Dr. James Frederic Madden probably attended medical school at the Medical College of Louisiana in New Orleans. This school eventually became Tulane University. The students would purchase Medical College Lecture tickets admitting them to attend the course lectures that they needed for graduation.

"Prior to 1900, most medical schools or colleges used a system of lecture cards or 'tickets' to pay their faculty and doctors who taught in the schools. The doctors who taught the course would issue a ticket to the students for their respective lecture in return for a (small by today's tuitions) fee paid by the student. A student may have previously graduated or attended a medical school and the course would be taken as a refresher or extended knowledge course. Not everyone who attended or bought a 'ticket' was there to graduate. Some just attended or 'audited' the course to update their education.

Typically in the early and mid 1800's, medical school was only for two years and students would buy tickets for the courses they needed to graduate. If they left for a year, when they returned, they could buy just the 'tickets' they needed to complete their degree. At the beginning of each year, the students would buy a set of lecture tickets from the various lecturers/doctors to cover the requirement for that year. Each year they bought another set of tickets toward their degree, but typically it was for a two year program."