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SCIENCE 



[N. S. Vol. XXX. No. 761 



me most probable that we shall find it ad- 

 vantageous to follow in this respect the ex- 

 ample set for us by the older countries, 

 that is to add a year of hospital service as 

 an obligatory part of the requirements for 

 the degree in medicine or for the license to 

 practise medicine. As we all know, this 

 change has been strongly recommended by 

 the council on education of the American 

 Medical Association. Second, there is much 

 complaint from many sources, particularly 

 from the teachers of the medical sciences, 

 that the professors of the clinical subjects 

 do not make adequate use of the results 

 and methods of science in their instruction. 

 "What is the use of giving the student a 

 scientific training if the man who instructs 

 him in diagnosis and treatment neglects to 

 show wherein this knowledge is applicable ? 

 This is largely a matter of comparison. 

 We know that in foreign countries the 

 clinical teacher is usually well prepared to 

 use the results of science. In our own 

 country, outside some anatomy, normal and 

 pathological, this statement can not be 

 made. Our best clinicians heretofore have 

 been lacking in acquaintance with the facts 

 and methods of the underlying experimen- 

 tal sciences. This, however, is a defect 

 which time no doubt will remedy. The 

 newer appointments to these chairs will be 

 made from a group of men who have en- 

 joyed the benefits of a better scientific 

 preparation. It would, however, be a real 

 advance if we should adopt what seems to 

 be a practise in other countries, namely, to 

 require those who expect to take positions 

 upon the medical or surgical staffs to serve 

 a preliminary year or two in a scientific 

 laboratory, engaged upon research not too 

 immediately practical in character. The 

 suggestion made by Dr. Bevan that the po- 

 sitions upon the clinical staff might be 

 filled by men who had served as instructors 

 in anatomy, physiology or pathology is 



most excellent. If this procedure became 

 customary, if the professor of medicine, for 

 example, selected his assistants from the 

 teaching staff of the departments of physi- 

 ology, physiological chemistry and pathol- 

 ogy we should have an arrangement which, 

 on the one hand, would supply the clinical 

 departments with well-trained men, ca- 

 pable of undertaking independent in- 

 vestigations, and, on the other hand, would 

 probably direct toward the laboratory sub- 

 jects an abundant supply of young medical 

 graduates, whereas under present condi- 

 tions it is frequently necessary to go out- 

 side medicine in filling such positions. 

 Third, What shall be the character of the 

 duties and qualifications expected from 

 those who have the chief direction of the 

 work in the clinical departments 1 It is an 

 interesting and somewhat surprising fact 

 that in this part of our system of medical 

 education no change of importance has 

 been made in the methods of teaching dur- 

 ing the last few decades. So far as the stu- 

 dent himself is concerned no fundamental 

 change in opportunities is required. Clin- 

 ical instruction from the students' stand- 

 point always had the great merit that it 

 employs what we may call the laboratory 

 method, as opposed to the method of learn- 

 ing from books. The student is brought 

 face to face with experiments made by na- 

 ture and he is given an opportunity to 

 learn from personal experience rather than 

 from the experience of others. In our 

 modern schools his opportunities of this 

 kind have been greatly increased and to this 

 extent his instruction has been improved 

 in his clinical years along the same line as 

 in his preparatory years. But has there 

 been a development in the methods of 

 teaching in these clinical years correspond- 

 ing to that which has taken place in the 

 laboratory subjects 1 What we find is that 

 the backbone of the instruction in the clin- 



