POST-GRADUATE INSTRUCTION ABROAD.

593 London Institute, certain theological colleges and colleges music, and the London medical schools should be at The once admitted as schools or colleges in the University. students were to be divided into those attached to those institutions (internal or collegiate students) and those The ana.tta.cbed (external or non-collegiate students). osxaRiina.tions for the internal student3 were to be arranged ably an Academic Council of the members, and those for the .external students by a board specially appointed for that purpose. The final examination for the degrees in either were to be the same or to represent the same standard of knowledge, and"identical, so far as identity is consistent with the educational interests of both classes of - ttudents.’’’ The governing body was to be a Senate It of the Chancellor and 65 other members. .composed was also proposed that these recommendations should be .effected not by Charter, but by legislative authority and by the appointment of a Commission with statutory powers. These recommendations were accepted by the Royal Colleges .and by University College and King’s College after some .modifications in favour of the latter. Deputations in support of and in opposition to the scheme were received by Lord JtOSEBERY as Prime Minister and were told that the Government would "consult very largely the vote of Convocation, whenever it is taken." On Jan. 22nd, 1895, a meeting of Oonvocation took place, when 206 voted in favour of the - -scheme and 174 against. On May 14th, a.t the next meeting, Mr. B9MPAS endeavoured to get the resolutions which had been passed at the last meeting rescinded, but iie was defeated by 238 votes against 116. As if to .-show the futility of consulting the graduates Mr. NAPIER, -LL.D., a marked opponent of the scheme, was elected a Fellow of the Senate at the same meeting by 1231 votes, whilst only 738 graduates supported Mr. CozEXS-HARDY, one of its most prominent and influential advocates.. On May 9th, 1895, Lord PLAYFAIR introduced a Bill in the House of Lords to carry out the recommendations of the Cowper Commission. The Bill was a very short one and the of

’operative

clause

was as

follows

:-

1. The Commissioners shall make statutes and ordinances tror the University of London in general accordance with ithe scheme of the report hereinbefore referred to, but - subject to any modifications which may appear to them -expedient after considering any representations made to
should be able to exercise the right of veto even by proxy vote and without. a personal attendance at Convocation, so that the prospects of the Bill at the end of

graduate a

The opposition of the by the rejection of Sir graduates JOSEPH LISTER (now Lord LISTER) as a Fellow in favour of the late Mr. WALTER RiviNGTOX in June, 1896. Another amended Bill was introduced in the House of Lords, and 1895

far from

were

was

hopeful.

further shown

withdrawn in the House of Commons. tried in 1897. Some were important points not in the former Bills were now introduced by way of compromise, and these satisfied a large section of Convocation which had formerly been actively hostile, although many graduates under the leading of Mr. it

passed

Other

but

was

tentative

measures

FLETCHER MouLTON still continued a strenuous opposition. The Bill was, however, again introduced in the House of Lords

by the Lord passed through the tion. -It

President on Feb. 21st, 1898, when it various stages without material altera-

then introduced in the House of Commons the second reading on June 15th, when it was at passed once referred to the Standing Committee on Law. It was was

and

returned from this

body practically unaltered and, although

many obstructive amendments-formerly defeated-were again urged, it passed successfully through the Committee stage in July and received the Queen’s assent on

August

12th.

Sir JOHN GORST is much to be commended for the firm but courteous manner in which he piloted the Bill through the Lower House and the solution of the question will do the

Government great credit. The Statutory Commission is composed of Lord DAVEY, the Bishop of LONDON, Sir WILLIAM ROBERTS, M.D., Sir OWEN ROBERTS, Professor JEBB, Professor MICHAEL FOSTER, M.D., and Mr. EDWARD HENRY HUSK, LL.B., and we hope that they will begin their important and laborious work as speedily as possible. Mr. T. BAILEY SAUNDERS has been appointed secretary to the Commission. ’

——’

.

