OCTOBEE 10, 1913] 



SCIENCE 



497 



been waged by certain of the medical men 

 themselves who have been unsparing critics 

 of the old-fashioned methods. 



Helpful agencies have been especially 

 the Council on Medical Education of the 

 American Medical Association composed of 

 six individuals, and Abraham Flexner, 

 who prepared a report on the condition of 

 the medical schools of the country for the 

 Carnegie Foundation. 



The medical problem is not a simple one. 

 There are 49 states and each state has its 

 own examination for the license of its 

 physicians. There is no national control, 

 and the standards vary greatly. Thus, in 

 twenty-seven states, the law gives the li- 

 censing board the power to refuse recog- 

 nition to the graduates of low-grade med- 

 ical colleges, a power too little made use 

 of. In four states, it is not even necessary 

 that an applicant for medical license be a 

 graduate of a reputable medical college, 

 and the authorities of Tennessee, in 1912, 

 presented the spectacle of licensing 175 in- 

 dividuals who were not graduates of any 

 medical school whatever. 



In 1904, when the Council on Medical 

 Education began its activities, there were 

 166 medical schools in the country, which 

 was about one half of the world's supply. 

 There are now 110 in contrast with 21 in 

 England, 20 in Germany, 20 in Italy and 

 5 in Prance. 



The reduction in the number of medical 

 schools by extinction or merger has been 

 the happy outcome of severe and public 

 criticism. The Council on Medical Educa- 

 tion set to work to bring about conform- 

 ance to certain standards which may be 

 thus abbreviated: (1) A higher entrance 

 requirement which includes a year's work 

 in chemistry, physics and biology, as given 

 in the universities. (2) The presence of 

 at least six full-time professors in the 

 fundamental sciences in charge of thor- 



oughly equipped laboratories in which the 

 student works during his first two years. 

 (3) Two years of clinical work in hospitals 

 and dispensaries. (4) A post-graduate 

 year as interne in an approved hospital. 

 (5) The medical teaching to be of high 

 excellence. 



As an instance of notable accomplish- 

 ment, it may be stated that whereas in 

 1904 only four of the 166 medical colleges 

 required more than a four-year high school 

 course for entrance, and the majority of 

 the others admitted all who applied, at 

 present sixty medical schools have adopted 

 the higher entrance requirements and six 

 states have adopted two years of univer- 

 sity work as a necessary preliminary to, 

 the medical course. 



An effective stimulus to medical educa- 

 tion has come through the grading of med- 

 ical schools into four different classes. 

 This has been done as the result of personal 

 inspection. The Council has recently pub- 

 lished its third grading. In Class A Plus 

 there are 22 acceptable medical colleges 

 giving a four-year course. In Class A 

 there are 31 colleges lacking in certain re- 

 spects but otherwise acceptable and giving 

 a four-year course. In Class B there are 

 22 colleges needing general improvement 

 to be made acceptable and giving a four- 

 year course. In Class C there are 27 col- 

 leges requiring complete reorganization to 

 make them acceptable. Besides this, there 

 are eight institutions offering only the first 

 two years of medicine and there are four 

 schools for the colored race, two in Class A 

 and two in Class C. 



The publication of these classifications 

 has been of inestimable benefit in creating 

 public sentiment against unworthy institu- 

 tions. The work was greatly advanced in 

 the Flexner report which gave detailed de- 

 scriptions of abominable conditions in low- 

 grade schools. Dr. Henry S. Pritchett, 



