But since the courses in medical colleges have been raised to three and four years and the sessions lengthened to eight and nine months the schools need other assistance than that derived from clinical instruction in the hospitals; for, notwithstanding the great value of this instruction, it is not a source of revenue at all. The schools should not be left to depend upon tuition fees for support. This fact is becoming known to men of wealth, and some institutions are receiving substantial assistance from them.

Mr. William Deering, a wealthy Chicago manufacturer, has given $50,000 to the trustees of the Northwestern University, to endow a chair in honor of Dr. N. S. Davis, in the medical department of the university-the old Chicago Medical College, of which Dr. Davis was the founder.

The Harvard medical school received a bequest in 1894 valued at $50,000, under the will of the late Rev. W. C. Moseley, of Newburyport.

The New York Homeopathic Medical College received from the estate of Mr. William Ogden $50,000.

The medical department of the University of Pennsylvania received $50,000 from Dr. William Pepper when resigning his position as provost of the university.

STUDENTS HAVING DEGREES.

It would be of interest to know how the percentage of medical students having degrees in arts or science at the present time compares with the number of such students some years ago, especially since we find the secondary schools constantly . increasing the amount of work required of their students and consequently raising the age at which it can be completed; while, on the other hand, the medical schools are all adopting courses of three or four years and at the same time becoming much more rigid in the requirements for matriculation. To determine with any accuracy the number of medical students having degrees in arts or sciences is a difficult matter, for only a few medical schools keep an accurate record of this item. Harvard Medical College is one of the few institutions which keep this record. In it the decrease in the number of graduate students since 1884 has been remarkable. The figures are as follows:

Here we find that since the year 1884, with one exception, there has been a uniform decrease. The per cent of students holding degrees in Harvard medical school would no doubt compare quite favorably with the number in any other school, and since it is about to add a fourth year to its course the proportion of graduate students will probably be diminished still further.

Medical graduates would doubtless be well qualified for their work if they first completed the entire secondary school course, which President Eliot places at about the eighteenth or nineteenth year; then a college course at 23 and the medical at 26 years of age, or at 27 in those schools which require four years; and allowing them only three years for hospital experience and in which to get located and a practice started, such students might be expected to become self-supporting at 30 years of age. No allowance is made here for the loss of a year or two by failure to reach the required standard at any time, or on account of sickness, or other reason, but it is a steady, nonintermittent course, and one which needs to be sustained by a well-filled purse. At a recent congress of American physicians and surgeons a member claimed that the medical student should have the A. B. degree, requiring four years; then he

should spend four years in a medical school, one year in a hospital, and one year in a medical school in Europe-making ten years in all. Dr. P. S. Connor, of Cincinnati, argued that it would be unjust to insist upon all students that they should first be in possession of the A. B. degree, and then possibly have to practice at some country crossroads where the people around were unable to speak a single sentence correctly. However, to prescribe a course of training is one thing; to have it followed is another. To make it a requirement of all medical students that they should take the course mentioned above, requiring ten years for completion and only to be finished after 30 years of age, would be to demand what is impracticable. Not only would many students be prevented from taking such a course from financial reasons, and others claim that their prospective income in rural districts would not justify it, but there are also some educators who hold that there should be a better adjustment of the collegiate and professional courses-that the collegiate student should have better opportunities for electing studies preparatory to his professional work, or that his professional course should help constitute the requirements for an academic degree. The latter plan has been adopted by a few institutions. But in objection to this the question may be asked, What special reason is there why the practitioner of medicine should receive an academic degree at all if he can not obtain it in the regular way? If he is not to receive the training and knowledge which the collegiate course is designed to give, then the degree would be misleading and deceptive and therefore objectionable; although it may be said that his medical training develops his mental faculties in the same way as collegiate studies, it is answered that he receives the M. D. degree for the completion of the medical course and that it should not entitle him to double distinction. If so, why should not the medical student take an extended course in purely medical education and then receive the three degrees, A. B., Ph. D., and M. D.? There would be one advantage in this: he would not spend one-half his life preparing for the other half. He could complete his secondary course at 18 or 19 years of age, his medical course at 25 or 26, and still be able to enter upon the practice of his profession with honors heaped upon him. Another plan has also been adopted by some institutions to enable medical students to enter earlier upon the practice of their profession. In about one-fourth the medical schools of the United States students who are graduates in arts or science are allowed to enter upon the second year of the medical course, thus completing the course one year earlier than nongraduates.

"The average age of students who enter the Harvard academic department has been gradually rising during the whole of this century, until it has reached nearly 19 years. The student who enters the medical school, therefore, finds himself just beginning the preparation of the real work of his life at an age when many of his contemporaries are already engaged in the productive work of their professions. In Germany the best class of students begin their professional studies at a little earlier age than that at which our young men enter Harvard College. As the course of study leading to the degree of doctor of medicine lasts five years, it follows that the German physician is ready to begin practice before he is 234 years old." Says President Eliot in his report of 1892-93:

"The professional schools are demanding longer and longer periods of study; and this demand, coupled with the improvement in the secondary schools, makes it more and more natural, and for young men of small me ans even necessary, to go direct from secondary schools to professional schools."

