|NEAR THE END OF OCTOBER 1853 President Ballou received a letter from Dr. Oliver Wendell Holmes in reply to an inquiry. The Massachusetts-born doctor, essayist, and poet was at the time dean of the Harvard Medical School and held the chair of Parkman Professor of Anatomy and Physiology. Dr. Holmes made some suggestions about a medical course that might be included in the curriculum of Tufts College. His recommendations as to texts and branches of study to be undertaken were concise and pointed; he specified also that "clinical attendance at the Hospital from the first and throughout the course of study" was indispensable. Dr. Holmes' advice was to lie fallow for exactly forty years, for Section 2 of the Tufts charter, granted by the state legislature in 1852, authorized the Trustees "to confer such degrees as are usually conferred by colleges in New England, except medical degrees." The reasons for this restrictive clause were embedded in the preferential position that the Harvard Medical College had enjoyed in Massachusetts almost from the time of its founding in 1782. It had achieved through the years a virtual monopoly in the state over the academic training of doctors and was loath to relinquish it. The restrictive clause in question was the result of a law passed in 1818 intended to curb the widespread practice of using the agency of the courts to collect fees levied by "irregular practitioners." Although the law was repealed in 1835, its spirit remained in force. Amherst College, in 1825, was the first Massachusetts institution to have the restrictive clause applied to it, and the College of the Holy Cross, established in 1843, had a similar limitation in its charter. New England colleges outside Massachusetts operated under no such restriction.|
In the decades before 1860 the number of medical schools in the United States, most of them unaffiliated with a college or
|university, had mushroomed with bewildering rapidity. Between 1840 and 1860, for example, the number had skyrocketed from thirty-three to sixty-six, and little systematic effort was made either to establish or to enforce standards of medical education. It was not until after the American Medical Association was organized in 1847 that a nation-wide attempt (although initially unsuccessful) was made both to elevate the standards of the profession and to exert some measure of control over practices (and malpractices) in the field of medicine. Massachusetts had, by the time of the Civil War, contributed its share of medical schools to the fast growing number. Between 1823 and 1836 Williams College had granted medical degrees by means of an affiliation with the Berkshire Medical Institution in Pittsfield. The arrangement was abandoned because it proved unprofitable to Williams. The Worcester Medical Institution, established in 1849, was in the interesting position of being prohibited from conferring degrees or granting licenses to practice medicine. The New England Female Medical College was established in 1848 and was absorbed by Boston University in 1872 as one step in the creation of a coeducational medical school.|
The decision of the Tufts Trustees to have the prohibition on the granting of medical degrees removed from the College charter was made in the fall of 1866. This by no means implied that Tufts was about to install a medical curriculum. However, President Miner was no doubt aware that the Boston City Hospital had been opened in 1864 and might be available to furnish clinical facilities.
|He probably knew that at the very time the petition was being presented to the state legislature the Berkshire Medical College was preparing to close its doors. It should be noted also that Oliver Dean, then president of the Tufts Trustees, had been a practicing physician for about a decade and possessed an M.D. degree. He had served an apprenticeship, like so many doctors in the early nineteenth century, and had been awarded his medical degree by the Curators of the Massachusetts Medical Society, which served for many years as an accrediting agency. The intent of the Trustees was to have the restriction removed on broad principle as well as to give the institution a free hand if a determination were at some time made to grant medical degrees. Furthermore, there were other matters relating to the charter that needed attention, and it was thought that all of the requests for amendments might as well be made together to simplify procedure and to avoid delay. The College had reached such a point in the mid-1860's that the ceiling of $20,000 on income from endowments placed in the original document was unrealistic and overly restrictive, and a request was made (and granted) that the figure be revised upward to $100,000.|
The petition became a bill in routine fashion and had passed through the customary stages in both branches of the legislature when the faculty of the Harvard Medical College got wind of it and requested its recommittal to the Committee on Education. This would allow objections to be filed against it. President Miner, on behalf of the Tufts Trustees, consented to the recommitment, and a formal hearing followed. The debate was protracted, and Dr. Edward H. Clarke, Professor of Materia Medica at the Harvard school, represented the remonstrants to the petition. The legislative
|committee reported the bill back favorably, but it was opposed by some in the lower house. The vote was about two to one in favor of the petitioner, and the Senate passed the bill without debate. Tufts had won a major victory, although whatever corporate ego it had at the time was subjected to a severe bruising and battering at the hands of Dr. Clarke.|