POST-GRADUATE INSTRUCTION ABROAD. MEDICAL

study is only nominally complete when a licence practise is obtained, and all qualified men will acknowledge the importance of keeping themselves well informed in the various improvements in diagnosis and practice which are from time to time introduced. The opportunities afforded by post-graduate courses in this country are periodically referred to in the columns of THE LANCET; and with the object of treating the subject as fully as possible a short series of articles is now published, showing what has been and is being done in this direction at the to

’

great continental schools. In this connexion it is not necessary to remind our readers that Vienna, for instance,

has for many years been a favourite place of study for medical men desirous of completing their education after having gained their diplomas, and the institution of special The Bill passed its first reading, but its further progress courses there, to be carried on in the vacation months, will On be a further inducement to resort to this famous centre -was stopped by the resignation of the late Government. the accession to office of the present Ministry an influ- of medical learning. FRANCE. .ential deputation waited on Nov. 28th, 1895, on the Duke of There is not in France any special institution correspondDEVONSHIRE, as Lord President of the Privy Council, ing exactly to the post-graduate schools of some other countries. Students who wish their medical education to be - asking him to introduce a similar Bill, but with a right more comprehensive than that which is required for obtaining .af appeal to the Privy Council added. The deputation a diploma usually undertake the additional study before the .met with little encouragement and Sir JOHX LuBBOCK in presenting of their thesis, because they may present their Ms election address adopted the strange position that every thesis whenever it suits them best, and they usually wait

