NOTE 1, p. 6. l. 24.
To be heard with confidence we must prove that we have anticipated
objections. There are those who shew reason for believing that the
inflectional elements were once independent roots: in other words
(or rather in a formal expression) that a given case = the root+a
preposition, and that a given tense = the root+the substantive verb. Now
believing that, although two forms may be thus accounted for, the third
may have a very different origin, in other words, drawing a difference
between _a_ method of accounting for a given part of speech, and _the_
method of so doing, I find that the bearings of the objection are as
follows:--
The independent words, anterior to their amalgamation with the root,
and anterior to their power as elements in inflection were either, like
the present prepositions and the verb substantive, exponents of the
relations of Time and Place, or they were, like the present nouns and
verbs, names expressive of ideas: and presuming the former to have been
the case, the old inflected Languages may have grown out of Languages
like our own; and, _vice versa_, Languages uninflected (or at least
comparatively so), like our own, may give rise to inflected ones like
the Latin: in which case, a Cycle is established, and the assertion
concerning the sequence falls to the ground.
Now the assertion concerning the _two_ stages professes to be true only
as far as it goes. The fact that certain nations are even now evolving
a rudimentary inflection out of a vocabulary of independent roots,
gives us, as an etymological phenomenon, a _third_, and an earlier
stage of Language; a stage, however, of which cognizance, out of a
work on Etymology, would have been superfluous. The independent roots,
however, in these Languages coincide, not with the prepositions and the
verbs substantive of (comparatively) uninflected Languages, but with
their Nouns and Verbs.
To an objector of another sort who should inquire (for instance) where
was the Passive Voice in English, or the Definite Article in Latin,
the answer would be that the question shewed a misapprehension of the
statement in the text, which is virtually this: not that there is
either in English or Latin, respectively, Passive Voices, or Definite
Articles, but that there are in the two Languages the processes that
evolve them. It may also be added, that (an apparent truism) the
quantity of Processes depends upon the _capacity_ of the Language. A
dialect consisting (as some do) of about ten-score words can _bear_
but a proportionate number of Processes. The truth, however, of the
statements in question depends upon this: viz. that all the processes
there existing are the processes that exist elsewhere, and that all
processes which, with a given increase of Language may at any future
time be developed, shall coincide, in kind, with the processes of other
Languages.
It may be satisfactory to the Author of the Principles of Geology to
discover that his criticism affects other sciences besides his own.
Notwithstanding the industry, and acumen of continental critics, it may
be doubted whether the Principles of Etymology (as a _Science_) have
not yet to be exhibited. I use the word _exhibited_ intentionally. That
many Etymologists _apply_ them I am most certain; where, however, do we
find them detailed in system, or recognised as tests?
We draw too much upon the Philologists of Germany; and where men draw
indefinitely they trust implicitly. I believe that the foundations
of Etymology are to be laid upon the study of existing processes;
and I grow sanguine when I remember that by no one so well as by an
Englishman can these processes be collected. With the exception of the
Russian (a doubtful exception) we come in contact with more Languages
than any nation under the Sun. Here then we have an advantage in
externals. The details of Etymology I can willingly give up to the
scholars of the Continent; in these they have already reaped a harvest:
but for the _Principles_ of Etymology, I own to the hope that it may
be the English School that shall be the first to be referred to and
the last to be distrusted. In sketching the outline of a system of
Scientific Etymology, I again borrow my analogies from Geology. Its
primary divisions would be two: 1stly, The processes that change the
_form_ of words, or the _formal_ processes. 2ndly, The processes that
change their _meanings_, or the _Logical_ processes. The first of these
would be based upon the affinities and interchanges of _sounds_, the
second upon the affinities and interchanges of _ideas_: the sciences
(amongst others) which they were erected on being, respectively,
those of Acoustics and Metaphysics; and the degrees of Etymological
probability would then coincide with the correspondence of the two
sorts of processes.