Here it seems that the young men, when they find it necessary to curtail the time required, have omitted or abbreviated the college course, holding that their early training should be full and accurate, a good foundation, but that as their professional attainment will form the basis of their lifework and determine its success, it should be the last to be abridged.

1 Dr. J. C. Warren.

In considering the subject of medical education it is well to remember that all students can not be expected to pursue the same stereotyped course of study; in some cases the limitations of age or of finances would compel the student to seek the nearest entrance to the practice of medicine, while in other cases the student would be able and desire to obtain first a full general education and then to spare neither time nor money in obtaining a thorough and accurate medical training, so that he would be able to practice his profession with that satisfaction to himself which only skillful training can furnish. There must of necessity be two standards of medical education; a minimum standard, to which all students are required to attain, and a maximum or ideal standard, to which all students should desire to attain if possible.

The first simply requires that the student shall have received a full secondary or high school education, then an attendance upon three full courses of lectures, and the passing of an examination in each branch of study. This course will be taken by those whose age or financial condition prevents the possibility of a more extended training.

The ideal course is the one mentioned on a preceding page, a full secondary education by 19 years of age, the completion of a regular four years' collegiate course by 23, then four years in a medical college and one or two years in a hospital, the student not beginning practice until 30 years of age. Of course many students can not take this ideal course, but there are many who will, and especially will those who expect to seek practice in the large cities endeavor to comply with it. Those schools whose graduates go mainly to rural districts and villages will probably receive the larger number of students taking a short course, while other schools possessing large endowment funds, and independent of tuition fees, especially those schools which constitute departments in the old and well-established universities where can be found every appliance for completo laboratory investigation, will be sought by those students desiring to receive the fullest medical training; while the large body of medical students will seek an intermediate plane between the two extremes, but each year approaching nearer to the highest standard. Of course the number of students pursuing the extensive course above mentioned is not large at present, but as the country becomes more densely populated and as the candidates for professional honors are increasing rapidly, only those who have received full preparation can long expect to compote successfully for medical practice.

WOMEN IN THE PRACTICE OF MEDICINE,

The

It is well known that in America woman has a wider, more independent, and more remunerative sphere of work than in any other part of the globe. In fact, there are but few callings here in which she has not at least a few representatives. Although there is a greater demand here for "woman's rights" and probably more conventions are held to secure them than in any other part of the world, still it is to America that they ever look for the nearest approach to the ideal condition of woman. greater freedom has whetted the appetite for still wider fields. But when we consider that some of the most skillful and eminent authorities on medical subjects have been women, we need not be surprised that they are still engaged in the work. When a Lachapelle and a Boivin have gone before, their followers are sure to be coming after. During the year 1892-93 there were 1,302 women enrolled as students in the various medical schools of the United States, including 61 students not reported in time to be tabulated. Women were enrolled in 61 medical schools as follows:

There are in the United States 7 schools for the medical education of women exclusively. One of these, the Woman's Medical College of Pennsylvania, has an enrollment of 210 students. There were also 161 women studying the cognate subjects pharmacy (98) and dentistry (63), not mentioning the 42 engaged in the study of law.

Taking three years as the average length of time required for graduation, and making some allowance for students dropping out, there would be about 300 medical students in the graduating classes, or 3,000 women in the last ten years licensed to practice. According to the Census bulletin giving the statistics of occupations in 1890, there were in the United States 4,555 women physicians and surgeons, out of a total number of 104,803 physicians and surgeons.

A French compiler, M. Marcel Baudouin, furnishes a résumé of the legal status of women in the medical profession in various countries, in which, singularly enough, he omits all but the merest mention of the gentler sex in France. According to M. Baudouin, women are rigidly excluded from the advantages of a university education in Germany, and consequently may not become candidates in any medical examination. "It naturally follows that no medical woman can be the possessor of a certificate carrying with it the slightest value in Germany," since a State license upon examination is necessary to practice in that country. In Austria-Hungary the situation is even worse; there the admission of women to higher grade instruction is formally forbidden by law. Spain is quite as bad; in fact, the difficulties are said to be even greater in the Iberian Peninsula than in Germany and Austria. In England, Ireland, and Scotland the universities-through which lies the registration necessary to the right to practice-are now all thrown open to women, Scotland having been the last to yield to the new order of ideas. In Ireland, however, while a woman is afforded every facility for obtaining a medical qualification, she may not fill any public office under the State. Similarly in Sweden, Norway, and Denmark the medical career is open to all without distinction of sex, save in the matter of State appointments. In Belgium, Holland, and Roumania the broadest views prevail regarding the medical rights of women; they may do and be, as physicians, all that men can and are, cæteris paribus, which they are not. The right of women to practice is fully recognized in Italy, and a woman occupies the chair of histology in the medical faculty of Bologna.

