To catch and imprison within the rigid symbols of language the spirit of a people, as shown in any aspect of their national life, so that the printed page may render back to each reader a faithful picture, is as difficult as the task of the painter, who would depict upon his canvas not merely the features, but the essence of that inner life which lies back of the ever-changing expression as a central unity. Without this there can be no true portrait. French medical science, in the modern sense, has a history of a little more than one hundred years, of rapid growth, of constantly increasing diversification, of shifting interests like the swing of the pendulum, often too far to one side, then to the other. Nevertheless, through it all can be traced something individual, a central stream of tendency essentially French, which, impinged on from either side by the flow of thought into it from other lands, has produced the actual achievements in each of the lines of special endeavor that will be recounted in the chapters which follow.

Sympathy and imagination are perhaps the most characteristic attributes of the French mind, as common-sense and justice are of the Anglo-Saxon, and orderliness of the German. Sympathy and imagination may, I believe, be traced through the whole development of French medicine. Wide and sympathetic interest in the relief of human suffering through the advance of knowledge of disease has been instinctive in their greatest scientists, and has prevented that intense absorption in a single field of research which leads to complete detachment and isolation of the investigator. Because of this, French physiology, from MAGENDIE through the immortal Claude BERNARD and MAREY to its modern exponents, has always been experimental medicine. Each of these men, while aiming at the elucidation of the normal function of the body, constantly strove to apply his discoveries to the unraveling of their complex disorders. The mention of Claude Bernard's name evokes first of all the thought of diabetes, not of the normal liver function. These men taught as they thought, presenting their subject in its relation to pathology and to clinical medicine, not as something independent and self-sufficient. The earlier chapters of Claude Bernard's "Leçons de physiologie expérimentale" contain the program of the modern medical clinic, set forth with a cogency and a lucidity which have never been equalled, a program which we are only just beginning to realize. So too PASTEUR, the chemist, with the highest type of scientific imagination, seeing in his discovery of the nature of putrefaction the key which would unlock the door to knowledge of the infectious diseases, and planning the simplest experiments by which he might reach his goal, is kin to the creative artist who, with a few bold lines, draws the picture that will live when mere photographs, with all their wealth of detail, shall have faded into nothingness.

Closely allied to the insight which grows out of imagination and sympathy is a certain attitude toward reality as a whole, which the French exemplify in their thought as in their medical science. They love life in all its baffling complexity better than abstract formulations. An intense desire to see and accurately describe every varied feature of disease in the actual patient has enabled French physicians to detect and record for the first time many rare morbid conditions and symptoms. They have been masters of the arts of clinical observation and description. This interest in the actual, in seeing things as they are through one's own eyes, is of all qualities the most important for the practitioner of medicine. It consorts ill with the tendency of the compiler, who laboriously gathers from other sources than his own experience all existing knowledge, and, systematizing it, makes it available for the mass of men. He is the bookkeeper of science, useful but uninspiring. The infinite variety of the expressions of disease in the individual has at times led the French school to erect unnecessary distinctions; but, in spite of occasional excesses, its keen discriminations have been the means of detecting many unsuspected clinical syndromes. Because of this fundamental interest in the concrete, French medical students have always entered the hospitals from the very beginning of their course, and have seen sick patients during the years in which they were mastering anatomy, physiology, and the other underlying medical sciences.

Finally, that passion for the mastery of his language as a vehicle for thought, which is so strong in the Frenchman, has lent to his medical teaching and to the publication of his scientific work a clarity, elegance, and charm which are rarely equalled in any other country. To the earnest student of medicine the manner in which he clothes his ideas can never be of small consequence; and the example which will be constantly before him as he listens to the presentation of a case in the hospital ward, or to the announcement in a few concise and telling words of an important discovery at a meeting of the Société de Biologie or the Société des Hôpitaux, will be one worthy of emulation.

In modern science, machinery and method have of late almost obscured from view that hidden, but essential, factor in progress, the mind of man. Machinery and method have proved their value, and we shall not discard them. France has perhaps in the past laid too little stress on the organization of research, but she has never failed to preserve that atmosphere of free intellectual inquiry and unconquerable scientific curiosity in which the genius who creates new machinery and devises new methods to solve new problems can best develop. The first great American physicians, one hundred years ago, sought in Paris at the feet of LAENNEC and Louis, of PINEL and RICORD, of DUPUITREN and VELPEAU, and of the great MAGENDIE, the inspiration which enabled them to lay the foundation of scientific medicine in our land. American medical science is now thoroughly organized, rich in facilities for research in hospitals and laboratories, full of enthusiasm for high achievement. It must appropriate and adapt to its own uses the best that it finds in all lands. In France it will find scientific imagination of the highest order, sympathy so wide as to unite all groups of specialists in devotion to the aims of medicine as a whole, acute observation of the finer details of clinical symptoms, a spirit which loves reality so intensely that it will not cramp it within too simple and artificial categories, and the best model for its imitation in the creation of its medical literature.

