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The Medical Schools of Scotland
From the Scottish Review of January 1894

ONE of the staple trades of Scotland is undoubtedly that of making doctors. During the five years 1888-92, there registered, as commencing their studies in her medical schools, 3,327 medical students, and during the same period there were licensed over 3,000 practitioners of medicine, brand new, qualified and authorised by law to practise every branch of their profession, and each with the hall mark of one of her Universities or licensing bodies. About one third of these were needed for home use, to make up the tear and wear among the existing doctors, and to supply the needs of the yearly increase of the Scottish population. There remained about 2,000 for export. It must be remembered that there are only 30,000 medical practitioners with British or Irish qualifications alive at home and abroad, in practice and out of practice, and that the whole number of diplomated practitioners turned out of all the British and Irish Schools of Medicine has been 6,630 during the past five years. Scotland, therefore, with only 11 per cent, of the population of the United Kingdom, has supplied 45 per cent, of the new crops of doctors for the Empire. This is a fact of great interest not only to Scotsmen but also to the rest of the kingdom and to our Colonies, where so many of her medical graduates go. The general public has a very profound concern in this matter, far more than many persons realise. Any man, woman, or child, in this Kingdom, or in our Colonies, may be the better or the worse for the kind of medical education given in Scotland. Their life or death may depend on it. Apart from the mere technical questions connected with medical education, the public, who are the doctors' masters, and fur whose service they are created, should know the general principles on which that education is now conducted, and should be encouraged to interest themselves in many, even of the details of modern medical schooling. Nowadays, the more the public know about the basis of all technical and professional institutions the better. The more every father and mother of a family understands of the principles of medical education the better, for they are as responsible for the health of their children as for their morals ; and their sons and daughters may themselves want to become doctors. The more correct the knowledge every Member of Parliament, and indeed every member of a Town or County Council, has of the qualifications required for a good doctor, the better it will be for the profession of medicine and for the public, whose health and well-being he is bound to conserve. When a man gets a diploma entitling him to practise medicine, he receives many valuable privileges with the view of his doing many responsible duties to the public. The profession of medicine is now urgently claiming a voice in framing sanitary and other laws; and it is the natural vehicle through which many of these laws, when passed, are carried out for the benefit of the community. The public should know not only how the doctor of to-day is made, but should understand to some extent the evolution of modern medical education. The medical student of 1893 has to study many things not required of his predecessor of 1883; and the methods and scope of his education have totally changed in manner and degree during the past forty years. within twelve months an extra year has been added compulsorilv to his period of study before he is allowed to come up to any examining board for a diploma, that is 25 per cent, to the four years needed previously—one fourth more in effort and cost—and a deduction of one thirtieth off his average money earning period of life. This means that the ideal of medical education has risen, and that its practical requirements have greatly expanded in recent years.

Let any one, when his life is in the balance, try to realise what he would like his doctor to be and to know. It does not need a vivid imagination in any man to conceive how much may depend on his doctor's knowledge, on his skill, and on his experience. It is a trite question, 'What is life without health % ' Few persons but have had its truth vividly before their minds when in pain or weakness. One's doctor may make all the difference whether life is worth living or not. He is welcome when no one else is admitted. Not only his knowledge and skill and practical resource, but his tone of mind, his honour, his courage, his sympathy and his innate power of inspiring confidence, may make a vast difference to any of us, a difference it may be between sanity and insanity, between penury and competence, or even between life and death. Few realise how much they are dependent on the sense of duty and the honour of the doctor apart from his professional skill. What do they know about the effects of the powerful drugs he gives? How can they detect or counteract his mistakes? Their bodies and their lives are in his hands far more absolutely than are the lives and fortunes of his subjects in the power of any Eastern despot. From the public point of view the profession of medicine is filling year by year a larger space. The community is looking to it for more light and leading about sanitation, about education, about the choice of occupations and professions for young people, about how to keep well and happy. Practical questions connected with heredity loom in the near future. Well might Mr. Gladstone say that of all the professions it is the one which is in the ascendant at present. Mr. Disraeli did not without cause construct his epigram ' Sanitas sanitatum omnia sanitas,' as being the question of questions at present. Lord Salisbury has lately added his emphatic concurrence as to the power and usefulness of the medical profession in modern life.

Let any intelligent man try to picture an ideal doctor, and, though ha will not succeed, for he does not know enough of the requirements, he will soon realise what an efficient medical education means, and the manner of men who should have the education of the doctor of the future. Let any man get and place before himself a series of the text books of to-day in the various subjects that must be studied by the medical student, and glance through them sufficiently to see the multiplicity and variety of the knowledge contained in these books, and he will have no doubt whatever that to master these subjects in any sense must require the best five years of any life. He will find that a minimum of 10,000 octavo pages of close print, must be read, marked, and digested. If he then tries to imagine that every one of those great volumes only contains the theory and the word-description, while the practice and the real knowledge of its subject must be obtained in the dissecting room, the laboratory, the hospital, the dispensary, the si^k room of the poor, and the asylum, he will be verily appalled by the task before every young man and woman beginning the study of medicine. There is not. one of those subjects but takes the whole undivided time of main-experts of great mental energy to cultivate it. Anatomy, which deals with the form and relations of all the organs and structures of the body, from the largest to those that need a microscope of high power to see; physiology, the science of normal life and function, and pathology, the science of abnormal life, structure and function, are the three great basal sciences on which the doctor's whole superstructure of professional knowledge and practice must rest. The knowledge in regard to the two last, physiology and pathology, are in a continual state of advance and flux, so that the text books of ten years ago are antiquated to-day. The proper study of these implies a mind eager to question, and, if possible, to penetrate the occult secrets of life .that have fascinated and puzzled the greatest minds among mankind in all civilized ages. Surgery and medicine, the technical parts of his course, are different and wide domains of knowledge, yet the student lias to know them, or he can be of no service at all. All the 'ills that flesh is heir to' are there depicted, so that in the hospital and bv the bed-side tliey may be diagnosed and treated. Knowledge and modes of treatment, and technique too, are ever advancing and changing, and his teachers, year by year, must advance. Most surgical operations are very different procedures now from what they were twenty years ago. Midwifery, and the diseases peculiar to women and children, must be studied carefully, for they form a large part of every medical man's practice. The ' specialties,' diseases of the eye, the ear, the throat, the mind and fevers, all claim some attention, and all are pushing their importance on him. Let any man go with a doctor in busy general practice, for a week, and see what he has to do each day, and the problems he has to solve, and we venture to say that he will be amazed at the extent of the practical skill and scientific knowledge called into exercise, and will be surprised that even in a five years' course of instruction he could have acquired it all. He has daily to see from 20 to 40 patients, almost all suffering from different complaints; his advice is asked about a dozen questions in each case, each needing wisdom as well as knowledge. His memory is crammed with secrets which he must not in honour divulge. To say that he must be a man of high moral tone is a truism. He must, in addition to common morality, have that delicacy of mind and that healthiness of moral constitution to which pruriency and smallness are absolutely unknown. His very presence should abash certain evil modes of looking at things. His whole life should be a public and private example.

