health is dealt with as though it were largely outside of such control. It is a well-known fact that the generously inclined promote far more readily the advancement of the mechanical and economic arts and sciences than the advancement of that most important science the science of medicine. It can be truly said that no better investment for the purpose of extending the useful knowledge. of the world can be made than in the endowment and support of the best medical teaching that carries with it also a wider medical research.

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THE CASE METHOD OF INSTRUCTION IN MEDICINE.1

The case " method advocated by Mr. Cannon, of Harvard University, in March, 1900, has received the indorsation of many teachers in England and the United States. This method is supposed to supplant the dreary, old-fashioned didactic lecture, and is an imitation of the plan adopted in the law department of Harvard. The plan is to secure printed histories of actual cases which perhaps the student may have seen in the hospital. Each student is previously supplied with a printed copy of the history for careful perusal some time prior to the discussion. The class and teacher meet and discuss the diagnosis, pathology, symptoms, and treatment. Text-books and other literature are consulted, and the case is thoroughly thrashed out. The student is learning the judgment of clinical data, the estimation and relative value of the various symptoms, distinguishing between the important and the unimportant, the common features and the more unique. He not only receives but acquires knowledge.

Advantages of the case system.2-The first claim made for the method was that by its use the objectionable features of the didactic lectures are avoided. The student does not spend his time duplicating his reading matter by lecture notes to be set aside for later study; he is learning his facts gradually from day to day by actually applying them to his work. Instead of depending on his uncertain records of lectures, he is training himself by practical experience to use his books just as later he may have to use them in reference to his patients.

The power of arousing interest and enthusiasm among the students was a second claim made for the method. This claim has been abundantly confirmed. The printed record of an actual case gives a center of interest. As one student said, "I used to sit down and read twenty pages of Practice' and be sleepy, but there is an excitement in hunting down the diagnosis of a case and in getting ready to stand by my idea of the treatment of it that keeps me lively." The exercises at which these cases have been discussed have had the largest regular attendance of all clinic exercises of this last half of the senior year. The students argue and discuss the case together in their rooms; they come to the conference and dispute and question not only one another, but also their instructor; they are kept alert and keen-minded throughout the exercise. Impressions made under such conditions, when the attention is naturally sharp and eager, are deep and lasting. It is the particular patient, the concrete instance, that gives body and form to text-book abstractions, holds the attention, and stimulates the reasoning power. Neither the lecture nor the recitation stirs enthusiasm; the case system, however, is on record as having accomplished this result most successfully.

The most important virtue of the case system, however, is its great value in drilling the mind of the student to meet intelligently the difficulties of practice. Let the students have a number of cases with similar symptoms, but with peculiarities and complications, and can any student fail to puzzle over them and study them? And, having studied them, will not the conference at which his diagnosis and treatment are either confirmed or questioned mean more to him and produce a more lasting impression than any lecture? The clinics train the medical student in observation; nothing at present requires him to look carefully on all sides of many cases, to think clearly and accurately, or to have reasons for his conclusions. Are not these powers among the most indispensable qualities of a physician? If so, the method of bringing these qualities into constant use and discipline, and at the same time demanding the most thorough and precise knowledge, is certainly that best adapted for the study of medicine.

In text-books symptom after symptom is written down without indication of importance or weight. In considering a particular case and discriminating between the various diseases it might represent the students first begin to see what may be called the perspective of symptoms; they are learning to distinguish

1 From address of Dr. J. R. Jones, of Winnipeg, Manitoba, before the Canadian Medical Association August 21, 1901. 2 B. W. Cannon, A. M., Harvard University.

between the big and the little, the important and the unimportant, the common features and the unique.

Among the new unforeseen merits characterizing the case method is the discovery that the particular instance may be stated so vividly that it will leave on the mind a picture quite as definite and lasting as the sight of a real patient. This virtue suggests the especial use of the method in teaching the management of acute urgent conditions, such as alarming hemorrhages, the agonizing distress of angina pectoris, and the cutting, stabbing pains of biliary colic, conditions which students never see in the hospitals and which they may be called upon at any time to treat.

Another of the unexpected features of the case method is that of showing to the students themselves, and also to their instructors, what they do not know and wherein their knowledge is inaccurate. The students are going through their last year in the school ignorant of their ignorance and complacent in their false knowledge, until meeting the actual conditions of real cases shows them their deficiencies.

The case method in the University of Pennsylvania.-In a crude form it has long been in use; the practice of demanding bedside diagnosis, etc., at clinics is an old one, and has been employed by many teachers. The introduction of the fully elaborated method at the University of Pennsylvania occurred some two years ago, and the details, as followed out in that institution, are given by Dr. Frazier in the University Medical Bulletin for September.

