420

the soluble malate of lead, and evaporate the malic acidin a steam or water-bath. The concentration may becarried further under an air-pump, in the usual way.The composition of malic acid is the same as that of

citric acid, C4 H2 04,

THE LANCET.LONDON, SATURDAY, JUNE 22ND, 1844.

MEDICAL BILL.-MEDICAL EDUCATION IN PRUSSIA.

THE introduction of the Medical Bill by Sir JAMESGRAHAM is again postponed. The motion now stands

for Tuesday next, the 25th instant. The period of thesession of Parliament is now so far advanced that Mini-

sters cannot seriously contemplate, in the very short

time which would now be allowed for its consideration,

enacting into a law a measure which must affect nearly30,000 practitioners in medicine directly, and the whole

community of the empire indirectly. All we have to

advise at this moment is, that the profession will be fullyprepared to encounter, by a determined and strenuous

opposition, any and every attempt which may be madeto hurry such a measure through Parliament, unless theBill be of such a nature as to satisfy the profession-acircumstance which we by no means expect.

. THE universities of Prussia, uniting the four facultiesof medicine, theology, philosophy, and law, are six in

number: Berlin, Halle, Kcenigsberg, Breslau, Greiswald,and Bonn. The teaching body is composed of three gradesof professors : the titulary professors (professores ordi-narii), the assistant professors (professores extraordinarii),the private professors (privati docentes). The two former

are regularly paid; the latter have no fixed salary. The

members of the senate or academical board are drawn

from among the titulary professors. The rector, the

university judge (Unirersitaets Richter), and the deans,are members ex officio. The election of the deans takes

place annually.The Faculty of Medicine of Berlin is actually com-

posed of fourteen chairs, occupied by fourteen titularyprofessors :-1. General anatomy and anatomy of the sen-sitive apparatuses (Professor J. MULLER). 2. Descriptiveanatomy (Professor SCHLEMM). 3. Medical pathologyand clinique (Professor SCHOENLEIN). 4. General phy-siology (Professor HORKEL). 5. Comparative physiologyand micrography (Professor EHRENBERG). 6. Botanyand pharmacy (Professor LINK). 7. General pathologyand materia medica (Professor ScHULTZ). 8. General

and special surgery, clinical surgery (Professor DIEFFEN-BACH). 9. Operative surgery, clinical surgery (ProfessorJUENGKEN). 10. Midwifery (Professor BUSCH). 11. Legalmedicine (Professor CASPER). 12. Sanitary police, publichygiene (Professor WAGNER). 13. History of medicine,encyclopedy, and methodology (Professor HECKER).14. Syphilitical diseases, special therapeutics of acute

and chronic diseases (Professor HORN). These professorsare assisted by eleven assistant, or extraordinary, andthirteen private professors.The other universities of the kingdom are less com-

plete, less favoured, than that of Berlin. Thus the Fa-

culty of Medicine of Hallé has only five titulary andfour private professors. In all the universities the ac-

cessory sciences are taught by the professors of the facultyof philosophy.No student is allowed to matriculate as a member of

any of the faculties of Prussia unless he present a cer-

tificate, certifying that he has terminated his classicalstudies in a college (gyrnnasill1lt), and has passed the11 abiturienten examen" (examen abiturorum in univer-

sitatem). This is the classical degree, or degree in arts.

On matriculating the student receives a card, on whichis printed a list of all the lectures he is expected to follow

during the course of his studies. Each course lasts six

months, and costs the student ten thalers (about l l.11s.)The entire medical curriculum exacted for the degree ofdoctor occupies four years, and is called the " quadri-" ennum academicum." The lectures are delivered three

times a week by the professors, and each course lasts sixmonths. The students are under no restrictions as to

the order in which they attend these lectures, and haveno medical examinations to undergo until they arrive atthe termination of their studies. The result of so de-

fective an organisation is, that during the first two orthree years of their university residence they do little or

nothing, devoting their time to amusement and idleness.

