January 3, 1908] 



SCIENCE 



17 



mediate results may be in individual cases. 

 The theme of this address naturally sug- 

 gests many topics relating to methods of 

 teaching and to the medical curriculum 

 which are questions of the day, but which 

 I must lay aside through lack of time. On 

 one only I beg to say a few words. 



In contrast to the German system, the 

 tendency in our American medical schools 

 has been toward a rigid curriculum, which, 

 though widely divergent in different 

 schools, is to be followed in precisely the 

 same way by all students without any con- 

 sideration of differing ability, capacity for 

 work, special aptitudes and interests. One 

 of many unfortunate results is that sub- 

 jects and courses of study which can not 

 properly be imposed as obligatory on al- 

 ready overburdened students find no place 

 in our medical schools, which should aim 

 to cultivate the whole field of medicine. 

 I agree with Dr. Bowditch and my col- 

 league, Dr. Mall, to whose admirable pres- 

 entation of this subject I would refer those 

 interested, that our students should have a 

 greater latitude of choice than is now cus- 

 tomary in subjects to be pursued, in the 

 amount of time to be devoted to their study 

 and in the order in which they may be 

 taken. Complete freedom can not be 

 granted. A minimum requirement for the 

 principal subjects must be made obligatory, 

 but if this minimum is properly fixed there 

 remains room for a considerable range of 

 choice of subjects and courses, greatly to 

 the advantage of student and teacher. At 

 the Harvard Medical School the system of 

 electives for the fourth year of the course 

 has been in operation for several years, and 

 other medical schools have also introduced 

 a similar plan. At the beginning of the 

 current academic year we adopted at the 

 Johns Hopkins Medical School a scheme by 

 which a large number of elective courses 

 are offered throughout the four years, and 

 the plan is now working most successfully. 



Some of our state boards of examiners 

 are greatly exercised over the differences 

 which they find in the curricula of the 

 various medical schools in this country, 

 and which in themselves are merely an in- 

 dication that there is, and, in my judgment, 

 there can be no agreement of opinion as to 

 every detail of a medical curriculum. 

 There are doubtless defects to be remedied, 

 but in attempting to apply remedies these 

 state boards should concern themselves with 

 no other question than that of educational 

 standards. They could make no greater 

 mistake nor inflict more serious injury on 

 the efforts of the better schools to improve 

 their methods of teaching than to attempt 

 to impose a uniform and rigid obligatory 

 curriculum on all schools. They do not in 

 their examinations apply any practical 

 tests whatever to determine the candidate's 

 fitness for the practise of medicine, whereas 

 our better schools are exerting every effort 

 to increase their efficiency by substituting 

 practical work in laboratories, hospital 

 wards and out-patient departments for 

 didactic lectures. The work of students 

 who gain their knowledge by serving as 

 clinical clerks and surgical dressers in the 

 hospital can not be measured by time 

 standards in the same precise way as that 

 of attendance on expository lectures. 

 Above all, the better schools should not be 

 hampered by restrictions imposed by state 

 boards of examiners in freedom to extend 

 the system of electives of which I have 

 spoken. 



The medical department of a university 

 should be a school of thought, as well as a 

 school of teaching, academia as well as 

 schola. Although there has been gratify- 

 ing progress in recent years, our medical 

 schools have not advanced along the path 

 of productive research to the same extent 

 that they have in the way of improvement 

 of their educational work. There are 

 several reasons for this condition. For one 



