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SUGGESTIONS AS TO HOW THE STATUS OF THE MEDICAL PROFESSION MAY BE ADVANCED.

In response to an inquiry for opinions as to the manner in which the status of the medical profession might be advanced, as far as it is influenced by the instruction in a medical school, about fifty replies were made, all, with three or four exceptions, from "regular" schools. hese are grouped under four heads: Suggestions that all candidates be examined and licensed (a) by State boards, (b) by national boards, (c) that the course be extended two or three years, and (d) Suggestions not falling in a, b, or c.

The drift of the suggestions in regard to the establishment of a State board is. that it should examine the student as to his competency to practice medicine after he has obtained a certificate or diploma from a medical school or college, the State examination to be independent of the college. The dean of the Yale medical school puts the matter thus: "(1) No practice without registration; (2) no registration without diploma or examination; (3) an impartial board to determine what diplomas could be registered (desirable for effect on schools and as best meeting the conditions in the different States); (4) registration only by examination, but not until conditions are more uniform in different States."

In eight cases a national board (or boards) of examination is suggested. In two of these the matter is expressed by saying that it would be of great advantage if the laws relating to medical education were uniform throughout the country.

A third of the deans think that the course should be lengthened to three years of lectures or graded course, and in some cases four years of study. As this is what is being very rapidly done, no comment is required.

In the miscellaneous category are suggested a preliminary examination, more laboratory work, and compulsory graduation from a medical college. From lowa it is answered: "A change in the law that now requires a student to study practical anatomy and then makes him a criminal for obtaining the material would materially advance the status of the profession." Another correspondent says: "The first law in Tennessee was passed by the legislature of 1888 and 1889. Having gained this one great step I think it unwise to attempt more too soon lest reaction result and we lose all."

Reply from the faculty of the medical department of the University of the State of Missouri.

Dr. WILLIAM T. HARRIS,

Commissioner of Education, Washington, D. C.:

DEAR SIR: Dr. A. W. McAlester asks me to reply to the request made on the back of the circular sent out by your Bureau for the purpose of obtaining statistical information of the medical schools of the country. I do so with some diffidence, and beg to call your attention to two things in this connection:

The first is, that length of course should, in my judgment, be measured by something else or additional than mere length of time; system, manner, and kind of instruction are of more importance in laying the foundation of a good medical education than time. The knowledge and mental discipline which the average medical student brings to the school or college of medicine is limited and deficient; to what extent this is the case no one connected with any medical school likes to tell. Such as he is, the medical student, hears five or six or even seven lectures a day; no one, I presume, will affirm that he masters them; and when the process is repeated another term, and may be a third, any general discernment has been sacrificed for the possession of disjointed and loose parts. The more a student at the beginning of his career is encouraged to attend to clinics and hospital practice, the more certain is this result attained: a certain handiness has effectually taken the place of knowledge. There are three things to counteract and overcome these tendencies:

1. A graded course, strictly adhered to and guarded well at the entrance; students should be made to take a narrow path rather than to spread themselves over the whole subject.

2. Lecture and text-book instruction not merely descriptive, but to stand in organic relation to the whole, and to be in themselves logical treatises of the subject they deal with.

3. Lectures to alternate with recitations; no quizz classes, where the aim is to rote and cram, but proper lectures and wise questions to strengthen as well as to test the intelligence, understanding, and progress of the students.

The other point is, that a difference should be made between a college of medicine and a medical school; the former teaches medicine as a science, the latter mainly as an art; the former attempts to make scientific physicians, the latter practitioners. A State university has no more business to make practitioners in medicine or advocates in law than it has to make carpenters or shoemakers. If the State desires to do so, it could establish technical or trade schools, of which the so-called agricultural and mechanical colleges are types. They stand in my judgment coequal with the university, each called into life by the foresight of the General Government, and each for a distinct purpose, their connection being, I take it, somewhat like this:

I. State university:

a. Academic college.

b. College of medicine.

c. College of law.

II. Agricultural and mechanical college:
a. School of agriculture.

b. Mining school.
c. Engineering school.

This dissociation between the schools and colleges could of course be carried farther, but as I have already spoken at some length, I will only add that I believe it to be rash to set up the claim that a medical graduate is, in virtue of his graduation, a skillful and experienced physician; he should, after graduation, receive one or two years hospital practice, which in no case is rendered unnecessary on account of clinical attendance while a student.

Respectfully yours,

P. SCHWEITZER.
WOODSON Moss, Secretary.
A. W. MCALESTER, Dean.

Reply from William M. Thornton, chairman of the faculty of the University of Vir

ginia.

