NOTES FROM THE UNITED STATES AND CANADA,
By
a
Peripatetic Contributor.
lay through Chicago to Canada and the Eastern States, where we saw what we could of the various medical institutions, though we cannot do more here than touch Fkom
lightly
Utah,
on a
our
route
few of them.
Let
us
take first the
medical schools, and the education and sion in America.
position
subject of profes-
of the
wide-spread impression that American degrees and American are infinitely below the English standard prevails among the profession at home ; and even men who are usually well-informed are apt to shake their heads and shrug their shoulders when they hear them mentioned. Some practitioners, indeed, talk as if all foreign degrees were worthless, and the holder of any diploma not borne on the Schedules of the Medical Council has but a bad time of it with his confreres, should he base his claims to public confidence upon it. It is true that we, English, are not the only sinners in this respect, for, unfortunately, the spirit of complacent self-satisfaction A
doctors
which leads
men
to conclude their
own
conditions and surround-
ings to be by nature the best, is limited to no nationality, profession, or time. It was this spirit which animated the Jews against the Gentiles, and the Greeks and Romans against the " barbarians ;" which makes modern European nations arrogate of "the civilized to themselves and their offshoots the tit world," and on the other hand, leads the Chinese mandarin in his turn to denounce Europeans as " outer barbarians" and " foreign devils." It is seen in perfection in the domain of religion,, where each sect seems to claim a monopoly of truth; and to a extent in the various schools of law, philosophy, and art. In politics it is almost as rabid as in religion and more dangerous. That medicine is not exempt from its influence is less
proved by the long range of bitter controversies in the past, and by the determined opposition which almost every innovator on the doctrines of the day has met with, from Paracelsus to Jenncr. It is the result of indolence and imperfect knowledge, of personal and national vanity, jealousy, and other factors,?nqt unfrequently of mere accident. The profession in Spain still suffers in reputation from our recollections of Sangrado, and the Frcr.ch physicians from the cutting satire of Moliere, while in our own day Italian medicine lias been unduly degraded io conae-
July 1,
NOTES FROM THE UNITED STATES AND CANADA.
1875.]
quence of the treatment of Cavour, and at this moment English surgery is under a cloud on the C-mtinent owing to the mistaken diagnosis of an English surgeon in the case of Garibaldi, and the death of
conspicuous personage while under As in all these cases there is a certain sub-stratum of fact and of truth, while none of them warrant the broad deduction drawn from them. So with the subject which treatment in
a
still
more
England.
has led to these remarks. There have been, perhaps still are, in America some colleges whose degrees are practically worthless, and others where the standard attained is low; but we are hardly as yet so free from reproach in this matter that we can afford
to throw stones ; and there is no doubt that many of the American a higher standard than some of our examining boards, and quite up to the average of the whole; while their best men are no whit behind the leaders of the profession in
schools reach
this country either in general culture or in professional skill. The standard is moreover constantly improving, and although political conditions render uniformity impossible and lead to a certain laxity here and there, the efforts of the profession
generally, and especially of the various medical societies, to raise the social and educational standard of the profession are most commendable and are meeting with considerable success, the chief difficulties met with are the powers possessed by each state to make what medical regulations it that the community is still young and
pleases, and the fact only beginning to have
proper facilities for special education. In the early days of the Republic, as in England prior to 1815, the happy-go-lucky system of apprenticeship was the only way in which a man could fit himself for practice, unless he resorted to
of the very few medical schools then open, or came to Europe, many did for more systematic training. Some of the best of the older generation of living practitioners picked up their knowledge in this way, which, if it is not to be compared with the system of modern education, had yet advantages of its own, one
as
some of which are in danger of being lost in the present day. At that time no doubt there was practically free trade in medicine, and in some states the regulations are still so lax that quackery flourishes unchecked ; but, as a rule, the states have come to see that the maxim of caveat emptor is perilous in its application to physic, and most of them have now a recognized college or colleges, entitled to confer degrees, and no man is considered a practitioner who has not graduated at one of these. In
regular
1873 there were in the Union 59 such Colleges, with a staff of 780 instructors and 6,491 matriculated students, 1,941 of whom graduated during the year. In some of these, as we have said, the education is imperfect and the degree inferior, but in many of them the course of study is very complete and well conducted, and a very thorough education is given in all branches both
theoretical and practical.
