there is no doubt in my mind that this is the only rational as well as adequate method of coping with the disease. Its fundamental stage is, beyond all doubt, epitheliomatous, and this is a malignant condition which is typical of true cancer. Whether parasitic in its nature or not has not as yet been satisfactorily demonstrated; but that it is eminently destructive admits of no question.

The purpose of the writer of this paper has not been so much to present a rare case as it has been to describe one which, in his opinion, has many replicas which pass by unrecognized and in whom proper treatment is not even inaugurated. If the attention of members of the medical profession shall have been awakened to that point that they shall examine carefully and report cases of this disease, then will the object of this paper have been accomplished.

REPORT ON MEDICAL EDUCATION.

BY WOODSON Moss, M. D., COLUMBIA, Mo.

Reports upon medical education usually consist of a few stereotyped plaudits or condemnations eulogizing or condemning that which we approve or condemn in our existing plan of education. That which is original in this paper is perhaps of this type. In preparing this paper I have quoted freely and liberally from three addresses: One by Prof. Hupley, of London, England, one by Dr. Pepper, of Philadelphia, and one by Dr. Bowditch, Boston.

Indeed, I have used these addresses a good deal like the fellow who wanted to save time and trouble in his use of the Lord's Prayer, instead of repeating it every night when he retired, he just tacked it upon the head of his bed, and when he was disrobed and ready, he would cast a look at the prayer and say, "Lord, them's my sentiments," and then he would roll in, with the peaceful satisfaction that he could say nothing better upon the subject.

In making this report to this society, I shall first give a brief sketch of the history of medical education, or the evolution of the medical college of the nineteenth century. I think this can be very appropriately done, as we have just turned the mile-post of that century. I do not intend to take a pessimistic view, for I am one of those who are proud of the record. Who has lived a life so perfect that he can look back over it and say that he has made no mistakes, or who would not like to rub out a great deal of the record? I do not mean to intimate that I am satisfied with the present state of medical education in this State or in the greater portion of the United States, but only to say that we have climbed

higher on the ladder in this century than, perhaps, in all of the combined centuries that have gone before.

The history of medical education in the United States begins with the establishment of a medical department in a University, and, if I were disposed to indulge in prophecy, I should say that this was but the beginning of the end. In 1765, when the city of Philadelphia, Penn., numbered only 25,000 population, the trustees of the University of Pennsylvania created the first medical school on this continent by establishing the Medical Department of the Pennsylvania University. There had been medical instruction given before the organization of this school, such, I think, as lectures and clinics given at some of the hospitals or almshouses to a limited number of such students, as we used to say rode with their preceptor, or in common parlance, the old, doctor. These lectures were given by the most eminent surgeons and physicians of the locality, and the banding together of these eminent clinicians and lecturers were the beginnings of our medical colleges, of which the Medical Department of the University of Pennsylvania was the first.

The plan of its organization was inspired by the two individuals first chosen to fill the position of professors, Dr. John Morgan and Dr. William Shippen, Jr., and as they and several of their colleagues had been educated at the University of Edinburgh, it was but natural that the system of education adopted in the new institution should be closely moulded upon that of its illustrious prototype. It was no idle boast on the part of the trustees that "their scheme of medical education was to have as extensive and liberal a plan as in the most respectable European seminaries, and that the utmost provision was made for rendering a degree or real mark of honor, the reward only of distinguished learning and abilities." I ask you to note with particular attention the requirements and qualifications which were attached to the medical degree at that early day when medical science was comparatively undeveloped, and when our country had not

66

yet passed the perils of feeble, struggling infancy. It was enacted (loc. cit.), "that all such students as bave not taken a degree in any college shall, before admission to a degree in physic, satisfy the trustees and professors of the college concerning their knowledge in the Latin tongue, and in such branches of mathematics, natural and experimental philosophy, as shall be judged requisite to a medical education." Two grades of degrees in medicine were established. For the lower of these, that of Bachelor of Medicine, the student was required to serve a sufficient apprenticeship with some reputable physician; to have a general knowledge of pharmacy; to attend at least one complete course of lectures, and to follow the practice of a general hospital for one year. After having shown his fitness at a private examination, he was then admitted to a public examination for the bachelor's degree. To obtain the degree of Doctor of Medicine, it was necessary that the applicant should have been a Bachelor of Medicine for at least three years, should have attained the age of twenty-four years, and should write and defend a thesis publicly in the college."

This indeed was a brilliant beginning, and if this venerated institution could have stemmed the tide and held aloft the standard of medical education, America would to-day lead in medical education, or, at least, stand abreast of the medical colleges of other countries. The noble example of this school was more often observed in the breach than in the observance, and she herself was compelled to lower her own standard, but only for a while, when she again took a stand for higher medical education and has continued the fight to the present day. The standard of medical education gradually sank lower and lower, until indeed it was in the very valley of the shadow of degradation. To create a medical college seemed to require neither capital nor brains. All that was necessary was for a few men to get together, elect themselves to the various chairs, select a board of trustees, rent some old house suitable or unsuitable, and,

with liberal employment of the press, to an

nounce the birth and vaunt the attractions of the new member of the sisterhood of medical schools, and the work of teaching begins." The announcements of their catalogues were like the platforms of political parties, very catching, but only to be observed when it was to the interest of those who made them

to do so. No preliminary examination required for entrance, not even to read, write and cipher. The length of each term was four months. The other eight months of the year were usually, from necessity, spent in farming, school teaching, clerking, etc. The few who could ride or read with their preceptor, or clerk in a drug store, were looked upon as the elect. The student heard the same lectures each year and generally saw the same old chronic cases. In 1877, Pepper, in his address on higher medical education, says: The vast majority of American medical students receive the degree in medicine without ever having felt a sick man's pulse, or listened to the sound of the heart or lungs." He also says: "Picture to yourself a medical class of several hundred stu dents. Some of them have already devoted two years to the study of medicine and are familiar with technical terms, with the elementary branches and, to a certain extent, with the more advanced subjects; while others have studied but one year and are correspondingly uninformed; and others, again, fresh from the high school, the academy, the farm, or the backwoods, now for the first time find themselves in a medical hall, and hear a language almost utterly unknown to them. Yet all of these sit side by side and listen to precisely the same instruction. This plan compels the teacher to repeat year after year the same course of lectures, in order that each successive crop of students may begin at the beginning. But it compels him also, either to lower his teaching so far towards the level of the understanding of the most ignorant as to sadly waste the time of the further advanced; or else to address himself to the latter portion of his class, and thus allow the new beginners to flounder around for a while, overwhelmed by the flood of new terms, by the constant allusions