How to Become a Doctor (in 1949)

By Allison Piazza, Reference Services and Outreach Librarian

how to become a doctor_watermark

How to Become a Doctor (1949) by George R. Moon.

While shelving books, I had the great pleasure of discovering a small book entitled How to Become a Doctor. Published in 1949, How to Become a Doctor is, at just 131 pages, “a complete guide to the study of medicine, dentistry, pharmacy, veterinary medicine, occupational therapy, chiropody and foot surgery, optometry, hospital administration, medical illustration, and the sciences.”

The author of the book, George R. Moon, was the Examiner and Recorder at University of Illinois Colleges of Medicine, Dentistry and Pharmacy.  As for Mr. Moon’s qualifications, the writer of the forward states: “it is probable that no one person in the world has met more students seeking advice regarding entrance to schools of medicine, dentistry and pharmacy.”

As intended, I learned quite a bit about the medical school admissions process while reading this guide. I was surprised to learn that, in 1949, not many medical schools required a bachelor’s degree for admission, with only 4 schools requiring the degree, 58 asking for three college years, and 7 indicating they would consider 2 years of college work.  This is basically unheard of today in the U.S.

Medical School by the numbers: 1948-1949 and 2016-2017

1948-1949 2016-2017
Approved U.S. 4-year medical schools 71 147
Applicants At least 20,000 53,042 [1]
Application fee $5-$10 per school $160 first school; $38 per additional school [2]
Enrollment 6,559 21,0301 [1]
Tuition at Harvard Medical School $830* $58,050 [3]
Female matriculates 11% (1947) 49.8% [1]
Medical school graduates 5,543 18,938 [4]

*The highest annual fee at any medical school in 1948-1949.

Further into the guide, Mr. Moon discusses the application process, offering a sample application from the University of Illinois.  One question from this four page application is: How and where do you spend your summer vacations?

After the application comes the interview.  Mr. Moon’s primary advice is on appearance, stating that “this is one place where the typical ‘Joe College’ attitude should be forgotten.” He goes on to say that the student should act natural and answer questions directly and fully but “avoid anything fancy.”

how to become a doctor 00078_watermark

Chapter images from How to Become a Doctor.

To conclude, just who was the ideal medical school applicant in 1949? Mr. Moon offers the following description:

“The ideal will, of course, have superior college grades, a broad, balanced liberal arts program, be not over 22 years of age, have high moral standards and professional ideals, be reasonably attractive personally, be poised and at ease in his interviews, speak clearly and correctly, be clean and fastidious as to dress and appearance, and have enough financial backing so that he will not be forced to work or be worried by money matters, and last but not least, be physically strong and healthy.”

References:
[1] “U.S. Medical School Applications and Matriculates by School, State of Legal Residence, and Sex, 2016-2017.” Association of American Medical Colleges, December 6, 2016.
[2] “Applying to Medical School.” Association of American Medical Colleges, n.d.
[3] “Tuition and Fees.” Harvard Medical School, November 29, 2016.
[4] “Total Graduates by U.S. Medical School and Sex, 2011-2012 through 2015-2016.” Association of American Medical Colleges, December 19, 2016.

Sample Medical College Admission Test (MCAT) questions from How to Become a Doctor:

Vocabulary:

1. AUDACIOUS: (A) splendid (B) loquacious (C) cautious (D) auspicious (E) presumptuous

Quantitative Ability:

2. It is known that every circle has an equation of the form Ax2 + Ay2 + Bx + Cy + D = 0. Which of the following is the equation of a circle?
A) 2x – 3y = 6
B) x2 – y2 + 4x – 2y + 3 = 0
C) 3x2 + 3y2 – 2x + 6y +1 = 0
D) 2x2 + 3y2 + 6x + 4y +1 = 0
E) None of the above

Understanding of Modern Society:

3. Japan today presents no immediate threat to peace in the Far East principally because:
(A) so much of the country has been devastated
(B) she has been stripped of her colonies and conquests
(C) the present Japanese constitution outlaws war
(D) the new Japanese government is much opposed to the military party
(E)there is now unity of purpose among the various interest in the Far East