The Chicago Medical College or Medical the North-Western University may be taken as
Department of a good example of the better class of schools, and, though founded only sixteen years ago, has already done much to raise the status of the profession in the North-Western States. The College building is one of the finest in the Union, and contains all necessary class-rooms, laboratories, museums, &c. The dissecting-room, "which is large, light and airy, is situated on the top storey, and the bodies?which are plentiful?are taken up and removed by a lift. Fire plugs, and these are fitted on every stage of the building, and a fire escape provides for the safety of the students in case of accidents,which, as our readers know, are common in Chicago. The medical faculty is complete, and numbers several wellknown names. The course of study extends over three winter sessions of five month3 and a half, and two summer sessions of three months each, and the lectures are so arranged as to lead the student on by easily progressing stages in the natural order of his subject?, so that the mastery of each prepares him to move easily, and fully master the next, while his mind is at no time burdened and confused with
a
vain attempt to
181
ramble over all the branches of medical science in sixteen or
eighteen weeks, as is the case in some American Colleges. Chicago set the example, since followed by Harvard (Boston) and other schools, of three annual courses, and a division of the professional examinations into sections to be passed at the end of each year, but competition still prevents this from being made compulsory, and a student who has completed a year of study by apprenticeship or otherwise may, if he can, pass at once into the second course, and finish within two years. The majority, however, go through the official programme, which follows very closely that of the English and Scotch schools. All the preliminary education insisted on can be obtained at any ordinary school, but most of the men know some Latin and a little Greek, while a few are graduates in arts of one or other of the numerous Colleges scattered over the country. Practical instruction is afforded in the Mercy Hospital, a large and well-arranged building, capable of accommodating five, hundred patients, situated in the same "block" as the College, and in the Davis Dispensary, which, of the hospital. may be called the out-patient department Besides the ordinary division into medical and surgical wards, there are departments for diseases of the chest, diseases of women and children, eye, skin, and venereal diseases ; in each of which special clinics, with practical instruction in auscultation, the use of the speculum, ophthalmoscope, laryngoscope, &c.( are given daily to divisions of the class numbering from six to eight students. The total number of students is about a hundred, and by this arrangement each one has an opportunity of acquiring at least a superficial knowledge of all the practical branches of the profession previous to graduation. Courses of practical chemistry and toxicology, instruction in. the use of the microscope, and atteadance on cases of labour are included in the curriculum, and the museum, which though small is well kept and constantly improving, fairly illustrates all that is most essential in anatomy, pathology, and surgery ; the series of gun-sliot specimens being remarkably complete, was near Chicago. as the largest depot for confederate prisoners The total cost of the curriculum, including a graduation fee of twenty dollars, is about ?10, which is less by half than at Boston or San Fancisco, but considerably higher than at some of the With all the newest medical and State Aided Colleges. surgical appliances and methods, the Chicago Staff, and consequently the students are quite familiar; and our enquiry convinced us that it must be the fault of the students themselves if after going through the very complete course just sketched they are one whit inferior in attainments to their con-
in any of our home colleges or schools. same conclusion was forced upon us at Boston and New York ; and if it be said that these are the best schools?as Philadelphia, Cincinnati, St. Louis, and San Francisco would
freres
The
by fairly represent the state of medical education in America, it might be auswered that as these, their best, answer to our best, so are the others to some other no
means
admit?and do not
of ours, which shall be nameless. Certain it is that the Canadian Schools, whose lectures are received by our own examining boards, and whose graduates often take good places, in our public competitions, afford fewer practical facilities than any of those mentioned, for attaining a competent knowledge of the profession. At Toronto there are no less than three separate schools, a great waste of power, especially of teaching and special clinics are not nearly s? power ; and the hospitals with material as Chicago, while subjects for dissecwell
supplied
tion are so scarce, that body-snatching is said to be frequently resorted to. The school forming the medical department .of the McGill University at Montreal is probably the best in Canada. It is situated a little away from the University proper, and is & substantial stone building very fairly furnished with all modern teaching apparatus. The staff is of admirable quality, and hopes are entertained that endowments sufficient to retain first-rate and
men
will
Physiology,
soon
be obtained for tiie chairs of Anatomy Au excellent medical
if not for others.
library
THE INDIAN MEDICAL GAZETTE.
