Medical care in nineteenth-century Texas differed little from that in other areas where frontier conditions prevailed. Throughout the United States physicians thought that disease was the result of poison and that the poison should be removed by bloodletting and purging. Liberal doses of calomel frequently brought death, but the belief in their value persisted. Complaints about physicians were common. During the antebellum period the quality of medical education in the United States was poor. Schools fell into two categories, university and proprietary. They offered a similar curriculum and faced the same difficulties, but because of their dependence on student fees proprietary schools were commonly known as diploma mills. Usually no premedical training was required, and laboratories and libraries were seldom available. The apprentice system was also used; young men learned the art of healing by studying a "winter or two" with an established practitioner.
The first mention of a medical school in Texas occurred in 1839 when Dr. G. F. H. Crockett of Mississippi wrote the president of the Republic of Texas, Mirabeau B. Lamar, about the possibility of opening a school there. Nothing came of the correspondence, although in 1844 the Texas Congress granted a charter for the establishment of Herman University, where medicine and other subjects would be taught. It never offered classes due to a lack of funds. Indeed, the first school that had courses of instruction was the Galveston Medical College, organized in November 1865. Poorly equipped, the school closed in 1873 after the faculty resigned in protest over the administration of Dr. Greensville S. Dowell. It was reorganized that same year as Texas Medical College and Hospital. Fort Worth School of Medicine was organized in 1894. In 1881 the legislature established a state university with a medical department at Galveston. Anticipating a new and state-supported school in town, the Texas Medical College shut down. However, the legislature could not provide the funds for the new school, and Galveston business interests and some physicians in 1888 reopened the Texas Medical College "to fill the gap until the university could begin its operations." It closed for the last time in 1891. Construction of the "Red Brick Building," headquarters of the University of Texas Medical Branch and a landmark in Galveston, began in 1890 next to John Sealy Hospital, which had opened that year. The original faculty in 1891 had thirteen members; eight were full-time. But the facilities were lacking. After the Galveston hurricane of 1900, the school received much better support and began a long period of expansion and development.
Medical schools multiplied at the turn of the century in Texas. Two, Baylor University College of Medicine and the University of Dallas Medical Department, were organized in 1900; the later gave rise to Dallas Medical College in 1901 as a result of a faculty dispute. At Texarkana, Gate City Medical College was started in 1902, and another two Dallas schools, Bell Medical College and Southwestern University Medical College, were founded in 1903 and 1907 respectively. It appeared that the founders of these schools had the best intentions to offer bona-fide instruction in medical science, but they had too few resources. Most of them ceased operations or were absorbed by other schools within a short time. Under pressure from the Texas Medical Association, which was affiliated with the American Medical Association, the legislature established the State Board of Medical Examiners in 1901. The law specified "that no member shall be a professor or teacher in any medical school." This measure took the power of licensure away from faculty members, thereby sounding the death-knell of proprietary schools. In 1907 the legislature passed stiffer requirements for applicants to the Board of Medical Examiners. Applicants must have attended a "reputable" medical school whose course of instruction should total 4,000 hours during four college years. The significance of the law was twofold: Texas physicians would henceforth have to attend a school with a four-year curriculum, and the schools would have to offer laboratory experience. In 1910 the influential Flexner report, recommended that only about one-fifth of the 147 schools in the United States be allowed to operate. The report identified four schools in Texas-Baylor University College of Medicine, Southwestern University Medical College, Fort Worth University School of Medicine, and the University of Texas Department of Medicine at Galveston. Only the graduates of the last, the report said, deserved the right to practice. The other schools might become acceptable only through large infusions of money. Baylor and Galveston were the only schools to survive the combined attack by the state legislature and the Flexner report. Dallas Medical College closed its doors in 1904. In 1911 Gate City Medical College closed when it was caught selling diplomas. Bell Medical College could not get recognition by the State Board of Medical Examiners and closed in 1908. Southwestern University was absorbed by Southern Methodist University in 1911, but closed in 1915. As a result of the Flexner report, the Council on Medical Education of the American Medical Association gave Baylor a B rating in 1911. Baylor expanded its laboratories, stiffened its entrance requirements, affiliated with Parkland Hospital, and received an A rating in 1916. In 1918 the last of the substandard schools disappeared when the Fort Worth School of Medicine, affiliated with Texas Christian University, was absorbed by Baylor.
