Admission Requirements Changed.

The change in the Medical School that attracted the largest amount of attention within the University related to the requirements for admission. This involved a departure from the policy, then nearly universal at Harvard, of requiring a bachelor's degree for entering the professional schools, and therefore it merits careful explanation. The requirement of the bachelor's degree for admission to the Medical School went into effect in 1901, but it was provided that students might be admitted without it by special vote of the Administrative Board. The exceptional cases were limited in 1909 to men who had spent two years in college and had pursued courses in physics, chemistry, and zoology. Moreover, they were admitted only as special students, and given a degree only if their marks in the School exceeded by a certain grade those of students regularly admitted. If, in addition to their two years of college work, they had pursued medical studies, they could be admitted to advanced standing only if they should "pass examinations and fulfil all requirements of laboratory and practical work in branches already pursued by the class to which they seek admission"; and then only as special students with the hope of a degree only if they obtained the higher grade. During the last few years the general state of medical education has led the Faculty to reconsider the wisdom of these provisions.

In the condition of knowledge at the present day training for medicine is of necessity longer than for the practice of any other profession. A thorough mastery of the subject requires four years, or, with the hospital experience which practically always follows in the best schools, it consumes five years; whereas other careers require at the most three years devoted to studies of a strictly professional character. Now, although a full college education preceding medical studies is highly valuable for a physician, and ought to be encouraged when possible, many young men well adapted to reach distinction in the profession are unable to afford the time and expense of eight or nine years of study, after leaving the high school, before beginning to earn a livelihood. Obviously, this is a much more important matter when the training requires eight or nine years than when it requires six or seven. Moreover, the time spent, after leaving the secondary school, in obtaining a medical degree in good schools both in Europe and America, is commonly six years. In Europe that is the case because young men habitually begin their medical or pre-medical studies at once on leaving the secondary school; and in almost all the American universities the same result is reached by allowing the first two years of medicine to count as the last two in college, so that in six years a young man obtains both his bachelor's and his medical degree.

"Combined Degrees" Unsatisfactory.

This American procedure, resulting in what is known as the "combined degree," we are unwilling to adopt at Harvard, because it involves counting the same work twice over for two degrees which together profess to require more time than has been expended, and because the college degree signifies with us a general non-professional education. In consequence, the Medial School was placed in the strange position of admitting men who had done two years of college and two of medical work, and thereby obtained a bachelor's degree, but of refusing them full credit for the medical knowledge. If they entered our School as regular students they must repeat their two years of study. If they sought credit for their medical work, they could enter only as special students and obtain a degree only if they achieved exceptionally good grades in medicine. Naturally they did not enter. Nor was this a theoretical difficulty alone. Many universities and colleges which provide the first two years of laboratory instruction in medicine are situated in small towns, without hospitals large enough for clinical instruction, and, therefore, give the clinical part of the course elsewhere, or in some cases do not give it at all. Young men who have acquired their laboratory instruction in this way must migrate, and some of them would no doubt prefer to go for their last two years to a school with large clinical material like ours.

What New Plan Will Achieve.

The rule of requiring a bachelor's degree for entrance, and not giving full credit for medical studies pursued before obtaining it, cut our School off from a valuable class of students. Moreover, it ran counter to an opinion very common in the medical profession, that a future medical practitioner had better devote his chief attention to biological studies from the moment he leaves the secondary school, and begin at that time a consistent six years' course ending in the medical degree. Whether we share this view or not, it is a mistake for any professional school to set itself against the current opinion of the profession, to the point of excluding what is commonly thought the best preparation for practice. What is, perhaps, not less important, the amount of clinical material in hospitals that can be used for teaching is limited, and therein medical education differs from that given in other professional schools. Our Law School, for example, takes only college graduates, but by doing so it neither implies that men without an academic education are unfit to enter the bar, nor prevents their getting a legal training. The equipment required to teach law is not expensive or difficult to procure, so that another law school in Boston can, and in fact does, prepare for successful practice men who are unable, or do not care, to enter our School. The Law School is, therefore, not wanting in its duty to the profession by receiving only a selected class of students. But hospital clinics being limited, a medical school would seem to be under an obligation either to admit all men who are, in its judgment, qualified to study medicine, or to share the best clinics fairly with another school which receives the qualified men whom it will not admit. Now, in the judgment of the medical profession, from which our School is not prepared to dissent, two years of college, even if not the most desirable, are a necessary and sufficient basis for the study of medicine.

