Oct. 19, 1876] 



NA TURE 



547 



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 

 should offer a thorough discipline in the principles and 

 practice of art to those in whom lies nascent the rare 

 faculty of aesthetic representation, or the still rarer powers 

 of creative genius. 



The primary school and the university are the alpha 

 and omega of education. Whether institutions interme- 

 diate between these (so-called secondary schools) should 

 exist, appears to me to be a question of practical con- 

 venience. If such schools exist, 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 rela- 

 tions 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 ; what 

 qualifications should be required of those who propose to 

 take advantage of the higher training offered by the uni- 

 versity. 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 everyone who can take 

 advantage of it, although be 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 any one to the university who could be rea- 

 sonably 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 not fit. 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 doubt- 

 less 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 desti- 

 tute. 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 sub- 

 ject 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 "i It is to 

 enable the practitioner, on the one hand, to prevent dis- 

 ease by his knowledge of hygiene ; on the other hand, to 

 divine its nature, and to alleviate or cure it, by his know- 

 knowledge of pathology, therapeutics, and practical me- 

 dicine. 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 cer- 

 tificate. This is one great truth respecting medical edu- 

 cation. 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 an- 

 other 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 hum.an 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. What we call therapeutics again, 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 con- 

 sideration 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 

 wilh 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 emer- 

 gency, and always ready for practical application. Con- 

 sider, in addition, that the medical practitioner may be 

 called upon, at any moment, to give evidence in a court of 



