June 6, 1913] 



SCIENCE 



851 



of the college courses do not often give this 

 direction. 



It must be borne in mind that it is pos- 

 sible to educate a student away from scien- 

 tific thought, as well as toward it. It has 

 been disappointing to note the effect of a 

 general college education on medical stu- 

 dents. They come to the medical school 

 often unwilling to adjust themselves to the 

 regime. They have lost much of their re- 

 ceptiveness, they are to a degree mentally 

 arrogant, they have a pseudo-philosophical 

 and not a scientific frame of mind. It is 

 for this reason that often the high-school 

 graduate gets more out of the course than 

 the man with a B.A. degree. 



In demanditig one year of college work 

 as an entrance requirement, the medical 

 schools have not only a right, but a duty, to 

 demand of the colleges that the course be 

 standardized; that it be made worth the 

 students ' time, both in content and methods. 

 Otherwise it is useless, both from the cul- 

 tural and technical standpoint. It will be 

 not a specific, but a quack remedy, pre- 

 scribed for the cure of our educational ill- 

 ness. I firmly believe in better preliminary 

 education of the medical student, and am 

 only raising these questions that they may 

 be discussed. 



What influence will the added year of 

 preliminary training have on the medical 

 course? WiU it allow of changes in our 

 present curriculum? For it is conceded 

 that at present it is overcrowded; that the 

 difficulties of medical education are in- 

 creasing; that the burden is heavy on both 

 teachers and student; that there is a waste 

 of effort that is almost tragic. 



The problems of medical education are 

 bound up with the progress in medicine 

 and therefore can not be solved once and 

 for all, but must be constantly under con- 

 sideration and adjustment. In all consid- 

 eration of them, certain facts must be kept 



constantly in mind. The period of study 

 can not be indefinitely extended. There 

 must be a proper proportion between the 

 period of preparation for and practising 

 of a profession. As Professor Starling has 

 so well put it, ' ' The brain of man does not 

 increase in capacity or in power of assim- 

 ilation with the growth of science. " " How 

 is the necessary limited time of medical 

 education to be most profitably employed 

 in imparting to the student such knowl- 

 edge as is most useful to him in his future 

 career ? ' ' The effect of the overloaded cur- 

 riculum on the student is most harmful. 

 He gets a smattering of many things, in- 

 stead of a thorough grounding in prin- 

 ciples. He forms faulty mental habits, 

 early becomes surfeited and loses interest 

 in the work; everything is gauged by ex- 

 amination value; he has no sense of pro- 

 portion, small details and facts loom large, 

 basic principles are unimportant. At what 

 point should the unloading begin? What 

 ballast should be thrown overboard? 



Notwithstanding the work of the com- 

 mittee on curriculum of this association 

 and that of the council on medical educa- 

 tion of the American Medical Association, 

 the usual medical course still contains 

 much useless ballast, some of it traditional, 

 some of it due to demands of state board 

 examinations and some gradual "accre- 

 tion" due to a desire to meet the advances 

 in medical sciences. 



Professor Welch, in opening the discus- 

 sion on "The Medical Curriculum" at the 

 meeting of this association at Baltimore, 

 said: 



One of the fundamental things is to inquire, What 

 is the object of medical education? To make good 

 doctors ; there is no question that that should be the 

 underlying conception in our schemes for medical 

 education, and unless you can define a given course 

 as bearing on that training, it has no place in the 

 medical curriculum. If the training in physiology 

 can not be shown to be to make good doctors, it is 



