THE PROGRESS OF SCIENCE 



IOI 



MEDICAL EDUCATION IN THE 

 UNITED STATES 



The Carnegie Foundation has issued 

 a bulletin on medical education in 

 America, which is likely to do good 

 service in attracting attention to the 

 low standards and inadequate endow- 

 ment of many of the medical schools 

 of the United States. On behalf of the 

 foundation, Mr. Abraham Flexner has 

 visited every one of the 155 medical 

 schools, and gives a brief description 

 of each. The conditions in each state 

 are summarized, and plans are pro- 

 posed for their improvement. This de- 

 tailed report is preceded by an intro- 

 duction by President Pritchett and by 

 fourteen chapters by Mr. Flexner on 

 the whole subject of medical education 

 in this country, beginning with a his- 

 torical sketch and ending with the 

 education of the negro. The bulletin, 

 which extends to 347 pages, may be 

 obtained by sending seventeen cents 

 for postage to the foundation. 



The conditions of medical education 

 in the United States have been investi- 

 gated with equal thoroughness by the 

 council on education of the American 

 Medical Association, and are well un- 

 derstood by experts. There are too 

 many inadequately trained physicians 

 in the country, and one of the prin- 

 cipal difficulties is the existence of 

 proprietary schools dependent on the 

 fees of students. Physicians are ready 

 to be professors in medical schools for 

 the title and connections. When the 

 school depends for its support on the 

 fees, low standards are likely to be 

 adopted in order to attract students. 

 It was at one time possible to conduct 

 a proprietary school with tolerable 

 efficiency, as can now be done in the 

 case of law, but with the development 

 of laboratory and clinical methods, the 

 cost of a satisfactory medical educa- 

 tion can not be met by fees. It is 

 certainly a scandal that one third of 

 our medical schools have incomes be- 

 low $10,000, all from fees, that in some 

 cases there are as many professors as 



students, and that many students do 

 not have even a high school education. 

 One school actually exists with twenty- 

 six professors and a total income of 

 $1,060. 



But while every one knows and ad- 

 mits the evils, the remedy is not clear. 

 Though Dr. Pritchett and Mr. Flexner 

 have obtained their medical education 

 by a short course, they have had expert 

 advice and their general point of view 

 is sound. We need several university 

 schools of medicine emphasizing re- 

 search and demanding long preliminary 

 preparation, the schools for the train- 

 ing of the great mass of practising 

 physicians should require a training in 

 science and the languages equal to two 

 years of college, the schools in the 

 south can not at present reach this 

 standard, but should require a prepara- 

 tion equal to a four-year high school 

 course. Each school should have ade- 

 quate laboratories for anatomy, physi- 

 ology, chemistry and pathology under 

 the charge of professors and instructors 

 who give their whole time to the work 

 of teaching and research. The clinical 

 departments should be under the 

 charge of professors whose practise 

 does not interfere with their teaching, 

 and there should be a suitable hospital 

 and dispensary controlled by every 

 school. 



But how are we to reach these stand- 

 ards ? We are slowly approaching 

 them. When the Johns Hopkins Med- 

 ical School was opened seventeen years 

 ago, it was the only well-organized 

 department of medicine in the country. 

 With Harvard it still maintains pre- 

 eminence; but there are now some 

 thirty schools which give adequate 

 training for the medical profession. 

 The commercial schools are closing and 

 being merged every year, for by the 

 nature of things they can not last 

 when they do not pay. When good 

 schools are adequately endowed in all 

 sections of the country, students will 

 naturally frequent them. The states 

 can accomplish more for the profession 

 of medicine and the people by support- 



