July io, 1891.] 



SCIENCE. 



17 



Is it advisable that the same medical school shall under- 

 take to furnish such different courses as to provide for all 

 wants — to offer to meet the minimum requirements for the 

 degree of doctor of medicine, as well as the wants of those 

 who demand more advanced and detailed instruction? The 

 answer to this depends largely on the location of the school, 

 and on the means which it can command, especially as re- 

 gards facilities for hospital and clinical instruction. In any 

 case, its diploma of doctor of medicine should have a uni- 

 form value, and if it does undertake the double function, the 

 higher education must be largely post-graduate work. It 

 must also be, to a great extent, a voluntary matter on the 

 part of both schools and students. 



As indicated at the beginning, this address is not intended 

 to criticise existing medical institutions, or to give specific 

 advice to any college or university. I have simply tried to 

 formulate roughly what seems to be the present ideal of a 

 course of medical education in the minds of many physi- 

 cians, and then to show what the carrying out of this ideal 

 involves to the schools and to the students. 



I believe in ideals, that is, in their beauty and in their 

 utility when they do not dominate a man so as to make him 

 a visionary, or a dangerous crank or fanatic; but one ideal 

 is often more or less incompatible with another, and all of 

 them must be held subject lo the possibilities afforded by 

 surrounding circumstances. But we must not be too scepti- 

 cal about these possibilities. And we are all directly inter- 

 ested in this matter, every one of us. Every one of this au- 

 dience will probably see the time when the knowledge and 

 skill of the physician called in to advise in the calamity 

 which has fallen on him or his wife or child will seem to 

 him of vast importance. 



Sometimes he can select his physician, often he cannot, 

 but must rely on the first one who can be found. Hence 

 these discussions about medical education, although chiefly 

 carried on by physicians, because they are most familiar 

 with the difficulties of the subject, should be considered by 

 those who are not physicians quite as much as by those who 

 are, or intend to be. It is a dangerous business, however, 

 for a doctor to discuss other doctors in public. He can make 

 more trouble for himself in less time in this way than by 

 almost any other method that I know of. Nevertheless, it 

 is my duty to tell you that there is little probability that the 

 ideal facilities for higher medical education, either here or 

 elsewhere, will be furnished by the doctors themselves. 

 There are several reasons for this, but one is sufficient, and 

 that is, they have not got the money, which I have shown 

 you is necessary to provide and maintain these facilities. 

 Hence, if these ideals are to be realized, the means must be 

 furnished by those who are not members of the medical pro- 

 fession, and it seems to me that this is what will be done. 



What is the best way for a university, a real university, 

 to begin this line of work? In most cases I should say by 

 establishing one department at a time on a proper basis. 

 Which departments should be the first to be thus estab- 

 lished? Just here is where many of the doctors will begin 

 to differ. 



I should say that the first of these departments to he pro- 

 vided for are two which will form the main links in the 

 university bond between the medical and other departments, 

 covering two branches of knowledge which every university 

 graduate should study somewhat, namely, biology and hy- 

 giene. For the clergyman, the teacher, the journalist, and 

 the sociologist, systematic instruction in these two branches 



is as desirable as it is for the physician ; for the lawyer it 

 will be useful; only the philologist would I excuse entirely 

 from these departments. 



Of course, in specifying that they are to teach, and to 

 teach undergraduates, I do not mean that teaching is to be 

 their sole function. This is not the modern idea of a scien- 

 tific department of a true university. It is to increase 

 knowledge as well, to provide for the needs of special inves- 

 tigators and seekers who have obtained their elementary 

 training elsewhere. 



Let the plans for such a department be well thought out, 

 the expenses carefully estimated, and then bring the matter 

 to the attention of those who have the means to realize this 

 ideal, and sooner or later it certainly wilf be realized. I 

 have elsewhere ventured to express my sympathy for two 

 classes of men who have in all ages and in all countries re- 

 ceived much disapprobation from philosophers, essayists, 

 and reformers, namely, rich men and those who want to be 

 rich. 



So far as the wealthy are concerned, there seem to be a 

 good many of them in these latter days who use their stored 

 force to endow universities and professorships, to build libra- 

 ries and laboratories, and to such let us give due praise and 

 honor. They may not be scientific men, but they make sci- 

 entific men possible. The unscientific mind has been defined 

 as one which is willing to accept and give opinions without 

 subjecting them to rigid tests. "This is the kind of mind 

 which most of us share with our neighbors. It is because 

 we give and accept opinions without subjecting them to rigid 

 tests " that the sermons of clergymen, the advice of lawyers, 

 and the prescriptions of physicians have a market value. 

 The unscientific public has its uses, and one of its character- 

 istics is a liking for ideals, some of which it occasionally 

 helps to realize. I can only hope that whenever an Ameri- 

 can university approves the ideal which I have roughly 

 sketched, this public will see that the means are provided for 

 carrying it out. It may be objected by some that it would 

 be better to help to raise the average standard by endowing 

 chairs in the medical schools in large cities, than to provide 

 special facilities for the use of a limited number. It is quite 

 true that all medical schools should be endowed; and this is 

 coming, for voluntary associations of physicians, who are 

 not a wealthy class, cannot afford to compete with endowed 

 schools when State laws shall come to enforce a high stan- 

 dard of acquirements. Nevertheless, we need universities 

 properly so called, as well as colleges and higher schools, 

 and we need university men in the medical profession as well 

 as elsewhere. 



I have no fears as to the creation of a medical aristocracy 

 by giving facilities for higher education to those who have 

 the means to avail themselves of them. It is quite true that 

 only a fraction of those who have the means will use these 

 facilities properly, and that there will be a number who have 

 not the means who would make good use of such facilities if 

 they could get them; but these last will not be helped by the 

 total absence of such facilities for anybody. Let us try to 

 give the best minds a chance to obtain the best ti'aining: let 

 us try to discover these best minds wherever they may be, 

 and if their owners have not the means to avail themselves 

 of training, let us try to furnish the means. But to do this, 

 one of the first and most essential steps is to provide some- 

 where the teachers, and the buildings and apparatus, neces- 

 sary for giving such instruction, and where is a better place 

 to do this than in connection with a university, or, if you 

 please, in connection with this university? 