Few Etymologists have any conception of the enormous influence of
small and common processes, provided that the extent of Language that
they affect be considerable. In the very generalizing classification
of Languages into Monosyllabic, Triliteral, and Polysynthetic, I
put no trust; for I can refer (to my own satisfaction at least) the
differences that are generally attributed to an original diversity of
composition, to a diversity in the development of processes: in other
words, I know of processes which with a given degree of development
render the three classes convertible each in the other. With these
notions I, of course, take exceptions to the _Principle_ of the
classification; for I deny that the _Form_ of a Language is, in any
degree, an essential characteristic. The axiom is not _Propter formam
Lingua est id quod est_, but _Propter elementa Lingua est id quod est_.
The question concerning the Classification in point is analogous to the
question concerning the Chemical and the Natural-History Classification
in Mineralogy.
NOTE 2, p. 7. l. 22.
Were it not for the admixture of other questions, the present Lecture
might have been entitled _The Sufficiency of the English Language as
a Disciplinal Study in Grammar and Etymology, irrespective of the
fact of its being the native Language of Englishmen_. The appended
qualification is in no wise a superfluity. Our native Language is the
best instrument in Disciplinal Study simply because it is our native
one; and a Pole, a Spaniard, or Hungarian can best lay in their ideas
of General Grammar from the special study of the Polish, Spanish, and
Hungarian Languages respectively. The very palpable reason for this
is that, before we can advantageously study the System of a Language,
we must have acquired a certain quantity of the detail of it. Now,
in the attempt to collect ideas of General Grammar from the study of
a Foreign Language, we shall find that the Theory will be swamped by
the Practice; in other words, that, by attempting to do two things at
once, we shall do one of them badly. Merely, then, to have predicated
in England, of the English Language, that it was a good and sufficient
Disciplinal Instrument would have been to have remained silent as to
its _abstract_ merits as such.
Of these abstract merits the degree depends upon the chronological
extent of Language that we make use of. To get them at their _maximum_
the Two Stages must be taken in: and the Two Stages being taken in, it
is more on a par with the Languages of Classical Antiquity, than it
has generally been considered to be. Still (considered thus far only)
it is inferior to them. For the Greek and Latin, exceeding it in the
quantity of original Inflection, have run through an equal quantity of
change. Considering, however, not the English only, but the whole range
of allied Languages forming the Gothic Stock, the question takes a
different shape. As a Magazine of Processes and Principles, the Gothic
Stock not only equals the Classical, but exceeds, by far, the Greek
Branch of it. The Hebrew from its _quasi_-symbolic form has Disciplinal
merits of its own.
Let the Languages of Greece and Italy be learned for their own sake;
and by those who have the privilege to appreciate them. One might think
that the works of Homer and Demosthenes, of Lucretius and Cæsar, were
a sufficient reason for turning with diurnal and nocturnal hands the
copies that exhibit them. But let us not (as we often are) be told
that it is necessary to study the Latin or the Greek Accidence for the
sake of learning grammar in general. The self-deception that in taking
up Latin and Greek we are studying a Grammar, instead of beginning a
Literature, is too often the excuse for concluding our studies just
where they might advantageously begin, and for looking with complacency
upon limited acquirements just where limited acquirements are
pre-eminently of little use.
NOTE 3, p. 8, l. 27.
I feel that the assertion here made requires modifying and explaining.
I should be sorry to be supposed to have made it, under the old notion
that in any written records of the Saxon Literature there is any
ostensible admixture of Danish (_i. e._ Scandinavian); still less do I
participate in the belief of the early Gothic Scholars in the existence
of their so-called Dano-Saxon Dialect. I recognize, moreover, the
criticism that refers the apparent Danish (Scandinavian) element of
the East-Anglian, and Northumbrian Glossaries to the original affinity
between the extreme Low German and the extreme Scandinavian Dialects:
thus making it _indirect_. It was once my opinion (one which I have
since modified but not given up) that in the present English, and
consequently in the Low Germanic Branch of the Gothic Stock, obscure
traces of the great Scandinavian characteristics (_viz._ the existence
of a Passive Middle or Reflective Voice, and the peculiar expression of
the sense of the Definite Article) could be discovered: but it was not
upon this idea that I founded the assertion in the text.
