36 



SCIENCE 



[N. S. Vol. XXXVIII. No. 96T 



that he was preparing a similar report on 

 medical education in Germany, France and 

 Great Britain. This report received their 

 careful consideration. 



The fundamental principle underlying 

 Flexner's argument is that university 

 teaching can be given only by men who 

 are actively and systematically engaged in 

 the advancement of knowledge in the sub- 

 ject they teach. And this, of course, is a 

 principle upon which the commission has 

 insisted strongly in dealing with the gen- 

 eral question of the essentials of university 

 teaching, and the position and duties of 

 the university professors. 



But what is suggested and insisted on is 

 that if, as is admitted, cooperation is neces- 

 sary for the practise of medicine at the 

 level of medical science to-day, it is also 

 necessary, even in a higher degree, for the 

 advancement of medical science beyond its 

 present stage ; further, that his cooperation 

 does not exist in the hospital medical 

 school, and can not do so as long as the 

 physicians make use of science only to aid 

 them in recognizing and curing disease, 

 and in teaching their students to do so on 

 the basis of existing knowledge. It is 

 maintained that they must give their time 

 to attacking the problems of disease, and 

 that they can not do so alone, but must be- 

 come members, and controlling and direct- 

 ing members of a group of men working 

 together for a common end — a group in 

 which the subordinate members are selected 

 with a view to the special knowledge re- 

 quired to aid and supplement that of the 

 leading and directing mind. They must 

 devote themselves to original research 

 under the conditions which make it pro- 

 ductive in the case of the exceedingly com- 

 plex problems which medical science has 

 to solve. Finally it is said that the hos- 

 pital unit is the kind of organization which 

 experience has already shown provides the 



conditions required; and that it is only 

 when the conditions have been found and 

 established which make research in medical 

 science possible and actual that the true 

 university spirit will inform the teaching, 

 and that the teachers will be the kind of 

 men the commission have spoken of as uni- 

 versity professors — men who will do for 

 medicine what other men do for physiology 

 and chemistry, and, indeed, for every sub- 

 ject which is capable of being scientifically 

 treated. If this kind of teaching is essen- 

 tial, it seems to the commission clear that 

 it can not be expected of men who are 

 largely engaged in private practise; not 

 only would the teaching and preparation 

 for it make too great a demand on their 

 time, but it is the kind of teaching which 

 can really be successfully undertaken only 

 by men whose main occupation is original 

 research in the science of their subject. 



Further in the opinion of the commission 

 the University of London ought not to be 

 satisfied with the present clinical teaching 

 in the London medical schools. It appears 

 to them beside the point to say, as some 

 witnesses do, that the time for training is 

 not the time for research, that a man has 

 enough to learn then in order to make him- 

 self a good doctor, and that the leisure for 

 research comes afterwards when he has 

 taken his degree. It is not suggested that 

 the undergraduate should engage in re- 

 search in the medical faculty more than in 

 any other, but that is no reason why he 

 should not receive a university education. 

 The commission has made it clear in the 

 earlier part of the report — (a) that uni- 

 versity education can be given only by 

 university teachers, and (&) that it is a 

 necessary condition of the work of univer- 

 sity teachers that they should be systemat- 

 ically engaged in original work. Again, 

 it is said that a good deal of scientific 

 teaching is done by the present teachers, 