202
of 4,000 volumes, open to the students, is a good feature in connection with this school. We noticed the " Indian Annals" and other Indian works on the shelves. A matriculation examination,
by the General Medical Council, is insisted on, and themedical course extends to fourannimedici,three of which must be at a recognized school. So far Canada is in advance of the States, and the systematic teaching leaves similar to that recommended
but the opportunities of practical limited that for ourselves we should prefer instruction are Chicago as a school. Tho Montreal hospital contains only 140 to
nothing
desired,
be
takes a
leading place by
[July 1, virtue of its
culture,
1875.
and in those
plea-
sant coteries by which American society and American humanities are chiefly known to us, are many medical men who take an equal place with the Einersons and Irvings, the Prescotts and Motleys, the Long-fellows and the Bryants. There is much more of " sweetness and light" in the States than uninformed strangers generally suppose, and the members of our profession
have their full
share of it and
of the consideration which it
self-regarding prejudices of birth and education" which lead many in England to disparage American society would rapidly disappear; could the two peoples teds, and the wards are small and ill-ventilated. Improvements be brought into nearer contact ? It is a society, per se, which,, are much needed. and cases Phthisis and typhoid aro promised, while it has all that is best in European culture for its basis, occupied most of the beds on the medical side during our visit. is yet strictly national, and has well marked individual pecuwhich is and is as common, unfortunate, shipping Erysipelas very a and piquancy of its own. machinery accidents are numerous, and get more frequent yearly, liarities, which give it raciness And here, in conclusion, we must say a word as to the great owing to the rapid increase of the city, the finest and most Mr. and kindness shown to us throughout our trip. flourishing in Canada. Stone is rare, only some twenty cases civility Erichsen has borne public testimony to the cordiality and having presented themselves in the last six years. We saw an heartiness of the welcome he met with, and to the kindness and interesting case of popliteal aneurism, which had been comThe hours. in twelve cured hospi- hospitality everywhere lavished upon him. He was, however, by digital compression pletely previously well known, by name at least, to every Surgeon in tal work is taken in rotation by the medical officers, two at a America, to most of whom his book is a sort of surgical bible ; time, in tours of three months--a good plan considering the but the same cordial welcome was everywhere accorded to u?, all as students are as and of possible many small number beds, unknown even by name, and without (at first) other introduction employed as dresaers and clinical clerks. The school is than a common calling card. Leaders of the profession took attended by from 150 to 180 pupils from all parts of Canada, furnished us about, shewed us the hospitals, asked us to dinner, its The on deserves awarded and certaiuly popularity. degree us with introductions, and gave us every assistance and informgraduation is the double one of Doctor of Medicine and ation in their power in a way which astonished us, and to which Master of Surgery, there being no division of the profession this poor acknowledgment does but scant justice. and in British Northinto Physician Surgeon exclusively America, although of course each practitioner, while taking general practice, may lay himself out for any special subject so
or
branch.
The school at Quebec is similar to, but smaller than, that at Montreal, but the hospitals afford even fewer facilities for practical work. The Marino Hospital?which is the chief?is old, dingy, ill-constructed, badly situated, badly ventilated, and out of
and
repair.
The Hotel
Dieu, in the upper town, belonging to, sisterhood of French nuns, is a model for cheerfulness and good management, but 13 not open
mannged by,
cleanness,
a
to the students. Complete courses of lectures are given, as at Montreal, and the examinations are said to be very thorough, and the degree a good one. A thesis has to be defended at tho end of the second year, and every student has to pas3 a quarbefore the Senate, so that theoretically at least the men are well taught. The absence of proper oppor-
terly examination
tunities for hospital practice, and for acquiring a practical initiation into the art of healing, is however a great drawback ; and, though the most i3 made of the clinical opportunities ?which offer, and severe accidents ai-e not uncommon owing to the large shipping and timber trades, of which Quebec is the head, the material for illustrative teaching i3 lamentably small, and we hold that however competent a teaching and hospital staff may and that at Quebec is thoroughly so?medical education, minus good and full clinical instruction, is like Hamlet with Hamlet left out, and is more likely to qualify its pupils for the Wo havo role of the grave digger than for useful practitioners. no intention to apply this metaphor specially to Quebec, for we Inow at least one school at home with even fewer advantages. We have said so much of tho education that wo must dismiss the subject of the social position of tho profession very briefly. In America, as elsewhere, the position of the individual depends?as it naturally must?entirely on his personal qualities ; "but the conditions of society aro such that if these are good, they carry him to a (relatively) higher height than they can do elsewhere. From tho absenco of a hereditary nobility and the paucity of old families?tho few thero aro pride themselves on their descent quito as much as tho3c of Europe?tho two chief claims to social distinction have come
to be wealth
profession
and intellect; and while, as a rule, tho has small claim to consideration for its riches, it yet
brings
:
and the "narrow and
By
a
Peripatetic Contributor.
lay through Chicago to Canada and the Eastern States, where we saw what we could of the various medical institutions, though we cannot do more here than touch Fkom
lightly
Utah,
on a
our
route
few of them.
