USA > Massachusetts > Commonwealth history of Massachusetts, colony, province and state, volume 5 > Part 49
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Benjamin Waterhouse (1754-1846), of Cambridge, was fortunate in an unusual education in medicine in London, Edinburgh and Leyden. He introduced vaccination with cow pox for smallpox in 1801, and has been called the "Jenner of America." Waterhouse, like Douglass, did not hesitate to inform his less fortunate brother practitioners, who had not enjoyed European advantages, how ignorant they were; with the result that, what with their contentious dispositions and personal unpopularity, it was a hundred years before any his- torian could be found to say a good word for these two pio- neers, although their great contributions to the country were recognized. Waterhouse, with John Warren (1753-1815), founded the Harvard Medical School in 1782.
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PUBLIC INTEREST
The first State health law, the "Great Public Health Act," was passed by the Massachusetts Legislature in the year 1797. It authorized the appointment of local health officers by cities and towns, its chief object being quarantine regulations to prevent the spread of contagious diseases. Under this act Newburyport was the first town to create a local health organ- ization, Boston following suit in 1799. Paul Revere was the first president of the board of health. Thus we see that local health boards antedated a State board by seventy years. Medi- cine in Massachusetts got its first real start at the Revolution, when physicians were called into the army and navy; more or less efficient hospitals were inaugurated, and the treatment of the sick and injured received systematic and intelligent atten- tion.
Space serves to mention here only the outstanding facts con- cerning the founding of the chief medical institutions of the State. The advances in the science and art of medicine made in Europe, a region long civilized, were taken up by the phy- sicians of Massachusetts with increasing promptness as the nineteenth century ran its course. Most of the medical men of prominence finished their medical education abroad, bring- ing home, as had Benjamin Waterhouse, all that was new and best. The custom of training young practitioners by the three year apprentice system-as assistants to older physicians- gave place to matriculation in a medical school and service as an interne in a hospital, as soon as the schools and hospitals had been established.
THE MASSACHUSETTS MEDICAL SOCIETY (1781-1930)
In order to safeguard the inhabitants of the State from untrained and ignorant practitioners and quacks, the Massa- chusetts Medical Society was organized and incorporated by the Legislature in November, 1781, thirty-one physicians in different parts of the Commonwealth being the incorporators. It was a small select society for the first twenty years of its existence, its membership being limited to seventy Fellows.
In 1803, its charter was modified, and the society made democratic-any reputable physician being eligible for fellow-
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ship-the bill laying down the rules for its government being drawn by Judge Samuel Sewall of Salem, afterwards Chief Justice of the State. This statute is in force at the present time and the membership of the society has increased from 117 in 1804 to 4622 in 1930, the increase being progressive through all the years and including (according to the figures published in the last directory of the American Medical Asso- ciation) seventy-one per cent of all the physicians of the State.
LICENSING OF PHYSICIANS (1781-1930)
By its charter of 1781 power was conferred on the state medical society to license practitioners of medicine. Again, in 1789, by another act, the duties of the society were defined more precisely, for the act set forth that the society was also to give "medical instruction or education as they [the society] shall judge requisite for candidates for the practice of physic or surgery." Thus early, the society took steps to improve the status of medical education, in conjunction with the Har- vard Medical School, then the only institution of the sort in the Commonwealth. This situation continued, with modifica- tions introduced by the founding later of other medical schools, until the belated passing by our Legislature-belated because almost all the other states of the Union had preceded us in practice acts-of the medical registration law of 1894. The State government has continued to take a paternal interest in the medical society even to the present ime. In 1859 a law was passed requiring every candidate for admission into the society to pass an examination before a board of censors of the society as a requirement for fellowship, a condition which exists today. In 1921 the Legislature authorized the society to publish a weekly journal devoted mainly to medicine and surgery, the Boston Medical and Surgical Journal.
