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NATURE 



[February 28, 1901 



every stage of their careers. It is in the highest degree satis- 

 factory to kno.v that this principle is being acted upon in the 

 courses of scientific instruction followed in many of our schools 

 and colleges — more particularly in the Schools of Science and 

 Higher Elementary Schools of the Board of Education. But a 

 large class of students of a higher grade are introduced to scien- 

 tific subjects on the old-fashioned plan, the reason in most cases 

 being that they have no time to pursue a course of work con- 

 structed on rational lines. Metaphorically, they endeavour to 

 enter the field of science by a shoit cut instead of following the 

 route of patient and persistent observation, and in the end they 

 find themselves without the certificate of admittance into the 

 Delectable City. Medical students are the greatest sinners in 

 this respect, but the fault lies not so much with them as with 

 their masters and examiners. So many subjects have to be 

 taken that it seems almost hopeless to look for greater oppor- 

 tunity for investigation or for the development of a spirit of 

 research in students whose knowledge of practical chemistry is 

 obtained by a few hours' test-tubing. In the teaching of physi- 

 ology, also, there is a great gap between rational methods and 

 existing practice, and Dr. W. T. Porter, associate professor of 

 physiology in the Harvard Medical School, directs attention to 

 it in an article which we reprint, slightly abridged, rrf)iii the 

 special educational number of the Philadelphia Medical Journal. 

 Dr. Porter shows, in addition, how large classes of students may 

 Le carried along the well-known roads that lead to scientific 

 power, and gives the results of one year's experience with a 

 method of instruction different from that usually employed. 

 His paper thus contains a statement of a course which has been 

 proved to be practicable, and has been accepted by the Faculty 

 of the Harvard Medical School. The methods described need 

 not, however, be limited to medical education, as they are based 

 upon principles which, mtttatis vmtandis, can be applied to in- 

 struction in any science. The paper is thus worthy of considera- 

 tion by every one interested in the extension of natural knowledge. 



To the physician the study of physiology is of use largely 

 because it creates a habit of thought essential to the highest 

 professional success. Physiology is a rational science. Its 

 problems require the scientific method. They demand the 

 precise statement of the question in hand, a severely critical 

 examination of the results of experiments, and the arrangement 

 of the accepted experiments in the order that shall lead logic- 

 ally, step by step, to a correct solution. Medicine is itself an 

 experimental pursuit. Its higher walks are open only to those 

 skilled in research. The scientific method cannot be acquired 

 by the study of anatomy and pathology in the purely descrip- 

 tive form in which they ordinarily are presented to the medical 

 student ; in this form they are stuff for visual and aural memory 

 — not for the exercise of reason. Nor can the experimental 

 state of mind be readily acquired by the study of clinical 

 medicine. Reliance must be placed on a well-developed, 

 highly rational science, cultivated to train rather than inform 

 the mind, pursued, not for its stores of information, but for the 

 highest product of human faculty— the system of inquiry that 

 leads to light through darkness. Too often in our medical 

 schools information is mistaken for knowledge. Only know- 

 ledge is power. The getting of mere information wastes the 

 student's time. The vast accumulations of centuries of medical 

 study confuse the undisciplined mind and crush the spirit. The 

 burden of fact which any man can bear is relatively small, and 

 each year grows relatively smaller. To find new truths and to 

 look undismayed upon the old is the perfect fruit of education. 

 This physiology can give, and on this power to train should 

 rest the high position of physiology in schools of medicine. 



The physiological lectures in medical schools are commonly 

 given by one man and cover the entire field of physiology. This 

 field is much too large to perinit of even superficial personal 

 acquaintance by one man. Necessarily, therefore, the instructor 

 must take the chief part of his lecture from text-books. To 

 this he adds citations of a few experiments or observations 

 taken from the original sources. He has not and cannot have 

 real knowledge as to the present state of special opinion on the 

 majority of the chapters in his subject, because none but a 

 specialist can cope with the constantly rising flood of meri- 

 torious research in any one chapter— to keep pace with the 

 whole of a science which stretches ample arms over the larger 

 part of human and comparative biology is impossible. Physi- 

 ology could not be taught by the lectures now so largely given, 

 even were lecturers gifted with superhuman knowledge. Physi- 



NO. 1635, VOL. 63] 



