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benefits the mass of the people, or to recognize social distinctions in schools which are established for all alike, is not in accordance with the spirit of the common-school act, and should not be tolerated."
SCHOOL-BOOKS. The school-books published under the authority of the commissioners of national education in Ireland are, as hitherto, more in demand in the schools of the colony than any other series, and this, it is stated, will continue to be the case as long as they are supplied at rates so much below all other publications of the kind.
Every facility is afforded for the establishment of evening schools, and the regulations relative to the payment of results in force in day schools apply equally to them.
TRAINING OF TEACHERS
Is reported as still in an unsatisfactory state; the institution now in operation is doing good work, as far as its capabilities extend, in turning out some fair teachers. The superintendent is zealous and painstaking, but the institution, although under the direction of the Church of England, is little more than the private speculation of the master. A general training institution, unconnected with any denomination and on a more extended basis, is a desideratum, to which the board has directed its attention.
TEACHERS' SALARIES AUGMENTED BY RESULTS.
Under the law the minimum salaries of teachers are fixed; they may, however, angment them by results, as has been stated, according to the amount of improvement apparent in classes upon examination. The report states that “the amount which a school is now competent to gain under results, called the maximun increment, is 45 per cent. of the average fixed salaries paid to the school month per month. Wo have reserved to ourselves the power, subject to the approval of the governor in council, to increase or diminish this maximum increment as the interests of education may require, or the amount voted by Parliament may render necessary. We have also provided that the balance, if any, of the amount set apart for results which may remain unexpended at the end of the present year, may, at our discretion, be distributed among all the schools.”
There is a system of pupil-teachers in operation, by which teachers are educated and fitted by experience for the work. These teachers receive salaries, and are permitted to improve their education by taking lessons out of school hours, under certain restrictions. A late rule adopted by the board of education upon this subject is as follows:
“That pupil-teachers be of the same sex as the principal teacher of the school or department of a school in which they are employed; but in mixed schools, or departments of schools, under a master and mistress, female pupil-teachers may receive instruction out of school hours from the master, on condition that some adult female, approved by the local committee and by the inspector, be invariably present during the whole time that the lessons are being given by the teacher; provided also that the teacher and said adult female be not both young and unmarried.”
This rule is somewhat similar to that adopted under the committee of council of education in England, but it is not so stringent. “It is unnecessary,"
“It is unnecessary,” says the report, "to make any remarks as to the advisability of such a rule.”
GENERAL FEATURES OF THE SCHOOL SYSTEM.
One of the prominent features of the school system is that of inspection, for which £6,500 was voted in 1868. The school system of Victoria also embraces many interesting peculiarities, to gain a full idea of which, the report should be examined.
EDUCATION IN ECUADOR.
Ecuador boasts of one university and eleven colleges, yet the people are not educated. Literature, science, philosophy, law, medicine, are only names. Nearly all young gentlemen are doctors of something; but their education is strangely dwarfed, defectivo, and distorted; and their knowledge, such as they have, is without power as it is without practice. The University of Quito has 285 students, of whom 35 are
parsuing law, and 18 medicine. There are 11 professors. They receive no fees from the students, but an annual salary of $300. The library contains 11,000 volumes, nearly all old Latin, French, and Spanish works. The cabinet is a bushel of stones cast into one corner of a lumber room, covered with dust, and crying out in vain for a
a man in the university to name them. The College of Tacunga has 45 students; a fine chemical and philosophical apparatus, but no one to handle it; and a set of rocks from Europe, but only a handful from Ecuador. The College of Riobamba has 4 professors and 120 students. In the common schools, the pupils study in concert aloud, Arab fashion. There are four papers in the republic: two in Guayaquil, one in Cuenca, and one in Quito. El Nacionel, of the capital, is an official organ, not a newspaper. It contains 14 duodecimo pages, and is published occasionally
by the Minister of the Interior. Like the Gazeta, of Madrid, it is one of the greatest satires ever deliberately published by any people on itself. There is likewise but one paper in Cuzco, El Triumfo del Pueblo. —The Andes and the Amazon-Prof. James Orton,
MEDICAL EDUCATION IN THE UNITED
STATES. "The medical faculty, in common with all enlightened members of the profession, desire earnestly that a rule might prevail in our country like that which prevails in most of the universities of Europe by which a liberal education should be the necessary introduction to professional study. The sciolist easily runs into the empiric, but he who has obtained a thorough scientific discipline knows how to discriminate between visionary conjectures and established truths.”—Catalogue of the University of Michigan, 1870.
A consideration of medical education is properly introduced by a short account of the number, public standing, relation to government, and organization of,
(I.) THE MEDICAL PROFESSION OF THE UNITED STATES. 1. Number.-The total tax collected during the year 1869 by the Internal Revenne Bureau from physicians and surgeons was $505,785 55. From this it is estimated that the number of practicing physicians and surgeons in the United States is over 50,000.
2. Public Standing. The profession is divided in this country into various schools or systems, founded on various theories of disease or treatment or medication. The hydropathic or water-cure, the eclectic, and homeopathic systems of practice forming the minority. But the vast majority of reputable practitioners in this country, as well as in other countries, belong to what they denominate simply the system or the regular system of medicine, repudiating any less extended or more descriptive designation.
The practitioners of all these systems seem to depend for their individual recognition by the public upon their individual qualities, personal and professional.
3. Relation to the Government.--Practically the medical profession in the United States stands in precisely the same relation to the State governments and to the General Government as is held by all the other professions and occupations. The National Government taxes a practitioner yearly, and, with the exception of the usages of the Army and Navy, takes no further supervision of the profession as such. The States, with perhaps one or two exceptions, take no action as to its character, the conditions of entrance, education, membership, or compensation ; they grant charters for hospitals and medical schools very often without consulting the needs of the profession or the public good, or even investigating the personal or professional character of the incorporators. Counties and towns employ physicians and surgeons for the care of the sick poor in their limits; (though this practice is by no means as universal as it should be;) and the larger cities of the country have established boards of health, and have devised various and often valuable regulations for public hygiene.
4. Professional organization.-The total absence of governmental authority above referred to, and the needs of tho profession, have combined to force it to organize itself. The physicians of a city or county have formed medical associations of a simple but generally efficient character. The objects of these societies may be generally described as being to impart information to each other, and to regulate the conduct of the members toward the public and the profession, to settle the scale of fees, &c. In many of the States the local and county societies, combining with the medical boards of the hospitals and the faculties of the medical schools, form State associations. The national organization is known as the American Medical Association, which is composed of delegates from the city, county, and State associations, medical college faculties, hospital staffs, and the medical corps of the United States Army and Navy.
The peculiarity of these associations is that they are perfectly powerless to coerce errant members of the profession. They can only annoy, they cannot punish.
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 innpuulence;) soine 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 reails 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 ; lie 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 barbarons 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 auything 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 appiication 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 thé 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 Soutli 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 it 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