588 THE COST OF MEDICAL EDUCATION.

this form of treatment galvanometric measurements can beused to check the strength of the current employed.The range of utility of localised electrification is also

extending, and one very important point is becomingclear from the systematic work done in the electrical depart-ments of the hospitals-namely, that patient electrical

applications extending over long periods of time are able todo many things which might be thought unlikely or impos-sible by those who judge of electricity only by its immediateeffects. There is not much which is instantaneous and

there is nothing which is magical about the results

of electrical treatment, and those who wish to benefit

their patients by electricity must be willing to

devote much time and patience to the treatment--

for example, the gradual amelioration of symptomsin rheumatoid arthritis under electrical treatment is un-

doubted, but it is slow; so with infantile paralysis monthsor even years of treatment may be required for some cases,but the final results are better than can be obtained in any

other way, and no case of this disease should be condemned as

hopeless until after a long and persevering course of electricaltreatment has been given. An objection to medical elec-

tricity which is often put forward is that the cases whichhave improved under the treatment would have improvedequally well if nothing had been done. This is by nomeans a convincing argument, for it might be appliedequally well to a large percentage of all therapeuticmeasures, and if it were true then much of all medical

treatment would be superfluous. In the case of elec-

tricity, however, all those who have had any real practicalexperience of it can call to mind numerous instances in

which morbid conditions, stationary for long periods whenleft to themselves, have at once commenced to improvewhen treated by electricity.The electrolytic action of the current is of use rather in

surgery than in medicine, and is of great service for manysmall operations, as, for example, the destruction of npevi;in what may be called cosmetic surgery it stands ui-l-

rivalled as a means of taking away unsightly moles and

removing superfluous hairs. In its indirect applicationsto medical and surgical practice as a means for heatingcautery wires and of illuminating small incandescent

lamps, electricity plays a humble but very useful part ;and the introduction of the cystoscope has already con-

siderably advanced our knowledge of the surgery of the

bladder.

While electricity has suffered from neglect at the hands of.some its progress has also been hampered by the too greatenthusiasm of others. Some of those who have written uponthe subject of medical electricity show a grievous indifferenceto the rules of logic and are far too careless in distinguishingbetween the post hoc and the propter hoe. This being thecase, it is the duty of all those engaged in this branch oftreatment to examine their results rigidly and to make

use, so far as is possible, of scientific measurements and

tests in recording the progress of their cases. Nor is it

necessary to seek to extend unduly the scope of medical

electricity so as to include all known disorders in its field

of action, but rather to confine it to those in which its valueis undoubted.

Of the fact that electrical treatment i.s at the present time

practically restricted to the hands of experts there is no

doubt, but we do not think that there is any necessity thatthis should always be so, and it will be far better when everymedical man owns and uses a battery as part of his regulararmamentarium. Then the self-styled unqualified " medicalelectrician," male or female, will be no longer required.The employment of such people is a mistake of some

importance, and it is a matter in which many practitionersshow very considerable laxity. Even from the lowest pointof view-that of pecuniary profit-it is surely unwise to

place in the hands of unqualified persons work which wouldbe far better done by members of the medical profession.Besides, with unqualifiea medical electricians there is no

security that they will not sooner or later undertake the

trea,tment of cases on their own account, promising cures, or

selling electric or magnetic appliances, or advertising them.selves in the public prints. Indeed, these things are com-

monly done. An aid to the progress of medical electricitywould, we think, be afforded by the more frequent introduc,tion of questions upon this subject in the final examinations,because this, more than anything else, would tend ta

increase the general knowledge of the younger members

of the profession upon a subject which has shown

remarkable vitality under adverse circumstances and is

certain to become an instrument of great value in the

hands of general practitioners.

THE COST OF MEDICAL EDUCATION.

