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SCIENCE 



[N. S. Vol. XLIII. No. 1107 



eluded in "Who's Who," four out of the 

 fifteen in the first graduating class are in 

 the starred list in "American Men of Sci- 

 ence. ' ' 



The relation of ultimate success to pre- 

 medical college training is of some interest. 

 While I have not time to go into this sub- 

 ject at present in any detail, I may point 

 out in Table VIII. that students coming 

 from the colleges of the Middle West have 

 been particularly strong in science while 

 those from the colleges of the North Atlan- 

 tic States have been strong in practical 

 surgery but have not gone much into re- 

 search or other fields leading to a more or 

 less national distinction. It is only by 

 putting the graduates of the collegiate de- 

 partment of the Johns Hopkins in the 

 North Atlantic division that this division 

 is enabled to make a fair showing outside of 

 surgery as compared with the other divi- 

 sions. Based on its clientele this depart- 

 ment might perhaps more justly be placed 

 in the Southern division. Some points 

 brought out by the table are difficult to ex- 

 plain. Why, for instance, should the grad- 

 uates of the University of California make 

 an unusually good showing from the point 

 of view under discussion and those of Le- 

 land Stanford an unusually poor one? 

 Why should the smaller colleges of the 

 South do so much better on the whole than 

 those of the small colleges of the rest of the 

 country ? 



From the records of the graduates of 

 these first ten classes of the Johns Hopkins 

 Medical School it is clear that their success 

 along orthodox lines has been unusually 

 high. Into this success numerous factors 

 have entered which we need not discuss 

 here but not all of which can we hope to 

 have generally repeated with the elevation 

 of entrance standards and reorganization of 

 methods in the medical schools throughout 

 the country. It is evident, however, that 



this general reorganization is accompanied 

 by greater scientific productivity in medi- 

 cine and a greater tendency to specializa- 

 tion than we have hitherto had in this coun- 

 try, accompanied by an increased tendency 

 to settle in large cities. What lessons can 

 we learn from this group of graduates who 

 represent in a way the first product of our 

 present methods of medical education and 

 what deductions can we make as to the di- 

 rections in which we should guide medical 

 education so as to provide adequately for 

 a generation ahead. 



The aim in requiring premedieal college 

 training in physics, chemistry and biology 

 and in greatly strengthening the laboratory 

 work in the basal medical sciences has been 

 to qualify men to bring the whole force of 

 modern science to bear on the solution of 

 medical problems. As a matter of fact the 

 main point of view presented to and ac- 

 cepted by the majority of the group of stu- 

 dents under consideration when they came 

 to clinical problems was what we may desig- 

 nate as a "looking backward" point of 

 view. The basis on which to found con- 

 ceptions of a given disease was that of its 

 ultimate ravages in a body incompetent to 

 resist. The course of the disease was to a 

 considerable extent reasoned out from the 

 findings in the autopsy room. Most of the 

 cases seen in the hospital wards were pa- 

 tients in whom disease was far advanced 

 so that the autopsy picture of similar cases 

 was an aid in formulating a picture of the 

 probable appearance of the organs. Even 

 in the dispensaries a large proportion of 

 the patients were advanced cases. Little 

 or no opportunity was given to study the 

 beginnings of disease and the conditions in 

 the individual or the community which pro- 

 duce these beginnings, although, of course, 

 opportunity was given to study specific 

 microorganisms and lectures were given on 

 etiology. Few of the group of graduates 



