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been of things demonstrable: of anatomical changes, of microorganisms, and of chemical products. Pathology, the study of disease for itself, as a branch of natural science, constitutes the one central point about which medicine, surgery, and all the specialties are grouped. It is pathology that makes our business a profession and not a trade.

It is only the student of pathology who can treat disease intelligently, for it is he only who knows what he is treating. He has seen the lesions which belong to each disease; he has watched their development from day to day; he knows what is their natural duration. He has learned how the symptoms and the lesions correspond, and can distinguish between the symptoms which belong to the disease and those which belong to the individual.

It is under the influence of the study of pathology that the student will begin and the practitioner will go on in his profession with the scientific spirit, caring for nothing but facts and paying no attention to theories.

It is a matter of importance to the community that it should contain a class of persons capable of judging about the rules of health and about the medicines and cures likely to benefit disease. Especially now when the world swarms with charlatans and cures does the community need protection, for it does not know how to protect itself. The utmost intelligence and learning in other departments are of no assistance here. It is impossible for people to judge wisely concerning matters of which they are profoundly ignorant. The astronomer, who would be insulted if you told him that the moon is made of green cheese, believes easily in the virtues of the liver pad. A theologian, who thinks hardly of Mohammedans and Buddhists, will be on the best of terms with all sorts of impossible "pathists." A financier, who would be ashamed to be deceived in his business, becomes the dupe of the most pitiful charlatan.

Nor are physicians who are ignorant of pathology much better off than the laity; they know only the outside of disease, nothing of its real nature. In every civilized country, however, we find a fair number of scientific physicians, of men who put their whole life into the study of disease without reference to anything but the advancement of knowledge, of

men who believe nothing that cannot be demonstrated. These men are not divided from each other by country or language, they form a little community united by a common interest, they constitute a supreme court to which can be referred all questions concerning disease and its remedies.

Of this knowledge only a limited portion can be imparted to the student. But it is of importance that the instructors should be competent, the methods good, and the facilities of dead house and laboratory sufficient.

Of the instruction in obstetrics and gynecology, I will not speak at the present time.

Instruction in the specialities-the diseases of the eye, the ear, the nose, the throat, etc., can only be given efficiently to small classes of students with the aid of sufficient clinical material. The facilities for such special instruction must be provided, but it is hardly possible for the students to study all of them during their undergraduate course. These studies must be put on the list of optionals from which the students may select. The more serious study of the specialities must be deferred until after graduation.

The main object, therefore, of the undergraduate course in medicine is to give the students sufficient instruction concerning the structure of the human body, the natural functions of different parts of the body, the natural processes of gestation and parturition, the causes of diseases, the changes produced in the structure and functions of different parts of the body by disease, the natural history of disease, the action of drugs, the principles and technique of mechanical treatment. All this is to be done as broadly and thoroughly as possible, but it only constitutes the first period of a medical education.

The second period of medical education consists of eighteen months spent as interne in a hospital. Now the student begins to do himself the things which he has been taught, to apply theory to practice, to learn the unwritten laws of his profession. Month after month he grows and develops as the spirit of the hospital, the graduated responsibility, the competition, the experience, the practical instruction exert their influence.

The third period of medical education lasts also for eighteen months. It is spent entirely in practical work, in learning the

technique and details which enter so largely into the successful treatment of disease. The student by this time has found out the branches of the profession to which he is best adapted, and the inevitable process of specialization begins. The instruction which the student now wants can only be obtained at colleges to which sufficient hospitals, dispensaries, and laboratories are attached. Whether such a college is situated in this country or abroad is immaterial.

The whole period of pupilage, therefore, lasts for six or seven years, and is divided into the three stages which I have described. I do not believe that less time than this is sufficient, nor that more time is necessary or advantageous. Such a medical education can be acquired in the United States at the present time,-I do not say that it always is acquired. All the necessary facilities exist for those who choose to take advantage of them.

After the period of pupilage is ended, comes the real life work of self-education from personal experience. The man has been furnished with the tools of his trade, now he must show how he can use them. It is not fair to expect too much at first. We do not suppose that a callow lawyer can argue a case before the Supreme Court, nor that a young architect can build a satisfactory cathedral, nor that serious surgical operations and dangerous cases of disease are likely to do well in inexperienced hands.