Let
us
take first the
medical schools, and the education and sion in America.
position
subject of profes-
of the
wide-spread impression that American degrees and American are infinitely below the English standard prevails among the profession at home ; and even men who are usually well-informed are apt to shake their heads and shrug their shoulders when they hear them mentioned. Some practitioners, indeed, talk as if all foreign degrees were worthless, and the holder of any diploma not borne on the Schedules of the Medical Council has but a bad time of it with his confreres, should he base his claims to public confidence upon it. It is true that we, English, are not the only sinners in this respect, for, unfortunately, the spirit of complacent self-satisfaction A
doctors
which leads
men
to conclude their
own
conditions and surround-
ings to be by nature the best, is limited to no nationality, profession, or time. It was this spirit which animated the Jews against the Gentiles, and the Greeks and Romans against the " barbarians ;" which makes modern European nations arrogate of "the civilized to themselves and their offshoots the tit world," and on the other hand, leads the Chinese mandarin in his turn to denounce Europeans as " outer barbarians" and " foreign devils." It is seen in perfection in the domain of religion,, where each sect seems to claim a monopoly of truth; and to a extent in the various schools of law, philosophy, and art. In politics it is almost as rabid as in religion and more dangerous. That medicine is not exempt from its influence is less
proved by the long range of bitter controversies in the past, and by the determined opposition which almost every innovator on the doctrines of the day has met with, from Paracelsus to Jenncr. It is the result of indolence and imperfect knowledge, of personal and national vanity, jealousy, and other factors,?nqt unfrequently of mere accident. The profession in Spain still suffers in reputation from our recollections of Sangrado, and the Frcr.ch physicians from the cutting satire of Moliere, while in our own day Italian medicine lias been unduly degraded io conae-
July 1,
NOTES FROM THE UNITED STATES AND CANADA.
1875.]
quence of the treatment of Cavour, and at this moment English surgery is under a cloud on the C-mtinent owing to the mistaken diagnosis of an English surgeon in the case of Garibaldi, and the death of
conspicuous personage while under As in all these cases there is a certain sub-stratum of fact and of truth, while none of them warrant the broad deduction drawn from them. So with the subject which treatment in
a
still
more
England.
has led to these remarks. There have been, perhaps still are, in America some colleges whose degrees are practically worthless, and others where the standard attained is low; but we are hardly as yet so free from reproach in this matter that we can afford
to throw stones ; and there is no doubt that many of the American a higher standard than some of our examining boards, and quite up to the average of the whole; while their best men are no whit behind the leaders of the profession in
schools reach
this country either in general culture or in professional skill. The standard is moreover constantly improving, and although political conditions render uniformity impossible and lead to a certain laxity here and there, the efforts of the profession
generally, and especially of the various medical societies, to raise the social and educational standard of the profession are most commendable and are meeting with considerable success, the chief difficulties met with are the powers possessed by each state to make what medical regulations it that the community is still young and
pleases, and the fact only beginning to have
proper facilities for special education. In the early days of the Republic, as in England prior to 1815, the happy-go-lucky system of apprenticeship was the only way in which a man could fit himself for practice, unless he resorted to
of the very few medical schools then open, or came to Europe, many did for more systematic training. Some of the best of the older generation of living practitioners picked up their knowledge in this way, which, if it is not to be compared with the system of modern education, had yet advantages of its own, one
as
some of which are in danger of being lost in the present day. At that time no doubt there was practically free trade in medicine, and in some states the regulations are still so lax that quackery flourishes unchecked ; but, as a rule, the states have come to see that the maxim of caveat emptor is perilous in its application to physic, and most of them have now a recognized college or colleges, entitled to confer degrees, and no man is considered a practitioner who has not graduated at one of these. In
regular
1873 there were in the Union 59 such Colleges, with a staff of 780 instructors and 6,491 matriculated students, 1,941 of whom graduated during the year. In some of these, as we have said, the education is imperfect and the degree inferior, but in many of them the course of study is very complete and well conducted, and a very thorough education is given in all branches both
theoretical and practical.
