicians

who did not hold medical degrees--those who had been educated

solely under the preceptor system and those who had attended

one session of lectures in a medical school, but had not continued

to a medical degree. Those who were educated solely under the

preceptor system were very decidedly more than those who attended

one course of lectures.

The number who had attended one session of lectures was

greater than those who held medical degrees, but up to 1835 the

number who had never attended any medical school much ex-

ceeded the total of both of these groups. The proportion who had

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PIONEER PHYSICIANS OF OHIO              197

 

not attended at all gradually diminished, but there was not an

equalization until after the Civil War.

In all medical schools the number who graduated in that school

was less than those who attended without graduation. In the Col-

lege of Physicians and Surgeons of the Western District of New

York at Fairfield (1812-1840) the proportion was about thirty to

seventy. In Castleton Medical School of Vermont (1819-1861)

the proportion was about forty to sixty. In Willoughby Medical

School (1834-1847) thirty per cent of all students graduated. In

Western Reserve Medical School up to the Civil War (1843-1861)

and not including honorary degrees, there were 707 graduates and

1141 non-graduates, i.e., thirty-eight per cent of the students

graduated.

The average physician in Ohio who began practice in 1935

did so with much better education, training, and facilities than his

professional brother who began practice in Ohio in 1835. How-

ever, the beginning Ohio general practitioner of 1935 should not

deride the men of a hundred years ago. In some respects these

1835 men were better prepared to enter practice than those of

1935, especially in the art of medicine. They had seen in their

preparation many bed patients, not under the ideal conditions of

the modern hospital, but in the conditions in the home, from hovel

to mansion, which the physician must meet in his daily duties.

The physician of 1835 was, also, professionally more independent

and had far more resourcefulness than the practitioner of today,

because he was compelled to carry his patients through without

trained nurses, or hospital facilities.

The Ohio practitioner of today owes much to his professional

brothers of a hundred years ago, for they, especially through the

initiative and ideals of their contemporary leaders in the profes-

sion, laid the foundations of medical art and medical organization

which we enjoy today in Ohio.

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