The organization of the so-called irregular systems of medical practice (when they have any organization worthy of the name) is similar in principle.

Having noted some facts respecting the profession, we naturally arrive at the consideration of its methods of instruction. For want of space it will not be possible to allude to its history except when necessary to the explanation of some point in

(II.) THE PRESENT CONDITION OF MEDICAL EDUCATION IN THE UNITED STATES.

1. Preliminary training.-The medical student in this country generally has little more than a common school, or at the most, an academic education, as a preliminary to his professional studies.

Probably four-fifths of our college graduates who study professions enter law or divinity schools. In other words, ordinary medical students, when commencing their studies, have some acquaintance with the English branches: reading, spelling, writing, arithmetic, geography and grammar, (though they are frequently so deficient as to make their classmates envy their impudence;) some of them have, in addition, some knowledge of natural philosophy, of the rudiments of Latin and Greek, and of algebra and geometry; a very few have enjoyed greater opportunities, and may claim to have pursued a course of ancient or modern languages, (rarely both,) of the higher mathematics, mental and moral philosophy, chemistry, political economy, and logic. 2. Professional instruction.-The rule of regular medical colleges is to demand three years' study, (in which are included at least two courses of lectures,) so the aspirant for medical information generally makes an arrangement with a practitioner to study in his office. In former days it was quite common to indenture the student to his preceptor, his services in compounding pills, plasters, and draughts compensating for his instruction and use of books, and affording him an opportunity to become practically acquainted with the uses, doses, and composition of inedicines. In later years, pharmacy is being gradually but surely separated from medicine, in accordance with the tendency of the age; and medical students, especially in cities and towns, are year by year less likely to have a practical knowledge so useful in these respects to the profession.

The student remains in a medical man's office for a period varying from three months to a year, during which, if his preceptor is a busy and popular practitioner, he has not been examined on the progress he is making times enough to make it worth mentioning or remembering. He during this time reads some work on human anatomy without any appliances except a defective set of bones, the relic of his preceptor's dissecting days, and perhaps a fair set of anatomical plates; he also reads some books on physiology, materia medica, and perhaps chemistry, and even attacks the theory and practice of medicine; sometimes minor surgery is also read. During all this route he is apt to be bothered by the strange and seemingly barbarous phraseology of these works, and to wonder why the language his tongue is accustomed to speak cannot describe the facts his eyes can see.

The neophyte then hies to some medical school, pays a small matriculation fee, writes his name, age, and residence, and the name of his preceptor on the matriculation book, which are absolutely the only necessary qualifications for his entrance. He pays for his lecture tickets, and where courses of practical anatomy and hospital clinics are obligatory, for the hospital and demonstrator's tickets, finds a place to lodge and get his meals, and begins attendance on the course which he finds is not at all compulsory, and that he can cut a lecture when he pleases.

Here at the very outstart in most colleges he finds a very puzzling difficulty. He finds that he is in the same room with and listening to exactly the same lectures as the men who have already taken one or two courses of instruction. He sits despairingly, note-book in hand, as the majestic physician, or the celebrated surgeon pours out statements, observations, allusions, theories, and directions, familiar to himself and understandable by the advanced students, but to the tyro astounding and bewildering. He follows the ward officers of the hospital in the clinical round, and, amid a crowd of fellow students, catches fragmentary glances at the patients and imperfect hearings of the glib diagnosis, prognosis, and treatment of cases, before, perhaps, he has learned anything about the province of physical examination, the use of the microscope, chemical tests, the thermometer, and other diagnostic means, or the favorable or nfavorable signification and interpretation of symptoms, or the appropriate application of remedies.

He finds that the short duration of the lecture-course necessitates enormous crowding of matter. From twenty to thirty lectures of an hour apiece, as well as hospital clinics, and dissecting each week, practically prevent his reading very much on the subjects the lectures treat of, or the cases illustrate.

The duties of the professors to their patients preclude any very extended daily examination of the students in the subjects of the lectures they have heard the day before; and thus they cannot know very well what points need elucidation, what

errors need correction, and in what direction the private study of the student should be turned.

