August 12, 1910] 



SCIENCE 



207 



against reform; there are others who find it 

 painful to change from methods which were 

 useful and the best in their day, and who 

 resent criticism of them; much crass opposi- 

 tion has to be overcome. For this task de- 

 tachment from the profession was necessary. 

 It was an extraordinary advantage, therefore, 

 that the work should have been undertaken by 

 one of the leading pedagogical authorities of 

 the United States : pedagogy is one of the 

 greatest of sciences because it serves all 

 others, and it deserves the warmest welcome 

 from our profession. Starting from this 

 favorable approach, Mr. Flexner has been able 

 to add the assistance and advice of such men 

 as Dr. Welch, Dr. Simon Flexner and Dr. 

 Bevan to his owri power of diagnosing the 

 causes of evil, his inescapable criticism and 

 incisive style, and his comprehensive vision for 

 solutions. And for the report prepared under 

 this fortunate combination of circumstances 

 and abilities the widest circulation has been 

 made possible by " access to the pocket of a 

 multimillionaire." 



The reviewer ridicules the condemnation 

 of proprietary and fee-dividing schools by 

 arguing that four of the faculty of Johns 

 Hopkins (which in the bulletin is held up as 

 the model for medical schools) were graduates 

 of such institutions. It may be asked where 

 men were to be obtained when this school was 

 founded except from the proprietary and fee- 

 dividing schools; there were no others. It 

 may, with like reasonableness, be asked why 

 those who were brought up under the old 

 method devised the new one, unless they 

 thought it better. In the case of these men 

 we are not left to inference; they have spoken 

 and written against the method under which 

 they were educated. They lend their names 

 also to the authority of this bulletin. 



The inherent vice of the argument is ap- 

 parent. The issue is not whether Dr. A. is 

 a skilled surgeon or Dr. B. a capable physi- 

 cian, but whether we can better our medical 

 teaching. Defence of a school system because 

 distinguished doctors have come out of it, is 

 in logic the method of the empiric in medicine. 

 A logic which opposes the names of individual 



" giants " produced by old and vicious systems 

 of education to proposals of better instruction 

 for all in the future, would carry us crab-like 

 to the schools of Ambroise Pare and Vesalius, 

 and eventually to the times of Galen and IIii>- 

 pocrates as the golden period of medical edu- 

 cation. 



Mr. Flexner's advocacy of laboratory and 

 hospital work is marred for this writer by 

 supposed injustice to the value of didactic 

 teaching. The bulletin does not urge its aban- 

 donment : it lays the emphasis where in the 

 study of a science it is needed, namely, upon 

 contact with facts, with observed causes and 

 consequences. The medicine of to-day rests, 

 to an extent undreamed of in the past, upon 

 the scientific foundation of laboratory and 

 hospital knowledge, and acquaintance with de- 

 tails at second hand no longer suffices. Stu- 

 dents will not be satisfied with looking on 

 while some one else does the work; they will 

 insist on working with their own hands and 

 their own brains on real facts. The best law- 

 teachers found this out when they supplanted 

 the abstractions of text-book teaching with 

 the close study of real lawsuits. The study 

 of books alone will make good examination 

 candidates, but it will not make good doctors : 

 skill is defined as " personal expertness or dex- 

 terity," and the world is less in need of men 

 who can quote text-book descriptions of dis- 

 eases than of men who are " skilled " to cure. 

 Handling of facts is the basic thing, and then 

 supplementary information and breadth of 

 view may be had from didactic teaching. As 

 the bulletin says : 



The lecture — hugging as closely as may be the 

 solid ground of experienced fact — may therefore 

 from time to time be employed to summarize, 

 amplify or systematize. 



The editor's final perplexity is over Mr. 

 Flexner's insistence upon a connection between 

 medical school and university. " Until re- 

 cently," the reviewer says, he himself ''' thought 

 it of enormous advantage for a medical school 

 to be in close relationship with a university." 

 The phraseology leads to the conjecture that 

 he thinks so no longer, and that in a brief 

 period of his cogitations what was recently 