Each student is given a manifold copy of the complete clinical data of a case in the hospital records, including family history, physical examination, antecedents, blood, urine, sputum, etc., examinations, as well as the full history of the disease. He is instructed to prepare a report from the facts, including diagnosis, prognosis, and treatment; in some cases only one or two of these may be required; in others, special attention is called to the diagnosis, prognosis, or treatment. No conclusions are accepted or given credit for unless based on logical reasoning from the facts given. These papers are distributed each Saturday and a report required on the following Saturday. A week later the instructor analyzes the reports before the class, points out their errors and omissions, states what further examination might be conducted to elucidate the case, and gives the subsequent history, results of treatment, etc., as they occurred. As a rule, typical cases are not selected, but those that give the student some exercise of judgment in his diagnosis, and they are so chosen as to work into a systematic scheme embracing instances of affections of each important class. Dr. Frazier finds the method of value in developing the power of discrimination, educating the judgment, encouraging research into authorities, and widening the reading of the student. He also finds that it especially arouses enthusiasm and interest, a point the importance of which is not to be underrated.

It is evident that a plan that presents, as this does, cases as they occur in actual practice must be more interesting than purely impersonal facts or dry enumeration of symptoms.

FRAUDULENT DEGREES IN DENTISTRY.

[From report of the foreign relations committee of the National Association of Dental Faculties for the year 1900-1901.]

In our last report we made public the fact that a number of the fraudulent institutions were suppressed and their conductors imprisoned. We hoped that this would practically close up all of them, but special circumstances have intervened to protect certain ones, and the work is not yet completed.

It is not generally known in this country that thousands of fraudulent diplomas have been sold abroad. Were it possible for foreigners to distinguish between the reputable and the disreputable schools, this would not so much matter, but it is possible to incorporate degree-granting institutions which have practically no State supervision or responsibility whatever, and which with legal sanction are, under the great seal of the State, certified as lawfully organized colleges. By that certification the most unblushing impostures are placed apparently upon the same plane with reputable institutions, and foreigners are deprived of all means by which they can positively determine which is worthy of recognition and which is not. As a consequence, some foreign governments have used this condition, either honestly or as a desirable pretext, to discriminate against all Americans, and have refused them permits to practice, and positively prohibited, under

1 Jour. A. M. A., Sept. 21, 1901.

heavy penalties, the employment by anyone of the American degree or title. This interdiction is spreading very fast, and unless something is done to forestall it, soon the possession of an American diploma, whether legitimately or illegitimately obtained, will be a positive detriment to a practitioner. In fact, that is the case to-day in some parts of Germany. The influence of such enactments upon American educational affairs and upon the members of this association may perhaps be imagined. Already prohibition is practically accomplished in southern Germany, is impending in northern Germany, has been commenced in France, in Italy, and other countries, and there is sharply threatened a combination of all Europe against the American dental degree and the American dental school. * * *

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Practically no fraudulent degrees are sold in America; the countries of Europe are the sea into which the foul tide empties, and the sweetening of the waters can not be effected there. It is in this country that the remedy must be applied, and until a healthy public and professional sentiment can be evoked here nothing can be done. The condition has existed for years, and it is constantly growing worse. A pest hole can not be cleansed until it is uncovered. A festering wound must be laid open that access may be obtained to its foulest depths. The community must be convinced whence an infection proceeds before it will abolish the source. Few dentists are aware of what exists in this country. Any man knows that when the honest intelligence of our profession is fully awakened to any enormity, it will move heaven and earth if necessary to put an end to it. The name of Consul Worman has been mentioned. Your committee believes that his efforts to rehabilitate the American degree in Europe have been, and promise to be, of the greatest benefit to dentistry, and his work should be sustained by everyone. Your committee has not been able to give him all the assistance it desired, because it was this year without the credit upon the treasurer of the association that has been accorded it in the past, but it hopes that the good work may not be hindered by this obstacle in the future. Our national, our professional, our individual reputations are at stake. The good name of every member of this association is in the balance, and our vindication from a foul blot upon our professional escutcheon must not be a matter of indifference. To assume that this is in the interests of antagonistic foreign governments, that it is doing their dirty work, is to attempt to cover up and apologize for and justify the villainy that is being done in our names, to assume complicity with the men who are trading on our good deeds, and who, under cover of the high reputation of American dentistry won by us, are endeavoring to foist upon foreign communities a counterfeit that must of necessity throw doubt upon the original.