If any one will take a good Annual Report of an ordinary Medical Officer of Health of a County, and peruse it carefully, he will see what a medical education means in that direction. The topography of the County, the climate, the rainfall, the occupation of the inhabitants, the diseases they are subject to, and that they die of; the kind of houses they live in; the epidemics that have been prevalent, with the modes of isolating and arresting their progress, are all treated of. Such documents freely circulated and read are one of the very best popular sources of education in health and sanitation. The Reports of the Medical Officer of-the Privy Council, and the Reports of the Registrar General, are documents of supreme importance to the community. They are often marvels of industry, of patient searching out of causes of disease, and of profound scientific reasoning. They all depend on the knowledge modern medicine has given us, and are all written for the good of the public. They often treat of the effect of environment on health in a way that is most instructive to legislators. The mere enumeration of the different death-rates among the various trades and professions, with a medical commentary on the causes of the great differences that are found to exist, touches questions that affect every man who has his living to earn, and some of the people who are so unfortunate as to be idle. Some of the Blue Books, such as the Report of the Board of Supervision and the Report of the Commissioners in Lunacy, are full of medical facts, needing interpretation to the public for their information and guidance. In all these documents, and their value to the nation, medical education plays a part.

In any account of the medical schools of Scotland, that of Edinburgh must stand out above all the others, overshadowing them by her marvellous success, and having influenced them all by her example and through having sent to them men imbued by her spirit and trained in her class rooms to be their most successful teachers. Her spirit has gradually pervaded the other schools, so that in their modern history they all may be truly said to be her children. With her 2,000 medical students, drawn from every quarter of the world, only about 45 per cent, of them being Scottish, her yearly output of 450 medical graduates and licentiates, her list of illustrious medical teachers, investigators and authors, and her position as the second or third medical school in the world in number of students, the gray metropolis of the North may well be proud of what she has achieved in the past and is now doing for medicine, and through it, for humanity. Edinburgh had no special advantages for developing a great medical school, such as the endowed hospitals of London gave the metropolis. She gradually, almost tentatively, produced a system of teaching largely her own, and she has always had an abundance of earnest and enthusiastic men to devote their lives and best energies to teaching, and to hand on the torch from one generation to another. Medical teaching in Edinburgh did not begin in the University, and has never been confined to the University, yet for a century and a half the University has been its centre. The Colleges of Surgeons and Physicians both began the teaching of Anatomy, Surgery, and Medicine before any Medical Faculty existed in the University, or any real medical teaching existed there. Eight of the Medical Chairs were instituted at the instance of the Royal Colleges. The Royal Infirmary of Edinburgh, which has been the great clinical centre of instruction, without which there never could have been an Edinburgh Medical School, was founded by the College of Physicians, Lord Provost Drummond, and the first Monro, in 1736. No doubt there were Professors of Medicine in 1685, but no practical teaching was done in the University till the first Monro was made Professor of Anatomy and Surgery in 1720. It was a happy combination of five institutions in Edinburgh that created its Medical School. The Colleges of Surgeons and Physicians, the Infirmary, the University, and the Town Council, by their common efforts, by their rivalries, by their combinations and by their competitions have unquestionably done so, so far as institutions apart from men can be said to create anything. And, as we shall see, the absence of any single guiding and regulating authority gave a spirit of freedom and of spontaneity that has really been one great source of its life. The struggle for existence in nature has been repeated in Edinburgh with happy effect to its medical teaching. The strong have lived and established themselves, while the weak have gone to the wall; and there have always been successive crops of vigorous youth to strive for mastery over each other, and to take the place of the old. In Anatomy, the foundation of medical study, a series of men of extraordinary ability and fitness have followed each other in the University and outside its walls. The story of the two first Monros, as told by Dr. Struthers in his Edinburgh Anatomical School, is a very remarkable one. Of a good Scotch family, John Monro, a man of high professional and social position, a surgeon in Edinburgh, trained his son, Alexander Monro, from his boyhood for the Anatomy Chair. He was sent to London and Paris, and Leyden, and on his return was elected by the Town Council to the Chair of Anatomy when 22 years of age. The Town Council had, in the dark age of Scotland, in 1505, made provision for the dissection of the human body—a wonderful example of farseeing wisdom. The first Monro had a most distinguished career as a teacher, a practitioner in the city, an author and an original investigator. He trained his youngest son, Alexander, ' Monro Secundus,' to follow in his footsteps. He became as great a teacher and author as his father. The father began with 57 students; the son ended with 400. So great had the fame of Edinburgh as a teaching school of medicine become by the end of last century.

Goodsir, a man of real genius, caught up the new ideas of the German anatomists, and of Owen, and extended their scope. He was not content to describe what could be seen by the naked eye, but used the microscope as a part of his ordinary class instruction, and did not confine his investigation to structure only, but was always asking what form and structure meant when in vital action. He was thus one of the founders of Modern Physiology. Then came Turner, when still more thorough and systematic teaching was needed; when, through the enormous increase of the number of students, a new department was required for the subject, with a new and more thorough organisation and administration. This remarkable succession of teachers within the University was not the only source of instruction in the subject in Edinburgh. The Colleges of Surgeons and Physicians originally established teachers in various subjects, but in time other men wished to teach and were encouraged to do so. So that there sprang up outside of the University, teachers in this and all other medical subjects. In 1855, on Professor Syme's initiative, and after a severe fight, these lectures were accepted by the University as being of equal value to the teaching of the professors, to the extent of four classes out of the whole curriculum. This was called at first 'The Extra Mural,' or 'Extra Academical School,' and now 'The Edinburgh School of Medicine.' Any man who satisfies the Colleges that he can lecture, and has the means of proper teaching is allowed to do so. As many as like can lecture on the same subject. If the professor gets old, or lazy, or inefficient, the students can go, and do go, to the extra mural teacher. A healthy rivalry and stimulus were thus established. There are often three or four teachers of Anatomy, and five or six teachers of Surgery and Medicine. The system allows any man to try his power. If he succeeds he gets students and an income, and has a good chance for the professorship when it becomes vacant. That, indeed, is commonly his goal. If a professorship of his subject falls vacant in another Scotch or Irish University, or great English School, he has already proved his fitness and often gets the appointment. Thus in Anatomy, when Monro tertius was getting old and decadent, Bell, Barclay and Knox, as outside teachers, taught the students, while the .Anatomical School has sent out to other schools as anatomists or surgeons—the two subjects were so closely connected early in the century that one man often taught both—Sharpey, Allen Thompson, Ferguson, Lister, Struthers, Cleland, Cunningham, Thomson, Symington, and many more. When a man could get no students or lost the Chair he was aiming at, he often quietly retired and no more was heard of him. The system is one of unlimited competition, and giving a chance to every man who imagines he has a vocation to teach. But it may be said that this is a very unseemly scramble for students and their fees, and is unacademic in its tradesmanlike pushing of business. No doubt both these results sometimes happen; but we must take the bad with the good in every system, and up to this time and in this country no other has proved itself to have half the vitality or to produce anything like the good lessons this has done. The system of salaried Privat-Docenten and graded professorships in Germany, of graded promotion in France, of fellowships in the English Universities, and of a multiplicity of small appointments in the medical schools of the hospitals of London and Dublin, all have their advantages, but the Edinburgh system seemed to suit the northern soil, and it was one of spontaneous growth very like nature's processes. It must be kept in mind when estimating the system, that in Edinburgh the professors derived their incomes chiefly from their students' fees, and in proportion as these students were attracted to the extra mural teachers the professors income fell off. It was a system therefore of every man for himself, and starvation to the hindermost, in and out of the University. No other school has adopted the same system. It is unique in the world. The new Universities Commission have, by their recent ordinances, seriously modified the competitive aspects of the system so far as the professors are concerned. They are in future to have an irreducible minimum salary and a fixed maximum. Starvation is not to follow incompetency, the slothful professor is not to come to want, and a brilliant success is no longer to lead to fortune.