The historian who attempts to trace the development of modern physiology (that is to say, physiology as an experimental science based on physics and chemistry) will find it necessary to refer constantly to the names of the great French physiologists of the 9th century, François MAGENDIE and Claude BERNARD. While much good work was being done in England at that period, largely on anatomical lines, and in Germany Johannes MÜLLER and his famous pupils were making notable contributions to physiology and, indeed, to biology in general, the really modern spirit of physiological research found its most earnest advocates and exemplars in the two French physiologists named. In his wonderful experimental lectures, given at the Collège de France, MAGENDIE over and over again emphasized the importance of experimental investigation as opposed to speculation and theorizing, and in his words and by his works he indicated clearly the lines along which physiology should advance,---the lines in fact along which it has advanced. His great pupil BERNARD, filled with his master's spirit, and endowed with a scientific mind of the first order, made those remarkable discoveries which entitle him to be ranked as the greatest physiologist that the world has produced. At that time physiology was the sole experimental medical science; and the great influence exerted by these two men made itself felt not only upon the subsequent development of physiology as a separate science but in the modernization of medicine as a whole. Medical men from all countries went to Paris to work with Bernard, and by this means his influence was extended through personal contact over a wide area.

In addition there grew up round him a group of pupils, MAREY, FRANÇOIS-FRANCK, BERT, RICHET, D'ARSONVAL, GREHANT, DASTRE, and others, who in their turn have contributed brilliantly to the advancement of the subject. The work of BERT upon barometric pressure is worthy of special notice. Conceived and executed in a scientific and comprehensive spirit, it met at first, singularly enough, with some bitter criticism from abroad; but it has since come to be recognized as the classic and starting point for all investigations dealing with the physiological effects of variations in atmospheric pressure. No less noteworthy are the important contributions made by MAREY to the study of movements and the development of a beautiful technique for graphic reproductions of all kinds. Physiologists of all countries are deeply indebted to his genius in devising apparatus and methods.

The living French physiologists comprise such names as RICHET, DASTRE, D'ARSONVAL, FRANÇOIS-FRANCK, GLEY, WEISS, MORAT, DOYON, LANGLOIS, NICLOUX, LAPIQUE,---names known to the physiologists in all countries because of the important contributions to science associated with them. RICHET has had the honor of a Nobel prize for his fundamental work in anaphylaxis. D'ARSONVAL, brilliant as a physicist as well as physiologist, is remembered also in connection with some of the early work upon internal secretions done in collaboration with BROWN-SÉQUARD. GLEY'S work has taken a wide range, but his contributions to the physiology of the internal secretions, especially of the parathyroid glands, have been of fundamental importance. FRANÇOIS-FRANCK has published many beautiful papers upon vasomotor regulation, important in their results and models of technical skill. DASTRE, in his own name and through the workers in his well-equipped laboratory, is known for work in all branches of physiology and physiological chemistry. The work of these men and their pupils includes all the existing fields in physiology.

The longer contributions appear in the "Journal de Physiologie et de pathologie générale," the successor to the well known "Archives de Physiologie normale et pathologique:" but the pages of the weekly journal "Comptes rendus de la Société de Biologie" teem with shorter communications that touch on every phase of biological research, and reflect like a mirror the latest thoughts and aspirations of the workers in science.

Instruction. Any student who wishes to pursue advanced work in Physiology or desires instruction in modern methods of research will find in France, and especially of course in Paris, able and distinguished teachers and ample laboratory facilities. In the laboratories of the Faculté de Médecine, at the Sorbonne in the Faculté des Sciences, at the Collège de France, the Muséum d'Histoire Naturelle, and the Institut Pasteur, opportunities are offered for investigative work in all branches of physiology, and in biological chemistry and physics. Details in regard to the lecture courses and laboratory courses which may be followed are furnished by the "Livret de l'Étudiant" of the University of Paris; but arrangements in regard to participation in research work must be made of course with the directors of the laboratories.

Libraries are numerous and complete. In addition to the great Bibliothèque Nationale, there are special libraries at the School of Medicine, the Pasteur Institute, the Biological Society, etc. In the use of these libraries the American student will not find the same freedom and liberality that he is accustomed to in American universities. So far as the writer is informed none of the Continental libraries follow the generous American plan of giving students free access to books and periodicals. But if the regulations in force are learned and observed, no serious difficulty is encountered in obtaining any literature that may be desired.

Outside this routine work in lectures and in laboratories, the physiological student in Paris has an almost unequaled opportunity to acquire a broad cultural basis in the related sciences and in the historical development of his subject. Numerous public lectures and exercises may be attended without charge; and in the many museums, especially in the Museum of the Conservatoire National des Arts et Métiers, objects of historical interest in science may be seen and studied.

Since the dawn of scientific medicine the neurology of France has been preëminent, sometimes almost to the point of isolation. And the present maintains the traditions of the past. Now, as formerly, productivity in this department is largely concentrated in Paris. Unless it be on account of some sporadic activity (such as the work in hypnotism at Nancy thirty years ago), the student of nervous diseases will have no occasion to go elsewhere. In the Capital the science and art of neurology flourish as on no other soil. Enormous hospitals and infirmaries furnish clinical and pathological material without parallel, and here are more men of parts actively engaged in neurological work than in any other city of the world. The Société de Neurologie de Paris is the best, the best organized, and the most active neurological society in existence. There are numerous laboratories where research work is constantly prosecuted; there are regular courses covering the various aspects of neurology; during vacation periods there are short courses for graduates; and there is a medical library of 160,000 volumes. Added to this, there is a policy of freedom, a ready accessibility, and a personal welcome such as are found in no other great medical center of Europe.

In presenting a brief outline of the opportunities for graduate work in neurology we may assume that the student has mastered the more elementary steps. If he has not, there are laboratories where he can familiarize himself with the structure of the nervous system and histological technique. Likewise he will find practical courses in methods of clinical examination, diagnosis, and treatment. Such courses are given especially in connection with the Clinic for Diseases of the Nervous System at the Salpêtrière, where the material is peculiarly rich.

