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CATECHETICAL INSTRUCTION, owing to many misconceptions, has been very generally decried. To guide and systematise the student's reading, to oblige the careful noting of hospital cases and attention to lectures, to stimulate the careful obser. vation of the appearances presented by dissection, to exercise his reasoning faculties, so that he shall completely digest and understand the many varied facts offered to his mind, and to enable him to express clearly, fully, and systematically, bis ideas, are its legitimate objects—and who can deny their utility ? Passive attention to a lecture is, especially with some, very diffi cult, and while a student would hesitate to stop a lecturer to ask him on some point he did not understand, be often does so with a tutor. But men are apt (as in many other instances) to confound the abuse with the nse, and then justly depreciate its exclusive adoption. That any mere word-of-mouth instruction, which only loads the faculty of memory, could be substituted for all others, is simply impossible; and how inapplicable would such information be to relieve the maladies of the living patient! This system of " cramming" may stock the mind, but it fails in that moulding of the mental powers, and in developing that most inestimable of faculties, a sound habit of thought, which other methods perform. A “grinder" is paid according to his success; if school and clinical teachers were so paid great changes would occur. If the former passes a pupil in a few months, the latter should do it more efficiently, with all his cases and museums at command, if he did bis duty.
I would then advocate an efficient system of tutorial instruction throughout the whole period of the student's pupilage, and thus avoid "forcing" or "cramming," which an appropriate method of examination would altogether suppress.
Tutorial instruction should never be conducted at the hours allotted to hospital or lecture,
as this would afford a pretext to the idler to neglect these most indispensable duties. Such a system is now adopted in many institutions where medical tutors are appointed, and in Edinburgh the late Professor Goodsir stated its advantages to be that it allows the pupil to see and more closely examine the structures shown at lectures, that it affords more full and precise information, and keeps the student au courant with the lectures." The great Medical Congress of Paris reported : “Private instruction does not supersede that which is official, inasmuch as it can confer no title to the acquisition of degrees; but as an adjunct to public instruction it is highly useful, and from the ranks of the private teachers have arisen many of the most distinguished professors." The professors in German universities are also chosen from among the private teachers of each subject who most distinguish themselves. There are usually two or tbree such teachers in every subject. Some years since, also, the court of the Royal College of Surgeons in London stated, “in the system of oral examination they see nothing objectionable, but, on the contrary, innumerable advantages. They are, therefore, must favourably disposed to any efficient course of private tuition carried on in connexion with lectures and hospi. tal practice, but they cannot too strongly express their opinions that such instruction should be extended over the greater part of the student's career.”
However, a general resume of the candidate's previous laboạrs immediately before the final trial (or "strapping" as it is called, carrying the sharpening metaphor still further) cannot be disadvantageous. Nevertheless in one of the most severe letters which ever appeared against grinding, “ Observator" complains of the following advice given by a grinder to pupils about " to pass the Hall:" • If you get Mr. A. you may rest pretty easy in your mind. He is very kind and gentlemanly, and is always unwiiling to reject apy man who knows his Pharmacopoeia. Louk
well over that book, and remember that the subjects always come in it alphabetically, so that in searching for anything to which he shall direct your attention, you may be able to open on the right place, with the air of a person who is quite familiar with the learned volume in question, and understands it from its alpha to its omega. If you get Mr. B. you will find him thoroughly practical, so be sure to narrate all the cases you have seen, especially midwifery ones. If you get Mr. C. you will find him pettish, very fond of putting catch-questions, as the Latin derivation of hemoptysis (a word you will recollect really derived from the Greek). He will also make a little fun of you, and perchance tell you that
you know no more of your profession than & governess or a washerwoman.
Take care, by the way, that you do not admit to this gentleman that you studied in Scotland, if such be the case, for he has a most sneering antipathy to all medical schools and professors north of the Tweed, and would like, if he could, to pluck you for the very admission." Now, really, if examiners have such absurd peculiarities, and if the governing bodies of the colleges will not substitute more sensible men, I do not see why it is improper that candidates should be advised of them. Private tutors should be appointed to the proportion of three or four for every 100 pupils, and as they cannot be expected to be omniscient, they should be restricted to anatomy and physiology, surgery and medicine, chemistry and materia medica respectively. The fees should be regulated like lecture fees, about £4 for all the tutors from each pupil for the session. Besides the regularly-appointed tutors, others might endeavour to get pupils who were particu-. larly slow, or who had been especially idle, to pay by the month for an hour's private instruction daily; but the tutors should be protected by at least two sessions being spent in their class by each pupil.
READING. The reading of a student must be necessarily confined, in great degree, to the compendia of the various branches of medical science, as bis leisure from lectures and hospital would never allow him to read the numerous monographs which issue from the press (121 purely medical works were entered at Stationer's Hall last year). This is, however, the less to be regretted as they are often written in so diffuse and unpractical a manner that they could not fail to distract attention, and many of them are written more to display the writer's special knowledge than to teach the reader. So much was this the case at one time, that it was made a rule in medical ethics never to publish during an author's lifetime. The writings of the moderns might with advantage be modelled after those of Pott, W. Hunter, and such masters of medicine and surgery, which are minute without being tedious, and are always clear and precise. Watson's “Physic" is a model student's book, for it is most pleasantly written a character which much aids its digestion and is not encumbered with foot-notes, which, although they make a show of erudition, are very confusing to the student.
There are some invaluable treatises not all, by the way, of the most modern date, the writings of Colles, Graves, Brodie, and Syme, for example—which must be perused. Prof. Harvey of Aberdeen proposed to reform medical education by the enforcing of regular and special text-books, which should afterwards be the sole subject of examination. If such perfect books could be written, they would supersede all other means of instruction; for, to use Mr. Simon's expression, they would give all the words of the lecturer except his “ hums” and “haws." Text-books should be remarkable for accuracy yet conciseness-rather aphoristic than diffuse, so that the facts of each science may be
174 expressed in as few words as possible, and the thoughts packed closely, for the reflection of the student and
the explanatory efforts of the teacher will make them more fall and explicit. If disputed matters and such less important subjects are to be discussed in the pages of text-books, they should be printed in distinct type, so as to allow the junior student to value the important and the unimportant. The additions of questions on the facts of each chapter, or, when the licensing bodies improve their systems of examining, selected from their papers, affords a most useful exercise for the student's memory and judgment. The professor of the subject might advantageously follow the order of such books. A regular system of reading certain hours daily should be adopted and persevered in. Reading should be not merely receptive of the author's ideas, but reflecting and discriminating, and such kind of study is fortunately less tiresome than the mere stuffing of the memory.
It was once the fashion to decry “reading and such theoretical knowledge;" and both Sydenham and Dr. Gregory, when asked by a student what to read, are said to have told him “ Don Quixote” (a great psychological study, by the way). Medical works
are too often crowded with hosts of opinions; and, although nothing is more valuable than precedent, yet sach crowds of authorities, often of inconsiderable value, and introduced to oblige or propitiate contemporaries, are altogether too great a tax on the student's memory, and possess no practical benefit. The illustrious Göethe, of whom qur profession is so proud, on this point remarks, “ All professional men labour under a great disadvantage in not being allowed to be ignorant of what is useless. Every one fancies that he is bound to transmit what is believed to have been known." To a certain extent, however, remembrance and gratitude for those who have enriched our science should be preserved, as otherwise it is quite possible for a former author to be