72 



SCIENCE. 



[N. S. Vol. XVIII. No. 440. 



training than if he had contemplated medi- 

 cine from the commencement of his educa- 

 tion and may be equally well fitted to pur- 

 sue the study, but he finds himself at least 

 one year, and possibly two years, behind 

 his fellow student who had medicine in 

 view from the beginning. For this reason 

 it is probable that the majority of colleges 

 will give elective coiirses, beginning with 

 the junior year, which will lead imme- 

 diately to medicine, and that many stu- 

 dents will be forced by circumstances to 

 make this early decision. 



This hasty and somewhat patience-trying 

 review, I fear, of the circumstances of 

 medical education hitherto in America 

 prepares me now to speak of the duty and 

 responsibility of a university in medical 

 education. 



It is apparent that the present require- 

 ments for medical education have become 

 so expensive and exacting that schools 

 which have hitherto been maintained as 

 commercial ventures and for the private 

 gain of their owners can no longer be 

 profitable if they honestly seek to do their 

 duty towards the student. Expensive 

 laboratory courses are required in histol- 

 ogy, embryology, anatomy, physiology, 

 bacteriology, pathology, clinical micros- 

 copy, pharmacology and physiological 

 chemistry. They necessitate much appa- 

 ratus, many salaried instructors who are 

 precluded by their duties from adding to 

 their income by private practice, and a 

 limitation in the size of the class to permit 

 of personal work. Former methods of 

 medical instruction dealt with students en 

 masse; present methods must consider in- 

 dividuals, and the unit of instruction be- 

 comes one person instead of five score. If 

 this altered educational condition is to be 

 honestly met by a school which depends 

 upon its fees for its support— and to the 

 credit of many schools, it should be said 

 that they are making the most praise- 



worthy efforts to meet the requirement— it 

 means a loss of income and an ultimate 

 extinction of the school. "With many of 

 them, in fact, the end is not far off. They 

 already suffer from Falstaff's incurable 

 disease — 'consumption of the purse.' On 

 the other hand, if the situation is not fully 

 realized and frankly met, we must be pre- 

 pared to see the commercial school retain- 

 ing its profits by furnishing insufficient 

 medical instruction and an inadequate 

 training. The medical man is thus fitted, 

 as in the past, to become a practitioner 

 rather than a student and a teacher. To 

 modify a phrase iised by another, 'such 

 schools can do something for learners and 

 but little for learning'; in other words, 

 they can help make the doctor, but not the 

 science of medicine. 



The present situation, then, demands 

 that schools connected with universities 

 shall perceive the need of the student and 

 protect him from imposition by affording 

 him instruction of a high standard. The 

 university, in fact, must set the standard. 

 The working of the law of supply and 

 demand, it is universally agreed, is no 

 longer adequate to supply the higher edu- 

 cation. It must be endowed by individ- 

 uals or furnished by the state. Individual 

 enterprise and initiative can no longer be 

 depended upon to teach astronomy, the 

 classics, higher mathematics or any other 

 than technical or purely bread-and-butter 

 branches. Medical instruction consequent- 

 ly can not be left to the initiative of the 

 private school any more than can instruc- 

 tion in any other form of higher knowl- 

 edge. If instruction in medicine is to 

 form part of the university curriculum, 

 the work should be done thoroughly and 

 in such a manner as to add to the dignity 

 of the science. I am aware that, mainly 

 because of the imperfect preliminary edu- 

 cation required for admission to the study 

 of medicine, there has always been a query 



