Page:Carnegie Flexner Report.djvu/95

Rh heads by the time night comes. The actual outcome of this absurd overcrowding is that only a small amount of what is heard is retained. One can profitably listen only when one can take in readily and follow up systematically with work at home."

The maturity of the student body at this level makes possible another innovation. The low standard or immature type of medical student must have his medical knowledge carefully administered in homeopathic doses. He carries a half-dozen studies simultaneously because his untutored interest fatigues easily and his assimilative ability in any one direction is relatively slight. Time and energy are of course lost in hourly breaking off one connection and making another. But it is unavoidable; the practitioner teacher must leave at the close of his "hour" anyhow. At the university studies may be concentrated. The laboratories are open all day; the professors are there at work. The first months of the medical curriculum are then given over to anatomy alone; for it is clearly illogical to begin even physiology till the anatomist has made some headway. Concentration is economical of time and energy, and stimulates the student to push on beyond definitely prescribed limits. How far it can wisely be carried is a point to be determined by experiment.

The schools of our second division — those requiring for admission high school graduation or the "equivalent"—move within narrower limits. Two factors are at work. Most schools of this class live on their fees; McGill, Toronto, Tulane, are among the few that are enabled by additional resources to provide a complete laboratory outfit. The strongest of the others, Jefferson and Northwestern University, for example, relying practically altogether on income from students, can at best develop highly a department or two; the rest are necessarily restricted. The quality of the student body is likewise a limitation. Laboratory courses, following the lines that we have marked out, are impossible to boys whose preliminary training in science has barely begun. At best the students have an elementary acquaintance with physics or chemistry; frequently not even that. Those that have and those that have not sit side by side on the same benches. A difficult dilemma is thus presented. It is impossible to teach the medical without the pre-medical sciences; the medical course, already crowded, cannot be either cut or compressed sufficiently to accommodate them. The situation cannot, therefore, be wholly retrieved within the medical school. Makeshifts vary somewhat from school to school. A rigid medical curriculum, clipped to the quick, leaves perhaps a few hundred hours available for pre-medical work. Chemistry as a rule absorbs them all; nothing is attempted in biology; occasionally physics gets a slight opportunity, as at Tulane, where first-year students hear one lecture a week,