Premedical Sciences:

4. Which one of the following is 75 percent carbon, by weight, and 25 percent hydrogen, by weight?
(A) 
C3H
(B) 
CH
(C) 
CH3
(D) C2H3
(E) CH4

Answers: 1. (E), 2. (C), 3. (B), 4. (E)

Deafness as a Public Health Issue in the 1920s & 1930s (Part 2 of 2)

Today we have part two of a guest post written by Dr. Jaipreet Virdi-Dhesi, the 2016 Klemperer Fellow in the History of Medicine at the New York Academy of Medicine and a SSHRC Postdoctoral Fellow in the Department of History at Brock University in St. Catharines, Ontario. She is working on her first book, Hearing Happiness: Fakes, Fads, and Frauds in Deafness Cures, which examines the medical history of hearing loss and “quack cures” for deafness. Some of these cures are explored on her blog, From the Hands of Quacks. You can find her on twitter as @jaivirdi.

Promotional photo by the New York League for the Hard of Hearing and its hearing clinic for testing and examination (The Bulletin, Dec. 1935)

Promotional photo by the New York League for the Hard of Hearing and its hearing clinic for testing and examination (The Bulletin, Dec. 1935)

The New York League for the Hard of Hearing launched several campaigns during the 1930s addressing the “psychological aspect” of acquired deafness mentioned by Wendell C. Phillips. Since deafness is an invisible affliction, Phillips emphasized the deafened person often feels isolated and unable to adjust to the sensory change, especially if the hearing loss occurred suddenly. Other otologists agreed as many patients narrated similar stories: their hearing was perfectly fine and normal, then one day something happened and they became deaf, and the process of coming to terms to the newfound deafened state was a difficult one. Illness such as influenza, pneumonia, meningitis, diphtheria, scarlet fever, measles, or ear abscesses were usually the culprit. So too were heard injuries, age-onset deafness in the elderly, misuse of drugs such as quinine, a poor diet (including too much sugar), and other ordinary factors:

“It is well to bear in mind the effects of hair-dyes, excessive smoking or drinking, and indeed, improper underwater swimming and diving. Vigorous blowing of the nose is also frequent causes of hearing impairment.”[1] 

Otologists claimed individuals needed to take responsibility for their hearing—to conserve what hearing one had, through proper diet, lifestyle, and hygiene, before it disintegrated. This was a remarkable shift from the 1920s “prevention of deafness” campaigns that concentrated on a screening program of early detection and medical care. While constant surveillance was still promoted, the late-1930s campaigns transformed hearing loss into an affliction that could easily be treated or managed by good habits.

Pamphlets reveal how parents were encouraged to become more “ear-minded” toward their children, that is, to pay attention if their child exhibits any signs of hearing loss, to avoid a circumstance in which a neglected hearing issue ends up turning a deafened child into a problem.

Advertisement for the New York League Hard of Hearing (The Bulletin, 1934).

Advertisement for the New York League Hard of Hearing (The Bulletin, 1934).

Image 6b

Advertisement for the New York League for the Hard of Hearing (The [Hearing] News, October 1935)

 

 

 

 

 

 

 

 

 

 

In other words, the “problem of deafness” became less about the triumphs of medical cures for hearing loss or social organizations providing communication services, but more about conserving one’s hearing before it was gradually diminished. Themes for “Better Hearing Week” especially reflect this: the 1937 theme was “It’s Sound Sense to Conserve Hearing,” while the 1938 was “Help Conserve Hearing.”

Front page of the October 1937 issue of The Bulletin magazine, promoting the National Hearing Week, with reprints of letters from FDR.

Front page of the October 1937 issue of The Bulletin magazine, promoting the National Hearing Week, with reprints of letters from FDR

The American Society for the Hard of Hearing also launched their own campaigns. In 1937, the organization listed a four-point program publicizing their mandates: the prevention of deafness, the conservation of hearing, the alleviation of social conditions affecting the hard of hearing, and rehabilitation. In addition to popular radio broadcasts on the National Broadcasting System, 327 feature articles and 189 editorials were released in over 1600 newspapers.

