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is opposed by the results of experiments made with the view of showing that parasitic plants can be transferred by inoculation to apparently healthy organisms, and then give rise to morbid phenomena: thus, for instance, Hassal' was able to transfer, by inoculation, parasitic fungi from diseased to healthy lettuces, in which they produced the same disease, (softening of the stem.) These cases, however, prove but little: they merely show, that in some instances the disposition to fungoid development need not be great; and they are, moreover, open to the objection that the plants which were inoculated having, perhaps, the same habitat, and living under similar relations, already bore within them the morbid disposition." p. 428.
Dr. Vogel then describes the different fungi found in animal fluids the yeast plant, and sarcina ventriculi; and next the parasitic fungi found on the integument, and its appendages, of man-those of porrigo, mentagra, plica polonica, and of the mucous membranes; after which he treats of the different parasitic animals; terminating with a learned view of malformations, in which he includes the different forms of monstrosity.
The plates, ten in number, are well executed, and the whole work is exceedingly instructive. It indicates on every page that the author is a well read, painstaking, and accurate observer; fully aware of what has been done in other countries as well as his own; and always anxious to do justice to his brethren who have been engaged in the same labours. We shall look with anxiety for the promised volume on special pathological anatomy, which we doubt not will be worthy to take its place alongside the one before us.
Dr. Day-the translator-appears to have executed the dutyif not elegantly-faithfully. He modestly states in the preface, that the additions he has made are trivial and unimportant, with the exception of the plates and their explanations. "These," he remarks, "are almost entirely selected from the author's 'Icones Histologiæ Pathologicæ,' and will, I trust, be found valuable aids to the clear understanding of the subjects they are intended to illustrate." p. xx. We wish he had added "Tabula xii" of the "Icones"-"Epizoa atque Entozoa Hominis," in which the different parasites are delineated. The other plates, * Froriep's N. Notizen. Oct. 1843, p. 54, &c.
referring--as they do-to lesions of special organs, will doubtless appear in the next volume.
We are glad to find, that this valuable treatise is about to be reprinted in this country by the enterprising house of Lea & Blanchard of this city.
Medical Instruction in the United States: an Address delivered to the students of the Philadelphia Association for Medical Instruction, at the close of the Session of 1846. By ALFRED STILLÉ, M. D., Lecturer on Pathology, and the Practice of Medicine.
In this address, Dr Stillé controverts the assertion of Professor Paine "that American physicians greatly surpass all other uations, not only in the decision, but in the success of their practice," and argues that in attainments, so far from being equal to those of the different nations of Europe, they are greatly behind, and therefore cannot possibly surpass them in decision or success in the treatment of disease.
After contrasting the qualifications for entering upon the study of medicine, demanded in various sections of Europe, with the looseness which prevails in the United States, the lecturer makes the following statement:
"After all the preparatory study we have described, what term of attendance on medical lectures is required of European students? In Austria and France fifty months; in Prussia and the secondary states of Germany forty months; in Great Britain and Ireland twenty-four months; while in the United States, we undertake to produce a competent physician in eight months, or one-third of the time deemed necessary by the lowest of the European schools."
In this statement the system of medical education pursued in the United States, it strikes us, is not quite fairly compared with what obtains in Europe. With us, three years study we believe is demanded by all the colleges, including attendance on lectures. The student in his attendance on lectures, instead of being confined to two or three subjects in different years, thus extending the term to four or five years, is occupied with all the branches at once, so that in two courses of four months each he may hear as many lectures on certain subjects as would consume double
the period of time when but half the number are given. Whether the number of subjects taught simultaneously is more than the mind of an industrious student can master is another question. Every one, who attends but two lectures a day, will not learn more of these particular subjects than others who are engaged with six; and therefore, according to our republican notions of justice, the industrious man, who can acquire a competent knowledge of his profession to commence the practice of it in three years, should not be subjected to the expense of a protracted pupilage, because the drone and the dolt may require five or seven. With us, it must be recollected, no part of a medical student's expenses are borne by government, as in continental Europe, and in the yet infant state of our country the means of parents generally are not adequate to great expense in the education of their sons; nor does government, in most of the states, afford to the regular physician any protection against competition from the uneducated.
There is a wide difference in these respects, between our situation and that of the old institutions and despotic governments, to which Dr. Stillé refers as patterns for our imitation.