Space will not admit of any detailed description of the vexation of studying chemistry without any appliances for repeating, and thus firmly fixing in mind, the experiments displayed by the professor during the lecture; or of the wild shots the embryo dissector makes in the anatomical room for want of supervision; or of the numberless annoyances that he meets with at every hand. Suffice it to say, that the student generally neglects the dryer branches for the two he thinks will be the most immediately useful, so that practice of medicine and surgery crowd chemistry and anatomy to the wall with a majority of every class.

The student worries through his first course without being examined, goes home, and resumes his studies with his preceptor, and, when he becomes a little rested by the cessation of these incongruous and multifarious attacks on his mind, if a sincere student, gradually arranges and classifies the information he has received, reads the text books, applies the stethoscope and the thermometer to some cases, assists in reducing some dislocations, &c., thus, during the time intervening between his two lecture courses he becomes, in many respects, fitted for rapid progress when he returns to the medical school. But mark, he is as far from nearly all anatomical and chemical appliances as he was when he began his studies; and the appalling dryness of the text books on these subjects also contributes to prevent him from becoming acquainted with the very foundations of the science-the facts on which surgery and medicine are based. Many students, especially in the West, take only one course, before seeking practice. Those who are more able or wiser return to the medical school and resume their studies.

Now, our student finds another trouble. He discovers, if he has worked hard all this past time, that a great deal of the course is to him familiar-familiar do I say?— musty, clogging, a hinderance, not an assistance. He wants to hear new things, to enter new fields, to acquire new treasures, not to endure a dreary review of his past instruction. If he is a thorough student, he takes up anatomy, chemistry, and whatever he knows he is defective in, only paying attention to the lectures sufficient to enable him to stand a creditable quiz (examination) when the professor finds time, or his conscience forces him to the effort. If he has spare means, he generally joins a quizclass, in which the members are thoroughly questioned on the subjects of lectures they have heard. These classes are held by members or attachés of the faculty, as supplementary to the lecture instruction, and are of immense service to the student. Very poor men, as many of the class are, cannot take advantage of this aid.

3. Graduation.-Finally the days of examination arrive. The candidate for medical honors has written and presented his thesis, (in English,) has deposited his graduation fee, has crammed furiously, or has wisely made up his mind that if he is fit to graduate the professors will be apt to know it, or, if more shrewd than well grounded, thinks that the college wants the graduation fee as badly as he wants its diploma, and will pass him if there is the smallest excuse for doing so; he goes to each professor or before the whole faculty in session, (the usage varies in different colleges,) answers or tries to answer the questions asked him, in accordance with his best convictions, and with the professor's hobbies, if any exist; if he has become known as a good student, a punctual and steady attendant at lectures and clinics, and his thesis happened to please the examiners, he finds that his path is made smooth, and he goes away exalted.

Generally very few of any class get plucked. Sometimes men are allowed to graduate if they will promise to pursue a certain amount of study subsequently under the surpervision of the faculty.

4. Degrees.-They graduate, are called medicinae doctores, and go home or out in the world to practice the precepts they have bolted in such haste. Comparatively few men (at least in the South and West) ever study three full years before applying for a diploma.

5. Post-graduate course.-If a graduate wishes to pursue his studies further, he must do so independently of any instructions our medical schools furnish; he has, generally, the privilege of attending further courses of lectures by paying a small sum. But for an extension of his studies he must go to Europe or depend on books at home. No proper post-graduate course is provided in our country.

6. Summary. This is the ordinary course of medical study in this country. In it the following branches are taught to a greater or less extent, viz: anatomy, descriptive surgical, and pathological, with dissections; chemistry, inorganic and physiological; physiology; hygiene; therapeutics and materia medica; theory and practice of medicine; surgery and operations, major and minor; obstetrics and diseases of women and children; toxicology and medical jurisprudence, with medical and surgical, and, sometimes (very rarely) obstetrical and ophthalmic clinics.

