Repert on Medical Education - University ef Mexice - Based en Visit te Mexice August 13 ~ 27, 1923, by Decter Alan Gregg le LOCATION - The geegzraphical lecatien ef the scheel is near the center ef pepulatien ef the entire country and abeut equally distant frem the larger previncial tewns (exeepting Heride_ond Menterrey). The Scheel is lecated in the city ef Mexice in the heart ef tewn at a distance ef abeut tvwe te three miles fren the main hespital where clinical werk is dene. Its tewn lecatien is in every way unfertunate and ill-censidered. 2. HISTORY - In 158@ the first chair ef medicine was established in the then very small clerical university and was, ef ceurse, hardly mere than a title fer the prefesser ef natural philesephy and histery. After slew grewth threugh the 18th Century the natienal university was erganized in 191@ by the federatien ef varieus scheels ef law, medicine and engineering. Buring the ten years fellewing, hewever, the scheel suffered severely fren censtent pelitical disturbances. In 1921 the natienal university was put under the department ef public instructien. At 7 time has the medical scheel ef the university been centrelled by educaters whe were independent ef gevernment er clerical centrel. 36 @RGANIZATION ~ The University is cempesed ef a cembinatien ef the scheels ef law, medicine, engineering, fine arts and higher studies. Te the University the natienal preparatery scheels are clesely affiliated as being almest the mly seurce ef students and under the centrel alse ef the Minister ef Public Instructien. The Minister ef Public Instructien is the chief ef the Univer- sity, but the gevernnent ef the University is detailed te » Recter and a 26e University Councile The Rector is appointed by the President of the Re- public for a term of three years and can succeed himself indefinitely. He cannot, however, be at the same time a director of one of the component schools or a professor in any subject. The Rector's duties consist of (1) presiding over the University Council, (2) supervising the work of the University and the work done in its component schools, (3) after con- sultation with the University Council and with the approval of the Minister of Public Instruction, the Rector may remove ordinary professors and he may also contract special professors with the approval of the Minister of Public Instruction, (4) to supervise the expenditure of the funds of the University, (5) to issue reports on the progress of University work, and (6) to promote the establishment of definite study courses within the University when he has the agreement of the director of higher studiese The University Council is composed as follows: the rector; the directors of the component schools of the University and the director of primary education, ex officio; four professors to be named by the Minister of Public Instruction; and ten professors, two for each school, elected by the ordinary professors (ordinarios) by secret ballot from their own faculties; (one half of the above named elected representatives are renewed each year) then one student for each national school, to be chosen among the actual scholars, (renewal each year). Students have only the position of informants and have no vote. The work of the University Council is (1) to discuss, resolve and bring to the Minister of Public Instruction, after they have been ' discussed by the faculty of the school concerned, changes in study plens, program, methods of instruction, or examination in any of the component Se schools of the University; (2) to create new institutions and new classes where necessary within the University; (3) to organize University exten- sion courses; (4) to approve, modify or refuse the salaries of professors paid for by the government - these are proposed by the directors of the various schools after consultation with their faculties. If approved by the University Council the salary list is submitted to a branch of the national treasury and to the President of the Republice On his approval “the treasury gives its decision. In case of refusal, 2/3 vote brings it directly to the President. (6) To nominate or remove personnel paid for from University funds, (i.e. Funds not supplied by Government). (6) To give opinion on removal of regular professors to the Rector in case they are not doctors of medicine (Professors on government pay are removable only by the federal executive.) 4, UNIVERSITY FINANCES - ‘+ The University has two types of funds: (1) funds put at the disposal of the University by the government and not considered the legal property of the University; (2) funds from private or non-governmental sources, and considered legal property of the University. The administration of the private funds is the work of a commission formed by three persons named annually by the University Council. They are obliged to make a report annually to the Rector in regard to the disbursement of the money 2/3 of the committee must agree ir any specific case of disbursement for it to become effective. For amounts above $5,000 (U.S.) all financial trans- actions require the approval of the Minister of Public Instruction in addition to that of the University Council. For smaller amounts approval of the Council only is requested. The accounts of the commission controlling the disbursement of private funds are sudited annually