During the last year they in vain attempt to recover thelost time, and are obliged to resort to a wholesale systemof grinding, in order to be ready to pass the final exa-minations. Out of a hundred pupils, says Dr. HOEFER,there are not five who seriously employ the entire periodallotted to study.During the first year, what little time they give to

science is generally devoted to the lectures on natural

philosophy, chemistry, botany, mineralogy, zoology, logic,and psychology. These sciences constitute the absolu-

torium philosophicum, or, the reunion of the preparatorysciences, on which an examination has to be undergoneat the Faculty of Philosophy before the doctor’s degreecan be obtained. The dean of the Faculty of Medicineis obliged to be present at this examination. The expenseof the examination is ten thalers.

The second and third years are, or ought to be, de-voted to anatomical studies, to physiology, pathologicalanatomy, external and internal pathology, legal medi-

cine, toxicology, and the history of medicine. These: studies are generally purely theoretical ; dissection even. is optional, and, as might be anticipated, the dissection

rooms are seldom crowded with pupils. In some faculties

l there is a great want of subjects, as a very small pro-: portion, only, of those who die in the hospitals are given, over to the anatomical rooms. This is owing to the· popular prejudice against dissection being very general

in Germany. The fourth, or last year, is employed in> the study of midwifery, and of external and internal

clinical medicine in the hospitals. It is the period allottedthe practical examination of disease.The clinical studies in the German faculties appear

421MEDICAL EDUCATION IN PRUSSIA.

very judiciously organised, but will not bear close in-

spection. Let us, for instance, take the most celebrated-the Medical Faculty of Berlin. The hospital in whichare the clinical wards, subordinate to the faculty, is the

Charité. It contains 1000 beds, but ninety only aredivided between the medical and the surgical clinical

professors. There are also clinical wards for eye diseases,

midwifery, diseases of children, syphilitical, and mentaldiseases. The ninety surgical and medical cases con-tained in the clinical wards are alone accessible to the

students; and as they are nearly all acute, they havelittle or no opportunity of studying chronic disease. The

students are not allowed to see the other nine hundred

patients, the latter objecting to being seen or examined.This they have a right to do, as they pay for their re-sidence in the hospital. The hospitals in Germany are

not, strictly speaking, places where hospitality is given.Nearly throughout the entire country the patients payfor their board. Thus, at the Charité of Berlin, the

patients pay a month in advance on entering, and if

they do not belong to the town, two. The day after theiradmission they are visited by an enregistrator, who in-

quires into their residence and their means of existence.If the answers received are not satisfactory, he addresseshimself to the police, which undertakes to ascertain the

precise social position of the refractory or suspicious- looking patient. In case the latter is unable to pay the

expense of his residence in the hospital, it falls upon the

parish in which he was living previous to his admission.Masters are obliged to pay two months in advance to gettheir servants admitted.

During the first three months of their university studiesthe pupils only follow the visits of the physician or

surgeon, listening to his examinations of the patients,and to his lectures; they are then called auscultantes. In

the second trimestre they become practicantes, that is,they themselves have patients to see and to examine.The "practicans" is obliged to visit his patient everymorning, often twice a day. Moreover, he has to draw

up the history of the case entrusted to him, and to

submit it to the clinical professor. If the patient dies,the practising student is called upon to perform the au-

topsy, and to make a report to his superior.The pupils are not obliged to take charge of

patients. Those who wish, however, to gain practicalinformation in this manner apply to the clinical pre-

fessor, who inscribes their names in a book, and calls

upon them in the order in which they are inscribed. In

the surgical clinique of the Charité, the practising- student examines the patient under the eye of the sur-

geon, gives his diagnosis, and assists, in the reserved

part of the amphitheatre, at the operation ; but once the

operation has been performed his functions cease ; notonly is he not entrusted with the after dressing, but he doesnot see the patient again, when once he has been trans-

ported into a ward which is reserved for those who havebeen operated on. The practical information thus gainedis, therefore, very slight, especially when we consider

that a " practising student" can only have three or four

patients to study in each trimestre, and that one year,seldom two, is all the time that is devoted to hospitalpractice.To graduate as Doctor, at the end of the four years,

the student has to produce, first, a certificate from the

faculty of philosophy, of having passed the tentamenphilo-sophicum ; the examination in logic, and the accessorysciences to which we have already alluded. Secondly, acertificate of having devoted four years to medical studies.The examination for the degree is a mere formality. It

consists in a written and in an oral trial. The candidate

composes a Latin dissertation, or thesis, on a subjectchosen by himself, or by the dean, which he supportspublicly. Having fulfilled these conditions, he is saluted

by the title of doctor medicinæ rite promotus. The fact of

having gained the dignity of doctor, does not, however,entitle him to practise. To obtain a licence to that effect,he has to pass the staats examen, or state examination.