Professorial human nature is thus to be deprived of two strong motives to exertion, and there will be an undoubted risk of a standard of work being fixed to suit the pay. Duty, scientific ambition, academic pride will still be left as motives to hard work; high thinking and plain living, being compulsory. Time only will show whether the teacher of the future will work as hard when a legitimate sordidness has been thus eliminated. We have taken the subject of Anatomy to illustrate the Edinburgh system. In almost all the other subjects the same general history applies. It would be beyond the limits of this article to enumerate the galaxy of great medical names that the Edinburgh school has produced during the past 150 years in every department. Men of genius and men of great talents have abounded. In Physiology, Bennett and Rutherford; in Physic, the two Gregorys, Cullen, Alison, Laycock, Bennett, Begbie, Stewart, Greenfield, Balfour, Bramwcll, Wyllie, James, Affleck, and Gairdner; in Surgery, John Bell, Sir Charles Bell, Syme, Liston, and Lister, Duncan, Annandale, Bell, Watson, and Chiene; in Materia Medica, Duncan, Christison, and Fraser; in Midwifery and Gyneocology, the Hamiltons, the Simpsons, Keith, Matthews Duncan, Croom, Berry Hart, and Barbour, are names of European reputation that have attracted students from all over the world, and raised to a high pitch the fame of the Edinburgh School. It is truly remarkable that in Medicine so brilliant a combination of men should have arisen in so remote a corner of Europe. No doubt it was partly due to the system of open competition in teaching, but also largely to the fact that men devoted themselves to teaching as their great aim and highest professional ambition, and that a practical subject like Medicine seems attractive to the Scottish inind. There is something clue to the fact that the profession of Medicine is free to all men, is hampered by no artificial obstructions, and is open to men of small means, and that when men enter it they have a fair field and no favour. The number of Edinburgh men that have risen to the highest eminence in London have been innumerable.

The steps through which the Edinburgh School has passed through her chief stages of evolution have been; first the demonstrative teaching of Anatomy and Surgery by the Monros, then the great epoch-making work of Cullen in general Medicine, then the work of Syme in Clinical Surgery, of Christison in Materia Medica, and of Simpson in Midwifery and women's diseases. Following close on this, Hughes Bennett, after the French lead, devised a system of teaching Medicine clinically, literally by the bedside, that had never before been equalled in Europe. Then Lister began in Edinburgh that system of ante-septic Surgery which he further developed in Glasgow and London, and which has entirely revolutionised the treatment of wounds. Thomas Keith was one of the leaders of 'Abdominal Surgery,' through which hundreds of lives are now saved. On the foundation of each of these men's labours and discoveries his successors in Edinburgh built up a goodly fabric. Neither the science nor the practical methods were ever allowed to become fossilised in unquestioned and unthinking stagnation. Finality was never written up. Every now and then there were brilliant and dramatic eras in the school, such as Sir Charles Bell's discovery of the distinction between the motor and sensory system of nerves, Sir James Simpson's discovery of the anaesthetic properties of chloroform, and Sir Joseph Lister's treatment of wounds antiseptically. Such things drew the attention of the world to the school, and immensely added to its numbers of students, which rose from 400 or 500, to which they fell in 1826, up to at least 2,200, in 1892.

We have purposely not referred to the purely scientific subjects of Botany, Natural History and Chemistry, which the Edinburgh students who aimed at the University medical degree had to study. No doubt, these might have flourished in Edinburgh had there been no medical school at all, but practically they were dependent on that school, and helped it on greatly. One of the characteristics of the Edinburgh medical student has always been that he dabbled in pure science more or less ; that early in his career he was a naturalist and cultivated his scientific instincts, and that in a very large number of instances, indeed his heart and mind were captivated by one of these sciences, so that after he took his degree, he devoted his life to science instead of medical practice and teaching. Charles Darwin was the greatest example of this, but his followers have been innumerable.

Besides the directly good effect of developing the students' faculties of observation and inductive reasoning the preliminary whiff of science all had to take gave a tone which was of high value to them. It redeemed the merely money-earning aspect of their craft, and helped to form an ideal of life in their youthful enthusiastic minds that soared beyond merely professional success. How few Edinburgh men have not, when in their first years of study, suffocated their landladies bv the chemical fumes from all too primitive apparatus; or formed a herbarium in the summer vacation ; or dug for geological specimens for live-long summer days in lonely quarries; or formed an inchoate collection of badly stuffed monstrosities intended to be a natural history museum! He did not then know it, but to the student's mental and moral nature, this short pursuit of the natural sciences before he settled down to his hard life's work, conveyed some breath of sweetness and light that never thereafter left him. Few of the great medical teachers of Edinburgh have been Doctors or Surgeons, and nothing more. Christison and Maclagan became Presidents of the Edinburgh Royal Society ; Simpson began his lectures on midwifery with a course on embryology, and was besides a learned and enthusiastic antiquary. Laycock could meet the psychologists 011 their own ground, and to a certain extent anticipated Darwin in his doctrine of Evolution, and Spencer in his philosophy. Lister is combined physiologist, chemist, pathologist, and bacteriologist. By such powerful influences and examples was the Edinburgh medical student widened and liberalised in his mental horizon all through his course.

