The course of the University of Pennsylvania, given below, is, generally speaking, the type of those of the Northwestern, Wake Forest, and Wisconsin universities. At the Northwestern University, however, mathematics takes the place of history in the first year, and logic, psychology, and physics the place of physiology and botany in the second. Mathematics, psychology, and physics also appear in the course of the Wisconsin University, while "rhetorical work and military drill are required as of other students." The course at Cornell University agrees with the type in having French or German, and with the Northwestern University in having logic and psychology. Closely related to the Pennsylvania type is another furnished by three elective courses, each of two years, which are prefaced by one or two years of collegiate study, the entire course of three or four years being capped with the degree of bachelor of science. The institutions at which these courses obtain are the Johns Hopkins University, the John C. Green School of Science (Princeton College), and the Sheffield Scientific School (Yale University). They are in reality academic courses in biology, for they are of sufficient completeness to be rewarded with a degree, and are by no means preparatory to the study of medicine in the sense that the first year of a graded course of a medical school is preparatory to the study of the second year. Were this distinction not a true one every academic course in biology might be classed as a medical preparatory course, which is not the pedagogical function of biology as a collegiate study. This type, therefore, is not represented in the curricula that follow.'

Truer preparatory courses are those offered by the University of Virginia and others. In one of these, that of the University of West Virginia, the instruction is given in a "school of biology," it must be admitted; but it is stated that "practical anatomy" is required of those who intend to study medicine; while the others study general anatomy only. The question of priority of establishment is always a dangerous one to discuss; but as it appears that the University of North Carolina was the first to inaugurate a course of this kind, its course, were it not of a single year, would be used to illustrate the type of curriculum now under discussion, instead of that of the University of Virginia. The course of the latter institution was established for the following reasons:

"Graduation in medicine, as in the other departments of the University of Virginia, does not depend upon the time which has been spent in the study of medicine, but upon the preparation of the student as indicated by rigid written examinations which he is required to pass. It is possible, therefore, for a wellprepared and laborious student to graduate in one session, and examples are not wanting where such graduates have attained conspicuous success in professional life. But the severe and protracted labor necessary for this purpose is attended with evils of which the medical faculty is fully conscious. And while the regular course is complete as far as professional studies are concerned, it leaves the student without the benefit of certain scientific studies, which furnish an admirable preparation for and enlargement of the strictly professional course. Students are therefore advised to devote two sessions to the work; and for the benefit of those who can afford the time to pursue them, special courses in biology and physics have been arranged with particular regard to the training needed for medical studies."

From an examination of the curriculum given below it will be seen that the repetitional feature is strongly emphasized.

Now what value do the medical schools of the country place upon these various kinds of preparatory courses? In the case of the course at Princeton College the faculty of the Medical School of Columbia College will accept it as equal to six months study under a preceptor in case the student attends three sessions at that medical college, while the Chicago College of Physicians and Surgeons, Rush Medical College, and the Chicago Medical College "have approved the four years' course [of the University of Wisconsin], and will accept it as the equivalent of one year's study." The course of the Portland Preparatory School is to supply the place of the preceptor not of the medical college, and what the introductory courses of the Universities of Virginia and Pennsylvania are intended to do has already been very fully explained in the words of their own competent faculties.

It will be noticed that the department of biology of the Illinois State University (p. 1013) has a special course preparatory to medicine.

Course preparatory to medicine in the University of Pennsylvania.

Preparatory course for students of medicine of the University of Virginia.

This first year of preparatory work will comprehend

1. The course in general chemistry attended by all medical students.

2. A special course in physics.

3. A special course in biology and comparatíve anatomy.

4. The course in anatomy required of all medical students.

Those who are graduated in this preparatory
course will attend for the second session-
1. The regular courses in physiology and
surgery.

2. The regular courses in medical juris-
prudence, obstetrics, and practice of
medicine.

3.

The course in materia medica.

4. The regular course in practical anatomy repeated.

THE PLACE OF THE STUDIES IN THE COURSE.

The admission requirements, the didactic, the clinical, and the laboratory instruction of the medical schools of the United States have in turn received attention. It has been shown how an effort is being made to dispense with a course in the humanities by inaugurating a preparatory course in science, and it now is necessary to examine the character of the medical curriculum as a whole, just as in the foregoing its parts have been discussed.

In 1876 on the call of several colleges a convention was called to meet at Philadelphia. This convention became the American Medical College Association, which adopted a scheme of instruction consisting of eight chairs. In 1882 the scheme of minimum requirements of the Illinois State Board of Health, adopted in 1880, went in effect. For convenience these curricula and that of the U. S. Army medical service are placed side by side.

