MEDICAL EDUCATION IN FRANCE. THE present organization of the hospitals, medical schools and laboratories of France, and more particularly of Paris, is the product of centuries of experience and gradual evolution, and it differs materially from that of other countries. For abundance and diversity of teaching, wealth of material and facilities for study, Paris is one of the most renowned medical centres in the world; and the advantages it offers are, with the most generous and courteous hospitality, freely placed at the disposal of students of all nationalities. The harmonious unity characteristic of the whole system is the result of a centralization and order of government that extends to the minutest details, and simplifies and regulates the work in every brauch. Those who come for clinical observation and work in the hospitals and laboratories with a view to complete studies commenced elsewhere are subjected to no examinations or vexatious requirements; they have no fees or charge of any kind to pay; and they are at liberty to follow their own inclination in choice of work or attendance. Where the student aspires to a certificate or diploma there are certain fixed charges, which, however, are slight. The total fees for the whole curriculum of medical study and for the whole series of examinations, covering a period of five years, which must be passed to obtain the diploma of M.D., is about $175, and this sum includes the cost of anatomical material. Students and practitioners who attend the courses of the Faculty of Paris cannot but remark the facility of expression, the wide knowledge and orderly habit of teaching which are common to almost every one of the officers of the hospitals and schools. This is not the result of chance, but comes from a most laborious and unique system of preparation and final selection by concours, or competitive examinations. The hospital surgeons and physicians, the assistant professors, and the lecturers and professors of the faculty, are all, from the very outset of their career, taught to aim at the acquirement of complete and almost encyclopedic information, and to practice the arts of logical arrangement, lucid exposition and orderly teaching. The office of resident hospital surgeon or physician is the most coveted of all posts, for it is from this position that the first steps must be made that lead successively to the rank of supervising hospital officer, assistant professor, and, finally, professor of the faculty. To attain this initial position the senior students attend classes amongst themselves, at which the senior house and a fixed period is allowed for preparation. large amphitheatre of the faculty, dressed in evenThe candidates are required to deliver a lecture ing costume, and with the notes thus briefly ardasting three-quarters of an hour on any subject ranged delivers a lecture occupying exactly the within the range of scientific or practical medi- time prescribed. Successively each candidate decine or clinical experience. livers an address upon the subject that chance The public competitive lectures illustrate the has assigned him; and it must be said that these fundamental difference between the schools of orations are remarkable for their fluency and the Paris and those of other countries. Each can logical development of each separate element in didate in turn draws by lot, from a number of the history, pathology, anatomy, differential dipapers previously prepared by the judges, the sub- agnosis, clinical consequences and general treatject for his discourse, and from this chance selec- ment of the disease. tion, after fifteen minutes granted for preparation of his notes, he mounts the rostrum in the In front of the lecturer sit ten professors of the Faculty of Medicine of Paris and of the provincial Faculties of Nancy and Montpellier, arrayed in their picturesque scarlet robes and velvet caps. The great amphitheatre is filled with an audience of several hundred medical men and students, and it is not too much to say that each one of the addresses exhibits a mastery of rhetoric and a profundity of knowledge that go far to explain the high position held by this school in the scientific world. Medical teaching in Paris comprises official, didactic and clinical courses given by the faculty, and hospital teaching, where the members of the faculty are re-enforced by a great number of physicians, surgeons and accoucheurs appointed especially for this purpose. Professors GermainSée, Jaccoud, Potain and Peter occupy the four chairs of clinical medicine; Professors Verneuil, Le Fort, Duplay and Le Dentu the chairs of clinical surgery. Besides these, there are the special chairs of clinical teaching represented by Professors Charcot* (nervous diseases), Ball (mental