The Chicago Medical College or Medical the North-Western University may be taken as
Department of a good example of the better class of schools, and, though founded only sixteen years ago, has already done much to raise the status of the profession in the North-Western States. The College building is one of the finest in the Union, and contains all necessary class-rooms, laboratories, museums, &c. The dissecting-room, "which is large, light and airy, is situated on the top storey, and the bodies?which are plentiful?are taken up and removed by a lift. Fire plugs, and these are fitted on every stage of the building, and a fire escape provides for the safety of the students in case of accidents,which, as our readers know, are common in Chicago. The medical faculty is complete, and numbers several wellknown names. The course of study extends over three winter sessions of five month3 and a half, and two summer sessions of three months each, and the lectures are so arranged as to lead the student on by easily progressing stages in the natural order of his subject?, so that the mastery of each prepares him to move easily, and fully master the next, while his mind is at no time burdened and confused with
a
vain attempt to
181
ramble over all the branches of medical science in sixteen or
eighteen weeks, as is the case in some American Colleges. Chicago set the example, since followed by Harvard (Boston) and other schools, of three annual courses, and a division of the professional examinations into sections to be passed at the end of each year, but competition still prevents this from being made compulsory, and a student who has completed a year of study by apprenticeship or otherwise may, if he can, pass at once into the second course, and finish within two years. The majority, however, go through the official programme, which follows very closely that of the English and Scotch schools. All the preliminary education insisted on can be obtained at any ordinary school, but most of the men know some Latin and a little Greek, while a few are graduates in arts of one or other of the numerous Colleges scattered over the country. Practical instruction is afforded in the Mercy Hospital, a large and well-arranged building, capable of accommodating five, hundred patients, situated in the same "block" as the College, and in the Davis Dispensary, which, of the hospital. may be called the out-patient department Besides the ordinary division into medical and surgical wards, there are departments for diseases of the chest, diseases of women and children, eye, skin, and venereal diseases ; in each of which special clinics, with practical instruction in auscultation, the use of the speculum, ophthalmoscope, laryngoscope, &c.( are given daily to divisions of the class numbering from six to eight students. The total number of students is about a hundred, and by this arrangement each one has an opportunity of acquiring at least a superficial knowledge of all the practical branches of the profession previous to graduation. Courses of practical chemistry and toxicology, instruction in. the use of the microscope, and atteadance on cases of labour are included in the curriculum, and the museum, which though small is well kept and constantly improving, fairly illustrates all that is most essential in anatomy, pathology, and surgery ; the series of gun-sliot specimens being remarkably complete, was near Chicago. as the largest depot for confederate prisoners The total cost of the curriculum, including a graduation fee of twenty dollars, is about ?10, which is less by half than at Boston or San Fancisco, but considerably higher than at some of the With all the newest medical and State Aided Colleges. surgical appliances and methods, the Chicago Staff, and consequently the students are quite familiar; and our enquiry convinced us that it must be the fault of the students themselves if after going through the very complete course just sketched they are one whit inferior in attainments to their con-
in any of our home colleges or schools. same conclusion was forced upon us at Boston and New York ; and if it be said that these are the best schools?as Philadelphia, Cincinnati, St. Louis, and San Francisco would
freres
The
by fairly represent the state of medical education in America, it might be auswered that as these, their best, answer to our best, so are the others to some other no
means
admit?and do not
of ours, which shall be nameless. Certain it is that the Canadian Schools, whose lectures are received by our own examining boards, and whose graduates often take good places, in our public competitions, afford fewer practical facilities than any of those mentioned, for attaining a competent knowledge of the profession. At Toronto there are no less than three separate schools, a great waste of power, especially of teaching and special clinics are not nearly s? power ; and the hospitals with material as Chicago, while subjects for dissecwell
supplied
tion are so scarce, that body-snatching is said to be frequently resorted to. The school forming the medical department .of the McGill University at Montreal is probably the best in Canada. It is situated a little away from the University proper, and is & substantial stone building very fairly furnished with all modern teaching apparatus. The staff is of admirable quality, and hopes are entertained that endowments sufficient to retain first-rate and
men
will
Physiology,
soon
be obtained for tiie chairs of Anatomy Au excellent medical
if not for others.
library
THE INDIAN MEDICAL GAZETTE.