594

l

until their class-work is over and they are about to enter on to these laboratories is always granted on application beingpractice. In Paris there are numerous advanced courses of made to the professor; in general there is no fee for instruction in subjects which are not required at the qualify- admission, but any outlay required for the work that is ing examinations, and they are attended by the above-men- undertaken has to be paid for. The workers are under the tioned section of students as well as by foreign medical men, control of the professor, whether they undertake original already qualified to practise in their respectivecountries, who investigation or merely seek to increase their knowledge of come to Paris in great numbers every year. Such courses recognised subjects ; in almost all the laboratories lectures. will be found at the Faculty of Medicine, at the College of are delivered by the assistants. At the School of Anthropology there are free public France, at the Faculty of Sciences, at the Pasteur Institute, at the Museum of Natural History, in the free lectures deli- lectures on Prehistoric Anthropology, Medical Geography,,. vered at the Ecole Pratique of the Faculty, and in the poly- Ethnography, Ethnology, Biological Anthropology, Zoologiclinics of individual surgeons. At the Faculty of Medicine cal Anthropology, Physiological Anthropology, Sociology, a private course of bacteriology is given in a laboratory of and Comparative Ethnography. the Ecole Pratique ; it is not official, because there is not as The Pasteur Institute has an admirably organised school yet a chair of bacteriology at the Faculty ; it is conducted of Microbiology and numerous laboratories arranged in five by M. Chantemesse, and consists of demonstrations, the use services, with accommodation for fifty persons. In order to of the microscope, and the making of cultivations, including be admitted to this school it is necessary to send an applithe study of the most important micro-organisms. Many of cation to the institute, together with a description of the the official lectures delivered at the Faculty are, either from investigations or the work contemplated. A person so admitted the nature of the subjects or from the advanced style in can remain at the institute for an indefinite time provided. which they are treated, more adapted to medical graduates that his work is continuous. For working in the laboratories. than to students ; lectures to students are the special there is a fixed charge of 50 francs (;E2) a month, which, province of the assistant professors (areges), who confine however, is remitted in the case of a certain number of themselves to instruction of the usually accepted kind. It students selected by the institute. The five laboratory may almost be said that medical education in Paris is services above mentioned are as follows : (1) Rabies embodied in the lectures delivered by the assistant professors, (M. Grancher, M. Charrin, and M. Chantemesse); (2 and that the lectures of the professors form a kind of general microbiology (M. Duclaux) ; (3) technical microschool of a higher grade, free from anxiety about examina- biology (M. Roux), together with laboratory for diphtheria. tions and not occupied with matters of common know- (M. Martin) ; (4) microbiology applied to hygiene, inledge. All the lectures of the professors and the assistant cluding vaccins (M. Chamberland) ; and (5) morphological’ professors are public, and fees are charged for attendance. and comparative microbiology (M. Metchnikoff). The The professors’ lectures, which are most largely attended by department of technical microbiology presided over by foreigners, are those on general pathology (Professor M. Roux is devoted to teaching as well as to original investiBouchard), on Experimental and Comparative Pathology gation. The course of instruction lasts six weeks, and (Professor Chantemesse), on Forensic Medicine (Professor admission to it is obtained by merely entering one’s nameBrouardel), on Hygiene (Professor Proust), on Pathological and paying a fee of 50 francs (.62). As the places assigned In addition there are at to workers are at present not very numerous it is necessary Anatomy (Professor Cornil), &c. the hospitals four extensive courses on Clinical Medicine, to enter one’s name two years in advance. four on Clinical Surgery, four on Nervous Diseases, two on Finally, there are in Paris numerous private hospitals and Clinical Obstetrics, one on Syphilis, one on Affections of the polyclinics which are well attended by both students and Urinary Passages, one on Ophthalmology, and one on practitioners. At some there are lectures open to all-comers. Diseases of Children, each of them constituting a small and free. In others the medical men who attend accompany school in which the same organisation is repeated on a the physician or surgeon on his visit, and clinical instruction reduced scale, the professor discoursing on unusual and is given on the cases which happen to be under treatment ; difficult cases to advanced students and practitioners who such is the case in the celebrated ophthalmological clinics wish to increase their stock of knowledge, whilst the (Galezowski, de Wecker, Landolt, &c.), as well as in those. assistants and the chefs de cliniq7l&bgr; deliver more elementary of laryngology and gynaecology. The laryngological clinic expositions to the students. Moreover, in the majority of the of Dr. Castex has recently been incorporated with the School hospitals the physicians and surgeons haveof their own accord of Medicine, and a fee is charged for instruction. With this arranged for an analogous organisation, independent of the exception it is in all cases sufficient to apply to the Faculty, and some of these courses are very popular on physician or surgeon for permission to attend his clinic, and account ef the excellence of individual teachers. Under the request is immediately granted. this head may be mentioned the course on Gynaecology given GERMANY. by Dr Pozzi at the Hopital Broca, that given by Dr. Doleris at La Pitie, that on Diseases of the Heart and Vessels given and demonstrations are given in lectures Post-graduate by Dr. Huchard at the Hôpital Necker, that on Obstetrics most of the universities of Germany. As a rule, their given by Dr. Budin at the Maternite, and those on Surgery duration is from three to four weeks, the university vacation. given by Dr. Terrier and Dr. Lucas-Championniere, that on being the usual period. They are delivered partly by the Diseases of the Stomach given by Dr. Debove, &c. This ordinary professors and partly by privat-docents or lecturers. constitutes the clinical instruction obtainable in the These lectures and demonstrations are not included in the hospitals ; it is free, but is given by physicians and surgeons official course of university instruction, they are privateattached to the hospitals. undertakings ; but those who attend them are none the less. At the College of France there are numerous courses in freely admitted to the university laboratories and hospitals. the higher branches of various subjects, some of which have Medical men wishing to join these courses have no formalities a bearing on medical questions-such, for instance, as that on to comply with beyond entering their names and paying the Medicine that on the fees for the lectures or the practical work which they happen (Professor d’Arsonval), Experimental Natural History of Organised Bodies (delivered by Professor to prefer. In the event of their intending to study in Berlin François Franck and developed into a course on Physiology), they should apply to Mr. Anders, Registrar of the Associaand that on General Anatomy (Professor Rouvier). This tion for Post-graduate Study, Langenbeck House, N.W last-mentioned chair is in reality an advanced School of Ziegelstrasse, 8. Lists of the lectures may be obtained from Histology ; the lectures of the professor are public and free ; this gentleman, and may also be seen in the advertisement columns of the leading German medical journals. there is also a special course lasting two months. At the Museum of Natural History will be found courses AUSTRIA. on Comparative Anatomy (Professor Filhol) on General the attendance on which is limited to of Courses on lectures, Pathology Comparative Physiology (Professor Grehant), (Professor Chauveau), and on Anthropology (Professor medical men in practice, are delivered in Vienna, but not-. Hamy). All these lectures are delivered three times a week ; in any other Austrian University. They were introduced. on the initiative of Professor Wagner, who appointed they are open to the public and are free. At the Faculty of Sciences there are lectures on Physiology two months (August and September) during which they are (Professor Dastre), on Biological Chemistry (Professor delivered in two series by the most eminent pr-ivat-docent:;; Duclaux), and on the Evolution of Organised Beings (Pro- and assistants of the Faculty. Each course lasts four weeks, fessor Giard). and the fees vary from twenty gulden (;E117s.) to fifty To all these chairs there are attached spacious laboratories gulden (R4 13s.), according to the subject. The first in connexion with an organisation which unites them all series comprised last year the following courses : Pathounder the name of the Ecole des Hautes Etudes. Admission logical Anatomy (Dr. Albrecht and Dr. Stoerk), Bacteriology

