doctor and patient, lawyer and client, teacher and pupil, the leader and the led. Sarcasm and invective never prove as effective against false doctrines, selfish leadership, and the harm that comes from indifference and neglect, as do persistent and tactful campaigns to secure the intelligence and confidence that tend to remove the opportunity for such things.

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(g) And, finally, that the physician shall be an apostle of right living, not merely in the avoidance of disease but in securing the fullest development of mind and body. Men are learning slowly, very slowly, as all great lessons are learned, that a sound body is their best defence; that excesses-whether of work or any other kind-are inevitably weakening; that pure air and exercise, moderation in eating and drinking, and generally correct habits can do for them what no amount of dosing with drugs can ever do." And this right living includes right thinking as well as right acting. Whatever may be the nature of the mind, it is so closely connected or interrelated with the body that its well-being enters deeply into the account. This broadens the field of the physician's work and makes him touch shoulders with education and all the other social forces in his efforts. Like the educator, no matter how limited his field of special effort, he will never get the best results from it without intelligently and sympathetically grasping its place in the larger interests of which it is an integral part.

It is quite clear that the most promising results for public health can be gotten only by beginning early in life, -in fact, with the parents even before the birth of the child. American statistics indicate that fully one-third of the babies born die before they reach the age of five years and that, in any single year, from one-fifth to one-fourth of the entire death-roll is made up of infants less than a year old. And the physical risks that the remainder run because of the neglect, ignorance, bad judgment, and weakness of parents and others is not pleasant to contemplate. As a writer in McClure's for August well says, why should we worry about a declining birth-rate when more babies are born merely to die? And why should we be anxious to save their lives if they are only to swell the great army of

the defective and diseased? No line of interest is of more importance to the physician and the educator than this, and it is significant that the mind of the public turns more and more each year toward this more promising field of work. But nothing, after all, means so much for the public health as the attitude of hopefulness that is slowly replacing the old feeling of hopelessness and helplessness in the presence of disease. Even the idea that it is "God's will" offers little comfort to pious people who see their loved ones cut off in the prime of their usefulness. “To-day we know that it is not 'God's will' that children should die of diphtheria or young men be destroyed in the flower of their manhood by typhoid fever. We are awake to the fact that it is man's ignorance or man's carelessness that is responsible, and we are inspired to work on toward the glorious ideal set before us by Pasteur when he said, 'It is within the power of man to cause all infectious disease to disappear from the earth.""

The Newer Medical Education.

This changed attitude toward disease has not only made new demands upon the medical profession, but it has also made necessary new ideals and a change of emphasis in the training of physicians. While the older education emphasized the knowledge and text-book phase of medical training, the newer is insisting upon the importance of trained observation and the laboratory method. It is not that knowledge is not important, and a large amount of it even necessary, but that study and practice must be permeated by the newer spirit which recognizes that so little of absolute fact is known and so much of new insight is possible that every practitioner, worthy the name, must prepare himself for being an intelligent observer and a possible discoverer. There never has been a time when professional men were so thoroughly permeated with the spirit of questioning existing practice, of investigating, testing, and observing for the finding out of new truth, as they are to-day. There also has never been a time when the people were expecting and even demanding so much from their experts as to-day. It is to such influences that

the harvest of criticism of the established order of things is due. It is this, no doubt, which suggested the investigation of the conditions of medical education in the United States that led to the fearless, critical 1910 report of the Carnegie Foundation for the Advancement of Teachinga report which, in 1912, has very properly been followed by a critical study of Medical Education in Europe, with a view of suggesting improvements in medical education in the United States. This report is pervaded by the spirit of the newer ideals and is made very largely the basis of what immediately follows:

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And,

I. In the introduction to this report, Doctor Pritchett, the president of the Foundation, calls attention to the fact that medical education is an educational rather than a professional problem. This is evident for two reasons: First, because "the striking fact emerges from the careful study of the problem in any country, that there is an absolute dependence of professional teaching in medicine upon the general educational system of the country itself." second, because, particularly in America, professional education has suffered from the notion that to train a man for his profession, one must have the viewpoint of the practitioner only, and not the viewpoint of the teacher as well." And this in spite of the fact that proper training for any profession is more concerned with a high order of reasoning, and the ability to observe facts and to marshal them in proper order so that correct conclusions may be reached, than it is with the demonstrations of a highly trained expert. Definite knowledge and the inspiration of a high order of skill are both needed, but the student's training, after all, must be self-training; and improvement for him can come only through a clear recognition by his instructors of the educational process by which it may best be obtained. Frail foundations of general education always have and always will mean professional failure. Although occasional brilliant practitioners will arise under such conditions, the profession itself will thereby always be under the ban of an average low training, and subjected to the menace of a mass of ill-prepared men who drag down ideals and gain their livelihood at the expense of the public. Medical instructors who lack pedagogical insight and skill fail to lay

hold of and develop the highest possibilities of their students and are apt to present their subjects in a manner that is wasteful of the time of the class.

Acceptance of the view that such education is not merely a medical matter, Doctor Pritchett says, would involve in the United States a changed condition, especially in the prevailing practice in the teaching of clinical medicine and surgery. While it is now pretty generally conceded that the basic sciences of chemistry, physics, and biology, as well as the more definitely medical sciences of anatomy, physiology, pathology and bacteriology, must be imparted by those who are primarily teachers and who give their whole time to teaching and research work, it has not been so generally recognized that the clinical instruction should be done under the same conditions. Germany is the only country in which a consistent practice is followed throughout; and it is owing to this, combined with the efficient foundation work done in its secondary schools, that Germany's medical training has reached such a high stage of efficiency. Too often in America, he says, the teaching of clinical medicine and surgery is placed in charge of a prominent practitioner who makes it a side issue in his busy life.

2. Thoroughness is to be the keynote of the newer medical training. This is to be attained in two ways: First, by having the basic work well performed before the student is permitted to enter upon his professional career. Even in Germany, with its system of strong secondary schools, a boy is still permitted to enter a medical school without a proper knowledge of the fundamental sciences and with the disappointing hope that he may get this knowledge in the medical school itself. Teachers of medicine readily admit that, to students who have really mastered elementary physics and chemistry and biology, medical education means far more than to those who have not mastered them. Mastery of these subjects gives a higher and better viewpoint; and, besides, it familiarizes the student with the scientific concepts, nomenclature, and methods of reasoning that are so necessary to the proper development of medical ideals and practice. Second, but even if the student enters upon the study of medicine properly trained in the funda

mental sciences, the problem of the medical curriculum remains an important one. The many allied interests and the number of new discoveries that are constantly clamoring for admission to the medical course create a constant tendency to overburden the curriculum, or to increase the time for it, or both. We have reached a point where it must be recognized that we cannot do everything during the period of formal training, nor dare we unduly prolong the period. The medical curriculum, especially in Europe where it is now extended over a period of five years, "has reached the limits of its capacity; it can contain no more." An overcrowded curriculum creates a tendency to fly from one task to another at such a pace that little time is left for thorough preparation or for serious consideration. Under such conditions a disposition to neglect thoroughness in essentials, and even a tendency to fail to see what are the essentials, develops very rapidly. The important thing in any system of training is that the student shall accomplish certain indispensable minimums and shall at the same time be imbued with a disposition to remedy his own deficiencies both during and after his course. By offering a simplified course, with certain required minimums and important inducements for intensive work in some direction beyond the requirements, the Germans are now endeavoring to secure these results.

3. "The wholesome effect of an examination system at the close of the professional study which shall at one and the same time test theoretical knowledge, ability to think, and technical skill" must not be forgotten. There has been in America a revulsion against badly overdone and badly mangled examination systems which has probably caused us to swing too far in the opposite direction. In the last analysis, the examination has probably disappointed us more in its failure to secure for us good teaching than in its failure to test the standing of the pupil in that which has been taught. Everything does not, of course, yield itself to formal test, but there are certain essentials of knowledge and quality that do so yield themselves, and an efficient educational scheme should always be able to measure up, in recognizable data, to such standards. But these standards must be the recognized standards of