No. 2350.

[SEPT. 12, 1868.

THE LANCET.

LONDON: SATURDAY, SEPTEMBER 12, 1868.

STUDENTS’ NUMBER.

THE DUTIES, DIFFICULTIES, AND OBJECTS OFSTUDENT LIFE.

WITH the yearly issue of this number of our journal we areaccustomed to address a few words of welcome to the numer-

ous body of young men who are about to enter upon thestudies peculiar to the medical profession, and to add to thosewords of welcome some of encouragement, of advice, and of

warning.With the returning month of October in each year upwards

of 1000 men, for the most part fresh from school, commenceeither in London or the provinces, the study of the profes-sion, and exchange the restricted field of scholastic for thefar wider range of scientific knowledge; and as the former

may be regarded as merely a preparation and introductionto the latter, so this, in its turn, is in truth only the pre-paration of the mind for the right discharge of the activeduties of social and professional life. In order to ascertain

whether the student has profited by his elementary edu-cation, all the examining bodies have for some years pastjudiciously insisted that he shall pass a Preliminary or Ma.triculation examination. Such an examination should presentlittle or no difficulty to the candidate, since it takes up those

subjects only on which he has been engaged for at least tenyears. Yet so faulty is the school education of this country,as every examiner can testify, that the most lamentable de-ficiency exists, not only in a practical and useful acquaintancewith the dead languages, but in the more homely knowledgeof grammar and spelling; whilst in arithmetic the student

may sometimes say, and perhaps feel, with Don ARMADO, " Iam ill at reckoning; it fits the spirit of a tapster." " The time

is not yet quite ripe for it, but we cordially trust that beforemany years have elapsed inquiry into the extent of such ele-mentary knowledge will be considered wholly superfluous,whilst the student shall be compelled to show that he possessessome acquaintance with the fundamental facts of Natural

Science and Philosophy, ignorance of which constitutes so

great a drawback to his advance during the first year of hos-pital work, and which for all practical purposes might beacquired far better at home or in the country.Supposing our young friends to have passed their initiatory

ordeal with success, let us next endeavour to point out thedifficulties they will meet with in their further progress, themeans by which those difficulties may be overcome, and finallythe results that are sought to be attained.The difficulties which oppose the progress of medical students

are, perhaps, first, the extent and range of the subjects re-quired to be known, leading them to feel that, as it is mani-festly impossible for them to know all, it is useless for themto attempt to learn any; secondly, the tendency that existsin every mind to relax in the energy of its pursuit after know-ledge, however vigorously and impetuously commenced, if

unexpected difficulties arise, or even if it be found that, the i

knowledge acquired is not directly or immediately useful; andthirdly, which is closely allied to the foregoing, the liabilitythat a young man, thrown, if we may use the expression, withinsufficient ballast on the world of city life, experiences of

falling into and yielding to temptation, under circumstancesin which there is little restraint, beyond his own good prin-ciples, to keep him in the paths of rectitude and honour.Perhaps the difficulties of the student may be shortly summedup by saying, they are those he meets with in acquiring anadequate and useful knowledge of a wide range of subjects inthe limited space of time at his command.

Now, with regard to the nature and extent of the work be-fore him, the course of study, as at present arranged, embracesAnatomy, Physiology, and Chemistry during the first winter,and Practical Chemistry, Materia Medica, and Botany duringthe first summer session; and the student will find, in thedue acquirement of these subjects, sufficient material to taskhis utmost powers of application and memory. Of all of themit may truly be said that they are deeply interesting, whilstthey all largely exercise the faculty of observation, and aretherefore rightly placed in the front rank of those to be attainedby men whose whole lives are to be spent in the close, careful,and scientific investigation of natural phenomena. If there be

a faculty which the student of medicine should cultivate withmore diligence than another, it is that of observation, since toits discriminative exercise we are indebted for all we know of

the causes of disease, of the recognition and interpretation ofsymptoms, of the distinctive features of very different thoughoften deceptively similar maladies, and of the means of cure ;and they who occupy a prominent place in the long roll ofdistinguished physicians and surgeons have invariably pos-sessed it in a high degree.The science of Chemistry will always command the atten-