This examination is passed before a committee named bythe " Superior Medical Board," or by the Ministry, andis a serious and practical examination. It alone gives the

privilege to practise, the degree of M.D. being merely an

honorary title.The committee of the " staats examen" sits at Berlin,

and is renewed every two years. The regulations bywhich it is governed were adopted in 1825. It grantslicences to doctors, to surgeons, and to apothecaries.The doctors (rite promoti) are those who have graduated

in the universities. They either intend to practise bothmedicine and surgery, or medicine only ; and the exami-nation differs accordingly. They who wish to become

general practitioners are examined on anatomy, operativesurgery, and on all the branches of the healing art.They who merely intend to practise internal pathology,are nevertheless examined on the surgical diseases as wellas on medicine.

The candidates for the licence to practise as surgeons ofthe first class, are students who have not graduated at theuniversities. They are obliged to prove by certificatesthat they have studied medicine and surgery three yearsin an university, or that they have studied two years inan university, and served two years, in addition, as as-

sistant-surgeons in the army, or in practice. They areexamined on anatomy, and on clinical and operative surgery, and on clinical medicine.

To be admitted to examination for a licence to practise ’as an apothecary, a candidate must have served at leastthree years as assistant, and followed lectures in an uni-

versity, for at least six months, on botany, chemistry,natural philosophy, pharmacy, and materia medica. He

is examined on chemistry, botany, chemical manipula-tion, toxicology, legal medicine, and chemical analysis,and on all the branches of knowledge necessary for the

practice of pharmacy.The functions of « cantonnal inspector," are ob-

tained, as we have already stated, by an exami-

nation. The examination consists in a certain number

422

of dissertations on subjects of legal medicine, which are

given three or six months in advance, in the performanceof a judicial autopsy, according to the usual forms, in re-

cognising spurious drugs; and, finally, in an examina-tion on all the sciences which have reference to publichygiene.The examination takes place at Berlin before the

"Superior Medical Board," or in the provinces, before ajury specially named by the minister. The board sits at

Berlin, but in order to spare the expense of travelling topoor candidates, the minister names special juries in the

following towns: Coblentz, Breslau, Koenigsberg, andGreifswald.

MEDICAL REFORM.

TO THE MASTER, WARDENS, AND COURT OF ASSISTANTSOF THE WORSHIPFUL SOCIETY OF APOTHECARIES OF

ENGLAND AND WALES.

GENTLEMEN,-Under the impression that one faculty ofmedicine, with equality of rank and title, is a conditionunattainable under existing circumstances, and equallyimpossible to retain, if chance for the moment annihilatedall existing grades, and afforded an opportunity for tryingthe experiment; and believing also (admitting such achimera to be practicable) that neither the public or theprofession would be benefited by such an arrangement, Itake the liberty of offering for your consideration the

following suggestions, with the sincere hope that by afree and unreserved interchange of opinion, some planor other may be devised for harmonising the threebranches of the profession, so that they might work honour-ably and satisfactorily together. As a preliminary step,however, I must premise that the Apothecaries’ Societyshould immediately take the lead, and detach their scien-tific and professional department from that which

properly should never have been combined with it,namely, their trading establishment at Apothecaries’Hall. They should, in point of fact, never have heldtheir examinations for licences to practise medicine attheir shop in the city ! It detracted from the credit and

dignity of the profession, and has constituted, at all

times, the most fertile source of opprobrium and dissa-tisfaction. This separation is, I. conceive, the first stepthat the society should take, for by this means the titleof apothecary, which has become so objectionable toprofessional men that they seldom, if ever, designatethemselves by it, might altogether cease as an appellationfor them, and be retained only to describe the membersof the trading society of apothecaries-one of the city

corporations..

