jurisprudence, materia medica, and pharmacology. Fifth, part 1: Surgical and obstetrical clinics (clinique externe et obstétricale); part 2: Clinical medicine, practical evidence of work in pathological anatomy (clinique interne, épreuve pratique d'anatomie pathologique).

Thesis: The candidate sustains this test upon a subject chosen by himself. "ART. 4. The first examination comes off between the fourth inscription and the fifth [i. e., after 12 or 15 months of study]; the first part of the second examination between the tenth and twelfth inscriptions and second part between the twelfth and fourteenth inscriptions. The third examination can not be taken before the expiration of the sixteenth trimonthly period of study. Every candidate who shall not have passed the first examination by November at the latest shall be adjourned to the end of the year and can take no inscription during the course of that year.

ART. 5. Candidates for the doctor's degree, the students of the schools of full exercise and the preparatory schools, are examined before the faculties at the times stated in the preceding article; the first examination, however, may be taken, after the twelfth inscription. In such cases they must stand both parts of the second examination before taking the thirteenth inscription, but the student following this course is subjected during each semester beginning with the second year of studies to interrogations the results of which are transmitted to the faculties that they may be considered in the final examination for the degree.

ART. 6. The inscriptions for the degree of officer of health (the lower medical grade) shall in no case be converted into an inscription for the doctor's degree. This conversion, however, may be authorized in the case of officers of health who have practiced medicine during two years at least.

"ART. 7. Practical work in the laboratory, dissection, and hospital attendance are obligatory. Each annual period of work in the laboratory, and in dessecting covers a semester. The hospital attendance (le stage près des hospitaux) shall be two years at the least."

When satisfied that an attempt at reform is not merely a whim or the ignorance of the reformer, the intelligent inquirer immediately asks to know the grounds upon which the change is made. What then is the motive that has induced the French legislature to modify the law of 1803? M. Wurtz,' as a member of the superior council of public instruction, gives several in reporting on the desirability of adopting the provision contained in the above decree. His remarks are in brief as follows:

The old law of 1803 prescribed that an examination should be made at the end of each of the first three years of the course (without value in obtaining the degree however), and then five examinations more when the fourth and last year of study had been completed. In 1825 the examinations at the end of the year were abolished and the five final examinations distributed through the course of four years. But this was found to bring the examinations too near together and to cause the student to slight his studies (la scolarité était abrégée), inasmuch as the most important examination (cn clinical surgery and medicine and accouchements) was put off until the last year. This caused a new regulation in 1846, which, rejecting the examinations for the degree at the end of the whole course, instituted examinations at the close of each year. Although these annual examinations kept the student busy, thirty years of experience had shown their weakness as tests of capacity and as a means of discipline. The object in drawing the above law was to divide the four years of study into periods, in such a manner that each period would be devoted to several related subjects and could be closed with a test examination on those subjects.

The question then became a purely pedagogic one. In what order should the periods follow each other? The degree of bachelier ès lettres testified to the medical student's literary qualifications, and the modified degree of bachelier ès sciences testified to his proficiency in the natural and physical sciences. Should the student, possessing such intellectual maturity and such knowledge of those sciences which are the necessary introduction to the study of medicine, proceed immediately to the study of anatomy and physiology, which are the foundation of med cine? No, says M. Wurtz, the medical student must study physics, chemistry, and natural history in a course that is neither a repetition nor even a development of his scientific studies in a lycée. The student is now to study these subjects as applied sciences, and to them he is to devote one year.

Dean of the Paris Faculty of medicine from 1866 to 1874, member of the institute, professor of chemistry at the Sorbonne, senator of France, etc., etc.

ED 90-56

But will one year fix these subjects indelibly, especially if the first examination is the only one upon them? This was precaution the old programme had taken by keeping up the examination on physics and chemistry to the end of the course. But what followed? The first examination was frequently weak; the students were careless and the examiners indulgent; while towards the end of the course it was intolerable for the student to take his mind from his proper professional work to rectify the neglect of the first year of his course. The new programme attempts to remedy this, says M. Wurtz. The applications of the sciences to physiology, to hygiene, and to pathology [subjects of the second and third examinations] have now become so important, that it is easy to introduce in the programmes corresponding to the examinations many questions touching the application of pure science to the subjects of these examinations.

