JuLT 29, 1921] 



SCIENCE 



83 



the lectures whicli are given can serve this im- 

 portant purpose equally as well as recitations. 

 The informal recitation has the further advan- 

 tage of permitting a better evaluation of the 

 ability of the individual student than is pos- 

 sible with the more formal and more auto- 

 cratic recitation conducted by the teacher. 

 Inherent reticence of the student often pre- 

 vents an answer to a teacher's question and 

 yet permits of an adequate answer to the same 

 question from one of his colleagues. The pro- 

 tection of the community and the maintenance 

 of high standards in a school of medicine 

 demand that the teacher form a proper esti- 

 mate of the students' ability and this estimate 

 can be materially aided by observation in the 

 democratic and informal recitation. 



A certain amount of flexibility in program 

 is provided for in offering elective courses in 

 the various divisions of special pathology. 

 Considering the content value of a technical 

 subject, it is difficult to adopt the program of 

 flexibility to any very wide extent. Neverthe- 

 less, the principle can be applied without too 

 great a sacriflce. Instead of assigning a 

 certain number of slides for each day, a cer- 

 tain number of days can be given over to a 

 particular subject; the total number of slides 

 or other material can be indicated and the 

 proportionate division of the work left to the 

 student's personal wishes. Eecognizing the 

 fact that drawing illustrations of slides or 

 other material has considerable value, never- 

 theless, flexibility may be adopted here. For 

 example, the students of our present class have 

 been told that fifty drawings are required in 

 the subject of special pathology. Their se- 

 lection of the subjects to be illustrated is of 

 far more significance than is actual technical 

 skill in drawing. No particular forms are 

 given for the report of experiments and the 

 method of presenting these reports gives the 

 student complete freedom and serves as a 

 guide to his grasp of the subject. 



The correlation of the material acquired in 

 pathology to the daily affairs of the stu- 

 dent's and physician's life is a matter which 

 has given the writer considerable concern. 

 Fundamentally, this means the interpretation 



of pathology in terms of clinical medicine. 

 The introduction of experiments to illustrate 

 in animals these disturbances has been of the 

 utmost vlaue. Simply performing the experi- 

 ments is insufficient ; they must be interpreted 

 so as to demonstrate their application to hu- 

 man disease. The method adopted in our 

 work has been described.^ Even this proves 

 insufficient and every opportunity must be 

 taken to impress on the student the fact that 

 the material he deals with comes from living 

 patients. Correlation can also be approached 

 by means of the clinical pathological confer- 

 ence, as adapted to the needs of students. In 

 our courses eight periods of one and one 

 half hours each are employed for this purpose. 

 It is possible as a rule to cover two or three 

 cases in each period. Two students of the 

 third year class are required to present the 

 history and differential diagnosis of a case 

 that has recently come to autopsy. Following 

 the discussion of this presentation, the organs 

 from this patient are demonstrated by two 

 other students either of the same class or of 

 the second year class; this is succeeded by an 

 attempt at correlation of symptoms and mor- 

 phologic disturbance, as well as a discussion 

 of the sources of error in clinical diagnosis. 

 These exercises have proven to be most suc- 

 cessful. In addition to these conferences the 

 second year students at the end of the studies 

 of the disease of the heart and of the diseases 

 of the kidney take part in exercises which were 

 first utilized with the cooperation of Dr. F. W. 

 Peabody and are now being practised with the 

 cooperation of Dr. R. W. Scott. These exer- 

 cises have been described in detail^ but they 

 can be summarized by an illustration from a 

 recent exercise. The students gathered in the 



1 Karsner, H. T., ' ' The function of the experi- 

 mental method in the course in pathology, ' ' Boston 

 Med. and Surg. Jour., 167: 511, 1912. Pearce, 

 R. M., ' ' The teaching of experimental pathology, 

 and pathological physiology to large classes," 

 Bull. Johns Hopkins Hospital, 22: 249, 1911. 

 Karsner, H. T., ' ' Teaching the pathology of func- 

 tion, " Jour. Am. Med. Assn., 75: 361, 1920. 



2 Karsner, H. T., ' ' The experimental method as 

 utilized in the clinico-pathological conference, ' ' 

 Boston Med. and Surg. Jour., 170 : 723, 1914. 