tion of the young by the brilliancy of its experiments, whilstthe more mature intellect is attracted by the certainty of itsresults. That it has always exerted a singular fascinationover the minds of men is indicated by the fervour with whichits study has been pursued even from the earliest historicalperiods. In the magic of the ancient Egyptians, in thealchemy and necromancy of the middle ages, however con-cealed by superstition, lay hid the germ of much that themore exact observation of modern times, has. developed intoimportant truths; and though we no longer believe in thephilosopher’s stone, in the transmutation of metals, nor inthe elixir of life, we are compelled to acknowledge that theinvestigations which were set on foot by the hopes of discover-

ing these absurdities have constituted the basis of almost allthe knowledge we possess in this extensive and importantscience - so true is the doctrine of the great master, thatTruth is more easily educed from error than from confusion.Of late years Chemistry has become a very important hand-maid to Medicine, since there are few forms of disease to the

diagnosis or treatment of which it may not in some way be

made subservient; whilst for the due investigation of others,as the entire class of urinary affections, it is absolutely indis-pensable. Let, then, the student be diligent in his attendancein the laboratory; he will find the knowledge there acquiredmore serviceable to him in after-life than that obtained from

lectures or from books ; and if nought else, he will at leastlearn the value of order, the importance of slight variations inthe conditions present in modifying results, and the facility

336 THE DUTIES, DIFFICULTIES, AND OBJECTS OF STUDENT LIFE.

with which, for experimental purposes, simple but skilfullyapplied means may oftentimes be made to supersede costlyapparatus.Of Botany it is only requisite here to remark, that a know-

ledge of its principles is indispensable to the practitioner whois desirous of fully comprehending the laws and phenomena oflife, or biology in its widest sense. Plants, no less than

animals, are organised and living, and exhibit in many of theircharacters clear evidence of the activity of the same forceswhich are in operation in the highest animals. An acquaint-ance with the principal forms of vegetation is, or should be, apart of every scheme of liberal education, since, as recent

investigations have shown, there are conditions and circum-stances connected with the growth and reproduction of plants,and with the reciprocal relations of plants with animals, thatopen up new lines of inquiry, whilst, to say the least, it confers apleasure on every rural walk, and extends and improvesthe mind by the contemplation of the infinite variety of form andcolour displayed in this vast section of created beings. But to

us, who largely employ the parts or products of plants asremedial agents, it certainly presents a peculiar interest, andhe can only be said to possess a fragmentary knowledge of his

profession who is not acquainted with the chief physical fea-tures of the vegetable drugs-the so-called materia medica-he is daily in the habit of prescribing.

Still the student must remember that it is neither profitablenor possible for him to become a proficient in these sciences.The real business of the first winter session is to familiarise

himself with the broad outlines of Anatomy and Physiology,but especially of the former. To an equal degree with che-mistry and botany, anatomy improves the faculty of observa-tion, and exercises the memory; nor, when once thoroughlyknown, do its main features easily escape. The value that is

attached to it is shown by the threefold course of instructionpursued in regard to it in our mode of education-by lectures,by tutorial demonstrations and examinations, and by dissec-tions. He must be an indifferent teacher indeed who cannot

make even the "dry" bones interesting; and, notwithstandingthe repugnance that the young student naturally feels at firstto dissection, we venture to say that with good instructors tohelp him over the first difficulties, and with some dispositionon his part for natural science, there are few more engrossingoccupations than that of practical anatomy.

Coincidently with the pursuit of anatomy the student com-mences that of the science of Physiology, the most interestingby far, as it is the widest and most comprehensive, of all thebranches of human inquiry. Whilst the anatomist displaysthe dead structures, and describes their position and relations,the physiologist seeks to enter the penetralia of the living, andto show the mode and manner of operation by which these ’,

parts discharge their offices. Life is the object of his study. I

Life, as exhibited in the microscopic monad, or in the mightydenizens of the forest or of the deep. Life in its every phase,with all its strivings and efforts, from the earliest moment thatit springs into being, as it passes through the feebleness of in-fancy, acquires the strength of maturity, and wanes in thedeclining power of age. Life, as it expresses itself in physicalenergy and vigour, or as, more mysteriously, it acts in the mindand the thought. If the physiologist turn aside for a momentto regard the dead, it is but to acquire such knowledge of struc-ture, position, and form as may enable him to interpret the