Having briefly described the educational course of a medical student, (in which no individual institution is particularly alluded to but the average opportunities and the ordinary usage as faithfully as possible described,) it may be instructing to notice the

(III.) CONTRAST BETWEEN MEDICAL EDUCATION IN THIS COUNTRY AND

IN EUROPE.

1. In the United States.-I give below extracts and abstracts from the official publications of several colleges in this country, respecting the qualifications for admission demanded, the course of instruction given, and the requirements for graduation.

MEDICAL SCHOOL OF HARVARD UNIVERSITY.

There are 9 chairs: 1, morbid anatomy; 2, anatomy and physiology; 3, theory and practice of physic; 4, anatomy; 5, chemistry; 6, surgery; 7, obstetrics and medical jurisprudence; 8, materia medica; 9, clinical medicine. There are 10 adjunct and assistant professors and instructors.

The school is established in Boston to secure those advantages for the study of anatomy, physiology, and clinical medicine which are afforded only by large cities. Instruction is given throughout the year by thirteen professors, several instructors, and university lecturers. There are two sessions. The winter session comprises the lecture term, when systematic courses are delivered in all the departments, of which there are eleven. The summer session includes the spring and autumn terins, and is occupied by recitations and practical instruction of various kinds. During both sessions there are visits and clinical instruction in the Massachusetts General and City Hospital, at the dispensary, and eye and ear infirmary.

Students of medicine designing to attend the medical lectures, or any of them, shall be matriculated in this university by entering their names with the dean of the executive faculty, to be enrolled by him, and by signing an obligation to submit to the laws of the university, and to the direction of the faculty of medicine.

Every candidate for the degree of doctor in medicine must comply with the following conditions before being admitted to examination:

1. He shall satisfy the executive faculty that he is of good moral character, and has arrived at the age of twenty-one.

2. He shall have attended two courses of lectures delivered at the Massachusetts Medical College by each of the professors of the departments of anatomy, physiology, chemistry, materia medica and pharmacy, morbid anatomy, midwifery, surgery and clinical surgery, clinical medicine and the theory and practice of medicine; but if he shall have attended a similar course in any other college or university approved by the executive faculty, the same may be accepted in lieu of one of the courses above required.

3. He shall have spent three years in his professional studies, under the direction of a practitioner of medicine.

4. If he have not received a university education, he shall satisfy the executive faculty in respect to his knowledge of the Latin language and experimental philosophy.

5. He shall have given notice of his intention to the dean of the executive faculty four weeks previous to the day on which he presents himself for examination, and, at the same time, shall have delivered or transmitted to the dean a dissertation, written by himself, on some subject connected with medicine. Every dissertation shall be submitted by the dean to the examination of the executive faculty in the mode which they shall point out.

UNIVERSITY OF PENNSYLVANIA-MEDICAL DEPARTMENT.

There are 8 professorships: 1, materia medica and pharmacy; 2, chemistry; 3, anatomy; 4, surgery; 5, institutes of medicine; 6, obstetrics and diseases of women and children; 7, theory and practice of medicine and of clinical medicine; 8, clinical and demonstrative surgery.

There are also special clinical lectures on clinical medicine, (with 3 assistants:) physical diagnosis; microscopy and chemistry, applied to diseases of the urinary organs; diseases of women and children; clinical and demonstrative surgery, (with 8 assistants :) syphilis; diseases of the eye and ear; surgical diseases of the mouth.

There is 1 demonstrator of anatomy and 7 assistant demonstrators, 3 demonstrators of practical surgery, and 1 assistant in medical microscopy.

There is also an auxiliary faculty of medicine, with chairs of-1, zoölogy and comparative anatomy; 2, botany; 3, mineralogy and geology; 4, hygiene; 5, medical jurisprudence, including toxicology.

Ample means of teaching clinical medicine and surgery, and the diseases of women and children, are presented in the university and in the various hospitals and dispensaries of the city.

