referred is the full expression, does not lie at the bottom of the
minds of a great many people who yet would vigorously object to give a
verbal assent to the doctrine itself. However this may be, the main
point is that sufficient knowledge has now been acquired of vital
phenomena, to justify the assertion, that the notion, that there is
anything exceptional about these phenomena, receives not a particle of
support from any known fact. On the contrary, there is a vast and an
increasing mass of evidence that birth and death, health and disease,
are as much parts of the ordinary stream of events as the rising and
setting of the sun, or the changes of the moon; and that the living
body is a mechanism, the proper working of which we term health; its
disturbance, disease; its stoppage, death. The activity of this
mechanism is dependent upon many and complicated conditions, some of
which are hopelessly beyond our control, while others are readily
accessible, and are capable of being indefinitely modified by our own
actions. The business of the hygienist and of the physician is to know
the range of these modifiable conditions, and how to influence them
towards the maintenance of health and the prolongation of life; the
business of the general public is to give an intelligent assent, and a
ready obedience based upon that assent, to the rules laid down for
their guidance by such experts. But an intelligent assent is an assent
based upon knowledge, and the knowledge which is here in question means
an acquaintance with the elements of physiology.
It is not difficult to acquire such knowledge. What is true, to
a certain extent, of all the physical sciences, is eminently
characteristic of physiology--the difficulty of the subject begins
beyond the stage of elementary knowledge, and increases with every
stage of progress. While the most highly trained and the best furnished
intellect may find all its resources insufficient, when it strives to
reach the heights and penetrate into the depths of the problems of
physiology, the elementary and fundamental truths can be made clear to
a child.
No one can have any difficulty in comprehending the mechanism of
circulation or respiration; or the general mode of operation of the
organ of vision; though the unravelling of all the minutiae of these
processes, may, for the present, baffle the conjoined attacks of the
most accomplished physicists, chemists, and mathematicians. To know the
anatomy of the human body, with even an approximation to thoroughness,
is the work of a life; but as much as is needed for a sound
comprehension of elementary physiological truths, may be learned in a
week.
A knowledge of the elements of physiology is not only easy of
acquirement, but it may be made a real and practical acquaintance with
the facts, as far as it goes. The subject of study is always at hand,
in one's self. The principal constituents of the skeleton, and the
changes of form of contracting muscles, may be felt through one's own
skin. The beating of one's heart, and its connection with the pulse,
may be noted; the influence of the valves of one's own veins may be
shown; the movements of respiration may be observed; while the
wonderful phenomena of sensation afford an endless field for curious
and interesting self-study. The prick of a needle will yield, in a drop
of one's own blood, material for microscopic observation of phenomena
which lie at the foundation of all biological conceptions; and a cold,
with its concomitant coughing and sneezing, may prove the sweet uses of
adversity by helping one to a clear conception of what is meant by
"reflex action."
Of course there is a limit to this physiological self-examination. But
there is so close a solidarity between ourselves and our poor relations
of the animal world, that our inaccessible inward parts may be
supplemented by theirs. A comparative anatomist knows that a sheep's
heart and lungs, or eye, must not be confounded with those of a man;
but, so far as the comprehension of the elementary facts of the
physiology of circulation, of respiration, and of vision goes, the one
furnishes the needful anatomical data as well as the other.
Thus, it is quite possible to give instruction in elementary physiology
in such a manner as, not only to confer knowledge, which, for the
reason I have mentioned, is useful in itself; but to serve the purposes
of a training in accurate observation, and in the methods of reasoning
of physical science. But that is an advantage which I mention only
incidentally, as the present Conference does not deal with education in
the ordinary sense of the word.
It will not be suspected that I wish to make physiologists of all the
world. It would be as reasonable to accuse an advocate of the "three
R's" of a desire to make an orator, an author, and a mathematician of
everybody. A stumbling reader, a pot-hook writer, and an arithmetician
who has not got beyond the rule of three, is not a person of brilliant
acquirements; but the difference between such a member of society and
one who can neither read, write, nor cipher is almost inexpressible;
and no one nowadays doubts the value of instruction, even if it goes no
farther.
The saying that a little knowledge is a dangerous thing is, to my mind,
a very dangerous adage. If knowledge is real and genuine, I do not
believe that it is other than a very valuable possession, however
infinitesimal its quantity may be. Indeed, if a little knowledge is
dangerous, where is the man who has so much as to be out of danger?
If William Harvey's life-long labours had revealed to him a tenth part
of that which may be made sound and real knowledge to our boys and
girls, he would not only have been what he was, the greatest
physiologist of his age, but he would have loomed upon the seventeenth
century as a sort of intellectual portent. Our "little knowledge" would
have been to him a great, astounding, unlooked-for vision of scientific
truth.
I really see no harm which can come of giving our children a little
knowledge of physiology. But then, as I have said, the instruction must
be real, based upon observation, eked out by good explanatory diagrams
and models, and conveyed by a teacher whose own knowledge has been
acquired by a study of the facts; and not the mere catechismal
parrot-work which too often usurps the place of elementary teaching.
