tutor, an insight into methods of examination of diseases, and learns
practically the use of the stethoscope and other aids to diagnosis,
and of surgical and obstetrical instruments. In fact, it may be said
that each subject of instruction is duplicated. If this is taken into
account, it must be evident that the time of the student is fully
occupied, and the belief is rapidly growing that five years is too
short a period of study. As a matter of fact, the average time taken
to obtain a British licence to practise is upwards of six years. The
probability is that the solution of the difficulty will be found in the
inclusion of such subjects as physics, biology and chemistry in a
“preliminary scientific” examination, which may have to be undertaken
before registration as a medical student, thus leaving the
whole five years to be devoted to purely professional study.
The German regulations in regard to professional study are few. They are those for the Staats Examen, for which the university degree is no longer necessary. The regulations for the admission of candidates to the Staats Examen are contained in the royal proclamations of the 22nd of June 1883. They comprise: (a) Certificate of a course of study Germany. at a classical gymnasium of the German Empire. In exceptional cases, the same from a classical gymnasium outside the German empire may be considered sufficient. (For details of the course of study and examinations, see Minutes of the General Medical Council, vol. xxvii. appendix 3.) (b) Certificate from a university, certifying a course of medical study of at least nine half-years at a university of the German empire. (c) Certificate that the candidate has passed, entirely at a German university, the medical Vorprüfung, and thereafter has attended for at least four half-years the medical studies of a university. (d) The special testimony of the clinical directors bearing witness that the candidate has taken part as Praktikant (clerk or dresser) during two half-years at the medical, surgical, and gynaecological clinics; has himself delivered two cases of labour in the presence of his teachers or assistant physicians; and has attended for a half-year as Praktikant the clinic for diseases of the eye.
The medical Vorprüfung referred to is necessary alike for the Staats Examen and the degree of Doctor of Medicine. It takes place at the end of the second year (fourth semestre), and includes the subjects of experimental physics, chemistry, botany, zoology, anatomy and physiology. It is conducted by a board appointed yearly by the Minister of Education.
No one can practise medicine in France who does not possess the diploma of Doctor of Medicine of a French university. The qualification of Officier de santé is no longer granted. Before he can inscribe as a student of medicine the applicant must have obtained the diplomas of Bachelier ès lettres and Bachelier ès sciences. Although the course of professional France. study may be completed in four years, a longer time is generally taken before the student proceeds to the final examination for the doctor's degree. Each year is divided into four trimestres; at each trimestre the student must make a new inscription. The trimestres are (1) November and December, 56 days; (2) January, February, March, 86 days; (3) April, May, June, 86 days; (4) July, August, 56 days. Practically there are no regulations determining the division of the various subjects, or the number of lectures in each course, or requiring the student to attend the courses. The medical faculty of each university puts before the student a scheme recommending a certain order of studies (Division des études) for each of the four years of the medical course, and, as a matter of fact, this order of study is enforced by the system of intermediate examinations (Examens du fin d'année). All the lecture courses are free, as also are the clinics and the hospital service, and there is no system of ascertaining the regularity of attendance at lectures, or of certificate of attendance. If, however, the student fails to pass the Examen du fin d'année he is debarred from making the next trimestral inscription, and thus loses three months. The lectures are, however, closely attended. In contrast to the freedom in regard to attendance on systematic lectures, there are strict direction and control in regard to hospital attendance and practical courses. The student is required to sign a register ad hoc each time he goes in and out. From the beginning of the third year, e.g. from the ninth quarterly inscription, hospital attendance is enforced till the end of the fourth year. No one can renew his trimestral inscription without producing a schedule of his last trimestral stage, showing that during it he had not absented himself more than five times without explanation. Practical work is obligatory during each of the four years.
Besides systematic courses of lectures, Conférences are held by the assistant-professors (agrégés) in natural history, physiology, general pathology, internal pathology, external pathology. At the end of the first year the student is examined in osteology, myology and the elements of physiology; at the end of the second year, in anatomy and physiology in all their branches; at the end of the third year, in medicine and surgery; at the end of the fourth year, an examination is held over the whole field of study.
No one is allowed to enter on the study of medicine without passing the Artium examen of a secondary school. This is the equivalent of the German Abiturienten Examen of a classical gymnasium. After study for two semestres an examination must be passed in psychology, logic and history. The special professional examinations consist of (1) preliminary Denmark. scientific, in botany, zoology, physics, chemistry; (2) first special or professional, anatomy (orally and by dissections), physiology, and pharmacology; (3) second special or professional, written examinations in medicine, surgery, medical jurisprudence; practical and oral in operative surgery, in clinical medicine, and clinical surgery; and oral in pathological anatomy, medicine, surgery; and midwifery. The completion of the full medical course takes six years, of which the first two are devoted to the study of the natural sciences.
Authorities.—The history of the development of medical education from the earliest times down to 1894 will be found treated of generally in Puschmann's Geschichte des medicinischen Unterrichts (Leipzig, 1889–1905) translated by E. H. Hare (London, 1891). Those desiring more special information on the subject in regard to the details of British institutions should consult the annals of the various universities and colleges of Great Britain and Ireland. The following works supply much interesting information regarding the gradual rise and development of teaching and examination: Annals of the Barber Surgeons, by Sydney Young (1890); History of the Royal College of Surgeons of Ireland, by Cameron (1886); Early Days of the Royal College of Physicians of Edinburgh, by Peel Ritchie (1899); Historical Sketch of the Royal College of Surgeons of Edinburgh, by Gairdner (1860); Memorials of the Faculty of Physicians and Surgeons of Glasgow, by Duncan (1896); The Story of the University of Edinburgh, by Sir A. Grant (1884); University of Glasgow, by Stewart (1891). (J. B. T.)
As late as 1880 medical education in the United States was in a deplorable condition. In the early history of the country, before and shortly after the beginning of the 19th century, the few medical colleges had shown a disposition to require a liberal education on the part of those who entered upon their courses, and some effort was made, United States. through the agency of state boards, to control the licence to practise. But as the country increased in population and wealth preliminary requirements were practically abolished, the length of the courses given each year was shortened to four or five months or less, and in the second and final year there was simply a repetition of the courses given during the first year. This is to be attributed mainly to the fact that there was no general national or state supervision of medical training. Medical colleges could obtain incorporation under state laws without difficulty, and brought considerable advantages in the way of prestige and increased practice to those concerned. That the existence of a college depended solely upon the fees of the students encouraged the tendency to make both entrance and graduation requirements as easy as possible, especially as there was no state supervision, and the mere possession of a diploma entitled the holder to practise. Fortunately, during this period the practical character of the clinical instruction given in the better colleges fitted the graduates in some measure for the actual necessities of practice, while the good traditions of medicine as a learned profession stimulated those who adopted it as a career, so that in the main the body of practitioners deserved and held the confidence and respect of the community. From the middle of the 19th century there has been constant agitation on the part of the physicians themselves for an improvement in medical education. The first notable result was an increase in the time of instruction from two to three years (Chicago Medical College, 1859; Harvard Medical School, 1871), the lengthening of each session to six