The question has its peculiar difficulties. Words that have long
passed for Scandinavian, are continually being detected in the Saxon;
so that the Philologist who should say _this word is Scandinavian
and not Saxon_ has the difficult task of proving a negative. Again,
the point is one upon which no single person's assertion should be
received. Hastiness of Induction, in favour of particular Languages,
when we know these Languages (as every Language, indeed as every kind
of Knowledge, must be known) at the expense of some other, comes upon
us unconsciously. The Languages of the Gothic Stock that I know best
are those of Scandinavia; the Provincial Dialect of England which
I have most studied is that of Lincolnshire, and the neighbouring
maritime Counties. Here the preeminence of the Danish (Scandinavian)
element being acknowledged, the question is whether it be _Direct_ or
_Indirect_. I am free to confess that this circumstance sharpens my
sight for the perception (true or false) of direct Danish elements.
As a counterbalance, however, the consciousness of it engenders a
proportionate self-distrust.
Upon the whole, I would rather that the sentence had run thus: _the
Direct Scandinavian element in the English is still to be determined,
and here (as in many other places) there is open ground for the
original investigator_.
INTRODUCTORY LECTURE,
DELIVERED
AT THE MIDDLESEX HOSPITAL,
OCTOBER 1, 1847.
There are certain facts of such paramount importance, that they not
only bear, but require, repetition. The common duties of every-day
life, and the common rules of social policy, are matters which no
moralist states once for all: on the contrary, they are reiterated as
often as occasion requires--and occasion requires them very often.
Now it is from the fact of certain medical duties, both on the part of
those who teach and those who learn, being of this nature, that, with
the great schools of this metropolis, every year brings along with it
the necessity of an address similar to the one which I have, on this
day, the honour of laying before you.
You that come here to learn, come under the pressure of a cogent
responsibility--in some cases of a material, in others of a moral
nature--in all, however, most urgent and most imperative.
To the public at large--to the vast mass of your fellow-creatures
around you--to the multitudinous body of human beings that sink under
illness, or suffer from pain--to the whole of that infinite family
which has bodily, not unmixed with mental affliction, for its heritage
upon earth--to all who live, and breathe, and feel, and share with
yourselves the common lot of suffering--here, in their whole height
and depth, and length and breadth, are your responsibilities of one
kind. You promise the palliation of human ailment: but you break that
high promise if you act unskilfully. You call to you all those that are
oppressed; but you may aggravate the misery that you should comfort
and relieve. You bear with you the outward and visible signs, if not
of the high wisdom that heals, at least of the sagacious care that
alleviates. Less than this is a stone in the place of bread; and less
than this is poison in the fountain-springs of hope.
Not at present, indeed, but within a few brief years it will be so.
Short as is human life, the period for the learning of your profession
is but a fraction of the time that must be spent in the practice of it.
A little while, and you may teach where you now learn. Within a less
period still, you will practise what you are now taught.
And practice must not be begun before you have the fitness that is
sufficient for it. Guard against some of the current commonplaces of
carelessness, and procrastination. Lawyers sometimes say "that no
man knows his profession when he begins it." And what lawyers say of
law, medical men repeat about physic. Men of that sort of standing in
medicine which, like the respectability of an old error, is measured by
time alone, are fondest of talking thus; and men of no standing of any
sort are fondest of being their echoes. It is the current paradox of
your practical men, _i. e._ of men who can be taught by practice alone.
Clear your heads of this nonsense. It will make you egotists, and it
will make you empirics: it will make you men of one idea: it will make
you, even when you fancy it would do you just the contrary, the wildest
of speculators. The practice of practical men, in the way I now use the
words, is a capital plan for making anything in the world, save and
except practitioners.
