practitioner, on the one hand, to prevent disease by his knowledge of
hygiene; on the other hand, to divine its nature, and to alleviate or
cure it, by his knowledge of pathology, therapeutics, and practical
medicine. That is his business in life, and if he has not a thorough
and practical knowledge of the conditions of health, of the causes
which tend to the establishment of disease, of the meaning of symptoms,
and of the uses of medicines and operative appliances, he is
incompetent, even if he were the best anatomist, or physiologist, or
chemist, that ever took a gold medal or won a prize certificate. This
is one great truth respecting medical education. Another is, that all
practice in medicine is based upon theory of some sort or other; and
therefore, that it is desirable to have such theory in the closest
possible accordance with fact. The veriest empiric who gives a drug in
one case because he has seen it do good in another of apparently the
same sort, acts upon the theory that similarity of superficial symptoms
means similarity of lesions; which, by the way, is perhaps as wild an
hypothesis as could be invented. To understand the nature of disease we
must understand health, and the understanding of the healthy body means
the having a knowledge of its structure and of the way in which its
manifold actions are performed, which is what is technically termed
human anatomy and human physiology. The physiologist again must needs
possess an acquaintance with physics and chemistry, inasmuch as
physiology is, to a great extent, applied physics and chemistry. For
ordinary purposes a limited amount of such knowledge is all that is
needful; but for the pursuit of the higher branches of physiology no
knowledge of these branches of science can be too extensive, or too
profound. Again, what we call therapeutics, which has to do with the
action of drugs and medicines on the living organism, is, strictly
speaking, a branch of experimental physiology, and is daily receiving a
greater and greater experimental development.
The third great fact which is to be taken into consideration in dealing
with medical education, is that the practical necessities of life do
not, as a rule, allow aspirants to medical practice to give more than
three, or it may be four years to their studies. Let us put it at four
years, and then reflect that, in the course of this time, a young man
fresh from school has to acquaint himself with medicine, surgery,
obstetrics, therapeutics, pathology, hygiene, as well as with the
anatomy and the physiology of the human body; and that his knowledge
should be of such a character that it can be relied upon in any
emergency, and always ready for practical application. Consider, in
addition, that the medical practitioner may be called upon, at any
moment, to give evidence in a court of justice in a criminal case; and
that it is therefore well that he should know something of the laws of
evidence, and of what we call medical jurisprudence. On a medical
certificate, a man may be taken from his home and from his business and
confined in a lunatic asylum; surely, therefore, it is desirable that
the medical practitioner should have some rational and clear
conceptions as to the nature and symptoms of mental disease. Bearing in
mind all these requirements of medical education, you will admit that
the burden on the young aspirant for the medical profession is somewhat
of the heaviest, and that it needs some care to prevent his
intellectual back from being broken.
Those who are acquainted with the existing systems of medical education
will observe that, long as is the catalogue of studies which I have
enumerated, I have omitted to mention several that enter into the usual
medical curriculum of the present day. I have said not a word about
zoology, comparative anatomy, botany, or materia medica. Assuredly this
is from no light estimate of the value or importance of such studies in
themselves. It may be taken for granted that I should be the last
person in the world to object to the teaching of zoology, or
comparative anatomy, in themselves; but I have the strongest feeling
that, considering the number and the gravity of those studies through
which a medical man must pass, if he is to be competent to discharge
the serious duties which devolve upon him, subjects which lie so remote
as these do from his practical pursuits should be rigorously excluded.
The young man, who has enough to do in order to acquire such
familiarity with the structure of the human body as will enable him to
perform the operations of surgery, ought not, in my judgment, to be
occupied with investigations into the anatomy of crabs and starfishes.
Undoubtedly the doctor should know the common poisonous plants of his
own country when he sees them; but that knowledge may be obtained by a
few hours devoted to the examination of specimens of such plants, and
the desirableness of such knowledge is no justification, to my mind,
for spending three months over the study of systematic botany. Again,
materia medica, so far as it is a knowledge of drugs, is the business
of the druggist. In all other callings the necessity of the division of
labour is fully recognised, and it is absurd to require of the medical
man that he should not avail himself of the special knowledge of those
whose business it is to deal in the drugs which he uses. It is all very
well that the physician should know that castor oil comes from a plant,
and castoreum from an animal, and how they are to be prepared; but for
all the practical purposes of his profession that knowledge is not of
one whit more value, has no more relevancy, than the knowledge of how
the steel of his scalpel is made.
All knowledge is good. It is impossible to say that any fragment of
knowledge, however insignificant or remote from one's ordinary
pursuits, may not some day be turned to account. But in medical
education, above all things, it is to be recollected that, in order to
know a little well, one must be content to be ignorant of a great deal.
