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have in the preceding chapter briefly indicated three stages in the development of medical education in America,—the preceptorship, the didactic school, the scientific discipline. We have seen how an empirical training of varying excellence, secured through attendance on a preceptor, gave way to the didactic method, which simply communicated a set body of doctrines of very uneven value; how in our own day this didactic school has capitulated to a procedure that seeks, as far as may be, to escape empiricism in order to base the practice of medicine on observed facts of the same order and cogency as pass muster in other fields of pure and applied science. The apprentice saw disease; the didactic pupil heard and read about it; now once more the medical student returns to the patient, whom in the main he left when he parted with his preceptor. But he returns, relying no longer altogether on the senses with which nature endowed him, but with those senses made infinitely more acute, more accurate, and more helpful by the processes and the instruments which the last half-century's progress has placed at his disposal. This is the meaning of the altered aspect of medical training: the old preceptor, be he never so able, could at best feel, see, smell, listen, with his unaided senses. His achievements are not indeed to be lightly dismissed; for his sole reliance upon his senses greatly augmented their power. Succeed as he might, however, his possibilities in the way of reducing, differentiating, and interpreting phenomena, or significant aspects of phenomena, were abruptly limited by his natural powers. These powers are nowadays easily enough transcended. The self-registering thermometer,the stethoscope,the microscope, the correlation of observed symptoms with the outgivings of chemical analysis and biological experimentation, enormously extend the physician's range. He perceives more speedily and more accurately what he is actually dealing with; he knows with far greater assurance the merits or the limitations of the agents which he is in position to invoke. Though the field of knowledge and certainty is even yet far from coextensive with the field of disease and injury, it is, as far as it goes, open to quick, intelligent, and effective action.

Provided, of course, the physician is himself competent to use the instrumentalities that have been developed! There is just now the rub. Society reaps at this moment but a small fraction of the advantage which current knowledge has the power to confer. That sick man is relatively rare for whom actually all is done that is at this day humanly feasible,—as feasible in the small hamlet as in the large city, in the public hospital as in the private sanatorium. We have indeed in America medical practitioners not inferior to the best elsewhere; but there is probably no other country in the world in which there is so great a distance and so fatal a difference between the best, the average, and the worst.