The remonstrant from Harvard did not mince words in condemning Tufts' effort to have the restriction on medical degrees removed. There were, he said, already more medical schools in New England than were needed; one physician per 1,000 persons was sufficient. To keep the ranks full, only 150 should enter the profession annually. Graduates totaled 196 in 1867 - forty-six more potential physicians than were needed according to Dr. Clarke's formula. Enrollment in New England's medical schools ranged from Harvard's 303 to Berkshire's 40. Dr. Clarke declared flatly that Tufts had no medical school and no resources to establish one. The cost of educating a Harvard medical student was $111 , exclusive of salaries for teachers. Tufts College could "educate cheaper than this only by imparting an inferior education" or by receiving endowments much larger than the $180,000 then available to Harvard. Dr. Clarke argued that "competition between Medical Schools . . . tended to decrease the character and quality of their education. Every new College without liberal endowments increases this danger. When Tufts College has a fully equipped Medical Department, properly endowed and students to graduate, let it have a charter for conferring Medical degrees." If, as Dr. Miner implied in his petition, the right to confer such degrees might attract legacies to the College, a similar right might be sought by every educational institution in the state. The result would be to cheapen the value of a medical degree, and the country would "be overrun with medical incompetence and ignorance." The remonstrant from Harvard asserted that Tufts College had no resources, either then or in future prospect, to do more than "to place the Academic and Undergraduate departments on a proper basis." Any plan to establish a medical school under the circumstances would be ridiculous. Tufts was in
|no position to acquire competent medical instructors, and such teaching staff as could be assembled would turn out "young men ignorant of the great principles of the profession, to tamper with the health and jeopardize the lives of their patients."|
The arguments presented by President Miner were simply and cogently stated. After successfully challenging many of the statistics presented by his opponent, he contended that the charter rights of the College enjoined it to promote learning and allowed it to receive gifts and bequests accordingly, and that the restrictive clause was in conflict with these basic rights. He urged further that it was "absurd for the remonstrants to assume the protectorate of the State, in medical affairs," since medical education was never intended to be placed under the control of one institution. Miner appealed also to the principle of legal equality, arguing that the College was entitled to "stand upon the same basis as other New England colleges ... & that the community may enjoy the benefits of that honorable & unrestricted competition which is the chief guaranty of excellence." The right to establish a medical school and to confer medical degrees should inhere in the corporate character of the institution and should not be at the whim or caprice of another school that saw its vested interests threatened.
Having obtained the change in the College charter, the next step was to take advantage of the newly acquired right to offer medical degrees. The Trustees promptly followed up the action of the Massachusetts legislature in March 1867 by referring the subject of establishing a medical school to the Executive Committee for investigation and report. Only one alternative was apparently explored at the time. There was a possibility of acquiring the assets of the defunct Berkshire Medical College, which consisted of a building, one acre of grounds, and apparatus and specimens sufficient for twenty-five students. But nothing came of this, and when Capen took over the presidency in 1875 no other steps had been taken. The best he could report in 1882-83 was that a Trustee committee, appointed in March 1883 with Miner at its head, had been engaged "for some months in considering the expediency of establishing a Medical School." Their investigation had progressed sufficiently to indicate that such a school could be established "with a very moderate endowment" and that it would meet with general approval among the New England medical profession and at the
|same time "meet a want which is not now met by any other school." The committee, a year later, recommended the establishment of such a school "as soon as it can be done without encroachment upon the present resources of the College and a suitable faculty therefore can be organized." The Executive Committee was given the responsibility of taking appropriate action. Still another year went by before the matter of a medical school was taken up again. In 1885 consideration was given to acquiring for $1,000 the equipment and good will of the College of Physicians and Surgeons in Boston and as much of the staff as it was desirable to retain. This would all be done "with the understanding that the school shall not be an annual encumbrance upon the Treasury of the College."|
The institution referred to had been incorporated in 1880 under the general laws of Massachusetts and was empowered in 1883 to confer the degree of Doctor of Medicine. In 1884 it had a faculty of ten with professorial rank, all with M.D. degrees, and a roster of some fourteen lecturers on special subjects and three physicians who operated a dispensary in connection with the school. The medical college was headed by Horatio G. Parker, who held no academic or professional degrees. Claiming to be the first independent medical college to be coeducational, it was otherwise typical of many such institutions during the nineteenth century. It offered a three-year course but admitted applicants who were in all stages of training and experience, including college graduates, who could receive a diploma after attending one year of lectures and passing prescribed examinations. The College of Physicians and Surgeons might be said to have represented the second stage through which medical education had progressed in the United States. Early medical education, like most other professional training until well into the nineteenth century, had been largely a matter of individual apprenticeship under experienced practitioners. Aside from a few schools connected with institutions of learning, like the University of Pennsylvania and Harvard, very little was done to extend facilities beyond the opening of literally hundreds of so-called secondary schools. These were operated as combined training and profit-making efforts by a group of physicians who charged fees and divided the income among themselves. The training was usually meager,
|and laboratory and clinical facilities were inadequate or non- existent.|
The initiative that had brought the College of Physicians and Surgeons up for consideration by the Tufts Trustees had been taken by members of that school's faculty. They had offered the properties of their institution for sale to a college or university. Their efforts represented an advance into the third or "university" stage of medical education, whereby a more or less intimate relationship was established which could work to mutual advantage.
