this way familiar with conditions singly and in their combination and interconnection. He gets cross-sections of disease -- a most important experience, but, once more, not the same thing as the continuous observation of the developing disease process and the influence thereon from day to day of whatever therapeutic procedure is adopted. In the same way, an instructor in physics might take his students through a large laboratory, showing them how electrical attraction or some other single factor produces a particular type of effect in each of a dozen different experiments,-a most valuable method to impress upon them the specific tendency or effect of the force under discussion; but no substitute for experiments performed by the student himself from beginning to end, in which electrical attraction and much besides come into play. Under any but the most vigorous teaching, the demonstrative method may fail to stimulate sufficiently: the student looks and listens,—a passive attitude that may relapse into something more deeply negative. Finally, the ease with which an expert passes from case to case, the necessity of confining attention to decisive features which he selects, may, if not elsewhere corrected, tend to encourage the superficial examination and the hasty conclusions with which current practice may be justly reproached. Outside the wards there is a narrowly limited use for demonstrative instruction in the class-room or small amphitheater, where groups of cases can conveniently be shown; but the value of demonstration increases apace, as it approaches the intimacy of the individual experiment. Remoteness is quickly fatal. “The larger the circle of listeners, the more difficult for the teacher to hold the interest of them all; as soon as those sitting some distance off no longer see and hear exactly what is to be seen and heard, their thoughts run wild, they lose the logical thread of the diagnostic process.”[1] This is especially true of spectacular amphitheater surgery, which is of meager educational value, though as a rule prominently exploited.
Other methods have their uses also; even the didactic lecture may not perhaps be wholly dispensed with. Case work is discrete; students rarely possess sufficient generalizing power to redeem it from scrappiness. At the bedside not much time is available for comprehensive or philosophical elucidation. The lecture—hugging as closely as may be the solid ground of experienced fact—may therefore from time to time be employed to summarize, amplify, and systematize. In time, the student's sense of reality will be sufficiently pronounced to enable him to grasp a rare condition that he knows only through exposition. The wards may have failed to supply an example. But however used—whether to classify first-hand knowledge or to fill up a gap—the didactic lecture would appear to be pedagogically sound only at a relatively late stage of the student's discipline. It has no right to forestall experience, filling the student with ill comprehended notions of what he is going some time to perceive.
Some ingenious Harvard men, profiting by the experience of the Harvard law school, have evolved an effective discipline in the art of inference. Just as a preliminary course in physical diagnosis, teaching the student how to gather his facts, is
- ↑ Von Strümpell, loc. cit., p. 23.
