588 



SCIENCE 



TN. S. Vol. XLIV. No. 1139 



may be made that the profession in France, 

 as in all other countries, was overcrowded 

 in the city and undersupplied in the thinly 

 peopled districts, because they failed to 

 offer the inducement of a livelihood. Out- 

 side Paris the ratio was 1 to 2,360 ; in 

 Lozerre it was 1 to 3,221. 



ENGLAND AND SCOTLAND 



In England premedical and medical edu- 

 cation are very different from the German 

 system. The following paragraph from the 

 Carnegie report is of interest : 



la striking contrast with organized and syste- 

 matized Germany are the conditions surrounding 

 secondary education in England. 



Mr. Flexner apparently had not the time 

 at his disposal to enable him to become so 

 thoroughly familiar with the complicated 

 English individualistic plan as with the 

 German systematic scheme, with its central 

 and, from the administrative viewpoint, 

 simpler control. He does not discuss the 

 Scotch system of education, which for the 

 average boy has long been much more easily 

 accessible and systematic than in England. 

 One who knows something of the British 

 system can easily sympathize with the 

 dilemma in which Mr. Flexner, an outsider, 

 found himself. Perhaps one of the most 

 striking examples of complexity is afforded 

 by the relations and inter-relations of the 

 various constituent colleges and depart- 

 ments of Cambridge or Oxford, where tra- 

 ditions, centuries old, often constitute the 

 basis of procedure, private and public. 

 Flexner mentions one instance to show the 

 lack of uniformity of standards when he 

 directs attention to a school whose sixth 

 form admits to Oxford whilst it announces 

 publicly that its fifth form prepares for 

 Birmingham or Durham Universities. He 

 could not understand how universities, 

 even those situated in large cities, compete 

 with secondary schools by conducting ele- 

 mentary classes for matriculation. 



England and Scotland have twenty-seven 

 medical schools, which is 29 per cent, more 

 than in Germany, although the population 

 is 40 per cent, less than that of Germany. 



Considerable space in the report is de- 

 voted to the differences in British stand- 

 ards of admission, graduation and licens- 

 ure, and the adequacy in general of the 

 British examinations is commended. Mr. 

 Flexner says: "Examination is a national 

 industry; getting examined a national 

 habit." I myself think the British exami- 

 nation is probably the main corrective 

 against the lack of uniformity in standards 

 and methods of premedical and medical 

 teaching. The examination system brings 

 many weaknesses and hardships. The Eng- 

 lish teacher, through fear of written exter- 

 nal examination dare not train his boys, in 

 the words of Sir William Ramsay, "to do 

 something instead of know something." 



The variation in the requirements for 

 entrance into medicine in Great Britain is 

 tremendous. The student may begin the 

 study of medicine as a graduate in arts or 

 science, or with mere university matric- 

 ulation, or even on a level distinctly below 

 that which would be demanded by a uni- 

 versity for admission. And yet students 

 from these differing educational levels are 

 to be found side by side in all the London 

 medical schools. 



It is unnecessary to go into the details of 

 organization and operation of the various 

 medical teaching mechanisms of the uni- 

 versities, colleges, halls and other such in- 

 stitutions, or into the methods of examina- 

 tion employed by various universities, col- 

 leges and other bodies, many of which have 

 not taught the students they examine. 



Doubtless it seemed strange to Mr. 

 Flexner to find graduates in arts of the 

 Universities of Cambridge and Oxford, 

 most of whom take their clinical work in 

 the London hospital medical schools, re- 



