SCIENCE 



NEW YORK, JULY 3, 1891. 



IDEALS OF MEDICAL EDUCATION.^ 



When ttie medical faculty of an ancient, famous, and 

 progressive university honors a physician by a request that 

 he will deliver an address to it, and to its friends, upon such 

 an occasion as this, the subject of that address must be sought 

 within certain limits. It should have some relation to the 

 special work of the faculty, — to medical education as it was, 

 or is, or should be. The fact that you have already had 

 three addresses bearing on this subject by distinguished med- 

 ical teachers, who are more familiar with its practical bear- 

 ings and needs than I can be, does not authorize me to try 

 another field, although it greatly increases my difficulty in 

 selecting reflections and suggestions which are suited to the 

 occasion and to the audience, and which, at the same time, 

 will not be a wearisome repetition of what is already familiar 

 to you. I know, however, that discourses of this kind are 

 soon forgotten: were it otherwise, this would indeed be a 

 hard world for address givers. 



Of course the medical department of Yale is organized in 

 the best possible manner, and is doing the best possible work, 

 under the circumstances. I do not know precisely what its 

 organization is, or work it is doing, or the exact circum- 

 stances which govern it, but I have no doubt it is safe to as- 

 sume this. There is one circumstance, however, which very 

 commonly affects medical schools and universities, and 

 which therefore may possibly affect you, and that is, the 

 want of means to do every thing that anybody may con- 

 sider desirable. Perhaps, then, some remarks upon certain 

 modern ideals of medical education, and upon first-class 

 medical schools and their cost, based upon data derived from 

 other schools, may be of some interest, especially in the light 

 of Eouchefoucauld's aphorism that there is something in the 

 misfortunes of our best friends which is not displeasing to 

 us. 



The great mass of the public — the majority of the voters 

 of all parties, and of the women who are not voters — know 

 little and care less about the details of professional educa- 

 tion, or about the standard of qualification attained to by 

 those to whom they intrust more or less of the care of their 

 souls, their property, or their bodies. The popular feeling is 

 that in a free country every one should have the right to 

 follow any occupation he likes, and employ for any purpose 

 any one whom he selects, and that each party must take the 

 consequences. 



It is noteworthy, however, that each individual professing 

 to hold this opinion almost always makes an exception to 

 his own occupation if it is one involving skilled labor. He 

 is in favor of free trade in the abstract, and of limitations 

 with regard to his own particular trade, either as to number 

 of apprentices, as to time of study, or as to some form of 

 trust which will prevent, as far as possible, competition in 

 that special business. In one of its aspects, medicine is a 

 trade, carried on for the purpose of making money in order 



' Address delivered before the Medical Faculty of Tale College, June 23, 

 1891, by John S. BUllngs, M.D. (Boston Medical and Surgical Journal.) 



to support the physician and his family; and to the majority 

 of practitioners this is a very important aspect, although 

 to very few of them is it the only one. Hence it is that 

 medical faculties must consider schemes of medical education 

 from this point of view also; not exclusively so by any 

 means, but, nevertheless, with reference to the questions: 

 What do we propose to ofiier? How much will it cost us? 

 How much shall we charge for it? With reference to the 

 first question, it is obvious that there are several quite differ- 

 ent kinds of education which a medical faculty may offer to 

 its students. It is by no means easy to decide as to the 

 quality and quantity of the article offered by consulting only 

 the advertisements, circulars, and prospectuses of the one 

 hundred and more medical schools in tlie United States, but 

 even from these it can be seen that one can get a diploma of 

 doctor of medicine in much less time, and at much less ex- 

 pense, from some schools than from others, — and we all 

 know that the diplomas of these different schools are guar- 

 antees of very different education and qualifications. 



There are also several different ideals as to what is desira- 

 ble in medical education. For instance, there is the ideal of 

 the literary man, of the clergyman, of the laborer, and of 

 other classes of the general public. There is the ideal of the 

 man who wants to obtain a medical degree as soon and as 

 cheaply as possible, in order that he may commence prac- 

 tice ; the ideal of the same man after he has obtained such a 

 degree and has been for two oy three years trying to get 

 practice; and the ideal of the middle-aged successful practi- 

 tioner who has learned several things by experience since he 

 graduated. Then we have the ideal of the army and navy 

 examining boards, the ideal of the man of means who wants 

 to become a specialist without ever going into general prac- 

 tice, and the ideal of the man who wishes to be an investi- 

 gator and a teacher, either from the love of science or from 

 the desire for fame. Let us consider these ideals briefly. 

 The chief demand of the great mass of the non-professional 

 public is for general practitioners, and the qualifications 

 which these should possess may be summed up in the state- 

 ment that they should be competent to recognize the forms 

 of disease and injury which are common in the com.munity 

 in which they practice, and should know, and be able to ap- 

 ply, the remedies which are most frequently used and found 

 efficacious in such cases. They are expected, for the most 

 part, to follow and not to lead, It is not necessary that they 

 should be skilled in the refinements of modern pathology, or 

 be thoroughly trained in minute anatomy or experimental 

 physiology, or be great surgeons, or be well up in all the 

 specialties. Observe that I say it is not necessary ; it may 

 be desirable, but in the majority of cases it is not practica- 

 ble. 



In their brief journey of life through this world the great 

 majority of people must travel on the routes and by the ve- 

 hicles provided for them by others, and, fortunately, they are 

 usually content to do so. They move in groups which are 

 "personally conducted," see the things they are told to see, 

 try with more or less success to admire the things which 

 they are told to admire; and their chief discontent occurs 

 when their conductors are either silent or give contradictory 