The Executive Committee of the Tufts Trustees in 1885 considered the acquisition of the College of Physicians and Surgeons desirable, but at a special meeting called to consider the matter, the Trustees adopted a resolution that it was "inexpedient at the present time" to take such a step. Eight years later (in the summer of 1893) another proposition was presented from the same group of the faculty of the College of Physicians and Surgeons "in regard to operating a Medical School in connection with Tufts College." This effort proved more successful than the one of 1885. The petitioners assured the Trustees that they would bring "a full complement of Lecturers and Instructors, well equipped for the work and earnest, hard working men. We propose to furnish a building, equipment, and everything necessary to carry on the work of a first class medical school without any expense to your institution." Negotiations began immediately, and within a matter of weeks Tufts had acquired a ready-made medical school.
The "original seven," as the first medical faculty came to be called and who had brought all this about, had joined together in 1886 as a group who were also members of the corporation of the College of Physicians and Surgeons. The institution had run into financial and administrative difficulties during its first six years. Between 1886, when the "original seven" took charge of the school, and 1893, matters improved; the enrollment increased from 17 to 10l; an indebtedness of $2,000 was paid off; a $500 bond was deposited on a building that was to become the property of the school; and recognition of the school by the Massachusetts Medical Society had been secured. Two circumstances had brought about the
|move to join forces with Tufts. The long-range motivation stemmed from a feeling on the part of the faculty that the standards of the school were too low, that insufficient laboratory and clinical work was being provided, and that in order to do its best work a medical school should not be merely a proprietary institution but should affiliate with a college or university so that its prestige could be raised and necessary educational facilities could be made available. The "original seven" were undoubtedly aware that, in the same year their own request was made, the Johns Hopkins Medical School had been organized, with full university status.|
|The second series of events which precipitated the petition to the Tufts Trustees arose out of dissatisfaction with the administration of the College of Physicians and Surgeons. The school was governed by a corporation of which the majority were lawyers, clergymen, and teachers "who paid but little attention to its affairs,|
|rarely attending even the annual meetings." Actual operation was left in the hands of faculty members who were also corporation members and whose interests frequently diverged from those of the rest of the corporation. At the annual meeting of the corporation in June 1893 matters came to a head. The laymen, apparently in the majority, elected a Board of Directors who were entirely out of sympathy with the faculty. The latter promptly resigned in a body, together with many of the instructors and assistants. The day after what must have been a tumultuous meeting the faculty found the school on Boylston Street securely padlocked.|
The summer of 1893 was an anxious one for the ex-faculty, for they were determined that "there was room in Boston for another school." They made an unsuccessful attempt to secure the charter of the old Berkshire Medical College and corresponded with various schools in the state. Because of the favorable attitude of President Capen, the "original seven" had decided to concentrate their efforts on Tufts College. Early in August a Trustee committee reviewed the situation with a committee of the physicians, and the Tufts representatives reported at the next full meeting of the Trustees that they were "satisfied with the character of the memorialists, all of whom are educated physicians, and members in good standing of the Massachusetts Medical Society." Plans were worked out and approved, and the Tufts College Medical School came into official existence on August 22, 1893, by unanimous vote of the Trustees.
The "original seven," who later comprised the Executive Committee of the medical faculty, were an unusually competent and well-educated group and were exceptionally active in community affairs. Dr. Charles Paine Thayer had received his M.D. from the University of Vermont. He served for many years as Health Officer and City Physician of Burlington, Vermont, as well as on the faculty of the University of Vermont Medical School. After he moved to Boston and joined the faculty of the College of Physicians and
|Surgeons he was secretary, purchasing agent, and Professor of General, Descriptive, and Surgical Anatomy. He was secretary, purchasing agent, and Professor of Anatomy at the Tufts Medical School from 1893 to 1905. If any single individual was the originator of the idea of associating a medical school with Tufts College, Thayer was that person. The second of the "big three" within the "original seven" was Albert Nott, also a holder of an M.D. degree from the University of Vermont and a practicing physician in West Newton, Massachusetts, for almost a quarter of a century. He was one of the negotiators in the exploratory talks with the Trustee committee and served as the first dean of the Tufts Medical School (1893-96) as well as Professor of Physiology. John Waldo Johnson, the third physician instrumental in drawing up the preliminary plans for affiliating with Tufts College, held an M.D. from the Harvard Medical School and practiced medicine in Boston for over thirty years. Besides serving as Professor of Obstetrics and Gynecology, and as treasurer of the medical school for its first three years, he operated a private hospital in Boston.|
The four other "founding fathers" were equally talented and active in professional affairs. Henry Watson Dudley, Professor of Pathology from 1893 to 1900 and Lecturer on Legal Medicine from 1901 to 1906, completed his formal education at Harvard Medical School. Before his service on the Tufts Medical School faculty he was active in raising standards for admission to the Massachusetts Medical Society. William R. Chipman was also holder of an M.D. from Harvard. He had been Professor of Operative Surgery at the College of Physicians and Surgeons and became the first Professor of Surgery at the Tufts Medical School. Walter Langdon Hall was a graduate of the Bellevue Hospital Medical College in New York. Like Dr. Chipman, Hall spent some time in Europe in postgraduate clinical work. He served as Professor of Theory and Practice of Medicine for four years, and the first faculty meeting of the new medical school was held at his home in Medford. Frank George Wheatley, variously Professor of Materia Medica and Therapeutics, vice-dean and acting dean, and Professor of Pharmacology between 1893 and 1926, received his medical education at the University of Vermont and at Dartmouth Medical School. While on the Tufts Medical School faculty he served for two years in the Massachusetts legislature.
