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Second year. Dissections, topographical anatomy, physiology, general pathology, prescriptions, instruments, apparatus, and bandages, pharmacology, preliminary study of climatology, percussion, and auscultation.

Third year.-Pathological anatomy and medical jurisprudence, with appropriate dissections, surgery, theoretical and operative, surgical and medical clinics, physiological and pathological chemistry.

Fourth year.-Clinics in medical jurisprudence, medicine, surgery, obstetrics, and diseases of the eye, dissections illustrative of medical jurisprudence, instruction in vaccination, &c.

Fifth year.-Surgical, ophthalmic, and medical clinics, descriptive and topographical anatomy, with dissections, physiology, &c.

The instruction in the several departments of study is given by 35 full professors, 19 assistant professors, and 39 privat docenten, all of whom give numerous lectures and demonstrative exercises during each half year.

GREAT BRITAIN.

The degrees conferred in Great Britain are those of bachelor of medicine, (M. B.,) master in surgery, (C. M.,) and doctor of medicine, (M. D.) No one is admitted, as a rule, to the course of medical study in a university who has not either graduated in the arts, or is able to pass an examination in the elements of mathematics, the Latin and English languages, and in at least two of the following branches, to wit: Greek, French, German, and higher mathematics, natural philosophy, logic, and moral philosophy. And in no case is a candidate for the professional examinations prerequisito to the degree of bachelor of medicine, or the degree of master in surgery, eligible to such examinations unless possessed of the general educational qualifications above named. Each candidate for degrees is also required to establish by certificates—

1. That he has studied medicine and surgery for four years, during each of which a course of at least 200 lectures, with corresponding clinical instructions, have been delivered, wherein he has studied for prescribed times the following departments of medical science: Anatomy, chemistry, materia medica, institutes and practice of medicine, surgery, obstetrics, diseases of women and children, general pathology, (or, in schools where no such course exists, morbid anatomy,) practical anatomy, practical chemistry, practical obstetrics with medical and surgical clinics, medical jurisprudence, botany, and zoology.

2. That he has attended the medical and surgical practice of a general hospital for two years, and outside practice for six months.

3. That one of the aforesaid years of study has been in the medical school of the university to which application for examination is made. (The Edinburgh school also requires that two of the four years of study shall have been either there or in some other university authorized to grant degrees.)

4. That he has at date of application completed his twenty-first year, and is not under any articles of apprenticeship to any surgeon, physician, or other master. Dr. Hoyt remarks:

"Thus qualified, the candidate may be received to examinations, both on written and oral: First, on the elementary branches of medical science, such as anatomy, chemistry, botany, and materia medica; secondly, on advanced anatomy, zoölogy, comparative anatomy, physiology, and surgery; third, on materia medica, and the strictly practical departments, including practical medicine, clinical medicine, clinical surgery, obstetrics, general pathology, and medical jurisprudence. A thesis on some medical subject is also required.

"The examinations in the natural history branches and in practical chemistry are conducted, as far as possible, by actual demonstrations upon material placed before the candidates, and the examinations in the practical departments are conducted, at least in part, in the hospitals, candidates being required to test their knowledge by examinations and prescriptions. As a general rule, those whose study is in the university are examined in the branches of the first and second divisions above enumerated at the close of the second and third years of their course; but admission to examination on those embraced in the third or practical division cannot take place until the candidate has completed his fourth year. Should the candidate fail, he cannot be admitted again until the completion of another year, or the expiration of such period as the examiners may prescribe.

"The degree of master of surgery can in no case be conferred upon a candidate who is not at the same time granted or has previously received the degree of bachelor of medicine.

"The degree of doctor of medicine is conferred upon candidates who have obtained the degree of bachelor; have spent, since their graduation, at least two years in attendance upon a recognized hospital, or in the military or naval medical service, or in medical or surgical practice, and are either possessed of the diploma of bachelor of arts from a recognized university, or have passed a satisfactory examination in Greek,

logic, and moral philosophy, and in French or German, or the higher mathematics, or in natural philosophy and natural history."

This is really an incomplete résumé of the medical course in these countries; but what a contrast in extent to the best that our own country affords.

(IV.) MEDICAL EDUCATION FOR WOMEN.

The fitness of women, from their exquisite humanity, patience, neatness, and skill as nurses, for the medical profession, was long ago suggested. Women have for many years, in Europe, been licensed and have practiced as accoucheûses. For years a scattering few in this country succeeded in obtaining a medical education in spite of the caution and conservatism (just in general) of the profession. But of late years this subject has received a very great impulse, and medical schools for their education in the regular practice have been established in New York, Philadelphia, and Boston. There is a homeopathic medical school for women in Cleveland, Ohio, and a physiopathic course of instruction in Cincinnati, Ohio.

