922 



SCmNGE. 



[N. S. Vol. VUI. No. 209. 



Lnt me say at the outset that in speaking 

 of the profession of medicine I use the term 

 not in its narrow sense, to designate the ai't 

 of caring disease, but in its broader signifi- 

 cation, to include a studj' of the whole en- 

 vironment of man as far as it affects the 

 pro<l action and maintenance of a healthy 

 mind in a healthy body. 



la what I shall have to say on this sub- 

 ject I shall confine mj'self chiefly to the 

 medical schools of this country, though it 

 will be found, I think, that the conclusions 

 to which I shall endeavor to lead you will 

 have their application to medical schools 

 through the world. 



The most important event in the history 

 of medical education in this country oc- 

 curred some thirty years ago, when many of 

 the principal schools abandoned the plan 

 of giving a series of winter lectures, which 

 were attended by all the students, irrespec- 

 tive of their proficiency, and established a 

 graded system of instruction in which the 

 studies of one year were preparatory to 

 those of the next. Those whose experience 

 in medical education is confined to the 

 period since this change was made can 

 scarcely appreciate the value and impor- 

 tance of the reform which raised the med- 

 ical schools of the countr}' from a condition 

 in which they were aptly compared to joint- 

 stock manufacturing companies, concerned 

 only in taking in as large an amount as 

 possible of raw material in the shape of 

 medical students and in turning out a 

 maximum of the finished product, i. e. , 

 doctors of medicine, with a minimum cost 

 to the producer. ' Cheap doctors and plenty 

 of them ' seems to have been the motto of 

 the medical schools of that period. Since 

 this reform the medical schools of the coun- 

 try have been conducted on sound educa- 

 tional principles and the best of them com- 

 pare favorably with the medical schools of 

 Europe. 



Daring the last quarter of a centurj' the 



improvement in medical education in this 

 country has consisted chiefly in increas- 

 ing the requirements for admission, in the 

 lengthening of the course and in the exten- 

 sion of the laboratory method of instruction. 

 Important as these improvements have been, 

 it may fairly be asked whether they have 

 kept pace with the requirements imposed 

 upon teachers by the remarkable advance 

 in everj' department of medicine during the 

 last thirty years. 



During this period we have seen the 

 germ theory of disease established upon a 

 firm basis and extended so as to throw 

 light upon a large number of morbid pro- 

 cesses with which it was formerly supposed 

 to have no connection. Antiseptic methods 

 have revolutionized the surgeon's art. The 

 study of the internal secretion of glands has 

 led to the development of a sj'stem of glan- 

 dular therapeutics. The use of the anti- 

 toxin treatment has robbed one, at least, 

 of the most dreaded diseases of more than 

 half of its terror, while the use of instru- 

 ments of precision has increased the accu- 

 racy of our diagnosis in nearly' all the ills 

 to which flesh is heir. 



At the beginning of this period it was 

 possible to impart to an intelligent medical 

 student in a three years' course of study a 

 considerable fraction of the acquired med- 

 ical knowledge of the time and to train 

 him to safely use the comparatively simple 

 methods of diagnosis and treatment then in 

 vogue. At the present time, were we to 

 seek to give to the same student a similar 

 proportion of the accumulated knowledge 

 now at the disposal of the profession and to 

 teach him the use of the refined modern 

 methods for the study and cure of disease, 

 it may be reasonably estimated that a ten 

 or even a fifteen years' course of study 

 would be required. As it is obviously im- 

 possible to prolong the course of medical 

 study to anything like this extent, the ques- 

 tion arises : In what way^ shall newlj^ ac- 