“Hearing through Life,” a national campaign launched by the ASHH (Hygeia, October 1937).

“Hearing through Life,” a national campaign launched by the ASHH (Hygeia, October 1937).

The publicity campaigns of the 1920s and 1930s were really about transforming public perceptions of the hard of hearing and deafened as handicapped persons, rather than as “defectives”—an important observation in light of the eugenicist concerns of the period. But they were also about addressing hearing impairment not as a social or educational issue, but as a public health issue, one that required cooperation between different levels of civic infrastructures. As otologist Edmund Prince Fowler noted in 1940, the hearing impaired “should never be dismissed with the thought, “Nothing can be done.”[2]

Promotional photo for the League’s “Children’s Auditory Training Project” campaign of the 1940s (The Bulletin, Nov-Dec, 1949)

Promotional photo for the League’s “Children’s Auditory Training Project” campaign of the 1940s (The Bulletin, Nov-Dec, 1949)

Special thanks are owed to Arlene Shaner at the NYAM Library for her generous research assistance and lively conversations.

References

[1] Samuel Zwerling, “Problems of the Hard of Hearing,” Hearing News (January 1938).

[2] Bulletin of the New York League for the Hard of Hearing, 18.7 (November 1940).

Deafness as a Public Health Issue in the 1920s & 1930s (Part 1 of 2)

Today we have part one of a guest post written by Dr. Jaipreet Virdi-Dhesi, the 2016 Klemperer Fellow in the History of Medicine at the New York Academy of Medicine and a SSHRC Postdoctoral Fellow in the Department of History at Brock University in St. Catharines, Ontario. She is working on her first book, Hearing Happiness: Fakes, Fads, and Frauds in Deafness Cures, which examines the medical history of hearing loss and “quack cures” for deafness. Some of these cures are explored on her blog, From the Hands of Quacks. You can find her on twitter as @jaivirdi.

In 1935, physician Francis L. Rogers of Long Beach read a paper addressing the worrisome statistics of deafness. One study discovered nearly thirty-five thousand Americans were deaf. Another found that out of a million people tested for their hearing, 6% had significant hearing impairment. Yet another study reported three million people had some kind of hearing impairment. This “problem of deafness,” Rogers emphasized, “is primarily of public health and public welfare.” Not only were there too many people failing to adequately care for their hearing, but many cities, schools, and governments lacked the proper infrastructure to educate the public on the importance of hearing preservation. Indeed, as Rogers stressed: “Today the three great public health problems confronting the world are heart disease, cancer, and deafness.”[1]

Image 1

A window display in Detroit (Hearing News, June 1942)

The notion of deafness being statistically worrying as a public health issue actually dates to the late nineteenth century, especially to the work of otologist James Kerr Love of Glasgow. Love conducted several statistical studies of the ears of deaf schoolchildren, discovering that the majority of them were not completely deaf, but had some level of “residual” hearing. With proper medical treatment, the hearing could be intensified enough to warrant a “cure.” For other cases, children could be taught to make use of that residual hearing through invasive training using acoustic aids and other kinds of hearing technologies.

Love’s research concluded that many deafness cases could actually be relieved if the ears of children were examined early and frequently—that is, deafness could be prevented. His “prevention of deafness” concept was influential for the new generation of otologists in America, especially those who were members of the New York Academy of Medicine’s Section of Otology during the first three decades of the twentieth century.

To raise awareness on the necessity of proper medical examinations and frequent hearing tests, these otologists collaborated with social organizations such as the New York League for the Hard of Hearing, which was established in 1910. The League was a progressive group catering to the needs of hard of hearing or deafened persons who were raised in a hearing society rather than in a D/deaf community and communicated primarily with speech and lip-reading rather than sign language. Composed mostly of white, middle-class, and educated members who lost their hearing from illness, injury, or progressive deafness, the League strove to construct hearing impairment as a medical issue. They argued hearing impairment was not an issue of education or communication, but rather a handicap.