The more advanced student will wish to spend his time with the leaders of French neurology in the various hospitals and in the laboratories for research and pathological work. Here it is difficult to separate the man from the institution, and consequently we shall make an attempt to consider them together,---a quite illogical, but we think useful method. And first of all,

La Salpêtrière (Hospice de). This is a huge infirmary or poorhouse for women. But it is on a hospital basis, divided into well organized services with complete attending and house staffs, the patients studied and recorded as in any modern hospital. It was here that CHARCOT pursued his epoch-making researches and where he finally induced the faculty to establish the far-famed university clinic for diseases of the nervous system. Later, to this service were added two large wards for men. On this terrain Charcot developed what was known as the School of Charcot, and here delivered the scintillating clinical lectures which have been the admiration and despair of other teachers and have remained a tradition and an example for his followers.

On his death in 1893, he was succeeded temporarily (two years) by the brilliant and beloved BRISSAUD, whose two volumes of lectures here delivered are neurological gems. The productive RAYMOND followed him; and the present incumbent is J. DEJÉRINE,(24) who for many years has been one of the strongest neurologists of France. He is the author of a remarkable "Sémiologie des Maladies du Système Nerveux"; with Mme. Dejérine has written a great Anatomy of the Nervous System; and has published innumerable valuable papers. During the school year he gives two clinics a week. That of Tuesday is more informal, more directly practical, involving the presentation of more patients without exhaustive consideration of any subject. The Friday lecture generally is devoted to more fundamental, systematic treatment of some disease or problem, and the same subject may run through several lectures. The great wealth of clinical material makes these lectures extraordinary. With this service is a large out-patient department.

At the Salpêtrière is also another immense service practically devoted to nervous diseases. The head is Pierre MARIE, perhaps the most celebrated neurologist of France. Only to catalogue his notable contributions to neuro-pathology would require a small book. Perhaps he is best known from his work on acromegaly, various aspects of apoplexy, scoliose rhizomelique, and aphasia; but there is scarcely a phase of organic disease of the nervous system which he has not touched to illuminate. He delivers no formal lectures but once a week has a "consultation d'externe," or dispensary service, where he holds an extemporaneous clinic. The patients are examined under his eye, and he makes diagnoses, comments and explanations. Of necessity the work is rapid and hence rather superficial; but the master exhibits a combination of erudition, perspicacity, and perspicuity, to be met not more than once or twice in a lifetime. For the student of nervous diseases it is a mine of information and inspiration. For more mature study and treatment many of these patients are taken into the wards which Marie visits nearly every day. The ward visits are free to any graduate, who thus hears the reports of assistants and internes, the comments, corrections, and conclusions of the chief. This is not a course of instruction, but routine work, and the visitor's tact will indicate to what extent he may ask questions.

In connection with these two dominant services at the Salpêtrière, associates and assistants frequently give courses relating to some special subject. These junior members of the staff are trained and generally eminent neurologists. One may mention André THOMAS, who knows as much of the cerebellum as any man; Henri MEIGE, who (following Brissaud) has made a profound study of the various tics; CROUZON, a good all-round man; FOIX, who is a laboratory expert as well as a good clinician; and whosoever happens to be chief of clinic for Dejérine.

In connection with the University clinic, but used also by the other services, is a very complete electric department under the personal direction of Dr. BOURGUINON, capable, enthusiastic, amiable. This, like everything else, is quite accessible to the graduate student, and offers unequalled opportunity to become familiar with electrodiagnosis and electrotherapeutics.

We may here state, for the Salpêtrière as well as for all other hospitals and infirmaries of Paris, that the qualified graduate will have no difficulty in associating himself with assistants and internes so as to watch their daily work, learn their methods and become acquainted with their cases. In many instances he may procure the privilege of examining patients himself, thus becoming familiar with rare types as well as classical clinical pictures.

Bicêtre (Hospice de) is an infirmary for men, corresponding to the Salpêtrière (though not so conveniently located), and is second only to the latter in wealth of neurological material. In the nature of things the cases are mostly chronic. Here patients are kept and observed, and here they come to autopsy. At Bicêtre the visitor will find many a patient who has served as text for a dissertation; he will recall his picture seen in a medical journal, and later he will read of the post mortem findings. Prof. A. SOUQUES, who was preceded by Dejérine and Pierre Marie, now has the choice service. As a rule he gives no regular course of instruction, but one may always make the ward visits with him and will be richly repaid. He is one of the ablest and best informed of the Paris school, as well as one of the most approachable, and he has a collection of patients not to be duplicated. Their careful study is well worth the time of any neurologist.

In the same institution is a huge service for the feeble-minded (idiots and imbeciles), where BOURNEVILLE made his remarkable pioneer studies and whence issued his valuable detailed reports.

L'Hôpital de la Pitié should next be mentioned, because here is BABINSKI, universally known from the reflex called by his name; certainly one of the most original, astute, and forceful of living neurologists. He seems to combine Gallic brilliance with the methodical thoroughness of the German, and by some is considered the greatest French neurologist. Having true scientific insight, the fruit of his labor is rarely without value. Deprived of his contributions on the reflexes, on spinal and brainstem localization, on cerebellar disorders, hysteria and many other things, modern neurology would be far from being what it is. He has not nearly so many beds as Marie, Dejérine, and Souques; but his turnover is more rapid, he has more acute cases and also a large outpatient following. During at least one semester he gives a course of semi-weekly clinical lectures which are unexcelled and which no student of neurology can afford to miss. Also one may make the ward visits with him and witness the examination of such patients as are brought to his "cabinet."

