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postgraduate school as developed in the United States may be characterized as a "compensatory adjustment." It is an effort to mend a machine that was predestined to break down. Inevitably, the more conscientious and intelligent men trained in most of the medical schools herein described must become aware of their unfitness for the responsibilities of medical practice; the postgraduate school was established to do what the medical school had failed to accomplish.

"When I graduated in the spring of 1869," says Dr. John A. Wyeth, "I can never forget the sinking feeling that came over me when I realized how incompetent I was to undertake the care of those in the distress of sickness or accident. A week later, after arriving in my native village in Alabama, I rented a small office and attached my sign to the front door. Within two months, the tacks were withdrawn by the hand which had placed them there and the sign was stowed away in the bottom of my trunk. Two months of hopeless struggle with a Presbyterian conscience had convinced me that I was not fit to practise medicine, and that nothing was left for me but to go out into the world of business to earn money enough to complete my education. I felt the absolute need of clinical experience, and a conviction, which then forced itself upon my mind, that no graduate in medicine was competent to practise until he had had, in addition to his theoretical, a clinical and laboratory training, was the controlling idea in my mind when, in later years the opportunity offered, it fell to my good fortune to establish in this city the New York Polyclinic Medical School and Hospital."

The postgraduate school was thus originally an undergraduate repair shop. Its instruction was necessarily at once elementary and practical. There was no time to go back to fundamentals; it was too late to raise the question of preliminary educational competency. Urgency required that in the shortest possible time the young physician already involved in responsibility should acquire the practical technique which the medical school had failed to impart. The courses were made short, frequently covering less than a month; and they aimed preëminently to teach the young doctor what to "do" in the various emergencies of general practice.

As the general level of medical education has risen, the function of these institutions has been somewhat modified. The general course, aiming to make good deficiencies at large, has tended to give way to special courses adapted to the needs of those inclined to devote themselves more or less exclusively to some particular line of work. Simultaneously, as the facilities of the schools have enlarged, they have become centers to which at intervals men practising in isolated places may return for