1000

and perhaps more especially during the last forty yearssince the passing of the Medical Act. Perhaps some daythat body which was presumably constituted for the pro-tection of the medical profession, the General MedicalCouncil, will awaken to the fact that it has some duties toperform in return for the heavy registration fee which itegacts from newly-qualified men, and will take steps toobtain powers which will put it on the same footing towardsour profession a,s the Incorporated Law Society holds towardsthe legal profession. Then unlicensed practice and quackerywill be put down with a firm hand, our profession willreceive that protection which it has a right to, ard thegeneral public will have some guarantee that when they aredealing with a man who calls himself a "doctor" " theyare really doing so, and have not fallen into the handsof some more or less incompetent and dishonest outsider.A retrospect such as I have put before you very clearlyshows that at all times and all ages there is a largesection of the public who like to be humbugged and

oheated, and while that is so we may be sure that, not-withstanding all legislation, their wants and desires willsomehow be satisfied ; but it also shows that the estimationin which the medical profession is held by the public and bythe authors who write for the public depends on the indi-vidual members of the profession. If it is a general rulethat when a medical man is introduced into a novel of thiscentury he is portrayed as a worthy, lovable, devoted man andtrustworthy friend, who has not been narrowed but broadenedby his professional work, a man, in fact, like Dr. Thorne, itmust be because novelists have met such persons in real life.If, on the other hand, they satirise the little meannesses andjealousies that are to be found among medical men it is forthe same reason. In fact, the reputation of the professionis in the hands of each member of it, and with each memberit rises or falls. Our predecessors and contemporaries haveso raised it that it is no longer said, as it was in Thackeray’sdays, " He’s only a doctor." Let it be our aim to raise it.still higher.

AbstractsOF

INTRODUCTORY ADDRESSES, ETC.,DELIVERED AT THE

LONDON AND PROVINCIAL MEDICALSCHOOLS

AT THE

Opening of the Session, 1896-97.

CHARING-CROSS HOSPITAL.

HUXLEY LECTURE BY PROFESSOR MICHAEL FOSTER.

PROFESSOR MICHAEL FOSTER’S first theme was the specialbearing on the profession of the advance of science, whichbecame apparent from a survey of the studies of the medicalstudent in the days of Huxley’s studentship and a compari-son of these with the like studies of the present day. An

examination of the schedule of compulsory studies issued bythe Royal College of Surgeons of England in the earlyforties, showed that of the sciences ancillary or preparatoryto medicine, no instruction was provided in physics and verylittle in chemistry, that little coming in the middle of thestudent’s course and being instruction by lectures only.Of general biology nothing was demanded by the College,save what incidentally came in materia medica, and onlya little botany by the Society of Apothecaries. On theother hand, the greater part of each of the three yearsof study, right to the end of the course, was taken up bywhat was called anatomy and physiology, but was in themain human anatomy, and which alone of the studies wastaught practically-namely, in the dissecting-room. In

appreciating the value of such a curriculum as the above itmust be borne in mind in respect to any science ancillary tomedicine that great as may be the practical usefulness ofthe facts embodied in the science, far greater is the worthof an adequate study of the science as a mental training.An ill-trained mind bungles with the facts which are

before it; a well-trained mind can pick up the factsas it goes along. The methods of medicine, themother of most of the the sciences, are at bottomthe methods of the children sciences ; a training inthe latter fits a man quickly for the use of the former. Atthe present day, physics, chemistry, biology, and physiologyhave each developed into a body of learning, capable, whenrightly taught, of being used as instruments of mental

training of great value, the right teaching being that bywhich in the laboratory the student is made to tread inthe very steps of those who have built up the science. Thisis the chief justification of the study of these sciences beingmade a part of medical education. In the days of Huxley’sstudentship things were very different. None of the sciencesin question, perhaps not even physics, presented such a bodyof truths as could be taught in such a way as to serve fora real training to the medical student ; what was taught tohim was taught merely for the practical utility of the facts.One branch of knowledge only had in that day achieved suchcompleteness and the machinery for teaching it become soperfected as to be a real engine of culture, and that washuman anatomy. The acquirement of that knowledge wasat that time the one real discipline for the medical student,and its value as a discipline even exceeded the practical use-fulness of the facts of which it was made up. Theauthorities of that day were wise in making that the back-bone of the student’s education. To-day we shall be wise if,departing from their letter, we follow their spirit in leadingthe student along that path of study which will best andmost swiftly arm his mind to grapple successfully with theseries of scientific problems making up the medical man’sdaily life.The second theme on which the lecturer desired to dwell