Ivry is a suburb where is located another huge hospice, like the Salpêtrière and Bicêtre, and like them it houses a large number of neurological cases. Until the outbreak of the present war this service was in charge of Prof. J. A. SICARD. This conflict once over, probably he will be transferred to a service within the city. Wherever he may be, he is well worth following, as he has had quite exceptional training, and is one of the most clear-sighted, enthusiastic, and energetic of the present generation.

The government plan of promoting hospital physicians ("médecins des hôpitaux") from one service to another makes it impossible to predict where the younger men may be found a year hence. Still, we must indicate some of these rising and risen men, whose courses should be taken and whose services visited as occasion offers. A full list is impossible; but of the best are Georges GUlLLAIN, Henri CLAUDE, HUET, ALQUIER, André LÉRI, LAIGNEL-LAVASTINE, CAMUS, KLIIPPEL, ENRIQUEZ, JUMENTIÉ, and LHERMITTE; for surgery of the nervous system, DE MARTEL.

We would particularly note that no follower of neurology should miss the monthly or semi-monthly meetings of the Société de Neurologie.

Laboratories. In addition to the regular University laboratories of anatomy and pathology, there are laboratories of neuro-pathology in connection with the services of Dejérine, Marie, Babinski, and Souques. That of the Clinic for Diseases of the Nervous System is extensive and well organized, and offers instruction in laboratory methods and normal and abnormal nervous tissues. In all of them a volunteer competent to work on pathological material or to carry on research work will be welcome, and will have the guidance, the support, and the inspiration of trained experts. Gustave ROUSSY, who is chief of the University laboratory of pathology, is a trained neurologist and especially interested in pathology of the nervous system.

Psychiatry. The focus of psychiatric teaching is at the Asile Sainte-Anne, where the professor of this department of medicine is chief and where he gives clinics. Who is to succeed the late lamented BALLET is not now known to us, but he is sure to be a strong man and a good teacher. For years it has been customary at this institution to give a two-hour clinic on Sunday mornings. At Ste.-Anne there is also another large service in mental diseases, so that the student devoting himself to this branch can with profit put in a large part of his time here. At the Salpêtrière and at Bicêtre are departments for the insane, freely accessible to graduates and where from time to time courses are given.

As nearly all ward visits are made in the morning and most clinical lectures delivered "ante méridian," the student devoted to clinical work alone may be a little embarrassed in the disposition of his afternoons. Especially welcome to him will be the Infirmerie Spéciale du Dépôt in the Quai de l'Horloge where every afternoon Prof. Ernest DUPRÉ (the worthy successor of LASÈGUE and GARNIER) examines those mentally deranged or suspected of mental disorder who have been arrested or picked up by the police. The work involves no profound study of any case, as the Infirmerie is a depot of transit; but we believe that nowhere can one so well learn how to go quickly to the kernel of a case of insanity. In most semesters Dupré gives a clinic once a week at which the cases are gone into more in detail. He is a psychiatrist of the highest order and a fine teacher.

The Société de Psychiatrie and several excellent journals afford the forums and clearing houses necessary to maintain the traditions and continue the honorable heritage of French psychiatry.

In France at the beginning of the last century modern methods of clinical observation had their birth.

BICHAT, following the great MORGAGNI, began to reveal those changes which occur in the organs as the result of disease, and to correlate the pathological alterations with symptoms which occur during life. And when his too short day was past, there followed a remarkable group of eager clinicians who endeavoured on the one hand, by physical means, to detect these changes during life and by the accumulation of careful clinical and post mortem observations to improve the art of diagnosis; and on the other, by the employment of a rigid statistical method to test the accuracy of diagnosis and treatment. It was into French that the generally neglected contribution of AUENBRUGGER, announcing the discovery of the art of percussion, was first translated (de Rozière de la Chassagne, "Manuel des pulmoniques, etc.," 16°, Paris, Humaire, 1770); and later, in 1808, it was CORVISART who first recognized the value of percussion and introduced it into general use (Auenbrugger, "Nouvelle méthode, etc.," par J. N. Corvisart, 8°, Paris, Migneret, 1808).

LAËNNEC followed with his discovery of the art of auscultation, which for the first time made possible the accurate diagnosis of diseases of the chest. The clinical methods of this great man, as set forth in the preface of his famous work "L'auscultation médiate, etc.," (8°, Paris, Brosson & Chaudé, 1819) are models for all time. His descriptions of emphysema, bronchiectasis, pulmonary oedema, and hepatic cirrhosis, are classical.

These precursors were followed by a remarkable body of students of whom a few may be mentioned:

BOUILLAUD, whose acute observations first called attention to the relation between acute polyarthritis and endocarditis, was also one of the earliest to point out the phenomena of cerebral localization. ANDRAL and CHOMEL, able clinicians and conscientious observers. RAYER, one of the earliest students of diseases of the kidneys, whose beautiful atlas is still regarded as a treasure by the fortunate possessor. Louis, .who through his patient studies and his "numerical method," contributed greatly to the elucidation of the symptomatology of tuberculosis, of yellow fever, and especially of typhoid fever which he and his students first clearly distinguished from typhus. To Louis' influence more than to that of any other one man do we owe the introduction of accurate clinical methods into America. Inspired by him, a large group of students, including the Jacksons, the Warrens, Bowditch, Holmes, and Shattuck of Boston; Alonzo Clark, Valentine Mott, and Metcalf of New York; Gerhard, Norris, Stillé, Clymer, Ruschenberger, and Pepper, Sr., of Philadelphia; Power of Baltimore; Gaillard, Gibbs, and Porcher of Charleston; Cabell, Selden, and Randolph of Virginia; brought home enthusiasm and ideals which have been of incalculable benefit to American medicine.

