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Faculty with the purpose of improving medical instruction. The members of the staffs of the hospitals, dispensaries, and asylums are selected for other qualities than their capacity to teach; but when the President and Fellows of Harvard College wish to get a medical teacher from without this immediate community, they are hindered by the fact that they cannot themselves provide with clinical opportunities the gentlemen whose services they seek. If there were a hospital within the control of the University this serious difficulty in the way of bringing admirable men from without to the service of the School would be greatly diminished; and it is from that point of view that I desire to see a hospital connected with our Medical School.

"These three points, gentlemen, are the ones which I wished to-day to have an opportunity of bringing to your attention, the expediency of prescribing a degree in Arts, Science, or Letters for admission; the desirableness of greatly extending the instruction of the School; and the need of a hospital within the control of the University. I ask your support for these measures, so far as they may in time commend themselves to your judgment, and I take this opportunity of thanking you once more for the extraordinarily cordial and effective support which has been given to the Medical School by this Association, and indeed by the medical profession of Massachusetts, during the rapid growth and expansion of our Medical Department since 1880."

After President Eliot had concluded, Dr. Roswell Park, of Buffalo, was introduced, who said in part :

"A few weeks ago I attended a convention in one of the Canadian universities, and although I sat within ten feet of the chancellor on the stage I was unable to hear anything that he said. They had that good old English custom of making a noise, and the students at the other end of the hall made such a commotion that it was impossible to hear anything that was said on the stage. Of course, you are aware of the Oxford and Cambridge customs, and it seems that they are still imitated on this side of the water. They also had a dinner afterwards, and I was asked to say something. In fact, our Canadian friends have a habit of calling to his feet every man who is still able to get there after a dinner. And I took occasion to allude, as gently and pleasantly as I could, to the commotion which I had witnessed and the scenes that had come under my observation, and I thought I would try them with a little anecdote about a friend of mine, who was making a Fourth of July speech in this country.

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During the progress of it he was annoyed a great many times by a man who persisted in asking him questions, or making remarks, and the gentleman finally called him down something after this fashion. He stopped abruptly in the midst of his speech and said: 'My friend, I want to speak to you. Are you a Christian?' He said, 'Yes, sir.' And you go to church regularly?' He said, 'I do.' Said he, 'My friend, do you believe in the efficacy of prayer?' 'I do; I say my prayers every night.' 'Good. Do you believe in the doctrine of regeneration?' He said, 'I do; I believe in it literally.' He said, 'Better yet. Now, my friend, I want to give you a piece of advice; when you go home to-night and retire to the privacy of your

bedroom, get down on your knees and pray very earnestly and faithfully, pray as you never prayed before, that you may be born again—and still-born.' Now, they saw it, if they were English."

Dr. Park, after giving many instances of the way in which until very recent times the intolerance of the Church has hindered progress in medicine, continued:

"But let us turn from the past, gentlemen, to the present. . . . Years ago I used to wonder how it happened that none of our text-books emanated from Boston. If you look over the college catalogues of this country and ask yourselves whose books are most studied, you do not find many Boston names. Now, why is that? It is a question I have never been able to solve for myself. Not because you have not as good colleges here, or as good practitioners as elsewhere. I pledge you my word, gentlemen, this is no idle compliment, I think that the best surgery done in this country to-day is done in Boston, and I think that will hold good about the other branches, though I do not know so much about them. I think the most scientific surgery done in America to-day is done right in this city. And the objection will not much longer hold good with regard to text-books.

"There have emanated from some of the teachers of this School of late certain books in my own line, as well as in others, but you will pardon me if I talk more about those which I know most about. There, for instance, is the volume of lectures by Dr. Cheever, which is full of his ripe, wonderfully ripe, experience. There is the work of Dr. Warren, which, I think, is the most creditable book on surgical pathology, and the most beautiful medical illustration of the bookmaker's art that has ever been issued from the American press. There are the contributions of Dr. Watson, of Dr. Bradford, and Dr. Lovett, which are superb in their way, and it will not be much longer that one can say, 'Who studies a book which came from Boston?""

