April 2, 1920] 



SCIENCE 



337 



superficial features of disease, history-taking, 

 physical diagnosis. X-ray examination, etc. 

 There should also be courses in pathological 

 anatomy, including study of the blood and 

 other tissues that can be obtained during life, 

 courses dealing with the application of physio- 

 logical and chemical methods to the study of 

 disease, and courses devoted to the study of 

 the pathogenic bacteria and other parasites. 

 As soon as possible, the students shotJd begin 

 the actual study of disease as it occurs in the 

 patient, and the results as seen at autopsy. 

 The students should spend a large part of their 

 time in the wards and laboratories, making 

 their study at first hand and relating all that 

 they do to actual cases of disease. Reading 

 must be encouraged and the student should be 

 urged to consult original sources. It might be 

 advisable to have the student devote a given 

 period of his course to the study of infectious 

 diseases, during which period much of his 

 time would be spent in the bacteriological and 

 pathological laboratories of the clinic. In 

 another period the time would be spent mainly 

 in the study of so-called diseases of metabolism, 

 during which period he would have his work- 

 ing place and spend much time in the chemical 

 laboratory of the clinic. 



During his course the student should make 

 an intensive study of at least one disease, ma- 

 king an attempt to learn all that is known 

 about that disease, repeating with his own 

 hands the important steps which have led to 

 present knowledge, and if possible, he should 

 add something, however slight, to existing 

 knowledge concerning this disease. By means 

 of seminars and conferences, 'both at the bed- 

 side and in the laboratory, each student would 

 at all times be kept in touch with the work of 

 all the other men in the clinic — students and 

 teadhers. The student would himself become 

 an instructor of his fellow workers. The teach- 

 ers would be engaged in directing and assist- 

 ing the students in this work and in carrying 

 out their own investigations. 



At the end of two years the student would 

 have acquired a great deal of knowledge about 

 a considerable number of diseases, their pre- 

 vention, nature, causes and treatment, and 



would be well trained in the methods of study- 

 ing disease. He wouid also be familiar with 

 the methods and principles of diagnosis. 



It may be true that the department of medi- 

 cine I have sketched will not provide the stu- 

 dent with the wide experience with disease in 

 its various manifestations which would make 

 him an able practitioner. But even with pres- 

 ent educational methods, no one assumes that 

 immediately after a student obtains his de- 

 gree he is a capable, or even a satisfactory 

 practitioner of medicine. It wiU be asked, 

 where, under the system proposed, will the stu- 

 dent get this wider experience and practise in 

 technique. He will get it exactly where he 

 gets it now, in the hospital year or years, or 

 where he used to get it, in actual practise. 

 !N"o better system for producing good work- 

 men, be they physicians or bricklayers, has been 

 devised than the apprentice system. It is of 

 great importance, therefore, that a good ex- 

 ample be set in the hospitals in which students 

 obtain experience and skill in the practical 

 application of medical principles; this is al- 

 most as important as it is that the work in 

 the ujiiversity should be of the right kind. 

 While the hospital can only occasionally and 

 with difficulty make good practitioners of men 

 who have had little or poor training in the 

 science of medicine, it can very easily ruin 

 men, however well they may have been funda- 

 mentally trained. There will always be the 

 opportunity and need for good practitioners 

 who teach by example. The preceptor system 

 is of great value in its proper place. The 

 trouble with the present system of medical 

 education is that it consists almost exclusively 

 of the old preceptor system employed in a 

 wholesale and frequently inefficient manner. 

 Modern developments require for medical edu- 

 cation a scientific basis, with a final polish 

 added by a preceptor system correctly applied. 

 . The question will now be asked : Should the 

 professors of medicine in the university de- 

 partment of medicine be trained in clinical 

 medicine, or may they be men who have been 

 trained only in physiological methods or chem- 

 ical methods, or who have had experience with 

 disease only as it occurs in experimental ani- 