The working out of the details for the operation of the new school and the establishment of its relationship to the College took place between August 4 and August 28, 1893, on which date Articles of Agreement were signed. On August 15 the Trustees acted favorably on the recommendations of a five-man Trustee committee. Several of the propositions of the committee representing the "original seven" were included. The Trustees agreed that (1) the by-laws be amended "so as to legally provide for the Medical School"; (2) the new department be designated as the "Medical School of Tufts College"; (3) seven professorships be created, to be occupied by the "original seven"; (4) the dean of the medical school faculty be appointed by the Trustees and the secretary be elected by the medical faculty - both officers to be members of the general faculty of the College; (5) lecturers be nominated and instructors be appointed by the medical faculty, subject to the approval of the Executive Committee of the Trustees; and (6) the special Trustee committee be empowered to work out all contractual arrangements and other details necessary to the operation of the school. The "original seven" were duly nominated for the professorships the same day, and amendments to the College by-laws were submitted. A week later, the recommendations of the special committee were adopted with minor modifications; for example, the new addition to the College became officially the "Tufts College Medical School." Albert Nott was confirmed as the first dean. The nominees for professorships, as the nucleus of the medical school, had met within twenty-four hours after the favorable reaction of the Tufts Trustees on August 15 and had elected Thayer as secretary and Johnson as treasurer. At the same meeting, the medical faculty elected seventeen staff members (lecturers, demonstrators, and assistants), of whom six were graduates of the College of Physicians and Surgeons while it had been under the direction of the "original seven.
The other arrangements made during those busy weeks in August set the pattern of administrative relationships between the medical school and the College. The Tufts Trustees agreed to consider it a department of the College for three years and to appoint the faculty for a corresponding period. The faculty were to serve without compensation and the school was to be operated at no
|expense to the College. The president of Tufts was to serve as chairman of the medical faculty and was expected to preside at faculty meetings as often as possible. Admission requirements, the course of instruction, the issuance of catalogues, and the provision of accommodations for the school, including a dispensary, were all to be under the control of the medical faculty, subject to the approval of the Trustees. At first only those with professorial rank were members of the medical faculty; instructors and those lower on the teaching scale were "exempted from membership." On recommendation of the Administrative Committee of the medical school in 1902, the position of Demonstrator of Anatomy was elevated to faculty rank. All candidates for the M.D. were to be recommended to the Trustees, subject to their action. The faculty was to receive all tuition and fees paid by the students, except that $10 from the graduation fee of each candidate was to be remitted to the Trustees to defray clerical and other expenses connected with Commencement. A financial report was to be made to the Trustees at the end of each term, and all records were to be turned over to them at the end of the three years. Modifications of the agreements could be made at any time by mutual consent.|
Quarters for the new medical school were immediately obtained in the same building on Boylston Street that housed the College of Physicians and Surgeons, which moved to other quarters. This prompt vacating of the Boylston Street location was assured by the fact that Tufts had for many years owned the building as investment property. Two floors were leased and within a year the use of a third floor was acquired. The medical faculty voted to open the school the first week in October 1893, so there was precious little time to make the necessary arrangements. It was thought that $525 would be sufficient to prepare the building, and Thayer, Nott, and Johnson immediately contributed $50 apiece "as a starter." A few weeks before the school opened, an assessment of $50 was levied on each member of the faculty to cover current expenses. The secretary was also authorized to spend $60 for advertising before the
|opening of the fall term. Somehow the hard-working physicians managed to conduct their medical practice, hold clinics, and have their building ready. The first floor occupied by the school contained the lecture hall, a faculty room, and a study area for women. It might be remarked parenthetically that it was taken for granted that the school, like the College of Physicians and Surgeons, would be coeducational. The Tufts Medical School, in sharp contrast to the portion of the College located in Medford, escaped the years of discussion, doubt, and debate that preceded the opening of the liberal arts divisions to women a year before the medical school was established. The second floor used by the medical school contained a smaller lecture room, the bacteriological laboratory, an office for the Professor of Medical Chemistry (a post created during 1893-94), and a study area for men. When added, the third floor included the general chemistry laboratory. An extension on the outside of this floor was built as a dissecting room and was reached from the inside by steps and a door cut through the wall of the main building. Cadavers for the dissecting room had to be hauled up three flights of stairs. Additional space for the school was soon needed, and consideration was given to acquiring an unused schoolhouse on Tennyson Street. Instead, space was obtained in 1895-96 in a building at the corner of Boylston and Tremont Streets, and at 30 West Street. The latter building was owned by the College, and one of its rooms served as the meeting place of the Trustees for many years.|
