690 



SCIENCE. 



[N. S. Vol. XI. No. 279. 



given to the objective side of education to 

 an extent which would have seemed to the 

 book-trained pedagogues of a former gener- 

 tionbut ill adapted to provide the well-stored 

 mind which it was thought to be the prin- 

 cipal object of education to secure. In the 

 professional schools also the reaction against 

 purely didactic methods has been strongly 

 felt. Even in those professional pursuits 

 to which the object method might seem at 

 first sight least applicable, in the study of 

 the law, the so-called ' case method' of in- 

 struction has been found to exert a vivify- 

 ing influence. 



In medical education in this country it is 

 interesting to note that, in the very begin- 

 ning, the instruction was more objective in 

 its character than at a somewhat later 

 period. In those early days it was in the 

 office of his preceptor and at the bedside, 

 as his actual assistant, that the embryo 

 physician was initiated into the mysteries 

 of his calling. Then followed a period 

 when it was clearly perceived that the 

 trained mind is necessary to interpret the 

 data of observation and that mental train- 

 ing is essential to correct observing. Hence 

 schools were established to provide this 

 training by means of systematic didactic 

 lectures covering all the departments of 

 medicine and usually extending over not 

 more than four months. These schools 

 were intended at first merely to supplement 

 the work of the preceptors but in process 

 of time the relative importance of these 

 two educational agencies was reversed and 

 the work of the preceptors, became supple- 

 mentary to that of the schools. The func- 

 tion of the preceptors finally became so 

 subordinate that their names no longer 

 appeared in the catalogues though this did 

 not always indicate that they had ceased to 

 afford students opportunities for practical 

 clinical work.* 



*See address by Henry Hnn, M.D., Albany Med- 

 ical Annals, October, 1896. 



The schools, once established, grew chiefly 

 by an increase in the length and number of 

 the lecture courses as new and important 

 subjects forced themselves upon the atten- 

 tion of the medical profession. Against 

 this undue extension of purely didactic 

 methods of instruction a reaction has now 

 set in and during the last ten or fifteen 

 years loud voices have been raised in ad- 

 vocacy of more objective methods than 

 those at present in use. It is not, however, 

 the reinstatement of the preceptor that is 

 urged but rather the greater use of labora- 

 tory methods in the strictly scientific de- 

 partments of medical instruction and their 

 application as far as possible at the bedside 

 of the patient. A fruitful discussion of the 

 relative advantages of the laboratory, the 

 lecture and the text-book as methods of med- 

 ical education cannot be undertaken without 

 a recognition of the fact that this education 

 has a double object. In the first place the 

 faculties of the student are to be so trained 

 that he may observe carefully, reason cor- 

 rectly, study effectively and judge wisely ; 

 in other words, he is to be ' trained for 

 power ' to use President Eliot's phrase. 

 In the second place there must be imparted 

 to him a sufficiently large fraction of the 

 acquired medical knowledge of the time to 

 make him a safe custodian of the health of 

 the community. Which of these two ob- 

 jects is the more important is a question 

 which we need not now discuss, but even 

 if we grant all that is claimed by the advo- 

 cates of training for power it is evident 

 that the constantly increasing range of 

 subjects with regard to which an educated 

 physician must be informed will greatly 

 reduce the time which, in the curriculum 

 of a medical school, may properly be de- 

 voted to courses of instruction not intended 

 to impart direct and valuable information. 

 In fact, ' training for power ' should be 

 largely a function of the academic depart- 

 ment of a university, and, when undertaken 