The professional and social tone of the school was high too in regard to money, to professional etiquette, and to a doctor's whole relation to his patient. A high standard was inculcated, and a good example was set. No doubt, one professor or lecturer would be at deadly feud with another, and made no secret of this to his class. It was a common thing for the student to hear Bennett ridicule and denounce in strong and picturesque language Alison's treatment of pneumonia one hour, and the next hear Christison, at the bed-side, contemptuously sneer at Bennett's doctrinaire ideas and practice; to listen with delight to Syme's incisive thrusts at Miller, and Laycock's supercilious references to Bennett's crass ignorance. But such personalities seemed to add interest to the hour's lecture, and to leave no abiding harm. There can be no doubt that the system and the men in Edinburgh produced hard and enthusiastic students, well grounded in scientific methods, and fairly equipped for practice. They for the most part acquired a high professional tone and a largeness of mental vision that raised them above the mere giver of medical services in return for the proper fees. They had some of the divine love of knowledge for its own sake, and thereby breathed a purer air than mere professionals do. The school was fortunate in having its teachers come in many cases from good old Scotch families who gave a high social tone to the profession and secured for it a position in the city equal to any other class.

There are two great recent departments of medicine where Edinburgh has not taken the lead, and, indeed, has scarcely followed the English and Continental lead so quickly as she ought. Those departments are, preventive medicine and bacteriology. The City of Edinburgh, to her enormous credit, took the lead of every city in the world, under the guidance of Dr. Littlejohn, her Medical Officer of Health, in getting a local Act, whereby the medical men were obliged to notify to a central authority every case of infectious disease they were called on to treat. But the great preachers of pure air and water and plenty of them, clean drains, of healthy airy workshops and factories, were found in England, not in Scotland at first.

To sum up—there are such obvious advantages in certain ways in the Edinburgh system that they have merely to be stated to be recognised. In addition to giving every man an opportunity of 'teaching, to the general stimulus of keen competition, to the provision for efficient teaching when a professor is getting old and past his best, to the training of men for professorships; there are other less considered advantages. It provides that the unfit as teachers are found to be unfit, and they retire. There is little or no temptation for either Professor or Lecturer to hold on beyond his period of efficiency. It provides too in the extra academical school for Lectureships on new subjects not in the curriculum, but which will be useful to many students. In this way, long before they were taken up by the University, the students could obtain instruction in diseases of children, eye diseases and mental diseases, in diseases of the ear and throat, in diagnosis, in climatology, in medical electricity, skin diseases and fevers. These are taught by experts, often outside the University, and by young lecturers who are anxious to work and prove their capacity as teachers. Medicine and Surgery are both perhaps tending to split up into specialisms too much, especially in London, but some of the greatest advances have been made of late years through the principle of one able man devoting himself to a special department and sticking to that alone. The range of knowledge is getting too large for most men to master the whole, so a part is selected and worked out thoroughly.

Two vast building schemes have been undertaken and accomplished in Edinburgh in connection with its Medical School within the past thirty years. The Royal Infirmary was re-built on a new site at a cost of £350,000, and became the greatest and best equipped hospital in the kingdom. In 1874 the University determined to re-house its Medical School, and to build and provide for it class-rooms, museums, laboratory and teaching appliances, such as no British school as yet possessed. Partly by subscription among the friends of the University, and partly by a grant from Parliament, the present magnificent new buildings were erected at a cost of £230,000, and were opened in 1884.

Next to Edinburgh as a Medical School comes Glasgow. Its history is in many respects similar to that of the capital, with certain distinctive features. In the beginning of last century Glasgow University had no Professor of Medicine to examine a candidate for the degree of M.D., and had to call In for this purpose two doctors in practice in the city. In 1712 a Chair of Anatomy was established. But real teaching only commenced in 174G, when Cullen began to lecture outside the University with the sanction of the Professor. A Chair of Practice of Medicine was founded for him in 1751. His power as a teacher brought him students, among whom was Joseph Black, who afterwards in succession held the Chairs of Chemistry and Anatomy and of Practice of Medicine, and added greatly to the fame of the University and to the number of its medical students. It was not, however, till the Glasgow Royal Infirmary was founded in 1794 that the medical teaching there became complete in principle. Without an hospital for Clinical instruction a Medical School in any proper sense cannot exist any more than a School of Art without living models, or a religion without a moral code. Glasgow, like Edinburgh, has owed much to competition in medical teaching; but the competition arose and now exists in a different way from that which exists in Edinburgh. The Faculty of Physicians and Surgeons, like the Royal Colleges of Edinburgh, actively promoted medical teaching in and outside of the University before it was taken up there. It claims for itself truly that the earliest medical teaching was given under its auspices. Anderson's College began medical teaching in 1799, and it has continued it ever since, producing many men of eminence, a large number of whom have received promotion to Chairs in the University. It has been a nursery for University Professors all along. It is a cheap school and has given a chance of a medical education to poor men like Livingstone, the great African explorer. It will be an evil day for Scotland when poor men cannot attain professional or higher education through its being too expensive. Medical education has now come to cost a large sum. In London, the ' Student's Number' of the British Medical Journal, for September 1893, puts down the minimum cost at the cheapest schools there, great economy being exercised in living, at £587, while in the provincial schools of England it is put down at £500. Now that is a sum which would have been absolutely prohibitive to very many Scotsmen who have greatly honoured the profession and benefited humanity by their'work. We have no doubt that at the School of Medicine in Edinburgh, or at Anderson's College, or St. Mungo's, or at Aberdeen, a young man, by stern economies, which will do him no harm in the long run, could enter the medical profession for between £300 and £400. Since the University moved from the Old College Buildings to the magnificently appointed palace at Gilmorehill, and the New Western Infirmary was put beside it, four other schools of medicine have arisen in Glasgow. The Royal Infirmary, when most of the University students went to the Western Infirmary, at once utilised its great clinical field by establishing a special school of its own ; and within the past five years St. Mungo's College has arisen with a full teaching staff and with fees only amounting to £50 over the five years of study. A Western Infirmary School or ' Polyclinic' and St. Margaret's College for women complete the present list of six medical schools in the great city of the West.

