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NATURE 

THURSDAY, DECEMBER 1, 1870 


MEDICAL SCHOOLS IN ENGLAND 
GERMANY 
Ill. 
HERE is something elevating in the thought that the 
hospital, while it provides care for the sick, at the 
same time makes them useful for the purposes of instruc- 
tion in the service of mankind. Still it is painful, on the 
other hand, to think that the patient enjoys this attention 
only in order to be made as profitable as possible to 
others ; that he is given over to a crowd of curious seekers 
for knowledge, who feel his painful spots, percuss and 
auscultate his weakened body, and, in short, by pro- 
ceedings of various kinds, disturb the rest he so heartily 
longs for. Such evils are not indeed of any account, so 
long as the number of students does not exceed a certain 
limit. Experience teaches that a patient is pleased to 
see a certain number of doctors about him; he soon gives 
them his confidence, he looks upon them as his friends, 
and willingly allows himself to be examined, partly with the 
idea that it will be better for him if the examination is 
several times repeated, partly in acknowledgment of kind 
attentions which are shown him. The difficulty arises 
when the number of students is so large that the patient 
can no longer feel at home with them. Apart from the 
fact that the disturbance of the patient increases with the 
increase of the crowd about him, it is also of the utmost 
importance to consider that the greater number of stu- 
dents must remain total strangers to him, that they are 
for him only intruders, who are learning from his body 
without offering him anything in return. 
The situation becomes, however, actually distressing in 
AND 

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to practice. They distribute themselves then among the 
hospitals where there are no students’ tasks, and there, 
with great loss of time, and under discouragements of 
many sorts, they are instructed in subjects which, 
according to their diplomas, they should have learned 
long before. Between such extreme unsuitableness 
and a really healthy state of instruction, there is, how- 
ever, a long road leading us through many schools of 
various grades. 
Instruction in medical science is good only where it 
happens to be endurable by the patient — that is, in 
smaller schools, where a few students only collect about 
his bed. Medical instruction has still another side. The 
student must not only learn the handicraft, he must also, 
through well-instructed teachers, be made familiar with 
the delicate processes which require delicate instruments, 
and experiments, and methodical thought for their elucida- 
tion ; for it is only by intercourse with thinking men that 
he can learn how careful observation and earnest thought 
on the phenomena with which his whole life will be 
occupied, can be made available for practical ends. 
In this connection, also, the question of the value of 
instruction in hospital wards must be answered. In point 
of fact the practising physician has always hitherto been 
regarded as the high school of medical science. Famous 
systems of medicine—that is, theories upon the nature of 
disease—took their start in hospital wards, and were 
taught at the bedside by distinguished masters. 
In this country, however, a total revolution has taken 
place, speculations upon systems of medicine are sup- 
| planted by exact medical science, and this, for the moment, 
| has fled from the ward and taken up its abode in the 
| 
| 
the neighbourhood of a distinguished teacher in one of | 
the large schools. An inquisitive throng crowds about 
the sick bed, utterly regardless of the patient’s comfort. 
The hospital becomes a market, the sick merchandise. 
Inasmuch as it is important for us to give the rela- 
tions of hospital and school a basis as humane as possible, 
we must inquire what those large schools have to offer 
in the way of medical instruction, and whether we may 
take the advantages as a set-off to the evils. 
As far as the art of medicine is concerned, we can main- | 
tain, without fear of opposition, that, ceteris paribus, 
clinical medicine will be taught with less success, the 
greater the number of students who crowd about the 
bed. The technical part of medicine should be taught 
orally. The student should be drilled in it as in a trade. 
In general, however, and to a certain point, the capa- 
bility of the person so drilled increases in proportion to 
the time which the teacher devotes to him personally, 
and it must therefore be in inverse proportion to the 
number of pupils whom a teacher has to instruct. 
Experience, in fact, teaches us that with large numbers 
of pupils the standard of individual capability is apt to be | 
extremely low. In Vienna, where about 300 students are 
instructed in clinical medicine around each bed, the 
amount of drill which each receives comes so near zero 
that for practical life it is scarcely to be taken into ac- | 
count. The students discover this as soon as they have 
left their studies behind them and begin.to look forward 
VOL, III. 

laboratory—here, at the present time, the most distin- 
| guished medical men and working pupils of superior gifts 
attach themselves to the laboratory, and remain there to 
study. Hence the phenomenon that, in Germany, in the 
department of pure clinical medicine, there is a want of 
worthy representatives. We are not to conclude on this 
account that our generation is inferior ; it is only that the 
distribution of its scholars is different. 
The modern students of clinical medicine seek to found 
their reputation by work in the laboratory, and they are 
unable to stand competition with those workers who are 
at home in it. First, because in general their ranks are 
not recruited by thinkers of the first order; secondly, 
because their profitable business coming in the way hin- 
ders their thorough education. They leave, therefore, the 
firm ground which the morphology of disease affords, and 
trust themselves to the weak ship of experimentation, 
which they are not able to steer. 
Even if the results of such investigations are taught at 
the bedside, the highest school of medical science is not 
to be sought there. The patient ought not to be dis- 
turbed, and the drill of the student neglected, for the sake 
of a science which is, or ought to be, better studied in the 
laboratory. It is the morphology of disease which 
belongs directly to the sick bed. One must have seen 
distinguished teachers of this kind, one must have 
| observed how they bring to light latent indications of 
disease, in order to concede that to such men, even a little 
misusage of the sick might be allowed in the interests of 
education. This bringing to light and grouping of pheno- 
mena for the purposes of diagnosis, is nowadays, indeed, 
F 
