IN 19TH-CENTURY AMERICA, medical education tended to be a haphazard affair. Various pathways were possible, including medical school, apprenticeship, house pupilship, and European study. Some led to the granting of a medical degree; others provided clinical experience but no formal study. Medical licensure was often laissez-faire in nature with neither a degree nor even a modicum of training a necessary prerequisite. In retrospect, it is easy to be overly harsh in evaluating this situation. However, the country was experiencing a growth spurt unparalleled in its existence. With an expanding populace, scattered over frontier territory, the rudimentary education and training that most physician/surgeons received was better than none at all. Quacks, empirics, and other medical miscreants ran amuck, and the obtaining of adequate health care could be a hit or miss proposition. In truth, medical science was not yet substantively advanced in its ability to treat most diseases. Accordingly, many citizens remained wary of what doctors could actually accomplish. Despite these deplorable conditions, early- to mid-19th century American medical education did manage to produce numerous medical and surgical luminaries. In most instances, such individuals pursued multiple paths of medical training that existed as supplements to the inadequate instruction provided at the country's fledgling medical schools.
Rutkow IM. Extramural Medical Schools. Arch Surg. 2001;136(4):479. doi:10.1001/archsurg.136.4.479