To prevent crowding the programme of the examination-a fault of the old examination scheme-an innovation was made which is the distinguishing characteristic of the new one. The second, third, and fifth examinations are divided into two parts. In the middle of the third year of the course, and eighteen months after the first examination, the candidate undergoes the first part of the second examination; at the close of the third year he undergoes the second part, after taking the twelfth inscription. In the second part of this second examination the chemistry of digestion, respiration, nutrition, composition of the blood, etc., is studied, as also the physical phenomena of hearing, seeing, and respiration as a source of heat, all very much specialized, it is true, but fruitful because of the solid foundation laid in the first year. The division of the two professional examinations, in the practical sense of the term-the third and fifth-was demanded by the faculties of medicine; for it was thought that it was too much to ask that both parts of these examinations be taken in immediate succession. It was found that under the old scheme mediocre candidates would neglect one part of the examination and prepare for the others, counting upon the benevolent intervention of an easily satisfied examiner and the indulgence of the others.

But there is another position from which the subject of teaching may be viewed. At an early meeting of the French society for the study of subjects related to higher instruction the question" of what faculties should a university be composed" was formally put to the society by its president. Dr. Le Fort, of the celebrated faculty of medicine of Paris, on this occasion, after stating the views of his faculty as far as the matter related to the faculty of medicine, proceeded to express his own, as follows:

"The place to study medicine is in the hospital and only in the hospital. Some medical savants devote themselves to laboratory study. Nothing can be better. But for the physician, who should above all things learn to care for and, if he can, cure his patients, the only school is the hospital. There may be courses in hygiene and medical jurisprudence, but there can be no theoretical course in medicine, none in surgery; there is only a course of clinics, and the professor at the same moment teaches the students the theory (of which they have obtained the principal notions from the books) and the practice."

Dr. Le Fort, speaking for himself and not for the faculty with which he is connected, may have been induced to speak so very practically in view of his opposition to bringing a faculty of medicine under the control of a contemplated University Senate;" but it can not be denied that public opinion is with him. His position seems to be, to judge from his remarks, that instruction in medicine consists of two operations-getting the principal notions out of the books a.. seeing practical work done and hearing it explained at the hospital.

It is quite supposable, however, that the curriculum of a medical school has the especial object to assist the student to obtain the principal notions from the books and to obtain them correctly. At all events, we shall assume that in America the original intention of the lecture course was to perform this service enerally imperfectly performed by the physician under whom a student has been placed, that by degrees, where possible, the hospital became the field for motexional sight-seeing, and in many cases a good deal more, and that during Pislest decade the laboratory has been added to the instruction of the lecture1oo and the clinic, as the biologist opened up a science of histology.

ng the following inquiry, as to the curriculum, then, three points calord. The manner in which the student obtains the "principal o medicine from the books, clinical instruction and dissecting, and The curriculum of the schools having a graded course will " work adapted to the purpose in hand.

TEXT-BOOK WORK.

Beyond the ability to read the printed page, which may in a measure be a mere mechanical operation, certain intellectual attributes are requisite for getting the principal notions out of the books. In the first place (presupposing a logical arrangement of the text-book) it is highly advantageous for the student to have attained an intellectual maturity sufficient to enable him to understand the system on which the text-book writer has arranged his matter, and, in the second place, the mental alertness to recognize the parts of the arrangement and their relations as they are filled in, so that what is material may be given the study due to its importance and the lesser matters be noted as such. Perhaps not less important in this process of getting the ideas of an author out of his book and into one's own head is a cultivated perception of the meaning of phrases and sufficient continuity of thought to carry a term, or phrase, or sentence in the mind until the idea it contains as an isolated part of the discourse has been reduced to its proper value by the modifying phrases or sentences which generally accompany the principal part of a sentence or of a paragraph. Thus we see why in some quarters so much stress is laid on a thorough literary education as a preparation for the study of medicine. Even during the eighth decade of this century, when the theoretical or literary science of the class and lecture room had reached its maximum and was soon to begin to give way to laboratory instruction, the well known German evolutionist, Prof. Ernst Haeckel, could say from his own experience that "in comparing graduates of classical colleges (Gymnasien) and those of scientific colleges (Realgymnasien), I have always observed an intellectual superiority in the former, despite their defective knowledge, and have even found during the teaching of my own specialty, zoology, that the former enter more easily into the higher and more general problems of science than the latter. I am, therefore," he continues, “against the admission of Realschul graduates to the medical schools (faculties), and I base this conclusion on my own experience."1

