Medical education in the United States and Canada : a report to the Carnegie Foundation for the Advancement of Teaching / by Abraham Flexner ; with an introduction by Henry S. Pritchett, President of the Foundation.

  • Abraham Flexner
Date:
[1910]
Catalogue details

Licence: Public Domain Mark

Credit: Medical education in the United States and Canada : a report to the Carnegie Foundation for the Advancement of Teaching / by Abraham Flexner ; with an introduction by Henry S. Pritchett, President of the Foundation. Source: Wellcome Collection.

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    and death are all in the day’s work for him from the very first. The training of the doctor is therefore more complex and more directly momentous than that of the technician. Be it noted, then, that the minimum basis upon which a good school of engineering to-day accepts students is, once more, an actual high school education, and that the movement towards elongating the technical course to five years con- fesses the urgent need of something more. There is another aspect of the problem equally significant. The curriculum of the up-to-date technical school is heavily weighted, to be sure; but except for mathema- tics, the essential subjects with which it starts are separate sciences that presuppose no prior mastery of contributory sciences. Take at random the College of Engi- neering of the University of Wisconsin. In the first year the science work is chem- istry, and though the course is difficult, it demands no preceding acquaintance with chemistry itself or with any other science; second-year physics is in the same case, and the mechanics of the second semester looks back no further than to the physics of the first. Very different is the plight of the medical school. There the earliest topics of the curriculum proper—anatomy, physiology, physiological chemistry—already hark back to a previous scientific discipline. Every one of them involves already acquired knowledge and manipulative skill. They are laboratory sciences at the second, not the primary, stage. Consider, for example, anatomy, the simplest and most funda- mental of them all. It used to begin and end with the dissection of the adult cada- ver. It can neither begin nor end there to-day; for it must provide the basis upon which experimental physiology, pathology, and bacteriology may intelligently be built up. Mere dissection does not accomplish this; in addition to gross anatomy, the stu- - dent must make out under the microscope the normal cellular structure of organ, muscle, nerve, and blood-vessel; he must grasp the whole process of structural de- velopment. Histology and embryology are thus essential aspects of anatomical study. No treatment of the subject including these is possible within the time-limits of the modern medical curriculum unless previous training in general biology has equipped the student with the necessary fundamental conceptions, knowledge, and technical dexterity. It has just been stated that physiology presupposes anatomy on lines involv- ing antecedent training in biology; it leans just as hard on chemistry and physics. The functional activities of the body propound questions in applied chemistry and applied physics. Nutrition and waste—what are these but chemical problems within the realm of biology? The mechanism of circulation, of seeing, or hearing—what are these but physical problems under the same qualifications? The normal rhythm of physiological function must then remain a riddle to students who cannot think and speak in biological, chemical, and physical language. All this is, however, only preliminary. The physician’s concern with normal pro- cess is not disinterested curiosity; it is the starting-point of his effort to comprehend and to master the abnormal. Pathology and bacteriology are the sciences concerned
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