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requires considerable practice, and long-continued attention to distinguish them. This is but a familiar instance of what we are perpetually meeting with, and which establish, beyond question, the necessity of some further instruction than that afforded by books, if we would be masters of the art upon which we intend to enter. The necessity of practical teaching may be further illustrated in this way:—A skilful nurse will be able to tell by the cry of an infant whether it proceeds from pain, from hunger, or from irritability. The sound alone is sufficient in her ear to determine the point. In the same way, the mere act of coughing, if attentively listened to, will be sufficient, in many instances, to determine the nature of the affection upon which it depends.
Clinical instruction consists of two parts, that given in the class-room and that at the bedside. The former is necessary, as embracing many topics connected with the cases which cannot be conveniently given before patients. Illustrative diagrams often require to be used, which would be out of place in the wards; and statements have to be made by the teacher which would be injurious or distressing to the patient if made in his hearing. The method I have been in the habit of pursuing in this hospital is, I believe, not practised elsewhere. It consists in reducing the principal points of the case, forming the subject of lecture, to a sort of skeleton sketch, writing them in large characters on paper, and then pointing them out to the attention of the class, as they become the text for the requisite remarks. In this way mistakes are guarded against, the attention is fixed, and an interest kept up, which is hard to be maintained when the pupils have only their ears to exercise.
The other part—namely, that given at the bedside, is a sort of practical demonstration; the teacher pointing out the prominent symptoms of disease as exhibited by the patient under examination, and drawing attention to the special peculiarities of each case, as they correspond with or differ from what is ordinarily observed in similar instances. Here we are accustomed not only to tell the students that they will find certain signs and symptoms in the patient, if they