Admission and graduation requirements had been set by mid-August. Applicants were (like those at the Medford campus) to be of good moral character and had to pass an examination "upon the branches of an English education," including mathematics ("higher arithmetic"), English composition, and elementary physics. Either the translation of "easy Latin prose" or satisfactory knowledge of the derivation of medical terms and medical and pharmaceutical terminology was also necessary. These examinations were required of all applicants except those who had previously matriculated in a regular medical school or were graduates of "a reputable college, high, or normal school." Accredited schools were defined in 1895 as those recognized by the Massachusetts Medical Society, except that students from homeopathic and eclectic schools were required to
|pass an examination in materia medica and therapeutics. Candidates for the M.D. were required to have studied medicine three full years, attended three courses of medical lectures (the third at the Tufts Medical School), taken a full course in dissection, and passed all of the required examinations. The requirements for graduation followed closely those just established by the Association of American Medical Colleges (of which the Tufts Medical School became a member in 1895) and in fact applied only to those students who matriculated in medical schools after July 1, 1892. Graduates of other medical schools could obtain the Tufts degree by attending one full course of lectures and passing the examinations of the senior year. Annual fees were originally established as follows: general lecture ticket, $90; laboratory, $5.00; matriculation, $5.00; demonstrations, $5.00; graduation, $50; and instruction in special branches of medicine, $40. Two modifications were made in this schedule: The total fees (exclusive of the last two) for the whole three-year course were $250 if paid in advance; and former students of the College of Physicians and Surgeons need pay only $85 for the general lecture ticket and those who graduated were to be charged only $30 instead of $50. Candidates could not receive their degrees until they were twenty-one years of age, and diplomas were frequently withheld for that reason. This meant considerable correspondence and record-keeping by the officers of the College, especially in a day when a sizable proportion of each graduating class went into medical training with only a high school diploma or less than four years of college. The three classes were initially designated Junior, Middle, and Senior.|
The freshman class took anatomy, physiology, histology, and general chemistry. The second-year students enrolled in pathology, materia medica and therapeutics, and medical chemistry. The senior year was devoted to obstetrics, gynecology, surgery, theory and practice of medicine, ophthalmology and otology, medical jurisprudence, neurology laryngology, and genito-urinary surgery. If the last year seemed particularly demanding, it should be realized that several subjects were taught by only one or two lectures a
|week for only one of the two terms into which the academic year was divided. For the first year of the school Professor J. Sterling Kingsley of the Tufts Department of Biology lectured at the medical school on histology. This was the first of many instances of cooperation between the school and the College.|
The school opened on schedule in October 1893, and President Capen, who had agreed to deliver the opening address, was much surprised to find no less than eighty students present. The explanations for the large number are not difficult to find. A printed circular prepared on August 17 - even before the medical school was formally created by the Trustees - had been addressed personally to a long list of graduating high school students whose names had appeared in current newspapers. The secretary, who had been authorized originally to expend $60 on advertising, was given permission to spend $75 for advertising in the New York Medical Record. But the great single source of recruits was the student body of the College of Physicians and Surgeons. Dr. Thayer had been the secretary of the school; after the seven faculty members had seceded from the corporation and he had been ordered to turn over the property of the school to its new Board of Directors, the enterprising doctor had retained the charter and book of records for nearly two months. As he told his listeners at the Medical Alumni Association meeting in 1908 with a chuckle, the corporation officers had not asked for these items specifically, and he had concluded that they had not been missed. While the records were in his possession, he copied the names and addresses of the students who had been in attendance, as well as the results of their examinations and the number of courses they had taken. This information, he thought, "might possibly be of use in the future." So, after the dissident faculty had left the school and arranged their association with Tufts College, Thayer could not only address a circular to each former student but include in it a statement that credit would be allowed for time spent, lectures attended, and examinations passed.
