JULY 7, 1899. ] 
strive for, and he who acquires them to a 
high degree is a great man; such were 
Helmholtz, Darwin, Newton and a few 
others out of all time. The two grades of 
observation and reasoning must be distin- 
guished, the lower repetitive grade and the 
higher original grade. Many a person of 
ability may be taught to see and under- 
stand that which has been seen and under- 
stood before. Such persons in medicine can 
make correct diagnoses of known diseases, 
but in the presence of the new unknown 
they fail. Such persons in science may do 
good work as followers, not leaders—pri- 
vates, not generals. To the few are accorded 
the privileges of the higher grade, right 
sight and right thought as they invade the 
unknown. The training in exact science 
does more than any other discipline to ele- 
vate those who have sufficiently great gifts 
into this highest intellectual grade. We 
say, therefore, unhesitatingly that severe 
scientific education is the principal addition 
we ought to make to our medical curricu- 
lum. So I come back to my opening asser- 
tion: We must teach how to learn, and how 
to learn from the unknown. 
If we admit the principle that science 
should have a more influential place than at 
present we must decide in what way that 
place can be provided. It is, I think, un- 
desirable to lengthen the medical course 
beyond the four years now required ; it is 
undesirable to omit any of the subjects now 
offered, and it is equally undesirable to en- 
large greatly the fundamental scientific 
courses in anatomy, physiology, pathology, 
etc. We seem surrounded by impassable 
walls, but there are two considerations 
which may guide us. On the one hand is 
the enormous growth of medical knowledge, 
which is beyond the power of any single 
student to master, so that some choice must 
be made for him or by him. On the other 
hand the science we are now seeking a 
place for is not that which is basal, but 
“SCIENCE. | 5 
that which is to perfect and end the whole 
training; it is to be the top, not the founda- 
tion. Clearly, then, the way out is to in- 
troduce the elective system on a large scale 
into the fourth and perhaps third year. 
Make aseries of these electives for advanced 
work in scientific subjects, such as anatomy, 
embryology, physiology, pathology, pharma- 
cology, bacteriology. As you know, this 
solution has been tried,and with most en- 
couraging results. May we not look for- 
ward to its becoming the universal method 
throughout America ? 
As regards the elective system I follow 
Dr. Henry P. Bowditch in believing that 
it should be greatly extended, and that the 
required studies in medicine should be re- 
duced to the minimum, and numerous elec- 
tives provided for every year of study. 
These proposed electives may be in subjects 
already taught and also may provide courses 
not usually offered, such, for example, as ex- 
amination of the blood, pathological chem- 
istry and psychology in its medical aspects. 
The elective system is the educational an- 
swer to the tendency toward specialization 
in practice, and I believe that we have no 
choice as to its adoption. 
We pass on to the consideration of the 
second phase of the case which we are de- 
bating. It will probably need a much 
longer and more sustained effort to bring 
about a correct recognition of the relations 
of medicine to biology than is needed to 
win recognition for science at large. 
Medicine is one department of applied 
biology, just as dyeing is one department 
of applied chemistry, or electric lighting a 
department of applied physics. Now if a 
man wishes to become an expert dyer or 
electrician he studies chemistry as a whole 
and physics as a whole, but the would-be 
physician begins at once with human an- 
atomy and human physiology, and probably 
to the end of his days never discovers that 
he has no conception whatever of biological 