Clinical instruction (without fee) is also given throughout the year in the Philadelphia Hospital, Pennsylvania Hospital, Episcopal Hospital, St. Joseph's Hospital, Will's Hospital for the Eye, City Lying-in Hospital, and Children's Hospital; also, the Ger

man Hospital, Jewish Hospital, and St. Francis Hospital. Additional instruction is also given in the university dispensary and the surgical wards in the college building. The dissecting room is open during the session, under the supervision of the professor of clinical and demonstrative surgery and his assistants. Every student is here thoroughly instructed and practically trained in the application of bandages and surgical apparatus, and in the performance of operations upon cadaver. Instruments, splints, and bandages are supplied free of cost.

The rules for graduation in medicine are as follows:

1. The candidate must have attained the age of twenty-one years, have applied himself to the study of medicine for three years, and been, during that time, the private pupil, for two years at least, of a respectable practitioner of medicine.

2. The candidate must also have attended two complete courses of the following lectures in this institution: Theory and practice of medicine; anatomy; materia medica and pharmacy; chemistry; surgery; obstetrics and diseases of women and children;

institutes of medicine.

3. Medical students who have attended one complete course in a respectable medical school, where the attendance on two complete courses is necessary to a degree, where the same branches are taught as in this, and which is placed upon the ad eundem of this school, are permitted to become candidates by an attendance here for one full course; the rules of graduation being in other respects observed.

4. The candidate, at the time of his application, must deliver to the dean of the medical faculty a thesis, composed by himself, on some medical subject. This thesis is referred to one of the professors, who shall examine the candidate upon it, and make his report thereon to the medical faculty.

JEFFERSON MEDICAL COLLEGE, PHILADELPHIA, PA.

There are 7 chairs: 1, general description and surgical anatomy; 2, institutes and practice of surgery; 3, practice of medicine; 4, obstetrics and diseases of women and children; 5, chemistry; 6, materia medica and general therapeutics; 7, institutes of medicine and medical jurisprudence; 1 lecturer on clinical medicine; 1 demonstrator of anatomy.

The course of instruction includes a carefully considered combination of didactic and clinical teaching, the result of many years' experience.

The clinical facilities of Philadelphia are unsurpassed. The clinic of the Jefferson Medical College is held in high esteem throughout the country, and the cases of every variety, from the rarest form of disease to that met with in daily practice, are presented during the session.

Besides the college clinic there are in the city 18 hospitals, 7 dispensaries, and 38 other charitable institutions, affording every facility for the practical study of disease and injury. The opportunities offered to the student, indeed, are only limited by the time at his disposal.

Believing that clinical studies pursued too exclusively can only lead to empiricism in practice, the didactic lectures are so arranged as to give the student a thorough knowledge of the principles of his profession. The most ample means of illustration are employed, and every care taken to treat the subject clearly and with a direct reference to practical results.

While it has not been found practicable to extend the regular course beyond the usual period, from October to March, yet the faculty, wishing to afford the fullest opportunity to the student, have arranged a course of supplementary lectures, which extends through the months of April, May, June, and September, without additional charge, except the registration fee of $5.

The candidate for the degree of M. D. must be of good moral character, and at least twenty-one years of age. He must have attended at least two full sessions of lectures in some regular and respectable medical school, one of which, the last, shall have been in this college, and must exhibit his tickets, or other adequate evidence thereof, to the dean of the faculty.

He must have studied medicine for not less than three years, and have attended at least one course of clinical instruction in an institution approved by the faculty. He must present to the dean of the faculty a thesis of his own composition, correctly written, in his own handwriting, on some medical subject, and exhibit to the faculty, at his examination, satisfactory evidence of his professional attainments. The degree will not be conferred upon any candidate who absents himself from the public commencement, without the special permission of the faculty.

DEPARTMENT OF MEDICINE AND SURGERY OF THE UNIVERSITY OF MICHIGAN.

