July 11, 1913] 



SCIENCE 



37 



although they are in active practise. For- 

 tunately, there are always exceptional men 

 who succeed in doing things which the con- 

 ditions of their life and work make difficult 

 for most; but it is necessary to consider 

 what conditions are conducive to the end 

 in view and likely to promote its attain- 

 ments as the general rule and not as the 

 exception. Having regard to the growing 

 complexity of the subject of medical sci- 

 ence, it seems to the commission that it will 

 become more and more difficult as time 

 goes on, for the really scientific teaching in 

 the subject to be given by men whose 

 powers are largely required for the ardu- 

 ous work of medical practise, and whose 

 minds are quite rightly occupied for the 

 most part with exacting claims and daily 

 anxieties of their professional work. It is 

 not conclusive that many eminent British 

 physicians and surgeons have in the past 

 made important contributions to the ad- 

 vancement of knowledge in this subject. 

 It is doubted if it can fairly be claimed 

 that the representatives of British medicine 

 make their proper contributions to the sci- 

 entific literature of the subject to-day, and 

 although admirable work is still being 

 done, it is all a matter of individual effort, 

 and generally carried out under difficul- 

 ties. But quite apart from this it makes 

 all the difference in the world to the stu- 

 dents of a university whether they have 

 received a purely professional training or 

 a university education in the course of 

 which they will come into contact with the 

 fringe of their subject, and will realize 

 that it is a subject which is growing — that 

 they can even play their part in making it 

 grow. 



The above summary from the report 

 shows that the excellent and courageous 

 studies on medical education by Flexner 

 are being considered in Europe as well as 

 in America. 



After Flexner testified before the com- 

 mission a number of eminent clinicians, in- 

 cluding Sir William Osier and Professor 

 Friedrich von Miiller, gave their opinions 

 on hospital organization and clinical teach- 

 ing. The conditions prevailing in Munich 

 were fully set forth by Miiller, and Osier 

 formulated an ideal plan based largely 

 upon the German clinic. Osier's hospital 

 unit for each of the important clinical 

 branches comprises about sixty beds, vari- 

 ous clinical laboratories, an out-patient de- 

 partment, and a director with a suitable 

 staff. The principal teachers in clinical 

 medicine and surgery in all the branches 

 ought to be university professors in the 

 same sense as the principal teachers in 

 chemistry or physiology in a university. 

 Under these conditions Osier thinks that we 

 can expect the professor of medicine to 

 carry out his three-fold duty ; namely, cur- 

 ing the sick, studying problems of disease 

 and teaching his students. Thus it is clear 

 that American influences are making them- 

 selves felt in England. The recommenda- 

 tions of Flexner and Osier are adopted in 

 practically every detail by the commission. 

 To what extent the clinician should carry 

 on private practise is quite definitely stated 

 by the commission, conforming much more 

 with Flexner 's recommendation than with 

 Osier's. 



While it is conceded that the medical 

 student should measure up to the univer- 

 sity standard, it is also insisted upon that 

 he should be taught by university clinical 

 professors who are active in research. 



Another matter to which the commission 

 refers is the question whether, and to what 

 extent, the professor should be prohibited 

 by the terms of his appointment from en- 

 gaging in private practise. One of the ad- 

 vantages of private practise is said to be 

 that men gain in this way experience of hu- 

 man nature which is of great value in the 