Well! this has seemed excursive, but it is not so: it is a reason
against the putting off of your learning-time. When your first case
comes, you must be as fit for it as you are ready for it.
A difference between old practitioners and beginners there always will
be--so long at least as there is value in experience, and a difference
between age and youth; but this difference, which is necessary,
must be limited as much as possible, must be cut down to its proper
dimensions, and must by no means whatever be permitted to exaggerate
itself into an artificial magnitude. If it do so, it is worse than a
simple speculative error,--it is a mischievous delusion: it engenders a
pernicious procrastination, justifies supineness, and creates an excuse
for the neglect of opportunities: it wastes time, which is bad, and
encourages self-deception, which is worse.
A difference between old practitioners and beginners there always will
be: but it should consist not so much in the quality of their work
as in the ease with which it is done. It should be the gain of the
practitioner, not the loss of the patient.
Now, if I did those whom I have the honour to address the injustice
of supposing that the moral reasons for disciplinal preparation,
during the course of study now about to be entered into, were thrown
away upon their minds and consciences, I should be at liberty to make
short work of this part of my argument, and to dispose of much of it
in a most brief and summary manner. I should be at liberty to say, in
language more plain and complimentary, and more cogent than persuasive,
that you _must_ be up to your work when you begin it. If you stumble
at the threshold, you have broken down for after-life. A blunder at
the commencement is failure for the time to come. Furthermore; mala
praxis is a misdemeanor in the eyes of the law, for which you may first
be mulcted by a jury, and afterwards be gibbeted by the press. This
fact, which there is no denying, ought to be conclusive against the
preposterous doctrine which I have exposed: conclusive, however, as it
is, it is one which I have not chosen to put prominent. Let a better
feeling stand instead of it. Honesty is the best policy; but he is not
honest who acts upon that policy only.
All this may be true; yet it may be said that the responsibility is
prospective. "'Sufficient for the day is the evil thereof.' We'll
think about this when we have got through the Halls and Colleges.
You must give us better reasons for sacrificing our inclinations to
our duty than those of a _paulo-post-futurum_ responsibility." Be it
so: you have still a duty, urgent and absolute--not prospective, but
immediate--not in the distance, with contingent patients, but close
at hand, with the realities of friend and family--not abroad with the
public, but at home with your private circle of parents, relatives, and
guardians. By them you are entrusted here with the special, definite,
unequivocal, undoubted object--an object which no ingenuity can refine
away, and no subtlety can demur to--of instruction, discipline,
preparation. You not only _come_ up here to learn, but you are _sent_
up to do so: and anxious wishes and reasonable hopes accompany you. You
are commissioned to avail yourself of a time which experience has shewn
to be sufficient, and of opportunities which are considered necessary:
and there is no excuse for neglect.
Great as are the opportunities, they are not numerous enough to be
wasted; and limited as is the time in the eyes of those who only know
it in its misapplication, it is the period that a considerable amount
of experience has sanctioned as a fair and average time for fair and
average abilities, and for fair and average industry:--not a _minimum_
period made for iron assiduity on the one hand, or for fiery talent
on the other, but a period adapted to the common capacities of the
common mass of mankind--a common-sense time,--a time too long or too
short only for the extremes of intellect--too short for the slowness of
confirmed dulness, too long for the rapid progress of extraordinary and
rarely-occurring genius.
Of this time you are bound to make the most. It is your interest to do
so for your own sakes; it is your duty to do so for the sake of your
friends.
You come to the hospital to _learn_--you come to the hospital to learn
in the strictest sense of the word. You come to learn medicine, as
you would go--if instead of physic your profession were the law--to
the chambers of a special pleader, a common lawyer, or an equity
draughtsman. In this strict sense does your presence here imply
study--study exclusive, and study without any loss of time, and without
any division of attention. You do not come here as a clergyman goes to
the University; but as artists go to Rome--not to keep terms, but to do
work.