Enrollment in the first three years was most heartening. All
|twenty-two students (including eight women) who came up for examination were graduated in 1894, and their names duly appeared on the Tufts Commencement program. Four of the first graduating class applied for admission to the Massachusetts Medical Society and were successful in meeting the examination tests for entrance. During the second year, 104 students were in attendance and 19 received degrees. In 1896, 176 students attended and 32 were graduated. Enrollment was so large and the prospects of the school were so encouraging that by the beginning of the second year the faculty was doubled. Chairs in Medical Chemistry, General Chemistry, Ophthalmology and Otology, Neurology, Gynecology, Clinical Medicine, and Diseases of Children were added. By the end of another year, the teaching force had increased to thirty-five; a Professorship of Mental Diseases was among the new positions. To insure efficient administration of a rapidly enlarging faculty, the senior members (the "original seven") were constituted as an Executive Board and given exclusive management of the financial affairs of the school. A clear distinction was maintained between the "faculty" (those of professorial rank) and the teaching force ("Board of Instruction"), which included lecturers, instructors, demonstrators, and assistants in addition to the "faculty." Candidates for the M.D. degree at other institutions were not allowed to serve on the Board of Instruction.|
The provision of adequate clinical facilities was a matter of concern from the start, and modest progress was made in the early years. The Suffolk Dispensary, of which Dr. Thayer was treasurer, had been used by the College of Physicians and Surgeons and continued to be available to the medical school staff; use was made of it by the physicians who taught neurology, clinical medicine, and ophthalmology and otology in 1894-95. During the next school
|year the Dispensary came under the complete control of the faculty, who even asked President Capen to raise money to cover a deficit. The first Professor of Clinical Surgery, Dr. Herbert L. Smith, was on the staff of the Boston City Hospital, and Dr. Harold Williams, Professor of Diseases of Children (and later dean of the school) supervised a clinic in the Boston Dispensary. The Professor of Gynecology, Dr. Ernest W. Cushing, operated a private facility near the Charity Club Hospital. Negotiations had been undertaken in 1893 with the Massachusetts General Hospital to allow clinical instruction in its wards for both faculty and students. Material from clinics in the New England Eye and Ear Hospital was offered for the use of Tufts medical students in 1894. The medical faculty as well as extramural teachers were allowed in 1895 the use of the school to give summer courses, with arrangements left up to the individual instructors.|
The faculty was pleased by the attitude and morale of the student body, although it did see fit in 1894 to prohibit card-playing in the rooms of the school. Attendance at lectures was good, and the first graduating class immediately formed an alumni association. The women students organized the Alpha Delta Society and the men the Alpha Kappa Kappa Society; both organizations were intended to encourage improvements in medicine. The school year in 1894-95 was increased from seven to eight months, a "Medical Museum of pathological and morbid specimens" was started. Sufficient magazines and pamphlets had been received by the fall of 1894 to "suggest the possibility of a library." The first substantial acquisition of medical books was received from the estate of Howard F. Damon in 1897.
The first major change in the medical curriculum was the establishment of a fourth year, made optional in 1894-95 and compulsory the following year. Dean Nott had suggested the desirability of a lengthened course of study in his first annual report. As he pointed out, there was so much embodied in a medical education, and such a demand for clinical work, that a fourth year was needed to improve medical training and better fit the student for his professional responsibilities. Under the new program the first three years emphasized medical theory and fundamentals and the fourth year provided opportunity for clinical experience. Dr. Nott also dropped the broad hint that too much attention had to be paid to
|general chemistry and insufficient time was available for medical chemistry; general chemistry should be a field for the preparatory school. The dean was also convinced that the purpose of the Tufts Medical School was to train competent general practitioners and deplored the fact that too much time was devoted to the "so-called specialties."  One advantage of the fourth year was the greater opportunity to specialize at the end of the formal degree program rather than throughout the course.|
The contract by which the "original seven" had operated the medical school in affiliation with Tufts College expired in August 1896. There was no hesitation on the part of the Trustees when the question of assuming the management and responsibility of the undertaking was put to a vote and the College took over the administration of the school. As Dean Nott put it in his final report, his Executive Committee turned over to the Trustees "a successful Medical School, well equipped, out of debt, thoroughly devoted to the College, and with every prospect of an abundant success in the future. . . . The Medical School is established as a part of a noble New England institution, thoroughly competent to meet the demands of our time in equipping men and women alike to practise successfully the healing art." The Trustees were frank to admit that the financial success of the school was an important factor in their decision. The records of the school amply demonstrated its solvency.
During the three-year period the school had met all its expenses, had paid the Trustees the required $730 to cover graduation fees, and had turned property over to the College valued at more than $1,500. The faculty was able to cancel the $50 individual assessment levied on its members in the uncertain days before the school was opened. By the end of the first year the secretary was authorized to receive a salary of 3 per cent of gross receipts per annum for his services, and there was a balance in the treasury sufficient to pay each member of the faculty $100. In only one respect had the medical faculty failed to comply with the original contract. For the first two years it neglected to file the financial report required to be deposited at the end of each term with the Trustees. When the records were finally received, the Trustees could well have been envious
|and possibly a bit wistful when they compared figures with those of the College on the Hill. The income of the medical school its first year was $5,600, of which $5,500 came from student fees; during the second year $6,000 of the $7,000 income had come from students; and the net profit of the school in 1895-96 was no less than $7,000. The net profit of the first year (1893-94) had been over $1,000. The advances of $150 from Thayer, Nott, and Johnson were repaid (with interest) out of this sum. Part of the profit in the third year was accounted for by the practice, begun in 1895, of running laboratory tests as a service to physicians not associated with the school. It was not surprising that President Capen considered the success of the school "most encouraging, and the outlook for the future exceedingly hopeful." The Board of Visitors in 1895 noted that "a good beginning" had been made, in spite of the need for more staff and clinical facilities. As one member expressed it, "you have adopted a child that will always, like your other children, be crying for more," but he was confident that the College would do its best.|
The recurrent phrase describing the medical school at the turn of the century was "uninterrupted prosperity." Enrollment steadily advanced, and standards inched up; in 1898-99, nearly 10 per cent of the students held college degrees. New courses in military and mercantile medicine were introduced. Five members of the medical faculty saw military service during the Spanish-American War, and the first mention of research being carried on was made in 1899, accompanied by a plea for funds to assist various projects. Dr. Timothy Leary had already begun to make a deserved name for himself and the medical school in the fields of pathology and bacteriology. During the war with Spain he had taken a leave of absence when he was appointed by the United States Government to investigate and report on contagious diseases in Puerto Rico.