EARLY MEDICAL EDUCATION (1782-1860)
The story of the medical schools of the State can be told here only in the most important features. Harvard, founded in 1782, graduated relatively few students previous to the late sixties of the nineteenth century. In 1822, fifty years after the founding, the graduates numbered 12; ten years later, 27;
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in 1872, 58, the number varying in the intervening years and reaching 137 in 1929. The next school to be founded was the Berkshire Medical Institution, at Pittsfield in 1823, aided and fostered by Dr. Henry Halsey Childs (1783-1868) of that city. This was connected with Williams College until 1837. It flourished until shortly before Childs's death, going out of existence in 1867. In the year 1830, it graduated 24 students while Harvard gave degrees to 21. One may note that in the same year the other medical schools of New Eng- land graduated students as follows: Dartmouth, at Hanover, N. H. (established in 1798), 18; Yale, at New Haven (estab- lished in 1813), 17; Medical School of Maine, at Brunswick (established in 1820), 37.
The Worcester Medical College ("eclectic," i.e., choosing the best) had an existence of eleven years (1848-1859), but not much is known about its graduates.
RECENT MEDICAL SCHOOLS (1914-1930)
The unexpired charter of the Worcester College was re- vived by the Middlesex College of Medicine and Surgery, in Cambridge, in 1914. That institution, having united with the Massachusetts College of Osteopathy, has graduated each year about 28 students. The New England Female Medical College (homeopathic) was organized in Boston in 1848 and was merged with Boston University School of Medicine in 1874, an institution founded the previous year and also home- opathic. The Boston University school became non-sectarian in 1918, graduated 49 students in 1929, and has improved con- stantly its courses of instruction and its teaching staff. The Tufts College Medical School began in 1893, with buildings in Boston. In 1929 this medical school graduated 114 doctors. It has been a growing and increasingly useful educational in- stitution.
The only other medical school in the State is the Boston College of Physicians and Surgeons, organized in 1880. It has had a checkered career from the start, partly because of its limited facilities. No efficient medical school, we know, can support itself on the fees from the students, which constitute only a third of the cost of medical education in the schools of the United States taken together. The Middlesex Medical
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College, which has called itself the medical department of the University of Massachusetts, and the Boston College have inadequate teaching equipment. The latter graduated nine students in 1929. Neither of these two schools has sufficient facilities.
Since 1893, Massachusetts has maintained three good medical schools. The standards of training have been raised progressively from a graded three-year course (1874) to a full four-year course. Students now are expected to follow their school training by an interneship of eighteen months in an approved hospital, before taking up practice, and they must pass an examination by the State Board of Registration in Medicine before they may be licensed.
NUMBER OF PHYSICIANS
According to the figures published in the "Educational Number" of the Journal of the American Medical Association in 1929, Massachusetts had enrolled as students of medicine in her five schools in 1929 a total of 742 students, the whole number for the United States being 20,878. The grad- uates of the medical schools of the entire country in that year were 4,446. Nearly all of these were from the so-called "Class A schools"; that is, rated as the best by the national medical society. Massachusetts, according to the same au- thority, had in 1929 a total of 6,375 physicians.
The scarcity of general practitioners in thinly settled dis- tricts, a subject that has been prominent in the press of late years, has not affected seriously this State, than which only four in the Union have a smaller area. We have few regions that are inaccessible to physicians during winter storms, and our roads are getting better every season. Although for a long time the trend of practitioners has been to settle in the cities rather than in the country, what with better roads, the motor car, district nurses, and the telephone, the inhabitants of the hill and mountain districts are cared for even better than in the past.
HOSPITALS (1784-1930)
The earliest hospital in the State was, apparently, the hos- pital connected with the Boston Almshouse, which, at the
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time it was first used as a place of teaching for the students of the newly founded Harvard Medical School (1784), had about 50 patients. The Boston Dispensary was opened in 1796 and incorporated in 1801. The Marine Hospital, estab- lished at Charlestown in 1803, then cared for about 30 patients. The hospital at the state prison, also at Charlestown, erected in 1805, provided the clinical facilities for the students of the medical schools up to the opening of the Massachusetts Gen- eral Hospital in 1811. The beginnings of the other early hospitals of the State may be enumerated as follows: Massa- chusetts Charitable Eye and Ear Infirmary, 1827; Boston Lying-In Hospital, 1832; Lowell Corporation Hospital, 1839; Massachusetts Homeopathic Hospital, 1855; New England Hospital for Women and Children, 1862; Carney Hospital, 1863 ; Boston City Hospital, 1864; St. John's Hospital, Lowell, 1867 ; Springfield Hospital, 1869. They are all in active opera- tion today. Space does not allow the tracing of the growth of the modern hospitals here. It is enough to say that in the year 1929 there were in the Commonwealth 307 registered hospitals, both public and private, containing a total of 48,905 beds.
