May 4, 1900.] 



SCIENCE. 



courses, which, when once chosen, become, 

 for the student choosing them, required 

 courses leading to examination. There is 

 in my opinion, no doubt that an arrange- 

 ment of instruction similar to that here 

 suggested for physiology could be advan- 

 tageously adopted in the departments of 

 anatomy, histology, bacteriology, medical 

 chemistry, pathology, surgery, and in the 

 courses of instruction in the various special 

 diseases, such as dermatology, ophthal- 

 mology, etc. 



In the existing state of medical education 

 the introduction of the elective system in 

 some form or other seems to be an essential 

 condition to any further important advance, 

 for the curriculum of most of our schools is 

 already so crowded that no considerable 

 amount of instruction can possibly be added. 

 Various arguments may, of course, be ad- 

 vanced in opposition to the change. It may 

 perhaps be urged that no choice of studies 

 can be made without determining to some 

 extent the direction in which the work of a 

 future practitioner is to be specialized and 

 that such specialization cannot be properly 

 and safely permitted until the student has 

 completed his medical studies. To this it 

 may be answered that, whatever may be 

 the dangers of too early specialization, the 

 dangers of crowding the medical course 

 with instruction of which many students do 

 not feel the need, and of thus encouraging 

 perfunctory and superficial work, are a cer- 

 tainty no less serious. It is, moreover, a 

 matter of common observation among teach- 

 ers in medical schools that a certain num- 

 ber of students very early make up their 

 minds either that they will become surgeons, 

 obstetricians, or specialists of some sort, or, 

 on the other hand, that they have a strong 

 aversion to certain branches of medicine and 

 a determination never to practice them. For 

 such students a prescribed curriculum neces- 

 sarily involves great loss of time and energy. 



If it be said that under this system the 



medical degree will cease to have the defi- 

 nite meaning now attached to it and that it 

 will be impossible to tell from his 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 afiected 

 with exactly this same uncertainty of sig- 

 nification, their value seems in no way di- 

 minished thereby. As long as the M.D. 

 degree stands for a definite amount of seri- 

 ous work on medical subjects, we may be 

 reasonably sure that those who hold it will 

 be safe custodians of the health of the com- 

 munity in which they practise. 



If it be urged that the elective system 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 thoroughness in special 

 instruction, the evil may be expected to di- 

 minish rather than to increase. 



METHODS OF INSTRUCTION. 



Having thus recognized the necessity of 

 I'emodeling our conception of the subject 

 matter to be taught and noted the impor- 

 tance of distinguishing between the essential 

 and the desirable in medical education we 

 must next consider by what methods the 

 needed information may be best imparted 

 and the necessary training secui-ed. There 

 is perhaps no way in which modern educa- 

 tional methods diifer more from those of an 

 earlier period than in the greater promi- 

 nence given to object lessons. Beginning 

 with the kindergarten the child is trained 

 to cultivate his power to observe accurately 

 and to manipulate skilfully and, through 

 his school and college life, prominence is 



