July 30, 1909] 



SCIENCE 



l.U 



the creation of the numerous poor schools 

 with which this country was afBicted, and 

 whose ill-prepared graduates practised in 

 tlie centers of population as well as in the 

 outposts of civilization. One can not en- 

 tirely suppress the suspicion that motives 

 of personal gain and commercial expedi- 

 ency were largely responsible for the de- 

 plorable condition that prevailed in the 

 latter half of the nineteenth century. A 

 few schools possessed of good traditions 

 made an earnest fight for better things 

 under very adverse circumstances, and we 

 must recognize that among the graduates 

 of the poorer schools there were some who 

 became able and even famous practitioners. 

 I venture to believe that this latter result 

 was in no way due to the system, but is to 

 be explained by the fact that the profession 

 of medicine will always draw to itself a 

 considerable number of able and high- 

 minded men, who are bound to make them- 

 selves felt upon whatever system their edu- 

 cation may be conducted. But the general 

 output of medical graduates was for a time 

 far inferior in quality to that supplied to 

 other nations. What else could be expected 

 from a system which permitted, indeed act- 

 ively encouraged, men to enter the medical 

 school without any previous education and 

 then qualified them to practise upon the 

 public after a bare ten or twelve months' 

 study of the science and art of medicine^ 

 It was much easier at one time to enter the 

 profession of medicine than to become a 

 recognized journeyman in a trade. The 

 conditions indeed became bad enough to 

 call urgently for reform, and this call has 

 grown increasingly imperative down to the 

 present day. In a democratic country like 

 ours a reform in a system of education is 

 naturally a slow process. Under a more 

 centralized form of government it is only 

 necessary to convince the few who have 

 authority and the desired reform may be 



inaugurated promptly and eflt'ectively. But 

 with us it is requisite to arouse the people 

 at large. If an improvement is called for 

 it can only be established permanently by 

 creating an enlightened public opinion in 

 its favor. It happens therefore in medicine 

 as in politics that the country gets about 

 the kind of service that the majority thinks 

 it wants, and progressive leaders have a 

 very hard time in making that majority 

 change its ideas. Certainly in medicine 

 the effort for reform has been a long and 

 laborious one, but we may feel sure that 

 now the tide of public opinion has turned 

 in favor of a better system. A necessary 

 preliminary step was the development of 

 an appreciation of science in this counti-y. 

 Fortunately our colleges and universities 

 have made splendid progress in this res- 

 pect. They have created a scientific atmos- 

 phere, they have let loose among us a sci- 

 entific spirit which has entered like a 

 ferment into the medical schools. There, 

 like a ferment, it has caused much commo- 

 tion and unrest of a healthy and normal 

 kind, the end-result of which will be no 

 doubt the establishment of a system of 

 medical training as good at least as that 

 found in other countries of the same grade 

 of civilization. It may be interesting to in- 

 quire how far we have advanced toward 

 this desirable end; and in what direction 

 our present tendencies are taking us. The 

 positive results of the agitation begun 

 during the present generation are impor- 

 tant and satisfactory. Our schools, if we 

 take them all into account, are still so 

 heterogeneous that it is scarcely possible to 

 make any general statements that shall be 

 equally applicable to all, but we have an 

 increasing number of strong schools which 

 are setting the pace for the rest, and those 

 that can not keep up will have to drop out 

 of the race altogether. According to re- 

 ports thirty schools surrendered to this fate 