WE have for several years been in the habit of placingbefore our readers an estimate of the cost of medical educa-

tion in order that those interested in arriving at the wholeamount of this expense, which is by no means limited tosuch obviously necessary payments as fees, bcard, and lodg-ing, may have some trustworthy materials before them onwhich to found a decision about joining a medical school.We obtained our original information from personal com-munications as answers to a schedule of questions placed.by the aid of the deans and registrars of the various

medical schools in the hands of a certain number of

selected students, who were requested to furnish in the

form of replies the data from which a general statementcould be prepared for the guidance of others. Altliou,-L,the habits of the individual students necessarily had

a great, even a preponderating, effect upon the replies,the returns were sufficiently numerous to yield averages,and it was easy to see that the average man spentmore money in the metropolitan centres than in the

provinces, and that the standard of living and the cost of £

maintaining a given standard varied from place to place.The most complete statement that we received came froma provincial student whose great economy in the matter

of personal expenses could only be looked upon as an

example to distantly follow. It would have been unfair

to expect that every student could live so frugally as tosupport himself and pay for rent and food (ten months),clothes, washing, recreation, fees, and even 1-incidental"and " unaccounted expenses out of the small annual sumof £ 65. But these headings will nerve as a plan uponwhich we can discuss the subject generally—pre-mising that only general information can be given that iR

589THE COST OF MEDICAL EDUCATION.

worth anything, as a medical student as much as any

other young man can make his expenses as large as he

wishes, while he can only reduce them to the point that

is permitted by the circumstances under which he is

studying.The cost of rent is the first item to be considered, and

naturally enough is a charge which varies greatly with the

locality. A student who occupies rooms in desirable

quarters of London will pay from C2 to .63 a week on thisaccount alone, while in many large provincial centres

lodgings are almost as expensive as they are in London.We may take it a student’s rent for furnished apartments

ought not to amount to more than one-quarter of the sumthat he can fairly count upon receiving as income. If his

parents can allow him .c150 per annum (a large sum and onethat is beyond the power of the parents of many medicalstudents to set aside for one child) his rent should not

be more than <61 a week. We are calculating that he

will reside at the particular centre of education for aboutten months during the year. In London it is not alwayseasy to live near the hospital and obtain lodgings for muchless than .61 a week, so that if a student can only expect2 a week or Z6 a month from his parents he is absolutelycompelled to spend an imprudent proportion of his incomein rent. Clearly none of this applies either to the studentswho live with their parents, or those who are studying at a

university for an arts degree concurrently. Nothing moredefinite on this subject can be said than that a careful mancan live as a medical student on E80 per annum, if he does not

spend more than 10s. a week on his lodgings; but he willnot always find it easy to obtain the lodgings, and everyshilling above this weekly sum will make it very hard

indeed for him to make both ends meet.

Referring to other centres, the rent of lodgings in Edin-

burgh is considerably less than in London, but in Dublin itis about the same as in the English metropolis. In Edinburghthere is a sort of residential club known as University Hall,which affords facilities of social intercourse and mutual

aid, as, for example, in the lending of books, which is

practised systematically amongst the resident students. In

addition to these amenities, the institution secures them

lodgings at a very moderate monthly rent. Glasgow lodgingsagain run at about the same level, whilst in Birminghamrent is cheaper still. The cheapest district of which wehave any full information is Aberdeen, where both in thematter of rent and of food we have heard of an economythat is altogether exceptional, 3s. 6d. a week in summer and4s. 6d. in winter, the additional shilling representing the costof fuel to cope with the Scottish winter. In towns like Cork

and Leeds the average rises above this limit, but 15s. a weekis a somewhat high charge. In the Irish provincial townsthe rent of rooms is very low, 5s. and 6s. being by no meansbelow the average. A somewhat higher rent is asked, bututill ranging about 10s. a week, in English provincial towns,such as Stockton, or Rugby, or Devonport ; but residence inthese involves constant railway travelling, and would hardlybe adapted for the purposes of a student’s career, unless somespecial considerations influenced the decision with which

fne questions of comparative expense would not come intocompetition. The lodging accommodation afforded by re-sidential colleges, hospitals, and the like institutions should

