Decembee 30, 1910] 



SCIENCE 



945 



diagnosis and treatment in their hospital 

 services, studied diagnosis in many courses 

 in Europe and have never been able, ap- 

 parently, to obtain any other view-point of 

 medicine by reason of these deadening in- 

 fluences at an impressionable age. In 

 some instances the results have been but 

 little short of a tragedy. 



When in the course of events I became 

 converted to this view, although firmly be- 

 lieving in a hospital training and in the 

 large field legitimately occupied by diag- 

 nosis in medical education, I could not 

 consistently help students to secure hos- 

 pital positions by a coiirse of instruction 

 which I believed was by its very nature 

 disposed to bring about their practise of 

 medicine in hospital work as though it was 

 a finished science. The problem thus pre- 

 sented itself to me very clearly. Should I 

 devote my time to instilling in the minds of 

 students the unfinished or the completed 

 condition of medicine? So I became an 

 anarchist in so far as my energies have 

 been concerned in destroying what in other 

 ways was being built up. The disapproval 

 of a considerable number among the stu- 

 dent body was immediately my portion 

 when I took this step. 



In passing from this to another phase of 

 these matters it is proper to remark that 

 the field of my labors, having to do con- 

 siderably with the examination of dead 

 bodies, is not one which helps to give the 

 worker in such a field a fair and just esti- 

 mate of the heights to which diagnosis in 

 medicine has actually attained. 



You may be interested and perhaps a 

 little chagrined to know that in your in- 

 struction in pathology during the last two 

 years of your medical course, j'ou have 

 played the role of apparatus in a pedagog- 

 ical experiment, an experiment which has 

 been going on now almost nine years. I 

 have already pointed out that our gradu- 



ates in spite of the absence of any consid- 

 erable didactic instruction in pathology 

 during the last two years in medicine pass 

 the state board examinations ; as you know, 

 the percentage of failures is commendably 

 small. The large number of graduates 

 from this school who secure hospital posi- 

 tions by written examinations do so with- 

 out participation by members of the 

 pathological department in the instruction 

 of the class preparing for such examina- 

 tions. These conditions, however, had 

 nothing to do with the initiation of the 

 pedagogical experiment I wish to describe. 



The teaching of pathology has, to my 

 knowledge, no fixed or standard method. 

 In each medical school or university meth- 

 ods are in vogue which are largely matters 

 of tradition. There is no widely endorsed 

 plan nor is there any organization among 

 pathologists for the purpose of ascertain- 

 ing and adopting the most desirable 

 method of teaching this branch of medi- 

 cine analogous to the associations of other 

 professional teachers, for example the Na- 

 tional Society for the Promotion of Engi- 

 neering Education, in this country. Per- 

 haps the nearest approach to any concerted 

 effort of this sort has to do with the recom- 

 mendations of the council of medical edu- 

 cation previously referred to which deal 

 with the apportionment of the time to be 

 spent in the different studies. It has been 

 left to each instructor to follow his own 

 methods and ideas. In most institutions 

 following the acquirement of the prin- 

 ciples of general pathology and bacteriol- 

 ogy students are expected to obtain with 

 more or less thoroughness a knowledge of 

 the subjects usually included in the text- 

 book considerations of special pathology 

 or regional morbid anatomy, a systematic 

 review of the lesions of particular tissues 

 or organs. 



There were several reasons for abandon- 



