VISITATION OF PRELIMINARY EXAMINATION IN GENERAL EDUCATION FOR THE DEGREE OF DOCTOR OF MEDICINE IN THE UNIVERSITY OF EDINBURGH.

October, 1867.

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HAVING last year, on two occasions, visited the Preliminary Examination for the Degree of Doctor of Medicine in the University of Edinburgh, and having then expressed satisfaction with all the departments of it, with the single exception of the English Department, we have not deemed it necessary to visit any but that department this year. We reported last year, that the English Examination Papers then used in the Edinburgh University were somewhat meagre, and that they might be with advantage extended and made to embrace questions on syntax, etymology, &c., and that an exercise in writing to dictation was desirable." We have to report that our suggestions have this year been fully carried out, as will be seen from a perusal of the English Examination Paper which is appended to this Report. We have examined a number of the written answers of different qualities, and find that they have been fairly judged, and that no Candidate has been allowed to pass who does not deserve it.

(Signed)

ANDREW WOOD, M.D.
ALEX. WOOD.

MEDICAL DEGREE.-PRELIMINARY EXAMINATION.

Tuesday, 22nd October, 1867.

The Answers on each subject to be written on a separate paper.

The paper to be folded according to pattern shown, and the Subject, as well as the Name and Address of the Candidate, to be written on the outside.

The Name of the Candidate to be also written on this printed paper, which is to be returned along with the Exercise. Both to be given up to one of the Examiners before the Candidate leaves.

No Books or Notes of any kind are allowed, and no Communication among the Candidates.

Any Candidate who communicates with another by word or signs, or who permits his paper to be seen by another, will be required to leave the room, and will be reported to the Senatus.

ENGLISH.

1. Take down the following passage, from one of Lord Macaulay's Essays, as it is read to you, attending to penmanship, spelling, and punctuation. (Passage to be read here.)

2. Write a short Essay on this theme, attending carefully to spelling and punctuation, as well as to composition :-" The Uses of Photography."

3. Parse the following sentence, and analyse it so as to show its grammatical structure :

"To go through the grammar of one language thoroughly is of great use for the mastery of every other grammar; because there obtains through all languages a certain analogy to each other in their grammatical construction."

4. Rewrite the two following passages, correcting the errors in grammar and expression, and explaining the nature of the errors :--

"The state of opinion now current in Great Britain on the question of public education is different to what it was some time ago, and to what it might have been expected still to have been. Impressed with the necessity, under the circumstances in which we are, of all the children of the community at least not growing up without being taught to read and write, it is often argued now that education to this extent, upon these kind of matters, ought to be compulsory."

"It is hoped that no sooner will the present questions he glanced over when the pens of each of you will be busy writing the answers. It lays in the power of the larger majority of you to make the answers correct; and we will be happy to find it so."

5. Give the derivations of the following English words,-Definition, music, martyr, street, alms, bishop, telescope, adventure, romance, field, pilgrim, poet, beef, veal, surgeon, doctor, medicine, fever, typhus, daisy, countess, police.

6. Give the meanings of the following English words and terms :-Essence, equivocal, transpire, prevaricate, penal, analogy, cabal, deduce, elicit, eliminate, firth, invective, morbid, umbrage, stanza, torpid; adjective, transitive verb, blank verse.

VISITATION OF THE CLINICAL EXAMINATIONS IN MEDICINE FOR THE DEGREE OF MEDICINE OF THE UNIVERSITY OF GLASGOW.

24th July, 1867.

HAVING visited and reported fully on the Clinical Examinations in Surgery of this University last year, we considered it unnecessary to visit them again this year; we confined our attention, therefore, to the Clinical Examinations in Medicine, which we had only a partial opportunity of witnessing last year.

These Examinations were conducted in the Medical wards of the Royal Infirmary by Professor Gairdner, assisted by Dr. Coates, non-Professorial Examiner. Having been kindly favoured by Professor Gairdner with full notes of the details of this Examination, we are enabled to give a very accurate account of the method employed.

On this occasion three Candidates were examined. Each Candidate was requested, in the first place, to examine and note the facts of a case of disease. Time allowed, from half-an-hour to an hour. The Candidate was told to investigate the leading facts first, and the less important facts according to time and opportunity,

The first Candidate was examined on a case of anæmia in a male adult, a miner, where there was no very obvious organic disease. There had been no previous hæmorrhage; there was slight oedema of the feet, but no albumen in the urine. After the case had been stated by the Candidate, he was minutely questioned on the diagnosis as regards liver, spleen, kidney, heart, blood— murmurs in vessels functional and organic. Causes and pathology. Hæmorrhages? Ague? Leuchæmia? Prognosis and treatment under each of these hypotheses.

