926 



SCIENCE. 



[N. S. Vol. VIII. No. 209. 



diploma in what way a physician has been 

 educated, it may be replied that, though 

 the degrees of A.B., A.M., Ph.D. and S.D. 

 are affected with exactly this same uncer- 

 tainty of signification, their value seems in 

 no way diminished therebJ^ As long as the 

 M.D. degree stands for a definite amount of 

 serious work on medical subjects directed 

 on the lines above indicated we may be rea- 

 sonably sure that those who hold it will be 

 safe custodians of the health of the commu- 

 nity in which they practice. 



If it be urged that the elective sj'stem in 

 medical education will lead to the produc- 

 tion of a class of physicians who, owing to 

 the early specialization of their work, will 

 be inclined to overrate the importance of 

 their specialty and to see in every disease 

 an opportunity for the display of their 

 special skill, it may be pointed out that 

 this result is apt to be due not so much to 

 early as to imperfect instruction in the 

 work of a specialist, and that, since the 

 elective system tends to encourage thor- 

 oughness in special instruction, the evil 

 may be expected to diminish rather than 

 to increase. 



I have spoken of the extension of labora- 

 tory instruction as an important forward 

 step in the improvement of educational 

 methods in medicine during the last quarter 

 of a century, and I desire to bring mj' re- 

 marks to a close with a few words on the 

 relation between laboratory and didactic 

 methods in medicine and on the employ- 

 ment of both methods in a system of in- 

 struction including both required and elec- 

 tive courses. 



There is perhaps no field of human 

 activity in which the pendulum of reform 

 makes wider excursions than in that of 

 education. Whenever any given method 

 is found to give unsatisfactory results there 

 is a strong tendency to abandon it alto- 

 gether in favor of some entirely different 

 method. Thus the obvious defects of the 



oral system of examination employed in the 

 Harvard Medical School thirty years ago 

 led to its complete abandonment and to the 

 adoption of the written examination book, 

 though there is little doubt that a system 

 combining the advantages of both the oral 

 and the written methods could easily have 

 been devised. In the same way the fact 

 that many subjects have been, and indeed 

 still are, taught in systematic didactic lec- 

 tures which can be better taught by labora- 

 tory methods tends to obscure the equally 

 important fact that there are many other 

 subjects in the presentation of which the 

 living personality of the lecturer is a very 

 important factor and which, indeed, can be 

 properly presented to students only by those 

 who have had much experience in weighing 

 scientific evidence. In this connection it is 

 interesting to recall the wise words of Hux- 

 ley, who expressed himself on this subject 

 as follows : " What the student wants in a 

 professor is a man who shall stand between 

 him and the infinite diversity and varietj' 

 of human knowledge, and who shall gather 

 all that together and extract from it that 

 which is capable of being assimilated by 

 the mind."* 



To what extent the laboratory can re- 

 place the lecture room will, of course, de- 

 pend upon the nature of the subject taught. 

 In such a branch as Anatomy, where facts 

 learned by observation form the greater 

 part of the knowledge to be imparted, 

 laboratory work can be substituted for di- 

 dactic instruction to a greater extent than 

 is possible in subjects like Phj'siology and 

 Pathology, where inferences from observa- 

 tions and conflicting views must frequently 

 be presented. In no department of medi- 

 cine, however, will it probably be found 

 possible to dispense entirelj' with a system- 

 atic course of lectures in which a trained 

 instructor may give to his class the benefit 

 of his accumulated experience. 



