The physician's apprentice

In the early 19th century, aspiring physicians learned by “reading and riding with the doctors.”

In March 1811, at the age of 22, Elijah Woodward Carpenter of Brattleboro, Vt., signed his name to an indenture, a contract with Cyrus Washburn, a doctor in the nearby town of Vernon. Carpenter agreed to serve as Washburn’s apprentice for the next two years or more and pay him a fee of $133.33. In return Washburn would provide room and board in his home, and would instruct Carpenter “personally and by the use of books, in the art & science of Anatomy, Surgery and Physic.”

At that time only a handful of American medical schools existed, and Carpenter’s apprenticeship represented the most common form of medical training in the New World. The Medical Institution of Yale College had been chartered the previous year, but its first class, in which Carpenter would be one of 37 students, would not begin studies until November 1813.

For the elite, premier medical training could be had in European universities. But for Carpenter—who was born in a log hut—university training in Europe was not an option. In fact, it took him three years to pay Washburn’s fee. For most Americans who wished to pursue medicine, apprenticeship to a local practitioner was the only option.

The quality of the training, which usually lasted for two or three years, depended on the skills of the teacher. Often described as “reading with the doctors and riding with the doctors,” apprenticeship consisted of book study and a later phase in which the student attended his preceptor on his rounds—on horseback.

In exchange for his on-the-job learning, the apprentice did the “grunt work” of the medical practitioner. Carpenter agreed to “diligently during said term attend to the study, and art of practicing Physic, Surgery &c. and agreeably to the directions of the said Washburn from time to time, prepare & Compound medicines for his the said Washburn’s use.” Carpenter may have been lucky: Beyond compounding medicines, apprentices often tended the horses and cleaned the stables.

Despite its shortcomings, apprenticeship offered a crude prototype of clinical training. It was the most practical system available, and physicians saw apprenticeship as one way to standardize medical training. In 1800, a committee of the Connecticut Medical Society, seeking to regularize physician education in the state, recommended that candidates wishing to practice medicine be at least 21, have a good reputation, have a college education, and have two years of study with a respectable physician or surgeon.

When the apprenticeship concluded, the preceptor sent off his student with a written certificate, much like the one Washburn provided Carpenter in July of 1814 after Carpenter had attended one course of lectures at Yale’s fledgling medical institution. (Lack of funds prevented Carpenter from taking a second course.) Washburn began his testimony by citing Carpenter’s “reputable family” and “good moral character.” Then he explained that Carpenter had “with much industry and success devoted three years to the theory & practice of Physic, Surgery &c. under my immediate inspection.”

Washburn’s certificate would be virtually worthless to anyone not familiar with his skill, thus underscoring a major problem with apprenticeship: its authority resided with the preceptor. What was lacking was a standard and objective body of knowledge, and an institution to communicate such knowledge. As the medical school grew in stature, it would become the locus of science, and the medical profession in the middle and later parts of the 19th century would embrace both.

Carpenter went on to a successful career as a physician and surgeon in Vermont and was a surgeon’s mate in the Massachusetts militia. He died in Vermont in 1855.

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