February 28, 1901] 



JVA TURE 



42y 



Greeks survived only in a few men of genius, a spark that in our 

 own time has been fanned into flame. Joined to the powerful 

 example of the most liberal education of that period was the 

 difficulty of obtaining material for dissection. Stark necessity 

 united with specious theory to fasten upon this most concrete of 

 sciences the methods of the schoolmen, and to this day the bulk 

 of the instruction in anatomy remains didactic, and consists of 

 books, diagrams, and more or less misleading models. Dis- 

 sections are made to illustrate the book. The printed descrip- 

 tion is learned by rote, and the dissection practised too often 

 simply as a manual exercise. The anatomy of the medical 

 college is largely a memory drill — such as belongs pedagogically 

 in the secondary schools. These seventeenth-century notions 

 have been passed from anatomy to physiology. That which 

 began as a makeshift has become a dogma. 



Practical work in physiology has also been kept back by 

 the erroneous ideas that the cost of apparatus and other 

 materials is prohibitory, that medical students cannot master the' 

 details of exact experimentation, that delicate apparatus cannot 

 be trusted in their hands, and that instruction to the extent 

 required cannot be given to large classes because the course will 

 become too complicated to be carried out. 



Perhaps the chief obstacle which has kept physiology in an 

 ancient and now almost abandoned path, is the public belief 

 that because anatomy and physiology were once taught chiefly 

 from books, they should still be so taught ; that the functions of 

 living organs can be learned from books with the occasional , 

 exhibition of dead organs ; that the natural sciences should con- 

 tinue to be studied in secondary schools without laboratory 

 work ; in brief, that nature can be studied apart from nature. 

 The public has a just contempt for men who profess to have 

 learned disease without practical observation of the sick — ex- 

 perience is conceded to be necessary here — but the public is 

 ready to applaud, and even to compel by law the study of the 

 same organs in their normal state by reading or hearing a 

 description at second hand of what some third person saw. The 

 real drags upon progress are the failure of the secondary schools 

 to teach science by scientific methods, and the fatal conserva- 

 tism that binds teachers of medicine to a past that we should do 

 well to forget. These venerable delusions no longer impede 

 experts in pedagogy, but unfortunately medical teachers for the 

 most part are more zealous than learned in pedagogy. They 

 fail to see that medical training should be "for power," and 

 only secondarily for information. 



If it be replied to these strictures that a system which pro- 

 duces so many able physicians cannot be much in need of 

 improvement, I answer that the men of talent veil the defects of 

 the mass. They owe much to themselves ; genius will thrive on 

 the intellectual diet that stunts the merely industrious man. 

 The average student does not build upon a sound foundation. 

 He knows little anatomy, less physiology, and still less 

 chemistry, and even his training in practical medicine has to be 

 supplemented where possible by postgraduate work in a hospital. 

 On the whole, it may be said that his industry has been largely 

 misdirected. 



The picture I have drawn of the instruction in physiology in 

 the average medical school will be accepted by teachers of that 

 science. The sense that the usual methods of instruction 

 neither develop nor much inform the mind is general. Careful 

 inquiry should therefore be made to determine how far the 

 defects can be remedied with the means at our disposal. The 

 problem is : How far can the correct theory be realised in 

 practice? To what extent can all students of physiology be 

 taught in the manner in which men are trained to be pro- 

 fessional physiologists ? Evidently physiologists are likely to 

 study their own subject in the most profitable and labour-saving 

 way. 



The expansion of physiology has broken it into specialities. 

 Even professional physiologists can no longer have personal 

 acquaintance with the whole subject, or even a relatively 

 large part of it. To a considerable degree the physiologist 

 himself must acquire his information from reading the work of 

 others. It would therefore be idle to expect the student to get 

 a personal experimental knowledge of the whole subject. His 

 limited time must be used chiefly for training, and not chiefly 

 for'the acquisition of facts, as at present, and this training must 

 follow the lines laid down by physiologists for their own 

 development. 



