tion, as it certainly has given it status as a course in science. It is certainly so in the case of the Medical School of the University of Michigan, for its faculty states explicitly that the extension of the course from three to four years "is largely due to the need for the more through instruction in laboratory work," for the student who spends but "three years in attendance upon lectures and one year of study with a preceptor can not reap the advantage of the full course of laboratory instruction."

Laboratory instruction as given in the American colleges of medicine may, in view of the laboratories in which it is given, be classed under six heads, to wit: 1. Dissection or "Practical Anatomy."

2. Chemical manipulation (general and analytic).

3. Physiological.

4. Histological.

a. Normal.

b. Pathological.

5. Bacteriological.

6. Materia medica.

Dissection has already been spoken of; normal histology will be spoken of further on; while other than noting that it affords each student the opportunity to go through a course of chemical experiments, the instruction of the chemical laboratory calls for no special mention except as to that form which at the Yale Medical School is called the course in physiological and medical chemistry.

This course consists of recitations and a practical laboratory study of the composition and reactions of the various animal tissues and fluids, the processes of metabolism and digestion, and the action of ferments. Due attention is paid to the composition of foods, the physiological use of the digestive preparations, and other matters of medical interest, especially to the recent analytical methods employed in clinical work. The study of normal urine is supplemented by abundant practice in the chemical and microscopical examination of patholog ical specimens. At the Jefferson Medical College, the same tendency towards the pathological side is shown in the instruction in its laboratory of practical chemistry. The student there examines the normal and abnormal products of the human body as aiding diagnosis, and studies practically the "morbid chemistry of the bile and blood" and the most approved methods of examining urine. At the University of Michigan there are two courses, one in qualitative chemistry and the other in urinalysis as applied to chemical uses and physiological study; but, in addition to them and at the option of the student, two other courses are offered, one in physiological chemistry and the other in pathological chemistry. The first of these optional courses deals with the analysis of the solid and fluid parts of the body, the other embraces courses in qualitative and quantitative analysis and the examination of foods and of the tissues and fluids of poisoned animals. One might venture to call this specialization of chemistry diagnostic chemistry. Toxocologic chemistry also appears as a department of the chemical laboratory, but sometimes is connected with medical jurisprodence. The physiological laboratory, of which there are very few in the country, is to the medical school what the mechanical or testing laboratory is to the college of technology, and in some schools (which care to mention the fact) what the biological laboratory is to the vivisectionist. The instruments with which such a laboratory is fitted up and the use made of them may be illustrated by the laboratory of the Jefferson Medical College. The teaching of this college in its course of experimental physiology embraces the demonstration of the essential phenomena of digestion, absorption, circulation, respiration, excretion, the functions of the nervous system, including the special senses, the reproductive apparatus, and development of the embryo. For these demonstrations, as well as for original research, the laboratory is equipped with the following apparatus. For the study of

Digestion and absorption.-Chemical appliances for the investigation of the properties of the albuminous bodies, the chemistry of the tissues, the composition of the digestive fluids, blood, etc., instruments for making gastric and intestinal fistula, water baths, and dialysers, and apparatus for recording rate of secretion.

This school, with great propriety, classes dissections as laboratory work. Other schools, seemingly with less propriety, also class the witnessing an autopsy as laboratory work, considering it as a part of the work of the pathological laboratory. It would be scarcely permissible to call a "didactic" lecture on chemistry, illustrated by experiments, a laboratory exercise. In both the autopsy and the chemical lecture the student is a spectator and listener, not an ac tive agent. At Harvard, however, and at the Bellevue College, the student is called upon by turns to make an autopsy.

Circulation.-Czermack's holders; kymographion clockwork motor; Foucault'; regulator and three recording cylinders, including those for continuous tracess mercurial manometers; Bernard's differential manometers; Brindley's and Sanderson's cardiographs, cardiophone with telephonic attachment, Haldat's and other apparatus for demonstrating hydrostatic phenomena; Marey's simple cardiograph and sphygmograph with Sanderson's modification; Marey's apparatus of rigid, elastic, and vertical tube; arterial schema; Hawksley's vascular schema; Majendie's cardiometer; Fick's spring kymograph; Marey's cardiac clamp; Coat's apparatus with Brubaker's modification; Franck's double myograph; Marey's cardiac sounds for horse, apparatus for retardation of pulse, cardiograph for small animals, Ludwig's strohmuhr, and apparatus for studying capillary circulation, the warm and electrical stages, gas chambers, Gower's apparatus for counting blood corpuscles, also a hæmoglobinometer.