BRETONNEAU, celebrated for his studies on diphtheria to which he gave its name. VILLEMIN, who in 1866 demonstrated the transmissibility of tuberculosis. TROUSSEAU, the brilliant clinician, author of the celebrated Clinique de l'Hôtel-Dieu. MAREY, initiator of graphic methods of the study of the circulation. POTAIN, whose early studies on the blood pressure and other cardio-vascular problems contain so much that is suggestive and valuable; author with Teissier, Vaquez, François-Franck and others, of "Clinique médicale de la Charité" (8°, Paris, Masson, 1894). LANCEREAUX, who first suggested the relation of the pancreas to diabetes. HUCHARD, student of diseases of the circulatory apparatus. RICORD, whose contributions to venereal disease, especially to the definite separation of syphilis and gonorrhoea are, as Garrison. has said, "memorable in the history of medicine." FOURNIER, the famous syphilographer. HANOT, well known for his studies on cirrhosis of the liver, who, with Chauffard, first described pigmentary cirrhosis. CHARCOT, probably the greatest clinician of his day, whose earlier contributions on various branches of general medicine were scarcely less valuable than his classical studies upon nervous diseases which followed. DIEULAFOY, student and successor of Trousseau, fascinating clinician, author of the well-known treatise on medicine and of six volumes of clinical lectures. DUCHENNE of Boulogne, the great neurologist; BRISSAUD, JOFFROY, GILLES DE LA TOURETTE, LANDRY, and MORVAN, to mention but a few only of those who have made notable contributions to neurology.

PASTEUR, who opened the whole chapter of the relations of infection to medicine; whose service to mankind looms larger with every addition which has been made to our knowledge of infectious diseases. YERSIN, to whom we are indebted for the sero-therapy and prophylaxis of plague.

These are but a few of the Frenchmen who within the last century have contributed to the advance of medicine.

Instruction. These men have had worthy successors; and it may be well briefly to mention a few of the living leaders of French medicine whose influence and inspiration the student of today may seek.

ROUX, the director of the Pasteur Institute, who with Yersin, in 1888, demonstrated the existence of the toxin of diphtheria, and later, independently and almost simultaneously with Behring, introduced the method of treating diphtheria by antitoxin.

RICHET, the brilliant professor of physiology, who with HÉRICOURT in 1888 demonstrated the presence of antitoxic substances in the blood of animals convalescent from infectious diseases; who in 1891 made the first sero-therapeutic injection in man; who with PORTIER in 1902 first demonstrated the important phenomenon of anaphylaxis.

LAVERAN, the distinguished discoverer of the parasites of malaria, who from the laboratory of the Institut Pasteur is still giving forth valuable contributions to parasitology.

LANDOUZY, whose name, with that of DEJRINE, is associated with a form of muscular atrophy; who has contributed to many branches of medicine but especially to the study of tuberculosis, pointing out, among the earliest, the almost constant relation of tuberculosis to the so-called idiopathic sero-fibrinous pleurisy. Dean today of the Medical Faculty, he is still active in his clinic for tuberculosis at the Hôpital Laënnec.

DEJRINE, professor at the Faculty, one of the most distinguished of living neurologists, author of a monumental anatomy of the nervous system and (with ANDRÉ-THOMAS) of the volume on diseases of the spinal cord in the "Nouveau Traité de médecine et de thérapeutique" (1909); a brilliant clinician whose exercises at the Salpêtrière are most stimulating.(26)

Pierre MARIE, professor at the Faculty, who first described the disease Acromegaly and pointed out its association with tumours of the pituitary body; author of many contributions to the science of neurology and especially of the admirable "Leçons sur les maladies de la moelle" (1892); editor of "La pratique neurologique" (Paris, 8°, Masson, 1911); presides now over a clinic at the Salpêtrière.

BLANCHARD, professor at the Faculty, who is today probably the leading parasitologist of the world.

WIDAL, professor of medicine, distinguished clinician, well known for his adaptation of the Gruber-Durham phenomenon to the diagnosis of typhoid fever; who, through a long series of studies has made important contributions to our knowledge of nephritis, as well as notable investigations concerning haemolytic jaundice; director of a well organized service at the Cochin with good laboratories offering an excellent opportunity for the well equipped post-graduate student.

CHAUFFARD, professor at the Faculty, a brilliant and suggestive clinician; (with HANOT) described pigmentary cirrhosis (1882); author of many contributions to various branches of medicine, including (with LAEDERICH) an excellent work on diseases of the kidney (1909); discoverer of the nature of haemolytic jaundice (1907); director of a service at the Hôpital Saint-Antoine.

VAQUEZ, agrégé, able clinician, whose studies have especially concerned the cardio-vascular apparatus; author of many contributions to medical literature; discoverer of the disease Polycythaemia, which is sometimes spoken of as Vaquez' disease; editor of the "Archives des maladies du coeur," etc.; director of an active service at the Saint-Antoine, which should offer a good field for post-graduate study.

LETULLE, professor at the Faculty, author of an important work on pathological anatomy, director of a service at the Hôpital Boucicault.

BABINSKI, distinguished neurologist; author of important contributions to this branch of medicine; presides over a clinic at the Pitié.

MARFAN, professor at the Faculty, a leading authority on diseases of children; one of the ablest and most stimulating clinicians in Paris, whose visits at the Enfants-Malades, where he directs a service, are always replete with suggestion.