The following are recognized as the reforms most urgently needed in medical education:

1. The separation of the teaching and licensing bodies already carried out in Virginia should be adopted in all the States. This reform was advocated by the late Prof. James L. Cabell, of this State and University, in 187, in an address before the American Medical Association; was persistently urged by him, and was finally carried into effect in 1885 in Virginia.

2. The grading of the course of medical studies and the inclusion of biology and comparative anatomy, as follows:

First year course: Chemistry, physics, biology, and comparative anatomy, with laboratory practice in each case.

Second year course: Human anatomy, physiology, histology, with laboratory practice in each case.

Third year course: Pathology (with laboratory practice), obstetrics, gynæcology, surgery (with laboratory practice), practice of medicine, materia medica, medical jurisprudence, clinical surgery.

3. The extension of the term of study to nine months in the year. The step indicated in 3 has been approved by the faculty, but the visitors consider it one for which the public is not prepared.

WILLIAM M. THORNTON,
Chairman of the Fculty.

Reply from II. D. Didama, M. D., LL. D., dean of the College of Medicine of Syracuse University.

"If you had asked for opinions instead of information I might have answered: "Observation proves that higher matriculation requirements and better systems of education do not originate with the great schools in the State of New York, but are forced upon them by the profession through the legislature.

The schools did not adopt a matriculation examination of any value. Some had no examination whatever. Most of them had been content with the old unnatural two six-months' courses, both exactly alike, so that if the student had a good memory on course would have been all sufficient.

The profession should demand enactments requiring fitness at the entrance, a thorough graded course of three years of eight months each, and a rigid examination at the termination of the three courses, if not at the end of each year. But you asked only for information, and I forbear."

"H. D. DIDAMA,

"Dean."

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Reply from I. T. Talbot, M. D., dean of the Boston University School of Medicine. The great difficulty is, and has been in the past, that the student entering upon the study of medicine is often entirely lacking in qualification. This oftentimes arises from the fact that many men as ignorant as themselves, often holding diplomas, acquire reputations and large incomes. To obviate this state of affairs this school requires the first of its four years to be devoted to the preparatory or foundation studies of a course of medical instructions. These include, in addition to a good English education, Latin, physics, biology, zoology, microscopy, chemistry, botany, human osteology, comparative anatomy, and animal dissections. Many of these can be studied in the last year of a college course in arts, while the remainder can be pursued under the direction of a medical instructor or in the first year of a medical school. Knowledge on these subjects must be tested by a thorough entrance examination to the second year of the medical course. Such students will be prepared for thorough subsequent work.

I. T. TALBOT,

Dean.

THEOLOGY.

A comparison of the annual reports received from theological seminaries and departments during the ten years last past shows the necessity of having some standard by which may be determined the characteristics of a department or school of theology. There seems to be a distinction of some kind made by the management of higher institutions of learning in which theological instruction is given; for frequently the forms sent out by this Bureau are returned with the indorsement: Not a regularly organized school of theology," or the Bureau fails to obtain a response at all. Either of these circumstances vitiates the comparison of statistics of one period with those of another, for the school which appears in the report for 1881, but thereafter fails to report or reports that it is not a theological school for two successive years, will not appear in the report for 1883.

On the other hand there is still more embarrassment as to what constitutes a theological curriculum. Some colleges having a course in theology return the whole number of the students within their walls as members of the theological department. The effect of this may be illustrated by the reports of an institution during a series of years, as follows:

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When the catalogue is at hand these errors can be rectified, but as the false figures are usually prepared for the printer long before the catalogue containing the true ones is received they become a matter of record.

Still referring to the curriculum of a true theological school, the question may be asked: "Of how many branches is that curriculum composed?" In the case of medicine anatomy and physiology are undoubtedly the groundwork of the study, but pathology, therapeutics, theory, and practice, etc., are also indispensable to complete the training of a skillful and legitimately successful physician. And we see how unremittingly the profession of medicine is laboring to awaken the The following letter admirably illustrates the above remarks:

COMMISSIONER OF EDUCATION:

MCKENDREE COLLEGE,
Lebanon, Ill., October 22, 1890.

DEAR SIR: Recently I received from your department a circular asking for information as to the theological department of McKendree College, Lebanon, Ill. In reply permit me to say that McKendree College has no theological department or school. There is a small theological class of ten to twelve students who pursue a limited irregular course of study in some branches of theology. This class can not be regarded as a department.

