924 



SCIENCE. 



[N. S. Vol. VIII. No. 209. 



voted to a course of professional study it is 

 quite impossible for even the most intelli- 

 gent students to assimilate all the varied in- 

 formation which such a school may reason- 

 ably be expected to impart. 



It seems, therefore, to be evident that in 

 arranging a course of medical study a dis- 

 tinction must be made between those sub- 

 jects which it is essential that every student 

 should know, and those subjects which it is 

 desirable that certain students should know, 

 i. 6., between those things of which no man 

 who calls himself a physician can afford to 

 be ignorant, and those which are important 

 for certain physicians but not for all. In 

 other words, provision must be made both 

 for required and for elective studies. 



The introduction of the elective system 

 into a professional school is not an alto- 

 gether novel proposition. For several 

 years a large part of the instruction in the 

 fourth year of the Harvard Medical School 

 has been given in elective courses in various 

 specialties, such as ophthalmology, otology, 

 etc. The extension of the elective system 

 to the earlier years of the course would be 

 attended by no difiBculty as far as details of 

 administration are concerned, and has, in- 

 deed, been advocated by President Eliot in 

 a speech at the dinner of the Harvard Med- 

 ical Alumni Association in 1895. But the 

 question may, perhaps, be asked whether it 

 will be possible under such a system to se- 

 cure the proper training of young men for 

 the duties of a profession in which experi- 

 ence of life contributes so largely to success 

 and in which, therefore, a student at the 

 beginning of his career may be supposed to 

 be peculiarly in need of the guidance of his 

 teachers. 



It is true that in the academic depart- 

 ment of Harvard University the capacity of 

 the average student to choose his course 

 wisely and well has been demonstrated by 

 the experience of many years, but it may be 

 properly urged that the success of the system 



in the academic department does not neces- 

 sarily justify its extension to a professional 

 school. The responsibility of the medical 

 faculty in granting the degree of M.D. is 

 very different from that of the academic 

 faculty in giving the A.B. diploma, since an 

 imperfectly qualified practitioner of medi- 

 cine may endanger the lives of his patients, 

 while an unworthy graduate of the academic 

 department can, as a rule, injure no one but 

 himself. Hence the medical faculty may 

 justly be required to exercise greater caution 

 in bestowing the degree of M.D. than is nec- 

 essary in the case of the A.B diploma. We 

 must, therefore, enquire whether it is pos- 

 sible to obtain the advantages of a flexible 

 curriculum consisting largely of elective 

 courses without losing the security against 

 superficial and imperfect work which the 

 present compulsory system is supposed to 

 afford. 



Any one who is familiar with the existing 

 methods of medical instruction is aware 

 that in nearly every department many 

 things are taught which are subsequently 

 found to be of use to only a fraction of 

 those receiving the instruction. Thus the 

 surgical anatomy of hernia is taught to men 

 who will subsequently devote themselves 

 to dermatology ; future obstetricians are 

 required to master the details of physio- 

 logical optics, and the microscopical anat- 

 omy of tumors forms a part of the instruc- 

 tion of men destined to a career as alienists. 

 Now, no one can question the propriety of 

 including instruction on all these subjects 

 in the curriculum of a medical school, but 

 it may be questioned whether every student 

 should be forced to take instruction in them 

 all. It may, perhaps, be urged that no 

 choice of studies can be made without 

 determining, to some extent, the direction 

 in which the work of the future practitioner 

 is to be specialized, and that such specializa- 

 tion cannot be properly and safely permitted 

 until the student has completed his medical 