be mentioned. But concerning these a word may suffice.The 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 thriftilyselected. There may also be in some instances impatience

on the part of the student of the control imposed by theregulations, which are necessarily devised for the orderlyconduct of such institutions. Nevertheless, the select

society, and even the inevitable restraint, of such institu-

tions are of great service, especially to young students, whohave reason to dread nothing more than solitude and an irre-sponsible control of any considerable proportion of their, owntime. On the other hand, the cost of board and lodging insuch institutions is not greater than the average cost of thesame accommodation in private lodgings in their neighbour-hood. A plan that involves no inordinate expense is to

place a student in the house of a medical practitioner in theneighbourhood of the school which he is attending. It will

be found that when the educational facilities thus placed inhis way are taken into account, in addition to the mere com-mercial value of his board and lodging, the arrangement is

usually a very economical one. The opportunities for doingthis are, of course, not unlimited, but they are sufficientlynumerous to merit mention here.

Passing to the next heading, that of food, we mayobserve that here again nothing can be said precisely, but.we can indicate the minimum sum that can be spent, andvariation from this sum must be dictated by the student’s

purse. The prevalence of high prices or of low prices, asthe case may be, affects such figures very little, and we maysay that C30 is, we consider, in London, the least sum thatwill meet necessary expenditure on food. This again refers

only to ten months in the year.Clotlees cannot properly be chargeable to the educa-

tion account, since the student would in any case

be clothed, and the amount expended upon his ward-

robe will be determined by his personal habits, andin no sense:by his professional studies or occupations.

Lastly, with regard to fees, the composition fee which ispublished by the various schools, and is in a sense a com-prehensive charge, may easily be supposed to be more com-

prehensive than it is. A glance at our tables will show

exactly how it is arrived at and what it covers. Broadlyit may be said to include all the professorial fees ; butit does not include books -that is a matter of course.

Equally it does not include instruments, and ;these twoitems together cannot be fairly written down at less

than Z8 a year in an ordinary case. Many circumstances

may occur to falsify this estimate. A successful

student may largely supply himself with books by prizewinning, or access to a suitable library may minimise his

personal requirements in this respect. With instruments,bones, parts for dissection, and the like, the case is some-what different, and the expenditure under these heads can

only be avoided at the expense of the student’s education.A niggard hand in such matters makes therefore a grievousmistake, and this should be clearly appreciated at first,otherwise the temptation to undue parsimony will be

supported by a grudging mind. Another item which is for

very good reason omitted from the composition paymentis the /J7Ia?’ge i"0l’ eo!amination fees. The reason of this

590 SHORTHAND IN MEDICINE.

will be at once apparent if it is only considered that the

teaching bodies and the examining bodies are distinct, andthat whereas the composition fee represents a sum payableto institutions of the former class, the examination fees arereceivable by institutions exercising the examining function.It will be hard to quarrel with an arrangement which is

justified by the importance of paying the fee to the rightperson. Less obvious, but of the same kind, is the explana-tion of the circumstance that tlltM’ial fees are not included

in the composition. Many students pass through their curri-culum by the aid of lectures and professorial instructiononly. This is very possible when only pass examinations

are attempted ; but for competitive examinations additionalinstruction is generally an indispensable preparatory. Such

additional instruction must of course be paid for, but its

occasional character prohibits its inclusion with the indis-

pensable items in the comprehensive payment.To sum up, we have this position: The minimum sum

that a student must be prepared to spend in London duringa year on board and lodging is E60, though f.50 will coverhis expenditure in these directions in other centres, and

less if he is careful. He can save 20 per cent. of this

expenditure by living with a fellow-student to their mutualbenefit. He must be prepared to spend 10 more at least inbooks, or instruments, or both. He will be almost the

exception if he does not incur one or two extra liabilities inthe way of special tuition during his five years’ career. He

will require another 10 a year as pocket money, and tothese figures must be added his fees and the price of hisclothes. We do not think that in London any youngman should be asked to attempt to maintain him-