I must here guard against the misinterpretation of an expression used a
few sentences back. I wish to let nothing drop that may encourage the
germs of an undue presumption. I expressed an opinion--which I meant to
be a decided one--that the time allowed for your medical studies was
full, fair, and sufficient,--so much so that if it prove _in_sufficient
the fault must lie in the neglect of it. _Sufficient_, however, as it
is, it gives no opportunity for any superfluous leisure. It must not
be presumed on. You have no odd months, or weeks, or days, or even
hours, to play with. It is a sufficient space for you to lay in that
knowledge of your profession which the experience and opinion of your
examining boards have thought proper to require. I believe the amount
thus required, to be, like the time granted for the acquisition of
it, a fair amount. But it is not a high one, and it is not right that
it should be so. Standards of fitness that are set up for the measure
of a body of students so numerous as those in medicine, rarely err
on the side of severity. They favour mediocrity; and they ought to
favour it. It is safe: and that is all they have a right to look to.
What they profess is never very formidable; and what they require is
generally less than what is professed. But the time that is sufficient
for this _modicum_ (or _minimum_) of professional learning is not the
time sufficient for the formation of a practitioner of that degree of
excellence which the competition of an open profession, like that of
medicine, requires as the guarantee of success. An examining board
has but one point to look to--it must see that you can practise
with safety to the public. It never ensures, or professes to ensure,
that you shall practise with success to yourself, or even that you
shall practise at all. In the eyes of an Examiner, as in those of a
commissioner of lunacy, there are but two sorts of individuals; those
that can be let loose upon the public, and those that cannot. In the
eyes of the public there is every degree of excellence, and every
variety of comparative merit or demerit.
Now as to the way of attaining these higher degrees of merit, and the
rewards, moral or material, which they ensure--which follow them as
truly as satisfaction follows right actions, and as penalties follow
wrong ones. The opportunity we have spoken of. It consists in the whole
range of means and appliances by which we here, and others elsewhere,
avail ourselves of those diseases that humanity has suffered, and
is suffering, for the sake of alleviating the misery that they seem
to ensure for the future. Disease with us is not only an object of
direct and immediate relief to the patient who endures it, but it is
an indirect means of relief to sufferers yet untouched. Out of evil
comes good. We make the sick helpful to the sound; the dead available
to the living. Out of pestilence comes healing, and out of the
corruption of death the laws and rule of life. Suffering we have, and
teaching we have, and neither must be lost upon you. It is too late
to find that these objects, and objects like them, are repugnant and
revolting. These things should have been thought of before. Your choice
is now taken, and it must be held to. The discovery that learning
is unpleasant is the discovery of a mistake in the choice of your
profession; and the sooner you remedy such a mistake the better--the
better for yourselves, the better for your friends, the better for the
public, and the better for the profession itself.
Steady work, with fair opportunities--this is what makes practitioners.
The one without the other is insufficient. There is an expenditure of
exertion where your industry outruns your materials, and there is a
loss of useful facts when occasions for observation are neglected.
See all you can, and hear all you can. It is not likely that cases will
multiply themselves for your special observations, and it is neither
the policy nor the practice of those who are commissioned with your
instruction to open their mouths at random.
See all you can. If the case be a common one, you get so much
familiarity with a phenomenon that it will be continually presenting
itself. If a rare one, you have seen what you may seldom see again.
There is every reason for taking the practice of the hospital exactly
as you find it. It represents the diseases of the largest class of
mankind--the poor; and, although in some of the details there may be a
difference, upon the whole the forms of disease that are the commonest
in hospitals are the commonest in the world at large; and _vice versâ_.
Hence, what you see here is the rule rather than the exception for
what you will see hereafter. The diseases are not only essentially the
same, but the proportion which they bear to one another is nearly so. I
mention this, because there is often a tendency to run after rare cases
to the neglect of common ones; whilst, on the other hand, remarkable
and instructive forms of disease are overlooked, simply because they
are thought the curiosities rather than the elements of practice. You
may carry your neglect of common cases, on the strength of their being
common, too far. You may know all about catalepsy and hydrophobia, and
nothing about itch or measles. You may find that, of the two parties
concerned, the patient and yourself, it is the former that knows the
most about his complaint. You may live to have your diagnosis corrected
by the porter, your prognosis criticised by the nurse. On the other
hand, by missing single instances of rare disease, you may miss the
opportunity of being able to refer to your memory rather than to your
library.
