THE COST OF MEDICAL EDUCATION.

584 of all officers lent to the Civil Department are replaced at the disposal of the military authorities. The following are the rates of retiring pensions and half-pay at present offered : Pensions, after thirty years’ service for pension, £700 per annum; after twenty-five years, £500 per annum ; after twenty years, f365 per annum ; after seventeen years, .E292 per annum. Rates of half-pay for, a Brigade-SurgconLieutenant-Colonel and Surgeon-Lieutenant-Colonel, lls. a day ; for a Surgeon-Major, 9s. 6d. a day; for a SurgeonCaptain, 7s. a day ; and for a Surgeon-Lieutenant, 3s. a day. Officers admitted to the Service will, after retirement on pension before completing thirty years’ service, be liable to recall to military duty in case of any great emergency arising, up to fifty-five years of age. Wound and Family Pensions.-Medical officers are entitled to the same allowances on account of wounds as other officers holding the corresponding military rank. Pensions to widows, varying from £120 to f50 a year, and compassionate allowances to children, varying from E20 to R12, are granted in cases where officers die before retirement. In addition to these pensions and compassionate allowances, every officer of the Indian Medical Service is obliged to subscribe to the Indian Service Family Pension Fund. From this fund pensions to widows are granted, varying, according to the rank of the deceased officer, from £160 to £40 a year, and to children, according to age, from f10 to £30 a year ; the pensions for boys cease at the age of twenty-one ; while the £30 pension for a daughter rises to £45 on attaining the age of twenty-one years and continues during life or until marriage. Officers of the Service are eligible for the military distinction of the Bath and for good-service pensions. As a rule "the Bath " is only given to men who remain in military employment. The Knighthoods and Companionships of the Star of India and of the Indian Empire are given to officers of the Civil Department. The Order of St. Michael and St. George is occasionally given to officers when sent on duty beyond the Indian frontier. The Victoria Cross and the Distinguished Service Order can also be won by members of the Service. Six of the most meritorious officers are named Honorary Physicians and six are named Honorary Surgeons to Her Majesty. _________

THE COST OF MEDICAL EDUCATION. IT is very desirable that the parents and guardians of youths who contemplate entering upon a course of medical study should have the means of ascertaining with some precision the whole cost which will have to be incurred in the educational process. It is obvious that this cost is by no means covered by the tabulated fees which appear in our pages to-day. Indeed, these fees do not comprise the whole expense of medical education in the narrowest and most direct sense of the word, since there are incidental expenses for books, instruments, and the like, which cannot be avoided by the student. Over and above this there is the additional cost, by no means inconsiderable in an ordinary case, of maintaining him away from home during his career of studentship. A general impression upon these matters might, no doubt, be attained without much trouble by any person of intelligence, but such general impressions do not fully meet the case. For one thing, there is an appreciable difference in respect of these incidental expenses between localities. It will often be a matter of consideration whether a lad should be consigned to one centre of education or to another, and in such a case the question of relative expense may well enter into the discussion. With the view of elucidating this matter the Editors of THE LANCET issued last year a circular to medical students from which a body of most useful information bearing upon this point was obtained. The results have been already made public ; but, as they are of more than fugitive interest, we reproduce to-day the main substance of our article founded upon the replies to this circular and published in our Students’ Number of last year. The figures given below represent annual expenditure, and as the student’s curriculum covers a period of five years, it will be understood that the provision to be made for his maintenance will be proportionate to this space of time. The returns by the light of which we are writing are sufficiently numerous to yield averages, and it is easy to see that the average man spends more money in the metropolitan centres than in the provinces, and that the standard of living and the cost of maintaining a given standard both vary from

to place. The most complete statement that we hare received comes from a, student at the Leeds school, where great economy in the matter of personal expenses appears to prevail. This return slightly generalised may serve as a type. The student in question finds it necessary to occupy the one. room which serves his purposes during ten months of the year, for which the£ s. cl. Rent, including attendance, amounts to ... 13 0 0 Food for the same period............... 15 0 0 Clothes (as to which item he seems to enjoy 310 0 some advantage) Washing ac......................... 2 0 0 Stationery and incidental expenses......... 4 00’ Examination expenses 7 00’ Recreation 15 0 0 Books &c......................... 4 0 0 Unaccounted for..................... 110 0

