A PLEA FOR BETTER METHODS IN MEDICAL TEACHING. BY WINTHROP T. TALBOT, M.D., BOSTON, MASS.

[Read before the American Institute of Homœopathy.]

At the present time, when the best and most progressive medical schools in this country have adopted increased requirements and the four-years' course as prerequisite to graduation, it is not strange that a demand should be made for reform in the methods of medical instruction.

Medical study to-day means of necessity economy of time and labor. Increased knowledge and the introduction of new branches essential to medical training bring added labor to the student, and the question is "How can the knowledge of our fathers be gained by their sons in a way which will leave sufficient time and force to enable them to conquer the new fields of knowledge also?"

Is it possible to improve upon the methods of the past? The lecture, as it has existed for many years in our schools and colleges, consists of a more or less carefully prepared digest or resumé of what is known on the particular subject treated, or what happens to be accessible to the lecturer. There are three classes of men who listen to lectures. The first and largest give fairly good attention one half of the time, and then wonder what the weather will be to-morrow, who made the pictures on the black-board, or how it is possible for a man to recite so many facts in such an impressive way without going into a state of senile degeneration. The second—rari aves are conscientious and in good health, and give their whole minds to the lecture, endeavoring to fix it so thoroughly in the memory that they may recall it later at any time—and third, the very industrious and somewhat narrow-minded class, who make elaborate notes of the words spoken and the facts stated, to which they may (or may not) refer in some distant future. The second class, those who are blessed or burdened, as the case may be, with a memory which is an omnium gatherum of facts, are few in number. The third class, the note-takers-intent on the words of the speaker, often confuse ideas, and many a lecturer would be startled by statements which may be found in an abstract of his lecture made by even a good student. The proneness of the human mind to err, especially in noting statements of fact, is notorious. So much for the general subject of lectures and indiscriminate donations of knowledge received without equivalent effort on the part of the student; when it comes to special branches let us examine the conditions which attend them.

The student must study anatomy: can he do so to better advantage than at present? He is a clever man who can lecture

for an hour upon anatomical facts and be original even in his method of presenting them. Is it not better for the student to spend more time in dissection and demonstrate more thoroughly what he has dissected rather than be compelled to listen to lectures which he justly suspects are cribbed from Gray or Quain? Yet, even in this branch, it is true that didactic instruction may sometimes be useful. In topographical anatomy, for instance, as illustrated with the living model, the lecturer occupies a field of great importance; no one subject perhaps is of greater service in making the student efficient when he comes to the clinical work in the wards or out-patient department and yet no subject is more neglected in our medical schools than this.

Physiology is less definite - here of necessity we deal with theories, but the less of theory the better, at any rate before graduation, and a short course of lectures with plenty of laboratory work and quizzes three times a week, will cover the ground sufficiently well in one year.

Of Chemistry, it were idle to attempt to persuade intelligent persons that the lecture is of any value compared with laboratory work and recitations thereon.

To pass to more advanced courses: In Operative Surgery, after a few lectures to familiarize the student with the main lines of work, it is impossible for the learner to get as much benefit from lectures as to spend the same amount of time in doing the actual operations himself upon the cadaver under the supervision of an instructor, — there is not time for both, even in a four-years'

course.

In Obstetrics will the student, after reading Lusk, learn as much from an hour's lecture on Version as from ten minutes' work on the manikin under proper instruction? In Clinical Medicine, who of those who have delighted in the classes of six or nine under the experienced first assistants in Vienna, will say that if the opportunity were offerd for choice their preference would be for the old-fashioned bookish lecture? No, to-day men of ambition look for something better. No one can learn from lectures how to handle the laryngoscope or ophthalmoscope, or become practised in diagnosis or pathology without much labor in the ward, clinic or laboratory. It is not that the lecture is useless or that it is not the best means to certain ends - especially in Therapeutics and Materia Medica, but the plea of this paper is for a curtailment of its functions in the medical school. Ward work, laboratory work, practical work of all kinds that is what fits the student to treat sick people, and makes a truly practical scientific man—not a mere theorist.

Aside from the work done by the student himself, the recita

tion will do much to formulate his ideas and give exact and ready expression to his thoughts. It is a common saying that to learn a subject thoroughly, the easiest and best way is to teach it; that is to say, knowledge is crystallized into a lasting form only by giving definite expression to it. The mere pouring in of knowledge is nothing. Only that which is digested and properly assimilated gives growth and strength. The mind must be trained to observe and study rather than merely memorize. To learn how and when to gather in facts is as important as a knowledge of the facts themselves.

It is certainly true that the lecture cannot be abandoned — it has its important uses — rather let more be made of it by not abusing it. The student of to-day is lectured nearly to death. He has lectures in twenty-nine subjects in one of our best schools to-day enough to overwhelm the most energetic notetaker. Of the information contained in these lectures, it is safe to say that with judicious advice from the instructor the student can get seven-eights of the whole amount in less time, with less trouble, and more lastingly, from the excellent text-books which should be his daily pabulum, but which the present lecture system, with its everlasting note-taking, leaves no time for him to read.