by another commission 4e selected by the University Council from among the officials of the treasury ond state departments of the federal governnente These accounts _ must be published. No figures were submitted in regard to the general university financese '5e FINANCES OF THE MEDICAL SCHOOL = The salary budget of the Faculty | of Medicine for 1922 was in Mexican money $692,916, divided as follows: Administration $58,400; teaching $583,233.50; service $51,282.50. The analysis of the teaching budget shows the following accounts by depart- ments: Anatomy Mex. $70,919.50 Biology 2,555. Histology and Microbiology 39,201. Physiology 15,074.50 Physiological chemistry 9,198. Pathology and pathological anatomy 41,281.50 Pharmacology 9,672.50 Clinical medicine 75,190. Clinical. surgery 145,270. Nodical therapeutics, physiological ' therapeutics and nursing 26,535.50 Surgical therapeutics 13,140, Parasitology and tropical diseases 5, 3296 Psychology 4,380. Legal medicine 5, 3296 Obstetrics 59,4956 Pediatrics 4,380. Ophthalmology 8, 760. Dermatology 8,760. Hygiene * By 3296 Deontology 1,460. Laboratory work (clinical pathology) in Juarez Hospital 6,643. Laboratory work in general hospital 6,643. Consulting staff 15,330. Physica] education of medical students 2,920. The above is salary list and does not cover cost of equipment, deprecia- tion, etc., on which no notes were given. The professors are paid upon a basis of hours actually spent in lecturing and not upon a fixed rate of salery per annume De 6 BUILDINGS - The medical school is housed in a large early colonial building originally used as headquarters for the Inquisition. Its space is sbout that of 1s of the units of the Harvard Medical School, much of its apparent size being lost in the form of a courtyard in the center of the building. The location is unrelated to that of hospitals in which clinical work is done. The ground floor is devoted to lecture rooms, offices of the administration. All the rooms are small with the excepticn of one which has space for about 200. Lighting is poor and the equipment antiquated. There is a gymnasium room opening off a large central courte The second floor is devoted to class rooms and improvised laboratories. Large amounts of apparatus ere stored in wall cases. The laboratory and the museum also are on the second floore The third floor contains a few small lecture rooms, improvised laboratories, and a small animal house on part of the roof‘. Plans of the buildings were requested but have not yet been furnishede Te LABORATORY FACILITIES ~ Anatomy - The anatomy laboratory. has 12 tables; specimens kept in brine; dissection of entire body required of each stue dente Room fairly well lighted, but it is difficult to imagine how classes can be accommodated with so small a number of tables even though anatomy is continued through two years. Textbooks for reference during dissection not in evidence. Wo frozen sections; a few charts; no manikins seen. Histology ~- Taught soparately from physiologye Students not obliged to make their own sections though each has a microscopes Loan collections it was said are furnished each studente Physiology - Apparently a large amount of equipment in very 66 crowded quarters. Instructors work by preparing demonstrations for groups af five to ten students. During one such demonstration no notes were be- ing taken by the students. Chemistry laboratory = Not seen; methods not diseussed.. Pathology - Said to be taught with loan collections as is histolo- eye Each student furnished with a microscope. Husoum ~ Easily accessible to students; greatly overcrowded; fair number of wax models of pathological and anatomical preparations from Vas~ seur, Paris; excellent bone preparationse The diener for the museum pre- pares and sells skeletons for Kny Scherer & Company. Museum apparently not used to furnish material for illustrating lectures in other parts of the buildinge Goodman informed AG that laboratory work in all courses was very deficient. Students arrive at medicel school with very little preparation in chemistry, biology or physics and this deficiency continues. Goodman attempted to do experimental study on pulque, but was much hampered by lack of apparatus, material, and comprehension on part of the professors. 8. CLINICAL FACILITIES - The population of Mexico City given as 615,000 is in reality nearer 1,000,000 because of numerous contributory outlying tome which are indistinguishable from the city proper. General Hospital - Cases in medicine, surgery and obstetrics; between 600 and 650 beds; only one private ward of 30 beds; nearly all the clinical instruction for the school is given here although the hospital is not controlled by the school. The staff of the hospital is composed in part of professors in the medical school. There are 28 pavilions on Te the unit system. The teaching is deficient by reason of youth and inexper- ience of the instructing staff. Professors. do not give the majority of the instruction and exercise only a very little control over instruction givon by younger assistants. Direction of the school is in the hands of politicians. It is possible for students to have the position of practi- cantes at the general hospital, receiving 120 pesos a month from Mexican Red Cross. For these practicantes considerable clinical experience begins as in French hospitals at the outset of the course in medicine. Autopsies ' are easily obtained at the hospital but inadequately worked up. Hospital Jesus - 80 beds used largely by gynecology and out- patient department and to limited extent by students. Founded by Cortez in 1528. Antiquated in administration and inelastic in its adaptation to teaching needs of the school. Morelos ~ 200 beds; venereal diseases for women; used relatively little for teaching purposes. Juarez ~- 250 to 300 beds for accident and police cases with a few maternity cases. Students work largely on their own responsibility at their om choice in these hospitals, beginning to have clinical experience from the beginning of their course. Only in general hospital is residency on part of practicantes in vogue. 