Let it not be supposed that I am proposing to narrow medical education,
or, as the cry is, to lower the standard of the profession. Depend upon
it there is only one way of really ennobling any calling, and that is
to make those who pursue it real masters of their craft, men who can
truly do that which they profess to be able to do, and which they are
credited with being able to do by the public. And there is no position
so ignoble as that of the so-called "liberally-educated practitioner,"
who may be able to read Galen in the original; who knows all the
plants, from the cedar of Lebanon to the hyssop upon the wall; but who
finds himself, with the issues of life and death in his hands,
ignorant, blundering, and bewildered, because of his ignorance of the
essential and fundamental truths upon which practice must be based.
Moreover, I venture to say, that any man who has seriously studied all
the essential branches of medical knowledge; who has the needful
acquaintance with the elements of physical science; who has been
brought by medical jurisprudence into contact with law; whose study of
insanity has taken him into the fields of psychology; has _ipso facto_
received a liberal education.
Having lightened the medical curriculum by culling out of it everything
which is unessential, we may next consider whether something may not be
done to aid the medical student toward the acquirement of real
knowledge by modifying the system of examination. In England, within my
recollection, it was the practice to require of the medical student
attendance on lectures upon the most diverse topics during three years;
so that it often happened that he would have to listen, in the course
of a day, to four or five lectures upon totally different subjects, in
addition to the hours given to dissection and to hospital practice: and
he was required to keep all the knowledge he could pick up, in this
distracting fashion, at examination point, until, at the end of three
years, he was set down to a table and questioned pell-mell upon all the
different matters with which he had been striving to make acquaintance.
A worse system and one more calculated to obstruct the acquisition of
sound knowledge and to give full play to the "crammer" and the
"grinder" could hardly have been devised by human ingenuity. Of late
years great reforms have taken place. Examinations have been divided so
as to diminish the number of subjects among which the attention has to
be distributed. Practical examination has been largely introduced; but
there still remains, even under the present system, too much of the old
evil inseparable from the contemporaneous pursuit of a multiplicity of
diverse studies.
Proposals have recently been made to get rid of general examinations
altogether, to permit the student to be examined in each subject at the
end of his attendance on the class; and then, in case of the result
being satisfactory, to allow him to have done with it; and I may say
that this method has been pursued for many years in the Royal School of
Mines in London, and has been found to work very well. It allows the
student to concentrate his mind upon what he is about for the time
being, and then to dismiss it. Those who are occupied in intellectual
work, will, I think, agree with me that it is important, not so much to
know a thing, as to have known it, and known it thoroughly. If you have
once known a thing in this way it is easy to renew your knowledge when
you have forgotten it; and when you begin to take the subject up again,
it slides back upon the familiar grooves with great facility.
Lastly comes the question as to how the university may co-operate in
advancing medical education. A medical school is strictly a technical
school--a school in which a practical profession is taught--while a
university ought to be a place in which knowledge is obtained without
direct reference to professional purposes. It is clear, therefore, that
a university and its antecedent, the school, may best co-operate with
the medical school by making due provision for the study of those
branches of knowledge which lie at the foundation of medicine.
At present, young men come to the medical schools without a conception
of even the elements of physical science; they learn, for the first
time, that there are such sciences as physics, chemistry, and
physiology, and are introduced to anatomy as a new thing. It may be
safely said that, with a large proportion of medical students, much of
the first session is wasted in learning how to learn--in familiarising
themselves with utterly strange conceptions, and in awakening their
dormant and wholly untrained powers of observation and of manipulation.
It is difficult to over-estimate the magnitude of the obstacles which
are thrown in the way of scientific training by the existing system of
school education. Not only are men trained in mere book-work, ignorant
of what observation means, but the habit of learning from books alone
begets a disgust of observation. The book-learned student will rather
trust to what he sees in a book than to the witness of his own eyes.
There is not the least reason why this should be so, and, in fact, when
elementary education becomes that which I have assumed it ought to be,
this state of things will no longer exist. There is not the slightest
difficulty in giving sound elementary instruction in physics, in
chemistry, and in the elements of human physiology, in ordinary
schools. In other words, there is no reason why the student should not
come to the medical school, provided with as much knowledge of these
several sciences as he ordinarily picks up in the course of his first
year of attendance at the medical school.