. phenomena presented to his observation; and when it is re-

. membered that the tribes of animals are almost infinite, andthat well-marked differences exist in even nearly allied speciesin respect to the performance of their functions, it maywell be conceived that the field before him is boundless. No

subject has such close and intimate bearings upon the prac-tice of our profession as this, since it is obvious that before wecan know or estimate the kind and degree of disorder present wemust first know what are the operations of healthy structures.There is none, therefore, with which the student should bemore thoroughly familiar, and it is certainly true that no manwas ever a good practitioner in medicine who was not also a

good physiologist.A department of anatomy which has for some reason fallen

into the hands of the physiologist is minute or microscopic ana.tomy. The relations of histology to medicine and surgery aredaily becoming of greater importance. Microscopes are nowmade so cheaply that they are within the reach of every student,and they are withal so good that for three or five guineas afar better instrument for all practical purposes can now bepurchased than could be obtained for ten times that sum fiftyyears ago. With such an instrument in his possession let thestudent daily devote a short space of time to the examinationof the healthy tissues, and take every opportunity of preparingpathological specimens for himself. A few glass slides and

covers and his dissecting-case are all the apparatus he needs,whilst with a little glyceiine and gum he may long retainhis specimens unaltered.To enable the student to overcome one primary difficulty-

that, namely, of the vast extent of the unknown land beforehim-we would recommend him to avoid attempting too muchat first. As children learning geography are first taught thegrand divisions of countries and then the smaller ones of pro-vinces and counties, descending from the general to the parti-cular, so let the student proceed. Let him purchase somesmall but well-written work on each subject, and endeavourduring the ensuing winter session, by thoroughly masteringtheir contents, to acquire a good general knowledge. Then,in the second year, the study of the larger and more compre-hensive treatises may be undertaken, which at the outsetwould only serve to disgust and confuse. But, in learningthese subjects, it should never be forgotten that, however we

may subdivide nature into sections for our own advantage in

investigating them, and call this botany, that anatomy, andthis physiology, all are but parts of one continuous chain,governed by the same immutable laws, evidencing the sameprinciples of design, though variously modified with wonderfulingenuity for special purposes, and testifying by the simplicityand appropriateness of the means adapted to the ends attainedthe wisdom and goodness of the Creator. As regards all ofthem, but of anatomy in particular, let him not for a momentthink a competent knowledge can be gained from books orplates; these are aids to the memory, not the facts and phe-nomena themselves. As chemistry must be learned in thelaboratory, and botany in the fields, so anatomy can only bethoroughly and satisfactorily acquired in the dissecting-room.In the second place, we would strongly recommend the prac-

tice of writing out diligently at home what may have beenheard at lecture during the day. There is no surer means of

fixing the attention than this. Whilst reading makes a pro-found, writing makes a correct, man. In youth the mind

337THE DUTIES, DIFFICULTIES, AND OBJECTS OF STUDENT LIFE.

possesses the faculty of receptivity in its highest degree ; im-

pressions are then most easily received, most permanentlyretained : yet the practice of writing will be found of infiniteservice in enabling the mind to tabulate or arrange the factsalready possessed. And in this way, as well as by occasioninga repetition of ideas, and by rendering them clearer and moredefinite, it will materially facilitate subsequent reading, andwill often determine the result of a competitive examination.

Thirdly, when he meets with a difficulty, let him not toohastily apply to his tutor for a solution. Most difficulties can

be overcome with a little care and attention, and it is betterexercise for the mind, and renders a man more self-reliant, towork out a problem for himself than to obtain its solution fromanother. But let him not be restrained by false shame fromasking for information when he is really ignorant. Teachers

often neglect to explain a point because they are so familiarwith it themselves that they forget it is new to their hearers,and there are few who would not willingly answer a well-directed question.We counsel every man from the day of his entrance into the

hospital to attend, as far as he can, the out-patient practice.He will find an advantage, too, in attending in the surgery inthe morning, when, at most hospitals, the house-surgeon seesand dresses many slight injuries, or he may accompany thehouse-physician or surgeon in his morning rounds to the in-patients. He will thus gain an infinite fund of informationon minor details, of which at a later period of his career hewill be ashamed to avow, though he may keenly feel, hisignorance.