595

(Dr. Ghon), Experimental Pathology (Dr. Biedl), Pharmacology (Dr. Hockauf), Internal Medicine (Dr. Hammerschlag, Dr. Czinner, and Dr. Tiirk), Neuro-pathology (Dr. Redlich), Diseases of Children (Dr. Franz), Ophthalmology (Dr. ’Topolanski, Dr. Hanke, Dr. Gruber, and Dr. Konigstein), Laryngology (Dr. Grossmann, Dr. Rethi, Dr. Ebstein, and Dr. .Koschier), Diseases of the Ear (Dr. Bing and Dr. Kaufmann), Dermatology and Syphilis (Dr. Rille and Dr. Spiegler), Obstetrics and Gynsecology (Dr. Wertheim, Dr. Woyer, Dr. Hink, Dr. Ludwig, Dr. Knauer, and Dr. Savor). The - second series the included following courses :Anatomy (Dr. Tandler), Pathological Anatomy (Dr. Kolisko .and Dr. Albrecht), Bacteriology (Dr. Ghon), Experimental Pathology (Dr. Biedl), Forensic Medicine (do. Haberda), Internal Medicine (Dr. Pal, Dr. Schlesinger, Dr. Eisenschitz, and Dr. Sternberg), Surgery (Dr. Fraenkel), Dr. Schnitzler, and Dr. Friedlander), Ophthalmology (Dr. Bernheimer, Dr. Konigstein, Dr. Sachs, and Dr. Wintersteiner), Diseases of the Ear (Dr. Bing, Dr. Pollak, Dr. Alt, and Dr. Kaufmann), Dermatology and Syphilis (Dr. Rille, Dr. ’Spiegler, and Dr. Zeissl), Obstetrics and Gynaecology (Dr. Lott, Dr. Braun, Dr. Herzfeld, Dr. Wertheim, Dr. Neumann, Dr. Ludwig, Dr. Knauer, and Dr. Savor). These likely to be preferred by medical practitioners to those delivered during the session from October to July, as they are not attended by students.

Dr.

Woyer,

courses are

ITALY. In many Italian medical schools

special courses of instrucgiven to men who are already engaged in practice. Those who attend are mostly neither on the one hand dispensary practitioners or divisional surgeons (medici condotti) or, on the other hand, graduates who take up special courses of study (particularly laboratory work) in order to become eligible for public health appointments under Government. For instance, at the University of Pavia a special series of lectures and demonstrations in .hygiene has just been brought to a conclusion. The course *was organised by Dr. Giuseppe Sormani, professor of the .subject in the University, and was attended by graduates from all parts of Italy, attracted not only by the well-known - expository power of the professor, but also by the preferential claim to sanitary posts conferred on all who have passed the examinations instituted by the Pavian school. Again, at Genoa, the post-graduate session of Dr. Maragliano, tion, clinical and theoretical,

are now

Professor of Clinical Medicine in that school, attracts an attendance from other provinces besides those of the Alta Italia. In this course instruction is given in the refinements of sero-therapy, particularly as applied to pulmonary tuberculosis. HUNGARY. Foreign medical men who do not desire to obtain Hungarian qualifications, but merely to increase their knowledge by post-graduate study, will find no difficulty An pursuing their objects. They are allowed to enrol themselves among the ’’ ausserordentliche H6rer"(students in special subjects) at a comparatively low fee, and are given <3very facility for practical study ; vivisection, for instance, Us amply provided for. All the lectures are delivered in the Hungarian language, but all the professors and teachers speak German, and some of them speak French and English The cost of living in Budapest is nearly the same ;as well. .as in Vienna ; the journey between the two towns takes five hours by railway