self entirely and pay all necessary fees and expenses of

education as well upon a less sum than E100 a year. That

many receive less and, to their infinite credit, make it sufficeand crown the self-denial of their youth with a successthat is sweetened by the struggle to obtain it is undeniable ;but many more of their fellow-students receive largerallowances and find them inadequate. Upon individual

instances. with their innumerable reasons for special treat-ment, we do not attempt to dwell, and we desire our

readers to remember that, roughly speaking, the figureswhich we now give for London are a little, perhaps 15 percent., in excess of those that with the practice of economywould be found to apply to the provinces, Scotland, andIreland. Our advice is very general and is as follows :

If a student cannot command personally or by allowancefrom his parents &pound; 100 per annum, and look to receivingit regularly for at least four out of the five years of his

curriculum, we consider that he is rash in these exactingdays to embark upon our profession. I

SHORTHAND IN MEDICINE.

FROM the time when man iirst began to express his ideas

by means of signs and symbols he must have seen the needof doing so in as brief and expeditious a manner as possible,and this is clearly shown in the evolution of alphabets. It

is not known when the art of short writing first originatedalthough some have credited the Egyptians with beingit inventors, but it is certain that abbreviated writing

or tachygraphy was known to the Romans, and probablyto the Greeks at an early date. From the tenth centuryuntil nearly the end of the sixteenth all knowledge of theart seems to have been lost, but in 1588 "Characterie: anArte of Shorte, Swifte, and Secrete Writing by Character,Inuented byTimothe Bright, Doctor of Phisicke," was pub-lished. Since that time several good systems have beeninvented, but phonography-almost the latest-is now in

more general use than any of its rivals. One of the-

first uses to which shorthand was put was, of course, the

recording of oratory ; but it has been, and is, used in almostall walks of life, the commercial world being perhaps thefirst to take full advantage of its use in the saving of timeand in the expedition of labour. Of its utility in the learnecl

professions there can be no doubt. Amongst lawyers anddivines it has been in use for many years, and there are

those eminent in the medical profession who attribute muchof their success to the fact that they possess a knowledgeof shorthand.

To the practitioner who wishes to rapidly Take notes ofcases or to record facts in his note-book which he has gleanedin reading or by observation, shorthand will be found, not

only to greatly economise time, but will change the laborious.task of recording notes in longhand into a work of pleasure.Its use by the student is of equal value. In the .lecture

theatre, in the demonstration rooms, by the bed-side, in the

out-patients’ department, and in a variety of other ways theuse of shorthand will enable him to record his ex.

perience in less time and in a more convenient manner

than by the use of longhand, and, in addition, the

information will be ready to his hand when wanted.

There is also another advantage, and this not a small

one, which the study of phonography confers. Rightlyused it has an educational value of its own. In acquiringany kind of knowledge two of the most important habits to

develop are attention and method, and both are developedand strengthened by an intelligent use of phonography.A knowledge of shorthand is one of the greatest helps.

that a student can have in the study of any profession but.in that of medicine, perhaps more than in any other, muchwill depend upon the way in which the art is used, forunless it is used intelligently it may prove to be one of his.

greatest hindrances. For example, we can conceive of

nothing more useless to the student than a note-book

encumbered with his crude attempts to take a verbatim

report, and this is generally what the inexperienced persondoes, or rather attempts to do, with his newly acquired art.Notes such as these are not only useless and a waste

of time, but the subsequent endeavour to extract the

grain from the chafE is likely to lead him to abandon

with disgust what with a little instruction would

prove a valuable possession. It is unnecessary here to pointout the various ways in which shorthand can be used in

medicine, especially as this has been done in two little bookspublished under the auspices of the Society of Medical

Phonographers : but apart from its work in mere recordingthere is another way in which it will be found to be of

1 The Use of Shorthand by the Student. The Use of Shorthand bythe Practitioner. Both issued by the Society of Medical Phono-

graphers and sold by Sir I. Pitman and Sons, 1, Amen-corner, London,E.C, and New York. Price 8d. each.