NOVEMBEB 8, 1907] 



SCIENCE 



621 



lengthened or essential subjects must be 

 curtailed. 



We may indeed go further than this and 

 say that the disposition to add anything to 

 the present medical course which will 

 necessitate lengthening it is a tendency that 

 needs to be restrained. Unless the schools 

 are to adopt an impracticable standard for 

 which certain idealists seem to be contend- 

 ing, we may well be satisfied with the pres- 

 ent four-year course. No one can deny the 

 great advances which have been made 

 within recent years, but is it not idle to 

 suppose that educational courses can ever 

 be made theoretically perfect and complete 1 

 Let us abandon the notion that the whole 

 field should be covered in the medical 

 course, and recognize the fact that as knowl- 

 edge advances, and specialization increases, 

 the ability of the individual to master the 

 whole diminishes, so that the first and evi- 

 dent duty of the medical school should be 

 to teach essential fundamentals and well- 

 established principles, and leave many spe- 

 cialties, and most of the subjects which are 

 still debatable, to be treated in optional 

 courses or in other institutions. 



And to my thinking it is no less true 

 that the time spent in preparatory work is 

 often much too long. The favored pupil 

 who leaves the high school or academy at 

 eighteen, college at twenty-two, and the 

 medical school at twenty-six, if he takes 

 a year or two of hospital or other 

 post-graduate work, or studies abroad, 

 will hardly be able to begin his prac- 

 tise until he is approaching thirty. This 

 is quite too long a preparation. The 

 man who has nothing to do, and plenty to 

 do it with, may spend his time thus if he 

 so chooses and no one be the worse perhaps, 

 but the average man can not afford it, few 

 men need it, and many men are injured by 

 it. Doubtless some men mature less rapidly 

 than others and need to be kept under 



tutors and guardians longer, but no educa- 

 tional system should be planned to meet the 

 needs of the weaklings or the demands of 

 idlers. Montaigne in his essay on "Age" 

 says : 



I esteem that our souls show at twenty years 

 of age what they mean to be. No soul that has 

 not by that time given evidence of its strength 

 will give proof of it ^.fterwards. The qualities 

 and natural virtues produce in that time or never 

 what they have of vigor and beauty. It is possible 

 that with those who occupy their time well sci- 

 ence and experience may increase witli life, but 

 vivacity, promptitude and firmness, and other 

 more important essential faculties, will fade and 

 deteriorate. Therefore I complain of our laws; 

 not that they leave us too long to our work, but 

 that they do not employ us earlier; for consider- 

 ing the frailty of our life and the many ordinary 

 accidents to which it is exposed I complain that 

 so large a portion should be given up to childhood, 

 to idleness and to apprenticeship. 



If that was sound doctrine in the six- 

 teenth century it is even sounder in the 

 twentieth and needs restatement. Too 

 much time is wasted in preparatory schools 

 and colleges, but if these things can not be 

 remedied then, to my thinking, the pros- 

 pective medical student will do well to go 

 from the high school directly to the med- 

 ical college, or spend at the most not more 

 than two years in intermediate work, which 

 he may well devote chiefly to physics, chem- 

 istry, biology and modern languages. The 

 old-fashioned college course is of little serv- 

 ice to the student of medicine, and the 

 time spent in pursuing it is frequently 

 worse than wasted. The habits and asso- 

 ciations which are formed are too often 

 distinctly detrimental, and that four of the 

 most valuable years in a man's life should 

 be given over, as often they are, to aimless 

 study, boyish frivolity and the formation 

 of ideals which must be abandoned, and of 

 habits which must be corrected in after life, 

 is indeed deplorable. The youth who at 

 eighteen or nineteen is without plans for 

 the future and is carried along by in- 