Under the circumstances in which we are placed, it would be both unjust and impolitic to prescribe a longer time or greater outlay than experience may show to be indispensably necessary for the accomplishment of the desired object. What may be the shortest time necessary is a question about which men of equal experience will differ; but as the object of all hese requirements is to insure a competent amount of knowledge for the safe and judicious exercise of the office of a physician, and as this can be arrived at by a proper examination, and in no other way, there ought to be no difference of opinion on this point. If every aspirant for admission into the ranks of the profession were subjected to this test, there would be little occasion for any other. There need be no inquiry where he got his knowledge, nor how long he was about it. But here lies the difficulty. The completeness of the examination must depend upon the character of those who are to conduct it. Who shall these be? In order to arrive at a correct appreciation of this matter, we must first look to the form and operation of our government, for no voluntary or self-constituted board, whether examiners or
those by whom they are appointed, can exercise any effective control or jurisdiction in the case. Of this fact, there can be no doubt. The federal government possesses no power under the constitution to regulate the business pursuits of the citizens of the States. Every thing of that kind is left with the States respectively. This is the practice as well as the theory of our government. Every state in the union, then, possesses exclusive power over this subject within its limits. But most of the states have refused, absolutely, to restrict the practice of medicine, or to prescribe any qualifications whatever for those practising it, leaving to the common law the task of guarding their citizens by suits for malpractice.
The states respectively have the power, and many of them have exercised it, of establishing colleges for giving instruction and granting degrees. Will these colleges surrender the business of teaching to other and irresponsible associations? That would be to neglect and refuse to perform the duties of a public trust, for which the law has instituted them; and if the existing faculties were to take that course, there is little doubt but that the trustees who govern these institutions would soon find other occupants for their chairs, even among those most eager for reform.
Will the faculties and trustees of the colleges decline to grant diplomas or testimonials of competency to their pupils, whose deportment and acquirements have justly earned them? That is not likely. It would be surrendering the common privilege possessed by all men, of rewarding merit. It would be denying to themselves the right possessed and exercised by every school master and master mechanic, of testifying to the good conduct and proficiency of their pupils and apprentices. Until some legal enactments can be had, prescribing who may practice, and by whom they shall be examined, which is not likely to occur in many of the states in any short period, we apprehend that the present system of examination will continue, and that the character of those who shall be recognised as members of the medical profession will depend on the more or less general diffusion of education and the character of the professors in the different medical schools; whilst the character and fitness of the latter will depend upon whether the honors and emoluments of
their stations shall afford adequate inducements to properly qualified individuals to accept the appointments. That such will continue long to be the case may be doubted, when we see the facility with which charters are obtained, and the genera rage for engaging in the business. If the system of medical education is to be improved, and the respectability of the profession maintained, the number of medical colleges must be limited to the actual wants of the community. How this is to be attained it is difficult to say. Most likely the college fever will be allowed to run its course, until a crisis ensues from the complete exhaustion of all means of support. In some instances, like too many plants in one parterre, some will wither and die, whilst others, deriving additional strength and support from their decay, will bring forth better and more abundant fruit.
Notwithstanding the unfavourable picture of us painted by Dr. Stillé, we very much doubt whether we are really so much worse off, or the physicians of the United States are in practical tact and usefulness so much in arrear of their European brethren. Take, for example, the following sketch of matters in England, quoted by him from a work by Mr. Surgeon Wilde, of Dublin: "In England, with few exceptions, (and even in those exceptions the kind of instruction is very meager) there is little or no preparatory education required by the different colleges and licensing bodies. The student is at perfect liberty to choose what lectures, or how many, he will first attend; the object being not how he can best prepare his mind by initiatory degrees, for the more mature branches of study, but how he can soonest, easiest, and cheapest, become possessed of the certificates of attendance on the lectures he has never heard. There are no tests required as to his knowledge of any of the subjects he is supposed to study till the hour of his examination-and when this examination does arrive, the chances that he is never asked a question, except upon anatomy and surgery, and a little physiology, are, in the chief licensing institu tions of Great Britain, so slight as almost to amount to a certainty."
If there is any institution for granting degrees in the United States where the business is conducted as badly as this picture represents, we are wholly ignorant of it.
But the author of the lecture says they manage things better