5So 



NA TURE 



[OcTOIiER 15, 1896 



THE HUXLEY LECTURE.— RECENT AD- 

 VANCES IN SCIENCE AND THEIR BEARING 

 ON MEDICINE AND SURGERY} 

 I. 

 A WHEN fifty-four years ago the scliool of Charing Crii>s 

 Hospital gathered itself together for its winter vvorU, 

 among the new comers was a pale-faced, darU-haired, biight- 

 eyed lad, whose ways and works soon told his fellows that he 

 was of no common mould. To-day I am about to attempt the 

 fulfilment of the duty, which the authorities of the school have 

 done me the honour to lay upon me, of delivering the first of 

 the series of lectures which the school has wisely instituted to 

 keep alive, in the minds of those to come, the great services 

 which that lad's strenuous and brilliant life rendered to the 

 healing art. The trust of the Huxley Lectureship provides 

 that the lecturer shall dwell on recent advances in science, and 

 their bearings on medicine and surgery. I venture to hope 

 that I shall be considered as not really departing from the 

 purpose of the trust, if I attempt to make this first lecture a sort 

 of preface to the volume, or rather the volumes of lectures to 

 come. And since a preface bears a different paging, and is 

 written in a difierent fashion frcmi that which it prefaces, I shall 

 be so bold as, with your permission, to make the character of 

 my lecture to-day different from what I suppose will be that of 

 the lectures of my successors. It will, I iiTiagine, be their duty 

 to single out on each occasion some new important advance in 

 science, and show in detail its bearings on the art of medicine. 

 Each succeeding lecturer will, in turn, be limited in the choice 

 of his subject, and so assisted in his task by the choice of his 

 predecessors. I to-day have no such aid. It seems fitting that, 

 for the purposes of this initial lecture, the word "recent" 

 should be so used as to go back as far as the days of Huxley's 

 studentship. If it be so used, I am brought to face advances 

 in science affecting medicine and surgery, so numerous and so 

 momentous that any adequate treatment of them as a whole 

 would far exceed not only the time at my disposal, but also, 

 what is more, my powers to treat and your patience to hear. 

 I will not dare so hopeless a task. Nor will I attempt to select 

 what may be deemed, or what may appear to me, the most 

 important of these advances, and expound the bearings on 

 medicine of these alone. I venture to hope I shall best fulfil 

 the duty laid upon me, and meet with your approval, if I single 

 out and dwell on one or two general themes suggested by the 

 history of science during those fifty odd years. 



The first theme is one suggested by a survey of the studies 

 which engaged young Huxley in the school here in 1842. This 

 will firing before us a special bearing, on our profession, of the 

 advance of science, which, though it may not be evident at first 

 sight to every one, is nevertheless real and important. 



Each case of illness is to the doctor in charge a scientific 

 problem to be solved by scientific methods ; this is seen more 

 and more clearly, and acknowledged more and more distinctly 

 year by year. Now it is true that each science has to a certain 

 extent its own methods, to be learnt only in that science itself; 

 and from time to time we may see how a man eminent in one 

 branch of science goes astray when he puts forward solutions of 

 problems in another branch, to the special methods of which he 

 is a stranger. In nothing is this more true than in an applied 

 science like that of medicine. At the bedside only can the 

 methods of clinical inquiry be really learnt ; it is only here that 

 a student can gain that kind of mind which leads him straight to 

 the heart of disease, that genius artis, without which scientific 

 knowledge, however varied, however accurate, becomes nothing 

 more than a useless burden or a dangerous snare. Vet it is no 

 less true that the mind w hich has been already sharpened by the 

 methods of one science takes a keener edge, and that more 

 quickly, when it is put on the whetstone of another science, 

 than does a mind which knows nothing of no science. And 

 more than once inquiry in one science has been quickened by 

 the inroad of a mind coming fresh from the methods of a quite 

 different .science. For all sciences are cognate, their methods 

 though different are allied, and certain attitudes of the mind are 

 common to them all. In respect to nothing is this more true 

 than in respect to the methods of medicine. Our profession has 

 been the mother of most of the sciences, and her children are 

 ever coming back to help her. In our art all the sciences seem 

 to converge — physical, chemical, biological methods join hands 



1 Delivered at Charing Cross Meilic.il School, on October 5, liy Prof. 

 Michael Foster, Scc.R.S. 



