December 30, 1898.] 



SCIENCE. 



923 



quired knowledge in the science and practice 

 of medicine be incorporated into the exist- 

 ing curriculum of the medical student ? 



Up to the present time this question does 

 not seem to have been seriously considered. 

 As new and important subjects have forced 

 themselves upon the attention of the med- 

 ical profession, our schools have sought to 

 meet the new condition simply by adding 

 to the existing curriculum a more or less 

 lengthy course of instruction on the subject 

 in question. Thus the importance of en- 

 abling physicians to recognize pathogenic 

 microbes has led to the establishment of a 

 department of bacteriology in our principal 

 medical schools, while the great advance 

 made in the treatment of special classes of 

 disease has occasioned the appointment of 

 numerous professors of specialties, such as 

 gynaecology ,orthoepedic surgerj', ptediatrics, 

 etc. 



The medical curriculum has thus grown 

 by what may be called, in biological lan- 

 guage, a process of accretion, and there has 

 been little or no attempt to make room for 

 new instruction by the omission of less 

 valuable courses or parts of courses, though 

 in certain directions the advance of knowl- 

 edge, by demonstrating the inaccuracy of 

 previously accepted views, has led to a 

 simplification of instruction. When it has 

 been found absolutely impossible to add 

 any further courses a remedy for the con- 

 gestion of instruction has been found in 

 the prolongation of the medical curriculum 

 from three years to four. 



It is, of course, evident that this process 

 cannot be indefinitely continued. In fact, a 

 slight study of the subject sufiBces to show 

 that a limit has already been reached. In- 

 deed, as long ago as" 1870 Huxley was so 

 thoroughly impressed with the crowded 

 condition of the medical curriculum in 

 England that he expressed "a very strong 

 conviction that any one who adds to med- 

 ical education one iota or one tittle beyond 



what is absolutely necessary is guilty of a 

 very grave offence," * and quite recently 

 Professor M. Foster, in speaking of the 

 enormously increased requirements in med- 

 ical education, has expressed himself as fol- 

 lows : " Now it is obvious that, whatever 

 may have been possible ouce, it is impos- 

 sible nowadays to demand that all or each 

 of these things should be learnt by the 

 student of medicine. Though possibly the 

 power of man to learn is increasing; though 

 each science as it becomes more and more 

 consolidated can be expounded and appre- 

 hended with greater ease; though the grasp- 

 ing of one science is in itself a help to the 

 grasp of other sciences, yet beyond doubt 

 that which has to be learnt is enlarging far 

 more rapidly than is man's ability to 

 learn. "f 



To extend the course of instruction in the 

 medical schools of this country beyond the 

 present four-year limit does not, under the 

 prevailing conditions of education in Amer- 

 ica, seem desirable, and the curriculum of 

 most of our schools is already so crowded 

 that no considerable amount of instruction 

 can possibly be added. In what way, then, 

 can we give to our medical students an 

 adequate amount of information on all the 

 subjects embraced in the constantly widen- 

 ing domain of medical science and art ? In 

 other words, how shall instruction keep 

 pace with knowledge? 



In seeking an answer to this question it 

 may be assumed that a medical school of 

 the first rank should be an institution in 

 which the most advanced instruction in all 

 departments of medicine can be obtained, 

 and on this assumption it is, of course, im- 

 possible to arrange a course of study that 

 every student must follow in all its details, 

 for in the time which may properly be de- 



* 'Medical Education.' Collected Essays, Vol. III., 

 D. Appleton & Co., 1894. 



t Address to the Students of Mason University 

 College, Birmingham, October 3, 1898. 