So one more disquisition on medical education goes into the great waste paper basket of oblivion. Let me hope that if anything of it lingers in your recollection, it will be this: That the age of superstitious medicine has passed away, and that the time of rational medicine is already here; that the study of our profession is the study of a natural science; that of the members of our profession it ought to be possible to say: They recognized no title to superiority but knowledge, and confident of that knowledge they despised all the dignities of the world. On the rich and the eloquent, on nobles and priests, they looked down with contempt; for they esteemed themselves rich in a more precious treasure, and eloquent in a more sublime language, nobles by the right of an earlier creation, and priests by the imposition of a mightier hand!"

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SOME OF THE THINGS THAT THE YALE "ASSOCIATIONS" ARE ACCOMPLISHING.

THE vigorous life which has of late manifested itself in the different Yale "Associations," scattered all over the United States, and now numbering nearly forty, is being attended by some results which may be of lasting advantage to the University. We have space at present to do no more than allude to one or two of them.

The first is the increased esprit de corps of the individual classes, not only in the Academic Department, where there has always been a great deal of it, but also in the Sheffield School, and even in the different Professional Departments.

This new manifestation of esprit de corps is shown not only by the larger numbers of graduates who return at Commencement for the purpose of attending the meetings of their class, but by the character of the reunions. They awaken such interest that those who are present, and those who are unable to be present, alike feel that some record of what has been said and done should be published, in order to keep fresh their attachment to each other and to the University. Some classes have even provided that an annual printed letter, in the shape of a pamphlet, shall be prepared and sent to each classmate with a few words of greeting furnished by each one for the others. The tone of affectionate remembrance of the days spent together, under the elms, which pervades these Class Reports and Class Letters is very noticeable. As a single illustration, we quote from one of these yearly Letters which lies before us, in which we find a letter from the judge of the highest court of a distant State, who says: "For all these years, whenever I have dreamed, I have always imagined myself back on the Yale Campus, moving about the halls of the dear old buildings, and talking with the old friends with whom I spent so many of the years of my life. I have been told that some of the old trees and some of the buildings have been taken down, but no power can take them away from my affectionate remembrance."

The Report of the last meeting of the class of 1850 also lies before us, and from this we make another quotation. "The class that graduated from Yale College on the 15th of August,

1850, numbered seventy-nine men. On the 24th of June, 1890, there were forty-seven members of the class living, and on the evening of that day twenty-two members of the class met at New Haven. They sat down to the dinner-table at half-past six in the evening and rose from it at one o'clock next morning." Then, after an account of what was said by these men who had been forty years out of college, the chairman in his Report adds: "Many people suppose that the value of a college education is to fit men for the learned professions only. But the majority of the members of the class of 1850 who were present at that dinnertable were not members of those professions. They had taken hold of the commercial industries of the world, and had found that their college education had fitted them for all the special work which they had had to do. While some of the class had gained eminence in theology, in politics, in medicine, in mathematics and astronomy,-and in the latter case to such an extent that one has received from the American Academy of Sciences the Lawrence Smith gold medal, the first and thus far the only one that has been awarded on that foundation,-others had turned their steps in a different direction. They have built railroads ; have organized banks; have excavated canals; have dealt in Bonds for the Government of the United States; have published books, historical, polemical and scientific; have engaged in commercial affairs of various kinds, achieving results in an honest manner, and without making any noise about it in the newspapers. I was surprised to learn what work had been accomplished by these twenty-two men, in the course of forty years, for which they had attained no personal fame. No doubt, the twenty-five classmates who were absent from us that evening have accomplished works equally important since our graduation. It was a new assurance of the fact that a college education not only fits men for the learned professions, but it also qualifies them in an extraordinary degree for the practical affairs of life. It tends to make men intelligently true to the trusts imposed upon them."

But a still more important result of the new life that has of late manifested itself in the different Associations is the widespread interest that has been awakened among the graduates as to whether some large development of the University cannot at once be secured by united effort. The country is demanding institutions for the higher education, which, in all their equipments, shall be fully equal to the best Universities to be

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