The philosophy on which the school was operating remained the same as it had been from the beginning. As Dean Williams explained when he was in the process of negotiating for the services of Dr. Edward O. Otis to fill the new chair of Climatology and Tuberculosis (Pulmonary Diseases), the aim was "to educate practical physicians," as broadly trained as possible. Theory, research, and practical application of medical principles had to go hand in hand.
|Staff appointments continued to be made that in turn gave some degree of access to hospitals in the Boston area for Tufts medical students. Clinics of the Massachusetts Charitable Eye and Ear Infirmary, Carney Hospital, the Free Home for Consumptives, and the Good Samaritan Hospital were all made available to some extent in this way. During an outbreak of smallpox in Boston in 1901-2, the medical school dispensary was made a public vaccination station by the state Board of Health, and almost 5,000 persons were treated. When the disease disrupted the work of the Boston City Hospital, the Tufts Dispensary handled many of their surgical out-patients. A surplus continued to appear in the revenues of the medical school, and there were several apportionments in the form of salary among the faculty.|
Members of the Boards of Visitors to the medical school hoped that College influence could be increased in the medical school, possibly with the election of a Tufts alumnus to the teaching staff. Relations between the College in Medford and the medical school in Boston were virtually non-existent in the early years. To most of the administrative officers (notably the president), the institution on the Hill and the medical school represented two different worlds. Their separateness seemed to be promoted even by the Trustees when the Executive Committee voted in 1907 that it was inexpedient to allow free tuition in the college of letters to children of the medical and dental faculties. The first direct student link of a formal kind between Medford and Boston came with the establishment of a one-year pre-medical course in 1915-16, but that arrangement involved only part of the student body, and the administration of the program did not contribute materially in bringing the two parts of the College closer together.
At the rate the medical school was growing, expanded accommodations had become a necessity even after overflow space had
|been obtained in 1895-96. The Trustees started negotiations that winter for the property of the Free Baptist Society at the corner of Shawmut Avenue and Rutland Street, but the vacant stone church was acquired too late for the opening of the school year. As a temporary expedient, the building near the Boston Public Library in Copley Square belonging to the Chauncy Hall School (which had moved to another location) was leased until the new property could be remodeled for the use of the medical school. It was provided by the Trustees that any net income from the operation of the medical school in 1896 was to be appropriated toward the new building and its equipment. Thereafter, a sum equal to 15 per cent of the gross annual income was to be set aside for the same purpose until the fund was equal to the cost of buildings and equipment.|
The ex-Baptist church, bought for $40,000, was transformed into a medical school during the summer of 1897. Except for stairways and walls, it was completely reconstructed, and a fourth floor
|was squeezed into the space under the roof of part of the building. Room was provided for a dispensary, and an amphitheater seating 200 was built, extending into the new fourth floor and with separate entrances for men and women. The new home for the school was opened with appropriate ceremonies on September 28, 1897. The speeches made at the exercises reflected satisfaction with the present and optimism for the future. Medical education had taken long strides and standards were being steadily raised. Dr. Ernest W. Gushing, Professor of Gynecology and long active in medical affairs, expressed gratification that at long last a state Board of Registration and Examination of Physicians and Surgeons for which he had labored for over a decade had been created to regulate the practice of medicine in Massachusetts. College officials sincerely believed that the converted church would be sufficient for at least a quarter of a century. But no sooner had Tufts assumed the new responsibility of the medical school than the quarters became manifestly inadequate. Another professional school came knocking at the door.|
The first official indication that Tufts was about to expand in another direction came in the summer of 1897 when the secretary of the medical faculty reported to the Trustees that the medical school had "received overtures from the Trustees of the Boston Dental College in regard to their students receiving instruction in Anatomy from your Medical faculty, which we strongly recommend." In the fall of 1898 the medical school was authorized to receive such students "at the total special charge aggregating thirty dollars for each student for the current year." The next step was a vote by the Trustees of the Boston Dental College in the same year that their school "be consolidated with some reputable college or university which has a medical department connected therewith." Less than a year later, this had become an accomplished fact. A legislative act authorized the union, and on March 14, 1899, the
|Tufts Dental School came into existence. The story back of this action was a record not only of negotiations on a local scale but also of a step illustrative of the evolution of dental education in the United States.|
 Irving S. Cutter, "The School of Medicine," in Raymond A. Kent, Higher Education in America (Boston: Ginn, 1930), p. 285.
 See Henry E. Sigerist, American Medicine (New York: Norton, 1934), especially Chapter 5, for background information. There is also a brief historical sketch of medical education in Abraham Flexner, Medical Education in the United States and Canada (New York: Carnegie Foundation for the Advancement of Teaching, Bulletin No. 4, 1910), Chapter 1.
 See Frederick Rudolph, Mark Hopkins and the Log: Williams College, 1836-1872 (New Haven: Yale, 1956), p. 12.
