Medical Practice without a Medical Degree

The practical effect on Dr. Goforth of his having been diverted by the Doctors Mob from his goal of obtaining a medical degree was not disastrous under the circumstances of the day. As already mentioned it was commonplace at the beginning of the nineteenth century in America to practice medicine with no other training than apprenticeships such as Goforth completed in New York before the riot, and as Drake completed under Goforth's preceptorship in 1804. In his comprehensive Contributions to the Annals of Medical Progress, J.B. Toner has the following commentary on medical practice at the time of the Revolution: ^[62]

It is probable that at the time of the Revolution there were not living in all the colonies 400 physicians who had received medical degrees; and yet .... there were presumed to be over 3,500 practitioners. The American colleges had up to 1776 in the aggregate issued but fifty-one degrees, including that of bachelor of medicine. At the close of the century, those who had received degrees from American institutions did not number 250, but probably five times this number had attended one course of lectures at the different colleges, and who were then in practice. ....(Up) to the beginning of the revolutionary war but two medical colleges had been organized in the United States. .... During the period from the close of the Revolution to (1800), .... there was a marked increase of medical students in the country, and no less than five additional colleges, or rather medical faculties, organized; but in 1800 we find only four of them still in existence, welcoming within them the medical students of America.

Drake, however, was not content to continue medical practice without formal medical studies and an MD degree. He traveled 18 days by horseback to Philadelphia to take the course of lectures at the University of Pennsylvania School of Medicine in 1805-1806 when Benjamin Rush was in his heyday. Drake returned to Philadelphia in the fall of 1815 for further study, and received his MD degree from the University in 1816 at the age of 30. By this time he had become well established in medical practice in Cincinnati and had written two books in 1810 on the Climate and Topography of Cincinnati and the Miami Country that earned him a national reputation as an author.

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Drake at Transylvania Medical College

New horizons then beckoned Drake in academia. He was offered an appointment as Professor of Materia Medica and Medical Botany on the faculty of the Medical Department of Transylvania University in Lexington, Kentucky. This was the first medical school west of the Allegheny Mountains. It had been authorized by the Board of Trustees of Transylvania University in 1799, but regular instruction in the Medical Department did not begin until the fall of 1817. It was at this time that Drake took up his appointment. "Thus Drake, the first medical student of medicine in Cincinnati, the first Cincinnatian to receive a diploma in medicine, and the first medical author in the West, also became a member of the first accredited faculty of the first medical institution west of the Alleghenies." ^[63]

The 1817-18 session was the first recognized medical course conducted by the Transylvania Medical School, and 20 students were enrolled. Of this first class, there was only one successful candidate for the MD degree. Drake acquitted himself admirably of his teaching responsibilities, consisting almost entirely of lectures. An example of his earnest eloquence is to be found in his lecture to the departing class at the end of the year. In this final lecture he addressed the perennial theme of "medicine as a life-long study," and did so in the ornate language then much admired: ^[64]

When you leave the medical school, your studies are merely begun. The germ of your future professional knowledge is yet a tender seedling, which neglected by you must inevitably perish. Watch over it then unceasingly - foster it with tenderness - supply it with liberality, and you will elevate it in time to a magnificent tree. Its balmy exhortation will diffuse health and comfort among the wretched victims of disease; - the golden fruit of its wide spreading branches will supply your numerous wants, and in the shade of its ever green foliage you will glide serenely down the vale of declining life . . . . .

Dudley-Richardson Duel

When he joined the Transylvania faculty, Drake was unprepared for the academic polemics, and worse, that he encountered. But he later demonstrated a natural aptitude for the art of invective.

Dissension had erupted during the organizational meeting of the medical faculty at the beginning of the year, and continued throughout the session. Controversy was stirred when Benjamin Dudley, Professor of Anatomy and Surgery, objected to the presence on the faculty of William Richardson, Professor of Obstetrics, who held no degree in medicine. Tension remained high after the session ended in early March 1818 and a conflagration, to be ignited, needed only a spark.

This was provided by Drake's letter of resignation from the faculty in late March of 1818. Dudley openly accused Drake of breaking a promise to remain on the faculty two years, and of trying to destroy the Transylvania Medical College. In the ensuing correspondence with Drake, Dudley made insulting references to Richardson who became incensed when they came to his attention, and challenged Dudley to a duel. Although illegal in Kentucky, duels were still countenanced in defense of a "gentleman's honor", broadly construed. Dudley accepted the challenge and chose pistols as the weapons. To avoid intervention by the authorities, the duel took place in secrecy in the summer of 1818. Dudley's shot struck Richardson in the groin, lacerating a major artery, presumably the femoral. He would probably have bled to death from the wound had not Dudley rushed to his side and made pressure with his thumb on the artery proximally, thereby preventing further blood loss while Richardson's surgeon tied the vessel - without the benefit of either anesthesia or asepsis, both then unknown to medicine as we have already mentioned. All hail to the surgeon who performed this difficult operation on a patient stretched on the ground in a remote forest clearing.

Dudley recovered and, according to some versions of the affair, he and Richardson later became "fast friends." Although questionable, this outcome gains some credibility from the fact that they were both Past Masters of the Grand Lodge of the Fraternal Order of Masons in Kentucky. The Grand Lodge first suspended the duelists, and then reinstated them as a result of "the reconciliation which has happily taken place between said brothers." ^[65]

Dudley-Drake Confrontation

In his dispute with Dudley, Drake took a different approach from that of Richardson. He refuted Dudley's accusations against himself by publishing two pamphlets addressed to the citizens of Lexington that thoroughly demolished Dudley's arguments, and directed at him the following barbs:

How far the preceding facts are adequate to (prove all my conduct relative to the University to have been correct and honorable) is not for me to decide. But I may be permitted to remark, that in proportion as they establish my innocence, they inevitably demonstrate Dr. Dudley to be a base and unprincipled villain, who has wantonly and wickedly sought to destroy my reputation. For this outrage, my feelings require no other, and can have no higher satisfaction, than the favorable award of an impartial and intelligent public.

I have now finished a necessary but disgusting task, and shall with great difficulty be re-excited to another of the same kind. Although I cannot, like the Grecian Hercules, boast of having vanquished a monster, I may at least claim some praise for having ferreted out one of the vermin which infest our modern Attica.

In a final scornful thrust at his adversary, Drake let it be known publicly that if Dudley committed the further outrage of challenging him to a duel, he would accept it. Nothing more was heard from Dudley, and Drake departed the field of his first major academic encounter with a clear victory. He was not in future to fare so well. ^[66]

The unfortunate Richardson had in Drake at least one forthright and effective advocate. Recognizing the importance to Richardson of obtaining medical credentials if he was to survive in the academic arena, Drake on 31 December 1817 wrote to David Hosack, MD, at the College of Physicians and Surgeons in New York requesting that Richardson be given an honorary MD degree. The Honorary degree of Doctor of Medicine was awarded to Richardson on 6 April 1819, thus bespeaking Drake's already considerable stature in the medical profession at the age of 33. The cause of the delay in awarding the degree is unknown but was probably related to the complicated process by which such degrees were conferred, not by the College but by the Regents of the University of the State of New York. ^[67]