unique. A vast property is handed over to an administrative body,
hampered by no conditions save these;--That the principal shall not be
employed in building: that the funds shall be appropriated, in equal
proportions, to the promotion of natural knowledge and to the
alleviation of the bodily sufferings of mankind; and, finally, that
neither political nor ecclesiastical sectarianism shall be permitted to
disturb the impartial distribution of the testator's benefactions.
In my experience of life a truth which sounds very much like a paradox
has often asserted itself; namely, that a man's worst difficulties begin
when he is able to do as he likes. So long as a man is struggling with
obstacles he has an excuse for failure or shortcoming; but when fortune
removes them all and gives him the power of doing as he thinks best,
then comes the time of trial. There is but one right, and the
possibilities of wrong are infinite. I doubt not that the trustees of
the Johns Hopkins University felt the full force of this truth when they
entered on the administration of their trust a year and a half ago; and
I can but admire the activity and resolution which have enabled them,
aided by the able president whom they have selected, to lay down the
great outlines of their plan, and carry it thus far into execution. It
is impossible to study that plan without perceiving that great care,
forethought, and sagacity, have been bestowed upon it, and that it
demands the most respectful consideration. I have been endeavouring to
ascertain how far the principles which underlie it are in accordance
with those which have been established in my own mind by much and
long-continued thought upon educational questions. Permit me to place
before you the result of my reflections.
Under one aspect a university is a particular kind of educational
institution, and the views which we may take of the proper nature of a
university are corollaries from those which we hold respecting education
in general. I think it must be admitted that the school should prepare
for the university, and that the university should crown the edifice,
the foundations of which are laid in the school. University education
should not be something distinct from elementary education, but should
be the natural outgrowth and development of the latter. Now I have a
very clear conviction as to what elementary education ought to be; what
it really may be, when properly organised; and what I think it will be,
before many years have passed over our heads, in England and in America.
Such education should enable an average boy of fifteen or sixteen to
read and write his own language with ease and accuracy, and with a sense
of literary excellence derived from the study of our classic writers: to
have a general acquaintance with the history of his own country and with
the great laws of social existence; to have acquired the rudiments of
the physical and psychological sciences, and a fair knowledge of
elementary arithmetic and geometry. He should have obtained an
acquaintance with logic rather by example than by precept; while the
acquirement of the elements of music and drawing should have been
pleasure rather than work.
It may sound strange to many ears if I venture to maintain the
proposition that a young person, educated thus far, has had a liberal,
though perhaps not a full, education. But it seems to me that such
training as that to which I have referred may be termed liberal, in both
the senses in which that word is employed, with perfect accuracy. In the
first place, it is liberal in breadth. It extends over the whole ground
of things to be known and of faculties to be trained, and it gives equal
importance to the two great sides of human activity--art and science. In
the second place, it is liberal in the sense of being an education
fitted for free men; for men to whom every career is open, and from whom
their country may demand that they should be fitted to perform the
duties of any career. I cannot too strongly impress upon you the fact
that, with such a primary education as this, and with no more than is to
be obtained by building strictly upon its lines, a man of ability may
become a great writer or speaker, a statesman, a lawyer, a man of
science, painter, sculptor, architect, or musician. That even
development of all a man's faculties, which is what properly constitutes
culture, may be effected by such an education, while it opens the way
for the indefinite strengthening of any special capabilities with which
he may be gifted.
In a country like this, where most men have to carve out their own
fortunes and devote themselves early to the practical affairs of life,
comparatively few can hope to pursue their studies up to, still less
beyond, the age of manhood. But it is of vital importance to the welfare
of the community that those who are relieved from the need of making a
livelihood, and still more, those who are stirred by the divine impulses
of intellectual thirst or artistic genius, should be enabled to devote
themselves to the higher service of their kind, as centres of
intelligence, interpreters of nature, or creators of new forms of
beauty. And it is the function of a university to furnish such men with
the means of becoming that which it is their privilege and duty to be.