 Its charter was transferred to the Middlesex College of Medicine and Surgery in Cambridge and Somerville, which was later relocated in Waltham and became the School of Medicine of Middlesex University. It lasted until the Second World War. As late as 1940 it required only a high school diploma and two years of college. Its graduates were licensed to practice only in Massachusetts and the District of Columbia.
 One editorial correction was to remove the awkward definite article throughout the charter that referred to "the Trustees of the Tufts College."
 The petition to have the charter changes made was dated November 20, 1866. The writer is obligated to Dr. Benjamin Spector, Professor of Bioanatomy Emeritus and Professor of the History of Medicine Emeritus of the Tufts University School of Medicine, for the History of the Tufts College Medical School which he prepared for the celebration of its semicentennial in 1943. He tracked down in the Archives of the Commonwealth of Massachusetts all of the documents pertaining to the charter changes of 1867. They are reproduced in his History, which was published by the Tufts College Medical School Alumni Association. He generously deposited in the University Archives photostatic copies of the important documents.
 The bill became law on March 16, 1867.
 There were six medical schools in the area at the time: Bowdoin (Maine), University of Vermont (Burlington), Dartmouth (New Hampshire), Yale (Connecticut); and Harvard and Berkshire (Massachusetts).
 This information was derived from Francis H. Brown, Medical Register for New England, 2d ed. (Boston: Cupples Upham & Co., 1884).
 Much of this information, and what follows, was derived from "A Sketch of the Tufts College Medical School during its First Three Years," presented at a meeting of the Medical Alumni Association in 1908 by Dr. Charles P. Thayer, who assumed the leadership in the move to affiliate with Tufts College and who coined the expression "the original seven."
 For biographical sketches of the seven, see Spector, A History of Tufts College Medical School, Chapter IV.
 Thayer's father, Samuel White Thayer, had helped reorganize the medical department there in the 1850's and had served in many academic capacities. See Julian I. Lindsay, Tradition Looks Forward: The University of Vermont, A History 1791-1900 (Burlington: University of Vermont, 1954), p. 214.
 The College of Physicians and Surgeons remained in existence until after the Second World War and graduated its last students in 1949. Like the Middlesex College of Medicine and Surgery, its graduates were licensed to practice only in Massachusetts and the District of Columbia.
 Schools of this type were based on principles of drug use and classification of disease not accepted by the majority of physicians and hence not considered first-class schools.
 Abraham Flexner, in his report Medical Education in the United States and Canada, gave a rather erroneous impression of the first graduating class of the Tufts Medical School. To underline his point about low standards in many medical schools, he cited several instances of senior classes allegedly recruited and graduated the same year, and used Tufts as one of five examples. He noted that the Tufts Medical School had opened in 1893 and graduated its first class in 1894 (Medical Education, p. 7 n.). He either overlooked or was not aware of the circumstances under which the school was created or the sources from which it drew many of its first students.
 The Board was provided for in the by-laws of the school, which were adopted on June 18, 1894.
 When the rank of Assistant Professor began to be used in the school in 1896, the holders were considered members of the "faculty."
 It was through his efforts that the time for these was reduced from two hours to one hour a week in 1896-97.
 Graduates of the Tufts Medical School appeared on the school staff very soon after 1893. One of the first was Charles D. Knowlton, who served as a Demonstrator in Anatomy before he received his degree in 1894, and later as, successively, Assistant, Instructor, and Assistant Professor of Theory and Practice of Medicine. Dr. Olga Cushing Leary became, in 1910, the second appointment of a Tufts Medical School graduate who had completed the entire course; she was also the first woman to join its faculty.
 The same had to be said of the dental school after it became a part of Tufts in 1899.
 The Board referred to had been established in 1894. Three years later, the medical school had provided that practicing physicians who had passed the examinations of the state Board could be admitted as fourth-year students and become candidates for the Tufts medical degree.
 At the same time the dean of the medical school was approached by the Boston Veterinary College, which wished to become a part of Tufts. There is no indication that the College followed up this opportunity to expand in yet another direction.
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|Chapter 1: Almost Altogether an Uphill Business|
|Chapter 2: 'That Bleak Hill Over in Medford'|
|Chapter 3: One Building, Four Professors, Seven Students|
|Chapter 4: 'A Sound and Generous Culture'|
|Chapter 5: Capen at the Helm|
|Chapter 6:'A Fair Chance for the Girls': Coeducation and Segregation|
|Chapter 7: Medical and Dental Education: Beginnings|
|Chapter 8: Medical and Dental Education: Problems and Progress|
|Chapter 9: A University: De Facto|
|Chapter 10: Academic Indispensables: Curriculum and Faculty|
|Chapter 11: Academic Indispensables: Students and Alumni|
|Chapter 12: From a Semicentennial Through a World at War|
|Chapter 13: 'A New Era Dawning...'|
|Chapter 14: The Fletcher School of Law and Diplomacy|
|Chapter 15: Tufts and a Second World War|
|Chapter 16: Professional Education: Old Problems and New Ventures|
|Epilogue: 'A Small University of High Quality'|