It is, I hope, unnecessary for me to give a formal contradiction to the
silly fiction, which is assiduously circulated by fanatics who not only
ought to know, but do know, that their assertions are untrue, that I
have advocated the introduction of that experimental discipline which
is absolutely indispensable to the professed physiologist, into
elementary teaching.
But while I should object to any experimentation which can justly be
called painful, for the purpose of elementary instruction; and, while,
as a member of a late Royal Commission, I gladly did my best to prevent
the infliction of needless pain, for any purpose; I think it is my duty
to take this opportunity of expressing my regret at a condition of the
law which permits a boy to troll for pike, or set lines with live frog
bait, for idle amusement; and, at the same time, lays the teacher of
that boy open to the penalty of fine and imprisonment, if he uses the
same animal for the purpose of exhibiting one of the most beautiful and
instructive of physiological spectacles, the circulation in the web of
the foot. No one could undertake to affirm that a frog is not
inconvenienced by being wrapped up in a wet rag, and having his toes
tied out; and it cannot be denied that inconvenience is a sort of pain.
But you must not inflict the least pain on a vertebrated animal for
scientific purposes (though you may do a good deal in that way for gain
or for sport) without due licence of the Secretary of State for the
Home Department, granted under the authority of the Vivisection Act.
So it comes about, that, in this present year of grace 1877, two
persons may be charged with cruelty to animals. One has impaled a frog,
and suffered the creature to writhe about in that condition for hours;
the other has pained the animal no more than one of us would be pained
by tying strings round his fingers, and keeping him in the position of
a hydropathic patient. The first offender says "I did it because I find
fishing very amusing," and the magistrate bids him depart in peace;
nay, probably wishes him good sport. The second pleads, "I wanted to
impress a scientific truth, with a distinctness attainable in no other
way, on the minds of my scholars," and the magistrate fines him five
pounds.
I cannot but think that this is an anomalous and not wholly creditable
state of things.
XII
ON MEDICAL EDUCATION
[1870]
It has given me sincere pleasure to be here today, at the desire of
your highly respected President and the Council of the College. In
looking back upon my own past, I am sorry to say that I have found that
it is a quarter of a century since I took part in those hopes and in
those fears by which you have all recently been agitated, and which now
are at an end. But, although so long a time has elapsed since I was
moved by the same feelings, I beg leave to assure you that my sympathy
with both victors and vanquished remains fresh--so fresh, indeed, that
I could almost try to persuade myself that, after all, it cannot be so
very long ago. My business during the last hour, however, has been to
show that sympathy with one side only, and I assure you I have done my
best to play my part heartily, and to rejoice in the success of those
who have succeeded. Still, I should like to remind you at the end of it
all, that success on an occasion of this kind, valuable and important
as it is, is in reality only putting the foot upon one rung of the
ladder which leads upwards; and that the rung of a ladder was never
meant to rest upon, but only to hold a man's foot long enough to enable
him to put the other somewhat higher. I trust that you will all regard
these successes as simply reminders that your next business is, having
enjoyed the success of the day, no longer to look at that success, but
to look forward to the next difficulty that is to be conquered. And
now, having had so much to say to the successful candidates, you must
forgive me if I add that a sort of under-current of sympathy has been
going on in my mind all the time for those who have not been
successful, for those valiant knights who have been overthrown in your
tourney, and have not made their appearance in public. I trust that, in
accordance with old custom, they, wounded and bleeding, have been
carried off to their tents, to be carefully tended by the fairest of
maidens; and in these days, when the chances are that every one of such
maidens will be a qualified practitioner, I have no doubt that all the
splinters will have been carefully extracted, and that they are now
physically healed. But there may remain some little fragment of moral
or intellectual discouragement, and therefore I will take the liberty
to remark that your chairman to-day, if he occupied his proper place,
would be among them. Your chairman, in virtue of his position, and for
the brief hour that he occupies that position, is a person of
importance; and it may be some consolation to those who have failed if
I say, that the quarter of a century which I have been speaking of,
takes me back to the time when I was up at the University of London, a
candidate for honours in anatomy and physiology, and when I was
exceedingly well beaten by my excellent friend, Dr. Ransom, of
Nottingham. There is a person here who recollects that circumstance
very well. I refer to your venerated teacher and mine, Dr. Sharpey. He
was at that time one of the examiners in anatomy and physiology, and
you may be quite sure that, as he was one of the examiners, there
remained not the smallest doubt in my mind of the propriety of his
judgment, and I accepted my defeat with the most comfortable assurance
that I had thoroughly well earned it. But, gentlemen, the competitor
having been a worthy one, and the examination a fair one, I cannot say
that I found in that circumstance anything very discouraging. I said to
myself, "Never mind; what's the next thing to be done?" And I found
that policy of "never minding" and going on to the next thing to be
done, to be the most important of all policies in the conduct of
practical life. It does not matter how many tumbles you have in this
life, so long as you do not get dirty when you tumble; it is only the
people who have to stop to be washed and made clean, who must
necessarily lose the race. And I can assure you that there is the
greatest practical benefit in making a few failures early in life. You
learn that which is of inestimable importance--that there are a great
many people in the world who are just as clever as you are. You learn
to put your trust, by and by, in an economy and frugality of the
exercise of your powers, both moral and intellectual; and you very soon
find out, if you have not found it out before, that patience and
tenacity of purpose are worth more than twice their weight of
cleverness. In fact, if I were to go on discoursing on this subject, I
should become almost eloquent in praise of non-success; but, lest so
doing should seem, in any way, to wither well-earned laurels, I
will turn from that topic, and ask you to accompany me in some
considerations touching another subject which has a very profound
interest for me, and which I think ought to have an equally profound
interest for you.