I have given you reasons against being afraid of over-observation, and
against the pernicious habit of neglecting this case because it is
common, and that because it is rare--a common excuse for neglecting
_all_ diseases, and a popular reason for doing so. _Medicus sum,
nihil in re medicâ a me alienum puto_, &c. Some minds, indeed, are so
constituted that they can make much, very much, out of single cases,
out of solitary specimens of diseases. The power of minute analysis is
the characteristic of this sort of observation. It is just possible so
to seize upon the true conditions of a disease, as to satisfy yourself,
once for all, of its real permanent attribute--of its essence, if I may
so express myself. And this being seen, you may, for certain purposes,
have seen enough; seen it at one glance; seen it at a single view as
well as others see it at a hundred. I say that certain minds are thus
constituted; but they are rarely the minds of many men in a single
generation, and never the minds of beginners. Before this power is
attained your observation must be disciplined into the accuracy and the
rapidity of an instinct; and to this power of observation--attainable
only by long practice, and after long practice--a high power of
reflection must be superadded.
No such power must be presumed on. If the student delude himself, the
disease will undeceive him. The best practitioners, in the long run,
are those whose memory is stored with the greatest number of individual
cases--individual cases well observed, and decently classified. It
is currently stated that the peculiar power of the late Sir Astley
Cooper was a power of memory of this sort, and I presume that no better
instance of its value need be adduced. Now the memory for cases implies
the existence of cases to remember; and before you arrange them in
the storehouse of your thoughts you must have seen and considered;
must have used both your senses and your understanding; must have
seen, touched, and handled with the one, and must have understood and
reflected with the other.
I am talking of these things as they exist in disciplined intellects,
and in retentive memories; and, perhaps, it may be objected that I
am talking of things that form the exception rather than the rule;
that I am measuring the power of common men by those of extraordinary
instances. I weigh my words, when I deliberately assert, that such,
although partially the case, is not so altogether; and that it is far
less the case than is commonly imagined. In most of those instances
where we lose the advantage of prior experience, by omitting the
application of our knowledge of a previous similar case, the fault
is less in the laxity of memory than in the original incompleteness
of the observation. Observe closely, and ponder well, and the memory
may take care of itself. Like a well-applied nick-name, a well-made
observation will stick to you--whether you look after it or neglect it.
The best way to learn to swim is to try to sink, and it is so because
floatation, like memory, is natural if you set about it rightly. Let
those who distrust their remembrance once observe closely, and then
forget if they can.
There are good reasons for cultivating this habit at all times, but
there are especial reasons why those who are on the threshold of their
profession should more particularly cultivate it. Not because you have
much to learn--we have all that--nor yet because you have the privilege
of great opportunities--we have all that also--must you watch, and
reflect, and arrange, and remember. Your time of life gives you an
advantage. The age of the generality of you is an age when fresh facts
are best seized: and best seized because they are fresh. Whether you
are prepared to understand their whole import, as you may do at some
future period, is doubtful. It is certain that the effect of their
novelty is to impress them more cogently on your recollection.
And this is practice--practice in the good sense of the term, and in
a sense which induces me to guard against the misconstruction of a
previous application of it. A few sentences back I used the phrases
_practical men_, adding that those so called were men who could be
taught by practice only. I confess that this mode of expression was
disparaging. For the purpose to which it was applied it was meant to
be so. It is a term you must be on your guard against. _Practice_ is
so good a thing of itself that its name and appellation are applied
to many bad things. Slovenliness is practice; if it suits the purpose
of any one to call it so; contempt for reading is practice; and
bleeding on all occasions when you omit to purge is practice;--and bad
practice too. Be on your guard against this: but do not be on your
guard against another sort of practice: the practice of men who first
observe, and then reflect, and then generalise, and then reduce to a
habit their results. This is the true light for you to follow, and in
this sense practice is not only _a_ safe guide but _the_ safe guide. It
is experience, or, if you choose a more philosophic term, induction.
