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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.
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. The 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 homớopathy 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 Homæopathy.] 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 given what 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 partnot 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 any. thing 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
senses -through the eye and ear, through the brain-sweat, and the constant drill of memory -- and by hard work, and not merely by the ear.
It may be very nice and wonderfully easy to listen to the learned professor; but we must study the authorities for our selves, and there is no better test of exact knowledge than by recitation.
There are two distinct methods of human culture : one refers to the great fact of receptivity, or the receiving of facts, and data from all history, science, and thought - that is, what men have said and done. The true scholar is always a receiver, and in his profession he must give account of his receivership, "qui non proficit, deficit.” In this sense the mind and the memory are a sort of hopper, to gather facts and history, and adjust the same. While this is of the last importance, it is not all by any means. The mind must give out as well as take in, and this is the true process of education.
Grass and grain are good for milk and cream, but the digestive and internal arrangements are necessary to convert the coarse material into the finer product ; so the knowledge poured into the mind must be worked out by internal processes to get the best results. For what is education ? It is a grand word full of meaning; it is the culture, the educing of the mind, not filling it up with outside matter; it is the leading out of the mental powers, an intellectual development, an evolution.
The original Latin word education means the culture and discipline of the mental forces; thus training the faculties to act upon whatever comes in contact with the mind as fact, a science, a theory, or a philosophy.
The medical student is not merely to be receptive automaton, and to receive his education through the auditory nerve alone. With every sense and faculty alert he must use the midnight oil ; he must dig, and delve, and develop, and put into shape, for active duty, what he knows, and this he can best do by faithful study and recitation. And all his professional study and work must be based upon a preliminary classical education ; Latin and mathematics should come before professional duties. I believe in a thorough education. “Non doctior, sed meliore imbutus doctrina" - (Not more doctors, but doctors better taught).
" Let us, then, be up and doing,
With a heart for any fate;
Learn to labor, and to wait."
“Now, my little man, describe your symptons.” “I haven't dot any symptoms, I dot a pain."
SOME REMARKS ON APPENDICITIS.
BY ALONZO BOOTHBY, M.D., BOSTON, MASS.
[Read before the American Institute of Homeopathy.] Among the diseases characterized by pain and swelling in the right inguinal region are prominently mentioned typhlitis, perityphlitis and appendicitis. According to many recent authorities perityphlitis, as a distinct pathological condition, does not occur, and typhlitis is rarely found except in a secondary inflammatory process, but the appendix vermiformis is held to account for nearly all of the trouble.
Concerning this point I shall express my views later on.
By most authorities typhlitis (inflammation of the cæcum) is recognized, associated with lodgement of feces. Males between three and thirty years of age seem to be most susceptible, and there is usually a history of constipation, errors in diet, or, not unfrequently, traumatism. There is pain in the right iliac fossa, constipation, nausea, slight fever, rarely above 101 F.; usually there is discomfort on extension of the right thigh. On pressure there is tenderness, and in many cases a doughy, "sausageshaped " tumor may be detected. The attack lasts from three days to a week. The pain and tenderness gradually subside, the tumor disappears, and recovery is completed in the majority of cases. Rarely fecal ulcer occurs with perforation and its consequences.
Perityphlitis, or inflammation of the connective tissue about the cæcum, may coexist with inflammation of the cæcum itself, or occasionally may exist primarily. Pus may form, and perforation into the bowel take place, or resolution may occur, as in typhlitis.
Appendicitis is described as occurring under three forms: Catarrhal, ulcerative, and perforative. In the catarrhal form the entire tube is thickened, firm and stiff, the mucosa covered with tenacious mucus; slight circumscribed peritonitis may have occurred, so that adhesions are often formed with adjacent structures. Very frequently small fecal concretions are present.
The ulcerative and perforative forms of appendicitis may be due to tuberculosis, typhoid inflammation, irritation from foreign bodies or enteroliths, or from obliteration of the cæcal end and distention of the lumen with fluid.
The results of perforation may be as follows: (a). No adhesions forming, perforations may at once produce diffuse and violent suppurative peritonitis. (6). Quite commonly adhesions do form, and peritonitis remains local with circumscribed abscess, following which resolution may take place. (c). If the appendix passes behind the cæcum and colon, and is not in the