NO. 1407, VOL. 54] 



to form the complete clinical method. This is the real justifica- 

 tion for that period of preparatory scientific study, which each 

 enactment of the authorities makes longer and harder for the 

 student of medicine. It is this, and not the mere acquirement 

 of facts. The facts, it is true, are needed ; every day the doctor 

 has to lay hold, for professional use, of mechanical, physical, 

 chemical, biological (acts, but facts are things which the well- 

 trained mind can pick up and make use of as it goes along at 

 any time and in any place. Whereas the mind which is not 

 well-trained will miss the facts or pick up the wrong ones, or 

 put to a wrong use even the right ones which it has in hand. 



Now the ideal training to be got from any science is that 

 of pursuing inquiry within the range of the science, according to 

 the methods of the science ; in that way only does the spirit ot 

 the science fully enter into the man. But such an ideal educa- 

 tion is impossible. We are fain to be content in merely making 

 the student know what truths in each science have been gained 

 and how they have been gathered in, such a teaching becoming 

 more and more efiective as a training, the more fully the student 

 is made to tread in the very steps, and thus to practise the 

 methods of those who gained the truths. 



The more complete the body of any one .science the more use- 

 ful does that .science become as a means of training, and hence 

 it is that advance of science has a double bearing on the medical 

 profession. As each science grows, not only does its new know- 

 ledge bring to the doctor new facts and new ideas, new keys to 

 open locked problems, and new tools to use day by day, but the 

 incorporated knowledge gains greater and greater power as an 

 instrument to train his mind rightly to use all the facts which 

 come before him. 



Let me, in the light of this view, call your attention for a 

 moment to the yoke of compulsory studies under which the 

 young Huxley had to bend his somewhat unruly neck, and com- 

 pare it with the like yoke which presses, heavily it seems to 

 some, on the neck of the young student of to-day. 



I have not been able to find an exact record of the course of 

 studies pursued by Huxley himself at Charing Cross in the years 

 1842-5, but I have been jirivileged to examine the stained and 

 tattered schedule of the College of Surgeons, duly " signed up," 

 for the years 1844-7, belonging to one who, during some of those 

 years, sat by Huxley's side, who was then, and afterwards, his 

 frienri, and who has won honour for himself and for your school, 

 under the name of Joseph Fayrer. 



I find that young Fayrer attended during his first year a course 

 of at least 140 lectures with 100 demonstrations on .Anatomy and 

 Physiology, a course of not less than 70 lectures on Materia 

 Medica, a course of lectures on the Practice of Surgery, and a 

 course of " The Practice of Physics," each of not less than 70 

 lectures, and a course of Hospital Practice in Surgery of not less 

 than nine months. In his second year he again attended the 

 140-lecture course on Anatomy and Physiology, and the 70- 

 lecture course on the Practice of Surgery, and again Hospital 

 Practice in Surgery, taking as well a 70-lecture course in 

 Chemistry, a like course in Midwifery and Hospital Practice in 

 Medicine. In his third year he once more attended the 140- 

 lecture course in Anatomy and Physiology, liut no other 

 systematic lectures ; the rest of his time was devoted to Hospital 

 Practice. To these demands of the College of Surgeons we 

 ought to add, in the case of the ordinary student, the demands 

 of the Comi^any of A])othecaries ; but the main addition thus 

 caused would be a course of Botany. 



Such a curriculum differs widely both in nature, extent, and 

 order from that in force at the present day. But I venture to 

 think that if we examine the conditions of the time, we shall find 

 that the authorities of that day were as wise as, possibly wiser 

 than, we of to-day. In judging such matters as these, we and, 

 perhaps, especially they who would drive the student on into 

 learning by the goad of compulsion, must bear in mind that 

 legislative enactments, such as those prescribing a curriculum ol 

 study, always exhibit a long latent period ; they come into visible 

 existence long after the stimulus which begat them has been 

 applied, long after the need of those things being done which 

 the enactments strive to do has been felt. .So long, indeed, is 

 the latent period, that often new needs have arisen calling for yel 

 other regulations before the old ones appointed to meet the old 

 needs have got into working order. Bearing this in mind, we 

 shall find that the course of study prescribed in Huxley's time 

 was wisely chosen to meet the needs of, at least, the time im- 

 mediately preceding that, if not, indeed, the time itself. 



It will be observed that the study of physics, or as it was then 

 more commonly called natural philosophy, finds no place what- 