Theoretical men can be taught by this, and the wisest theories _are_
taught by it. When I said that practical men were taught by practice
only, I never implied that they were the only men that practice could
teach. Experience makes fools wise; but fools are not the only persons
who can profit by experience.
See and hear--the senses must administer to the understanding. Eye, and
ear, and finger--exercise these that they may bring in learning.
See and hear--the senses must administer to their own improvement. Eye,
and ear, and finger--exercise these, that they may better themselves
as instruments. The knowledge is much, but the discipline is more. The
knowledge is the fruit that is stored, but the discipline is the tree
that yields. The one is the care that keeps, the other the cultivation
that supplies.
The habit of accurate observation is by no means so difficult as is
darkly signified by logicians, nor yet so easy as is vainly fancied by
empirics. It is the duty of those who teach you to indicate the medium.
The tenor of some of my observations runs a risk of misrepresentation.
It has been limited. It has spoken of cases, as if there was nothing
in the whole range of medical study but cases; and of observation,
as if the faculties of a medical man were to take a monomaniac form,
and to run upon observation only; of hospitals, as if they consisted
of beds and patients alone; and of clinical medicine and of clinical
surgery, as if there was no such a paramount subject as physiology,
and no such important subsidiary studies as chemistry and botany. It
is all hospital and no school--all wards and no museum--all sickness
and no health. This has been the line that I have run on; and I feel
that it may be imputed to me that I have run on it too long and too
exclusively. Whether I undervalue the acquisition of those branches
of knowledge which are collateral and subordinate to medicine, rather
than the elements of medicine itself--which are the approaches to the
temple rather than the innermost shrine--will be seen in the sequel.
At present I only vindicate the prominence which has been given to
clinical observation, by insisting upon the subordinate character of
everything that is taught away from the bed, and beyond the sensible
limits of disease. No single subject thus taught is the direct and
primary object of your learning. The art of healing is so. You learn
other things that you may understand this; and in hospitals at
least you learn them with that view exclusively. If you wish to be
a physiologist, chemist, or botanist, irrespectively of the medical
application of the sciences of physiology, chemistry, and botany,
there are better schools than the Middlesex Hospital, or, indeed, than
any hospital whatever. _There_ they may be studied as mathematics are
studied at Cambridge, or as classics at Eton--simply for their own
great and inherent values. But _here_ you study them differently, that
is, as mathematics are taught at a military college, or as classics
are taught at the College of Preceptors, for a specific purpose,
and with a limited view--with a view limited to the illustration of
disease, and with the specific purpose of rendering them indirect
agents in therapeutics. If you could contrive the cure of disease
without a knowledge of morbid processes, it would be a waste of time to
trouble yourself with pathology; or if you could bottom the phenomena
of diseased action without a knowledge of the actions of health,
physiology would be but a noble science for philosophers; or if you
could build up a system of physiology, determining the functions of
organs and the susceptibilities of tissues, independent of the anatomy
of those organs and those tissues, scalpels would be as irrelevant to
you as telescopes; and if these three sciences received no elucidation
from chemistry, and botany, and physics, then would chemistry, and
botany and physics, have the value--neither more nor less--of the art
of criticism or of the binomial theorem. What you are taught in the
schools is taught to you, not because it is worth knowing--for Latin,
and Greek, and Mathematics are worth knowing--but because, before
patients can be cured, they are necessary to be learned.
And, in order to be taught at all, they must be taught systematically.