NETTER, agrégé, who has made many contributions to the study of the meningitides and of poliomyelitis; director of a clinic at the Trousseau.

GAUCHER, professor at the Faculty, director of the great dermatological clinic at the Hôpital Saint-Louis, where almost unequaled advantages are offered for the study of diseases of the skin; author of an excellent volume on dermatology (1909).

GILBERT, professor at the Faculty of Medicine, director of the old clinic of Trousseau at the Hôtel-Dieu, who has made many contributions concerning diseases of the liver and jaundice; editor of the "Nouveau traité de médecine et de thérapeutique."

ACHARD, professor at the Faculty, director of a clinic at the Hôpital Necker, known especially for his studies of renal function.

JANET, professor of psychology at the Collège de France; director of a laboratory at the Salpêtrière; whose contributions to the study of hysteria are well known.

LABBÉ, agrégé, who has devoted himself especially to the diseases of nutrition and metabolism; director of a service at the Charité.

TEISSIER, agrégé, collaborator with Potain in his studies on the cardio-vascular system; editor of his posthumous volume on the blood pressure; physician at the Claude Bernard.

GUILLAIN, agrégé, one of the most active and productive of the younger neurologists; director of a clinic at the Hôpital Cochin.

BERNARD, agrégé, whose studies on renal function, on the supra-renal glands, and on tuberculosis are well known; one of the editors of the admirable "Annales de médecine."

RIST, director of a clinic at the same hospital, a suggestive clinician who has contributed to many branches of medicine.

LEGUEU, clinical professor of diseases of the urinary tract, director of Guyon's old clinic at the Hôpital Necker, in whose service the valuable work of AMBARD on the normal and pathological physiology of the kidneys was done.

HENRIQUEZ, author of valuable work on diseases of the digestive tract; director of a service at the Pitié.

CASTAIGNE, agrégé, who has written ably on diseases of the kidney and liver.

These are but a few of the many leaders of modern French medicine.

Good opportunities for study are offered also in the well organized clinics of Lyon, where the names of LÉPINE, TEISSIER, COURMONT, GALLAVARDIN, MOURIQUAND, and others, are well known; and in Lille, where CALMETTE, distinguished for his many contributions to bacteriology and serology, especially for his discovery of anti-venine and for his studies on tuberculosis, presides over the Pasteur Institute.

Opportunities for Graduate Work. There are in France few of those regularly organized and rather superficial short courses for post-graduate students which are so well known in some other continental countries. On the other hand, there are good opportunities for the student who desires to pursue research in any special branch or to acquire experience in clinical medicine.

As one looks back over the past hundred and fifty years it may be said that the French have excelled as clinical observers and as students of the symptomatology of disease. They have been peculiarly talented as clinicians and remarkably acute in the detection of pictures of disease by bedside study and investigation, and in the correlation of these pictures with the underlying pathological changes. The same may be said today. In no country is the clinical symptomatology of disease studied with greater acuteness or intelligence than in France.

The organization of the hospitals as relates to special laboratories for experiment and research has hitherto not been so attractive as in some other European countries; but great advances are being made, and' varied opportunities for serious post-graduate study may be found now in many of the clinics as well as at the Pasteur Institute. This is especially true with regard to diseases of the nervous system.

Regular courses of lectures and clinics, all of which are open to the public, are given annually by different members of the faculty. These exercises, which vary in character from year to year, are often as valuable to the post-graduate as to the undergraduate student. The opportunities for clinical observation in the hospitals of Paris during the daily public visits of the physicians are almost unequaled.

Libraries and Museums. Paris offers also great advantages in the way of libraries. The Bibliothèque Nationale, with its unrivaled collections, affords every opportunity for general study. The Library of the Faculty of Medicine, with 160,000 volumes, is accessible to all students, and the privilege to work in the Library of the Academy of Medicine may be obtained on special presentation.

The Musée Dupuytren has a valuable collection of pathological specimens; and the Musée Orfila at the École de Médecine is an excellent museum of normal anatomy and physiology. Valuable parasitological collections are also to be found at the laboratory of parasitology, and there are special collections at various hospitals.

Societies. Especially valuable to the post-graduate student are the weekly meetings of the Société de biologie, the Société médicale des hôpitaux, as well as the reunions of the Académie de Médecine, at which he may listen to the discussion of the actualities of medicine and biological science by the leading students of the day.

Following the Napoleonic wars there was a rapid advance in the French school of surgery, and Paris became the center of graduate study for the entire world.

DUPUYTREN (1777-1835) was the most illustrious French surgeon of the first half of the century. His clinics at the Hôtel-Dieu drew students from all countries. His most lasting contributions were in the field of surgical pathology. He was the first accurately to describe contracture of the palmar fascia and fracture about the ankle joint. His treatises on Injuries and Diseases of the Bones and Leçons Orales were extensively translated. VELPEAU (1795-1867) was a great operating surgeon, who wrote the first detailed treatise on Surgical Anatomy; a three-volume treatise on Operative Surgery, and an extensive work on Diseases of the Breast, were also among his writings. VELPEAU'S bandage for fixation of the arm is familiar to every medical student. MALGAIGNE (1806-65) was well known for his work in experimental surgery, especially on the healing of fractures. His treatise and atlas on fractures and dislocations remained a classic for many years. He is described by Billings as "the greatest surgical historian and critic whom the world has yet seen." His historical writings dealt especially with the Hippocratic period, and with the works of Ambroise PARÉ, the most famous surgeon of the 16th century, who at the siege of Damvilliers, in 1552, had begun to practice hemostase by ligation. CIVIALE was the first to perform lithotrity in 1824. Auguste NÉLATON (1807-73) had an international reputation as a teacher and operator. He wrote a treatise on surgical pathology, and is familiar to the modern student for his introduction of a valuable rubber catheter.

