both from his own and from a transmitted excellence, briefly though it shone amongst us. Let us emulate this doubly bright example, and, cherishing a memory identified with all the more exalted aspects of the healing art, let our institution bear within its walls to a remote posterity his name, joined to that other, which ever kindles our loyalty and affection.

1 James Jackson, Jr.

MEDICAL EDUCATION IN AMERICA.1

HAVING on former occasions said something of Medical Science and Medical Art, I propose here to offer a few practical considerations on Medical Education, with reference both to its daily use and to the progress of medical knowledge.

I am well aware that he who inculcates in general terms a high standard of knowledge, and bids God speed to progress, has a far more grateful task, in the approval of others, and possibly of himself, than he who stops to confront it with any consideration of its relative utility. But in an age of science, like the present, there is more danger that the average medical student will be drawn from what is practical, useful, and even essential, by the well meant enthusiasm of the votaries of less applicable sciences, than that he will suffer from want of knowledge of them; and I am quite aware that I may not hope for the favorable consideration of some of my friends, when I say that, if there is any idea which I particularly desire to present distinctly in these remarks, it is that of utility in medical education.

The zealous devotee of less serviceable science, to whom the world is indeed under obligation for often inadequately requited labors, whether in extending or in merely cultivating the domain of human knowledge, may well be pardoned the conviction that such science is worthy of pursuit for its own sake; but he should guard against the fallacious belief that it offers quite as good an investment of time for the student dependent on his profession for support, as if it had

1 The Annual Address read before the Massachusetts Medical Society, June 7, 1871.

an immediate and determinate practical value; and especially against a nebulous feeling that there is a savor of earthiness in the pursuit of knowledge which is likely soon to be worth something.

The lapse of centuries has removed the amulet from the physician's sanctum, and the stuffed alligator from his ceiling. Astrology, astronomy, and even natural history, are known to have no immediate connection with pathology and therapeutics; and as the area of our science expands we shall not only continue to eschew error, but shall leave to one side more and more of real truth pertaining less directly to it, still utilizing and incorporating its valuable results, and still finding an ample field of study beyond the compass of any one individual. If, on the other hand, it is fair to inveigh against a quackery which makes plain things difficult, buries principles beneath details, occupies the mind with mere therapeutic measures and routine, and attracts by persistent activity, I venture also to question that enthusiasm which mistakes novelty for value, and, overlooking much that is useful and practical, appropriates with eagerness whatever comes authenticated by recent alleged discovery, or flatters by a suggestion of exclusiveness in its pursuit.

Let us think carefully, then, before exacting from adult students collateral acquisitions which in practice they will not need, and will actually soon forget,— especially as much that is strictly medical is profitless, or nearly so, to the medical practitioner. When, a student in Paris, I listened to a lecture upon the plague, or upon the ligature of the posterior tibial artery, it reminded me of my fencing master, who was giving equally useful instruction how, in case of attack by more than three men at once, to place your back against a tree, and, drawing a rapier, dispose successively of each.

And yet there is a limit to this line of argument. No student or artisan is the worse for an outlook upon kindred

arts and sciences which help him to establish the true relations of his own, which will supply him with additional facilities and light for its pursuit, and with that training of his intellectual powers afforded by a systematic variation in their exercise. Let us concede, then, a certain latitude to the study of medical science, testing it rigidly and constantly by its applicability to subsequent medical pursuits, and especially by a frequent consideration of the question, how far it shall occupy the student's limited time, to the exclusion of what to him is more important.

Two classes of the profession at once claim our consideration: those who are to do the daily work of medical attendance only, and those who may be expected to contribute something to the development of medical knowledge. For each of these a course of education is to be provided, such as will not rise above the proper requirements of the one nor fall below the just expectations of the other; or, on the other hand, we may, with more economy, aim to devise a single system suited to the education of a body of students, not only as routine practitioners, but as something higher.

It is plain that the mass of work must be performed by the exclusive practitioner, who has been educated with the view of turning his acquirements to immediate practical account, and whose business so occupies him that he contributes comparatively little to the absolute advance of knowledge. Let us consider first just what the community should expect of this man.

It has often occurred to me, that, if steam power should be substituted on common roads for horse power, collisions would be of hourly occurrence. It is as often the beast who turns out as the driver, and I hold that, as a rule, outside of surgery and other surface work, it is the disease which turns for better or for worse, and not the physician who

turns it. Disease often advances with a dignity of progress not to be sensibly swayed to one side or the other by the interference of the physician. The balance of healthy function is disturbed; for a varying time the disturbance increases, and for another varying time it diminishes, until the balance is restored. A discourse, which first attracted public attention here to the fact that it is useless to try to cut short certain kinds of disease, justly called them self-limited, because, if not limited by their own inherent tendencies, they assuredly are limited by nothing else.

But let us not forget that, when we are able to limit the duration of disease, as we can that of fever and ague, or, more completely, of syphilis, then it will be no longer, as now, self-limited, but subjugated and controlled. And this

may be the future of any disease, not excepting tubercle and malignant affection, the failure and the exuberance of vitality, and even old age itself, provided only the chemist will manufacture, as of late he promises to do, the vital spark. So that, even if a large majority of fevers, epidemics, and the more serious derangements of structure or function, are as yet little controlled by anything which the physician prescribes, we are neither to doubt of future progress nor to lose sight of accomplished results.

He

An accurate and well defined knowledge of undisputed therapeutic principles and details should be exacted from every practitioner claiming to be properly qualified. should know how to treat, and of course how to identify, all common injuries and diseases, so that health shall be reestablished in the shortest time, whether by interference or by a resolute refusal to interfere. And you are to provide fifty such plain and competent men for one who knows more.

Look at the reverse of the picture, - at a practitioner deficient in respect to the quantity or the quality of his education, - accomplished in the right direction, it may be, but