I presume that the great majority of those whom I address propose to
devote themselves to the profession of medicine; and I do not doubt,
from the evidences of ability which have been given to-day, that I have
before me a number of men who will rise to eminence in that profession,
and who will exert a great and deserved influence upon its future. That
in which I am interested, and about which I wish to speak, is the
subject of medical education, and I venture to speak about it for the
purpose, if I can, of influencing you, who may have the power of
influencing the medical education of the future. You may ask, by what
authority do I venture, being a person not concerned in the practice of
medicine, to meddle with that subject? I can only tell you it is a
fact, of which a number of you I dare say are aware by experience (and
I trust the experience has no painful associations), that I have been
for a considerable number of years (twelve or thirteen years to the
best of my recollection) one of the examiners in the University of
London. You are further aware that the men who come up to the
University of London are the picked men of the medical schools of
London, and therefore such observations as I may have to make upon the
state of knowledge of these gentlemen, if they be justified, in regard
to any faults I may have to find, cannot be held to indicate defects in
the capacity, or in the power of application of those gentlemen, but
must be laid, more or less, to the account of the prevalent system of
medical education. I will tell you what has struck me--but in speaking
in this frank way, as one always does about the defects of one's
friends, I must beg you to disabuse your minds of the notion that I am
alluding to any particular school, or to any particular college, or to
any particular person; and to believe that if I am silent when I should
be glad to speak with high praise, it is because that praise would come
too close to this locality. What has struck me, then, in this long
experience of the men best instructed in physiology from the medical
schools of London is (with the many and brilliant exceptions to which I
have referred), taking it as a whole, and broadly, the singular
unreality of their knowledge of physiology. Now, I use that word
"unreality" advisedly. I do not say "scanty;" on the contrary, there is
plenty of it--a great deal too much of it--but it is the quality, the
nature of the knowledge, which I quarrel with. I know I used to have--I
don't know whether I have now, but I had once upon a time--a bad
reputation among students for setting up a very high standard of
acquirement, and I dare say you may think that the standard of this old
examiner, who happily is now very nearly an extinct examiner, has been
pitched too high. Nothing of the kind, I assure you. The defects I have
noticed, and the faults I have to find, arise entirely from the
circumstance that my standard is pitched too low. This is no paradox,
gentlemen, but quite simply the fact. The knowledge I have looked for
was a real, precise, thorough, and practical knowledge of fundamentals;
whereas that which the best of the candidates, in a large proportion of
cases, have had to give me was a large, extensive, and inaccurate
knowledge of superstructure; and that is what I mean by saying that my
demands went too low and not too high. What I have had to complain of
is, that a large proportion of the gentlemen who come up for physiology
to the University of London do not know it as they know their anatomy,
and have not been taught it as they have been taught their anatomy.
Now, I should not wonder at all if I heard a great many "No, noes"
here; but I am not talking about University College; as I have told you
before, I am talking about the average education of medical schools.
What I have found, and found so much reason to lament, is, that while
anatomy has been taught as a science ought to be taught, as a matter of
autopsy, and observation, and strict discipline; in a very large number
of cases, physiology has been taught as if it were a mere matter of
books and of hearsay. I declare to you, gentlemen, that I have often
expected to be told, when I have asked a question about the circulation
of the blood, that Professor Breitkopf is of opinion that it
circulates, but that the whole thing is an open question. I assure you
that I am hardly exaggerating the state of mind on matters of
fundamental importance which I have found over and over again to obtain
among gentlemen coming up to that picked examination of the University
of London. Now, I do not think that is a desirable state of things. I
cannot understand why physiology should not be taught--in fact, you
have here abundant evidence that it can be taught--with the same
definiteness and the same precision as anatomy is taught. And you may
depend upon this, that the only physiology which is to be of any good
whatever in medical practice, or in its application to the study of
medicine, is that physiology which a man knows of his own knowledge;
just as the only anatomy which would be of any good to the surgeon is
the anatomy which he knows of his own knowledge. Another peculiarity I
have found in the physiology which has been current, and that is, that
in the minds of a great many gentlemen it has been supplanted by
histology. They have learnt a great deal of histology, and they have
fancied that histology and physiology are the same things. I have asked
for some knowledge of the physics and the mechanics and the chemistry
of the human body, and I have been met by talk about cells. I declare
to you I believe it will take me two years, at least, of absolute rest
from the business of an examiner to hear the word "cell," "germinal
matter," or "carmine," without a sort of inward shudder.