8. A corps of teachers should be organized in connection with the Faculty, to direct, under suitable regulations, the studies of the pupils, during the recess of the lectures-the tuition to consist of oral explanations and examinations, chemical manipulation, pharmacy, pathology, clinical medicine and surgery, and conversaziones or discussions upon medical topics.

9. The final examination for degree should be conducted by a Board of Examiners, selected from the first medical talent of the State, without the presence of the Faculty. To avoid possible partiality or the influence of improper motive, the members of the Board should be liberally remunerated for their services, not only to indemnify them for interruptions and consequent losses to private business for the time neglected, but also to place them above the remote possibility of suspicion. The examinations should not be hurried or superficial. Every branch should receive its proper attention, and, whenever practicable, the candidate required to test his skill on the cadaver, and to diagnose disease at the bedside of the sick.

These views are not extravagant. The general ignorance of the profession, and the diminishing public confidence consequent thereupon, demand sound and healthy reform in the modes of medical instruction. It is time the educated mind of the country should be animated by a lofty independence in its dealing with a subject so important to science and humanity, and that, as the guardian of truth, it should devote its energies steadily and fearlessly to the great work before it.

It may be objected that the necessity of suitable preliminary education might exclude many deserving young men, who, without early advantages, possess those qualities of mental acumen and industry which cannot fail to constitute them ornaments of the profession and benefactors of the race. The obvious answer is that the application of no general rule, looking to aggregate good, should be diverted from its proper purpose from regard to excep

tions.

No man can be more sensible than is the writer of this report of the admiration due those men of extraordinary intellect, but limited means of early cultivation, who reflect lustre upon the profession of their choice. To all these the most respectful homage should be generously accorded. But to such minds what conditions of preliminary education would be insurmountable? The ambitious. but poor student would, by perseverance and the countenance and encouragement of liberal patrons of letters, control all opposing

difficulties, and make his way, pari passu, with the more favored into the arena of college competition.

It may be also urged against the plea to extend the cause of instruction that the country is in its infancy; that men are called to assume responsibilities early, and that time cannot be spared in protracted preparation for the duties of life. If this were really. so, it cannot be weighed against the inestimable advantage of sending out from our schools qualified practitioners instead of routinists and quacks. The argument of expense also falls to the ground for the same reason.

In every other country than the United States preliminary education is invariably required of the student of medicine, while the duration and thoroughness of college instruction greatly exceed

our own.

In Edinburgh five years is the term of study, six months of each year being passed in the university. After continued attendance upon lectures and other instruction, besides, for six months of each year of the period of study, he presents himself for the doctorate. The conditions annexed to this final examination are a complete statement of his studies, as well in literature and philosophy as in medicine, accompanied with proper certificates; a thesis, either in Latin or English, subject to the searching criticism of one of the college professors; a competent knowledge of the Latin language, and a thorough acquaintance (tested by written or oral questions) of anatomy, chemistry, botany, institutes of medicine, zoology, materia medica, therapeutics, pathology, practice of physic, surgery, theoretical and operative midwifery, medical jurisprudence, and toxicology. If found unqualified, he is required to study one or two years longer before he can be admitted to a second examination. After appearing, in compliance with the Senatus Academicus, to defend a thesis, he is admitted to his degree. This offers a mere outline of the course of medical instruction in one of the principal cities of Europe.

In Paris the number of professors amounts to twenty-eight, besides assistant or adjunct professors. The instruction is embraced in eighteen courses of lectures, two a year, comprising anatomy, medical chemistry, legal medicine, surgical pathology and therapeutics, pathological anatomy, operative surgery, clinical medicine and clinical midwifery, medical physics, hygiene, medical natural history, accouchements, physiology, surgical pathology, pharmacy and organic chemistry, therapeutics, and pathological anatomy.

Before matriculating, he presents certificates of moral character and Baccalaureate diploma; or, should he not have graduated in letters, he is obliged to submit to an examination of one hour's duration in the French, Greek and Latin, general history and geography. As at Edinburgh, the course of study is four years. To secure a diploma five examinations must be submitted to at intervals during the course of study-the first comprising chemistry, physics, and medical natural history; the second, anatomy and physiology; the third, internal and external pathology: the fourth, hygiene, legal medicine, pharmacy, materia medica, and therapeutics. The fifth, a practical, clinical lecture at the bedside. The theses must be publicly defended.