place

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Total ........................ 65 0 0 This case is exceptional in more respects than one although it is by no means unique save in respect of the fulness with which details are given. It is not, however, irr many instances that such a high standard of economy can be attained. A few words upon the various items enumerated will make this clear. The cost of rent is here exceptionally light, and this. naturally enough is a charge which varies greatly with thelocality. One student who occupies rooms in a very desirable suburb of London pays ;E2aweek for this item alone, but his case is more exceptional in the opposite direction than that of the Leeds man quoted above. In the matter of rent private lodgings in London are not on an average more costly than in most provincial towns, and rule-as the merchants say-at about 15s. a week. Our returns show that they vary from 9s. to the maximum of 40s. already mentioned. Referring to other centres, the rent of lodgings in Edinburgh is probably slightly less than in London; in Dublin about the same as in the English metropolis. In Edinburgh there is a sort of residential club known as University Hai), which affords facilities of social intercourse and mutuaJ aid, as, for example, in the lending of books, which i,,, practised systematically among the resident students. In addition to these amenities, the institution secures them lodgings at a very moderate monthly rent. Glasgow lodgings again run at about the same level, while in Birmingham the average of our returns is cheaper still, not exceeding 11s. a week. The cheapest district of which we have any full information is Aberdeen, where both in the matter of rent and of food our correspondents speak of an economy that is altogether exceptional, and indeed in one instance reaches the extreme limit for rent of 3s. 6d. a week in summer and 4s. 6d. in winter, the additional shilling representing the cost of fuel to cope with the Scottish winter. It should, however, be added that in this case our correspondent shares rooms with another student, thus minimising their cost. One of our correspondents from this town confesses to living in better style and more expensively than the majority of the students ata cost for rent not exceeding 14s. a week ; and another, who illustrates in his own case the system of sharing rooms, a says that under that system a student can live in Aberdeen well and comfortably for the small sum of 12s. a week;" ar,c! he proceeds to avouch cases in which men have lived ancl fared well at an inclusive charge for board, lodging, coals, and gas of 10s. a week. In towns like Cork and Leeds the average rises above this limit, but probably 15a. a week is here almost a maximum charge. In the Irish provincial towns particularly the rent of rooms is very low, 5s. and 6s. being by no means below the average. A somewhat higher rent is asked, but still ranging about 10s. a week, in English provincial towns, such as Stockton, or Rugby, or Devon. port ; but residence in these involves constant railway travelling, and would hardly be adopted for the p1’l1poses of a student’s career, unless some special considerations influenced the decision with which fine questions of comparative expense would not come into competition. There remains to be mentioned the lodging accommodation afforded by residential colleges, hospitals, and the lik institutions. But concerning these a word may suffice. Ihc advantages of residence in a college are manifold, but they are chiefly of the intellectual and social kind. The cost is not less than that of private lodgings thriftily selected. There may also be in some instances impatience on the

