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The College of Physicians and Surgeons, New York, the most respected medical body in America, has a medical school, and the Surgeon's Hall School of Edinburgh has nearly as close a connexion with the College of Surgeons as exists between the analogous bodies in Dublin.
How different from the small struggling schools of London and Dublin is the admirable system of medical education in Paris-one licensing body and one school able to accommodate some 1,200 pupils. For such an audience the professor, elected for conspicuous merit, may well bestow his entire time. In London and Dublin schools a lecturer's class may be under 20, and his profits not twice that number of guineas. Under such circumstances what encouragement is there to the lecturer (especially on such subjec as materia medica, medical jurisprudence, or botany, which do not lead to practice) to earnestly devote himself to excel ? In the London' schools altogether there is the rate of a professor to every four students; and in Dublin, adding the hospital officers and school lecturers, one teacher for every 3} pupils.
There are no means for determining accurately the number of students attending each of the Dublin schools—the only return being that presented to the Anatomical Committee, which is composed of a lecturer of each of the medical schools. The return from each school is merely an order to get subjects, the sum of £1 being lodged for each half. In schools, therefore, where there are chronic men, newly appointed and very industrious teachers, and army pupils and officers who wish to revive anatomical knowledge, several pounds will be lodged for the getting of subjects besides those required for the sessional pupils.
In Trinity College, arts students, if entered as medical students, are exempted from some subjects in the B.A. curriculum, and thus some of them for convenience,
or to try their tastes, enter as medical students, and appear in the returns of the anatomical committee as wanting subjects. The numbers returned for the present session were–Trinity College, 188; Ledwich School, 178; College of Surgeons, 161 ; Carmichael School, 100; Catholic University, 90; Stevens' School, 80; making a total of 797. As all licensing bodies require as many sessions of hospital attendance as of lectures, and some an additional year, the returns from the ten recognised hospitals ought at least to equal those from the schools ; yet, according to information supplied by the respective hospital secretaries, the total number of entered pupils is under 600. With regard to the distribution of subjects, an injustice is done the larger schools, for during the months of October and November, before the lists are closed, they only get the same number of subjects as the smaller ones. Surely the supply ought to be proportional to the average number of the three or five years preceding.
The Inspector of Anatomy should be called on to adjust this matter, and it would be very beneficial if he were to make a monthly visit to the schools, and requireeach entered pupil to record his signature. This would. give evidence at least of the visits of every student to, the city. It has been stated that certificates for attendance have been granted to gentlemen who throughout. the whole session were scores of miles distant. The certificates of candidates for licence should afterwards: prove conformable to these inscriptions. Except in Trinity College, and there only for the four compulsory courses, no reliable roll is called, or, if it be, at least the refusal of a certificate for insufficient attendance is scarcely recorded. There are great difficulties in the way; the idle will resent the compulsion by being noisy and inattentive. To call a roll of say 150 students would be to inflict a quarter of an hour's unprofitable routine instead of instruction on the class, and by some of them
in joke crying" here," a gentleman who is absent may get credit for attendance. Unless it is called every day, and that the lecturer himself misses no lectures, it would be evidently unjust to refuse & certificate, for the student might have been present on those occasions when the practice was omitted. Markers may be appointed, but will not be reliable. If one school was to be exact, some students would avoid it for those more lax. In continental universities that in Piedmont, for example collegiate misdemeanors are punished by denial of marks, and the culprit may bave to attend a course & second time. However, to secure some evidence of the student's presence in town, and of the real number attending each school, some independent person, such as the Inspector of Anatomy, Secretary of the Branch Medical Council in each of the three kingdoms, or deputy appointed by them, should be appointed to make periodical visits and call rolls, and perhaps ascertain the amount of information gained by each pupil. Some authority from the licensing body, the teacher, or an independent officer should ascertain, by periodical examinations, that students were paying for knowledge acquired instead of for the receipt or certificate all that is now demanded. If there were not among the schools such competition that the standard would be lowered to catch the money of the idle, this test of proficiency should be applied by the lecturer himself. Then a class-roll would be scarcely needed, for if the lecturer taught the subject well, the student would find it his interest to attend, and if he taught the subject badly, it would be fair to give the student the chance of making it up more readily by study or private teachers. The schools are under the visitation of the Royal College of Surgeons. The council of that body should, by periodical inspections, ascertain that the number of anatomical and pathological preparations, of microscopes, of pharmaceutical specimens, and of chemical apparatus is adequate to the efficient education of the pupils.
The duration of the winter session in the United King. dom is six months—in England, October, November, December, January, February, and March ; but in Ireland and Scotland the colleges begin and end a month later. Vacation is for three weeks at Christmas, and two at Easter, but the English periods ten and six day's respectively might be well followed. In Trinity College the session is for five months ending in March, and in the American schools five months only are devoted to study, commencing in October. In Philadelphia there is the “Summer School,” in which lectures are delivered from April to October on the subjects usually taught in winter, for the confessed purpose of forcing medical education. The fee is 50 dollars for all the courses, and about twice this is charged for the winter lectures, The fees must in most colleges be paid in advance. The hospitals in that city may be attended gratuitously.
In many of the American colleges there are “ adjunct professors” who assist the regular occupants of the chairs, and frequently succeed them on death or resig. nation. In some there is an unwise tendency to encourage specialities—such titles as “lecturer on diseases of genito-urinary system,” “professor of diseases of the chest," appearing in the prospectuses. In those in which the hospital and college are in the same building, lectures and clinical attendance are given alternating hours, so that the fatigue of attending didactic lectures for three or four hours successively is avoided. The autopsy room is usually provided with comfortable seats for all the students—a plan very worthy of imitation in some of our hospitals; and in Bellevue hospital there are prizes for the best preparations of surgical anatomy. Such, if established in Dublin, would stimulate the art of dissection, which is much neglected. In New York a free library of over 11,000 medical works has been founded as a memorial of the great Valentine Mott by his surviving relatives.
The number of practitioners annually licensed by the American colleges is enormous—for instance in Bellevue hospital alone 140 graduated in 1867; in Jefferson college 150 were capped, and 356 matriculated last session. In 1850 there were 43 colleges with the privi. lege of licensing, and in 36, which alone were in active operation, there were during that year 4,500 students and 1,300 graduates. In 1850 it was exposed that 20 of these colleges had no efficient provision for hospital instruction. Not being endowed, they thrive by making these institutions popular with students. It is calculated that there are in the United States at least 40,000 qualified practitioners, and a very great number of un. qualified ones.
The system of private teaching was unknown in the United States till last year, and seems to have been originated by schools with the view of keeping their alumni at home; but those who are able to afford it will still take the European tour, which they feel will not only enlarge their medical knowledge, but tend to give the refinement and polish which travel can alone confer. For greater attraction some of the colleges offer this system of grinding free, and in one of them twelve gen. tlemen conjoin to give it, each stating in their prospectus their qualifications and the European teacher under whom they had studied the speciality. Another teacher circulates the following odd handbill: “ Quiz Class in Midwifery—Dr. S., Assistant in practice to Prof. S., will drill students for their final examinations in midwifery, meeting the class two evenings each week during the college course. Dr. S. will endeavour to make the course a clinical one, so far as practicable, by demonstrating upon the living subject the special anatomy of the parts, foetal auscultation, and the mechanism of labour.–For particulars apply at Hotel Pelham. Office hours from 9 to 10, A.M., and from 1 to 3 P.M."
To enable an estimate of the quality of some of the