496 



SCIENCE 



[N. S. Vol. XXXVin. No. 980 



scientific research among the younger men 

 is sign of hope for the future. 



The hospital teaching of medical students 

 is being rapidly improved by the introduc- 

 tion of the English system of clinical 

 clerks, which was first used in America by 

 Osier at the Johns Hopkins. Patients are 

 assigned to different students who follow 

 carefully the course of the disease, using 

 laboratory methods, and perhaps finally 

 preparing a thesis upon a group of eases or 

 some particularly interesting case, present- 

 ing also the literature concerning similar 

 cases. Some of these theses are worth pub- 

 lishing and thus approach the German 

 "Doktorarbeit." 



The special medical subjects, such as the 

 eye, ear, etc., are treated by local special- 

 ists, as is the custom elsewhere. At the 

 Johns Hopkins, special hospitals for 

 psychiatry and for pediatrics have recently 

 been opened and placed under the direction 

 of first-class men. 



After receiving his diploma, the medical 

 student usually spends a year or two as a 

 hospital interne. The Council on Medical 

 Education of the American Medical Asso- 

 ciation reports that of 2,004 physicians 

 graduating during a year from 40 of the 

 better class medical schools, 1,403 or 70 

 per cent, received hospital internships. At 

 Harvard, 90 per cent, of the men followed 

 this custom. It is strongly advised by the 

 council that a year of hospital internship 

 be made compulsory before license to prac- 

 tise medicine is allowed. The 4,000 hos- 

 pitals in the country would afford ample 

 facilities'. 



Mention should be made of the influence 

 of the Rockefeller Institute in New York, 

 the MeCormick Institute for Infectious 

 Diseases and the Sprague Memorial Insti- 

 tute in Chicago, the Wistar Institute 

 of Anatomy in Philadelphia and other 

 examples of weU-endowed research insti- 



tutions which, for the most part, have 

 set an example of idealistic accomplish- 

 ment that has been of aid to the develop- 

 ment of higher aims of medical achieve- 

 ment. It would be of little value to set 

 forth at this time the extent and cost of 

 buildings devoted to medical education in 

 the United States for the essential factor is 

 the spirit of the institutions themselves 

 rather than their material embodiment. In 

 commenting on the behavior of a certain 

 young professor who complained that he 

 could not work on account of lack of lab- 

 oratory facilities, Carl Voit once said: 

 "Er ist faul. Er will nicht arbeiten. 

 Man kann in einem ganz kleinen Zimmer 

 arbeiten." It is not lavish expenditure but 

 the right spirit that is needed. 



INFLUENCE OP AGENCIES FOR PXIBLIC 

 WELFARE 



There have been various helpful agencies 

 at work which have wrought wonderful ad- 

 vances in medical education in the United 

 States. The country is thought to be nat- 

 urally conservative, and the medical pro- 

 fession especially so. The cause of this is 

 partly explained by quoting Vincent again. 



They (the American people) usually display hos- 

 tility or, at least, derisive disrespect for the spe- 

 cialized and their opinions. To the unspecialized 

 average man, the expert is in a way a personal af- 

 front. He suggests the idea of a superior class 

 and seems to reflect on the competence of the ordi- 

 nary citizen. This feeling is a natural survival of 

 the early days, especially on the frontier. 



To complete the picture and show how 

 difficult is reform in America, whether of 

 medical education or of the tariff or of the 

 currency, one has only to recall the re- 

 mark of A. B. Macallum that the progress 

 of the world is accomplished by one thou- 

 sandth of one per cent, of its inhabitants. 



The battle for correct principles and 

 ideals regarding medical education has 