Dr. Park closed by explaining how the University of New York controls the giving of medical certificates in New York State, and how the Chautauqua system there enables students who cannot attend a medical school to study at home.

Dr. George Dock, the next speaker, described the methods of education at the University of Michigan.

"That institution," he said, "is supported by the State, that is, it is supported by a tax, which varies from time to time, according to the good will of the Legislature. To show the sort of men that we get that tax from I need mention only one instance. Two years ago we asked the Legislature to appropriate from the State taxation the twentieth of a mill. One old Populist got up and said he thought a twentieth would be too much, but he was willing to compromise on a tenth.

"We have in Ann Arbor three things that are uncommon in medical schools, although two of them sometimes occur together. We have nominally a homoeopathic school; we have coeducation; and we have the four years'

course. Of the homoeopathic school I can say but little, as that body is almost defunct now, being kept alive only by injections of the elixir of life furnished by the same Legislature. Coeducation is becoming so important all over the country that stronger pressure may be brought on you than was some years ago; you may have to consider the question again. . . . The introduction of coeducation in a medical school seems to me to cause a very radical change in the manners and customs of the men students, at least at Ann Arbor. I have never seen the disorderly conduct that is only too prevalent in other schools. I think we can safely say that that is due to the presence of the women, and this gives an air of seriousness and attention to all the classes and all the laboratories that is rather unusual."

Dr. Dock next stated that the four years' course had already been successful, the number of students having increased ever since it was announced. He described the instruction given, and the great advantage the medical school has from having a hospital of its own which supplies plenty of clinical material. The patients, he said, do not object to being used for purposes of demonstration; for it not only breaks the monotony of their existence in the hospital, but also convinces them that they are being examined much more thoroughly than they have ever been before. Dr. Dock, after speaking of the lecture and examination systems, urged the necessity of establishing higher requirements for admission, and advocated shortening the academic course. He thought that students who do not leave the medical school till they are twenty-seven are often stale, unable to do as good work as if they had made an independent start two years earlier. But the chief gain in time must come from improving the secondary schools.

Dr. George J. Engelmann, of St. Louis, Mo., the next speaker, referring particularly to the conditions in the West, said:—

"We have too many schools; we have too many doctors; and, unfortunately, the dignity of the profession suffers. You are not aware of that so much here in the fortunate circumstances in your great centres. And whilst I admire every diligent worker, every untiring student, I should say that the nobility of our profession must stand foremost. Our calling is not a business alone; neither honor, nor the desire for the soaring eagle of glory or the heavy eagle of gold should make us waver from our path. We have invalid conditions, or conditions of which you know little or nothing here. . . . The great difference in the leading schools of that great country and the schools of the great centres is that here, and above all, in this school of Harvard, you can devote time and money to the study of medical science, to the laboratory work, whilst in the more practical and more distant regions the clinic and the hospital work is all important. But the laboratories are well furnished. Let me mention, for instance, Rush Medical College, which this past year has spent $60,000 upon a laboratory, and $60,000 from the pockets of the Faculty. If you will, it is a self-sacrificing profession which does this work, but the hos

pital is the important feature. And in the city of St. Louis two or three schools have their hospital attachments, have their hospitals under their immediate control, by the side of the school, with their clinics, sometimes a double set of clinics running all day. In Chicago five schools have their hospitals, and under the immediate control of the faculty, with facilities of city hospitals and other institutions in addition. That is the essential feature. And whilst the four years' course is a nominal one, three years of the school and one under the guidance of the preceptor, that depends upon the student. And the improvement in those schools will depend upon the general education, the improvement of the student, and of the legislator; and much, in fact all, has been done in the elevation of the standard of the medical schools by legislation. A large number of the Western States demand a diploma from a three years' school, or they accept no diploma from any school whatever, but demand an examination before their Board.