Of those who are entering upon their second and third

years’ study the wards of the hospital should be the scene oftheir daily work. They will there find collected in compara-tively small space a large number of various diseases which,as it were, pass in review before them; and the system ofclinical teaching which is now very generally adopted, and ’which, in fact, should almost, if not altogether, supplant sys-tematic lectures on medicine and surgery, together with thefacilities that exist for every diligent student to obtain a clini-cal clerkship or dressership, enable all who are so disposed toacquire, in a very moderate space of time, a good generalinsight into the right mode of investigating and treatingdisease.

There is a strong disposition on the part of many teachersto assist the student in this part of his work, by dispensingwith his attendance upon more than a single course of lectureson each of the above subjects. Lectures have for their objectto give the student a broad, general view of the particulardepartment of knowledge of which they treat, indicating thesalient points, and thus enabling the hearers to read at hometo the best advantage. When the lecturer is, as he shouldalways be, a master of his subject, and when his discourse issupplemented by diagrams, specimens, experiments, or caseswhich appeal to the eye, there is no more rapid or agreeablemode of acquiring or communicating knowledge, and it hasaccordingly been adopted as a means of instruction from timeimmemorial. But there is no question that it may be carriedtoo far, and that little can be acquired by even the most in-dustrious pupil who has to attend three or four lectures ondifferent subjects in rapid or continuous succession; whilstmany who derive great advantage from a first course may beinattentive and wearied with a second, unless the abilities of

the lecturer are of a very superior order. This difficulty hasbeen to a certain extent recognised and remedied by thegoverning bodies, and the number of lectures now required isconsiderably diminished compared with what was thoughtnecessary ten or twenty years ago. Still further concessions

we are sure will be made as the several Boards of Examiners

gradually perceive that they constitute the true mainspringsof work, and that in proportion as they render their examina-tions more and more stringent, students will quickly respondto, and prepare themselves for, the trial. Let us not be mis-

understood. By increasing the stringency of the examinationswe do not mean that questions of such difficulty should be putas none but an expert can answer; but we mean that theexamination should more thoroughly test the merit of, and thework done by, the candidate, so that none should pass butthose of whom there is good reason to believe they are familiarwith all the leading and essential facts of their profession. Thiscan easily be accomplished by increasing the number of papers,by prolonging the vivo voce, and by making it essentially a prac-tical examination; testing the candidate’s knowledge in ana-tomy by dissections ; in histology, by describing preparationsmade on the spot; in surgery, by bandaging, the applicationof splints, and the mode of passing a catheter; and in thissubject as well as in medicine, by the examination of cases,the use of the ophthalmoscope &c. What any man may be

called upon suddenly to undertake, all should be capable of

performing.The advanced student may also, whilst occasionally continu-

ing his work in the dissecting-room, give a helping hand tohis juniors. Such assistance is always most gratefully acknow-ledged, and serves to cultivate that friendly feeling whichshould exist between all the members of the same school. It

is of advantage to both the helper and the helped: the lattercan ask questions without reserve; and the former will findthat nothing shows him his own defects so clearly as theattempt to instruct another.

In the next place, every student should keep a record ofhis cases. But note-taking, to be of any service, is by nomeans so easy as it appears. Like other things, it requires anapprenticeship. JoHNSON, referring to the numerous correc-tions made by MILTON in his earlier works, observes that" what we hope ever to do with ease, we must first learn todo with diligence"-a remark that is eminently applicable tonote-taking. To make a satisfactory report of a case demands

orderly arrangement and a good method, keen, careful, and

patient observation, and accurate description of symptoms andphenomena; and to these may be added, intelligent apprecia-tion of what is essential. The unpractised hand makes a sad

jumble of a really valuable case by leaving out the importantand inserting unessential particulars; and nothing but con-stant practice will enable him to take such notes as will beuseful for reference at a subsequent period. The student will,perhaps, best consult his own advantage by limiting his effortsto taking three or four well-selected cases at a time, and fol-lowing them out thoroughly, whether to recovery or to a fatalissue. The time absolutely required to enter the particularsof an important case is very considerable. Take, for example,a patient affected with renal disease. The report of such acase cannot be considered complete unless, in addition to thedetails of the variations in the quantity, specific gravity, andchemical characters of the urine, thermometrical observations