Yours,

T. H. HERDMAN,

V. P., McKendree College.

ED 90-58

legislative conscience to the necessity of passing laws that will prevent the profession from being embarrassed by the practice of inadequately educated men. It may indeed be said that the ancient universities of Oxford and Cambridge have been in a certain sense theological seminaries, as the garb their students wear indicates, and that our own Harvard and Yale were theological seminaries to all intents and purposes in their early days. But if the interpretation of the term theological curriculum were to be based on such a plea, the difficulty of the statistician would not be solved. The question would no longer be what should be considered a curriculum of a theological school, but what difference if any is there between a school of theology and a college; for even in the sense that a study of the Bible and of the history of the Christian religion is enough to constitute a foundation for a pestorate, every German college (gymnasium) might be called a theological school, for in it some time is spent every day upon the Bible and church history. Under certain conditions there is much to be said for a course of instruction in theology that is not too advanced or too long, but it is mere justice to the advanced schools of theology that they should be classed by themselves.

Without pursuing further the discussion of so delicate a topic, the Bureau illustrates the idea of a theology school as held by two European countries, placing them in juxtaposition with several American curricula, one of which is a type of the several seminaries of the highest class that exist in this country and may therefore be compared with the faculties of France, especially those maintained by the Catholic Church, for the French state faculties of theology are all protestant institutions.

Course of lectures in the theological faculty of the University of Berlin.

General discussion of the sphere of theology (encyclopedia) and introduction to theological study on Wednesday and Sunday, 1 hour.

Introduction to the Old Testament, 5 hours. History of the text of the Old Testament, Sunday. Interpretation of Genesis, 4 hours. Interpretation of the Psalms, 5 hours. Interpretation of Isaiah, 5 times. Hebrew grammar for beginners (with exercises) 4 times. Exercises of the Institutum Judaicum (Society for Jewish Missions), 1 hour. The people of the Old Testament. 1 hour.

Introduction to the New Testament, 6 hours. Introduction to the synoptical Evangels, 1 hour. Biblical theology of the New Testament. 4 hours. Interpretation of the synop tical Evangels, 4 hours; of the Evangels and the Epistle of John, 4 hours; of the Epistle to the Romans, 4 hours; of the Epistle to the Galatians. 1 hour. Early history of the church, 5 hours. History of the church during the middle ages, 4 hours; in modern times, 5 hours. History of dogma, 4 hours. General history of religion, 4 hours. The early Christian and old Jewish burial places, especially the catacombs at Rome, illustrated by the

monuments in the museums, 2 hours Sunday evenings. The edifices of the Evangelican faith, their construction and interior decora tion, illustrated by the contents of museums1 and by visits to the churches of Berlin. 1 hour. Explanation of selected old Jewish inscriptions found in Italy, 1 hour. Relation of Judaism to Chistianity, 1 hour. Exercises on the history of the church, 2 hours. St. Augustine's confessions, 1 hour.

Philosophy in its application to religion, the proof of a Divine Being, etc., are taught in the faculty of philosophy.

Symbolism, 4 hours. Christian dogma. (apologetic), 4 hours; (systematic), 5 hours. ethics, 5 hours. The recent opinions held as to Christ and the Christian dogma (Die neueren Ansichten von der Person Jesu und das christologische Dogma), 1 hour. Dogmatic society, 2 hours. Theological society, 2 hours.

System of practical theology, 4 hours. Homiletics and catechetic, 3 hours. Pedagogy and catechetic, 4 hours. The pedagogical system of the nineteenth century, 1 hour. Praetical explanation of pastoral letters, 2 hours Sunday evenings. Introduction to practical sermon writing. Sermon writing, 2 hours.

Courses of instruction in the divinity school of a university of the United States.

As more courses are presented than are required for the degree of D. B., a certain amount of election will be allowed. Students must, in every case, submit to the faculty for its approval a list of the studies which they propose to take.

Old Testament.-1. Hebrew. Davidson's Grammar. Harper's Hebrew Method and Manual. Harper's Elements of Hebrew. Explanation of parts of the Pentateuch, Historical Books, and Psalms. Three times a week. 2. Hebrew (second course). Interpretation of parts of the Prophets and Poetical Books. Twice a week. 3. Jewish-Aramaic. Kautzsch's Grammar. Brown's Aramaic Method. Interpretation of selections from Daniel, Ezra, and the Targums. Twice a week, during the second half year. 4. History of Israel, political and social. Twice a week. 5. Old Testament Introduction. Twice a week. 6. History of the religion of Israel, with comparison of other Semitic religions. Twice a week. 7. Assyrian.

Lyon's Assyrian Manual. References to Delitzsch's Assyrische Grammatik. Delitzsch's Assyrische Lesestücke. 8. Assyrian (second course). Delitzsch's Assyrische Grammatik. The cuneiform inscriptions of western Asia (interpretation of selections). Prof. Lyon.