But since the distinguished professor wrote these words a new class of medical schools has arisen in America. At the beginning of the decade there were three or four courses of study whose object was to prepare the student for the study of medicine. The course covered two years, and was chemical and biological in character. At Cornell the student intending to pursue a preparatory medical course was advised to secure a degree in letters or science; at Johns Hopkins the course led to the bachelor's degree (A. B.). To-day we find three or four times as many such courses, as will be shown later on. In the mean time let us examine into the manner in which the student (much the larger number) who has neither the experience of the preparatory school, or the ability to collect, digest, and formulate his knowledge given by higher literary education, is instructed by the American medical colleges.

Until comparatively recently the method of didactic (i. e., nonclinic) instruction, called repetitional, held almost undivided sway. The essence of this system of instruction is the well-known pedagogical-that is to say psychologicalfact that repetition and attention are the most important elements in the acquisition of knowledge. The application of this not very obscure principle of pedagogy to medical instruction was made this way: There were so many "didactic professors in the school. Each of these gave the same course of lectures every year. The student listened to them during his first year and again during his second year, and had he attended a third year he would have heard them for a third time. This system has been severely criticised during the ten years past. It has, especially of late, been rapidly giving place to the graded or progressive course, which can not be finished in a single year by a well-prepared, intelligent, and laborious student, as at a celebrated southern university. But it is instructive to hear what may be said for the repetition principle by a department of a large university of the northwest, which sought to retain the

1 To the same effect Dr. Zarncke, professor of modern languages and literature, when dean of the faculty of philosophy of the University of Leipzig, says: There is a second view, which I call the pedagogie view. There is no better means of training the mind than the thinking and observing that the study of the classic languages necessitates. There is something mysterious in this result, and still an experience of many years has confirmed it. I am a member of two examining boards, one of which examines young men who have received their training in a gymnasium on a classical basis, while the other young men are without this foundation. The latter are very often superior to the former in information (Kenntnissen), but when mental maturity is tested by written work the graduates of the gymnasium surpass those of other schools to such a degree that a comparison can scarcely be instituted. "'

repetition feature in conjunction with a progressive course of three years. This defense is as follows:

"The course of instruction consists of three collegiate years of nine months each. The work of the course is systematically arranged, and so graded that the more elementary branches and the practical courses are first taken by the student, while the more advanced courses and theoretical subjects are presented later in the course, so as to secure, as far as practicable, an orderly succession of studies; while the more fundamental subjects are presented a second time during the course, so as to secure a more perfect comprehension of their principles and relations, and to fix the facts more firmly in the mind. The hours of the required lectures are so arranged that but few are given at the same time, and every facility is afforded for students to attend the repetition of the principal lectures as often as may be thought profitable. The faculty recognize, what is evident in the experience of all medical students, that attendance upon lectures on the same subject a second time, after other related branches have been studied, is much more interesting and profitable than the first; and hence they require students to attend lectures on all the leading subjects more than once.

In the catalogue giving the reorganized course of four years, however, nothing is said of the repetitional features.

But more particularly to facilitate the comprehension of the text-book matter and impress the principal notions which it contains, two methods have been adopted in America in addition to the "didactic" lecture. These are the recitation and the "quiz," neither of which are employed in the schools of university grade in Europe. Indeed, in America the lecture system may be said to be gradually becoming complementary to the text-book, just as in Europe the seminarium or conference is becoming supplementary to a course of lectures. Thus we are informed by the Yale Medical School that "in reorganizing the school as an integral part of Yale University in 1884, the inherent defects in the older and still common method of instructing chiefly by didactic lectures were recognized and the methods now employed are similar to those in vogue in the other departments of the university. Didactic lectures are still employed as best in some branches, but recitations from assigned readings, with explanatory lec.ures, laboratory work, and personal instruction in the clinics constitute the main portion of the curriculum." At the Albany Medical College it is believed that instruction by recitation is as essential in medical as in literary colleges, and the faculty have greatly enlarged and extended this department of the teaching in this college. The recitations, which have hitherto been held during unoccupied hours in the evening, are now made part of the regular curriculum. Every study taught in the college by lectures is also made the subject of recitations, the ratio of the number of lectures to that of recitations being in general two to one.