Respiration.-The Pettenkofer-Voit respiration apparatus; Regnault and Reiset's respiration apparatus; Ludwig's respiration apparatus; Valentin's respiration apparatus; Hutchinson's spirometer; recording stethometer: Marey's pneumograph; Bamberger's apparatus; Rosenthal's apparatus with Brubaker's modification; aerotonometer; Gréhant-Alverguiat gas pump; apparatus for artificial respiration, with water motor; anemometer scales turning the beam at the 16 of a grain, and standard barometer; Calliburce's instrument for vibratile cilia. Calorimetry.-Thomson's and D'Arsonval's calorimeters; thermometers, etc. Secretion.-Roy's kidney onkometer and onkograph. Apparatus for determining rate and amount of urea.

Nervous system.-Du Bois-Reymond's indication apparatus with Helmholtz's modification; spring myograph; muscle telegraph, nonpolarizable electrodes, diverting chambers, key, rheocord, round compensator, resistance box, whippe; commutator: moist chambers; Wiedemann's galvanometer, including telescope and scale; Thomson's Elliott galvanometer, including shunt, scale, lamp, etc.; Bunsen and Daniel batteries; Page's vibrator; metronome; chronograph; tuning forks, marking keys; Bernstein's differential herotome; Helmholtz's electro-magnetic rotator and myophone with telephonic attachments and pendulum myograph; Pflüger's myograph; Gréhant's chariot with clockwork motor; Brubaker's apparatus for electrotonus; apparatus for reflex movements, and Ludwig's section-cutter for spinal cord.

Vision, voice, and hearing.-Models of eye; Kuhne's artificial eye; Helmholtz's ophthalmometer: models of larnyx and ear; acoustical apparatus, including air pump and bell; Helmholtz's siren; acoustic bellows; sonometer; rods, membranes, plates, pipes, resonators, oboe vox humana; Koeing's manometric apparatus.

Embryology.—An incubator, capable of holding one hundred eggs for the study of development, and numerous microscopic sections.

Comparative physiology. This collection, embracing several hundred specimens, many of which are extremely rare, illustrates the comparative physiology of the teeth. stomach, etc., of the circulatory, respiratory and genito-urinary organs, of the nervous system, and of the successive stages in the development of the human embryo. The collection is used in supplementing the experimental demonstrations.

Arrangements have been made through which the laboratory can be also supplied from time to time, as required, with living fresh-water and marine objects for biological study, as well as ample material for dissection.

The physiological and histological department has been especially arranged with reference to the wants of the members of the attending class, the laboratory demonstrations constituting a part of the regular instruction during the winter session.

At the Loomis laboratory of the University of the City of New York, in addition to the recording and other instruments used by physiologists, the labora tory contains a large tank for administering to animals air or oxygen, compressed under many atmospheres of pressure; an air pump for experiments upon animals with rarefied air: hot-air chambers for the study of the effects of external heat on body temperature; large automatic models of the heart and spinal cord and of the mechanism of gland secretion, urine secretion, and micturition.

At the University of Michigan medical school the subjects commonly embraced in the practical course relate to the physiology of the special senses, muscular contraction, nerve, reflex action, circulation, and respiration. A smaller room is devoted to advanced work and original investigation. Conveniently situated are an apparatus room, a dark chamber for optical experiments, an incubation closet, and a large workshop containing machinists' and carpenters' appliances.

The instruction in physiology given by several schools is by means of a course in vivisection or lectures illustrated by vivisection.

The laboratory instruction (excluding dissection as such) the most generally introduced is in histology. Although there is a tendency on one side to class the work in med cal chemistry and other laboratory work under the general head of microscopy, as, for instance, at the Tulane University school, where there has been since 1889 a "microscopical laboratory for the better study of normal and morbid anatomy and bacteriology," there is a'so a tendency to group these subjects under the head of histology. Thus, at the University of Pennsylvania school, "each student of the second year is provided with a separate table and microscope and receives personal instruction in pathological histology, in micology, and in the microscopy of urine," in the "pathological laboratory" A term frequently used is histological and pathological laboratory or histology and pathological anatomy, in which the term histology appears to indicate the microscopic anatomical study of undiseased matter, and the term pathological anatomy the microscopic study of diseased parts.

