branches." In many other cases the requirements are "proficiency in grammar, arithmetic, geography, history," and even reading, writing, and spelling, and proficiency in all these subjects may be taken as a definition of a "good (or fair) English education." Such an education ought to be given in the public schools, and thus it follows that the requirement of the great majority of the medical schools of the country is a thorough common-school education. The entrance requirements of the medical schools of France are considerably higher, for in that country the matriculate must have obtained the degree of bachelor of letters and another degree, which is called bachelier ès sciences restraint pour mathématiques, and the curriculum of the German gymnasium, which is preparatory to a course of medical instruction, is quite as high and as thorough as that of the French Lycée. What the requirements in Great Britain are may be inferred from the special matriculation examination of the Bellevue Hospital School for those students who expect to present their diplomas for recognition in Great Britain. This examination embraces the following subjects: English language, including grammar and composition; arithmetic, including vulgar and decimal fractions; algebra, including simple equations; first two books of Euclid; Latin, translation and grammar, and one of the following subjects: Latin (first two books of Cæsar), Greek (St. John's Gospel), French (the first chapter of Télémaque or Charles XII), German (first part of Adler's Reader), natural philosophy, including mechanics, hydrostatics, and pneumatics (Peck's Ganot's, or Parker's Philosophy). There are some exceptions to the average requirements in the United States which call for attention. In several instances a familiarity with Latin grammar is demanded, though in four instances this familiarity may be obtained during the course of medical instruction. For admission to the department of medicine of Harvard University the requirements are that the applicant shall write an English composition of two hundred words and write English prose from dictation, translate easy Latin prose, possess such a knowledge of physics as may be obtained from Balfour Stewart's Elements, and elect one of the following subjects: French, German, elements of algebra or of plane geometry, or botany. At the Yale Medical School the requirements, with the exception of the languages, are about the same. In the case of the department of medicine of Michigan University stress is put upon a competent knowledge of zoology, and languages are not required, while in the case of the medical department of the University of Minnesota the examination embraces an English composition of two hundred words, Latin, French, German, or a Scandinavian language, an examination in algebra, plane geometry, or botany, and in physics. The College of Physicians and Surgeons in the City of New York (Columbia College) has an entrance examination in which the Latin (Caesar or Sallust), algebra, and geometry are fully equal to the requirements in those branches demanded by the abovenamed institutions. These schools are connected with our highest and wealthiest institutions of learning, and if they are unable to ask as much as the departments of arts, with which they are affiliated, how is it to be expected that nonuniversity schools, wholly dependent upon themselves for support, both moral and pecuniary, can ask as much? In addition to the examination as to intellectual attainments a certificate as to moral character is required. It is not to be supposed, however, that the attendance at these schools is made up for the most part of those who pass an examination which is "satisfactory to the faculty" of the school; for that examination is only required when the candidate can not present a diploma from a college, high school, or academy, normal school, or, in some cases, a teacher's certificate entitling him to teach in a public school of his State. The number of the matriculates who have obtained a degree in letters or science has been collected by this Bureau for a number of years. Consulting this record, which is by no means as perfect as it should be, the following facts are developed: Of the 96 institutions reporting to the Bureau in 1881, 42 returned 1,111 students having a degree in letters or science, and 3 report definitely that they had no scholar with a degree. In these 45 institutions there were 6,625 students. Thus in every hundred students there were 17 who, it may be said, had been liberally educated. If the other institutions (51) had reported specifically that they had no student who had received a degree in letters or science, the whole attendance as far as reported to this Bureau (11,399) could be compared with the number of students who were reported as having obtained a degree by the schools which answer the question d finitely in the affirmative or negative and no error occur. i If we assume, however, that these 51 institutions had no matriculate in attendance having a degree in letters of science, then, to do justice to the different parts of the country, comparison may take the following form: Continuing this sifting process by considering eleven schools of medicine which are departments of a university, it appears that at Medical School of Maine (Bowdoin College). New Hampshire Medical Institution (Dartmouth College). Medical department of the University of the City of New York Department of medicine and surgery, University of Michigan. Total a Average per cent. In 1886-87, 60 schools reported the number of their matriculates that had received a degree in letters or science and 5 schools definitely reported that they had no person thus distinguished among their students. In these 65 schools there were 6,690 students, of whom 15 in every 100 had received a degree in letters and science. Taking the same individual schools as before, the showing is as follows: Medical School of Maine (Bowdoin College) 85 Medical department of the University of the City of New York 631 190 New Hampshire Medical Institution (Dartmouth College) Department of medicine and surgery. University of Michigan. 321 55 7 10 22 13 [16] (b) Total..... 