The first advance which should be mentioned is a fundamental one—namely, methods of medical teaching. At the beginning of the nineteenth century there were only three medical schools in the United States: the Medical Department of the University of Pennsylvania, established in 1765; the Medical Department of Harvard, established in 1783; and the Medical Department of Dartmouth, established in 1797. The last report of the Commissioner of Education gives a list of one hundred and fifty-five medical schools now in existence in this country, many of them still poorly equipped and struggling for existence, but a large number of them standing in the first rank, with excellent modern equipment, both in teachers, laboratories, hospitals, and other facilities. The medical curriculum then extended over only two years or less, and consisted of courses of lectures at the most by seven professors who, year after year, read the same course of lectures, without illustrations and with no practical teaching. The medical schools, even when connected with universities, were practically private corporations, the members of which took all the fees, spent what money they were compelled to spend in the maintenance of what we now should call the semblance of an education, and divided the profits. Until within about twenty years this method prevailed in all our medical schools. But the last two decades of the century have seen a remarkable awakening of the medical profession to the need of a broader and more liberal education, and that, as a prerequisite, the medical schools should be on the same basis as the department of arts in every well-regulated college. To accomplish this the boards of trustees have taken possession of the fees of students, have placed the faculties upon salaries, and have used such portion of the incomes of the institutions as was needed for a constant and yet rapid development along the most liberal lines. COLLEGE HOSPITALS The first step has been the establishment in connection with most schools of general hospitals in which the various teachers in the college should be the clinical instructors, and where the students would have the means not only of hearing theoretically what should be done to the sick, but of actually examining the patients under the supervision of their instructors, studying the cases so as to become skilled in reaching a diagnosis and indicating what in their opinion was necessary in the way either of hygiene, medicine, or surgical operation. More than that, in most of the advanced schools to-day the students assist the clinical faculties of the hospitals in the actual performance of operations, so that when they graduate they are skilled to a degree utterly unknown twenty years ago. ESTABLISHMENT OF LABORATORIES