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Ban on American dental colleges removed.'-United States Consul Worman, of Munich, has succeeded in securing from the Bavarian Government a decree removing the wholesale restriction placed upon the practice of dentistry under foreign diplomas. This restriction was aimed principally at American diplomas. Mr. Worman immediately set to work to protect the American dental colleges entitled to support, and, acting upon his representations, the Bavarian Government has modified the original decree so as to allow the recognition in Bavaria of degrees obtained from "reputable" American dental colleges.

DEGREES IN PHARMACY.

There is great variance among the schools of pharmacy in the bestowment of degrees and in the manner of abbreviating them. Nine schools give only one degree, that of Graduate in Pharmacy, which they usually abbreviate Ph. G. Sixteen other schools give the same degree upon completion of one course, and another degree upon completion of another course. Two schools give only the degree of Doctor in Pharmacy-the National College of Pharmacy, Washington, D. C. (which it abbreviates Phar. D.), and the Maryland College of Pharmacy (Pharm. D.). The following schools give the degree of Graduate in Pharmacy:

1. Chicago College of Pharmacy.

2. Northern Indiana School of Pharmacy, Valparaiso.

3. Iowa College of Pharmacy, Des Moines.

4. State University of Iowa, Department of Pharmacy.

5. Detroit College of Pharmacy.

1 The Washington Post, November 7, 1901.

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6. Albany College of Pharmacy.

7. University of North Carolina, School of Pharmacy.

8. University of Texas, School of Pharmacy.

9. Milwaukee Medical College, School of Pharmacy.

In the catalogues of the following institutions the requirements for graduation are mentioned, but it was not ascertained what degree is given. It is probably that of Graduate in Pharmacy:

School of Pharmacy of the Medical College of Alabama.

Atlanta College of Pharmacy.

Tulane University, Pharmaceutical Department.

New Jersey College of Pharmacy.

Leonard School of Pharmacy, Shaw University.

Sewanee Medical College, School of Pharmacy.

The degrees granted by the other institutions are as indicated below:

Kansas City College of Pharmacy (gives Ph. G. and Ph. B.).-Upon the completion of the regular two years' course and three years of experience in a pharmacy the degree of Graduate in Pharmacy is received, but if the candidate has not obtained the required shop experience he is given the degree of Bachelor of Pharmacy. (Cat. 1902, p. 19.)

University College of Medicine, Department of Pharmacy, Richmond, Va. (Ph. G., Ph. B.).-Gives the degree of Graduate in Pharmacy upon completion of a two years' course and three and one-half years of shop experience. If the student has not the latter qualification he receives the degree of Bachelor of Pharmacy. (Cat. 1902, p. 93.)

National College of Pharmacy, Washington, D. C. (Phar. D.).-Gives Doctor of Pharmacy after three years of instruction and four years of shop experience. (Cat. 1902, p. 27.)

Maryland College of Pharmacy (Pharm. D.).-Gives Doctor of Pharmacy after two years of instruction, shop experience not being required. (Cat. 1901, p. 25.) Louisville College of Pharmacy.-Gives Doctor of Pharmacy upon completion of two courses of instruction and four years in a pharmacy. The degree of Master of Pharmacy is bestowed upon graduates of this college of not less than five years' standing upon presentation of some work showing original research of exceptional merit. (Cat. 1902, pp. 5, 7.)

Brooklyn College of Pharmacy (Ph. G., Phar. D.).-Gives Graduate in Pharmacy when the student has completed the regular course of two years and four years of pharmaceutical experience, and after one year's postgraduate attendance the student may receive the degree of Doctor of Pharmacy. A student completing the regular two years' course, but not having the required experience, receives a certificate which may be exchanged for the regular diploma upon receiving the required experience in a pharmacy. (Cat. 1902, p. 9.)

College of Pharmacy of the City of New York.-Same as Brooklyn College of Pharmacy. (Cat. 1902.)

Medico-Chirurgical College of Philadelphia, Department of Pharmacy.-Same as Brooklyn College of Pharmacy. (Cat. 1901.)

California College of Pharmacy, University of California (Ph. G., Phar. D.).— The degree of Graduate in Pharmacy is received after two years of attendance and four years of practical training. (Cat. 1902, p. 370.)

College of Physicians and Surgeons, Department of Pharmacy, San Francisco.Gives Graduate in Pharmacy upon completion of the two years' course and four years of experience, and "a graduate of this college of not less than five years' standing who shall by original research have executed work of exceptional merit and present same to the examination committee of this college in the form of a thesis, together with such product or products as may have been obtained, shall, if deemed worthy by said committee, receive the degree of Doctor in Pharmacy.' (Cat. 1902, p. 9.)

Purdue University, School of Pharmacy, Lafayette, Ind. (Ph. G., B.S.). Gives Graduate in Pharmacy upon completion of two years of instruction (no shop experience required), and upon completion of a four years' course Bachelor of Science in Pharmacy. (Cat. 1901, p. 12.)