was the complexity of the progress of science, and the

intricacy of the bearings of even a single scientific obser-vation. In illustration of this the lecturer proposed to con-sider the bearings of some three or four physiologicaldiscoveries, some three or four observations each the resultof experiments on living animals made in the years of, or inthose following closely upon, Huxley’s studentship. Thefirst such observation was that made by the brothers Weberin 1845, in Huxley’s last student year, in which they showedthat electric stimulation of the vagus nerve stopped the heartin diastole or, as we now say, inhibited it. If the questionbe asked, what has been the gain of that experiment ? theanswer is that its effects have gone far and wide into thewhole of physiology, and thus into the whole of medicine,and indeed have not yet come to an end.The next such observation to which the lecturer called

attention is that by Claude Bernard in 1851, when he showedthat section of the cervical sympathetic led to fulness of theblood-vessels in the head and face. The same experimenthad been made a century or so before, but dropped still-born,the fulness of its time had not yet come. In Bernard’s handthe experiment became the origin, the beginning, and so thecause of all that advance of physiological and medical know-ledge which is indicated by the word °‘ vaso-motor."There can be no need to dwell on how this knowledge hasentered into and modified our conceptions of physiologicaland pathological events, general and special, or how, againand again, it comes to the front in therapeutic endeavours.Yet when Huxley was a student the very basis of that know-ledge was not as yet assured.! The lecturer next dwelt on Bernard’s discovery in 1850 ofglycogen. This had an immediate and direct effect onmedicine in throwing light on that terrible disease diabetes,a light which, even if it has not fulfilled the hopes whichwere first held, has at least, by pointing the way towardsalleviation, saved much suffering and greatly prolonged valu-able life. But this has been only one and not the greatest ofits effects. It has had a most powerful influence as themother of ideas. It was the first clear direct proof of thesynthetic powers of the animal body and as such has beenthe parent of great additions to knowledge, more especiallyin these latter days. But its chief influence has been,perhaps, by showing how a tissue in a hidden wayprofoundly affects the blood, apart from any visible event,such as an outward blow, of secretion fluid, or a muscularcontraction or a nervous impulse. t, was the first exemplarof what we now call " internal secretion."The last illustration taken was Waller’s observations in

1850 and 1852 on the dependence of the nutrition of a nervefibre on its continuity with the body of the nerve-cell ofwhich it is a process. This discovery, also the direct gain of

1001experiments on animals, was in itself alone of value as acontribution to our knowledge of the influences which thecentral parts of a cell surrounding the nucleus exert on otherparts of the cell, and perhaps we do not as yet fully realiseall that the observation teaches.The lecturer concluded by a few words concerning the

influence exerted by Huxley on physiology and so on medi-cine.

____

LONDON SCHOOL OF MEDICINE FOR WOMEN.

INTRODUCTORY ADDRESS BY MR. A. BOYCE BARROW.

MR. BARROW gave an address to the students entering theLondon School of Medicine for Women and the Royal FreeHospital, and having expressed a hearty welcome he pro-ceeded to speak to them upon some of the endowments ofthe human body. Drawing their attention to the constantseries of chemical changes going on in each cell ofthe body, and pointing out how these changes were

concerned, not only in the maintenance of the cell itself,but also in the manufacture of forces by which workcould be done, he went on to show that the amount

of energy produced depended upon the amount of . food

thoroughly consumed, just in the same way as the amountof power in a steam-engine depended upon the amountof fuel consumed. He gave illustrations to show howany particular tissue could develop increased size and

power by exercise, and that this increased power wasassociated with a storage of energy. He advised thestudents to apply the lesson learned from these examplesto the training of their own mental powers, so as to