TRAINING OF NURSES (1872-1930)
The first training school for nurses in the United States was founded by Dr. Susan Dimock (1847-1875) at the New England Hospital for Women and Children, Roxbury, in 1872. The previous year she had received a degree in medicine at the University of Zurich, after studying at the New Eng- land Hospital and being denied admission to any of the classes for male students at the medical schools of this country. She sensed the need of nurses not of the Sairey Gamp variety, and succeeded in opening the doors of a training school at her alma mater. Unfortunately her brilliant career was cut short only three years later, when she was drowned at the wreck- ing of the Schiller off the coast of England.
Training schools for nurses were established within the next few years in New York City at Bellevue Hospital; and at the Massachusetts General Hospital and the City Hospital in Boston.
At the present time there are in the State 124 hospitals that have training schools connected with them, with a total of
Courtesy of the Treadwell Library
MASSACHUSETTS GENERAL HOSPITAL, BOSTON
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4643 student nurses under training. On January 1, 1927, there were 15,591 registered nurses in Massachusetts, or one registered nurse for every 37 persons of the population. The State requires thirty-six months of training before a nurse may be registered by the State Board of Registration of Nurses. Attendant nurses and pupils, who have gone through a course of instruction less protracted, are now graduated by a school in Boston, for the care of the less serious and chronic cases of illness.
MEDICAL JOURNALS (1812-1930)
The chief mouthpiece of the profession was started by Dr. John Gorham, Dr. John C. Warren and Dr. James Jackson in Boston in 1812 as a monthly named The New England Journal of Medicine and Surgery. It was to be the official organ of the Harvard Medical School. It had a precarious existence until 1828 when, through the energy of Dr. Walter Channing (1786-1876) and Dr. John Ware (1795-1864), who assumed the editorship, the journal was converted into the Boston Medical and Surgical Journal, which has appeared every week since that time, completing one hundred years in February, 1928, when its name was changed to The New Eng- land Journal of Medicine. At present it contains about forty pages of reading matter, and twenty-four pages of ethical ad- vertisements. Until 1921, the journal was an independent publication, carried on by different public-spirited medical men, who often had to reach into their pockets, besides furnishing free copy. In that year it was purchased by the Massachusetts Medical Society, to act as its official organ. Of late it has been also the official organ of the New England Surgical Soci- ety, the Boston Surgical Society, the New England Pediatric Society, the New Hampshire Surgical Club, and the New Hampshire and Vermont medical societies. The journal is managed by a committee of the State medical society and an ex-president of the society-Dr. Bowers, of Clinton, who is managing editor. It is now the only weekly medical journal in the country except the Journal of the American Medical Association, published in Chicago, with a weekly output of 100,000 copies. Several monthly journals have been started,
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many of brief life, such as the Medical Magasine (1832-1835) and the New England Medical Gazette, the organ of the Mas- sachusetts Homeopathic Medical Society.
CONTAGIOUSNESS OF PUERPERAL FEVER (1843)
An outstanding event in the history of medicine in this State was the discovery in 1843 of the contagiousness of child- bed fever by Dr. Oliver Wendell Holmes (1809-1894). February 13 of that year his essay on the "Contagiousness of Puerperal Fever" was read before the Boston Society for Medical Improvement, an organization of long and honorable existence, made up of the leading members of the profession. Holmes declared that physicians carried the contagion of childbed fever from the autopsy room and from one case to another on their hands and clothes; that the nail brush should be used, the hands washed in chloride of lime solution and the clothes changed after leaving a case of the disease. The essay caused an outburst of indignation in the profession, especially in Philadelphia.
