Very interesting also, Mr. President, were your remarks with reference to the influence which medicine has in these days upon public health and the interest which the public in general takes in medical things.

I do not know a more impressive illustration of that than what is taking place in the municipal campaign in the city of New York at this moment, where one of the chief arguments and main supports for the retention of the present administration there is the excellent work that is being done in the Health Department, the low death rate, the influence which the administration has had upon the death rate from contagious diseases.

I have, perhaps, said enough, but I wish also to say that I have the fullest confidence in the future of these laboratories. It is not the building but it is what is done within them and the men who work within, that really count; and I close with the hope and expectation that these laboratories will be the home of sound scholarship and be productive of important investigations in medicine and that they will attract students from far and near and that they and your university may prosper.

The President then asked Professor Townsend Porter to read a paper which had been prepared for the occasion by Professor Bowditch of the Department of Physiology in Harvard.

PROFESSOR BOWDITCH, HARVARD UNIVERSITY.

I desire in the first place to extend my heartiest congratulations to the University of Toronto on the acquirement of the enlarged educational facilities, which it has been our privilege to inspect, for these beautiful building will not only enable the University to play an important part in the advancement of medical education in America, but they afford a substantial guarantee that the part will be played with distinguished success by this enterprising and well-equipped institution of learning. The importance of this movement for the advancement of medical education in America cannot easily be exaggerated, for if the momentum of the past quarter century be sustained, it may easily result in shifting the centre of medical teaching and research to the Western Hemisphere, so that, though our grandfathers sought medical inspiration in London and Edinburgh, our fathers in Paris and we ourselves have studied in Berlin, Leipzig and Vienna, future generations of physicians may find their Mecca on the banks of the Hudson, the Schuylkill, the Patapsco, the St. Lawrence, the Charles or the Great Lakes.

Nor is it in medicine alone that we find evidence of abounding activity in the laboratories of the new world. Chemists.

and physicists have not been idle, but this is a theme upon which lack of time forbids me to dilate, and it will suffice if I merely allude to the important work recently done in Montreal which has contributed so effectively to produce, in our conceptions of the nature of matter, the revolution which now seems imminent.

It will be found, I think, interesting to enquire whether the American movement in medical education is characterized by any special features which distinguish it from those which have taken place elsewhere. Now no one who has studied the work done in American medical schools during the last ten or fifteen years can fail to be impressed by the enormous expansion of the laboratory method of instruction, which has there taken. place. Whereas thirty years ago anatomy and chemistry were the only departments of medicine in which laboratory methods were in use, we have now laboratories of physiology, pathology, pharmacology, hygiene, bacteriology and surgery, while anatomy has greately extended the scope of laboratory work by including the allied sciences of histology and embryology, and chemistry has become, to a large extent, the handmaiden of clinical medicine. Nor is it alone for purposes of advanced instruction and original research that laboratory methods have shown their value. Experience has proved that they may be extensively used by beginners in medicine in acquiring elementary knowledge of the various medical sciences. In fact there is practically no limit to the amount of laboratory work which first year students in medicine, with an academic training behind them, can perform under the guidance of competent instructors. A few years ago when my colleague, Dr. Porter, was arranging a laboratory course in nerve-muscle physiology, he announced his intention of supplying the first year students with capillary electrometers. I was inclined to doubt the wisdom of the plan for I knew the delicacy of the instrument and the care needed for its manipulation, but, nothing daunted, Dr. Porter proceeded to construct capillary electrometers by the hundred and placed them in the hands of the students. To my surprise the experiment was a complete success and the students acquired a practical knowledge of the electrical phenomena of nerves and muscles which they could have got in no other way.