The peculiarity of the system of competition in medical teaching in Glasgow is, that though very extensive it still is limited. There may be one Professor or Teacher of Surgery in each of the six schools, but there can be no more in ordinary circumstances, while in Edinburgh, as we have seen, there may be an unlimited number. Then, most of the Glasgow appointments have some endowment or definite position that may tempt an inefficient man, once installed, to hold on after 'his uselessness has become apparent. In Edinburgh, every man except the Professor in the University, may be literally starved out when he ceases to attract students. Free trade in teaching and death to the weakest is, as we have seen, the rule of the Edinburgh school, except that by the new ordinances the great queen bee in the University is now always to be kept moderately fat. Much may be said for both plans. The small endowment plan would certainly in many cases be an enormous blessing, and an incentive too, to young and able men of an original turn of mind but of small means. We think we have known men who might have turned out great medical lights had £200 a year been attainable for bread and butter during the first ten years of teaching and working, but who were lost to the school for the want of it. Simpson and the Edinburgh School narrowly escaped this fate.

Glasgow, during the first half of this century was, beyond any question, on a lower plane than Edinburgh in regard to the all pervading spirit of original investigation and scientific enthusiasm among its teachers, and also in the social position of the profession of Medicine. It taught men to practice Physic up to the standards then known in a creditable way ; but its ideal was not high enough. When Dr. Allen Thompson went from teaching

Physiology in Edinburgh, imbued with the scientific and Edinburgh spirit, to teach Anatomy in Glasgow in 1818, a bright day dawned for Medicine in the West in all respects. Sir Joseph Lister migrated westwards in 1860, and there fairly inaugurated the new era for Surgery. Dr. Gairdner followed from Edinburgh in 1862, and has become the recognised head of Scottish Medicine. Glasgow has now produced for herself Professor MacEwen, the greatest living surgeon in Scotland. The number of medical students has risen from 283 in 1861 to 349 in 1871, to 624 in 1881, and to 798 last year. These numbers only include University students ; something like 150 or 200 more must be added for the other schools, thus making up a great total of about 1000 students of Medicine. Not only have the numbers risen, but the professional tone of the schools. To enter the profession merely to earn a livelihood is no longer the dominant idea. Glasgow's facilities for teaching Anatomy and for clinical work exceed those of Edinburgh, and she has a fair chance of coming still nearer the capital in numbers of students and in scientific reputation.

King's College, Aberdeen, seems to have been the first in Scotland to have a Professor of Medicine, for before the Reformation there were 'Mediciners' there among the other members of the college, but whether they taught Physic to the students, and if so, how they taught it is not known. Except during a short period, about the middle of the 17th century, there seems always to have been a Professor of Physic, who lectured on the subject. But the numerous distinguished doctors that Aberdeen was always sending out all over Europe seemed to have got their real medical education in Edinburgh or elsewhere. Several of the family of the celebrated Gregorys undoubtedly taught Physic in a living and effective way in Aberdeen, last century; and Dr. James Gregory of Edinburgh began his great career as a medical teacher in Aberdeen. Marischal College appointed a Professor of Medicine in 1701, and there have been successors in that office ever since ; but in 1818, it is stated, there was no medical teaching in the College. The Aberdeen Infirmary was opened in 1741, and from the first the physicians and surgeons seem to have taken the students round the wards in their daily visits. In 1789, the Aberdeen Medical Society was founded by twelve medical students of the city. This fact, and the subsequent history of the Society, showed that the true modern spirit of Medicine was then alive and vigorous in Aberdeen, the spirit of enquiry, of healthy scepticism about old doctrines and of intense enthusiasm about new discoveries. When the news of John Hunter's death reached Aberdeen in 1793, it was agreed that for six weeks the President's desk should be hung with black cloth to show respect for that great man. For medical students of last century this was hero-worship of an extraordinarily discriminating kind. They selected the patient, quiet worker, and the greatest investigator of Anatomical, Surgical and Physiological facts of the time for this quaint act of reverence, instead of a poet or a warrior of the clay. Still the best of the Aberdeen, students went to Edinburgh or the Continent to finish their studies. The teaching of Medicine sank low in the first half of this century. The medical professors had not then the same status in either of the colleges as the Arts and Divinity Professors. There was an unseemly rivalry between King's and Marischal Colleges in granting medical degrees on very insufficient examination, and an idea got abroad that its M.D. was virtually sold. The lecturing was a 'mere sham,' and the students picked up the practical knowledge they obtained, in the dissecting room, hospital and druggist shop, as best they could. The fame and example of Edinburgh did not at that time stimulate, but rather seemed to paralyse the other Schools of Medicine in Scotland. No doubt there were one or two exceptions to the prevailing lowness of medical tone, of whom Dr. Kilgour was perhaps the most brilliant example. The fact seems to have been that Aberdeen produced many distinguished physicians, but could not afford to retain them for itself. There was no scope for them there ; the tone and status of the profession was not high enough.

In 1858, with the Scottish University Act of that year, came the beginning of a change for the better. The two Colleges were united into one University. The city was getting large and prosperous; money was becoming far more plentiful in the North. Aberdeen does not commonly fail for want of trying to accomplish anything awi it then determined to have a good Medical School. The Chair of Anatomy fell vacant in 1863, and Dr. Struthers, then a successful 'extra academical' lecturer in Edinburgh, was induced to accept the position. The school had 158 medical students that year. For two years the numbers fell, so that in 1865 they were only 136. Struthers clearly saw the defects of the medical teaching, and he saw yet more clearly that they could not be remedied without a stern hard struggle. For an outsider to enter on that in Aberdeen against Aberdonians needed both courage and some callousness. The Aberdeen master qualities of mind had to be outdone. The Arts and Divinity faculties had to be made to feel that medicine was the rising science of the day and must have her due place in the University. Dr. Struthers was just the man to do this. He showed himself more of an Aberdonian than any one connected with the University in determination to have his own way. He worked hard and he fought hard. He knew what he wanted, and his persistency in getting it was irresistible even by hostile natives already in possession of the field. In sheer, fighting power he was more than a match for the upholders of the former academic traditions. He was hated and resisted with an intensity only known in Aberdeen. But under his initiative new life soon came into the school. The number of students rose to 251 in 1873, to 360 in 1883, and stood at 439, with 71 medical graduates in 1892. All the requirements of modern medical teaching have been gradually acquired. iNew professors were imported from Edinburgh or elsewhere, and now men of high eminence adorn most of the chairs. Museums, rooms for practical work, an addition to the Infirmary, have all been provided at great cost. Students have been attracted from all over Scotland, from England and from the colonies. A fair share of Indian and Army appointments have fallen to the Aberdeen medical graduates. The School specially acquired a reputation as a place where students were individually looked after by the teachers, and every man made to work or asked the reason why. Original research in every department of medicine is being prosecuted, and a great building scheme to perfect the University is now being carried out with enthusiasm. If there is duty, honour and profit in having an efficient medical school, Aberdeen is clearly not to be behindhand in securing for the North of Scotland and for herself nil its advantages.

