students is of little value. To make bedside observation available for large classes, any one of the class should be allowed to visit the wards and examine patients and study their records during a set time of two or three hours daily and at a time in which there will be no serious interference with other clinics or other work. For purposes of bedside instruction the writer makes use of a diagnosis chart which was presented to this Society on a former occasion, which assists a student to go through a routine examination of any case assigned to him.

Amphitheatre clinics have their advantages and drawbacks. To utilize clinical material to the best possible advantage requires a large floor space for setting up ten to twelve tables for the simultaneous examination of as many patients. Demonstrable regionary lesions can be marked in colors on the skin of a patient or may be recorded by means of a chart. Not more than four matriculates should be invited to each table and, guided by competent instructors, should be given an opportunity to examine each case. After such demonstration en masse the students would take their seats and the teachers would proceed to point out the important differential diagnositc features and therapeutic indications in each case. Diagnostic punctures and manual methods of treatment, such as stomach and bowel irrigation, bathing, feeding by gavage, tapping the thorax, the abdomen, the spinal canal, intubation, removal of adenoids and tonsils, etc., can be demonstrated with advantage before a large class. The Lumiere color photograph is also available for clinical teaching

The broadening influence of pediatric study has not been sufficiently emphasized and is probably underrated, but must be conceded as we realize how thoroughly the practice in diseases of children brings us into close touch with almost every other special line of medical work, including general surgery, the eye, ear, nose and throat specialties, orthopedics, skin diseases, etc.

Owing to the lack of flexibility in medical matters, much time will pass before medical schools will be properly equipped to teach practical pediatrics, but it is so ordained that all evils will in time work their own cure, and these few reflections are offered as a small contribution to the propaganda of adjustment.






It was in the hope of throwing some light on the medical aspects of the Kindergarten question that the investigation, of which this paper is a report, was instituted. This investigation was begun without prejudice either for or against the system and purely in a spirit of inquiry, with a view to obtaining information on some of the vital questions which the physician is called upon to decide in daily contact with his patients.

It may be stated at the outset that there is no intention of offering a final solution of the various questions involved. The opinions received from sources of equal authority are so diverse as to render a positive conclusion impossible. Indeed, as the subject is developed it will be noted the results obtained are in a sense disappointing. Yet I feel that the views expressed are of sufficient interest and importance to warrant the presentation of this paper, in which both the pros and cons of the question will be impartially stated.

It is beyond the scope of this paper to enter into a detailed discussion of the philosophy of Froebel. Yet, a résumé of the history of the Kindergarten will, I think, not be amiss.

SOME POINTS ON THE PHILOSOPHY OF FROEBEL,* The kindergarten had its origin with Froebel (1782 to 1852), whose Philosophy of Education is based upon abstract thought. His philosophy is in essential agreement with the philosophical system known as Idealism, which formed such an important part in the intellectual life of the Germany of his day. The ideas of Kant, Fichte, Schelling and Hegel had impressed themselves on the thought of the times. When Froebel had arrived at the age of serious reflection, he was influenced by the philosophy of his predecessors. The philosophic spirit of Idealism, under the spell of which Froebel lived and breathed,

. For this reference to Froebel's philosophy, I quote freely from a paper by John Angus MacVannel, Ph.D., Instructor in Education, Teachers' College Record, 1903.

attempted to unify the world and human life and its keynote was the grandeur and dignity of man.*

Froebel did not present educational thought which was altogether new. Like all human progress, it was evolved from previous knowl. edge. The germs of Froebel's thought may be found among the ancient philosophers. Socrates, Plato and Aristotle speculated in a mystical way concerning the deeper problems of life. Similar speculations struggled through the Middle Ages and found vigorous exponents in Luther, Bacon and Comenius. Kant began a movement which thought to discover the unity of all life, of nature and humanity in the Absolute Spirit. Hegel developed this thought into a system. Froebel was directly influenced by the philosophic teachings of Rousseau and Pestalozzi. He sought the latter as his teacher and supplemented his doctrines by making all educational work all sided and universal.†

As Pestalozzi owed his inspiration directly to Rousseau, so Froebel, sitting at the feet of Pestalozzi at Ifferton, received the message from the lips and the work of his great master.

Froebel's strict adherents believe that education is no mere empiri. cal matter, but has its warrant deep in the very nature of the world. But the unbiased reader will at times encounter in his writings conclusions that seem unwarranted, and important questions that are not satisfactorily answered. It cannot be permanently our purpose to accept Froebel's system without qualification, or at least more adequate interpretation in the light of results of later science and experience. It is at the same time all important that the fundamental truths of his thought shall be rationally preserved and that in the process of its worn-out forms its vital essence and spirit shall neither be lost, nor even for a time impaired. As Green, of Oxford, said of the system of Hegel, so may we say of the system of Froebel, “It will all have to be done over again.” Yet, in this very process of transformation, the fundamental character of his thought will be more fully recognized and its permanence more completely assured. Commenting on the philosophy of Froebel, Oppenheim says:

"His methods rested upon a foundation of keen observation, of love, fellowship and sympathy. But he knew very little of the reasons outside of metaphysical considerations for his course of work. In addition, there was a certain amount of lazy thought, of mysticism in his belief. He set up a sort of glorified child worship."

No account of kindergarten instruction would approach completeness without a reference to the basic principle of Froebel's teaching, namely, a consideration of what he termed “gifts."