Paul BROCA (1824-1880) was the first great brain surgeon, and a leader of the modern French school of anthropology. He located the speech center in the third left frontal convolution, and introduced the term "motor aphasia." He invented craniometry, and was an ardent supporter of the theory of evolution; at the period of its introduction he was credited with the aphorism: "I would rather be a transformed ape than a degenerate son of Adam."

The work of PASTEUR revolutionized surgery, as it did all of the other special branches of medicine, but the French surgeons were not the first to see its great practical importance in their particular field. After LISTER had established antiseptic surgery, it was quickly adopted by the French. LUCAS-CHAMPIONNIÈRE (d. 1916) was its earliest advocate in France and on the continent. Aside from his early work on antisepsis and asepsis, he wrote an exhaustive treatise on fractures, in which he advocated early massage and passive motion as the most successful agents for preventing delayed and nonunion and stiffness of neighboring joints.

Overlapping the antiseptic period were a number of well known French surgeons. OLLIER (1825-1900), of Lyon, did the most extensive and valuable experimental work of the century on bone regeneration and transplantation. His pathological and clinical writings on diseases of the bones are noteworthy contributions. Félix GUYON (1831-1903) was one of the great genito-urinary surgeons of his time. His clinic at Hôpital Necker attracted students from all over the world.

REVERDIN, of Geneva, belonged to the French school, and is famous for his method of skin grafting, and for his needle which is still extensively used in France.

Many of the French surgeons who have contributed so largely to the advances in aseptic surgery are still living or have died only in recent years. TERRIER (1837-1908) contributed extensively to the development of abdominal surgery, especially to the operative treatment of gall-stone disease. BERGER (1845-1908) was best known for his operative treatment of fracture of the patella and interscapulothoracic amputation. RECLUS has taken a leading part in the development of local anaesthesia. For twenty years he has performed about two thirds of the operations in his clinic at the Hôtel-Dieu under local anaesthesia. JABOULAY, of Lyon, showed the relation between the cervical sympathetic ganglia and the thyroid gland, and introduced cervical sympathectomy for the treatment of exophthalmic goitre. Félix LEJARS is one of the ablest surgical anatomists of the day. His book on emergency surgery has been translated into many languages. Edmund DELORME (1847-) has been a prominent figure in French military surgery, and introduced the operation of pulmonary decortication in chronic empyema. DOYEN (d. 1917) was a brilliant operator, and is well known for his numerous improvements in operative technique and as the inventor of a number of valuable surgical instruments. His magnificent private hospital, excelled by none in its equipment, was in 1917 placed at the disposal of the American Red Cross, under Dr. J. A. Blake.

The names of the leaders in surgery of today will be found in the list of the staff members of the Paris hospitals.

Instruction. The opportunities for graduate work in surgery that attract the American student to France are found almost entirely at the University of Paris. Of the specialties that are found at some of the provincial Universities---such as legal medicine at Lyon---space does not here permit an account.

The French school of surgery has been renowned for its efficiency in anatomy, many of the ablest clinicians having advanced from anatomy into surgery. Consequently, excellent opportunities for work in surgical anatomy and operative surgery are to be had, particularly in the department of anatomy at the École Pratique, which is under the direction of NICOLAS. The undergraduate work in surgery is taught in the surgical divisions of the various city hospitals, the staffs of which are controlled by the University. It is in connection with these clinics that the best opportunities for graduate work are to be found. Students work on the service as clinical clerks, have ward walks with the chief and staff, attend the operations and clinics, and work in the outpatient department. It is possible under certain conditions for graduate students to secure these positions, which are analogous to clinical clerkships in the English schools. Special courses in diagnosis and operative courses on the cadaver in general surgery and the various specialties are given from time to time by the assistants in some of the clinics. Laboratories are attached to certain clinics where opportunities for pathological, bacteriological and research work are to be had.

General surgery. In most of the hospitals there is no division of the surgical service; general surgery, genito-urinary surgery, and gynecology being done by the same staff. The principal hospitals with their chief and assistant attending surgeons at the onset of the war were as follows:---Hôpital Beaujon: TUFFIER, with BAZY and MIHAUX. Hôpital Bichat: MORESTIN and staff. Hôpital Cochin: QUÉNU, with SCHWARTZ and FAURE. Hospice des Enfants-Assistés: JALAGUIER and VEAU. Hôpital des Enfants-Malades: KIRMISSON, with BROCA and PERRIN. Hôtel Dieu: RECLUS, with POTHERAT and Pierre DESCAMPS. Hôpital Laënnec: HARTMANN, with SAUVE. Hôpital Lariboisière: CHAPUT, REYNIER and PICQUE; Oto-rhino-laryngology, SEBILEAU. Hôpital Necker: Pierre DELBET, with ROUTIER; Genito-urinary, LEGUEU. Hôpital de la Pitié: WALTHER and ARROU. Hôpital Saint-Antoine: LEJARS and RICARD. Hôpital Saint-Louis: BEURNIER, RIEFFEL, ROCHARD, and MOUCHET. Hospice de la Salpêtrière: GOSSET.