338 THE DUTIES, DIFFICULTIES, AND OBJECTS OF STUDENT LIFE.

and a careful ophthalmoscopic examination have been super-added. But all these require assiduous labour. From one

such case, nevertheless, the student will learn far more thanfrom sauntering round with the physician for a month. Even-

ing work should consist in reading diligently some sound andpractical work on the cases actually under observation. If

this plan be diligently carried out, the student will find at theend of a year that there are few diseases or surgical affectionswhich have not fallen under his notice. Such a plan willenable him to avail himself of the opportunities he now pos-sesses of learning the mode of application of the different

ingenious instruments by which the interior of the body isexplored. The use of the ophthalmoscope, the laryngoscope,and the endoscope, he will find very difficult to learn in after-years by himself, it may be remote from England, and hewill be puzzled to describe or avail himself of what is actuallyunder his eyes; whilst a few lessons from a good teacher willin a short time give him such a grasp of the subject as willenable him readily to pursue and extend it as opportunityoffers.

At most schools there is a debating society, and great ad-vantage will be found in attending the meetings of this, aswell as of the Junior Medical Society. No single accomplish-ment tells so powerfully in this country as good speaking. At

the risk of being pedantic, he should work up the subject fordiscussion from books, or write out and commit to memorywhat he has to say; but it should be clear, terse, and to the

point.In reference to the temptations of London and other large

towns, we really believe they are greatly exaggerated. Theyare certainly not very obtrusive, and unless a man is disposedto discover and yield to them, we do not think, with the workbefore him conscientiously pursued, he has much time forthem. As regards relaxation, again, we should be the last toraise our voice against rowing, cricketing, football, or gym-nastic exercises. Our games are acknowledged on all handsto have contributed to make the English a vigorous, hardy,and determined race. But, after all, the student may remem-ber he is no longer a boy; that to follow such exercises in

London entails a considerable sacrifice of time; that, withvery few exceptions, they will thoroughly indispose him formental exertion; and, lastly, that, as there are at least threemonths in the year of complete holiday, he may well foregohis pleasures for those more serious duties, on the due perform-ance of which the success of his future career will in greatmeasure depend. The watchwords of the student must be

energy and perseverance. Without perseverance his energywill be spasmodic-a mere flash in the pan; without energyhis perseverance will degenerate into dull, plodding, non-

progressive routine. Both must be blended in the successful

pioneer, or even in the successful practitioner, of medicine.As regards examinations, which to most students loom like

an undefined thunder-cloud in the distance, we may observethat no steady-working man need fear the results of even themost severe and searching. On the contrary, the more pro-longed and careful is the inquiry into the nature and extent ofthe knowledge he possesses, the more likely is he to receivethe credit due to his diligence. Examinations, like laws, aremade not for the good, but for the bad; and, on the whole,they fairly fulfil the purpose for which they were designed,since, though idle but ready-witted men sometimes slip through

whilst the plodding man is occasionally rejected, yet it mayfairly be said that few slothful students can stand the tripletest which will soon be universally enforced of vivu-voce inter-

rogations, written answers in reply to questions, and a prac-tical examination into the extent of the candidate’s attain-

ments. To familiarise himself with these, the final tests of his

knowledge, the student should take every opportunity of at-tending the weekly examinations held at all schools on everysubject. They will confer upon him that which he will ob-tain neither from reading, writing, nor reflection-readiness,no unimportant part of his mental discipline.The object of the education of the student, or the result

sought to be attained, is to make him an able practitioner,prompt to recognise the various forms of disease, and judiciousin his treatment of them : not pursuing with blind confidenceone set line of treatment, dictated by the mere name of themalady; but quick in the appreciation of changes either in thegeneral type of disease, or in the individual peculiarities ofhis patient, and capable of modifying his treatment accordingto the different exigencies that may arise.That every member of our profession should possess brilliant

or even remarkable abilities is not expected by the public.It is enough if he can form a correct judgment on the casebefore him; if he can bring to its consideration such an amountof skill and knowledge as will enable him to combat withwisdom and energy the progress of disease. It is an un.