9. LIBRARY FACILITIES - Library about 10,000 volumes with between 20 and 30 periodicals. General appearance is that of a private collection zealously guarded by an old man suspicious of the motives of those who visit the library. A small collection is accessible to students for use in the library and a smaller collection, of which no note was kept, exists 8 for lending books to poor students. The lighting is poor; the reading room open 9 to 1@ in the morning and 3 to 6 in the afternoon. ‘The balance of volumes is as follows: Anatomy 546 Chemistry 262 Physiology , 44.2 Minerology 103 Pathology 851 Education 172 Gynecolory, obstetrics Phurmacolory 400 and pediatrics 400 Public and private Legal medicine 381 hygiene 192 Physiology 69 History, biography and Botany 73 "medical literature" 145 Dictionaries of medicine 420 As an example of the general character of tne library books in pathology, 851 in number, in all were found to be divided as follows: Number of books edited later than 1914, 216; number of books between 1910 ond 1914, 43; previous to 1910, 592. In physiology no books were found dated later than 1914. 10. FACULTY - Names by departments were requested but not furnishede All the faculty engage in private practice. ll. Tid ADMISSION REQUIRGMENTS for the school are a diploma from one of the national preparatory schools und special approval is necessary in case preparatory studies are taken in any other school. The national prepara- tory schools vary considerably in value and thoroughness of preparation according to what state they are in. For program of studies see pe 16 of Codigo Universitario. Secondary students are admitted to the medical school with widely differing qualifications. 12. FEES OF STUDMNTS - Rezular instruction fee is 15 pesos (37) per semester. In addition to this in order to take the final examinations 100 pesos are required as special fee. ublication of thesis is not requirede 13. DEGRELS = he degree of i.e De may be granted at the termination of Qe the required course or as an academic honor in any special instance or ex officio to the officials of the medical school. In ordinary academic life the honorary and ox officio degrees are not common. No other de= grees than that of Me De are given by the medical school. 14. COURSES ~ The school year is of 42 weeks; the number of hours per week in each year are as follows; lst year, 16 hours; 2nd year, 18 hours; 3rd year, 22 hours; 4th year, 23 hours; Sth year, 245 hours. For the plan of studies see page 46 of the Codigo Univsrsitario. 15. NUMBER OF STUDENTS - 500 to 600, 16. SOURCE OF STUDENTS ~ A few students come from outside Mexico. Guate- mala furnishes the majority of these. Of those coming from the different states of Mexico, the largest number come from the federal district and the adjoining states. No figures were uvailable on this point. 17.2 DISTRIBUTION OF GRADUATES - Distribution of graduates is widely over Mexico. No school in Mexico can compare with the medical school at Mexico City in this regarde In the small provincial towns the doctor in practice does not fail to have on his shingle the fact that he is a graduate of the Faculty of Medicine of Nexico Citys None of the provincial schools sommand: the same prestige. 18. THE MEDICAL SCHOOL of the national University of Mexico is easily the most important in the epubliee The other schools arc as follows: School of Medicine of Guadalajara " " " " bierida Monterrey Oaxaca uo " " puebla Miichoacan San Luis Potosi National School of Homeopathy in Mexico City Free School of Homeopathy in Mexico City Military Medical School in Mexico City “al tt " It 10, 19. LIST OF PUBLICATIONS by staff during the five past years requested, but not furnishede The above information was secured from conversations with Doctor Manuel Gea Gonzalez, Dean of the Medical Faculty; Doctor Alfonso Fruneda, Public Health Department; Doctor Albert Goodman, graduate of the School and of Columbia; Doctor Angel de la Garza Brito, a teacher in the school detailed to look after Dre F. F. Russell during his visit in Mexico City; and from the Codigo Universitario of the University of Mexico for 1922. The outline for report on medical schools was left with Doctor Gonzalez with the explanation that the Division of Medical Education was interested in securing the information referred to in the outline from all medical schools throughout the world and that it would be considered a great fae vor if Doctor Gonzalez could arrange to furnish the information requestede This he promised to doe No reply, however, has been received from him to dates October 22, 1923.