202
of 4,000 volumes, open to the students, is a good feature in connection with this school. We noticed the " Indian Annals" and other Indian works on the shelves. A matriculation examination,
by the General Medical Council, is insisted on, and themedical course extends to fourannimedici,three of which must be at a recognized school. So far Canada is in advance of the States, and the systematic teaching leaves similar to that recommended
but the opportunities of practical limited that for ourselves we should prefer instruction are Chicago as a school. Tho Montreal hospital contains only 140 to
nothing
desired,
be
takes a
leading place by
[July 1, virtue of its
culture,
1875.
and in those
plea-
sant coteries by which American society and American humanities are chiefly known to us, are many medical men who take an equal place with the Einersons and Irvings, the Prescotts and Motleys, the Long-fellows and the Bryants. There is much more of " sweetness and light" in the States than uninformed strangers generally suppose, and the members of our profession
have their full
share of it and
of the consideration which it
self-regarding prejudices of birth and education" which lead many in England to disparage American society would rapidly disappear; could the two peoples teds, and the wards are small and ill-ventilated. Improvements be brought into nearer contact ? It is a society, per se, which,, are much needed. and cases Phthisis and typhoid aro promised, while it has all that is best in European culture for its basis, occupied most of the beds on the medical side during our visit. is yet strictly national, and has well marked individual pecuwhich is and is as common, unfortunate, shipping Erysipelas very a and piquancy of its own. machinery accidents are numerous, and get more frequent yearly, liarities, which give it raciness And here, in conclusion, we must say a word as to the great owing to the rapid increase of the city, the finest and most Mr. and kindness shown to us throughout our trip. flourishing in Canada. Stone is rare, only some twenty cases civility Erichsen has borne public testimony to the cordiality and having presented themselves in the last six years. We saw an heartiness of the welcome he met with, and to the kindness and interesting case of popliteal aneurism, which had been comThe hours. in twelve cured hospi- hospitality everywhere lavished upon him. He was, however, by digital compression pletely previously well known, by name at least, to every Surgeon in tal work is taken in rotation by the medical officers, two at a America, to most of whom his book is a sort of surgical bible ; time, in tours of three months--a good plan considering the but the same cordial welcome was everywhere accorded to u?, all as students are as and of possible many small number beds, unknown even by name, and without (at first) other introduction employed as dresaers and clinical clerks. The school is than a common calling card. Leaders of the profession took attended by from 150 to 180 pupils from all parts of Canada, furnished us about, shewed us the hospitals, asked us to dinner, its The on deserves awarded and certaiuly popularity. degree us with introductions, and gave us every assistance and informgraduation is the double one of Doctor of Medicine and ation in their power in a way which astonished us, and to which Master of Surgery, there being no division of the profession this poor acknowledgment does but scant justice. and in British Northinto Physician Surgeon exclusively America, although of course each practitioner, while taking general practice, may lay himself out for any special subject so
or
branch.
The school at Quebec is similar to, but smaller than, that at Montreal, but the hospitals afford even fewer facilities for practical work. The Marino Hospital?which is the chief?is old, dingy, ill-constructed, badly situated, badly ventilated, and out of
and
repair.
The Hotel
Dieu, in the upper town, belonging to, sisterhood of French nuns, is a model for cheerfulness and good management, but 13 not open
mannged by,
cleanness,
a
to the students. Complete courses of lectures are given, as at Montreal, and the examinations are said to be very thorough, and the degree a good one. A thesis has to be defended at tho end of the second year, and every student has to pas3 a quarbefore the Senate, so that theoretically at least the men are well taught. The absence of proper oppor-
terly examination
tunities for hospital practice, and for acquiring a practical initiation into the art of healing, is however a great drawback ; and, though the most i3 made of the clinical opportunities ?which offer, and severe accidents ai-e not uncommon owing to the large shipping and timber trades, of which Quebec is the head, the material for illustrative teaching i3 lamentably small, and we hold that however competent a teaching and hospital staff may and that at Quebec is thoroughly so?medical education, minus good and full clinical instruction, is like Hamlet with Hamlet left out, and is more likely to qualify its pupils for the Wo havo role of the grave digger than for useful practitioners. no intention to apply this metaphor specially to Quebec, for we Inow at least one school at home with even fewer advantages. We have said so much of tho education that wo must dismiss the subject of the social position of tho profession very briefly. In America, as elsewhere, the position of the individual depends?as it naturally must?entirely on his personal qualities ; "but the conditions of society aro such that if these are good, they carry him to a (relatively) higher height than they can do elsewhere. From tho absenco of a hereditary nobility and the paucity of old families?tho few thero aro pride themselves on their descent quito as much as tho3c of Europe?tho two chief claims to social distinction have come
to be wealth
profession
and intellect; and while, as a rule, tho has small claim to consideration for its riches, it yet
brings
:
and the "narrow and