Gynecology. Most of the gynecology is done as a part of general surgery; but the gynecological clinic of the University is at Hôpital Broca, under the headship of POZZI. Ward walks, operations, and clinics are held in the forenoon. Special courses in diagnosis and operative gynecology are given by the assistants in the department by arrangement. There is a very efficient gynecological service at the Hôpital Cochin in charge of Dr. FAURE. No regular instruction is given here, but the operations and ward walks are open to visitors and will be found of extreme interest.

Genito-urinary surgery. The French school has long held a leading place in the field of Genito-urinary surgery. The University clinic is located at Hôpital Necker. The chair of surgery (formerly occupied by GUION and ALBARRAN) is now held by LEGUEU. Special courses are given by the chief of staff and assistants as follows: Clinics, by LEGUEU; Diagnostic courses, by PAPIN; Polyclinic and out-patient courses, by MARSAN and DICHIRARA; Practical courses in urine examination, functional tests, etc., by AMBARD; Genito-urinary pathology and bacteriology, by VERLIAC; Cystoscopy, by PAPIN; Ureteroscopy, by MARSAN; Electrotherapeutics, by COURTADE.

Foreign students may be attached to the clinic as monitors for periods of 6 to 12 months. Special afternoon courses for foreign students in cystoscopy and diagnosis and in operative surgery on the male and female are given according to demand.

Orthopedic and Children's Surgery. Special courses in diagnosis and treatment are offered as follows :---Hôpital Trousseau: SAVARIAUD. Hôpital des Enfants-Malades: KERMISSON with BROCA. Hôpital de la Charité: Special clinic on diseases, of bones and joints by MANDAIRE.

In the large orthopedic hospital at Berck-sur-mer, CALOT offers special diagnostic and therapeutic courses during the summer months.

Oto-rhino-laryngology. The University clinic is located at Hôpital Lariboisière, under the direction of SEBILEAU. There is a large ward and out-patient service, and in addition to the routine work of the clinics special courses are given upon request.

The term Pathology is here used to comprise morbid anatomy, bacteriology, and hygiene.

General Courses. In the University of Paris certain courses in the regular curriculum belong properly to the field of Pathology. They are briefly as follows: a course in general pathology, by CASTAIGNE; a course in pathological anatomy, by Pierre MARIE, assisted by ROUSSY; a course in the history of medicine and surgery, by LETULLE; a course in hygiene, by CHANTEMESSE; and a course in experimental and comparative pathology, by ROGER. These courses are accompanied by practical laboratory work.

Other courses are given in Paris in institutes affiliated with the University. Among such courses are those in bacteriology and hematological technic, by ROGER; in parasitology, by BLANCHARD; and in tropical pathology and hygiene, by WÜRTZ; all given at the Institute of Colonial Medicine (Institut de Médecine coloniale). Completion of the course in colonial medicine in this institution entitles the graduate to a special diploma in the subject, given by the University of Paris (Diplôme de Médecine coloniale).

The course in Medical Microbiology, given each year at the Pasteur Institute in Paris from November 15th to March 15th, is perhaps the most famous, complete, and practical course in this subject given anywhere in the world. It is offered by the division of microbiology under the direction of ROUX and with the immediate laboratory supervision of BORREL, NICOLLE, and others. Completion of satisfactory work in this course leads to a certificate from the Institute (Certificat de présence et d'études).

Special Research. Opportunities for advanced study of special problems are afforded in the University laboratories in pathology, hygiene, and also particularly in connection with the various hospitals which are affiliated with the University. It is sufficient comment on the true investigative spirit of the French to note that these opportunities are not listed in their catalogues. They depend on the particular desire of a graduate student to do some definite piece of work, and on the attraction of some particular man's name or personality to decide him where that work shall be done. Graduate study is represented by no definite curriculum and by a reward in the shape of a diploma in its initial phases only. True graduate study, even in medicine, consists essentially in the personal stimulation of some particular master and the intensive study of some specialty or the investigation of some particular problem.

The practical aspects of pathological research, in its bearing on clinical diagnosis, are well exemplified in Paris, where many able practitioners are also pathologists of note. Men like Maurice LETULLE and NATTAN-LARRIER may be mentioned in this connection.

The opportunities for advanced scientific research in Paris are more specifically available in connection with the Pasteur Institute. This institute is divided into several services which deal in turn with the practical applications in preventive and curative medicine, particularly in relation to the infectious diseases. There is a clinic for the preventive treatment of rabies, under the direction of CHAILLON and VIALA, and a service of serum therapy under the direction of MARTIN with the assistance of DOPTER. These two services include the Pasteur Hospital for the treatment of those infectious diseases which the Institute has studied or is studying. In addition to these more practical applications of the scientific advances in pathology is the service of scientific research (Service de Recherches scientifiques) so-called, formerly under the direction of the late the METCHNIKOFF, and including such men as BESREDKA, BURNET, DUJMDIN-BEAUMETZ, and LEVADITI. There is also the service of colonial microbiology (Microbiologie coloniale) with LAVERAN and MESNIL. The mention of these names alone is sufficient to indicate the type of original investigation that is going on, and in which properly accredited investigators may participate for a nominal fee to pay the expense of material.

Space permits no extended reference to the general medical curriculum in the universities of France outside of Paris. As examples of more advanced work certain men may be mentioned in connection with some of these universities, as for example: RODET in Montpellier, COURMONT in Lyon, and particularly CALMETTE in Lille. Lille possesses, in addition to the university, a Pasteur Institute under the direction of CALMETTE, with whom are associated BRETON and GUÉRIN, whose work in occupational diseases and particularly in tuberculosis is well known.