increasing

_____________

SOME OF THE CHIEF APPOINTMENTS HELD BY MEDICAL MEN. Medical Ojficer to the Local Government Board.-This

appointment is

in the hands of the President of the Local Government Board for the time being, and has hitherto been filled by the promotion of one of the two assistant medical onicers of that Board. Medical Inspeetors of tke Local Government Board.-These appointments also are made by the President of the Local Government Board. Qualification and experience in public health are taken into consideration. Medical Referees under the Workmen’s Compemation Act, 1897.-This office was first constituted in the early part of 1898. The principal duties of the referees are to act as the advisers in medical matters of the committees, arbitrators, and county court judges who are empowered to decide all

questions arising in proceedings under the Act. For this duty they are paid by the Treasury. The arrangement will eventually apply to the whole of the United Kingdom but at present arrangements have only been made for England and Wales. The fees payable by the Treasury vary from 1 guinea to 3 guineas and in addition occasions may arise where a workman will present himself to the medical referee for examination. Applications for the appointments should be addressed to the Home Secretary and sent under cover to the Private Secretary to the Secretary of State, Home Office, London, bearing on the envelope the words " Medical Referee," and should state the applicant’s qualifications, age, &c., and the county court circuit to which he wishes to be attached. Preference, other things being equal, will be given to those applicants holding hospital appointments or to those who are not closely by the nature of their practice with the classes affected by the Act. (The full text of the circular from the Home Office will be found in THE LANCET of April 23rd, 1898, page 1137.) Medical Officers to Poor-la7v Districts.-These appointments are made by the guardians of the union or parish in question, subject to the approval of the Local Government Board, which approval is primarily concerned with the medical and surgical qualifications of the persons appointed and the locality of their residences. Public Vaceinators.-The conditions of appointment are the same as those already described for medical officers of Poor-law districts. District Medical Offleers of Health.-The appointments are made by the urban or rural district council in question, subject to the sanction of the Local Government Board, which sanction takes account of statutory qualifications, salary, area of district, &c. County Medical Officers of Health.-The appointments are made by the respective county councils, with whom the question in all its details absolutely rests. Lord Chancellor’s Fisitors in Lunacy.-There are two Visitors in Lunacy nominated by the Lord Chancellor. The appointments are usually bestowed on gentlemen who have distinguished themselves in the specialty. Prison Medical Service.-Two medical officers are attached to each of the first-class"prisons and one to several of the larger "second-class" prisons. They are required to devote their whole time to their official duties. The service is a small one and vacancies do not often occur. Forms of application can be procured from the Secretary to the Prison Department at the Home Office. The salary commences at <&250 per annum, with free quarters, or an allowance in lieu thereof. Medical Officers of the Mercantile Marine.-The Merchant Shipping Act, 1894 directs (Section 209) that every foreigngoing ship having 100 persons or upwards on board shall carry a duly qualified medical practitioner. Ship’s medical officers, however, are more often appointed under the part of the same Act relative to " emigrant ships." For the purposes of the Act an emigrant ship is defined as one which carries more than 50 steerage passengers, and a steerage passenger is defined as one who is not a cabin passenger. Section 303 provides that a medical practitioner shall be carried on board an emigrant ship where the number of steerage passengers exceeds fifty, and also where the number of persons on board (including cabin passengers, officers, and crew) exceeds 300. A medical practitioner shall not be considered to be duly authorised for the purposes of this Act unless (a) he is authorised by law to practise in some part of Her Majesty’s dominions, or in the case of a foreign ship in the country to which that ship belongs ; and (b) his name has been notified to the emigration officer at the port of clearance, and has not been objected to by him ; and (e) he is provided with proper surgical instruments to the satisfaction of that officer. If any person proceeds or attempts to proceed as medical practitioner in any emigrant ship without being duly authorised, he shall be liable to a fine not exceeding £100. Surgeons in charge of passenger ships should keep a record of any sickness that occurs on the voyage, whether among saloon passengers, emigrants, or crew, and they are requested to report the same to the emigration officer at the end of the voyage. The remuneration for these appointments is extremely variable, ranging from a free passage to the port of destination to a salary of £10 a month during continuance in the service. The appointments are of course made by the various firms of shipowners and the applicants are sometimes numerous.