NATURE 



435 



THURSDAY, OCIOBER i, 1874 



HINTS ON MEDICAL STUDIES 



FEW of those who to-day commence their medical 

 education will be able fully to realise what would 

 have been their position if they had done the same some 

 fifty years or more ago, instead of now. After an ap- 

 prenticeship of from three to five years to a country 

 practitioner, during which time, at the expense of their 

 .general education, they would have been employed in 

 dispensing medicines, and other less honourable duties, 

 they would have entered on their medical studies, properly 

 so called, possessing a certain empirical acquaintance 

 ■with a few of the details of professional life, which might 

 howc\'er, have been obtained in an infinitely shorter time 

 after the principles of the subject had been mastered. 



This state of things is fortunately past. The pupil now 

 leaves school, having had a more liberal general training, 

 conducted mostly during the lime which used to be 

 wasted in apprenticeship, and after being tested by a 

 commencing examination in Latin, arithmetic, &c., he 

 immediately begins his special studies at a recognised 

 college and hospital. At the outset several questions 

 respecting the direction that his work has to take, suggest 

 themselves, which are only partially answered in the 

 calendars of the different examining bodies, and on 

 which there is considerable di\ersity ol opinion amongst 

 teachers and the profession generally. One of the most 

 important of these refers to the question whether or not 

 it is advisable to commence clinical work at once, or to 

 wait until some knowledge of anatomy and physiology 

 has been obtained. As the medical education consists of 

 two parts, a theoretical and a practical, one conducted in 

 the lecture-theatre and the dissecting-room, the other in 

 the wards, out-patient department, and post-mortem 

 theatre of the hospital : is it wise to pursue these two 

 independent courses simultaneously, and if not, which 

 should have the preference .' This question is not diffi- 

 cult to answer, for it is evident that attendance in the 

 wards of the hospital during the first medical session 

 must very much resemble the justly disparaged period of 

 apprenticeship. Like it, the knowledge acquired will be 

 almost entirely empirical, and therefore so much the less 

 useful ; for the numerous facts which the student is 

 learning from the classes he is attending at this early 

 period, must for some time be so crudely associated in his 

 mind that he will experience difficulty enough in re- 

 taining them there at all, let alone having to apply them 

 to previously unexpected instances. We therefore would 

 ad\ ise that the first winter session at least should be 

 entirely devoted to lecture-work and the dissecting-room, 

 and that the wards should not be systematically visited 

 until the following summer. Then, even, as Materia 

 Medica is not a winter subject, but little can be learnt 

 with reference to treatment, except in surgery ; expe- 

 rience in diagnosis must consequently be the only object 

 kept in view. Afterwards, as much time as can be spared 

 may be devoted to clinical work. 



Another question which requires an answer refers to 

 the number of subjects which ought to be embraced in 

 the necessary course of study. Without wishing at 

 Vol. X.— No. 257 



present to enter into a discussion as to whether the 

 vital force which is at work in the living body is any- 

 thing sui generis, or only an elaboration of other well- 

 known forces which are manifested by inorganic matter, 

 there is no doubt that those physiological phenomena 

 which are within the reach of complete human compre- 

 hension are all capable of being represented as problems 

 of pure physics. Such being the case, the great import- 

 ance to all thinking students of medicine, of a knowledge 

 of the fundamental properties of matter, must be self- 

 evident. Some may have had the opportunity of learning 

 a little about mechanics, heat, light, and electricity at 

 school, but most will be sadly ignorant on these subjects ; 

 and being so, when they have advanced sufficiently far in 

 physiological and pathological investigation to appreciate 

 the enormous fields for work which they open up, they 

 will find no greater stumbling-block to their further pro- 

 gress than their imperfect training in the science of 

 physics ; it will act as a barrier against sound original 

 work in all directions, and prevent many an' able man 

 from doing full justice to his mental capacities. 



It is this unsoundness of the physical basis of physiology 

 which maintains the considerable interval between physio- 

 logists and physicists ; which makes it necessary to have 

 physiological and physical laboratories as separate institu- 

 tions instead of as dilferent departments of the same esta- 

 blishment, and which allows flagrant physical inaccuracies 

 in physiological investigations to be stated and restated 

 under the approving sanction of those who ought to know 

 better. What can horrify a pure physicist so much at 

 the present state of physiological knowledge as, when he 

 reads in a recently published work by one who is consi- 

 dered to bs the British representative of the subject on 

 j which he treats, to learn that in the flight of birds the 

 wings strike downwards and forwards ; and in another 

 work, by another prominent author, that the aortic valves, 

 which correspond to the secondary valve of an ordinary 

 pump, close during the contraction of the ventricles of 

 the heart ? Similarly, the phenomena of electrotonus, in 

 the eyes of a physicist, hive as little to do with the true 

 nerve-current as the spark obtained from a Leyden jar 

 has with that circulating in an ordinary electric telegraph 

 cable. These instances, and many others which might 

 be adduced, all point to the importance of a thorough 

 knowledge of physics to the student of medicine. 



Second only to physics, as a collateral part of medi- 

 cal education, is zoology. Many, however, would place 

 botany next. No doubt a knowledge of botany is 

 essential to a thorough comprehension of the details of 

 Materia Medica ; nevertheless, for the prosecution of work 

 bearing on medicine proper, an acquaintance with the 

 structure of animals is more important than that of plants. 

 The latter may, most of it, be left to the pharmaceutical 

 chemist, and be neglected by the physician. Very little 

 is gained by the medical student when he learns that 

 podophyllin is obtained from the rhizome of a ranuncu- 

 laceous plant, or even that the natural order Solanaceffi 

 has been divided up in a manner which physiological 

 action justifies ; but that the c;ecum of the intestine is 

 absent in many mammalia, and that it is of very much 

 larger proportionate size in some than in man, must have 

 an important bearing on our conception of the function of 

 that organ. Many other similar instances might be given. 