No new medical schools appeared until near midcentury, when important changes in the socioeconomic life of the state brought new activity. In 1920 the urban population of Texas was 34 percent, but the percentage had climbed to 63 percent by 1950. By 1947 Texas ranked twelfth in value added by manufacturing. Some of the New Deal agencies of the 1930s provided many Texans with health care for the first time; participants in the Civilian Conservation Corps were given physical examinations, and the Federal Emergency Relief Administration authorized the use of funds for medical, dental, and nursing care. The Social Security Administration, established in 1935, channeled money into the care of crippled children, maternal and child care, and the promotion of state and local public-health boards. Some Texans received their first hospital and physician care in the military during World War II, and passage of the Hill-Burton Act in 1946 brought an expansion of hospital construction. Voluntary health insurance grew, and participation in prepaid group practices did the same. Texans, like all Americans, began to plan for and expect medical care as part of their standard of living.
In 1939, Dr. Edward H. Cary, a graduate of Bellevue Hospital Medical College in New York, obtained a charter for the Southwestern Medical Foundation in Dallas. For a while, it appeared that the foundation and Baylor would combine into one, but Cary announced in 1943 an independently operated Southwestern Medical College. It affiliated with Parkland Hospital and received a probationary A rating from the American Medical Association-an unusual occurrence, but the wartime emergency served to justify it. A sense of competition developed when the proposed merger of the two schools failed, and Baylor's trustees believed "it would have been extremely difficult, if not impossible, for Baylor's medical college to have continued in Dallas." The trustees conferred with the newly established M. D. Anderson Foundation in Houston, which had decided to support a major medical center. Baylor and the foundation reached an agreement, and Baylor graduated its last class taught in Dallas in 1943 and moved to Houston. At the midcentury point, the three schools in Texas graduated about 200 physicians. That did not mean, however, that the Lone Star State had an adequate supply of physicians.
An explosion in population, industrialization, and urbanization occurred. By 1970 Texas had 11,197,000 inhabitants, of which 79 percent lived in cities. Industrial wealth expanded nationwide; manufacturing had made Texas the seventh-richest state. Greater per capita wealth brought a natural increase in health care, and the establishment in 1965 of the federal-state medicare and medicaid programs also intensified demand. The aging veterans of World War II and Korea, plus the needs of the younger Viet Nam veterans, put more stress on veterans' hospitals. The explosion of medical knowledge brought new specializations, longer residencies, and greater diversification of classroom teaching, thereby lengthening the time physicians spent in professional preparation. Schools felt pressure to diversify their curriculum and keep up with new knowledge, pressure that necessitated more faculty members, better library holdings, and new laboratory equipment. By the mid-1960s, the United States had a "doctor shortage." In 1970 Texas had 111 physicians per 100,000 residents, below the recommended rate of 133 per 100,000. In some rural counties, the rate was one-third of the national average. To combat the M.D. crisis, the federal government began promoting medical education. Passage of the Health Professions Educational Assistance Act in 1963 provided matching grants for construction. The Medical Library Act in 1965 provided funds for library improvements. To assist with veterans' care, the Veterans Administration Medical School Assistance and Health Manpower Training act of 1972 provided one school and four regional medical centers.
With the availability of federal funding and the growing conviction that the United States faced a shortage of physicians, Texas established four new schools. In 1959 the legislature authorized the University of Texas Medical School at San Antonio, which enrolled its first class in 1966. The University of Texas Medical School at Houston and Texas Tech University Medical School were authorized simultaneously in 1969. The Veterans Administration Medical School Assistance and Health Manpower Training Act of 1972 established Texas A&M University Medical School, which opened in 1977, to provide care for the growing number of veterans. Though private, Baylor University benefited from the surge of activity; in 1972 the legislature began appropriating funds that amounted to $27 million by 1983 for Baylor to use toward an increase in enrollment. The Texas College of Osteopathic Medicine in Fort Worth, a new private school, was founded in 1966. Its first class enrolled in 1970 in temporary quarters at the Fort Worth Osteopathic Hospital. In 1975 the school became a tax-supported institution when it affiliated with North Texas State University, and three years later it moved into permanent quarters. The eight schools in Texas compare favorably with the number in other highly industrialized states. Only New York has more, and Texas shares second place with three states. By 1985 Texas had 26,304 physicians, almost twice the number in 1974 (13,956). Vacancies appeared in some schools, and the ratio of physicians to population had climbed to 165 per 100,000. New schools in the twentieth century seemed unnecessary. See also HEALTH AND MEDICINE.