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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 University 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.
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.
Monday. Tuesday. Thursday. Friday.
Third period, from Monday, January 13, to Friday, February 28, inclusive.
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.
Monday. Tuesday. Wednes- Thurs- Friday.
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. 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.”
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.1
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.
American Medical College
1. Anatomy (with dissection). 2. Physiology.
4. Materia medica and therapeutics.
8. Practice of medicine.
English, three hours a week.
Latin, French, or German, four hours.
Chemistry, five hours.
Preparatory course for students of medicine of the University of Virginia.
This first year of preparatory work will comprehend
Those who are graduated in this preparatory
1. The course in general chemistry at-
1. The regular courses in physiology and
3. A special course in biology and comparatíve anatomy.
2. The regular courses in medical jurisprudence, obstetrics, and practice of medicine.
4. The course in anatomy required of all medical students.
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.
3. The course in materia medica.
4. The regular course in practical anatomy repeated.