93-03-05:  Jefferson Defied Prevailing Views in Establishing 
                    Medical Education at U.Va.


     "Thomas Jefferson believed knowledge of medicine should be
an integral part of an educated person's background," said
medical historian Todd L. Savitt Feb. 24 at the Claude Moore
Health Sciences Library. His commemorative lecture traced the
origins of medical education at U.Va.

     "Jefferson himself was medically self-reliant; he read
medical texts and knew a lot about the body," said Mr. Savitt,
who teaches medical humanities at East Carolina University's
School of Medicine.

     Medical education in the United States was not standardized
in the early part of the 19th century. Most aspiring doctors did
not attend medical school, but engaged in apprenticeships.
Students who did attend one of approximately a dozen privately
owned medical schools purchased tickets from various professors
to attend classes for a four-month term. They would then begin
a preceptorship with a local physician and later return for
another round of lectures covering similar ground, according to
Mr. Savitt.

     During the 18th century, scientists tried to adapt the
rational, scientific approach that had been applied to the
natural sciences to human and other biological systems. Patients
were disassociated from the diagnostic process. Theories that the
body should be understood as a machine or as a chemical system
took precedence over what could actually be observed in a sick
patient, said Mr. Savitt.

     While living in Paris, Mr. Jefferson became familiar with
the French Ideologue movement and the work of physician-reformers
connected with the Paris School of Medicine, such as Pierre Jean
Cabanis (1757-1808), who challenged those who relied strictly on
theories in the practice of medicine. For "ideologues" or
"sensualists", as they were sometimes called, "nothing could be
really known except through the senses. A physician had to
observe and use his senses to find out what was going on in the
body," Mr. Savitt said.

     "Jefferson had no respect for physicians who did not apply
what they had learned to what they saw in front of them. He
didn't like speculative theories in medicine, and he didn't want
such theories taught at the University.

     "In creating a school of medicine, it was not Jefferson's
intention to train doctors, but to provide students with basic
knowledge of the human body.

     Students who wished to become doctors would continue their
training elsewhere," said Mr. Savitt, who earned his Ph.D. in
American history from U.Va.

     "Unlike other medical schools where five or six professors
taught, Jefferson's school of medicine would initially have only
one. Jefferson  thought having only one professor would eliminate
competition over theories of medicine or styles. Though no
clinical subjects would be taught, students would use their
senses by studying models, prepared specimens, charts and
dissected materials. The curriculum would include anatomy,
surgery, physiology, chemistry, pharmacy, and the history of the
progress and theories of medicine," said Mr. Savitt.

     Mr. Jefferson thought Charlottesville was too rural to be
a good place for clinical training; people would be unwilling to
be treated by students, explained Mr. Savitt. Cities with large
populations, such as Boston and Philadelphia, provided the best
opportunities for this aspect of medical education. 

     According to Mr. Savitt, Mr. Jefferson was adamant that the
University's professor of medicine would not be permitted to have
an outside clinical practice, though he might see students in the
dispensary. Rather, his full-time focus would be teaching.

     "This restriction on medical practice almost spelled the
doom for the medical school before it started. Jefferson asked
some top-notch people to take the position, but all declined the
opportunity to live in Charlottesville, especially when they
learned an outside practice and income would not be allowed.

     "Recognizing that Europe had large numbers of qualified
people in the sciences, Jefferson commissioned friend and
intended professor of law Francis Walker Gilmer to travel to
England to engage professors of math, ancient and modern
languages and medicine," said Mr. Savitt.

     Gilmer had a difficult time recruiting a professor of
anatomy and medicine due to the prohibition on outside practice
and income. He communicated his frustrations to Jefferson who
wrote back that he and the Board of Visitors had decided "to
delay the establishment of the medical school until a more
favorable time."

     Before Mr. Jefferson's letter reached him, Mr. Gilmer had
met and hired Robley Dunglison, a 26-year-old professor, who had
trained in Scotland and France. In accepting the chair of
medicine, Dunglison became the first full-time professor of
medicine in the country, said Mr. Savitt. 

     Dunglison became not only Jefferson's friend but also his
personal physician. In time, the Board of Visitors gave him leave
to be a "consultant," and he saw students in the dispensary
several times a week, Mr. Savitt said.

     Francis Gilmer, who died not long after his successful
recruitment mission, is the real hero in the story of the
founding of the University's medical school, according to Mr.
Savitt. "If he hadn't found Dunglison, who knows when medical
education would have been introduced into the University's
curriculum?"