If competition in teaching within themselves has helped the growth of the Edinburgh and Glasgow Medical Schools, why has Aberdeen grown and flourished in almost the same degree as they have done during the past thirty years without any such competitive teaching? This question is difficult to answer, but it seems to show that so far as attracting and teaching students, a school may attain great success without it. No doubt Aberdeen had the most formidable outside competition in Edinburgh and Glasgow. Her only chance lay in doing her work well. But to produce teachers as Scotland has done of the first class, and in such numbers, the Edinburgh School exporting them wholesale to the Scotch Universities, to England, to Ireland, and to the Colonies, we do not see how any other system than that of unlimited competition could possibly have been successful.

In any account of the Scotch Medical Schools, a mention of St. Andrews is necessary, though that ancient University never had a complete medical faculty, nor an efficient Medical School, because of its having no means of Clinical teaching. Medicine was taught as far back as 1579. There is a Chair of ' Medicine and Anatomy,' a Chair of Chemistry, a Chair of Natural History, and a Lectureship on Botany. By the new ordinances of the Universities Commission St. Andrews is combined with the University College Dundee in the formation of a Medical Faculty. This College has, within the past year, opened its doors to medical students, and the Dundee Royal Iufinnary has been made the teaching Clinical field for the combined schools. Three years' instruction out of the five now required can be given there. It has a corps of able young tcachcrs ; it has large Clinical facilities, and it has a reputation to make. Why should it not succeed, at all events, up to a certain point? The existence of a school does immense good to the profession in any city; it quickens the life of an hospital, and it is convenient and cheaper for some of the students who live in the locality and city. It will no doubt have a hard struggle against its great competitors, but having to struggle against difficulties has made Scotland what it is to-day. It seems to an onlooker suicidal for this school not to utilise in harmony the academic traditions, the reputation and the degree-granting power of St. Andrews University ; and for St. Andrews not to take willing advantage of Dundee Royal Infirmary to complete its teaching. But, as we have seen, internal competition, rivalry, and even some healthy quarrelling has been the milk on which Scottish medical teaching has grown lusty. St. Andrews University brought some contempt on Scotch medical degrees, and caused much scandal early in the century by virtually 'selling' its degrees without examina tion. No doubt they were only conferred on men who had a medical qualification already, and who could show testimonials of good character and professional repute; but it was a very grave academic crime to have committed ; and under the enactments of the 1858 Act, the University was fitly punished by being deprived of the full power she had possessed, and was allowed only to give ten medical degrees each year to suitable men who had been in the profession for some time, and after proper examination.

No account of the Scottish Medical Schools would be complete without a notice of the schools for women of which there are now three. The Edinburgh School of Medicine for women was the first to be established after Miss Jex-Blake's heroic fight to storm the Edinburgh University had failed. Then came St. Margaret's College in Glasgow, and then the Medical College for Women in Edinburgh. They all have fully equipped staffs, and no doubt in time they will give a good account of themselves scientifically. About 80 women students are now being taught, and well taught; the students being enthusiastic, earnest and talented. They have to pass the same examinations as the men and have no favour shown them in any way. It will be almost more necessary for them to strive after a high ideal of scientific enthusiasm and of professional tone than even the men, for they have their way to make, and they have to demonstrate that certain female minds are as coldly scientific, as scientifically enthusiastic, as able to discover new facts and to generalise on them; as intensely abhorrent of quackery and sham in every form, as healthily sceptical, as cautious, as wise, and as high in professional aim as the leaders of medicine have been in the past. Thus only will women prove their fitness for the medical profession. It is not on any sentimental grounds of any kind whatever that their success will ultimately rest. No mere considerations of sex fitness and of sufficient ability to treat common complaints in women and children will avail in the long run to vindicate their claim to be a power in the profession. Exceptional women there will always be in the future as there have been in the past who can do any work that the human brain is capable of. Such women will be an honour to medicine and thereby a great blessing to humanity. But the leaders of the present movement will have hard work and will have to see to it that no lower standard is tacitly admitted for women than man's ideal. Medicine can accept nothing less than the best and* the highest. Her mission for humanity will not admit of her making allowance for sex weaknesses. If a bone has to be set there must be the skill and strength to do it. If a woman is in labour and there are twenty miles of road to ride over in a dark night, the doctor must do the distance in the shortest time possible. If an epidemic is raging he must be on duty night and day while he is wanted. When humanity is suffering healing must be administered according to the latest light science has shed on the problem. No mere placebo will do. If there is any want of real power to understand and grasp those most difficult problems that underlie all real progress in modern scientific medicine then they should not be undertaken.

What then are the principles on which the education for this great profession, with such responsible duties to the public, is founded at the present day t And what are the subjects the doctor has to master in detail and be examined on"? Before he is allowed to register as a medical student at all, or count the first of his five years of study, he has to pass a searching preliminary examination in Elementary Mathematics, English, Latin, with the option of French or German or Greek. This is the test of a good general education. Having passed this, it is understood that the first year is devoted to the four great sciences of Botany, Zoology, Physics and Chemistry, with a preliminary study of Anatomy. It need hardly be said that his studies in those sciences must necessarily be somewhat elementary; but they are now made very practical, so as to cultivate the faculty of observation, and to develop the scientific instinct in the young student. Merely hearing and absorbing lectures will not pass a man. He must come into direct contact with the facts and laws of nature under experienced teachers. Some of the best men of the present day consider that there is still too much lecturing, and too little demonstrating and doing actual work under supervision and proper instruction. We should be glad to see lectures reduced to two or three days a week, and practical work on the others. After his first year's work he has to pass his first professional examination in these subjects, but not in anatomy, which comes later. He has to show that he has begun to be somewhat of a naturalist in the wide sense. He has to enter medicine by this temple gate. His mind has to undergo the moulding towards observation, induction, taking an interest in the processes and constitution of the dead and living world around. Well is it for his future if the fire of scientific enthusiasm is kindled within him at this period, so that he begins to love his study for its own sake, and not for what it may bring him. The enthusiasm of science and the enthusiasm of humanity should be two of the dominating and redeeming qualities of any doctor. To excite these is the greatest thing a medical teacher can do in a pupil. The dry bones of facts, and the details of professional knowledge must be illuminated by a spark of something that is not mere medical schoolmastering. No man needs to cultivate an ideal more than a doctor. His work may be a poor affair; and his life that of a tradesman if he does not consciously, and as a stern duty as well as a pleasure, cultivate the ideal in his life. A scientific ambition may have nothing to do with his visiting list, but it is very necessary ; a high social tone too, makes him feel that the spirit of his work is beyond what can be paid for at Christmas. Truth, honour, the keeping of secrets, joy in the health, physical welfare, and happiness of the community among whom he lives, and a hatred of all causes of human degeneration and disease, should be the breath of his professional life. Preventible disease should be a personal and professional reproach to him. Sin, and vice, and social degradation, should be to him evidences that human bvains are badly developed, and human environments evil, and all diseases should appear to him preventive by medical science at some future time when the laws of life are understood and obeyed. Some religionists hold that if a man is not converted before 20, his chances rapidly decline thereafter; and we hold that if a man does not find scientific salvation in his first years of study, the sacrsd fire has after that less chance of being kindled. Hence the supreme importance of his then coming under the influence of men who not only know their subjects thoroughly, but have in them magnetic natures that kindle interest and enthusiasm. Depend upon it, teachers of this kind are the sort to make Scotch medical professors of. They have great heterogeneous masses of young men poured into their lecture rooms whom they cannot possibly reach individually. They must therefore kindle enthusiasm or be lamentable failures. At the risk of academic damnation they must h't themselves out in spirit and rouse their pupils. If a man, after taking their lecture, does not in his next holidays do some tramping with a vasculum on his back, dissect cats, and spoil his bedroom carpet doing chemical experiments, their teaching has not taken hold of the innermost recesses of his spirit. This ideal teaching has been done in Edinburgh above all the other Scotch or British schools, as the results have proved. Other schools have trained doctors, Edinburgh has created teachers. The best schools of the future will certainly have to imbibe her spirit of scientific and professional enthusiasm.