2,659 c 23 a The total number of students (188) possessing a degree at time of matriculation is taken from president's report, 1890. No answer. e Average per cent. These figures show a slight increase during the six years; but, if the institutions making no answer could have been included, a decrease might hav› resulted, which would have tended to confirm the average for the 65 schools which furnished definite reports for 1886-87. Finally let us consider the statistics of the year 1889-90. One hundred and ten institutions have reported to this Bureau, 78 of which report definitely the number of students having a degree in letters or science or that they have no student possessing such a degree. In these 78 schools 15 per cent of the matriculates had obtained a degree before entering upon the study of medicine. The absolute figures are, 16 schools with no students enrolled who had obtained a literary or scientific degree, 62 schools with 1,382 students having a degree; tɔtal enrollment in the 78 schools, 9,389. Adding to the enrollment of the 78 schools the enrollment of the 32 which answer "Don't know," "No data," etc., the total enrollment of the 110 schools reporting is 13,793. Comparing the enrollment in these 110 schools with the number of matriculates reported by the 78 schools as having degrees, the result is that 10 per cent of the enrollment in the medical schools of the country were possessors of a degree in letters or science. Considering the States by sections and including only the 78 schools which report 15 per cent of their matriculates having a degree in letters or science, it is found that 18 per cent of the matriculates in the medical schools of the North Atlantic Division had a degree in letters or science. 13 per cent of the South Atlantic division, 18 per cent of the South Central division (including Tulane University, estimated at 25 per cent), 9 per cent of the North Central Division, and 9 per cent of the Western Division. These figures show a diminution for the schools of the North and an increase for those of the South. Considering the statistics of the eleven individual medical schools as before, Medical department of the University of the City of New York. 633 19 New Hampshire Medical Institution (Dartmouth College) 16 3 Department of medicine and surgery, University of Michigan. Total a These figures are taken from the president's report for 1890. The medical department made no report on the blanks prepared for replies from such schools sent out by this Bureau. b Average per cent. From the foregoing statements it appears that there has been a slight reduction in the number of matriculates (17 in every 100 in 1881, 15 in 1890) at medical schools, who had received a degree in letters or science; while the statistics of the eleven departments of universities (where one would expect a large percent of the matriculates to have obtained degrees) show that there has been an increase of but 1 per cent in the matriculates who had obtained a degree in letters or science. Indeed in the instance of the College of Physicians and Surgeons (the medical department of Columbia College) of New York City a decrease of 2 per cent is shown when the per cent of enrollment for the decade 1870-1880 (37 per cent) is compared with that for 1880-1890 (35 per cent); or comparing the per cent for the first half of the decade 1880-1890 with the second half, a reduction of over 3 per cent is shown. The question, then, is: Has there been no improvement in the scholarship of the matriculates at medical schools? The first of several questions asked on the form of inquiry sent out at the close of the school year 1889-90 was "Have you noticed during the last decade that the students of later years were in a scholastic sense better prepared to enter upon the study of medicine than those who preceded them?" Of the 86 "regular" schools reporting, 75 answer the question, 67 in the affirmative and 8 in the negative. Of 7 "eclectic" schools only 1 answers "no." Of 13 "homeopathic" schools, 12 answer yes, 1 fails to answer. How are these facts to be reconciled? Statistics show that the number of matriculates having a degree is not increasing relatively to attendance (see diagram 15, Chapter X), and yet the medical schools are almost unanimous in asserting that there has been an improvement in the scholarship of the matriculates. Is this unanimous report as to advanced scholarship to be attributed to an increased attendance at the secondary schools of the country? Are more graduates of high schools matriculating at medical schools? If we compare the attendance of secondary schools (exclusive of public high schools and departments of. normal schools and of institutions for superior instruction) for 1880-81 with that for 1888-89 we find that there has been an increase in the attendance of schools for secondary instruction of 13 per cent. If we compare the attendance at the public high schools of one hundred and thirty-two cities in 1880-81 with the attendance in the public high schools of those cities in 1887-'88 an increase of 37 per cent is shown. Or, speculating upon the subject from the still more general standpoint of population and considering that the public high school is always a feature of urban life, it may be concluded that the increase of 7 per cent in urban population during the decade 1880-1890 has increased the high-school attendance of the country at large. Some confirmation of the idea that the improvement in the scholarship of matriculates at medical schools is due to high schools is found in the great protest against secondary and collegiate education because it tends to overcrowd the learned professions, especially those of law and medicine. But a protest is entirely too insecure a foundation to build a theory upon. What is necessary is information as to the localities whence the matriculates at medical schools come, whether from towns and cities or from the rural districts, for public high schools with few exceptions are located in centers of population and rest on a system of grades beneath them from which they are fed. The public high school of the rural districts it should be said is, in many cases, the State normal school or agricultural college. In examining the reports made to the Bureau some expressions are found that corroborate what has been suggested above. A medical school of California, in answering the question as to a better scholarship, answers, "Decidedly so," and adds: "18 had attended universities, academies, or colleges, 12 were graduates of high schools, 17 were graduates of State normal schools, or held educational diplomas or first-grade certificates, and 40 passed examinations." A southern school, in denying improvement, adds: "The common-school system has destroyed the private schools, and only an elementary education can be had outside." (There is no normal school in this correspondent's State.) The medical department of a celebrated university of the Northwest replies.: "Our students average far better now than formerly, as nearly all who enter now [who are not possessors of a degree] are graduates of high