The laboratory work in histology consists of two parts: One, the preparation (cutting, staining, and mounting) of the specimens and the manipulation of the microscope, the other the study of the import of the specimens. At the Univer sity of California school the second process is thought to be attained by the mere mechanical work of the first, "which illustrates and fixes in the mind of the student" the general principles of normal growth and development and the operation of pathological laws. At the Columbia College school the course of mounting, etc., teaches the "methods" not only of preparing, but of studying normal and diseased tissues, and furnishes the student specimens from which he prepares a series of outline sketches.

On the other hand, at the Northwestern University school, students of the first year work two hours a week in cutting, staining, and mounting normal histological sections. Material for this course is furnished in abundance and each student secures a full series of normal histological slides. Free-hand drawing of a large number of the sections mounted in this course is compulsory. Students of the second year devote two hours each week to the study of mounted sections of pathological tissue already cut and stained for them. Free-hand drawings of the sections is compulsory, and the quality of a student's work in this course is considered in his grading in the department of pathology. In the four years' course the work in the microscopical laboratories will be more extensive. All of the work in the microscopical laboratory is done in the presence and under the supervision of the demonstrators of the respective departments. Students are required to furnish their own slides, cover glasses, mounting needles, and spatulæ.

At the Yale medical school histology is treated from the embryological standpoint. By this method the student is enabled to gain not only a thorough understanding of the structure of the various tissues and organs of the body, but also to trace their development and growth. The course of instruction consists of lectures, recitations, and laboratory work. The lectures are very fully illustrated by lantern transparencies made from photographs of typical sections and drawings. These are accompanied by recitations from a standard text-book. In the laboratory, each student receives carefully prepared sections and specimens of all the tissues and organs of the body, both in the adult and embryonic condition; these are mounted for permanent preservation and from them careful drawings are made. Practical instruction is given each student in the technology of the subject. The laboratory cabinet contains an extensive reference collection of histological specimens and serial sections of embryos; this, together with the most recent instruments and publications and an abundant supply of material, affords good facilities for advanced work.

The University of Maryland school announces that, with the introduction of the three-years course, a laboratory of normal and pathological histology will be opened and that constantly increasing attention will be devoted to the development of this laboratory work, as the faculty fully recognizes its all-important influence in modern medical education.

The bacteriology course is frequently united with the work in histology, but in perhaps half a dozen cases it has a laboratory of its own. At the University of Michigan school work of this character is done in the laboratory of hygiene. The work is, in an elementary way, on the model of that done in the laboratories of Koch and Pasteur.

The several laboratories of materia medica and experimental medicine may be illustrated by that of the University of the City of New York. This laboratory is provided with a full assortment of the various articles of the materia

medica to be used in giving the students a practical acquaintance with each drug and its preparation. Classes will be formed to work in the laboratory under supervision, for the purpose of insuring familiarity with the compounding and administration of medicines. In addition to this, practical instruction will be given in the use of remedies which are not medicines. This will include a special course in electrical therapeutics, for which purpose the laboratory has been fully equipped.

Incidentally the programme of laboratory instruction has been given in the programmes of clinical instruction on pages 888 and 910. It is therefore only necessary to give by way of illustration the special rosters of the University of Pennsylvania school.

Roster of laboratory instruction in pathology and instruction in orthopaedics, for students of the third year.

I.

For attendance upon these courses, the third year class is divided into four sections, A, B, C, and D, which attend as follows:

First period, from Thursday, October 3, to Friday, November 15, inclusive.

Second period, from Monday, November 18, to Friday, January 10, inclusive.

Pathological histology.
Orthopedics..

C
ABD

A

B

D

Third period, from Monday, January 13, to Friday, February 28, inclusive.

Pathological histology.
Orthopedics....

B
ACD

A

C

D

Fourth period, from Monday, March 3, to Friday, April 11, inclusive.