Image 2

An otologist examining a young patient’s ear (Hygeia, June 1923)

The collaboration between New York otologists and the League eventually created a national network of experts, social services, teachers, physicians, and volunteers who banded together to address the so-called “problem of deafness.” That is, the problem of how to best integrate the hard of hearing, the deafened, and to some extent, even the deaf-mutes, into society. One key achievement of the League was the establishment of hearing clinics to properly assess hearing impairment, especially in children, to ensure medical care could be provided before it was too late. This project was primarily spearheaded by Harold M. Hays (1880-1940), who was recruited as president of the League in 1913, becoming the first active otologist collaborating with the League. After the First World War, Hays set up a clinic for treating hearing loss in children at the Manhattan Eye, Ear, and Throat Hospital.

Image 3

Group hearing tests of schoolchildren, using an audiometer. Headphones are used first on the right ear, then the left. (Hygeia, February 1928)

Hays claimed that hearing impairment might be a handicap, but “the sad part of it is that 90 percent of all hearing troubles could be corrected if they were treated at the proper time.” With regular hearing tests, this was possible. Yet, as Hays argued, regular hearing tests were not considered on par with other hygienic measures under public health services:

We are saving the child’s eyes! We are saving the child’s teeth! Is it not worth while to save the child’s ears?”[2]

During the 1920s, Hays’ activism for regular hearing tests was so instrumental that in 1922, the League’s newsletter, The Chronicle, told its readers “we believe that the League would justify its existence if it did no other work than to prevent as much deafness as possible.”  To achieve this mandate, the League launched a large public campaign to raise awareness on the importance of medical care. Indeed, in one report for the League, Hays remarked that with the increased publicity, there were 10,000 calls to the League in 1918 alone inquiring about aural examinations. A steady increase in patients would follow: 17 clinic patients in 1924, 326 in 1926, and then 1,531 in 1934.

Another publicity campaign spearheaded by the League was the establishment of “Better Hearing Week” in 1926, a week-long awareness program (later renamed “National Hearing Week”). Held in October, the campaign included symposium discussions on the “Problems of the Hard of Hearing,” including topics on the relationship between the physician and his deafened patient, how the deafened could build their lives, and even on newest technological developments in hearing aids. October issues of The Bulletin (the renamed League newsletter) and the Hearing News, the newsletter of the American Society for the Hard of Hearing (ASHH) included reprints of letters from prominent leaders supporting the mandates of “Better Hearing Week,” including letters from President Roosevelt and New York Mayor LaGuardia.

Image 4

Advertisement for Western Electric Hearing Aid, the “Audiophone.” These before-and-after shots were powerful for demonstrating the effects of “normal” hearing, sending the message that outward signs of deafness, such as the “confused face,” could easily disappear once being fitted properly with a hearing aid. (Hearing News, December 1936)

The 1920s publicity campaigns were primarily focused on fostering ties between otologists and the League, in cooperation with hospitals and schools. In 1927, the League purchased audiometers and offered invitations to conduct hearing tests in schools across New York, so children with hearing impairment could be assessed accordingly. Two years later, the League worked with Bell Laboratories to further substantiate the conviction that deafness was a serious problem amongst schoolchildren and that something needed to be done.

At the same time otologists across America established joint ventures between organizations like the America Medical Association and the American Otological Society. They formed committees to write reports to the White House on the national importance of addressing the “prevention of deafness.” Wendell C. Phillips (1857-1934), another president of the League and the founder of ASHH, particularly emphasized the need to address the “psychologic conditions and mental reactions” of the deafened patient, for the tragedy of acquired deafness meant it is a “disability without outward signs, for the deafened person uses no crutch, no black goggles, no tapping staff.”[3] It was an invisible handicap that needed to be made visible if it was to be prevented, if not cured.

References

[1] The Federation News, August 1935.

[2] Harold M. Hays, “Do Your Ears Hear?” Hygeia (April 1925).

[3] Wendell C. Phillips, “Reminiscences of an Otologist,” Hygeia (October 1930).