We need not, therefore, hesitate to employ laboratory methods of instruction from any doubt about the ability of the students to profit by them, but there is a distinct limitation to their use imposed by the fact that they are much more costly, both in time and money, than any other means of teaching and that, if employed exclusively, it would be quite impossible to impart to the student even a small fraction of the medical information which every educated physician must possess. It

is doubtless true that contact with the phenomena themselves and not with descriptions of them has a highly stimulating effect upon the mind of a student and that "the best knowledge is that which comes from personal experience" but we must not, on this account, condemn the lecture, the recitation and the textbook as worthless methods of instruction, nor deny all value to knowledge communicated from the experience of others.

It is, in fact, obvious that unless the student can profit by the experience of those who have gone before him, and begin where the latter have left off, no important advance in human knowledge will be possible. A wisely planned course of medical instruction will, therefore, recognize the lecture and the recitation as no less important than the laboratory, both for purposes of imparting information and as methods of mental discipline. We must remember that it is quite as easy to abuse the laboratory as the didactic method of instruction. Indeed, this seems to be a danger which now threatens us, and I fear that we may all live to see the day when we shall feel that the pendulum of educational reform has sprung too far in the direction of laboratory methods of instruction.

The future historian of medical education in America will probably point to the early years of the present century as the time when the elective system, already extensively employed in aca lemic instruction, secured a foothold in the professional schools. The idea of election in medical studies is not, however, altogether a new one even at the present time. In post-graduate schools the right to choose the courses desired is the essential feature in their organ zation, and since the establishment of the compulsory four years' course, a portion of the instruction of the fourth year has in some of our schools been given in elective courses in various specialties.

Now no one is likely to question the desirability of every first class medical school furnishing the most advanced instruction in all the departments of medicine. Such a school must, in fact, offer instruction in every subject which any student may desire to pursue, and this of course necessitates the adoption of some sort of an elective system, for it is obviously impossible for even the most intelligent students in the time. allowed to assimilate all the various information which such a school may be expected to impart.

The only question is whether the choice of medical studies should be limited, as it practically is at the present time, to postgraduate schools or whether undergraduates in medicine shall be allowed a certain freedom in determining the direction of their medical work. Now there is probably no medical school of which it may not be said that in nearly every department many things are taught which are subsequently found to be of

More

use to only a fraction of those receiving the instruction. over this state of thing is frequently fully recognized by the students themselves who are thus encouraged to do perfunctory and superficial work. It is indeed well known that a certain number of medical students very early make up their minds either that they will become surgeons, obstetricians or specialists of some sort, or, on the other hand, that they have a strong aversion to certain branches of medicine and a determination never to practice them. For such students a prescribed curriculum necessarily involves great loss of time and energy.

It

Led by these and similar considerations the Harvard Faculty of Medicine recently addressed itself to the task of revising the course of study with a view of distinguishing between the essential and the desirable in medical education. The required instruction in every department was reduced to the limit of that which was considered absolutely necessary for the mental equipment of a safe practitioner of medicine and all the more advanced instruction was provided for in elective courses. was thus found possible to condense the required instruction of the school into the first three years of the course leaving the fourth year to be wholly devoted to elective work. Hence at the end of the third year the Faculty practically says to tht students, "We now consider that you have received sufficiene training in all the matters of which no one who calls himself a physician can afford to be ignorant. We think you are not likely to make any serious error in the diagnosis and treatment of the ordinary diseases. We believe that you will know enough to call in the services of a specialist when your own knowledge fails We think that you have been so instructed in the fundamental principles of the various medical sciences that you can apply them successfully to the cases arising in your practice. We do not consider, however, that you are yet worthy of the Harvard M.D. degree. To obtain this distinction you must devote another year to medical study and in that year a wide choice of studies is open to you. If you wish to become a general practitioner of medicine take the elective courses in clinical medicine and frequent the general hospitals. If you desire to be a surgeon follow the courses in clinical surgery. If you incline toward any of the specialities take elective courses in the anatomy and physiology of the organs which interest you and follow the cliniques in those hospitals where those special diseases are treated. If you are particularly interested in any of the medical sciences take advanced instruction and research work in the laboratory devoted to the science of your choice."

It will be observed that an elective system thus arranged, while it permits, by no means compels an early specialization