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NATURE 



[Oct 19, 1876 



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 to enable him to per- 

 form the operations of surgery, ought not, in my judg- 

 ment, to be occupied with investigations into the ana- 

 tomy 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 practical 

 purposes of his profession that knowledge is not of one 

 whit more value, has no more relevancy, than the know- 

 ledge 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 Talley- 

 rand 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 him- 

 self, 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 j 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 con- 

 sider 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 to four or five lectures in 

 the day 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 divided. Practical exami- 

 nation 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 mul- 

 tiplicity of diverse studies. 



Proposals have recently been made to get rid of general 

 examinations altogether, to allow the student to be exa- 

 mined 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 provi- 

 sion 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 