From the standpoint of the instructor, also, a need of reform is evident. In the lecture-room there is a constant drain upon his resources if he be in earnest, no matter how well grounded in the work he may be; or, on the other hand, if he be of that kind, reading to class after class the same old pages, his interest flags as the years go by, and he uterly fails to inspire enthusiasm or interest in his pupils.

The

Perhaps it might be vandalism to pull down the venerable medical joke from its high estate and oust it from its throne in medical instruction. There is no scheme on foot to molest the funny story there is plenty of room for it in recitation or demonstration. The inspiration to teacher or student under the stimulus of intelligent question and answer is very great. student, compelled to personal work, and formulating his knowledge not "for examination purposes only," but every day and for the sake of the knowledge itself, feels his gain from day to day, and displays increased desire to learn. The instructor with a live class is inspired to do his best work, and the dull labor becomes interested pleasure.

The question is of vital importance to thousands of scholars, and as schools where homoeopathy is taught have taken the lead thus far in every advance in medical education, these suggestions are offered in the hope that the men who have made medical education a part of their life work during many years,

and who, by adopting the four-years' course, two years ago, put the Institute in the van of medical progress, may again place their shoulders to the wheel, and give it another lift in the right direction.

ADDRESS ON THE METHODS OF MEDICAL EDUCATION: SHALL IT BE BY LECTURES OR RECITATIONS?

BY T. GRISWOLD COMSTOCK, M.D., ST. LOUIS.

[Read before the American Institute of Homœopathy.]

The best methods of medical education, and every other education, have not yet been settled with any degree of unanimity. The question to be discussed is, plainly, what are the best methods of acquiring a first-class medical culture, and educing the "Doctor optimus"?

Education, which is really synonymous with evolution, is the one word that expresses all the difference that lies between barbarism and our noblest civilization.

Education is the evolution of science, art, invention, and discovery, and all the grandest things that man, in a progressive state, has accomplished and made monumental in history.

The civilized world, for forty centuries, has been in a constant struggle to develop its noblest powers, through culture; but this has been through brain-sweat and the agony of myriad failings. And even now the many plans and methods insisted upon for the sake of obtaining the highest culture are so various that the best modes of study and acquisition have not even been wholly settled.

In the classic days of Greece there were no primary schools, no kindergartens, and, in fact, no schools for children; but in the groves of Academus, Socrates taught the youth of Athens, in the double methods, by lecture and interrogation in the Socratic method. And Aristotle taught them in the lyceum of Athens. Plato, Zenophon and Alcibiades were developed, and won fame in all the ages for profound intellectual culture. And there were hundreds more whom the relentless tides of Time have swept into oblivion.

Doubtless there were recitations and discussions, questions and answers, and also a great deal of oral teaching was givenwhat we call lectures. But the question is still mooted, "Which is the better way; all lectures, or no lectures, all recitations, or no recitations?""

We know that the practice of the medical universities of Berlin, Vienna, and Paris, is almost wholly devoted to lectures; except in the gymnasium, and the lower schools, there is little done in recitation.

The pupil does the listening, if not weary and sleeping, while the professor, not always attractive or brilliant, does the talking. And thus attending a course or courses of lectures entitles the graduate to a "prüfung" (rigorosum), and, if satisfactory, then to a diploma; but this diploma gives no right to practice medicine in Europe. In addition, he must pass a long and thorough and painful examination by the government authorities ("Staats Examen ") before he is permitted to write a single prescription, or give a prognosis of any disease. I pause here a moment to say that that is just what should be in every State of the Union. Neither should we accept the dicta of a home-made or foreign diploma until a thorough examination has verified them.

A severe and thorough examination (like the "Staats Examen" in Germany) should tell the right of a graduate to practice. A diploma is not sufficient. What right have these graduates of Europe, or Canada, armed only with a college diploma, to come here to practice, without examination, upon the lives of free-born American citizens, when our physicians are not allowed to practice there? Reciprocity is a principle as good in medicine as in merchandise. Why should we give more credit to the foreign diploma than is allowed to ours? Nothing is more dear to an American than fair play.

The State Board examination should ascertain what the graduate knows of himself; not what he has heard some lecturer say on the subject in some college, whether in Vienna, or Berlin, or Montreal. They are not allowed to practice in their own country on their diploma; but they presume to come here and take advantage of our slack methods.

And now a special word in point. In the face of the practice of medical colleges in Europe, I would insist upon the urgent necessity of studies by recitations, and even bedside studies, in addition to lectures. The truth is, that the young graduate should gain some practice in medicine before he begins to practice. I trust this apparent solecism will be taken in good part not recitations alone, not lectures alone, but a mixture of both methods should prevail, and the best results will come from a thorough drill in recitation and bedside practice.

The whole civilized world, since any system of education has been in vogue, has recognized the necessity of the drill which only recitations, thorough and exact, can produce.

What proficiency could be achieved if a regiment of soldiers should hear lectures on the manual of arms, and never have anything but the theory to go on?

If there is any one thing more needed than another it is the exact and thorough mastery of medicine and disease; and this must come through the ministry of all the faculties and the