SCIENCE. 



[N. S. Vol. XI. No. 279. 



New York before the American Society of 

 Naturalists,* I gave the reasons which 

 seemed to me conclusive in favor of this 

 extension of the elective system and, with 

 your permission, I will take the liberty of 

 presenting as briefly as possible the views 

 there set forth. 



In the first place it may be assumed that 

 a medical school of the first rank should 

 be an institution in which the most ad- 

 vanced instruction in all departments of 

 medicine can be obtained, and on this as- 

 sumption it is, of course, impossible to ai-- 

 range a course of study that every student 

 must follow in all its details, for, in the 

 time which may properly be devoted to a 

 course of professional study, it is quite im- 

 possible for even the most intelligent stu- 

 dents to assimilate all the varied informa- 

 tion which such a school may be reasonably 

 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, 

 that is, between those things of which no 

 man who calls himself a physician can af- 

 ford to be ignorant and those which are im- 

 portant for certain physicians but not for all ; 

 in other words, provision must be made both 

 for required and for elective studies. The 

 task of drawing the line between the essen- 

 tial and the desirable in medical education 

 will require the greatest possible good judg- 

 ment and readiness for mutual concession 

 on the part of those engaged in the work, 

 but there is no reason to fear that the difQ- 

 culties will be found insuperable when the 

 importance of the change has once been 

 recognized. 



Any one who is familiar with the existing 

 methods of medical instruction is aware that 



*See Science, N. S., Vol. VIII., No. 209, p. 921 

 and Boston Med. and Surg. Journal, December 29, 1898. 



in nearly every department many things 

 are taught which are subsequently found 

 to be of use to only a fraction of those re- 

 ceiving the instruction. Thus the surgical 

 anatomy of hernia is taught to men who 

 will subsequently devote themselves to der- 

 matology, future obstetricians are required 

 to master the details of physiological optics 

 and the microscopical anatomy of muscles 

 forms a part of the instruction of men des- 

 tined to a career as alienists. Now no one 

 can doubt the propriety of including instruc- 

 tion on all these subjects in the curricu- 

 lum of a medical school, but it may be 

 fairly questioned whether every student 

 should be forced to take instruction in them 

 all. 



To better indicate the nature of the reform 

 which I am advocating, 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. An experienced lecturer will prob- 

 ably find it possible to condense into a 

 course of about forty or fifty lectures all the 

 most important facts of physiology with 

 which every educated physician must neces- 

 sarily be familiar. Attendance upon these 

 lectures, combined with suitable courses of 

 text-book instruction and laboratory work, 

 would suffice to guard against gross ignor- 

 ance of physiological principles. In addi- 

 tion to this work, all of which should be 

 required, short courses of not more than 

 eight or ten lectures each, should be pro- 

 vided, giving advanced instruction in such 

 subjects as the phj'siology of the special 

 senses, cerebral localization, nerve-muscle 

 physiology, the internal secretion of glands, 

 the physiology of the heart, circulation and 

 respiration, the digestive secretions, the 

 reproductive organs, etc. These courses 

 should be elective in the sense that no stu- 

 dent should be required to take them all. 

 Each student might, however, very properly 

 be required to choose a certain number of 