585 of the student of the control imposed by the regula- mining function. It will be hard to quarrel with an arrangetions which are necessarily devised for the orderly conduct ment which is justified by the importance of paying the fce of such institutions. Nevertheless, the select society, and to the right person. Less obvious, but of the same kind, is the explanation of the circumstance that tutorial fees even the inevitable restraint, of such institutions are of great service, especially to young students who have reason to are not included in the composition. Many students dread nothing more than solitude and an irresponsible control pass through their curriculum by the aid of lectures and proof any considerable proportion of their own time. On the fessorial instruction only. This is very possible when only other hand, the cost of board and lodging in such institu- crucial examinations are attempted. But for competitive tions is not greater than the average cost of the same accom- examinations additional instruction is generally an indispenmodation in private lodgings in their neighbourhood. The sable preparatory. Such additional instruction must of following is a list of London schools for medical students, course be paid for, but its occasional character prohibits its complete so far as the Editors have been able to make it, inclusion with the indispensable items in the comprehensive which have residential colleges attached :-St. Bartholo- payment. From what has last been said it will be perceived mew’s Hospital, Guy’s Hospital, King’s College, St. Mary’s that the cost of the professional course, especially in these latter items, will be laTgely affected by the nature of the Hospital, and Middlesex Hospital. At many schools a register is kept of suitable lodgings qualifications upon which the student sets his mind. A list which can be recommended to students. It is known that of examination fees appears on page 541, from which a suffisuch registers are kept at the following schools, but it is ciently precise estimate may be formed of the amount which feared that the list is imperfect:-London Hospital, it will be necessary to expend in this direction. It will, of St. Thomas’s Hospital, Westminster Hospital, Aberdeen course, be borne in mind that failure to pass an examination University, Anderson’s College, Glasgow, and the Catholic at the first sitting may involve the payment of a second fee In forming an estimate of University, Dublin. upon a subsequent occasion. A very excellent plan, and one that involves no inordinate prospective expenditure this contingency should not be expense, is to place a student in the house of a medical overlooked. practitioner in the neighbourhood of the school which he is attending. It will be found that when the educational facilities thus placed in his way are taken into account, in NOTES AND NOTE-TAKERS. addition to the mere commercial value of his board and lodging, the arrangement is usually a very economical one. " IF a man write little," says Lord Bacon in one of his The opportunities for doing this are, of course, not unlimited, best known Essays, "he need have a great memory." The but they are sufficiently numerous to merit mention here. Passing to the next item in our typical account, that of passage refers to the habit of taking down notes of what food, we may observe that here again our Leeds correspondent is observed or read-a habit which all students, but more has set a standard which will be rarely attainable. It can be especially the medical student, cannot too assiduously cultiparalleled in a very few instances only from our returns. vate. The power of taking notes efficiently does not come by The cost of board is generally not less than that of lodging, as many suppose, but is an art which improves with and may fairly be taken at about the same figure. As a nature, matter of fact, the similarity is closer than would be at first cultivation, and through which some of the highest qualities supposed, and, speaking broadly, it may be said that where necessary to a successful medical career are developed. We the one item is low the other is low also. It would seem as are not now referring to the expert note-taker who has if the prevalence of high prices or of low prices, as the case devoted years of hard study and long practice to the may be, affects both items, and affects them equally. It acquirement of the degree of skill which is necessary for the would then be more proper in an ordinary case to put this practice of his vocation, but to the student note-taker who item downat £30 a year than at ;t15. The remaining items takes notes of lectures for the guidance of his own study and in the statement may be accepted without much comment, as an aid to his memory. Indeed, it is very questionable if except perhaps that which is entered under the head of the student note-taker would gain much by attempting a clothes. This is an item of expenditure not properly charge- verbatim note, or whether a good deal of the educational able to the education account, since the student would in any value of the note would not be lost in the effort. The educational value of note-taking depends on the habits which it case be clothed, and the amount expended upon his wardrobe will be determined by his personal habits, and in no develops. One of these, in a very marked degree, is the habit of punctuality. The professional note-taker is rarely sense by his professional studies. It is very undesirable, and a matter to which more than late for his engagements, and so the student note-taker will not care to lose the connexion between one lecture and one of our correspondents has referred in a tone of irritation, that the incidental expenses should be overlooked. We have another on a subject in which the lecturer has interested him. already alluded to them above, but it seems not unimportant, He is rarely absent from his class, and the habit of regularity for the purpose of preventing misunderstanding, to refer is thus markedly developed. A lost lecture or two leaves a The com- hiatus in his note-book which costs much reading and remore pointedly and specifically to them here. position fee which is published by the various schools, and search among complicated text-books to fill up. As a rule, is in a sense a comprehensive charge, may easily be sup- it will be found that students attend to whatever is worth posed to be more comprehensive than it is. A glance at hearing; but the student who has developed a habit of our tables will show exactly how it is arrived at and note-taking is never caught napping in his class or furtively what it covers. Broadly it may be said to include all the perusing newspapers. The attention which is necessary to professorial fees. But it does not include books-this is a careful note-taking has become habitual with him. He has dematter of course. Eqnally it does not include instruments, veloped the habit of continuous attention, one which a student and these two items together cannot be fairly written down qualifying himself for any career in lifewill find most valuable. at less than ;E8ayear in an ordinary case. Many circum- Thoroughness is another attribute which note-taking tends to stances may occur to falsify this estimate. A successful foster. Points are noted in the class-room and at the clinical student may largely supply himself with books by prize lecture which after-study will expand, and which in many winning, or access to a suitable library may minimise his instances give the keynote to future research. These are the personal requirements in this respect. With instruments, main qualities which go to make a successful practitioner ; bones, parts for dissection, and the like, the case is somewhat and, if proof were wanted, the success of those medical men different, and the expenditure under these heads can only who have cultivated this habit will afford it. It would of be avoided at the expense of the student’s education. A course be invidious to specify them by name, but probably niggard hand in such matters makes therefore a grievous half a dozen of the most successful medical men in London, mistake, and this should be clearly appreciated at first, taken at random, would be found to be excellent note-takers, otherwise the temptation to undue parsimony will be from habits acquired in their career as students. The student’s note-book reflects the character, not only supported by a grudging mind in their bestowment. Another item which is for very good reason omitted from the com- of the lecturer, but of the teacher. Diffuseness in a lecturer position payment is the charge for examination fees. The is a common and sometimes fatal cause of discouragement to reason of this will be at once apparent if it is only considered the student at the outset of his career. The young note-taker that the teaching bodies and the examining bodies arc finds it impossible to lay hold of any definite statement. We distinct, and that whereas the composition fee represents a have known lecturers on subjects in the medical curriculum sum payable to institutions of the former class, the exami. who seemed to think they fulfilled their mission as teachers nation fees are receivable by institutions exercising the exa. of students by muttering in a low tone of voice from manu-

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