December 30, 1898.] 



SCIENCE. 



925 



studies. To this it may be answered that, 

 whatever may be the dangers of too early 

 specialization, the dangers of crowding the 

 medical course with instruction of which 

 many students do not feel the need and of 

 thus encouraging perfunctory and super- 

 ficial work are certainly no less serious. 

 Moreover, it will, doubtless, be found per- 

 fectly possible to establish such a relation 

 between the required and the elective 

 courses that the requirements in each 

 department will be in no way lowered, 

 while a certain freedom of choice is per- 

 mitted with regard to the direction in 

 which the work is pursued. To illustrate 

 this point, allow me to describe a possible 

 arrangement of a course of study in the 

 department of physiology with which I 

 am, of course, more familiar than with 

 any other. 



In the Harvard Medical School instruc- 

 tion in physiology is now given in a course 

 of about 100 lectures, besides recitations, 

 conferences and practical laboratory work. 

 Were the work to be rearranged in accord- 

 ance with the above plan it would probably 

 be found possible to condense into a course 

 of about 50 or 60 lectures all the most im- 

 portant facts of physiology with which 

 every educated physician must necessarily 

 be familiar. Attendance upon these lec- 

 tures, combined with a suitable course 

 of text-book instruction, would sufBce to 

 guard against gross ignorance of physio- 

 logical principles. In addition to this re- 

 quired work, short courses of eight or ten 

 lectures should be provided, giving advanced 

 instruction in such subjects as the physi- 

 ology of the special senses, cerebral locali- 

 zation, nerve-muscle physiology, the in- 

 ternal secretion of glands, the physiology 

 of the heart, circulation and respiration, 

 the digestive secretions, the reproductive 

 organs, etc. These courses should be elec- 

 tive in the sense that no student should be 

 required to take them all. Each student 



might, however, very properly be required 

 to choose a certain number of courses, which, 

 when once chosen, become, for him requii'ed 

 courses leading to examinations. The num- 

 ber of special courses which each student 

 should be thus required to elect should be 

 sufficiently great to render the total amount 

 of physiological instruction in no way in- 

 ferior to that which is given under the pres- 

 ent system. 



It would, doubtless, be found desirable 

 in practice not to confine the possibility of 

 taking elective courses to the year in which 

 the required instruction is given, for a stu- 

 dent may frequently, in the latter part of 

 his course, become interested in a subject 

 like mental diseases, for instance, and will 

 then be glad of an opportunitj^ to take spe- 

 cial instruction on the physiologj' of cerebral 

 localization. The elective courses should, 

 therefore, be so arranged that they may be 

 taken in any part of the medical curric- 

 ulum. 



There is, in vaj opinion, no doubt that an 

 arrangement of instruction similar to that 

 here suggested for physiology could be ad- 

 vantageously adopted in the departments of 

 anatomjr, histology, bacteriology, medical 

 chemistry, pathology, surgery, and in the 

 courses of instruction in the various spe- 

 cial diseases, such as dermatology, opthal- 

 mology, etc. Whether the instruction in 

 clinical medicine and clinical surgery can 

 be thus modified is a question about which 

 more doubt may be entertained and which 

 I prefer to leave to persons of greater ex- 

 perience than myself in methods of clinical 

 instruction. 



Under the existing conditions of medical 

 education the introduction of the elective 

 system in some form or other seems to be an 

 essential condition to any further important 

 advance. If it be said that under this sys- 

 tem the medical degree will cease to have 

 the definite meaning now attached to it, and 

 that it will be impossible to tell from his 