Music and Medicine: Thoughts on a G-String

This is one of several posts leading up to our day-long Performing Medicine Festival on April 5, 2014, which will explore the interrelationships of medicine, health, and the performing arts. Register for the festival here.

Guest blogger Dr. Danielle Ofri, editor-in-chief of the Bellevue Literary Review, will moderate the closing panel discussion at the event. This essay was originally published in The Lancet and is reposted with permission.

By Danielle Ofri

Danielle Ofri. Credit: Joon Park

Danielle Ofri. Credit: Joon Park

The moment has finally arrived. After three years of sweating through etudes, scales, and Suzuki practice books, my teacher utters the words that every cello student yearns to hear: “It’s time to start the first Bach suite.”

It started on a lark, really, when I asked my daughter’s first violin teacher how to coax a child to practice. She casually commented that the best thing is to see a parent practice. I hailed the nearest taxi and promptly purchased a cello. I started lessons, applying the same brute-force approach I’d acquired in medical school—playing the assigned notes over and over again until they were seared in my memory like the Krebs’ cycle and the 12 cranial nerves.

I added cello to the chores of my life—caring for patients, teaching, writing, and editing. But over the three years, an unexpected transformation occurred. Far from being a chore or a parental device to influence my daughter’s propensity to practice, cello turned out to be something that I genuinely wanted to do each night, almost to the exclusion of all else. Newspaper reading shrunk to cursory glances. Phone calls were avoided. Medical journals slipped to the subterranean level of the reading pile. Journal subscriptions lapsed.

I still love my “day job,” taking pleasure in teaching students and connecting with patients, but I have to be honest that, at this point in my career, the sense of growth has remained at a relatively steady state. With music, however, the intellectual challenges develop in ways that are new and surprising to me. The trajectory of learning, of frustration, and of accomplishment for the beginning musician has more in common with the intellectual vibrancy of life as a beginning medical student. I find that I am more driven to enhance my musical skills than I am my medical skills, although I certainly don’t wish the latter to falter.

As I continued to pursue the cello in the evenings, hospital-corridor conversations during the day revealed musicians hidden in all sorts of unlikely clinical corners: the pathologist who played violin, the ER doctor who was an accomplished cellist, the clinic director who played saxophone, the student who’d flipped a coin between Juilliard and medical school, the anesthesiologist who studied flute at the Eastman School of Music before “retiring” to a more practical career, the pulmonary fellow whose legendary beer-chugging habits masked a prodigious violin repertoire. Was this just a matter of uncovering a common hobby by making the effort to look, or might there be some intrinsic connection between?

I knew there was a doctors’ orchestra here in New York City, and as I started poking around I learned that there were others in Boston, Houston, Los Angeles, and Philadelphia. There was also one in Europe, one in Jerusalem, one in Australia; even a World Doctors’ Orchestra.

Was this merely because most doctors grew up in middle-class homes conducive to music lessons? I searched other professions, and uncovered one lawyers’ orchestra in Atlanta. But I couldn’t find a single accountants’ orchestra, or architects’ orchestra, or engineers’ orchestra. There wasn’t any orchestra made up of Wall Street executives, computer programmers, government officials, or direct marketers.

There have been writings about the relation between medicine and the listening aspects of music, but nothing on the playing of music. Why do so many doctors pursue music? Why does the orchestra of doctors in Boston (the Longwood Symphony) receive audition inquiries on a daily basis?

Mark Jude Tramo, a neurologist, songwriter/musician, and director of The Institute for Music and Brain Science at Harvard and Massachusetts General Hospital, feels that “there is overlap between the emotional and social aspects of relating to sick patients and communicating emotion to others through music. Some would speculate that there is [also] an overlap between aptitude for science, which most premeds major in, and for music.”

Lisa Wong—violinist, pediatrician, and president of the Longwood Symphony Orchestra—speaks for the many who came to medicine after years dedicated to serious musicanship. “The music we create builds in us an emotional strength, sense of identity, and sense of order. Then it is given away—we play for others, we play in ensembles. We come to medicine and it is the same thing. The giving, the service—in music and medicine—is a natural connection.”