To this end the university need cover no ground foreign to that occupied
by the elementary school. Indeed it cannot; for the elementary
instruction which I have referred to embraces all the kinds of real
knowledge and mental activity possible to man. The university can add no
new departments of knowledge, can offer no new fields of mental
activity; but what it can do is to intensify and specialise the
instruction in each department. Thus literature and philology,
represented in the elementary school by English alone, in the university
will extend over the ancient and modern languages. History, which, like
charity, best begins at home, but, like charity, should not end there,
will ramify into anthropology, archæology, political history, and
geography, with the history of the growth of the human mind and of its
products in the shape of philosophy, science, and art. And the
university will present to the student libraries, museums of
antiquities, collections of coins, and the like, which will efficiently
subserve these studies. Instruction in the elements of social economy, a
most essential, but hitherto sadly-neglected part of elementary
education, will develop in the university into political economy,
sociology, and law. Physical science will have its great divisions of
physical geography, with geology and astronomy; physics; chemistry and
biology; represented not merely by professors and their lectures, but by
laboratories, in which the students, under guidance of demonstrators,
will work out facts for themselves and come into that direct contact
with reality which constitutes the fundamental distinction of scientific
education. Mathematics will soar into its highest regions; while the
high peaks of philosophy may be scaled by those whose aptitude for
abstract thought has been awakened by elementary logic. Finally, schools
of pictorial and plastic art, of architecture, and of music, will offer
a thorough discipline in the principles and practice of art to those in
whom lies nascent the rare faculty of æsthetic representation, or the
still rarer powers of creative genius.
The primary school and the university are the alpha and omega of
education. Whether institutions intermediate between these (so-called
secondary schools) should exist, appears to me to be a question of
practical convenience. If such schools are established, the important
thing is that they should be true intermediaries between the primary
school and the university, keeping on the wide track of general culture,
and not sacrificing one branch of knowledge for another.
Such appear to me to be the broad outlines of the relations which the
university, regarded as a place of education, ought to bear to the
school, but a number of points of detail require some consideration,
however briefly and imperfectly I can deal with them. In the first
place, there is the important question of the limitations which should
be fixed to the entrance into the university; or, what qualifications
should be required of those who propose to take advantage of the higher
training offered by the university. On the one hand, it is obviously
desirable that the time and opportunities of the university should not
be wasted in conferring such elementary instruction as can be obtained
elsewhere; while, on the other hand, it is no less desirable that the
higher instruction of the university should be made accessible to every
one who can take advantage of it, although he may not have been able to
go through any very extended course of education. My own feeling is
distinctly against any absolute and defined preliminary examination, the
passing of which shall be an essential condition of admission to the
university. I would admit to the university any one who could be
reasonably expected to profit by the instruction offered to him; and I
should be inclined, on the whole, to test the fitness of the student,
not by examination before he enters the university, but at the end of
his first term of study. If, on examination in the branches of knowledge
to which he has devoted himself, he show himself deficient in industry
or in capacity, it will be best for the university and best for himself,
to prevent him from pursuing a vocation for which he is obviously unfit.
And I hardly know of any other method than this by which his fitness or
unfitness can be safely ascertained, though no doubt a good deal may be
done, not by formal cut and dried examination, but by judicious
questioning, at the outset of his career.
Another very important and difficult practical question is, whether a
definite course of study shall be laid down for those who enter the
university; whether a curriculum shall be prescribed; or whether the
student shall be allowed to range at will among the subjects which are
open to him. And this question is inseparably connected with another,
namely, the conferring of degrees. It is obviously impossible that any
student should pass through the whole of the series of courses of
instruction offered by a university. If a degree is to be conferred as a
mark of proficiency in knowledge, it must be given on the ground that
the candidate is proficient in a certain fraction of those studies; and
then will arise the necessity of insuring an equivalency of degrees, so
that the course by which a degree is obtained shall mark approximately
an equal amount of labour and of acquirements, in all cases. But this
equivalency can hardly be secured in any other way than by prescribing a
series of definite lines of study. This is a matter which will require
grave consideration. The important points to bear in mind, I think, are
that there should not be too many subjects in the curriculum, and that
the aim should be the attainment of thorough and sound knowledge of
each.
One half of the Johns Hopkins bequest is devoted to the establishment of
a hospital, and it was the desire of the testator that the university
and the hospital should co-operate in the promotion of medical
education. The trustees will unquestionably take the best advice that is
to be had as to the construction and administration of the hospital. In
respect to the former point, they will doubtless remember that a
hospital may be so arranged as to kill more than it cures; and, in
regard to the latter, that a hospital may spread the spirit of pauperism
among the well-to-do, as well as relieve the sufferings of the
destitute. It is not for me to speak on these topics--rather let me
confine myself to the one matter on which my experience as a student of
medicine, and an examiner of long standing, who has taken a great
interest in the subject of medical education, may entitle me to a
hearing. I mean the nature of medical education itself, and the
co-operation of the university in its promotion.
What is the object of medical education? It is to enable the
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, as
Talleyrand said of his physician, "Knows everything, even a little
physic;" 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 overestimate 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.