The following account of the course of training in the New York Infirmary Female Medical College shows how high a stand female physicians should hereafter take, if such programmes shall be generally adopted and steadily adhered to.

WOMAN'S MEDICAL COLLEGE OF THE NEW YORK INFIRMARY.

Every student upon matriculating will be required to deposit with the secretary a certificate of good moral character from a physician of good standing, clergyman, or other responsible person.

The plan of instruction which this school desires to carry out is arranged to secure a gradation of studies through the three years of the student's course.

For this purpose students must attend the winter sessions. During the first, they will be principally occupied with the elementary branches of anatomy, physiology, materia medica, and chemistry, with practical work in the anatomical rooms, and pharmacy.

In their second year they will continue these four branches, and receive full instruction in medicine, surgery, and obstetrics.

In the third year the instruction in these three departments will be continued, and the students will engage in practical medical work, under the direction of their teachers, and be required to furnish clinical reports of cases so attended.

Hygiene will be taught through the three years.

All students will be required to attend weekly recitations in the studies proper to their year, these recitations forming an essential part of the course.

Yearly examinations will be held at the end of each winter session, when every student will be examined in the studies pursued during the year.

Besides these a general examination will be passed by all students presenting themselves as candidates for graduation.

This final examination will be passed in anatomy, materia medica, physiology, and chemistry at the end of the second year, and at the end of the third year in hygiene practice, surgery, and obstetrics.

This progressive mode of study does not increase the length nor the expense of the student's course, as no extra charge is made for the third year.

It offers very great advantages as compared to the ordinary plan of reading for a year under private instruction and attending college during two sessions only.

It gives more facilities for practical anatomy, pharmacy, and clinical study, prevents the winter session from being over-crowded with work, and, by dividing the examinations, enables the student to prepare for them more easily and thoroughly.

In view of its much more satisfactory results, it has been adopted as the course of the school, and is warmly recommended by the faculty to all those beginning their education.

Students who are unable or unwilling to attend three sessions can complete their college course in two years by attending two winter and two summer sessions. The summer sessions, being devoted principally to practical work, will be taken as equivalent to the third winter session, where the student can bring satisfactory certificates of a year's previous study.

Clinical instruction is given in the New York Infirmary, Bellevue Hospital, the Eye and Ear Infirmary, Nursery and Child's Hospital, Demilt and other Dispensaries. Candidates for graduation must be twenty-one years of age, must be of good moral character, and have received a good general education.

They must have spent three years in the study of medicine, under the direction of a duly qualified physician, during which they must have attended three winter, or two winter and summer sessions of lectures, and received clinical instruction, according to the course laid down by the school.

A thesis on some medical subject and the passing a satisfactory examination before the faculty and the board of examiners will also be required.

A course of lectures in any recognized school will be accepted as one of the terms required by the college, but the last course before graduation must have been attended at this college.

(V.) CHANGES SUGGESTED.

The subject of improvement in medical education is one which has occupied the thoughts of the profession for thirty years. The American Medical Association, ever since its organization, has paid special attention to this matter, appointing yearly committees on the subject, and printing report after report in its transactions. Some of the most eminent names, living and dead, on the rolls of the profession have recorded their opinions on the subject, and the labors of many great physicians and surgeons for many years, in the lecture-room and the hospital, have been devoted to the practical training of the medical student.

Many valuable recommendations and many important improvements have during the present generation been made; but, notably, nearly all these improvements and recommendations have reference to the medical college, their departments of instruction, length of terms, text-books, practical anatomical and clinical opportunities, and only to a very limited extent with regard to preparatory or to post-graduate instruction. It is proper here to say that, in the writer's opinion, the most valuable recent suggestions in the American Medical Association have been made by the committees, of which Messrs. Chris. C. Cox, M. D., LL. D., Thomas Antisell, M. D., and A. B. Palmer, A. M., M. D., were chairmen.

For want of space, it will not be possible to separately mention recommendations heretofore made from those for which the writer of this article is responsible. In fact the scheme here presented is so little novel in most of its features, and most of its opinions have been so often expressed and indorsed by the voice of the profession, that it seems somewhat singular that more has not been practically accomplished.

And here it is proper to mention that no good can come from any attempt to revive any of the old legal discriminations between practitioners of different schools; partly because scientific; like religious belief, should be perfectly free, and if a practitioner pleases his patients he always will be able to make a living out of them. The attitude of government in all such private mutual relations should be perfectly impartial; and it is questionable even whether courts of law should encourage suits for malpractice; because malpractice depends in most instances on ignorance, and the most certain and satisfactory prevention of it is reached by legally enforcing a thorough education. To this matter, however, further allusion will be hereafter made.