At Berlin the number of professors and assistant professors is sixty seven, and the branches taught consist of psychology, natural philosophy, logic, metaphysics and anthropology, natural sciences, physics, climatology, theoretical and practical chemistry, botany, zoology and mineralogy, anatomy, physiology, history of medicine, institutes of medicine, pharmacology, dietetics, pathology and the rapeutics, mental diseases, surgery, ophthalmology, bandages and instruments, midwifery, medical jurisprudence, clinical surgery, clinical medicine, clinical midwifery, clinical ophthalmology, and dispensary practice. The examinations are made semi-annually, and no one is allowed to enter upon a second course without satisfactory evidence of his proficiency. The examination, preliminary to admission into the medical department, is exceedingly thorough, consisting of physics, chemistry, botany, natural sciences, the classics, mathematics, history, and philosophy. From four to six years are required to complete the course of study, during which the student is subject, under the laws of Prussia, to three distinct examinations, entitled respectively Examen Philosophicum, Tentamen medicum, and Examen rigorosum. The last is, as its title implies, very strict, and the final test of qualification. Anatomy is demonstrated upon the dead subject, or extemporary descriptions of the parts of the osseous, vascular, and organic systems. Materia medica, by deciding upon medicines submitted unlabelled for inspection, and writing prescriptions of variable preparations and combinations. The knowledge of the student is tested in surgery by operations upon the cadaver, and the application of bandages and other surgical appliances to the living subject; while the diagnosis of disease is to be made and explained at the bedside. The same extended and thorough course of instruction, and the same rigid scrutiny into

the qualifications and requirements of candidates for the doctorate, exist, with little variation, in the different medical universities of Europe.

These facts, which have been more carefully collected and more strongly and comprehensively presented in former reports, are suggestive of the estimate placed upon the importance of medicine in other countries. In Europe an educated physician is presumed to be an accomplished belles lettres and professional scholar. In this country, owing to causes already described, a doctor has no special prominence, and, because a graduate, is not therefore regarded as educated or learned.

The members of the Association are so generally informed in regard to the police regulations and modes of tuition of the various colleges of the United States, that it is unnecessary I should even allude to them. They are thus prepared to institute a comparison between our meagre plans of teaching and those recognized in the colleges of other countries.

These remarks are offered in no captious fault-finding temper, but with that regard for the general good of the profession and the advancement of medical science which should animate every member of the Association. It is to be regretted that the colleges have not responded as generally or as cordially to the recommendations of the Association, in reference to medical education, as was desirable. Still, the reform is not the less imperative, and the well intended efforts of this body should not cease until the great object be achieved, and both colleges and preceptors, throughout the country, induced to admit its paramount importance. In the language of a late issue of one of our prominent journals, in allusion to the present meeting, "The Association should not fail to maintain its jurisdiction in all matters pertaining to medical education. Let it reassert the propositions which it adopted at its last session, and enforce compliance with them."

In the examination before the Army and Navy Boards, a proper regard has always been had to the qualifications of those proposing to enter either branch of the science. Few comparatively of the candidates are finally accepted, although graduates of colleges in respectable standing. Each department has a series of regulations. and requirements which are invariably enforced. In the army the Board of Examiners is expected, in execution of the duty assigned them, rigidly to scrutinize the pretensions of each candidate; taking into careful consideration his physical qualifications and moral

habits, as well as his professional attainments, and to report favorably upon no case admitting of a reasonable doubt. "The Board will report the positive merit of the candidates in the several branches on which they may be examined, and their relative merit from the whole examination; agreeably to which they will receive their appointment and take rank in the department." If the candidate fail, he may be admitted to a second examination two years after, but if then unsuccessful, his name is finally dropped. If accepted, he becomes Assistant Surgeon in the army, but in five years is again examined for the post of Surgeon, when, if unsuccessful, his connection with the service is at once ended.

The certificate issued by the existing medical bureau of the army, and to which every applicant for examination must first subscribe, is as follows:

I,

a candidate for the appointment of Assistant Surgeon of the United States Army, do hereby declare that I was years of age on the day of last; that I labor under no mental or physical infirmity, nor disability of any kind, which can in any way interfere with the most efficient discharge of my duties in any climate; and

1st. That I have the degree of A. M. or A. B. from the

dated

2d. That I have the degree of M. D. from the

3d. That I have attended the clinical course of instruction at the

NOTE.-The 1st and 4th of the numbered requirements are not essential prerequisites for examination, but will be taken into consideration in making up the finding.

In the requirements the character and extent of the examinations are clearly stated.

The candidates are examined on the branches usually taught in