Medical Education and the Johns Hopkins University School of Medicine

The Johns Hopkins Medical School was the first of its kind on two counts. First, unlike the nation’s existing medical colleges, it was a strictly graduate-level medical institution. Second, it was the first such graduate institution to admit men and women on the same terms. While these characteristics can be directly traced to the conditions imposed by Mary Elizabeth Garrett and the Women’s Medical School Fund, the women were not the only ones to express concern about the state of American medical education.

Before the Johns Hopkins School of Medicine opened its doors, medical education in the United States occurred either through a loose apprenticeship system, at medical colleges, or in undergraduate programs at universities such as the University of Iowa and the University of Michigan.. The kind of standardized, graduate-level courses given in Europe had not migrated across the Atlantic. Instead, students pursued medicine rather than an undergraduate, liberal education. In his inaugural address as President of the Johns Hopkins University on February 22, 1876, Daniel Coit Gilman described the state of medical education in this way:

When we turn to the existing provisions for medical instruction in this land and compare them to those of European universities; when we see what inadequate endowments have been provided for our medical schools . . . when we see that in some of our very best colleges the degree of Doctor of Medicine can be obtained in half the time required to win the degree of Bachelor of Arts; when we see the disposition of the laymen at home and the profession abroad to treat diplomas as blank paper, and the prevalence of the quackery vaunting its diplomas . . . it is clear that something must be done.¹

William Welch professed similar concerns that “at present in this country no medical school requires for admission knowledge approaching that necessary for entrance into the Freshman class of a respectable college.”² With medical education in this sad state, reputable students and gentlemen stayed away from the field, preferring more respectable professions.

The something that must be done, they decided, was to improve medical education by raising it to the graduate level, including practical as well as theoretical training, and adhering to strict admissions guidelines. As with the rest of the university, the European schools served as models. The connection between the medical school (a division of the University) and the Hospital afforded opportunities for hands-on, clinical training. This was unusual at the time. It was also insufficient. According to Superintendent Henry M. Hurd, merely providing lectures at the Hospital does “not meet the expectations of the country and that the wonderful opportunity which is open to the University to initiate medical teaching of the higher character is being allowed to slip away . . . There is a universal demand for better medical education.”³

Gilman, the Trustees, and the Medical Faculty hoped to raise these standards and the quality of medical students by requiring undergraduate education in the natural sciences. Gilman developed a premedical course at the college of Johns Hopkins, and they hoped that similar programs would emerge elsewhere as students sought preparation for admission to the School of Medicine.

This hope was soon realized. Correspondence between Gilman and John Goucher, president of the Woman’s College of Baltimore (later Goucher College), shows that once the medical school was established, the admission standards had exactly their desired effect. Goucher wrote to Gilman that the announcement that women and men would be accepted on the same terms has been received with hearty approval . . . Women who propose to enter the profession of medicine, and who are ambitious to avail themselves of the most advanced training, are inquiring where they may take the preliminary course most thoroughly . . . a quite a number have applied to the Woman’s College, enquiring as to our provisions to give the preliminary course. The uniform answer of the Woman’s College is that we propose to offer the prescribed work, at the required standard, whenever the schedule of requirements shall be announced.⁴

Gilman replied with a proposed memorandum for inclusion in the Woman’s College announcement, which reflects how closely those at Hopkins involved themselves in improving medical preparation:

. . . The chief teachers of Chemistry and Biology have been nominated to the Woman’s College by Professors in the Johns Hopkins University, who have also visited the laboratories and given to the President the benefit of their counsel. Students who graduate from the Woman’s College after completing the courses in French, German, Physics, Chemistry and Biology, as now taught, may be assured of their admission to the Johns Hopkins Medical School ...⁵

The ripple effect of the changes made in the framing of the Johns Hopkins School of Medicine raised the level of both graduate and undergraduate medical education. This success, however, cannot be allowed to cast its shadow over the process of creating the school. That the Johns Hopkins Medical School would exist in this model was not preordained. Between the will of Johns Hopkins and the emergence of a first class medical school first intervened severe financial difficulties, and disagreements over the character of the school.