In 1893 there were 308 women attending medical lectures in Zurich, Geneva, Berne, Basle, and Lausanne, but there are only 10 women practicing in Switzerland. After graduating the students return to their own countries to practice, principally in Russia. In this latter country, Russia, there were 546 women practitioners in 1893, and women are there allowed by law to become assistant surgeons in all railway administrations; in 1890 a special medical school for women, after the American model, was established in Moscow. Universities in many of the English colonies have been open to women since 1875, and in France women first obtained foothold in a university in 1863, but five years later there were only 4 female students in l'École de Medecine of Paris; the more beautiful women of a most beautiful country do not seem to take kindly to the practice of physic, notwithstanding the illustrious examples of Mesdames Lachappelle, Bourgeois, and Boivin, concerning whom it has been said that "if their mantle could be made to fall on the shoulders of their sisters of the present generation, female delicacy would be saved many a rude shock and the cause of science would in no sense suffer." M. Baudouin concludes with the following tribute to this country:

"Only a moment's consideration of the following statistics is necessary to convince an inquirer that he must proceed to the United States of North America if he wants to study effectually the question of medical women. According to a statistical report drawn up by M. Louis Frank, of Brussels, there were in 1893 on the other side of the Atlantic fully 2,000 women practicing medicine in one or other of its forms, and inclusive of 130 homeopaths The majority were general practitioners, but there were also 70 hospital physicians or surgeons; 95 professors in the schools; 610 specialists for the diseases of women; 70 alienists; 65 orthopedists; 40 oculists and aurists; and, finally, 30 electro-therapeutists. In Canada there is but 1 medical school exclusively for women, but in 1893 there were 10 such in the United States."1

Journal of the American Medical Association, July 28, 1894.

HIGHER MEDICAL EDUCATION.

By Dr. WILLIAM H. WELCH, professor of pathology in Johns Hopkins University.

[From Western Reserve Medical Journal.]

The time has come when the need of medical education should be brought forcibly before the general public in this country. Medicine can no longer be taught with the simple appliances of former times. The proper teaching of medicine now requires hospitals, many laboratories with an expensive equipment, and a large force of teachers, some of whom must be paid enough to enable them to devote their whole time to teaching and investigating. These things require large endowments of money, and can not be adequately secured simply from the fees of students. If the public desires good physicians it must help to make them.

In this country, for the most part, we can not look to the State for endowment of medical education, but we must appeal to private beneficence. A few public-spirited and generous men and women have already given practical proof of their appreciation of these facts. With more general and fuller realization of the needs and present condition of medical education, and of the results which can be secured by its liberal endowment, there is every reason to believe that these benefactions will be largely and rapidly increased, and that thereby the condition of medical education in this country shall cease to be a reproach to us. During the last few years our methods and standards of medical teaching have shown remarkable improvement. What preparation should a student bring to the study of medicine? It is highly desirable, in my judgment, that he should be liberally educated; that is, that he should possess a degree in arts or science which shall be an index of that knowledge and culture which, apart from any immediate bearing upon professional studies, are recognized as entitling their possessor to be ranked among liberally educated men. Scientific studies have acquired the right to rank with classical studies in affording this liberal culture, but the humanities should have a fair share of attention at this period of education.

The question has been discussed whether or not during the period of collegiate education the student who intends to study medicine should be required to pursue any special subjects, and especially such as bear a direct relation to his future professional studies. The answer to this question seems to me to depend upon the character of collegiate training on the one hand and of medical training on the other. The primary purpose of collegiate education is to furnish a broad basis of mental discipline and liberal culture independently of direct relation to professional work. Where, as in the old-fashioned college in this country and in the gymnasia and lycées of Germany and France, the student enters college at the age of 15 or 16 and is graduated at 19 or 20, it is not necessary or even desirable that the undergraduate student should specialize his work with reference to his future profession. Under these circumstances, which obtain in most foreign universities, at least the first year of medical study is devoted mainly to physics, chemistry, and zoology, including comparative anatomy.

These are not, however, the conditions which prevail in this country at the present time, where on the one hand the average age of graduation from our best colleges is at least two years later than in Germany and France, and on the other hand the medical schools do not furnish adequate training in physics, general chemistry, and biology, whereas these sciences are now generally included in the curricula of our colleges. When we consider the fundamental importance of these sciences for the study of medicine, the advanced age of graduation from college, and the special conditions of collegiate and medical education in this country, it seems to me clear that during the period of collegiate study the student intending to study medicine should acquire a fair knowledge of chemistry, physics, and general biology, and to these sciences should be added the study of French and German. Inability to read French and German deprives the physician of personal acquaintance with a large part of the most valuable literature of his profession, and makes it impossible for him to keep thoroughly abreast with the progress of medical science and art.

*

There are certain points which should be clearly understood as regards the requirement that the preliminary education of a medical student should be a liberal one, indicated by a degree in arts or science, and should be made to include a specified amount and kind of knowledge of physics, chemistry, and biology, with a reading knowledge of French and German. The justification for the latter requirement is that inasmuch as students are kept at college in this country two years longer than in most foreign countries they should be permitted to pursue during at least the last two years of their course subjects which bear upon the study of medicine, but which, although included in the medical curriculum in foreign universities, are strictly liberal studies independent of their professional bearing. These sciences, preliminary to medical study, can be studied and taught better in the college than