The second Candidate was examined on a case of pleurisy with effusion, probably in course of reabsorption-a male. Left side dull and movements impaired. Heart moderately displaced. No protrusion of intercostal spaces. No marked fever. Emaciation. Anæmia. Questionable state of apex of

lung.

Case stated by the Candidate, and questions followed or were interposed during the statement of the facts on the significance of various markings made in ink by the Candidate on the body of the patient as indicating hepatic

dulness, displaced heart, pleuritic effusion, &c.; actual state of liver, heart, right lung, left lung, special state of apex of latter; probabilities or the contrary, as derived from the examination of a tubercular origin—sputa, question of hæmoptysis. Prognosis, modes of healing. Treatment, mainly expectant? Why so? Why not active-opium, salines, iodide of potassium -why or when each of these? Blisters? Tonic practice? Cod-oil? Iron? The third Candidate was examined on a case of open abscess in right side, near the lower edge of right lung. The Candidate was informed that the case had been sent up from the surgical wards as not being proper for surgical treatment. The probe had been used, and it might be inferred that no diseased bone was found; but results of probing to be taken as doubtful. Critical points of diagnosis to be investigated from the medical point of view; no new surgical examination allowed.

The case was stated by the Candidate and questions followed on diagnosis— alternatives presented; reasons pro and con as regards each hypothesis. Admitting that diagnosis is doubtful, what is the tendency of your opinion? Abscess merely? or empyema? If the latter, how caused-pneumothorax ? Relation of this to empyema and probable mode of origin of each. History of case critically considered with respect to all these views of it. Tubercle?

Also a case just admitted from Netley Hospital, not yet examined by the physicians in Glasgow. Candidate asked to make his observations in the presence of the Examiners, and communicate his information and his thoughts re infectâ; about five or seven minutes for the preliminary enquiry. Leading facts observed, viz., dyspepsia, dysphagia, suppression of left radial pulse, substernal dulness on percussion (towards left), slight murmur. Diagnosis— aneurism. Assume this as correct, what are the precise relations of the tumour? What of the dysphagia-dyspnoea? Arch? what part of arch? pressure in what directions? Resume the examination of facts so as to satisfy yourself if there is direct pressure on oesophagus, trachea, &c. Pressure on nerves-what nerves? what parts of them? Recurrent laryngeal-no laryngeal symptoms? try again. Cough specially observed and Candidate then altered his views on this point. Summary of Diagnosis.

All the three Candidates were afterwards examined on a collection of specimens of recent urine, exhibiting various sediments, &c.; and each Candidate had one specimen of urine to report on more particularly by all the ordinary chemical and microscopical tests.

"In this and other particulars," Dr. Gairdner remarked, "the Examinations of this term have been conducted almost exactly according to the general plan submitted last year. In particular cases, there is considerable latitude given and taken as to the method of procedure, and very often the replies of the Candidate suggest an entire change of method during the Examination.

"It is of almost no consequence, according to my experience, whether the

case is easy or difficult, and whether the ultimate diagnosis offered is correct or incorrect. It is possible for a Candidate to show ample knowledge and great skill, even in making an incorrect diagnosis; and it is equally possible to make a correct diagnosis verbally, while showing great ignorance both of facts and of methods of observation. I confess, however, that in the last case here alluded to (the one from Netley Hospital) the method of examination was such as would probably have unnerved a weak Candidate. The case presenting itself quite accidentally, and the man being fit for the case, the temptation was irresistible.

"In giving low or doubtful marks, I rarely feel satisfied with the examination of one case, and have repeatedly tested such Candidates on the obvious facts of half-a-dozen or more cases, sometimes extending the examination of one Candidate over two mornings. Hence in Clinical Examinations it would be impossible to make the rule of time an index to the number of possible marks, as suggested in the Report of the Committee of Medical Council. And for this reason, among others, I do not see how the system of notation there suggested can be carried out."

The fact that we have given the details of these Examinations at such length shows what value we attach to them. We cannot conceive any test more complete and more searching than these Examinations, which we witnessed with great interest, and let us add, instruction. They are creditable to Professor Gairdner and to the University of Glasgow. The decisions on the merits of the Candidates seemed to us to be fairly given in each case.