It is an easy matter to ask for a certain amount of these two
collateral sciences--to pick and choose just the parts wanted for
use, to require just that _modicum_ of botany which illustrates the
Pharmacopœia, and just those fragments of chemistry that make
prescriptions safe, and urine intelligible. It is easy, I say, to ask
for all this; but the art of thus teaching _per saltum_ has yet to be
discovered. The whole is more manageable than the half. What it may
be with others is more than I can tell; but, for my own particular
teaching, I would sooner take the dullest boy from the worst school,
and start him in a subject at the right end, than begin at the wrong
end with the cleverest prizeman that ever flattered parent or gratified
instructor. Bits of botany and crumbs of chemistry are less digestible
than whole courses.
Thus much for those studies that make your therapeutics rational.
Some few have spoken slightly of them--as Sydenham, in the fulness
of his knowledge of symptoms, spoke slightingly of anatomy, or as a
Greek sculptor, familiar with the naked figure, might dispense with
dissection. They are necessary, nevertheless, for the groundwork of
your practice. They must serve to underpin your observations.
And now we may ask, whether, when a medical education has been gone
through, you have collected from it, over and above your professional
sufficiency, any secondary advantages of that kind which are attributed
to education itself taken in the abstract? Whether your knowledge is of
the sort that elevates, and whether your training is of the kind that
strengthens?
Upon the whole, you may be satisfied with the reflex action of
your professional on your general education--that is, if you take
a practical and not an ideal standard. It will do for you, in this
way, as much as legal studies do for the barrister, and as much as
theological reading does for the clergyman; and perhaps in those
points not common to the three professions medicine has the advantage.
Its chemistry, which I would willingly see more mixed with physics,
carries you to the threshold of the exact sciences. Its botany is
pre-eminently disciplinal to the faculty of classification; indeed,
for the natural-history sciences altogether, a medical education is
almost necessary. Clear ideas in physiology are got at only through an
exercised power of abstraction and generalization. The phenomena of
insanity can be appreciated only when the general phenomena of healthy
mental function are understood, and when the normal actions of the mind
are logically analyzed. Such is medical education as an instrument of
self-culture: and as education stands at present, a man who has made
the most of them may walk among the learned men of the world with a
bold and confiding front.
I insist upon thus much justice being done to the intellectual
character of my profession--viz. that it be measured by a practical,
and not an ideal, standard. Too much of the spirit of exaggeration
is abroad--of that sort of exaggeration which makes men see in the
requisites for their own profession the requisites for half-a-dozen
others--of that sort of exaggeration which made Vitruvius, himself an
architect, prove elaborately that before a man could take a trowel in
his hand he must have a knowledge of all the sciences and a habit of
all the virtues. Undoubtedly it would elevate medicine for every member
in the profession to know much more than is required of him--yet this
is no reason for our requiring much more than we do. Such a notion
can be entertained only through a confusion of duty on the part of
those who direct medicine. Their business is the public safety; and
the position of their profession is their business _only_ so far as it
affects this. Trusts are intended for the benefit of any one rather
than the trustee.
Two objections lie against the recommendation of extraneous branches
of learning in medicine: in the first place, by insisting upon them as
elements of a special course of instruction, they are, by implication,
excluded from a general one; in the second place, they are no part of a
three years' training.
Concentrate your attention on the essentials. I am quite satisfied
that as far as the merits or demerits of an education contribute to
the position of a profession, we may take ours as we find it, and yet
hold our own. Nevertheless, lest the position given to medicine by
its pre-eminent prominence, in conjunction with the church and bar,
as one of the so-called learned professions, should encourage the
idea that a multiplicity of accomplishments should be the character
of a full and perfect medical practitioner, one or two important
realities in respect to our position should be indicated. We are at
a disadvantage as compared with both the church and the bar. We have
nothing to set against such great political prizes as chancellorships
and archbishoprics. We are at this disadvantage; and, in a country like
England, it is a great one: so that what we gain by the connection, in
the eyes of the public, is more than what we give; and the connection
is itself artificial, and, as such, dissoluble. It is best to look the
truth in the face--we must stand or fall by our own utility.