1. What, then, is the duty of the profession in regard to ante-professional study? No medical college of high character in the country pretends to be satisfied with the qualifications of its matriculates in general. No eminent professional man in any of the systems denies that a good preliminary education is of the greatest advantage to a medical student; yet very little care is taken to train the faculties of observation, memory, and reason scientifically and thoroughly for the work they will have to do. The profession expects its students to read and remember many text-books; to see many cases with numerous and complicated symptoms; to administer many drugs of the most varied powers and applications in the most varied doses and combinations; and all this without any attempt to train his mind to see, compare, and reason on the facts. What part do mathematics and logic, the instruments for training the human reason, take in educating an ordinary practitioner? How many have been drilled in linguistics, so that their memory, their taste, and their power of selecting and expressing their ideas, bear any but the slighest comparison to the importance of their vocation? What provision is there in an ordinary medical course for becoming acquainted, to any useful extent, with any of the collateral sciences-the contiguous regions of nature tangential to the circle of human life? Practically none.

There should be required by every medical college, of every candidate for matriculation, that he shall have studied some definite length of time, and shall pass an examination in the following subjects: in the common branches, reading, writing, arithmetic, modern geography, English grammar, and American history; the college should also examine the candidate in, or cause him to study, as preliminary to examination, the elements of inorganic chemistry, natural philosophy, natural history, logic, and general history; and should see that he possesses an ability to translate and construe some author in Latin or French or German, and that he has a fair knowledge of the principles of drawing.

All this should be preliminary to the study of medicine proper. There is nothing that cannot be mastered in two years by any intelligent youth who has previously studied in a common school. There is nothing demanded by it at all difficult of attainment in any decent high school or academy. Nor should it be at all difficult for any medical college to establish such a training school for the young men who will enter

its subsequent instruction. It is needless to expatiate here on the advantage of such previous study. The University of Michigan demands more in some directions of its medical matriculates, and does not seem to lack students. Harvard Medical School places some knowledge of Latin and philosophy among its requisites for graduation, which means (or should mean) pretty much the same thing as requiring it as an item in the preliminary training, the three years' medical course being so filled with professional studies that it is practically impossible to study Latin also during that period. 2. The profession also owes it to itself, and the public which it serves, to see that the medical colleges of the country do thoroughly what they have undertaken. Three courses of lectures, of at least twenty weeks each, should be a qualification for graduation, in which anatomy, physiology, hygiene, therapeutics, organic chemistry, toxicology, medical jurisprudence, obstetrics and its collateral subjects, materia medica, surgery and physic, should be the branches taught, and they should be taught practically as well as by lectures.

Anatomy should be taught regionally as far as possible, and dissections of the part lectured on should be demonstrated from by the lecturer, and cach dissection should be repeated by the class, under the supervision of the demonstrator, before the next lecture is delivered. Instead of discouraging the dissections by charging for each subject used in the demonstrator's room, the colleges should boldly demand a fee for practical anatomy, which will enable it to supply anatomical material to any extent demanded. This and the positive enforcement of dissections by every member of the class should be leading features in the revised system of medical education.

Physiology should be thoroughly illustrated by microscopic and chemical appliances, and by vivisections. Some time in each week should be devoted to a thorough written examination on the experiments and specimens exhibited by the lecturer, and the chemical tests used should be repeated by each member of the class personally before the lecturer.

Chemistry (after a rapid review of the inorganic portion) should be so taught as to mean something to the student, which it does not now. In fact, it is almost impossible to suggest amendments to a method of teaching so radically vicious as the way in which chemistry is ordinarily treated in our medical colleges. A knowledge of the inorganic part of our common text-books should be rigorously exacted before the student is matriculated. This should be reviewed by the class with experiments, and chemistry in its relations to physiology, materia medica, and toxicology taught in the amplest manner, and with all the necessary practical appliances. Every experiment by the lecturer should be repeated in his presence during weekly examinations, and all important reactions should be tabulated by the class on the blackboard. The antiquated nomenclature so long in vogue should be abolished, and every effort made to convince the students that chemistry is really a vital part of the science of medicine. There should be a fee for this chemical instruction sufficiently large to justify the gratuitous supply of chemicals and apparatus, and, like the anatomical, it should be obligatory on every student.

Materia medica should be taught with the drugs before the students. They should be thoroughly instructed in their physical properties, uses and doses, and the method of preparing the various forms in which medicines are administered; their physiological and therapeutic action should be illustrated by experiments, and, when possible, by clinical instruction.

Hygiene should be thoroughly treated in all its relations to the morality and prosperity of communities and individuals, as well as with regard to its efficiency in the prevention and cure of diseases.

This division of the instruction should occupy the first course of lectures, and at the end there should be a rigorous examination of the class in the subjects so studied. It may be well here to remark that every examination at the end of a term should be conducted by a board of examiners chosen by some authority outside of the college; and the members of this board should be men of such reputation and so remunerated for their trouble as to make certain that their examination shall be deliberate, thorough, and impartial.