Froebel's presentation of the subject of Gifts appears extremely complicated. The subject is a composite of mysticism, symbolism, mathematics, ethics and religion. The gifts were intended to serve a twofold purpose in the education of the child:-(1) to awaken his inner life to the percej of natural forces, and (2) to interpret the external world for him.

THE GIFTS. The degree of isolation that obtains in the study of the gifts is directly due to the conception that they are materials of independent

• MacVannel, Teachers College Record, November, 1903.
† "Law of Childhood," by W. N. Hailmann, 1889. Alice B. Stockham & Co.

For the subject matter referring to kindergarten gifts, I quote freely from a paper by Harriet Melissa Mills, Teachers College Record, November, 1904.

worth. The logical outcome of this isolation can be known through the study of kindergarten programmes and the actual demonstration of them in the kindergarten. It is the common practice in preparing an outline or programme to select a number of typical experiences from Froebel's "Mother Play," which are intended to initiate the child, through play, 'into his total environment. Correlated with these plays are songs, games and stories. The gifts are developed along independent lines in harmony with the prevailing notion, through long series of exercises that depend upon the logical sequence of form for their deepest significance.

The most notable effort in programme making and the one that has gained widest acceptance is the unpublished outline by Miss Susan Blow. The gifts in this outline are administered largely on the basis of form. They represent the subject-matter of exercises that in their initial steps concentrate upon some abstract notion inherent in the various gifts. In an address before the International Kindergarten Union, Miss Blow said: “The material used by the children for their productions has a geometric basis. Spheres, cubes, cylinders, squares, oblongs, triangles—indeed most geometric planes, and many geometric solids, thus become familiar to the little workers. Using them, the child comes to perceive them in all the objects around him. Numerical relations are also suggested, and thus is put into the little hands the mathematical key which unlocks the gates of inorganic nature.”

Turning now to the prevailing practices in the kindergarten, a striking illustration is afforded of what it means to follow the lines of least resistance in the Froebel philosophy. The decision having once been made that the child has urgent need to know the formal aspects of material things, the next step is to supply this need through the use of gifts. This the Kindergartner may do by preparing her own series of exercises, or she may turn to the Gift Book or various manuals, and find the exercises ready to hand that will unlock to the child the "whole wide world of form and its elements of faces, corners and edges.” Or, easier still, she may adopt outright a programme that must, because formulated by someone of large experience and insight, contain all the elements that child nature can need.

The formal programme also affords opportunities for building life forms; and naming the object and its uses becomes the subject of interesting conversation. For example, in an exercise with the fifth gift, the child builds a boat with cubes and triangular forms. The object is interesting because it touches life; but the practice of leading the child to a condition of awareness of the form built as a boat trapezoid crowds the exercise out of the range of the childish comprehension.

One of the fundamental characteristics of the fourth gift is contrast in dimension-length, breadth, height. These elements of dimension are permanently embodied in each of the eight bricks into which the cube is divided, and are made the point of departure for an indefinite variety of exercises that emphasize the relative position of the bricks as they are built into the three classes of exercises known as life, beauty and knowledge forms. These exercises may at the same time concentrate upon any one of the following ideas as the principal aim of the lesson, viz., divisions of the cube, enclosure of space, extension plays, surface movements, forms illustrating the laws of balance, illustrative lessons and geometric forms, of which there are at least thirtytwo examples of square and oblong prisms. Each gift has its own peculiar principles and laws to be demonstrated through play exercises, and theseknown only to the teacher-constitute the almost endless resources of the kindergarten gifts.

In kindergartens where the logical geometric sequence of the gifts is held inviolate, the children play through exercises that emphasize sphere, cube, cylinder, square and oblong. They count faces, corners and edges, first on the gifts and then on the objects around them.

They discover vertical, horizontal and oblique lines, angles and tri. angles of every description, while prisms-square, triangular, rhom. boidal, trapezoidal, etc., are made to develop in logical progression; and the road to discovery is so hedged about with limitations and restrictions that no element of chance enters to prevent the prearranged achievements. For example, in developing the right angle two sticks are given to the child, and the impulsive response results in the perfectly natural discovery of the right angle. This procedure has been defined as the "method of restricted freedom."

It is a well-known fact that Froebel did not complete the series of gifts as they are used at the present time. He left many vague hints concerning the extension of the gifts by the addition of new formsand subsequently of more sub-divisions—that would render the series more complete in its evolution of form, and further elucidate the fundamental properties of matter, time and space. There has been a persistent effort on the part of his followers to realize these suggestions, with varying success.

It is needless to say that as time has gone on the general adherence to the strict Froebelian teaching has relaxed, and while in some quarters there remains a semblance of orthodoxy, nevertheless, in the more enlightened quarters the 'interpretation is very liberal, and it would seem, almost at a glance, that the strict observances laid down by the founder must come to be regarded as obsolete because they are antiquated and not in accord with any definite knowledge of the brain per. ceptions of the child. The modern kindergartens, under the most enlightened leaders, tend to abandon the formal methods and programme and consider “that, after all, the child remains the heart and the inspiration of it all."


The investigation of kindergartens, from the physician's point of view, was suggested to me as a result of numerous conversations which I had with medical men concerning this subject. Some thoughtful colleagues were in the habit of advising parents most strenuously against sending children to kindergarten. Many of the reasons physicians gave for taking this position will appear in the subject matter which follows. I undertook the investigation in the hope of obtaining authoritative opinions. I myself could not arrive at any definite decision, nor was any conclusive information to be found in the medical literature. It seemed to me that in order to make the investigation far-reaching enough, it

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