JlLY 30, !90!)] 



SCIENCE 



185 



medical sciences. It will be observed that 

 these two important results have to do with 

 the preparation for practical medical work. 

 On the old system two j'ears were given to 

 acquiring a suiBcient knowledge of the art 

 of medicine. As scientific knowledge in- 

 creased and penetrated into medicine the 

 period of instruction was prolonged to four 

 years, or taking into account all of the 

 necessary preparation, to six or eight 

 years, but all of this additional time was 

 devoted substantially to preliminary or 

 preparatory training. This is a significant 

 fact. All of the trulj' art side of medicine 

 or of any other profession may be acquired 

 on the apprenticeship system, without any 

 previous preparation other than is implied 

 in a basis of general intelligence. It is the 

 scientific side of medicine which calls for 

 all of this extensive preliminary training. 

 Without it one might still in a two years' 

 course make a capable practitioner, to use 

 a distinction made long ago bj^ Magendie, 

 but not a scientific physician. The difiier- 

 euee between an able practitioner and a 

 scientifically trained phj^sician is not so 

 striking that it can be appreciated at once 

 by the public at large. The difference is 

 there, however, and eventually it means 

 everything to the advancement of medicine 

 to i-ecognize this difference and to increase 

 it by every means at our command, what- 

 ever cost of time and nionej- it may entail. 

 Excellence is generally the thing that costs. 

 If by the expenditure of more money we 

 can add a knot or two to the speed of our 

 steamships we know that it pays us to do so, 

 and if by longer and more expensive train- 

 ing the efSciency of the physician may be 

 increased a little, the difference is worth 

 the cost, for it also will add much to the 

 happiness and prosperity of the whole 

 community. 



The content of the curriculum of our 

 first two years, and the character of the 



instruction given during that period, may 

 be modified moi-e or less from time to time. 

 It may be expanded or more probably it 

 may be simplified, but it seems to me that 

 our system of medical instruction in this 

 country is committed definitively to the 

 general principle that these medical sciences 

 shall be taught as the other sciences in the 

 university are taught, by specialists who 

 give their entire time to the work and who 

 are active in research as well as in instruc- 

 tion. The force of successful example will 

 compel all schools to follow this type. But, 

 we may ask, is there no change that is desir- 

 able in the system of instruction in the 

 clinical branches 1 This is a question which 

 ought to be discussed by clinicians as by 

 those who know whereof they speak. But 

 it is a general truth, perhaps, that reforms 

 in teaching do not usually originate from 

 those occupying the positions in which 

 changes are called for. Feelings of per- 

 sonal interest or loyalty to traditions pre- 

 vent them from seeing clearly the defects 

 that may be obvious to others. It comes 

 about, therefore, that the initial impulse 

 to reform is often forced upon us by criti- 

 cism from without. In regard to the teach- 

 ing of the clinical subjects in our medical 

 schools three general changes have been 

 suggested at one time or another and are 

 likely to come up for serious consideration 

 in the immediate future. First, shall the 

 time devoted to these subjects, under the 

 auspices of the medical school, be length- 

 ened 1 At present the usual plan is to give 

 two years to this side, and the definite sug- 

 gestion made is that a third, exclusively 

 hospital year, shall be added. I shall not 

 stop to discuss this question. Our gi-adu- 

 ates themselves realize the value of this 

 additional experience and in increasing 

 numbers every year they are seeking a 

 term of service in the hospitals before en- 

 tering upon private practise. It seems to 