There are 7 chairs: 1, chemistry, mineralogy, pharmacy, and toxicology; 2, obstetrics and diseases of women and children; 3, pathology and practice of medicine; 4, anatomy and physiology; 5, organic chemistry and metallurgy; 6, therapeutics and

materia medica; 7, surgery; 1 assistant professor of chemistry; 1 demonstrator of anatomy.

Every candidate for admission shall exhibit to the faculty satisfactory evidence of a good moral and intellectual character, a good English education, including a proper knowledge of the English language, and a respectable acquaintance with its literature, and with the art of composition; a fair knowledge of the natural sciences, and at least of the more elementary mathematics, including the chief elements of algebra and geometry, and such a knowledge of the Latin language as will enable him to read current prescriptions, and appreciate the technical language of the natural sciences and of medicine.

Students are expected to be in attendance upon the first day of the term, as the regular course of instruction will commence upon, and continue from, that day, and by the rule adopted certificates are issued only for the period of actual attendance.

The annual session commences on the first day of October and continues until the last Wednesday in March. Four lectures are delivered daily. Previous to each lecture the students are carefully examined upon the subject of the preceding lecture. The total number of lectures in the term will thus be between 600 and 700.

Clinics are given every Saturday for both medical and surgical patients, when examinations are held, prescriptions made, and operations performed gratuitously to patients, in the presence of the class.

A special course of instruction in physical diagnosis is given by the professor of the theory and practice of medicine, for which a fee of $5 extra is required. Also, special instruction in microscopy is given by the professor of anatomy and physiology, for which also a fee of $5 is charged. Attendance on either of the above courses is optional with the students.

To be admitted to the degree of "doctor of medicine" the student must exhibit the evidence of having pursued the study of medicine and surgery for a term of three years with some respectable practitioner of medicine, (including lecture terms;) must have attended two full courses of lectures, the last of which must have been in the College of Medicine and Surgery of the University of Michigan, and the previous one in this or some other respectable medical institution; must be twenty-one years of age; must have submitted to the faculty a thesis, composed and written by himself, on some medical topic, and have passed an examination at the close of the term satisfactory to the faculty.

To encourage a higher grade of preliminary acquirement, an allowance of six months from the term of study is made in favor of the graduates of the department of science and arts, and of other respectable literary colleges.

Each candidate for graduation must announce himself at the commencement of his second year, and must be examined in anatomy, physiology, materia medica, and chemistry. He is also required, during the course, to submit to written examinations by each professor, on some subject pertaining to his department, in order to further test his knowledge of such subjects, and his ability to express himself correctly in writing. His final thesis may be written either in English, German, French, or Latin, and, if required, must be defended before the faculty.

ST. LOUIS MEDICAL COLLEGE.

There are eight professorships: 1, chemistry and pharmacy; 2, principles and practice of medicine; 3, principles and practice of surgery and clinical surgery; 4, general descriptive and surgical anatomy, military surgery and clinical surgery at the city hospital; 5, clinical medicine and pathological anatomy; 6, therapeutics and materia medica; 7, physiology and medical jurisprudence; 8, obstetrics and diseases of women and children; and a demonstrator of anatomy.

The course of instruction in the St. Louis Medical College continues twenty-three weeks. The hospitals of the city are as well appointed as can be found in other localities of medical instruction, and their size, giving accommodation to thousands of patients annually, affords to the student constant and extensive information on every subject connected with medicine and surgery. They are the City Hospital, with medical and surgical clinic; the Quarantine and Small-pox Hospitals; the St. Louis (or Sisters') Hospital, with surgical, obstetric, and ear and eye clinic; the United States Marine Hospital, and the St. Louis County Insane Asylum.

Requisites for the degree of doctor of medicine:

1. The candidate must be twenty-one years of age, of good moral character, and must have been engaged in the study of medicine for three years, (course of lectures included.)

2. He must have attended two full courses of lectures in this institution. Attendance on a regular course in some respectable and generally accredited medical school, or four years of reputable practice, will, however, be considered as equivalent to one of the courses above specified. The dissecting ticket must also have been taken contin