The instruction in orthopedics is given at the university hospital at 11 o'clock; in pathology, in the pathological laboratory.

II.

Special roster of laboratory instruction in histology, osteology, and syndesmology for students of the first year, session 1889-90.

For instruction in these laboratories the first-year class is divided into five sections, A, B, C, D, and E, which attend throughout the entire session as follows:

All students not occupied during the above hours dissect from 12 to 2 daily, and from 9 to 11 Friday.

PREPARATORY MEDICAL SCHOOLS.

The law of 1801 of the French Republic fixed the number of medical schools at six, of which three had been established by the date of 1840. In the meantime there had gradually grown up a lower kind of school for the purpose of initiating students of medicine into the elements of the art of curing disease. During 1820 these schools were placed under the control of the State educational authorities called the "university," and in 1840 they were reorganized by the minister. The eighteen schools whose instruction was thus unified had been founded independently, and on no common principle, and therefore were very diverse in their organization. Some had endowments, some lived on the meager diet of tuition fees, but the most were supported by the city or department, or by grants from the Governmental hospital bureau. In all the amphitheaters dissecting material and chemical advantages were poor or wholly absent. In 1840 a uniform course was given them as follows:

Chemistry and pharmacy; natural medical history (botany) and materia medica; anatomy and physiology; pathology (medical clinic); pathology (surgical clinic); accouchement, and diseases of women and children.

One of the great advantages of these schools, said the minister, is "that they give opportunities for anatomical study, that essential of medical study which can not always be furnished by the higher medical faculties (i. e., schools), where the students are frequently too numerous to follow with profit all the demonstra-tions." In each school there were to be six professors and two adjunct profes sors and the cities were required to furnish the necessary anatomical material and the hospitals at least fifty beds for clinical purposes.

In 1854 the American Medical Association had adopted a resolution "cordially approving of the establishment of private schools to meet the increased desire on the part of a respectable number of medical students for a higher grade of professional education than can usually be acquired by 'reading medicine' under the direction of a single instructor." In 1856 Drs. Dana, Robinson, and Fitch, of Portland, opened the Portland Medical School for Preparatory Instruction, Dr. Robinson representing materia medica, midwifery, and diseases of women and children; Dr. Dana, physiology, pathology, and practice; Dr. Fitch, anatomy, surgery, and chemistry. The school was located in the Portland Dispensary and opened with two students. The faculty of the school now consists of 9 professors and three adjunct instructors, and the student is requested to remain at least one year, which constitutes the course. The departments of instruction are four. In the first, systematic recitations are held in anatomy, materia medica and therapeutics, surgery, theory, and practice of medicine, and obstetrics. In the second, familiar lectures and demonstrations are given on the physical exploration of the chest and diseases of the heart and lungs, on minor and operative surgery, on diseases of women, and on physiology. In the third, clinical instruction at the school and various charitable institutions, Cases of midwifery will be furnished to advanced students as far as possible. In the fourth department the study of practical anatomy is a prominent feature of the winter term and during the last weeks of this term the recitations are omitted and the whole attention of the student given to dissections, lectures, and clinical study. No degrees are conferred.

At present fourteen institutions report preparatory courses in medicine; and two, including the Portland school just mentioned, report themselves as wholly engaged in such work. These courses are, with two exceptions, of two years, and it is sometimes indicated, in the remarks which explain why they have been formed, that they are for those who wish to prepare to pursue the study of medicine without spending the time required by a collegiate course. The proposition of the president of Harvard to reduce the four-year curriculum to three years, and the adoption by Columbia College of that period as a college curriculum leading to a degree to be given when the student has pursued the first year's course of the medical or other professional school is seemingly promoting the rapid creation of those preparatory medical courses in our higher institutions of learning. None of these courses by itself leads to a degree, even the four years' special science course, antecedent to medicine" of the University of Wisconsin does not lead to the bachelor of science degree. Their object is very well, stated by the University of Pennsylvania in the following terms:

This course preparatory to medicine was established in 1885 for earnest students who can not present the requirements for admission to the regular college courses or are unable to devote four years to the preparatory work, and yet desire some systematic training in scientific and liberal studies. The results have already shown conclusively that such a course was greatly needed and that the men who have faithfully pursued the work have excelled in their subsequent professional studies."