develop the various functions of the brain .to the greateststate of perfection. He cautioned them, however, againstexercising any one system of the body to the detrimentof the others, explaining that there must be a certain pro-portion of chemical activity in all the tissues in order tomaintain a satisfactory condition of health, and gave as aproof of such law the effect produced upon an individual bythe removal of the thyroid gland and the restoration tohealth again of such individual by the administration of thethyroid glands taken from other animals. He also cautionedthem that the energy produced in the body is a more or lesscommon commodity, and being used excessively by oneorgan, robs the others of some of their power, giving as aninstance that when much food is taken into the stomach it isliable to exhaust so much energy in digesting it that theindividual is unfitted for any other kind of work, and sleeps.He also pointed to the beneficial effect of exercise upon theorgans concerned in maintaining the body, inasmuch as theincreased employment of force means increased consumptionof food ; it calls upon the digestive, respiratory, circulatory,and other systems for increased work in order to supply thisextra demand, and that the body can react and accommodateto such a demand is evidenced by the development andincrease in functional activity of a kidney when its fellowhas been removed, or the development of the heart to over-come a difficulty in the circulation. He then spoke ofanother endowment of the body-the process of repair-and condemned the practice which has become so muchthe fashion of rubbing and manipulation of an injuredpart with the erroneous idea of causing the absorption ofwhat may be called "nature’s splint." He then expressedindebtedness to Sir Joseph Lister for having introducedmeans for protection of this reparative process against theattacks of the bacterial inhabitants of the air and dust.He spoke of these organisms as a part of creation, theirproper sphere of activity being to attack the dead body,and said that care must be taken to guard against themwhen the body is wounded or the tissues are lowlyvitalised, teaching the organisms to wait a little longer.He concluded by congratulating them upon having given upthe idea that it was an undignified thing for a woman towork-and especially upon their joining the medical profes-sion, in which they were employing their energies in prepar-ing for a calling of the highest and most responsiblecharacter and in which they could confer an appreciablebenefit upon their fellow-creatures. He thought that theywere fortunate in joining at the present time, when a"doctor" is no longer spoken of as a necessary evil; thatthey were fortunate in finding a ladies’ medical school sowell established and affording such ample opportunities forstudy, and he spoke in a very sanguine tone of their future

success in practice if they worked especially at the diseasesof women and children and thus gained the confidence of-their own sex.

THE PHARMACEUTICAL SOCIETY.INTRODUCTORY ADDRESS BY MR. R. BRUDENELL CARTER.

AFTER glancing at the altered conditions of pharmacyto-day as compared with those of fifty years ago, and aftercongratulating the society on the fact that through itsexertions it was no longer necessary even for countrypractitioners to dispense their own prescriptions, Mr. Carterwent on to say that the calling of the pharmaceuticalchemist, as it was now conducted, demanded from all who-would follow it the devotion of their best faculties, whetherof body or mind, and demanded also that these facultiesshould be assiduously trained for the better accomplishmentof the work which they would be called upon to perform.This was done to some extent by the school education

required in order to qualify the students for the necessarypreliminary examination-an examination which he hopedto see gradually elevated as to its standard and graduallywidened as to its scope. He wished to direct theirattention to the methods by which the benefits of theschool teaching might best be supplemented and con-

tinued, and by which their minds might best be preparedfor the recognition of truth and for the rejection oferror. He referred to the way in which the permanentresults to be hoped for from education were sometimes madesubordinate to the requirements of the coming examination,and pointed out that not success at the examination, but thedevelopment of the intellectual faculties, constituted thedifference between the blockhead and the philosopher. Itwas their business to consider how they could depart mostwidely from the former type and approach most nearly tothe latter. For this purpose it was necessary to cultivatethe power of observing with accuracy and the power ofjudging with discrimination, and to utilise the daily studies,not merely as sources of knowledge, but also as means ofmental cultivation. Regarded in this light he believed themost important educational agency was the study of a,

language-what language mattered little as long as a realmastery of it was obtained ; and as the requirements of’the preliminary examination did not extend to a thoroughmastery of Latin he advised them to attain sucha mastery of English, to know the precise meanings of’words so as not to be liable to misuse or to misunderstandthem, and the proper connexions and relations bet ween thedifferent parts of sentences so as to be able to expressmeaning coherently. After giving seme examples of faults.in these respects, and after saying that the thoughts of aphilosopher could not be expressed in the phraseology of acharwoman, he reminded them of Cobbett’s description of an.English sentence, that it should be as clear " as a pebbledbrook, not only not liable to be misunderstood. but not

capable of being misinterpreted," and said that this was theideal after which they ought to strive. He felt stronglythat they could acquire nothing which was more importantor more certain to be valuable than the power of saying orwriting precisely what they meant and the power of

perceiving the precise meaning of what they wrote or sa.id.Whoever could do these things was secured against muddle-headedness for the remainder of his life. He thengave some hints as to the conduct of study, and once

more urged his hearers to devote their best energiesto the attainment of a thorough knowledge of their ownlanguage and of the writings of those who have madethat language what it is, feeling safe in the prediction that ifthey did this whatever other kinds of learning they mightseek would be found to be comparatively easy of acquisition.

THE PURCHASE OF THE PORTSMOUTH WATER-WORKS.-A special meeting of the committee of the Ports-mouth town council, which has in hand the acquisition ofthe concern of the waterworks committee, has recommendedthe council to promote a Bill in Parliament for the purchaseof the works. It will be remembered that to make the

purchase a paying one financially to the town a loan of themoney required-a little over a million sterling-would haveto be made for at least eighty years, and the Local Govern-ment Board have intimated that sixty years is their limit in

this respect, so a clause providing for repayment in eightyyears is to be added to the Bill. The matter will not come.before the town council for another month.