The council should then invite the profession to unitewith them in a petition to the legislature for a charterof incorporation, as a college of general practitioners;the whole medical body now practising under the licenceof the Apothecaries’ Company being considered membersof the proposed college, and the present list of the cor-poration of apothecaries, as well as all existing or futurelicentiates of ten years’ standing, being constituted intoa constituency with the title offtllows, and who shall beeligible for, and privileged to vote for, the council, courtof examiners, and governing body of the college.That the college have the power of framing its own

curriculum; that the education and examination for itsdiploma be under the control of its own governing body,and that it should confer the right to practise as a generalpractitioner in all parts of her Majesty’s dominions. Thatthe education of the general practitioner should be inevery respect sufficient for all ordinary practice, andshould be in no degree inferior to that required by theSociety of Apothecaries as at present constituted. Toavoid interfering with existing institutions, and toafford the means for those who desire to cultivate a moreextended knowledge of any particular branch of medicalscience, the diplomas of the Colleges of Physicians and

Surgeons respectively may be required of all candidatesfor army, navy, Indian, hospital, or parochial appoint-ments. The College of Surgeons requiring a knowledgeof morbid, microscopic, and comparative anatomy, aswell as greater practical skill in surgical operations. TheCollege of Physicians conferring degrees of bachelor anddoctor of medicine only, granting no licences to practisewhatever, and requiring ample testimony that all onwhom the honour of a degree is conferred are by edu-cation fitted to uphold its dignity and ensure its respect.By these means the three great subdivisions of the me-

dical profession may be made to work harmoniously to-gether ; each gradation having its own college, with thearrangement of its curriculum, and the management ofits affairs under the control and regulation of its owngoverning body.To these suggestions it may be replied, that on the

passing of the Apothecaries’ Act in 1815, an applicationwas made to the legislature for a charter of incorporationand refused, on the ground that it was inexpedient togrant such charter without some experience of the work-ing of the new Act of Parliament, a plea which, how-ever reasonable at the time, is now clearly inadmissibleafter nearly thirty years’ experience, and with a retro-spect so highly creditable to the parties to whom theadministration of the Apothecaries’ Act was deputed.Surely a refusal under such circumstances should in nodegree intimidate or dismay the Society of Apothecariesat the present moment. What was then a matter ofdoubt, namely, the effect of their administration of therules and regulations for conducting the education of theapothecary on the acquirements of the future practi-tioner, is now a matter of triumphant congratulation.The rank, talents, and professional reputation, with thehold they have on society, fully entitle the present bodyof general practitioners to this mark of consideration. Ihave been induced to address these observations to the.Court of Assistants of the Society of Apothecaries, be-cause I consider both the public and the profession as

deeply indebted to them for the great benefits conferredon the former, and for the honourable position intowhich they have elevated the latter, and still more from .

an anxious desire to identify more completely the in-terests of the society and its licentiates. I have thehonour to remain, gentlemen, your very obedient servant,

JAMES BIRD.Orchard-street, June 11 th, 1844.

ON THE NECESSITY OF PRACTICAL INSTRUC-TION IN THE OPERATIONS OF SURGERY.

To the Editor of THE LANCET.SIR,—Now that medical reform is being so much agi-

tated, and discussions on the Anatomy Act taking place,I have thought it a suitable opportunity to take theliberty of addressing a few lines to you relative to thesupply of subjects at the metropolitan schools, in thesincere hope that through the powerful medium of yourwidely-circulated Journal something may be done toensure a much greater abundance of subjects than hashitherto been the case.

I perceive that in a former number of THE LANCET acorrespondent has stated the exorbitant charges demandedat the schools for subjects, varying from 31. 10s. to 41. 10s.each, and showing the great disadvantages which resultto gentlemen and students desirous of dissecting, fromthe present working of the Anatomy Act; but, Sir, thisis not all, for where, allow me to ask, is a student seenpurchasing a subject for performing the various opera-tions of surgery on ? I have now a book before me calleda ° Guide to the Hospitals in Paris," in which it is statedthat courses of operative surgery are delivered during thesummer months in that city, for which the fee generallycharged is 25 francs, or 11. For this sum a pupil not onlywitnesses the procédés of the lecturers, but is providedwith a sufficient number of subjects to enable him torepeat every operation two or three times under theimmediate superintendence of the lecturer, who furnisheshim with every surgical instrument he may require, andaffords him every facility to become tout à fait au fait inthe operative branch of surgery. How sincerely must