University of Maine, Department of Pharmacy (Ph. C., B. S., M. S.).-A course of two years leads to the degree of Pharmaceutical Chemist. The full course of four years includes instruction in modern languages, civics, and the

sciences, and leads to the degree of Bachelor of Science in Pharmacy. Further work of one year in residence or two years in absence secures the degree of Master of Science. (Cat. 1901, p. 115.)

Massachusetts College of Pharmacy (Ph. G., Ph. C.).-The degree of Graduate in Pharmacy is given after two courses of instruction and four years of shop experience. Students who complete two courses and submit a satisfactory thesis, but who have not the required practical training, receive the degree of Pharmaceutical Chemist. (Cat. 1902, pp. 21, 24.)

Scio College, Ohio (Ph. G., Ph. C.).-The course for the degree of Graduate in Pharmacy covers a period of forty weeks, and the course for Pharmaceutical Chemist two years.

Northwestern University (Ph. G., Ph. C.).-Upon completion of two sessions of six months each the student receives the degree Graduate in Pharmacy. Additional work during the fall and winter terms of the second year and full work during the spring terms of both years secures the degree of Pharmaceutical Chemist. (Cat. 1902.)

Cleveland School of Pharmacy (Ph. C.).-Completion of either the two years' course or the three years' course secures the degree of Pharmaceutical Chemist. (Cat. 1902, p. 7.)

Walden University, Pharmaceutical Department, Nashville, Tenn. (Ph. C.).— The degree of Pharmaceutical Chemist is given upon completion of the regular course of three sessions of not less than twenty-four weeks each. (Cat. 1901, p. 37.) Oklahoma University, School of Pharmacy (Ph. C.).-Upon completion of the regular course and two years of experience in pharmacy the student receives the degree of Pharmaceutical Chemist. (Cat. 1902, p. 58.)

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University of Kansas, School of Pharmacy (Ph. C., B. S.).—The degree of Pharmaceutical Chemist is given to any student who completes the course of two years or the course of three years. Those who finish the four years' course receive the degree of Bachelor of Science in Pharmacy. (Cat. 1902, p. 12.)

Buffalo College of Pharmacy (Ph. G., Phar. M., Phar. D.).-Gives the degree of Graduate in Pharmacy upon completion of the two years' course, no shop experience being required. For the degree of Master in Pharmacy the candidate must have had two years' professional training after receiving the degree of Graduate in Pharmacy or its equivalent, and he must present an acceptable original thesis. For the degree Doctor in Pharmacy the candidate must have received the degree Master in Pharmacy or its equivalent, and he must subsequently attend one session of the Buffalo College of Pharmacy and present an acceptable original thesis. (Announcement for 1903.)

St. Louis College of Pharmacy (Phar. G., Phar. B., Phar. C.).—Gives Graduate in Pharmacy upon completion of the regular course of two years and four years of drug experience, or when the latter requirement is not met the degree of Bachelor of Pharmacy is given. Upon completion of the course for Bachelor of Pharmacy and subsequently taking the third year's professional course in chemistry the degree of Pharmaceutical Chemist is obtained. (Cat. 1902, p. 27.)

University of Tennessee, Department of Pharmacy (Phar. C., B. Sc.).—Gives Pharmaceutical Chemist upon completion of the two years' course, and upon completion of the four years' course the degree of Bachelor of Science in pharmaceutical chemistry. (Univ. Cat. 1903, p. 47.)

Ohio State University, College of Pharmacy (Phar. C., B. Sc.).-Gives the degree of Pharmaceutical Chemist upon completion of the two years' course, and on completion of the four years' course the degree of Bachelor of Science in pharmacy. (Cat. 1902, p. 16.)

Vanderbilt University, Department of Pharmacy (Phar. C., Phar. M.).—Gives Pharmaceutical Chemist upon completion of a two years' course, practical experience in pharmacy not being required. Upon graduation in pharmacy and subsequent attendance for one year the degree of Master of Pharmacy is given. (Cat. 1902, p. 26.)

Pittsburg College of Pharmacy (Phar. G., Phar. D., Phar. C., Phar. M.).-The degree of Graduate in Pharmacy is given after two years of instruction and four years in a drug store. The degree of Doctor of Pharmacy is given to graduates in pharmacy who have attended a third year's course of instruction. The degree of Pharmaceutical Chemist is given students who have attended three courses of instruction but have not received the practical experience required for graduation in pharmacy. Master in Pharmacy is given to those who after graduation have continued for five years in the practice of their profession and who submit a satisfactory thesis. (Cat. 1902, p. 23.)