THE PROGRESS OF SCIENCE 
MEDICAL EDUCATION IN THE 
UNITED STATES 
Tue Varnegie Foundation has issued 
a bulletin on medical education in 
America, which is likely to do good 
service in attracting attention to the 
low standards and inadequate endow- 
ment of many of the medical schools 
of the United States. On behalf of the 
foundation, Mr. Abraham Flexner has 
visited every one of the 155 medical 
schools, and gives a brief description 
of each. The conditions in each state 
are summarized, and plans are pro- 
posed for their improvement. This de- 
tailed report is preceded by an intro- 
duction by President Pritchett and by 
fourteen chapters by Mr. Flexner on 
the whole subject of medical education 
in this country, beginning with a his- 
torical sketch and ending with the 
education of the negro. The bulletin, 
which extends to 347 pages, may be 
obtained by sending seventeen cents 
for postage to the foundation. 
The conditions of medical education 
in the United States have been investi- 
gated with equal thoroughness by the 
council on education of the American 
Medical Association, and are well un- 
derstood by experts. There are too 
many inadequately trained physicians 
in the country, and one of the prin- 
cipal difficulties is the existence of 
proprietary schools dependent on the 
fees of students. Physicians are ready 
to be professors in medical schools for 
the title and connections. When the 
school depends for its support on the 
fees, low standards are likely to be 
adopted in order to attract students. 
It was at one time possible to conduct 
a proprietary school with tolerable 
efficiency, as can now be done in the 
ease of law, but with the development 
of laboratory and clinical methods, the 
cost of a satisfactory medical educa- 
tion can not be met by fees. 
certainly a scandal that one third of 
our medical schools have incomes be- | 
low $10,000, all from fees, that in some | 
cases there are as many professors as 

It is | 

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students, and that many students do 
not have even a high school education. 
One school actually exists with twenty- 
six professors and a total income of 
$1,060. 
But while every one knows and ad- 
mits the evils, the remedy is not clear. 
Though Dr. Pritchett and Mr. Flexner 
have obtained their medical education 
by a short course, they have had expert 
advice and their general point of view 
is sound. We need several university 
schools of medicine emphasizing re- 
search and demanding long preliminary 
preparation, the schools for the train- 
ing of the great mass of practising 
physicians should require a training in 
science and the languages equal to two 
years of college, the schools in the 
south can not at present reach this 
standard, but should require a prepara- 
tion equal to a four-year high school 
course. Each school should have ade- 
quate laboratories for anatomy, physi- 
ology, chemistry and pathology under 
the charge of professors and instructors 
who give their whole time to the work 
of teaching and research. The clinical 
departments should be under the 
charge of professors whose practise 
does not interfere with their teaching, 
and there should be a suitable hospital 
and dispensary controlled by every 
school, 
But how are we to reach these stand- 
ards? We are slowly approaching 
them. When the Johns Hopkins Med- 
ical School was opened seventeen years 
ago, it was the only well-organized 
department of medicine in the country. 
With Harvard it still maintains pre- 
eminence; but there are now some 
thirty schools which give adequate 
training for the medical profession. 
The commercial schools are closing and 
being merged every year, for by the 
nature of things they can not last 
when they do not pay. When good 
schools are adequately endowed in all 
sections of the country, students will 
naturally frequent them. The states 
can accomplish more for the profession 
of medicine and the people by support- 
