JUNE 21, 1912] 
Such a plan insures diagnostic ability 
and therapeutic skill by training the pow- 
ers of direct observation as well as by in- 
struction in the methods of indirect obser- 
vation through the use of instruments of 
precision and the procedures of the chem- 
ical and biologie laboratories. The experi- 
mental method emphasized in the labora- 
tory years is thus continued through the 
clinical years. Laboratory procedures nat- 
urally fall into their proper place in re- 
lation to the methods of direct observa- 
tion, and as the student approaches each 
new disease in the spirit of the investiga- 
tor and not as an onlooker he gains a 
point of view which can not fail to have 
an important bearing on his work as a 
practising physician. 
The Hospital Year.—So much for the 
preparation which the training, facilities 
and opportunities of the modern medical 
school should offer as leading to the degree 
of doctor of medicine. Should the state 
and the public demand more? Yes, the 
state, through its machinery for the pro- 
tection of the individual, should demand 
a fifth year of hospital work, and this the 
public would force the state to demand if 
the easy-going public was thoroughly fa- 
miliar with the insufficient requirements of 
many of our state licensing boards. In- 
deed, some states are already drafting laws 
to protect their citizens from the products 
of the poor medical schools of a neighbor- 
ing state— 
For example, the state of Minnesota has enacted 
a law enforcing an educational qualification as to 
the training of physicians who are allowed to 
practise in that state. The law was adopted in 
order to protect citizens of Minnesota against the 
graduate of commercial medical schools in neigh- 
boring states, and particularly of Chicago. In the 
present state of medical education such a measure 
is entirely justifiable.” 
1 Pritchett, H. S., ‘‘ Education and the Nation,’’ 
The Atlantic Monthly, April, 1912. 
SCIENCE 
955 
Such a law not only protects the com- 
munity against the improperly prepared 
graduates of the poor school, but it encour- 
ages the good medical school to increased 
efforts. 
The hospital year as a prerequisite to 
licensure is to-day a live topic of discus- 
sion; to-morrow it may be in this and in 
other states a requirement legally stated.*° 
Indeed it is difficult to see how the progres- 
sive state of New York, the educational sys- 
tem of which is so wisely controlled by a 
special board of regents, can much longer 
delay in establishing such a requirement. 
But why wait for the regents to force this 
upon the schools? Already 80 to 90 per 
cent. of the men in the better schools se- 
cure hospital appointments. Why should 
not the schools compel the small minority 
of those who do not secure a hospital to 
take a fifth year in clinical instruction in 
the hospital which it controls and thus be 
prepared for the requirement which must 
inevitably come in this and other states. 
I realize fully that the deans of our various 
schools are divided on this question. Some 
take the position that although the hospital 
year is an excellent requirement, the bur- 
den of finding the hospital instruction for 
all its graduates should not be placed on 
the school; that the duty of the university 
is ended when it has given four years of 
instruction and that the fulfillment of the 
added requirement is an affair of the indi- 
vidual. What does this mean in the last 
22There is only one school at present which re- 
quires the fifth hospital year, and that is the 
University of Minnesota. No state boards at 
present require the hospital interne year. Those 
which to a certain extent have initiated practical 
tests at their examinations are Massachusetts, Min- 
nesota, Ohio and North Dakota, and to a lesser 
extent practical tests are being used in Colorado 
and Michigan. (Personal communication from N. 
P. Colwell, secretary, Council on Medical Educa- 
tion of the American Medical Association.) 