diseases), Fournier (syphilitic and skin diseases), and Grancher (diseases of children). Tarnier is surgeon in chief of the Maternity, with Pinard head of the clinic of accouchement, and Panas of that of ophthalmology, while Guyon treats of genito-urinary diseases and operations. Added to these, there is an extensive system of free teaching by the assistant professors of the faculty, or agrégés, who train the students in the A HOSPITAL AMPHITHEATRE. elementary and systematic courses of ordinary medical education. are The Faculty of Medicine is composed of thirtysix professors and one hundred assistant professors, or professeurs agrégés, whose courses principally in the hospitals and laboratories, and about 950 externes, internes and chefs de clinique, forming the staff or personnel of the different branches of the service. These positions, even to the highest, are open to men of foreign birth. Professor Brown-Séquard was an American, Professor Ball an Englishman; they became naturalized before they were appointed to professorships. Besides these, there are about 100 celebrated physicians and surgeons who are appointed to give clinical instruction in the hospitals, and some of them alsogive lectures in the hospital amphitheatres; Professors Péan, Pozzi, Lucas-Champonnière and Labbé are amongst the celebrated surgeons; Professors Dujardin-Beaumetz, Jules Simon, Lancereaux, Huchard and Luys among the physicians. The statistics of last year show that the Faculty of Paris had 9,215 students in attendance, as compared with 6,220 at Vienna and 5,527 at Berlin. The foreign student or practitioner coming to Paris to supplement or complete his studies generally seeks some specialty, either medical pathology and medicine, or surgical pathology and surgery, accouchement, or some department of laboratory work. The whole resources of the Faculty of Paris, the hospitals and the numerous medical laboratories, and those of the Sor-bonne, the Museum and the College of France, are open to him free of charge. In order to obtain the degree of Doctor of Medicine of the Facuity of Paris the student must possess. the diploma of Bachelor of Arts, or certificates of studies equivalent. If, in addition, he holds the degree of M. D. from any recognized foreign college, he may be exempted from a certain number of the earlier examinations, or at least may be permitted to pay all the subscriptions at once and proceed with his examinations as rapidly as he deems himself prepared, instead of pursuing the four years' graded course. He must apply, through his embassy or legagation, to the Minister of Public Instruction for permission to enter as a student at the Facultya permission rarely refused. Once inscribed, he must pass, in the order named, the following examinations, which take place in public before three examining professors, except the one at which he delivers his thesis, when four are pres ent: 1. Physics, chemistry, natural history, with practical recognition of plants. There are only three medical faculties in France, namely, at Paris, Nancy and Montpellier, all under control of one central government, the course and requirements being the same in each. There are 32 hospitals, having 12,486 beds, attached to the Paris Faculty, in which official teaching and clinics are given. If he intends to follow a practical course in medicine (pathologie interne), the student can choose the clinics of Professors Jaccoud and Robin at the Pitié, Potain and Bouchard at the Charité, Peter and Dieulafoy at the Necker, and Germain-Sée at the Hôtel-Dieu. For the study of surgery and surgical pathology there are the clinics of Pro 2. Anatomy, with demonstration of dissection: and his- fessors Le Fort at the Hôtel-Dieu, Tillaux at the tology, with microscopic demonstration. 3. Physiology. 4. Surgery, with practical demonstration in the anatomical dissecting room. Accouchement (oral only). 5. Practice of medicine and pathology. Pitié, Duplay at the Charité, Le Dentu at the Necker. To each of these chairs is attached a clinical chief (chef de clinique), who has taken his degree, and who has filled, for at least four 6. Hygiene, legal medicine, therapeutics, materia medica years, the office of interne in the hospitals. He and pharmacology. 7. Clinical surgery at the hospital: clinical obstetrics at the hospital. 8. Clinical medicine at the hospital; practical demon stration in pathology. 9. Thesis, which must be based upon some practical work of the author. replaces the professor when the latter is absent. These clinics are given by the professors at the hospitals, generally from nine to eleven in the morning. Besides these official clinics, there are numerous physicians and surgeons appointed to each hospital, whose clinical and didactic courses |