At their first meeting the Association of American Medical Colleges adopted the following:

Whereas a knowledge of the elementary branches of medicine should precede a study of the practical branches:

Resolved. That in the hope of inducing students to prolong and systematise their studies. this convention recommends to all medical colleges to offer to students the option of three courses of lectures, after a plan similar to the following: Students who have attended two full courses on anatomy, chemistry, materia medica, and physiology may be examined upon any of these subjects at the end of their second course. During their third course such students may devote themselves to the lectures upon the theory and practice of medicine, surgery, obstretrics, and diseases of women and children, upon which subjects only they shall be examined at the final examination for the degree of M. D., their standing, however, to be determined by the results of both examinations.

We now turn to the examination of the curricula of the schools having graded courses. In the first year we find invariably instruction in chemistry, anatomy, physiology and histology, and dissection. Materia medica in the majority of cases also comes in the first year. In half a dozen instances minor surgery is introduced thus early, and in eleven cases, at least, clinics, general and surgical," as at the University of Pennsylvania, or medical, surgical, eye,and gynecological, as at the University of Wooster, are also held. At least 9 colleges have instruction in hygiene during the year. Gynecology, physical diagnosis, pathology, principles of surgery, medical jurisprudence, ethics, and physics have place in the first-year course of one or more colleges.

Comparing these figures with those of ten years ago, and remembering that 43 graded courses (several not obligatory) are represented now against 13 in 1881, it appears that in the main features no change has been made and that chemistry, anatomy, and physiology are the groundwork of medical instruction.

Twenty-six schools report definitely as to the examination at the close of the first year. General chemistry is disposed of by the great majority of the 26 schools and normal histology and materia medica by a great many. Several schools have a final examination on the bones and ligatures. It is impossible to speak with more than approximate accuracy on the character of the examinations of the first year except to say that the final examinations on the fundamental subjects of anatomy, and physiology, and the subject of materia medica are passed during the second year, to the curriculum of which we now turn.

The principal studies of the second year are anatomy, theory and practice of medicine, surgery, therapeutics and materia medica, obstetrics, medical chemistry, and physiology. Clinical instruction is very generally given during this year. In twenty cases diseases of women and in fifteen, diseases of children are a part of the curriculum, and in ten physical diagnosis and hygiene. The special branches-eye, ear, throat, chest, and nervous disease-are represented in from three to five schools, and medical jurisprudence in six schools. Minor surgery and toxicology are each represented in four schools.

The language used by the schools in their curriculums is not uniform, but it appears that of 43 schools having graded or progressive courses but 3 do not have anatomy during the second year. One of these has "surgical pathology," another pathological anatomy, and the third pathology illustrated with morbid specimens. Ten schools do not report physiology, at least under that name, though it may be included in "medical chemistry," which is specifically named by 8 of these 10 schools. But the new studies of importance of the year are theory and practice of medicine, surgery, and therapeutics. Pathology and clinical instruction are also mentioned, in many cases alone, in others in connection with medicine and surgery, Occasionally there is a term such as this: "Theoretical, operative, and clinical surgery," or "theoretical and clinical medicine or obstetrics."

At the close of the second year the final examinations in anatomy, physiology, materia medica and therapeutics, pathological anatomy, and chemistry take place, and in several schools an examination in medicine and in surgery occurs. The third is the practical year of the three-year course. Medicine, surgery, and obstetries are represented in the curriculum of every school, while the subjects diseases of women and of children are not reported by 4 and 12 respectively. The new subjects of the year are the special branches, which are clinically taught, to wit, diseases of the eye, ear, throat, skin, nose, and nervous and mental diseases. Pathology, materia medica, medical jurisprudence, and hygiene are important features. In several schools orthopediatrics, electrotherapeutics, and bacteriology are mentioned as subjects of study.

The character of the four years' course is illustrated by the following programmes:

HARVARD MEDICAL SCHOOL.

The following tabular view illustrates the distribution of studies throughout the year.

Hour.

a In sections.

In the second half-year.

c In the first half-year.

d At 11 in second half-year.

a Till February in sections. In first half-year,

cTill January in sections. d Examination in February.

SECOND CLASS.

Wednesday.

a Auscultation Cl. Conf.
Child. Asst. Prof.
Rotch and Drs. Buck-
ingham and Sherman,
Mar. and Apr. No.
Grove St.
Surg. Conf. Prof. Por-
ter, M. G. H. after Oct.

Thursday.

e In second half-year in sections.

Each half of the class on alternate weeks till February.

g In sections of half the class till March.

2in sections.