Semmelweis of Vienna, five years later, proved that puer- peral fever was a blood poisoning or septicemia, by investiga- tions which he carried on in the great Vienna hospital where he occupied the position of assistant in obstetrics. By the use of simple cleanliness he lowered the mortality of the disease over 8.5 per cent. Both Holmes and Semmelweis encountered violent opposition, for who could be expected to believe, with- out a knowledge of the causative factor evidenced by germs, that a physician himself spread the infection of a disease which had been so fatal since time began? By persisting and reiterat- ing their views they forced the truth upon a doubting world, with the result that puerperal fever became a rare disease. To Holmes, the anatomist, belongs the credit of having first called the attention of the world of science to a great truth, a fact sometimes overlooked because of his greater reputation in the field of literature.
DISCOVERY OF SURGICAL ANESTHESIA (1842-1846)
It was only three years after Holmes's discovery that the first public demonstration of the use of ether as an anesthetic
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in surgery was made at the Massachusetts General Hospital in Boston. October 16, 1846, William Thomas Green Morton (1819-1868) administered the ether while John Collins War- ren (1778-1856), sixty-eight years of age-a son of Dr. John Warren,-operated for the removal of a small tumor of the neck. This beginning of a revolution in the art of surgery is an interesting story. Laughing gas (nitrous oxide) had long been used to deaden pain, particularly in the removal of teeth. Ether had been employed as an inhalation to relieve the pain of the late stages of consumption as long ago as 1795; while Sir Michael Faraday, English physicist, had called attention to the anesthetic properties of ether in 1818.
The drug had been employed by Dr. Crawford William- son Long (1815-1878) in Jefferson County, Georgia, in 1842, to remove a tumor of the neck. It is a curious coincidence that both of the first instances of the use of ether in surgery should have been for the removal of tumors of the neck. The med- ical world knew nothing of Long's employment of ether. He abandoned its use because he thought that the insensibility produced was too brief and ether anesthesia was impracti- cable. He lived far from medical centers and he published nothing concerning his experiences until long afterwards, when Morton's practical demonstration in public had aroused the world. Controversy subsequently arose as to priority in the use of ether as an anesthetic. The recorded facts sup- port the following statement.
THE TEST OF ETHERIZATION (1846)
Dr. Morton was a dentist who had studied medicine and held an M.D. degree. In order to fit artificial teeth it was necessary to remove the roots of decayed teeth-a painful process. Laughing gas produced a brief period of anesthesia and called for unduly rapid operating. Therefore Morton got some ether from the chemist Dr. Charles T. Jackson (1805- 1880), learned from him how to use it, tried the drug on animals and on himself, extracted teeth from several patients, and then made application to the senior surgeon at the Massa- chusetts General Hospital for an opportunity to put it to the test in the public amphitheater.
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The eventful day arrived. Morton was late, as his inhaler, just invented, was not finished on time. When he came into the operating room he brought with him a man named Frost, who had had a tooth removed while under the influence of ether. Dr. Warren pointed to him and said to the patient, a young man, Gilbert Abbott by name, "Are you afraid? There is a man who has breathed it and can testify to its success." "No," said Abbott, "I feel confident, and will do precisely as you tell me." The operation lasted about five minutes and the patient suffered no pain, as he testified later. Dr. Henry J. Bigelow, newly appointed surgeon to the hospital, who was present with many of the staff, said: "I have seen something today which will go round the world."
By assistance to Morton and by writing, Bigelow aided much to make etherization successful and to let the world of medicine know about it. The following day Dr. George Hay- ward (1791-1863), another surgeon to the hospital, removed a large tumor from a woman's shoulder, Dr. Morton giving the ether. There was no pain. Surgical anesthesia was an ac- complished fact and in future the human race could be relieved of countless disabilities which previously had been made im- possible by the suffering caused by the knife. Morton was justly accorded a niche in the Hall of Fame in 1920; for he found experimentally and independently the properties of ether, and demonstrated to the public how it could be used successfully in surgery.
APPENDICITIS (1886)
An event which redounds to the credit of Massachusetts was the first description of inflammation of the vermiform appendix, that very common disease which had been called previously "perityphlitis" and "inflammation of the bowels." In 1886 Reginald Heber Fitz (1843-1913) of Chelsea and Boston, who had been professor of pathological anatomy at Harvard since 1878, presented an article on "Perforating Inflammation of the Vermiform Appendix" at a meeting of the Association of American Physicians. It gave a clear pic- ture of the clinical course and diagnostic signs of the disease as well as the morbid changes which take place. Fitz advised an immediate operation to remove the appendix as the only
From a photograph Courtesy of the Author
HENRY J. BIGELOW, M. D.
