technique of modern medicine than a larger body, loosely supervised in an antiquated city hospital where "students" are eyed askance as interlopers. The defects of the former, due to somewhat circumscribed experience, a hospital year will quickly redeem, for he has, and knows how to use, the tools; the defects of the latter will as a rule never be repaired at all. Such a hospital year is in any event highly desirable. It is to be hoped that a more effective and economical organization of preliminary education and a more intelligent public opinion may presently make its exaction generally feasible.[1]
On the basis of the undergraduate instruction described, opportunities for advanced or graduate instruction must supervene. Such opportunities serve two quite different functions. In the first place, the various specialties must be systematically and thoroughly developed as graduate pursuits, resting on a thorough training and experience in general medicine. The number of these specialties is increasing, as more varied and more effective appliances suggest increased differentiation,—a safe tendency, in the interest of efficiency, provided the discipline required does not infringe upon undergraduate territory. In the next place, to these postgraduate institutions the hard-run intelligent practitioner in smaller towns will at intervals return, in order to be invigorated at the head-waters: he will want to get in touch with recent improvement, to see in a brief period a large variety of interesting material, handled by experts in his own field. To both these purposes, the larger hospitals of our great cities may freely lend themselves. Their abundant wards can be used to excellent advantage, even though they may continue to be governed by their present boards. It is probable that the obstacles to such use will largely disappear as the competitive and commercial exploitation of medical education is itself abandoned. For beyond all doubt, not the least serious of the deplorable consequences that have followed in the wake of mercenary medical education is the limitation of hospital opportunities, due to the rivalry of "faculties" and to the incompetent student body to which, largely because of such antagonisms, the intimacy of the ward privilege would have had to be extended.
- ↑ Our required medical course, prior to practice, now covers four years. In Germany five years must be spent at the university, a sixth in a hospital; in England, "official statistics published recently under the authority of the General Medical Council show that the mean length of the curriculum in the case of 1111 students investigated was three weeks less than seven years; only 14 per cent succeeded in obtaining a qualification in the minimum period of five years, 35 per cent obtained it in the sixth year, 18 per cent in the seventh year, 13 per cent in the eighth year. When the remaining 20 per cent obtained it does not appear, probably never. Looking at the figures in another way, we find that at the end of six years less than half had obtained a qualification for registration, and at the end of seven years only two-thirds." British Medical Journal, Sept. 5, 1908, p. 634.