Having thus studied through one winter, the class during the succeeding summer should be directed to revise the subjects they have been taught. They should be directed to make themselves further acquainted with medical botany, to practice anatomical drawing, to familiarize themselves with the use of the microscope and chemical apparatus. They may be set under proper medical supervision to study certain portions of some subjects in the next course; as, for example, the mechanism of the female pelvis in relation to midwifery; the effects of muscular attachments in fractures and dislocations; symptomatology, especially as regards the pulse and tongue; general causes of disease; minor surgery and surgical appliances. The main point is, that explicit directions as to the use of his time should be given to every student. His reading thus has a definite object, and surely no one should know what the student ought to study so well as the professors who have had him in charge for several months. Much time is wasted in idleness or misapplied labor under the present

system, which would, if properly employed, go far to complete the foundation for a good medical education.

During the second course of lectures, the class should have thorough instruction in the theory and practice of physic, surgery, midwifery, and female diseases, with a selection of illustrative clinical cases, not numerous in number, but so presented as to furnish the facts. It is true that almost any clinical instruction is better than none; but in no department of medical instruction is the old saying, "the half is more than the whole," truer than here. One case carefully explained to and personally examined by a student is worth much more than a dozen seen by him in a crowd of listeners; a careful explanation, with the difficulties of the case in view, is much better for the student than many cases of the difficulties of which he has not become aware. A selection, therefore, of clinical cases is recommended, and there should be weekly examinations on the subjects considered and the cases exhibited. The use of medical, surgical, and obstetric instruments and appliances should be demonstrated on the cadaver as well as clinically. Surgical and pathological anatomy should be taught in connection with surgery and practice, if it be deemed inadvisable to teach them during the first course of lectures, and toxicology should receive attention.

After a thorough examination on the studies of the session, the members of the class should again receive explicit directions as to their reading.

During the third course of lectures special attention should be paid to clinical instruction in medicine, surgery, and midwifery; reports of each case seen should be required from every student; they should be exercised in diagnosis and treatment in practical midwifery, and, under the professor's directions, in minor surgery, if not in capital operations. Medical jurisprudence should be thoroughly taught, and something of the nature of the moot courts of the law schools would be a good training school for this branch of instruction. Lectures and clinics on diseases of the eye and ear should also be given. In short, every practical application possible should be made, and, at the end of the course, there should be a very thorough examination on the studies pursued, with a review examination in the studies of the two previous courses.

Having completed this study and passed the examinations, the candidates should be graduated with the degree of bachelor of medicine, and the degree of doctor should not be conferred till after at least three years' honorable practice.

2. Duty of the State.-The ruling power should have enough interest in this matter to insure the proper action; and this is, as before stated, not to discriminate between the different systems in existence, but to insist that every person, regular, eclectic, or homeopathic, who practices medicine or surgery shall have studied a specified time in a specified way, and passed specified examinations before boards selected by the executive. There might be common boards for most of the branches, and special boards for examination in materia medica and practice. The State law should specify the number, duration, and minimum instruction to be given by the medical colleges of every system alike. The degree of M. B. would then mean something more than that of M. D. does now. The public would feel assured that the practitioner of medicine was an educated man, whatever his theory might be, and the profession would gain in general culture, breadth of mind, and in the respect of mankind more than it would lose of the present kind of professional dignity.

In regard to the proper attitude of the courts toward the profession there could much be said. In many States there seems to be a disposition to encourage suits for malpractice against doctors, even when they are instituted as a means of extortion. Courts should be very careful in this matter, and it is hoped that the course pursued in the late case of "Walsh vs. Sayre" in New York will be hereafter generally adopted, and that the question of malpractice will be submitted to medical experts, leaving the amount of the damages, if there has been malpractice, to the decision of the court and jury, as at present. It is an outrage to expose the professional character and standing and the purse of a physician to the greedy assaults of unscrupulous men, leaving the decision of the question solely to a medically-uneducated jury.

It will be observed that medical colleges have not been directly addressed on the subject of this reform in education. As this is not an appeal to them, but an article for public perusal, it is perhaps not necessary to say very much in apology for this neglect. But in reality there has been a steady and totally ineffectual pressure brought to bear on the colleges by the better part of the profession for thirty years, in order to obtain better preliminary training, a lengthening of the lecture terms, or an increase in their number, and an enlargement and improvement in the subjects of instruction.

The medical colleges of the country are mostly joint-stock corporations, who furnish as little medical education as they can sell at the highest rate they can obtain. Their number is excessive, and the competition between them very keen. They are consequently disinclined to introduce any new features which may scare students of low acquirements away, or which may add seriously to the expenses of the institution.

Nor are medical students free from a large share of responsibility for the present condition of things. They are in such haste to graduate that they are impatient of

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