doubted fact, that even very illiterate persons, much moretherefore the educated and refined, can, especially when suf-fering from the pressure of severe affiiction, acutely feel, ap-preciate, and criticise the duties and even the attainments ofthe medical attendant. In moments of difficulty and dangerit is easy to distinguish between the man who is confidentin his own knowledge and practical acquaintance with diseaseand him who by reason of his ignorance feels he is incapable ofavailing himself of the known resources of his art. All ac-

knowledge, of course, that the physician cannot prolong lifebeyond its destined hour ; but all can see whether the means

suggested are appropriate or conducive to the alleviation of thepain or infirmities of the sick. The utility of our professionby the bedside of the ailing and dying is often only in theslightest degree connected with the administration of medi-cines. It is rather by an intelligent supervision of all the con-ditions which surround the patient ; by active sympathy withhis suffering; by attention to the thousand minutive-as ofquiet, temperature, position, and diet,-which collectivelyexercise an important influence on his prospect of recovery,and which it is the duty of a good nurse to carry into effect,that the practitioner may make his visits of real advantage aswell as a source of anxious yet pleasurable anticipation to thepatient and his relatives, whilst he may be at the same timeacquiring information of the utmost importance to himself inthe practice of his profession.Year by year medical scientific attainments are becoming

of wider and still wider application to the general good,and are steadily acquiring increased importance in the State.During the last decade numerous commissions have been atwork, in all of which the medical element has largely entered;and it is by the ability with which these are conducted, andthe practical benefit that accrues from them to the communityat large, that the laity judge of our public utility. We have

already inspectors of lunacy, of vaccination, of prisons, of

339

factories; and, more lately, the Medical Officer of the Privy ICouncil has suggested the importance of a medical inspector of I,the water-supply, since the fearful epidemics of cholera of 1847,1849, and 1866, have taught us that, however cholera may beassociated with and fostered by overcrowding, it is not in thiscondition we are to look for its rapid extension through thecommunity, but that it is essentially to the condition of thewater-supply that its outbreak and spread are to be referred.It is gradually beginning to be felt that those hygienic mea-sures which the progress of modern investigation, founded oncorrect physiology and pathology, have discovered to be neces-sary, and which have always been insisted on by the moreenlightened members of our profession, must be carried intoeffect if the nation is to escape the wasting ravages of plague,of cholera, of typhus, and other frightful pestilences. Vac-

cination, like the talisman of boys’ story books, has reducedsmall-pox-that giant of a disease-to a tithe of its former

dimensions; and it is not impossible that Sir J. Y. SiMPsON’ssuggestion of stamping it out altogether, if well-concerted

measures were adopted throughout the country, might be suc-cessful. By-and-by, medical supervision must and will bebestowed on the dwellings of the poor. It is a reproach toour age that, as may be seen in any of our large towns, andbut too often in the country, double the number of peopleshould reside in the houses of the lowest of the populationthan the ventilation will, on chemical and physiologicalgrounds, admit of. No wonder fevers abound. No wonder

that half the entire mortality of England is due to causes

which are entirely preventable by hygienic measures. A noblework this for those who are now entering the profession to z’

advocate-to urge on the wealthier classes to render their aid

in abolishing these dens of wretchedness, to give their inha-bitants pure water and an abundant supply, to lodge them inrooms that possess such light and air as are at least sufficientfor the maintenance of life, and whose interior is cleanly. No

doubt such improvements can only slowly be accomplished,and require money; but if only one half of that which is

yearly transmitted abroad in futile efforts to convert Hindooswere directed to the outcasts of our own streets, and to the

improvement of the dwellings of the poor in our large cities,the return would exceed all expectation.

