course of instruction, three of them offer a four-years course, and the remainder offer, although only few require, a three-years course. The inaugurators of the reform of prolonging the course of study were the Chicago Medical College and the schools at Harvard and the University of Pennsylvania. At but few schools is the instruction graded for different years, and students are usually compelled to pay for hearing twice over the same course of lectures in two years. This, with a little dissection, a thesis, and examinations upon the lectures, is frequently all that is required of them before receiving a diploma. Almost all practical work is optional, and, instead of each student being obliged to secure a hospital experience, he is lucky if he obtains an appointment as interne after an additional competitive examination for which he has crammed himself full during months of toil over textbooks and lecture-notes.
The better class of students feel the inefficiency of this system and so far as possible supplement it by attending small "quiz classes" for recitations and practical work, which are, however, entirely independent of the colleges, and are in no sense obligatory. The success of these small voluntary classes (often conducted by men who are without any official connection with the colleges) in drawing students, who thus incur considerable additional expense, is in itself a severe commentary upon the poverty of the colleges which restricts them from making their own advantages all that they should be.
Such is the system in vogue to-day at a large number of our medical colleges. There are, fortunately, a few where a much higher standard is not only encouraged but required. No wonder that our students, immediately after graduating, go by the hundred to Paris, Berlin, Vienna, etc., where the Government encourages professional schools, laboratories, and scientific bureaus by substantial support and thorough system. They go abroad, partly because it is the fashion, and gives them a sort of advertisement as having done the proper thing, and partly to learn a new and useful language, and study foreign methods of life. But the fundamental reason of their going is that, instead of sitting in a huge lecture-hall with two or three hundred other men, to take notes verbatim of a lecture which often might be read in a textbook at home, they can join small classes in which they practically demonstrate every fact for themselves, under the guidance of an instructor.
Lectures have their value, certainly, but it is a relative value which is greatly enhanced by practical teaching. A gigantic picture of a sore throat, hung on the wall of a lecture-hall, is after all far less instructive for a student than looking into the real throat, telling what he sees there, and then looking again, while what he at first omitted is pointed out to him.
There are many demonstrations which can be better made, and many theories which can be more conveniently discussed, in a lecture;