ology deals with phenomena, not with words. Many of these 

 phenomena, for example the heart-sounds, cannot be described ; 

 others can be pictured dimly, but only to those who know re- 

 lated phenomena from having actually seen or otherwise sensed 

 them ; in no case can lectures properly instruct unless the fun- 

 damental facts or closely related facts have first been learned by 

 actual observation in the laboratory. The student should come 

 to the lecture already possessed by his own efforts of the pheno- 

 mena to be discu.ssed. Chapters, such as metabolism, in which 

 the fundamental experiments are unusually difficult or protracted, 

 should be preceded by less difficult though related chapters. If 

 the obstacles to practical work in any field are insurmountable, 

 the protocols of classical experiments in this field, together with 

 a suitable connecting text, should be studied before the lecture. 

 At present the lecturer.too often merely offers a list of facts which 

 mean little or nothing because they cannot be associated in the 

 student's mind with phenomena already observed. The lecturer 

 attempts to remind the student of that which the student never 

 knew. The secondary schools have prepared the student to see 

 nothing strange in this. Most men enter the" physiological 

 course persuaded that natural science can be acquired chiefly 

 from books, and leave convinced that a deal of talk and a penny- 

 worth of nature will give real knowledge of the action of living 

 tissues. 



A natural science cannot be weU taught except by those who 

 have themselves made experimental investigations in the special 

 field which they would teach. No one in these days can woik 

 profitably in many fields, and only necessity should make one 

 man attempt to teach them all. A man trained, for example, 

 in the physiology of digestion is likely to have but a relatively 

 feeble grasp on the physiology of the circulation, and nervous 

 system, or the special senses. It follows that most of the instruc- 

 tion in the one-man system does not adequately represent the 

 present state of knowledge. It is behind the times in all ex- 

 cept the special field cultivated by the instructor himself. So 

 far as possible, the didactic instruction in each field should be 

 given by the member of the physiological staff actively at work 

 therein, but this wise principle of the division of laVjour is nut 

 usually regarded. 



Passing now to the demonstrations, we find that in the larger 

 schools they are made before an audience of at least two hun- 

 dred. Thus the greater number cannot see the demonstration 

 clearly. If the class be divided into small sections, the brief 

 glimpse allowed each man does not suffice for a full grasp of the 

 details. Very commonly the demonstrations requiring much 

 time are given in a course separate from the lectures. In short, 

 most of the demonstrations as now given are an aid to the 

 memory rather than a means of training in science. The posi- 

 tion awarded them by the usual lecturer and by almost every 

 student is one of the evidences of the fundamental pedagogical 

 error which renders most medical teaching of anatomy and 

 physiology so largely futile, namely, the deplorable notion that 

 demonstrations are merely illustrative, and the book and the 

 lecture the main force. Never was the pedagogical cart more 

 squarely before the horse. Contact with nature is the essential 

 of all training in biology. 



The laboratory work in large schools is usually done in rela- 

 tively small sections, and is not coordinated with the regular 

 lecture course. The student feels that the experiments are 

 purely secondary. The experiments are imperfectly arranged 

 into groups. They merely illustrate the text- book. In no case 

 do they present a full picture of any field. The time allowed 

 is so short that criticism of results and insistence upon the proper 

 standard of excellence is not attempted. 



The instruction is the same to every stucjent without regard to 

 what his life is to be. Much time is given to matters which 

 have a very remote connection with the future of most students, 

 and which are not better material for training the mind than 

 matter bearing directly on the student's future work. 



It is important to inquire how this extraordinary system was 

 developed. The reply is that the present method is a survival of 

 mediiieval methods ; the student of tradition finds a rich field in 

 the history of medical teaching. The teaching of ph)siology 

 has broken away from anatomy ; men now living have taught 

 both subjects in the same course of lectures. Descriptive 

 anatomy became the most conspicuous discipline in medicine at 

 a time when the best mental training could be had only from 

 books, from lectures, from abstractions. It was the flowering 

 time of metaphysics, of authority, of the deductive method. 

 The true principle of approaching nature discovered by the 