Deal so far as possible with the phenomena themselves, and 

 not with the descriptions of them. Where the fundamental 



NO. 1635, VOL. 63] 



experiments cannot all be performed, fill the gap with the 

 original protocols from the classical sources. Associate facts 

 which the student can observe for himself with those which 

 he cannot observe. Use as the basis of professional insl ruc- 

 tion, where practicable, the facts and methods to be used by 

 the student in earning his living. Teach the elements by 

 practical work. Let the student state his observations and 

 results in a laboratory note-book, which, together with the 

 graphic records of his experiments, shall form one of the require- 

 ments for the degree. Control his progress and remove his 

 difiiculties by a daily written examination and a daily confer- 

 ence, in which the instructor shall discuss the observations made 

 by the student and supplement them from his own reading. 

 Stimulate the student by personal intercourse in the laboratory, 

 by glimpses of the researches in progress, and by constant 

 reference to the original sources. Diminish the distance be- 

 tween professor and pupil ; both are students, and both should 

 be fed on the same intellectual diet. There is but one way to 

 get and keep an education. Demand of every student a written 

 discussion of some very limited thesis, giving the results of the 

 original investigators, together with any observations the student 

 has made for himself. Give the more capable students oppor- 

 tunity for original experimental work. Towards the end of the 

 instruction, when the student is ripe for such work, offer a liberal 

 number of courses of didactic lectures with demonstrations. 

 Let each course consist of from one to four lectures not more 

 than forty-five minutes in length, presenting all that is known 

 of the chosen subject. These lectures should show the student 

 the historical development of scientific problems, the nature of 

 scientific evidence, and the canons of criticism that help to sift 

 the wheat from the chaff of controversy. From the beginning 

 to the end of the instruction hold fast to concentration, sequence 

 and election. Such are the lines along which sound theory 

 would direct the teaching of physiology in medical schools. 



Concentration, sequence and election are the safeguards of 

 economical labour. 



Whether the student's time is to be given wholly or only in 

 part to the subject taught is the first problem to be solved in 

 planning the actual instruction. Men in training for professional 

 physiology commonly concentrate their energies for a sufficient 

 period on this one subject ; and this is regarded as the most 

 economical way of mastering any science, for the ground gained 

 by one day's work is still fresh in the mind when the next day's 

 work begins, and continuity of thought is not disturbed. The 

 plea that the instruction in one subject should be broken by the 

 study of other subjects in order that the instruction in each may 

 have "time to sink in" need not be entertained ; experience 

 shows that much of it sinks in so far that it cannot be recovered 

 without the loss of valuable energy. A more serious objection 

 is that the method of continuous application is highly fruitful in 

 men of exceptional powers, who are keen in spite of protracted 

 effort, but is wasteful for the average brain, which is fatigued 

 and unreceptive after some hours of unremitting labour. The 

 truth of this must be allowed ; but the objection does not apply 

 to wide-ranging sciences such as anatomy and physiology, 

 which are not narrow, hedged-in areas, but which consist rather 

 of broad and diversified domains composed of many contiguous 

 fields, the varied nature of which is a perpetual refreshment. 



A correct sequence of study is also highly important. Very 

 often in medical schools the lectures in physiology are given 

 before the student has any acquaintance with the anatomy of 

 the structures considered, and still more are heard before the 

 student has any true anatomical knowledge — that based on 

 actual contact with tissues and not upon a glimpse of a distant 

 prosection or a hasty glance at a diagram. Similar instances 

 are not uncommon in later parts of the curriculum. The natural 

 sequence demands that the study of structure should precede 

 the study of function, and the study of the normal precede that 

 of the abnormal. Thus the natural order of medical study is 

 descriptive anatomy, physiology, pathology and medicine. 

 There is a considerable advantage in treating organs individually, 

 studying their structure, physiology, pathology, diseases and 

 treatment in continuity, but practical difficulties in arranging 

 such a course make this inadvisable. 



Election is correct in theory and unavoidable in practice. 

 Generations have passed since it was possible to teach every 

 clever student all things. Yet in many schools the effort is still 

 made. The herd of students is driven hastily past the monu- 

 ments of genius and learning in the hope that they who run 

 may read. Students are exhorted to be great, while littleness 