After the first year, and its examination if possible has been passed, the student devotes himself for the next year to the structure of the human body—anatomy—and its functions, or the processes of life—physiology—along with surgery and the study of drugs. It is a fault of the new ordinances that the student is allowed to go on to these even if he has not. passed his examination in the scientific subjects. That should be off his mind before he begins his second years work. he then begins that hospital attendance, too, which never ceases till his studies are finished. For the first time he sees humanity in pain and suffering from diisease, and is instructed how to discover what is wrong and bow to put it right. Day by day, often evening by evening, as dresser or clerk, for four years, he spends hours in the wards. Here comes in the work of the clinical teacher, perhaps the man who influences his medical life-work most of all. The great clinical teacher—and here again Edinburgh has greatly excelled —is a man of clear insight, ripe experience, some dramatic power, of felicitous speech, who can paint a vivid word-picture of disease with keen enthusiasm. The most painful and loathsome disease must be to him ' an interesting case,' and every student must be made to agree with him that it is so. An ideal clinicist has the power too of throwing a tinge of pity for the patient through all his teaching, like the 'atmosphere' that is all pervading in a good picture. He is a poor student, and he has had imperfect teachers, if, after his first year in hospital, he is not more serious, more gentle, and more human than he was at the beginning of it. The 'clinical instinct' is a great and special gift in a doctor that he must be taught sedulously to cultivate.

In his third year the student still does some dissection, but devotes himself chiefly to drugs and their uses, and to surgery studied clinically in the hospital, becoming a 'dresser' in the surgical wards. At the end of the winter lie passes his examination in Anatomy, Physiology, and Materia Medica. After that, for the next two years all his work is practical. He studies Pathology and Medicine, Midwifery and Medical Jurisprudence in his fourth year, and passes in the first and last of these subjects at the end of it. His fifth year is devoted entirely to clinical work in Medicine and Surgery, and to the special departments. He studies public! health, going to see systems of drainage, of ventilation, of water supply, of destroying and removing street refuse. He goes and sees cases examined, and tried in the Courts. He visits the Fever Hospital, and there sees cases of the epidemic and infectious diseases, how they are treated, and isolated. He has practical instruction in recognising and treating diseases of the eye, the ear, the throat, and the skin, in the Hospital. He studies the diseases peculiar to women in their special wards. He must attend twelve cases of midwifery under skilled instructors. He must take out a practical course of instruction in mental diseases, and study cases in an Asylum. Then, at last, he is admitted to pass his "final" in Medicine, Surgery, and Midwifery, the examination being partly clinical, in the Hospital wards. If he "gets through," he is addressed in words of wisdom by one of his teachers, and receives his degree, entitling him to practise in any part of Great Britain and Ireland, most of our colonics too accepting the Scotch degrees and licenses.

If the teachers are able, honest and enthusiastic, if the examiners are practical and thorough, if the students have been earnest and hard working, the course of instruction and of teaching should be a very ample guarantee to the public that they are to be medically treated by men of knowledge and skill. There is no other profession that approaches medicine in its practical requirements and training for entrants. The weak point is still that there is too much mental drill and mere acquisition of facts as opposed to assimilation of knowledge, each individual thinking out his problems for himself. He is apt to cram too much, and think too little. At a distance of 30 years we can remember little of the thousand lectures or so we heard when a student, though the lecturers were intellectual giants and men of genius in those days, to whom it was a daily delight to listen. But many of our hospital cases that we dressed and 'took' and discussed with our fellow clerks or the house physician at the Infirmary, and transcribed into our private ' Case Book,'—the page there never again opened perhaps from that day to this—we can recall as vividly as when we sat beside their bedsides. So much stronger is the mental impression of an assimilated clinical case than that of a lecture.

The Royal Colleges of Physicians and Surgeons of Edinburgh, and the Faculty of Glasgow, give a 'Triple' Combined License to students who do not desire, or cannot obtain a University degree, or wish to supplement it, on practically the same examination as the University, except that the scientific subjects of Botany, Physics and Biology are not examined on. The student coming up for that License may have studied anywhere. That this supplies a want is evident from the fact that during the past five years, a yearly average of 213 men and women have taken it, a great number of these not having studied in the Scotch Schools at all. In the same time about 450 men a year have taken the degrees of Bachelor of Medicine and Master of Surgery in the Universities. In those two ways Scotland turns out about 600 new doctors a year.

The ordinances of the present executive Universities Commission will be likely to affect the future of the Scotch medical schools in a marked way. Some changes were clearly needed to provide that they advanced with the times. Evidence was taken from the most experienced teachers. Every interest and party was allowed to have its say before the Commission. Draft ordinances were sent to all the bodies interested, for criticism and suggestions, before they were finally adopted. The Commission consisted of very able and experienced men, yet the results are by no means universally accepted as satisfactory. There is a strong feeling that the number of professors should have been increased to cope with the modern extended field of medical science. As Medicine and Surgery have made some of their most notable advances of recent years through specialising, one man or set of men devoting themselves entirely to a small department, it is thought that this might have been more recognised and provided for. A great school should now be great in the special departments as well as in General Medicine and Surgery Men should not have to go to Vienna or Berlin to get full opportunities of studying diseases of the throat, or ear or eye. The limitation of the great selfish principle of every professor getting as many students as he can and therefore as much money as he can make, is open to the very gravest doubt. It does not seem as if the new ordinances made sufficient provision for the encouragement of original research. The men who do this work are the salt of every school, without whom it would soon lose all its scientific savour. Could not the combined wisdom of the Commission have devised some scheme of payment by results for original investigation? We all know that there are some men who, in mind, embody the spirit of science, who are its redeemers from death and stagnation, who love original work for its own sake, who will work hard and steadily if they have opportunity and bread and butter. But they must live while they work. It is strange the Commission did not make at least an attempt to retain a dozen or so of such young men in each school by modest salaries to be held for a few years. The new laboratories in the schools without the men are mere confessions of failure. Success in keeping and developing all this original work in each school would have been a success indeed for the Commission, compared to which mere administrative and teaching reforms are small affairs. There are many departments of Medicine where work in detail is urgently needed. Germany is doing this, we are not fully using our opportunities. There are other departments where generalisations are much needed, founded on the work already accomplished. We are near the era of a Medical and Surgical Darwin. But it is doubtful if Darwin could have worked and thought out his results had his mind been distracted by the turmoil of ordinary medical practice. We all hope the best however from the earnest and patient labours of the Commission.