The obvious course for the Medical Faculty in seeking to meet the most pressing difficulties would have been to admit to regular advanced standing of two years men from other universities who had taken the combined degree, and the new general examination in laboratory subjects furnished an excellent means of determining whether the applicant had in fact acquired the knowledge given in the first two years of our own School. But the admission of such men would by itself have left the School in the position of saying that two years in another college and medical school, followed by our first general examination, would entitle a man to be a regular student in our third year, while two years in Harvard College and the Harvard Medical School would not. If a change in this direction were to be made at all, the only rational thing to do was what the Medical Faculty did, -- to admit as regular students men who had spent two years in a college of high grade. This, however, was to be done only in case an amount of time equal to one full year had been spent on physics, chemistry, and biology. It follows that men who have spent two years in college work and two in medicine may be admitted to the first general examination, and if they pass it may be registered as regular students in the third year. When the matter came before your board, fears were expressed that the change might open the door to an inferior class of students who felt little confidence of attaining a college degree; and, as the object was to admit on two years of college work only superior men, it was provided that the student in his two years of college work must have ranked in the upper third of his class. These changes were approved by the two governing boards of the University at the close of the academic year.

The men admitted by the new method, either to the first year of the School or to advanced standing, will probably not be numerous, at least for some time to come, but there is very reason to expect that they will be of good quality.

School for Health Officers.

Another innovation, and one that does not concern the Medical School alone, is the establishment of the School for Health Officers, which was organized during the year covered by this report and opened in the autumn of 1913. Preventive Medicine is a subject growing rapidly by reason of the increasing knowledge of infection, and the massing of people in cities where disease spreads freely. Nor is it enough that medical students should be taught the means of prevention. The knowledge is important for all persons who are charged, with the care of the public health, and for their purposes it must be considered not only from a strictly medical standpoint, but also from that of sewerage, water supply and so forth. The new School, formed by a combined action of the Department of Public Health in the Medical School, of Sanitary Engineering in the Schools of Applied Science, and of Biology in the Massachusetts Institute of Technology, was, therefore, organized with Professor Rosenau as Director, and Professor Sedgwick of the Institute as Chairman of the Administrative Board. The combination of the staff of Harvard and Technology for this purpose was highly gratifying and was soon to be followed by co-operation on a larger scale.

Co-operation with Technology.

The last annual reports of the Presidents of the University and the Institute expressed on each side a hope that in some form co-operation in the teaching of college graduates might be found possible. My report stated that no such plan had been devised, and in fact no negotiations were then in progress, but they were begun shortly afterwards. It was soon discovered that no satisfactory arrangement limited to graduates of colleges and technical schools could be made, and the basis of a proposed co-operation was enlarged. The change had for us the merit of giving effect more completely to the wishes of the late Gordon McKay, for he empowered the University to teach "applied science, from the lowest to the highest," and expressed his desire "that the instruction provided be kept accessible to pupils who have had no other opportunities of previous education than those which the free public schools afford." Although the negotiations were not brought to a successful conclusion until after the close of the year covered by this report, the agreement having now been ratified by the governing bodies of the two institutions, and made public, it seems better to speak of it here than to wait a year.

The agreement provides for complete co-operation in the teaching of mechanical, electrical, civil and sanitary engineering, mining and metallurgy, in case the buildings of Technology, now under construction on the Charles River Embankment in Cambridge. Each institution is to contribute such sums as it can, and in particular Harvard is to use for the purpose the income of the funds of the Lawrence Scientific School and three-fifths of the income of the McKay endowment, the remaining two-fifths being required for other branches of science useful to man not included in the agreement. The fees of students, for the present at least, are to be credited to the two institutions in the proportion of their students in the subjects covered by the agreement at the time it was made.

Appropriations for any purpose must be approved by the institution that supplies the funds used; but by far the most important of all appropriations are those for salaries, and they depend on the appointment of the teaching staff for which a special procedure is provided. All professors, associate and assistant professors,--that is, all the instructors of superior grade, all those who sit in the Faculty for the departments to which the co-operation extends,--can be appointed by the institution that pays their salaries only after consultation with the other. All these officers, now existing or hereafter appointed, are to have the titles and privileges of their rank in both institutions; and all their students registered at Technology, unless they signify a contrary intent, are to be entitled to the rights and privileges of students in the professional schools of the University, and deemed candidates for its degrees. The reason for using the phrase "professional schools of the University" is that it is contrary to the general policy of both institutions to permit professional students to play on intercollegiate athletic teams. By the arrangement thus made, the higher instructors in the subjects mentioned are professors both of Harvard and Technology, and the students in those subjects will, normally, be students in both, receive degrees from both, and become graduates of both.