schools;" while one of the foremost universities of the Southwest reports in the affirmative, adding, "many oour matriculates being graduates of high schools or universities." A college of Ohio makes a very striking answer in saying: "Yes, as to students who entef under 25 years of age; no, as to those over 25 years; " and a Southern collegr answers: "I have noticed an improvement in this respect, but it must be rememe bered that the students from the South now seeking admission to our colleges received their education (literary) during the decade following the war when educational matters were chaotic." Of 110 schools, 88 answer the question: "Has the average age of matriculates advanced?" Two-thirds of these answers are no, and 10 of them say the average has diminished. The Hospital College of Medicine (Central University) reports the age of seniors in 1880 as 26, in 1885 as 28, and in 1890 as 27. One college reports "age diminished; mental caliber advanced." THE CURRICULUM. THE CHARACTER OF THE CHANGE IN THE COURSE DURING THE DECADE AS REPORTED BY THE DEANS OF THE SEVERAL SCHOOLS. In reply to a general question as to the character of the changes during the decade in the medical curriculum, especially in regard to practical instruction, onefourth of the schools answer “no change," or ignore the question. The general tenor of the affirmative responses may be classified under two heads, to wit, increase of the time devoted to the study of medicine, and increase in the time devoted to laboratory and chemical instruction. The answers as to the time devoted to study may be classed under two heads, one class of answers showing a very decided movement to increase the course from two to three years and to grade it, and the other a tendency to prolong the session from five or six to eight months. The replies indicate a strong tendency to introduce laboratory instruction, chemistry and histology being the subjects most frequently mentioned. Clinical in struction also appears to be a subject in which improvement has been made. Entrance examinations, higher requirements for graduation, and recitations from text-books are only mentioned four or five times in each case. It is not to be supposed that all these subjects should occur to the gentlemen who answered the inquiry as they read the question on the blank. One thing would suggest itself to one and another to another. What appeared to each at the moment as most important was jotted down in the small space allowed for the answer. It is, therefore, surprising to find so many, though relatively few, answering the question in the same way. With this preliminary view of the character of the advance during the decade, and a reference to the summary of the condition of medical instruction in 1881, let us attempt to ascertain its condition in 1890. The first question that naturally is asked is, "What is considered to be a good preparation for admittance to practice medicine?" The regulations of the U. S. Army require the candidate to pass in the following subjects: 66 I. The physical examination will be rigid; and each candidate will, in addition, be required to certify that he labors under no mental or physical infirmity, nor disability of any kind which can in any way interfere with the most efficient discharge of any duty which may be required." II. Oral and written examinations on subjects of preliminary education, general literature, and general science. The board will satisfy itself by examination that each candidate possesses a thorough knowledge of the branches taught in the common schools, especially of English grammar, arithmetic, and the history and geography of the United States. Any candidate found deficient in these branches will not be examined further. The examination on general science will include chemistry and natural philosophy, and that on literature will embrace English literature, Latin, and history, ancient and modern. Candidates claiming proficiency in other branches of knowledge, such as the higher mathematics, ancient and modern languages, etc., will be examined therein, and receive due credit or their special qualifications. III. Oral and written examinations on anatomy, physiology, surgery, practice of medicine, general pathology, obstetrics and diseases of women and children, medical jurisprudence and toxicology, materia medica, therapeutics, pharmacy, and practical sanitation. IV. Clinical examinations, medical and surgical, at a hospital, and the performance of surgical operations on the cadaver. Due credit will be given for hospital training, and practical experience in surgery, practice of medicine, and obstetrics. The Illinois board of health, so well known by its activity in investigating the value of medical diplomas, has a schedule of minimum requirements of ten subjects-anatomy, physiology, chemistry, materia medica, and therapeutics, theory and practice of medicine, pathology, surgery, obstetrics, and gynecology, hygiene, and medical jurisprudence. But these curricula are a mere framework, so to speak, to be clothed with flesh according to the taste and conscientiousness of the instructors and examiners. Nor is the order indicated in which these special studies should be pursued, much less the reason why they should be pursued at all. If we turn to France we may obtain some information on both these points. It is well known that professional instruction in France has been remodeled during the last ten or twelve years. The reform began with the schools or faculties of medicine, and in 1878 the following decree was issued by the minister of public instruction: "ARTICLE 1. The course of study leading to the degree of doctor of medicine lasts four years. Of this period the first three years may be spent in the faculties' [. e., schools taught by the faculty using that word in our sense] or in the schools of full exercise [i. e., schools taught by a corps of instructors who can not grant degrees], or in preparatory schools of medicine and pharmacy [i. e., those which only educate for an inferior grade of physician or pharmacist]. The studies of the fourth year can only be pursued in à faculty or à school of full exercise. "ART. 2. * * The student undergoes five examinations and sustains a thesis. The second, third, and fifth examinations are divided into two parts. Examinations at the end of each year are suppressed. 營 ART. 3. The five examinations are as follows: First, physics, chemistry, medical natural history. Second, part 1: Anatomy and histology; part 2: Physiology. Third, part 1: Surgery, accouchements, operative medicine; part 2: Medicine (pathologie interne), general pathology. Fourth: Hygiene, medical |