"The State of Montana has just passed a law which admits to practice in that State only after graduation from a full four term school after July 1, 1898; and another step has been taken by one of our States, which, perhaps, may aid greatly in advancing the standard of the student, namely, that it takes away from the college, from the medical school, the privilege of admission, but admits to the medical schools of the State only after examination by its State Board. That, I believe, is a new departure, and is one which will tend certainly to attain the very point President Eliot and Dr. Dock have spoken of. You have no difficulty here, but the difficulty will be with the mass of schools throughout the land.. I would say but one thing more, and that is that I trust that this great school will not stand proudly aloof in the future as she has done in the past, but that she will extend a hand to her younger sisters, though many of them be still in short frocks. Much good will thus be done. And let us in our broad humanitarian work during this important period of a struggling profession, a rapidly progressing profession, - let us forget and forever cast aside those boundaries of East and West, as you have those of the North and South."

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Dr. John Green, '55, of Washington University, St. Louis, Mo., the last speaker, spoke of the Harvard Medical School as he knew it more than thirty years ago, as being the only school to insist on its "solemnly published requirements."

"Harvard was then in advance, as I believe, in its real requirements, of all the other schools of the country, but under the leadership of its young President about twenty-seven years ago, with the coöperation of men in its Faculty who believed that the system of medical education here was miserably inadequate, a course of three full years of medical instruction was provided by Harvard as an indispensable requisite to candidacy for its degree. Harvard has been followed by other medical schools; first by the University of Pennsylvania, and then by the College of Physicians and Surgeons, the Medical Department of Columbia University in New York. The date of Ann Arbor establishing a compulsory three years' course without permitting substitution

in the way of time spent with a preceptor for one of three courses was later, considerably later. The great colleges of the East very slowly fell into line following the example of Harvard, and for the proud position that Harvard holds, of having been the pioneer in this work, I believe the medical profession of the country, with the Harvard Medical School, is indebted to the present President of the University. That the change would have come, and come soon, is certain. That Harvard would have been the first in the country to make that reform, is perhaps doubtful."

Dr. Green then described how the State Boards of Health have helped to raise the standard of medical instruction, in spite of their often conflicting requirements. He alluded to the disinterested efforts of the Medical Faculty of Washington University, and then he referred to the Harvard Medical School at present, which has the task of educating two different classes of students, viz.: those who are graduates in Arts, Letters, or Science, and those who enter without previous collegiate training, by passing an examination which represents about the level of one year's work in a high school. The latter, he said,

"are men untrained in methods of medical study, or of the laboratory; they are men of narrow education. The logic of the situation is this, that Harvard University must before long do in the Medical Department what it has determined to do in the Law Department, — receive only men holding a first degree in Arts, Letters, or Science, or else it must establish two courses of instruction, one suited to the limited capacity of the student admitted on examination, and leading to a lower degree; the other a higher course suited to the abilities of the trained men six or seven years later. The outcome of it will be the ultimate establishment of a requirement of a degree as a condition for commencing the study of medicine.

"I have said that the pressure brought upon the medical schools in the interior of the country has come from State Boards of Health. As an illustration of how things are, the requirements imposed under the statutes of the different States as regards the candidacy for a degree in medicine, or in anything else, we have the statement of our guest to-night from New York of the working of the University of the State of New York in determining by examinations, whether of the candidate, or of evidence in the way of diplomas, his fitness to be recognized as a student before the Medical School can receive him as a candidate for a medical degree.

"The requirements in another State were tersely stated, and with a moderation which did not reach the actual state of facts, by a very judicious and wellinformed man, at this moment acting as mayor of one of the large Western cities, in which he said, 'Under the statutes of this State three barbers can associate themselves, call themselves a medical college, grant medical degrees upon any terms they please.' The statute does not require that the three men organization as a medical college shall be so nearly affiliated to physicians as barbers; they may be the first three men who pass the window on the street, provided they are inhabitants of the State. That State, I am sorry to

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