Michael Lasserson, a British double-bass player, retired family physician, and founder of the European Doctors’ Orchestra, speaks from the perspective of the dedicated amateur. Although he was raised in a family of professional musicians, it was clear rather early on that he was headed for medicine rather than the stage. But, “music never lets you go,” he says. And it is more than just a hobby to make one a happier doctor. “It is a means whereby one is lifted away from the essential loneliness of clinical decision-making and action, into a world of a common enthusiasm and endeavor as the group searches for the beauty of sound [and] the composer’s intent, and those few hours have what can only be described as a healing function.”

There is also the risk-taking that offers parallels between medicine and music. It takes a certain amount of fortitude to slice open a patient’s abdomen with a scalpel. No less is required to take on Mahler’s seventh or the late Beethoven string quartets. “We hurl ourselves with suicidal courage against the commanding heights of the repertoire,” Lasserson says, hoping just to “touch the hem of that greatness”, though he acknowledges that sometimes, for the amateur, “miming skills will come to the fore.”

I debate this every night as I approach that single precious hour of energy after all the childcare has been completed and before exhaustion forces me to bed. Do I read that groundbreaking clinical trial that will surely impact my practice? Do I work on that unfinished book chapter? Do I read the newspaper and catch up on world events? Do I organize the entropy of my desk? Do I exercise for 30 minutes as I routinely exhort my patients to do?

Unfailingly, the answer is “none of above.” No matter how tired I am, no matter how much neuronal lint has accumulated throughout the day, I tighten the hairs on my bow and dig the end-pin of the cello into my rutted carpet. As I start to work on my assigned music for the week, I find myself focusing ever more narrowly on a single page, a single line, a single measure—even a single note.

Temperamentally, this is the exact opposite of life in the hospital, in which I feel pelted by ringing phones, needy patients, impossible schedules, irritating bureaucracies, and a cacophony of meaningless minutiae. It is a glorious relief, instead, to struggle for—and occasionally achieve—precisely the right note. But then, there is a step even beyond that. The note doesn’t have to merely be right—it also has to be beautiful.

Beauty is not something that gets much shrift in medicine. Other than the experimental design of a classic study that might be referred to as “elegant,” there isn’t much in medicine that falls into the category of beauty. Beauty is inherently unpragmatic—it doesn’t enhance efficiency, increase productivity, earn a grant, or cure a patient. Maybe it is this lack of beauty that drives doctor–musicians to struggle to draw some into their lives via music.

But perhaps there is indeed something in medicine that is related to beauty. After all, medicine is about life—the wriggling, sensual, bodily aspects of being alive. This is not something that can be said about engineering, law, or accounting. Although being alive—and being sick—can frequently be unpleasant, it never ceases to be miraculous. That miraculousness—and the privilege of doctors to be part of it—is a beauty in itself.

Willa Cather once said, “Novelists, opera singers, even doctors, have in common the unique and marvelous experience of entering into the very skin of another human being.” The beauty of entering the very skin of another human being is how many musicians describe the emotional experience of playing music. And for many, it is the striving to achieve that—almost more than the attainment—that offers the most pleasure. As we physicians strive to achieve the best for our patients in the messy, corporeal world of clinical medicine, we work to enter that very skin of another human being, and perhaps—with luck—we can touch the hem of that greatness.

Touching the hem is about all I can aspire to, but that’s enough. I’m willing to grovel for that. The sheet music of the first Bach suite appears straightforward—two pages of evenly spaced notes in the key of G. No intricate timing, no double-sharps, no key shifts, no clef shifts, no fancy ornamentation. But as anyone who as ever tussled with Bach knows, that simplicity is ruthlessly deceptive. “One measure at a time,” my teacher has instructed me. “It needs to be completely memorized. Expect to put in about a year on this.” This is said without irony.

Week after week, month after month, I tiptoe gingerly through the music. The melodic phrases are simultaneously simple and horrifically complex. But when I’ve survived a measure and can play several notes in sequence, the beauty is astounding—the type of beauty that really does take the breath away. I haven’t made it to the hem yet, and may never. But that’s okay. It’s all in the reaching.