I am not saying this without full practical justification for the
statement. For the last eighteen years we have had in England a system
of elementary science teaching carried out under the auspices of the
Science and Art Department, by which elementary scientific instruction
is made readily accessible to the scholars of all the elementary
schools in the country. Commencing with small beginnings, carefully
developed and improved, that system now brings up for examination as
many as seven thousand scholars in the subject of human physiology
alone. I can say that, out of that number, a large proportion have
acquired a fair amount of substantial knowledge; and that no
inconsiderable percentage show as good an acquaintance with human
physiology as used to be exhibited by the average candidates for
medical degrees in the University of London, when I was first an
examiner there twenty years ago; and quite as much knowledge as is
possessed by the ordinary student of medicine at the present day. I am
justified, therefore, in looking forward to the time when the student
who proposes to devote himself to medicine will come, not absolutely
raw and inexperienced as he is at present, but in a certain state of
preparation for further study; and I look to the university to help him
still further forward in that stage of preparation, through the
organisation of its biological department. Here the student will find
means of acquainting himself with the phenomena of life in their
broadest acceptation. He will study not botany and zoology, which, as I
have said, would take him too far away from his ultimate goal; but, by
duly arranged instruction, combined with work in the laboratory upon
the leading types of animal and vegetable life, he will lay a broad,
and at the same time solid, foundation of biological knowledge; he will
come to his medical studies with a comprehension of the great truths of
morphology and of physiology, with his hands trained to dissect and his
eyes taught to see. I have no hesitation in saying that such
preparation is worth a full year added on to the medical curriculum. In
other words, it will set free that much time for attention to those
studies which bear directly upon the student's most grave and serious
duties as a medical practitioner.
Up to this point I have considered only the teaching aspect of your
great foundation, that function of the university in virtue of which it
plays the part of a reservoir of ascertained truth, so far as our
symbols can ever interpret nature. All can learn; all can drink of this
lake. It is given to few to add to the store of knowledge, to strike
new springs of thought, or to shape new forms of beauty. But so sure as
it is that men live not by bread, but by ideas, so sure is it that the
future of the world lies in the hands of those who are able to carry
the interpretation of nature a step further than their predecessors; so
certain is it that the highest function of a university is to seek out
those men, cherish them, and give their ability to serve their kind
full play.
I rejoice to observe that the encouragement of research occupies so
prominent a place in your official documents, and in the wise and
liberal inaugural address of your president. This subject of the
encouragement, or, as it is sometimes called, the endowment of
research, has of late years greatly exercised the minds of men in
England. It was one of the main topics of discussion by the members of
the Royal Commission of whom I was one, and who not long since issued
their report, after five years' labour. Many seem to think that this
question is mainly one of money; that you can go into the market and
buy research, and that supply will follow demand, as in the ordinary
course of commerce. This view does not commend itself to my mind. I
know of no more difficult practical problem than the discovery of a
method of encouraging and supporting the original investigator without
opening the door to nepotism and jobbery. My own conviction is
admirably summed up in the passage of your president's address, "that
the best investigators are usually those who have also the
responsibilities of instruction, gaining thus the incitement of
colleagues, the encouragement of pupils, and the observation of the
public."
At the commencement of this address I ventured to assume that I might,
if I thought fit, criticise the arrangements which have been made by
the board of trustees, but I confess that I have little to do but to
applaud them. Most wise and sagacious seems to me the determination not
to build for the present. It has been my fate to see great educational
funds fossilise into mere bricks and mortar, in the petrifying springs
of architecture, with nothing left to work the institution they were
intended to support. A great warrior is said to have made a desert and
called it peace. Administrators of educational funds have sometimes
made a palace and called it a university. If I may venture to give
advice in a matter which lies out of my proper competency, I would say
that whenever you do build, get an honest bricklayer, and make him
build you just such rooms as you really want, leaving ample space for
expansion. And a century hence, when the Baltimore and Ohio shares are
at one thousand premium, and you have endowed all the professors you
need, and built all the laboratories that are wanted, and have the best
museum and the finest library that can be imagined; then, if you have a
few hundred thousand dollars you don't know what to do with, send for
an architect and tell him to put up a façade. If American is similar to
English experience, any other course will probably lead you into having
some stately structure, good for your architect's fame, but not in the
least what you want.
It appears to me that what I have ventured to lay down as the
principles which should govern the relations of a university to
education in general, are entirely in accordance with the measures you
have adopted. You have set no restrictions upon access to the
instruction you propose to give; you have provided that such
instruction, either as given by the university or by associated
institutions, should cover the field of human intellectual activity.
You have recognised the importance of encouraging research. You propose
to provide means by which young men, who may be full of zeal for a
literary or for a scientific career, but who also may have mistaken
aspiration for inspiration, may bring their capacities to a test, and
give their powers a fair trial. If such a one fail, his endowment
terminates, and there is no harm done. If he succeed, you may give
power of flight to the genius of a Davy or a Faraday, a Carlyle or a
Locke, whose influence on the future of his fellow-men shall be
absolutely incalculable.
You have enunciated the principle that "the glory of the university
should rest upon the character of the teachers and scholars, and not
upon their numbers or buildings constructed for their use." And I look
upon it as an essential and most important feature of your plan that
the income of the professors and teachers shall be independent of the
number of students whom they can attract. In this way you provide
against the danger, patent elsewhere, of finding attempts at
improvement obstructed by vested interests; and, in the department of
medical education especially, you are free of the temptation to set
loose upon the world men utterly incompetent to perform the serious and
responsible duties of their profession.