Courtesy of the Author
THE FIRST PUBLIC DEMONSTRATION OF SURGICAL ANAESTHESIA, BOSTON, OCTOBER 16, 1846
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rational means of saving life. In his paper he analyzed nearly 500 cases which he had studied, showing that the old-fashioned treatment with large doses of opium and waiting was fraught with danger. Medical practice was ready for a new method of treatment. Abdominal surgery, under the ægis of asepsis, was just coming into being. Since the steam sterilizer had been introduced by Von Bergmann of Berlin, all instruments, towels, and dressings could be sterilized. Hence, although the rubber glove was yet to come, the abdomen might be opened with comparative safety, whereas in the past, if that cavity was invaded by the surgeon, the results were apt to be fatal. In this same year (1886) Alfred Worcester of Waltham did the first appendectomy on a girl with an abscess in the groin who was growing worse all the time and had been refused operation at one of the large metropolitan hospitals. Wor- cester opened the abcess, removed the appendix, and the girl recovered. Having a chronic appendicitis himself he per- suaded a bold surgeon, John Wheelock Elliot (1852-1925), to operate on him and take out his appendix; soon he suc- ceeded in having the same operation performed on several of his patients who needed it. The campaign for early operation was on its way to general adoption by the surgeons of Amer- ica, although a long time intervened before old prejudices had been overcome.
BOSTON MEDICAL LIBRARY (1875-1930)
Dr. James Read Chadwick (1844-1905) returned to Bos- ton in 1873 after study abroad, and soon developed a plan for a library of medicine, where those who wished to keep abreast of the times could consult the medical literature of the world. The previous year the small library of the Massa- chusetts Medical Society-1686 volumes-had been presented to the Boston Public Library. Henry Ingersoll Bowditch (1808-1892), founder of the first State board of health in the country, felt dissatisfied with this disposal of the books. In 1875 he collaborated with Chadwick and organized the Boston Medical Library Association, with rooms at 5 Hamil- ton Place. Dr. O. W. Holmes was the first president; Dr. Chadwick, librarian ; and Dr. Edwin Howard Brigham (1841- 1926), assistant librarian, in charge.
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At first the library had a small membership and not many books. Chadwick was librarian until his death; always travel- ling about with his "want book." Irrepressible, never resting, he obtained additional gifts and purchases from a large num- ber of sources, thus promoting the growth of the library until it became a medical center for New England, and the fourth largest medical library in the country. From 1878 until 1901, the library was housed in a made-over residence at 19 Boylston Place, the rooms being shared with the chief medical societies in Greater Boston.
On moving to a new fireproof building at 8 The Fenway, in 1901, the medical books of the Boston Public Library and of the Boston Athenaeum were turned over to it. Today the library, with its beautiful Holmes Hall reading room, houses over 151,000 volumes and 100,000 pamphlets, besides dupli- cates. It has a remarkable collection of medical medals, and many portraits of the medical worthies of the past, besides halls for medical meetings. It is badly crowded for room and must soon obtain larger quarters. The membership is about 900. Dr. John Woodford Farlow was the librarian from 1905 to 1928 and James F. Ballard assistant librarian, in charge since Dr. Brigham's retirement in 1909, is now di- rector. The library is open to the public.
MEDICAL EXAMINER SYSTEM (1877-1930)
Since earliest times there have been coroners both in Eng- land and America, petty lay officials whose duty it is to investi- gate all sudden deaths in a given community, to hold inquests and to report to the court having jurisdiction. As a rule they are without any scientific training and (in this state at least) had been political appointees and often notoriously corrupt. In the year 1877, after agitation by the state medical society, a bill was passed by the Legislature abolishing the coroners and providing in their place "medical examiners," men skilled in medicine and in pathology, to function in each county. The examiners are appointed by the governor with the consent of the Council for terms of seven years. This change in the law was brought about largely by the endeavors of Dr. Frank Winthrop Draper (1843-1909), an army officer of Wayland and Boston, later the professor of legal medicine at Harvard.
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