SCIENCE 



NEW YORK, JULY 10, 1891. 



IDEALS OF MEDICAL EDUCATION.' 



(Continued from p. 4.) 



Having thus roughly sketched what is wanted in the way 

 of medical education by different classes of students, — the 

 article for which there is a market, — let us next consider 

 briefly what a university may wisely attempt to provide in 

 this direction. Some suggestions on this point may perhaps 

 be obtained from an examination of the condition of affairs 

 as regards medical education in the University of Oxford. 



The Corporation of Oxford has a little more than half the 

 number of inhabitants possessed by the city of New Haven, 

 and its relations to London are, in many respects, similar to 

 those of New Haven with the cities of New York and Bos- 

 ton. For a number of years it has been urged by some 

 physicians in England that the University of Oxford, with 

 her great resources, has not been doing as much for medical 

 education as she should have done, and that it is her duty 

 to establish and maintain a completely organized medical 

 school of the usual pattern, using the small local hospital 

 and dispensary facilities for the clinical side of the work. 



On the other hand, other physicians, of whom my friend 

 Sir Henry Acland may be taken as the representative, main- 

 tain that it is much better that Oxford should use her re- 

 sources in giving a broad foundation of literary and scien- 

 tific culture, including, for those who propose to study med- 

 icine, the means of special instruction in general biology, 

 and in comparative and human anatomy, physiology, and 

 pathology; and that the men thus prepared shou\d go to the 

 great hospital medical schools of London to obtain their 

 clinical training; after which they may return and pass 

 their final examinations, and obtain the coveted degree of 

 doctor of medicine from the university. 



There is no doubt that this can be done, and that a great 

 part of the scientific foundation of a complete medical train- 

 ing can be furnished by a well-equipped university, with little 

 or no reference to clinical instruction at the same time and 

 place. This, for example, is the course followed by many of 

 the students in the medical department of the University of 

 Virginia, and it seems to me that there is also no doubt that 

 the men who go through such a course of training, followed 

 by clinical training in a great city, will have a better course 

 of instruction, a wider experience, and a better chance of 

 seeing and appreciating the methods of great clinical teach- 

 ers, than would those who obtained their clinical as well as 

 their scientific training in the small town, or than those who 

 obtain all their instruclion in a school devoted exclusively 

 to medical studies. Upon this last point I need not dwell, 

 for Dr. Welch, in his address before you in 1888, has clearly 

 pointed out the advantages of giving to a medical school a 

 university atmosphere, and of making the union of the 

 school and the university close and intimate. It should be 

 noted, however, that the more true this is, the more it is the 

 duty of a university to maintain such a school, because edu- 



1 Address delivered before the Medical Faculty of Yale College, June 23, 

 1891, by John S. Billings, M.D. (Boston Medical and Surglcaljournal.) 



cational work which cannot be, or is not, done so well else- 

 where, has superior claims upon university aid. The chief 

 thing which can be said in favor of the attempt to attract a 

 large number of medical students of average qualifications 

 to an institution having the means to give the higher educa- 

 tion are, first, that it brings in more money, and second, that 

 it enables those professors who desire advanced workers, to 

 select these from a somewhat wider field. 



It must be confessed that nearly all our great American 

 universities are unwilling to apply their funds to the creation 

 and maintenance of a well-equipped medical department. 

 They are willing to have such a department, no doubt, but 

 they want the money for establishing and maintaining it to 

 be provided in addition to money which has been, or is to 

 be, provided for the general purposes of the university. The 

 ideal university culture of the present day appears to be de- 

 signed to fit a man to take pleasure in his own thoughts and 

 musings, and in mental exercises in languages, literature, 

 the higher mathematics, and the problems of physics and 

 natural history. Incidentally his knowledge of these things 

 may not only give him pleasure, but enable him to help 

 others; but the studies are not to be pursued on account of 

 any practical utility which they possess, but for the love of 

 learning and pure science, that is, for personal gratification 

 of a particular kind. Those who hold these views are apt to 

 consider medicine as- a technological matter, which should 

 be left altogether to special schools, because, being practi- 

 cally useful in a commercial sense, the means of teaching it 

 are sure to be provided through commercial interests, just as 

 they are sure to be provided for the teaching of practical en- 

 gineering. This is far from the old university idea as em- 

 bodied in the three faculties and four nations of the Univer- 

 sity of Paris. So far as the interests of the public are con- 

 cerned, it is only the possession and control of a large amount 

 and variety of clinical material, or of unusually qualified 

 clinical teachers, which makes it the positive duty to use it, 

 or them, for purposes of medical instruction in order to train 

 ordinary general practitioners of medicine. There is no 

 present deficiency in the number of such practitioners, and 

 we certainly have plenty of schools for producing them, so 

 that there is no fear of failure in the supply. 



But in medicine, as in every other profession, art, or trade, 

 the supply of the best is never too great, and the demand 

 for something better than that which already exists never 

 ceases. 



What, then, does a university, or its medical school, need 

 in order that it may be able to supply the demand for this 

 higher medical education? First, competent teachers; sec- 

 ond, suitable buildings, collections, books, and apparatus; 

 third, clinical material. To secure and retain these things 

 requires money, and brains to use it. First, as to the com- 

 petent teachers. There are many teachers available, but the 

 number of these who have shown that they are competent 

 for, and suited to positions in a medical school which is 

 to supply the best and something better, is limited — much 

 more so than one who has not tried to find them would sup- 

 pose, and these few are not seeking engagements. How 

 many anatomists, or physiologists, or pathologists, of the 