It is a delicate matter for a stranger to the practical working of your
institutions, like myself, to pretend to give an opinion as to the
organisation of your governing power. I can conceive nothing better
than that it should remain as it is, if you can secure a succession of
wise, liberal, honest, and conscientious men to fill the vacancies that
occur among you. I do not greatly believe in the efficacy of any kind
of machinery for securing such a result; but I would venture to suggest
that the exclusive adoption of the method of co-optation for filling
the vacancies which must occur in your body, appears to me to be
somewhat like a tempting of Providence. Doubtless there are grave
practical objections to the appointment of persons outside of your body
and not directly interested in the welfare of the university; but might
it not be well if there were an understanding that your academic staff
should be officially represented on the board, perhaps even the heads
of one or two independent learned bodies, so that academic opinion and
the views of the outside world might have a certain influence in that
most important matter, the appointment of your professors? I throw out
these suggestions, as I have said, in ignorance of the practical
difficulties that may lie in the way of carrying them into effect, on
the general ground that personal and local influences are very subtle,
and often unconscious, while the future greatness and efficiency of the
noble institution which now commences its work must largely depend upon
its freedom from them.
* * * * *
I constantly hear Americans speak of the charm which our old mother
country has for them, of the delight with which they wander through the
streets of ancient towns, or climb the battlements of mediaeval
strongholds, the names of which are indissolubly associated with the
great epochs of that noble literature which is our common inheritance;
or with the blood-stained steps of that secular progress, by which the
descendants of the savage Britons and of the wild pirates of the North
Sea have become converted into warriors of order and champions of
peaceful freedom, exhausting what still remains of the old Berserk
spirit in subduing nature, and turning the wilderness into a garden.
But anticipation has no less charm than retrospect, and to an
Englishman landing upon your shores for the first time, travelling for
hundreds of miles through strings of great and well-ordered cities,
seeing your enormous actual, and almost infinite potential, wealth in
all commodities, and in the energy and ability which turn wealth to
account, there is something sublime in the vista of the future. Do not
suppose that I am pandering to what is commonly understood by national
pride. I cannot say that I am in the slightest degree impressed by your
bigness, or your material resources, as such. Size is not grandeur, and
territory does not make a nation. The great issue, about which hangs a
true sublimity, and the terror of overhanging fate, is what are you
going to do with all these things? What is to be the end to which these
are to be the means? You are making a novel experiment in politics on
the greatest scale which the world has yet seen. Forty millions at
your first centenary, it is reasonably to be expected that, at the
second, these states will be occupied by two hundred millions of
English-speaking people, spread over an area as large as that of
Europe, and with climates and interests as diverse as those of Spain
and Scandinavia, England and Russia. You and your descendants have to
ascertain whether this great mass will hold together under the forms of
a republic, and the despotic reality of universal suffrage; whether
state rights will hold out against centralisation, without separation;
whether centralisation will get the better, without actual or disguised
monarchy; whether shifting corruption is better than a permanent
bureaucracy; and as population thickens in your great cities, and the
pressure of want is felt, the gaunt spectre of pauperism will stalk
among you, and communism and socialism will claim to be heard. Truly
America has a great future before her; great in toil, in care, and in
responsibility; great in true glory if she be guided in wisdom and
righteousness; great in shame if she fail. I cannot understand why
other nations should envy you, or be blind to the fact that it is for
the highest interest of mankind that you should succeed; but the one
condition of success, your sole safeguard, is the moral worth and
intellectual clearness of the individual citizen. Education cannot give
these, but it may cherish them and bring them to the front in whatever
station of society they are to be found; and the universities ought to
be, and may be, the fortresses of the higher life of the nation.
May the university which commences its practical activity to-morrow
abundantly fulfil its high purpose; may its renown as a seat of true
learning, a centre of free inquiry, a focus of intellectual light,
increase year by year, until men wander hither from all parts of the
earth, as of old they sought Bologna, or Paris, or Oxford.
And it is pleasant to me to fancy that, among the English students who
are drawn to you at that time, there may linger a dim tradition that
a countryman of theirs was permitted to address you as he has done
to-day, and to feel as if your hopes were his hopes and your success
his joy.
* * * * *
Footnotes:
[1] Delivered at the formal opening of the Johns Hopkins University at
Baltimore, U.S., September 12. The total amount bequeathed by Johns
Hopkins is more than 7,000,000 dollars. The sum of 3,500,000 dollars is
appropriated to a university, a like sum to a hospital, and the rest to
local institutions of education and charity.
X
ON THE STUDY OF BIOLOGY
[1876]