Makch 17, 1916] 



SCIENCE 



379 



turn to himself. "With the profession eon- 

 fined to a few high-priced practitioners 

 there will be danger of increased quackery 

 for the mass of the people. 



If we try to reduce expense by educating 

 large numbers in relatively few medical 

 centers, as seems to be advocated by those 

 in charge of the investigations of medical 

 education for the Carnegie Institutions, 

 I believe that effective results will not be 

 obtained because intimate association be- 

 tween teacher and pupil is necessary for 

 effective training in a complex field like 

 medicine and this becomes difSeult or im- 

 possible when students are thought of in 

 large masses rather than as individuals. 

 Our schools with the largest endoivments 

 and best facilities are thus coming to limit 

 the number of students received in each 

 class. The tendency to encourage students 

 to get the premedical work in academic 

 colleges and the growing number of insti- 

 tutions giving the first half of the medical 

 course show us ways of keeping the num- 

 ber of students taking the preliminary 

 scientific training for clinical medicine re- 

 stricted to relatively small groups the 

 members of which can receive considerable 

 individual attention. There are two chief 

 difficulties at present connected with this 

 part of the work. First, work in the pre- 

 liminary sciences at the larger colleges and 

 universities is given to such large classes 

 and sections that individual instruction is 

 hampered unless special sections with spe- 

 cial instructors are provided for the pre- 

 medical students. Second, the premedical 

 work in the sciences is practically always 

 given and the work in the fundamental 

 medical sciences is to a greater or less ex- 

 tent given by men who have not had a med- 

 ical education and are not intimately ac- 

 quainted with medical problems. While 

 the fundamental sciences should be taught 



from a broad point of view and not be re- 

 stricted to a special aspect thought by the 

 teacher to be aU that is necessary for medi- 

 cine, the training in the basal sciences 

 should be such as to fit the student as 

 simply and directly as possible to view 

 medical problems from the point of view of 

 physics, chemistry and biology and the 

 more specialized sciences. That medicine 

 can be thus viewed from these various 

 points of view will be best appreciated by 

 the student if he is thrown with teachers 

 capable of doing so. Those who administer 

 preclinical courses should keep this fact in 

 mind. If it is kept in mind there is no rea- 

 son why there should not be gradually es- 

 tablished in the country a considerable 

 number of effective preclinical courses 

 where the student can get an effective 

 training for clinical work. Compared with 

 ordinary college courses such courses will 

 be expensive but viewed from the stand- 

 point of their value to society they should 

 be of great value. 



The clinical part of medical training 

 presents a more difficult problem. At pres- 

 ent the tendency is to devote about one 

 third of the second year and all of the 

 third and fourth years of the four-year 

 medical course, and an interne year to clin- 

 ical training. The premedical and pre- 

 clinical medical work takes up the major 

 part of our ordinary four-year academic 

 college course. In addition we require 

 three further years of clinical study, as 

 much time as is required of a college grad- 

 uate for a Ph.D. degree. The graduate 

 student has opportunities for teaching fel- 

 lowships sufficient to cover at least the cost 

 of living. The medical student is required 

 to pay large tuition fees in addition to his 

 living expenses except during the interne 

 year when he is relieved of the tuition fee 

 and gets room and board for his services 