There are certain difficulties that medical education has to contend with which are due solely to ignorance and prejudice on the part of the public, and which we believe have merely to be stated candidly and fairly to the public, to be largely removed. The doctor is a servant of the public. To be a good and useful servant he must have every facility to be taught everything that the public needs in his line. The sense of public duty and of public responsibility that is being awakened and strengthened by universal suffrage in every man who thinks at all, must not be confined in its scope to political questions. It .should, and it will certainly be directed to social, sanitary and health questions. The public will see that it is in its interest and for its welfare that doctors are thoroughly educated and have every facility to make themselves as useful as it is possible for them to be. The poor man and the working nni) have a greater interest in having :i good doctor than the rich man, for they need him most and oftenest. Now a man cannot be an efficient doctor and serve the public as ho might if he has not learned the anatomy of the human body thoroughly at the outset of his studies. Without this knowledge he cannot do surgical operations or staunch bleeding wounds with safety ; he cannot set broken bones or reduce dislocated joints, and lie cannot map out the lungs or liver in the living body when he examines his patients to discover what is wrong with them. For all this he must have human bodies in sufficient numbers to dissect, to do operations on and to study when a student. Surely it is no unworthy use for the earthly tenement when life has fled, to benefit the living, to succour the distressed, to assuage pain, and to cure disease. Yet the public are deeply and most unfavourably prejudiced on this question. They do not regard their best interests and those of their children. Certain public Boards are often crassly stupid in their proceedings in this matter. The prejudices, the ignorances, and even the superstitions of a barbaric age come in and do much harm to the present generation in this matter. At present all 'unclaimed' bodies may be used, that is, all persons dying in public institutions, who have been kept there at the public expense, who have no relatives whose feelings can be hurt, all tramps dying on the road, etc. Could any possible objection be raised by any sensible public-spirited man or woman to this rule"? Have not the public, and especially the poor, the right to demand that the bodies of all such persons should be available for the purpose ? If it were carried out honestly, heartily and intelligently all over Scotland, by every public body, in every poorhouse, hospital, asylum and prison, the medical student would have far more chance than he has of acquiring a thorough knowledge of anatomy. With the present facility for virtual embalming and the facilities of railway conveyance such unclaimed bodies could easily be carried to the medical schools from distant towns with no sort of offence or danger. The railways and steamers should relax their extravagant fares for the dead for this purpose. If every Parochial Boai'd would see to this, a great public gain would result. It is not a doctor's question. The ultimate gain would be to the public and the poor. It is a question about which undue reticence can, in our opinion, do no good. Let the intelligent public be educated on the point, and its true bearing will soon be seen. Sooner or later it must be so educated. The tramp and the professional pauper cost the public enough during their lives ; they might well do something to diminish human suffering after their death. A business-like scheme openly carried out, covering allScotland, to carry out the provisions of the present Anatomy Act, surrounded as that is by every sort of precaution against abuse, would, we believe, in no way shock the public. Undue reticence, foolish fears of rousing old prejudices, and timidity generally, alone hinder the Scottish Medical Schools, especially the Edinburgh School, in this matter. The time has now come for boldness and openness in regard to this important question. We lately heard of a member of a Parochial Board going round a poorhouse asking each pauper if he objected to be dissected after he died! Logically, such a fool, if he dislocates his shoulder, has no right to the services of a surgeon whose power to reduce it is got entirely through his anatomical knowledge. The public sentiment against post mortem examinations is equally the result of ignorance and unthinking prejudice. Both feelings are immoral, inasmuch as they do harm to the living, and obstruct the long crusade of medicine against pain and death. It has been an uphill fight and need not be made more difficult by ignorant prejudice and want of true public spirit. The science of pathology could not have existed without examinations after death, to see what the cause of death had been, and how the healthy organs and functions had undergone change. Foreign Schools of Medicine, and even English and Irish Schools, have had an advantage over Scotch Schools in the facilities they have possessed for anatomical and pathological research. There can be 110 cure without a knowledge of what disease really is.

The doctor, when he gets his degree, must keep to himself 110 medical secrets or discoveries that would benefit humanity, he must, be at the call of rich and poor alike ; he gives much of his time and energy to work that brings him in 110 direct reward ; his ideal should be to be a public servant, doing all the good he can, and not principally to make money and benefit himself only. The modern ideal of the doctor is that he should be the priest of the body. The modern aim of medicine is to prevent disease and to spread the knowledge of the laws of health. As health means happiness, contentment, capacity for work, and enjoyment of life, the future of humanity depends greatly on the attainment of that ideal. The Alms sana in corpore sano has a very close relationship to morals, to religion, to law, and to a reasonable socio-

The public and the State have therefore the right and the duty to see that medical training is thorough, broad, and on right lines. A Medical School where the tone and ideal was low ; where the students were only taught a technical knowledge of their profession; a school with no high scientific aspirations and no pervading sentiment of duty to society; where the chief aim was only to fit the man to earn a livelihood would be 011 the level of a trade, and deserve no general support from the State or the public. But there is no medical school and no medical corporation that does not repudiate such an ideal for the great profession of medicine. The Scotch Medical Schools will certainly endeavour in the future, as they have done in the past, to lead the van not only in numbers but in high tone and usefulness to society. We have no fear whatever as to their future. No doubt provincial Medical Schools in England are rising ud, and Cambridge University is developing a large Medical School, but the great characteristic of our schools has been that the teachers in them devote themselves to teaching as their highest aim and end in professional life. There is much less tendency than elsewhere towards making teaching a mere stepping stone to practice and fortune. We believe in the race, and Ave think that medicine and medical teaching is one of the strong points of Scotsmen. If that is so, they will hold their own just as surely as the best horse will win.

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