October 22, 1009] 



SCIENCE 



539 



competition for them, and the smaller place 

 offers a more certain reward to the medical 

 man of good training, good habits, good 

 health and perseverance. 



A smaller percentage of medical gradu- 

 ates may continue their preparation be- 

 yond that of the practitioner, with the in- 

 tention of becoming surgeons, medical con- 

 sultants or specialists. More and more at 

 the present time is surgical work done by 

 men specially trained and who confine their 

 work to surgery as opposed to the older 

 plan, very generally followed, of each phy- 

 sician doing some operative work. Even 

 with a very great increase in the number of 

 diseased conditions amenable to surgical 

 treatment, one skilled surgeon can do all 

 of the work needed by a population of con- 

 siderable size and not a very great number 

 of surgeons are needed in a community. 

 Consequently only a comparatively few are 

 likely to attain to success in this branch. 

 For the few who do, the reward is great 

 and the successful surgeon obtains an in- 

 come large even when compared with the 

 incomes of present-day industrial life, but 

 this success comes only after a period which 

 has involved a number of years' prepara- 

 tion beyond that received by him who 

 enters general practise. A considerable 

 special knowledge of anatomy and pathol- 

 ogy is needed by the surgeon and this 

 entails many hours of painstaking work. 

 Then comes the period of assisting some 

 trained surgeon, gradually attaining the 

 manual dexterity and the knowledge that 

 are required for the surgeon. The surg- 

 eon's apprenticeship should last six to eight 

 years, years in which his earning capacity 

 has been relatively small and his labors 

 arduous. Eemembering this, the surgeon 

 surely deserves a good income when his 

 period of matured activity comes and a 

 small group of men can anticipate this suc- 

 cess in surgery. 



For the medical consultant a very sim- 



ilar period of preparation is required. 

 This possibility to the young graduate is 

 essentially a recent development in medi- 

 cine in this country. In the past, the 

 medical consultant has been almost invari- 

 ably a man of mature years, trained by an 

 extensive general practise from which he 

 has gradually withdrawn as his consulta- 

 tion work has grown. Now there is a field 

 for a differently trained consultant, though 

 there is undoubtedly still a place in con- 

 sultation for the matured judgment of the 

 general practitioner, where his practical 

 experience is of extreme value. Still the 

 young graduate to-day can deliberately 

 train himself for consultation work. A few 

 years should be spent by him in the labo- 

 ratory gaining first-hand knowledge of 

 some one of the fundamental sciences of 

 medicine, anatomy, physiology, pathology, 

 bacteriology, chemistry or pharmacology. 

 Then a large part of his time should be 

 devoted to work in the hospital, where he 

 may combine observation of many patients 

 with laboratory investigation, supplement- 

 ing all, of course, with study of medical 

 literature. Five or six years of such work 

 will give him a deeper knowledge of the 

 facts and methods of medicine than many 

 more years spent in general practise, and 

 this knowledge should be useful to the gen- 

 eral practitioner, too busily engaged with 

 routine for maintained study of a subject 

 which like medicine is constantly progress- 

 ing and developing. Gradually there has 

 come a call for the consultant so trained 

 and I believe in the future an increasing 

 number of consultants will be thus trained 

 and this field of work will be offered as a 

 possible career for the graduate in medi- 

 cine, yielding him a better income than 

 general practise, though rarely as great as 

 that gained by the successful surgeon. 



There are various fields of special med- 

 ical work open to graduates, such as dis- 

 eases of the ej^e, the ear, the nose, etc. In 