Other Semitic courses are given, namely, two in Arabic, each twice a week; one in Ethiopic, once a week, and one in Babylonian-Assyrian, once a week.

The Semitic Seminary meets on the first and third Mondays of every month except June. At each meeting a short paper is read by a student or an instructor, and its subject-matter discussed; in this way the class work is brought into practi cal use, and various matters studied which do not come up in the class instruction.

New Testament.-1. New Testament times: the political, social, moral, and religious condition of the world when Christ appeared. Twice a week, during the first half year.

The Union Theological Seminary of New York City has a museum of this kind, as perhaps have other American seminaries.

Courses of instruction in the divinity school of a university, etc.—Continued.

2. Outline lectures on Theological Encyclopædia and literature; the characteristics of the New Testament Greek; the Septuagint; textual criticism; the life of Christ. Study of the Gospels. Essays and criticism. Twice a week. 3. New Testament introduction.-The origin, contents, and history of the New Testament writings, together with the formation of the canon. Twice a week during the second half year. 4. Outline lectures on the life of Paul; study of the epistles; essays and criticisms. Twice a week. 5. Lectures on our English Bible and its recent revision. Lectures on topics in biblical theology. Exposi tion of difficult texts. Essays and criticisms. Twice a week. 6. Biblical interpretation: Its history, its methods, its principles, and their application (to New Testament passages of historical, prophetical, ethical, and doctrinal import). Once a week. 7. Classical Aramaic (Syriac). Grammars of Nöldeke and Hutchinson-Uhleman. Roediger's Chrestomathia Syriaca. Reading of selections from the Peshitto Gospels, the Chronicles of Barhebraus and the Hymns of Efrem. Twice a week during first half-year.

The New Testament Seminary meets on the second and fourth Mondays of every month for the reading and criticising of essays by the students upon topics relating to the New Testament.

Church History.-[1. The conflict of Christianity with Paganism. Origin and development of the Roman primacy to its alliance with the Holy Roman Empire. A. D. 800. Twice a week. Omitted in 1889-90.] [2. The Medieval Church, with especial reference to its effect upon public life and upon intellectual and social progress. Twice a week. Omitted in 1889-90]. [3. The era of the Reformation in Europe from the rise of Italian Humanism to the close of the Council of Trent 1350-1563. Twice a week]. [History of Christian doctrines. Twice a week. Ömitted in 1889-90]. [5. Advance study and research in Church history in connection with courses 1 and 2. Omitted in 1889-90).

Comparative religion.-Studies in the com

Lutheran dogma.
Evangelical morality.
Exegesis.

Ecclesiastical history.

parative history of religions, particularly the Vedic religion, the Hindu philosophies, Buddhism, Mozdaism, and the Chinese religions. Twice a week.

Ethics.-Practical ethics of social reform; an examination of the problems of charity, temperance, labor, divorce, prisons, the Indian question, lectures, essays, and the study of institutions. Twice a week.

Theology.-1. The Philosophy of religion; an introduction to the study of theology. Once a week. 2. Systematic theology begun. The Psychological basis of religious faith. Once a week. 3. The same continued. The content of Christian faith. An elaborate essay on some theological subject is expected from each student taking this course. Three times a week.

The Theological Seminary meets on the first and third Wednesdays of every month.

Homiletics and pastoral care. The structure and analysis of sermons. Once a week. 2. Each student writes six sermons during the year, three of which are preached before the two upper classes and criticised by students and instructor; the rest are criticised privately, both as to composition and delivery, in preparation for the public preaching named below. [3. Liturgies and the history of Christian worship: its prayers, its hymns, and its preaching. Once a week. Omitted in 1889-90.] 4. Pastoral care and the conduct of Christian worship. Lectures. Once a week during the second half year.

Elocution.-1. Class work twice a week, supplemented by private instruction. 2. Similar to the above.

General exercises.-Preaching by students in the chapel of the school, open to the public. Once a week. Meetings for debate. Once in two weeks. Meetings for religious conference, conducted by students, alternating with the above. Once in two weeks. Morning prayers, conducted by professors and students.

Special lectures.A special course of six lectures by offers of the University who are not teachers in the Divinity School will be given.

French faculties of theology.

PARIS.

1. PROTESTANT.

Chairs.

| Calvinistic dogma.
Prascal theology.
History of philosophy.
Hebrew.

Complementary course.

Practical theology.

Conferences.

The Greek and Latin Fathers of the Church.

Sacred Philology (New Testament).

German Theological language and literature and ecclesiastical history.

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