The Long Island College Hospital, having the old system of lecture courses, has adopted a reading and recitation term, which begins at the close of the regular term and continues until June. It is designed to thoroughly prepare the student for attendance on the lectures of the ensuing regular term. Clinical instruction for advanced students is continued during the reading and recitation term. As the laws of the State of New York require three years' study of medicine, students are advised to commence their study at the beginning of the reading and recitation term.

The daily and weekly quiz appears to be but a modification of the examination at the end of the year or term without the breadth or formality of that ancient contrivance for testing the memory of the student or his ability to grasp the idea expressed by the words in the examination paper before him. At the University of Virginia it has been found that "the daily oral examinations on the subject of the previous lecture are of great value in stimulating the student to regular and systematic habits of study, and furnishing the professor an oppor tunity of discovering and removing the difficulties met with by the st ident." At the Medical College of Alabama still stronger language is used in favor of these daily oral examinations, and it announces that "so important is this method of impressing the leading facts considered in the lecture hour, and so useful is this method of instruction in obtaining systematic and accurate information considered, that members of the faculty will, after the middle portion of the term is reached, establish a daily quiz, which will be so arranged as not to interfere wi h any lecture or other duty, and will be of great interest, especially to those who contemplate applying for graduation."

As medicine principally deals with diseased conditions of the human body in an effort to restore it to health, it is not difficult to illustrate the lecture on anatomy, physiology, surgery, and even the practice of medicine by demonstrations,

specimens, models, and charts, and in this way even the "didactic" lecture has a semblance to the clinic. Without dwelling further on the subject of the didactic lecture, we now pass to the clinic, which must be treated with equal brevity.

'PRACTICAL WORK.

In his Life of Macaulay, Trevelyan gives an extract from his uncle's diary in which the historian gives the argument by which he dissuaded the Prince Consort from attempting to give the English universities a Continental form by introducing a faculty of medicine. Macaulay explained to the Prince the great difficulty there would be in getting distinguished physicians to exchange a princely revenue in London for the salary and retirement of a university professor at Oxford or Cambridge.

But there is another reason of still greater importance for locating a first-class school of medicine in a large city. The workingman feeds the hospital, and to enable a faculty of medicine to exist a great industrial center is necessary." This sentiment is supported by the testimony of the Harvard Medical School, which says that it was established in Boston in order to secure those advantages for clinical instruction and for the study of practical anatomy which are found only in large cities.

Practical instruction in medicine may be classed under two heads: There is, first, the nonpathological form, which goes by the name of dissection, and, second, the clinic, which may be subdivided into three forms, in one of which the subject is operated on in the amphitheater before the class; in the second the class, or a portion of it, is taken to the bedside, and in the third the advanced student acts as a physician or as an assistant.

The amount of work required in dissection is not uniform throughout the country and is still less uniformly stated. From 91 schools whose catalogues mention the work in dissection required for graduation, the following information has been obtained:

Work required of student.

Dissection of entire body

Dissection of three parts at least

Dissection of two parts at least.

Two courses of dissection.

One course of dissection.

Must dissect during two sessions (or courses).
Must dissect during one session.

Studied practical anatomy during two sessions..
Pursued one course of practical anatomy.

Must attend dissections while in school...

Must attend clinical lectures and dissections..

Must present certificate that necessary dissections have been made.

Must produce evidence of attendance in practical anatomy

Must produce evidence of having been adequately engaged in study of practical anatomy
Must produce evidence of having pursued the course of practical anatomy.
Must spend required time in practical anatomy

A satisfactory course in practical anatomy..

No. of schools.

34

7

6

10

3

65

11

5

16

2

1

10

The modification of the didactic lecture by the previously "assigned reading". by the Yale Medical School has been noted; it would appear that the method in vogue there for studying the framework of the human body is no less complete and systematic. This system of instruction in anatomy is as follows:

"As in the other fundamental branches of medicine, the instruction in anatomy is chiefly by means of recitations and laboratory work. The course extends through two years, with examinations at the end of each year. At the beginning of the course each student is provided with a box containing all parts of the skeleton for home study, and during the first term two weekly laboratory lectures are given on osteology and syndesmology, alternating with recitations from the text-book. After a thorough knowledge of the bones, ligaments, and muscular attachments has been obtained, the student enters upon laboratory work on the soft parts, in which eight hours weekly are required until the dissection of all parts of the body has been made. Preparations of the different Le Fort, at the meeting of the Parisian group of the Society for Higher Instruction in France.