In conclusion, let us observe that, whilst every professionhas its own duties, trials, and rewards, there is none in whichthe duties are more onerous, the trials and temptations moresevere, nor the rewards more satisfactory, than ours. Everyprofession possesses its own peculiar cast of thought andaction; there is none that demands a higher and purer tonethan ours. The subjects which it embraces are so vast andvarious that every kind and quality of intellect, the subtleand capacious alike, will find ample material for thought andreflection ; whilst it cheerfully acknowledges that every de-partment of knowledge may assist in its development andprogress. The pursuits of the historian and the antiquary arenot uncongenial to it, as more than one brilliant exampleattests. It has recently been shown that not only the chemistand the botanist, but even the geologist, may bring im-portant evidence to bear on the outbreak and extension (if

disease ; whilst all those branches of knowledge whose properstudy is Man are connected with it by the closest and mostindissoluble ties, and from no profession do these, as well asall the sections of physical science, find warmer or more able

supporters than from ours. They who enter the medical pro-fession must do so for the love of scientific investigation. Itwill yield them an honourable competence, but scarcely more.No mitre, no coronet, awaits even the most successful practi-tioner ; but he has a reward, and surely it is a sufficient

reward, in the knowledge that he has relieved pain, and thathe has mitigated the worst of the evils that flesh is heir to.

Let every man remember as he enters the portals of thehospital he has selected, that he must himself be the builderof his own fortune. For him TIME is; let him not so employit that he may hereafter, with shame and regret, be compelledto confess, TiME WAS. Let him assure himself that if he be

desirous of rising in the profession he has chosen, he mustfollow the footsteps of illustrious predecessors, must learn to"scorn delights, to live laborious days," must be his ownteacher, must examine the book of Nature for himself, and,content to stand at first at the foot of the ladder, must learnwith labour and patience to mount to clearness and know-ledge.ledge.

The heights by great men reached and keptWere not attained by sudden flight,

i But they, while their companions slept,Were toiling upward to the light."

SESSION 1868-69.

GENERAL COUNCIL OF MEDICAL EDUCATIONAND REGISTRATION.

RECOMMENDATIONS.

Preliminary Examination.THAT testimonials of proficiency granted by the following

educational bodies be accepted :-A degree in Arts of anyuniversity of the United Kingdom or of the colonies, or ofsuch other universities as may be specially recognised by theCouncil. Oxford Responsions or Moderations. CambridgePrevious Examinations. Matriculation Examination of theUniversity of London. Oxford, Cambridge, and DurhamMiddle-class Examinations (senior). Durham Examinationsfor Students in Arts in their second and first years ; and Re-gistration Examination for Medical Students. Dublin Uni-versity Entrance Examination. Queen’s University, Ireland :Two years’ Arts course for the diploma of Licentiate in Arts;Preliminary Examinations at the end of A.B. course; Middle-class and Matriculation Examinations. First-class Certificateof the College of Preceptors. Testamur granted by Codring-ton College, Barbadoes. Degree of Associate of Arts grantedby the Tasmanian Council of Education, with a certificatethat the student has been examined in Latin and Mathematics.Matriculation Examination of McGill University, Montreal.That the licensing bodies do not accept the certificate of pro-ficiency in General (preliminary) Education, unless such certi-ficate testify that the student to whom it has been granted hasbeen examined in English Language (including Grammar andComposition) ;* Arithmetic (including Vulgar and DecimalFractions) ; Algebra (including Simple Equations) ; Geometry(first two books of Euclid) ; Latin (including Translation andGrammar). And in one of the following optional subjects :-Greek ; French; German; Natural Philosophy (including Me-chanics, Hydrostatics, and Pneumatics).That students who cannot produce any of the testimonials

referred to in the above recommendation be required to passan examination in Arts, established by any of the bodies namedin Schedule A to the Medical Act, and approved by the GeneralMedical Council.

* The General Medical Council will not consider any examination in Eng-lish sufficient that does not fully test the ability of the candidate-1st. Towrite a few sentences in correct English on a given theme, attention beingpaid to spelling and punctuation as well as to composition. 2nd. To write aportion of an English author to dictation 3rd. To exp’ain the grammaticalconstruction of one or two sentences. 4 h. To point out the grammatiealen ors in a sentence ungrammatically composed, and to explain their nature.5th. To give the derivation and definition of a few English words in com-mon use.