UTILITARIAN SCIENCE. 87 



tain salient features of medical research, of medical practise, and of 

 medical instruction in America. 



In matters of research, the most fruitful line of investigation has 

 been along the line of the mechanism of immunity from contagious 

 diseases. To know the nature of microorganisms and their effect on 

 the tissues is to furnish the means of fighting them. ' The first place 

 in experimental medicine to-day/ says Dr. W. H. Welch, ' is occupied 

 by the problem of immunity.' That medicine is becoming a scientific 

 profession and not a trade is the basis of the growing interest of our 

 physicians in scientific problems, and this again leads to increased 

 success in dealing with matters of health and disease. The discovery 

 of the part played by mosquitoes in the dissemination of malaria, yellow 

 fever, dengue, elephantiasis and other diseases caused by microorgan- 

 isms marks an epoch in the study of these diseases. The conquest of 

 diphtheria is another of the features of advance in modern medicine, 

 and another is shown in the great development of surgical skill charac- 

 teristic of American medical science. But the discoveries of the last 

 decades have been rarely startling or epoch-making. They have rather 

 tended to fill the gaps in our knowledge, and there remain many more 

 gaps to fill before medical practise can reach the highest point of 

 adequacy. The great need of the profession is still in the direction 

 of research, and research of the character which takes the whole life 

 and energy of the ablest men demands money for its maintenance. 

 We need no more medical colleges for the teaching of the elements. 

 We need schools or laboratories of research for the training of the 

 masters. 



In the development of medicine there has been a steady movement 

 away from universal systems and a priori principles, on the one hand, 

 and, on the other hand, from blind empiricism, with the giving of drugs 

 with sole reference to their apparent results. The applications of 

 science — all sciences which deal with life, with force and with chemical 

 composition — must enter into the basis of medicine. Hence the in- 

 sistent demand for better preliminary training before entering on the 

 study of medicine. " Only the genius of the first order," says a corre- 

 spondent, " can get on without proper schooling in his youth. What 

 our medical investigators in this country most need is a thorough 

 grounding in the sciences, especially physics and chemistry." 



The instruction in medicine, a few years ago almost a farce in 

 America, has steadily grown more serious. Laboratory work and 

 clinical experience have taken the place of lectures, the courses have 

 been lengthened, higher preparation for entrance has been exacted, 

 though in almost all our schools these requirements are still far too low, 

 and a more active and original type of teacher has been in demand. 

 Even yet, so far as medical instruction is concerned, the hopeful sign 

 is to be found in progress rather than in achievement. A college 

 course, having as its major subjects the sciences fundamental to 



