May 4, 1900.] 



SCIENCE. 



693 



more restricted than might, at first sight, 

 appear for the amount of practical work 

 that can be successfully performed by first- 

 and second-year students in a physiological 

 or in a pathological laboratory is surpris- 

 ingly large. In the physiological depart- 

 ment of the Harvard Medical School, for 

 instance, during the current academic year 

 each pair of students in a class of 180 has 

 been furnished with a kymographion, a 

 capillary electrometer, a moist chamber, an 

 induction coil, unpolarizable electrodes, etc. , 

 and the most important experiments of 

 nerve-muscle physiology have been success- 

 fully repeated. The fundamental experi- 

 ments in the physiology of the circulation, 

 respiration, etc., are to be performed in a 

 similar manner. In the pathological labo- 

 ratory the students, working in sections of 

 ten, have had an opportunity of producing 

 for themselves and studying experimentally 

 the most important pathological degenera- 

 tions. They have also studied in the same 

 way the principal infectious diseases. In 

 the anatomical department also, while the 

 number of didactic lectures has been dimin- 

 ished, the whole class has had largely in- 

 creased facilities for the practical study of 

 bones and of various special organs. 



Still, after making due allowance for the 

 legitimate expansion of laboratory teaching, 

 it is probably safe • to say that a systematic 

 course of lectures in each of the medical 

 sciences will never be found to be superflu- 

 ous and that the day is probably far dis- 

 tant when the lectures will be merely ' ex- 

 planatory of the experiments. '* 



We have thus far considered the rela- 

 tive advantages of didactic and laboratory 

 methods in teaching the medical sciences, 

 but the agitation in favor of objective 

 teaching has extended also to the clinical 

 departments of medicine and the organiza- 

 tion of ' clinical laboratories,' in which the 



* Porter, Boston 3Ied. and Surg. Jotirnal, Dec. 29, 



cases of hospital patients may be studied 

 by the most refined methods of physiolog- 

 ical and pathological research, is a natural 

 outcome of this agitation. In fact, how- 

 ever, so far as instruction is actually given 

 at the bedside, clinical medicine has always 

 been taught by means of object lessons. 

 In many of our schools this instruction has 

 been supplemented by so-called ' confer- 

 ences,' exercises in which a student reports 

 before the class a case which he has him- 

 self examined, giving diagnosis, prognosis 

 and treatment. The subject is then dis- 

 cussed by the class and finally by the in- 

 structors. 



AVherever actual cases of disease are thus 

 utilized for teaching purposes the instruc- 

 tion is always likely to be more or less hap- 

 hazard and unsystematic, for the diseases 

 studied will be those of which actual cases 

 happen to be available. To remedy this 

 difl&culty it has been recently proposed * to 

 substitute the study of hospital records of 

 cases for the examination of the cases 

 themselves, a method quite analogous to 

 that known as the ' case-method ' which 

 has long been used with great success in 

 training students in the Harvard Law 

 School. It will thus be possible to group 

 cases so that they will throw light upon 

 each other and, though the student will 

 miss the stimulus of contact with the actual 

 patient, the method presents so many dis- 

 tinct advantages that it will doubtless com- 

 mend itself to many teachers of clinical 

 medicine and of theory and practice. 



It is thus evident that the reaction 

 against purely didactic methods of instruc- 

 tion is well under way. It is a movement 

 to be heartily welcomed, for there can be no 

 doubt that medical students have been and 

 still are too much lectured, but, like all 

 other reforms, it should be carefully guided 

 lest useful as well as useless things be swept 

 away. It should be borne in mind that it 

 * W. B. Cannon, A.M., 1. c. 



