October 27, 1916] 



SCIENCE 



585 



well as of physicians against overcrowding 

 in the profession is urged on grounds of 

 economy and efficiency by disinterested 

 experts of education, sociology and public 

 affairs, themselves not members of the 

 medical profession. 



Time will not permit us more than a 

 glance at the state of affairs which is set 

 forth in accurate detail in the reports men- 

 tioned. 



The educational systems, primary, sec- 

 ondary, university and professional of Ger- 

 many, Austria, France, England, Scotland, 

 the United States and Canada have been 

 carefully studied by Mr. Flexner. At- 

 tempt was made by him to measure all 

 countries by the same standards and to 

 analyze the conditions found. 



Since the outbreak of this world war it 

 is impossible to get accurate statistics, nor 

 if available would it be possible under pres- 

 ent abnormal conditions to judge from 

 them as to the efficiency of the existing 

 training mechanisms nor of the probable 

 adequacy or otherwise of the available 

 supply of physicians throughout the world 

 to meet the demand as it was before the 

 war, or as it will be at the conclusion of the 

 war. 



All of our standards have disappeared. 

 Old things have passed away. 



It seemed sufficient, therefore, for pur- 

 poses of this discussion, to take those sta- 

 tistics which were available before the 

 war, realizing, however, that post helium 

 evolution will probably be more accele- 

 rated than in ante helium times. The fol- 

 lowing figures were taken largely from 

 Flexner 's reports and from the publica- 

 tions of the American Medical Associa- 

 tion's Council on Medical Education. 



GERMANY 



Germany has only the one agency for the 

 training of physicians, her state universi- 

 ties. Twenty-one universities have been in 



operation for almost a century. Her train- 

 ing system for all her citizens is continu- 

 ous. There are no gaps and the state pro- 

 vides that training for each which appears 

 most needed for each. 



In an exhaustive article on "Continua- 

 tion Schools in England and Germany," 

 which appeared in the Fortnightly Review 

 of February, 1914, Mr. J. Saxon Mills, a 

 well-known British writer, calls attention 

 to the superiority of the German system 

 over the British system. He asks the perti- 

 nent question, "Wherein lies Britain's ad- 

 vantage in maintaining a two-ship power 

 while she permits Germany to maintain a 

 two-school power?" Her complete articu- 

 lation of teaching and investigation with 

 economic and military development has 

 made her the power she is. 



The German child goes to school from 

 the time he is six until he is ten. He then 

 enters the gymnasium, where he remains 

 until he is eighteen. The gymnasium com- 

 bines our school and university work and 

 gives the old-time classical and humanistic 

 training. Of recent years, the realschule 

 and the realgymnasia have been estab- 

 lished, in which the basic sciences are given 

 and the classical and humanistic training 

 correspondingly reduced. An increasing 

 number of prospective medical and tech- 

 nical students are now choosing these 

 latter courses instead of the gymnasium. 

 Roughly speaking, graduation from the 

 gymnasium, realschule or realgymnasium 

 is about equivalent to the completion of our 

 second year in a good American university. 



Graduates of these three intermediate in- 

 stitutions are now ready to enter the five- 

 year course in medicine afforded by the 

 universities. 



Flexner, who is himself an educationist 

 trained in the humanistic school, realizes 

 the rapid increase in the sum total of essen- 

 tial human knowledge and the consequent 

 need for prolongation of the training 



