No.2767.

SEPTEMBER 9, 1876.

THE LANCET.

LONDON: SATURDAY, SEPTEMBER 9, 1876.

ADDRESS TO STUDENTS.

WHATEVER may be said of Medicine as an art, Medicine

as a science-or congeries of sciences-is, undoubtedly, pro-gressive. From no point of view is this more strikinglyapparent than that occupied by the student standing at thethreshold of his curriculum; or by those who year after yearscan the prospect in his behalf, and try to bring what lightand counsel experience and sympathy may suggest to bearon his path. Each twelvemonth adds something to thetale of work, and the time allotted for its accomplishment isnot lengthened. It is true that certain branches of know-

ledge, until recently comprised in the medical course, are nowsupposed to have been mastered before professional studybegins; but these subjects have been crowded back by the

pressure of new requirements, and the business in prospectis not redueed.

It must be ever thus with an enterprise which has nature forits range, while the span of human life is the measure of man’s

opportunity. The field is boundless; the effort is limited.

The utmost a zealous explorer can do is to push forward afew leagues in advance of those who have gone before him.The only way others coming after can profit by his laboursis by tracking the path he trod with less than his difficulty,and so saving time and strength for the new work

beyond. Every fresh comer must begin where those beforehim began, instructed by what they have achieved, en-

couraged by their triumphs, warned by their errors. And

if he hopes to command success and perhaps win some honourfor his name, he must not only overtake, but outstrip themany toiling around and in advance of him.

Considerations such as these mark the character of the un-

dertaking that dawns on the student in all its immensity andruggedness to-day, and which, misconceived, may well dauntthe modest purpose of an earnest but untrained mind broughtsuddenly to face a mountain of work, seemingly impracticable.Able and intelligent young men are occasionally scared bythe first outlook, and to this discomfiture must be ascribedsome of the most regrettable mistakes made at the com-mencement of a medical career, and possibly not discovereduntil the time to mend the error is past, so that it can neverbe retrieved.

It is generally too late to recall the choice of a professionwhen the student for the first time realises, or fancies he can

grasp, the full extent of the task he has taken upon himself,and to which he stands engaged. Either he has not the

option, or he lacks the courage, to retire. Dismayed at thevery portal, he first hesitates, then loiters, until it becomesimpossible to enter by his own effort, and he must becarried through by the help of others; or, faint-hearted

and faltering at every onward step, he seems to court, andfinally encounters, a fall. A false start too often makes a

bad run. The first fault is setting out in the dark, or under

an erroneous impression, as to the kind of work to be done, themethod of setting about it, the mental effort necessary, the

energy required, the burden that will be imposed on time andindustry. Appalled or bewildered by the magnitude of thefeat to be accomplished, the student dallies with duty, andpostpones exertion. He is more to be pitied than blamed.Evil counsellors, misleading examples of seeming successsecured by sinister or unmanly devices, beset him on everyside. Feeble-minded folk, who, having done a silly thingthemselves take pleasure in seducing others to commit thelike folly, lie in wait for him. He yields to the fear of work,and in his lack of self-confidence resolves to reach the goalby some royal road. He will put off the evil day, and whenthe thing must be done do it as others before him. This is themedical student’s first peril, and let him be assured it marksa turning-point. It is from a false step at this stage we aremost anxious to save him.

Education and knowledge are essentially different qualities.They may be predicated of the same individual, or eitherattributed alone. A man may be well-educated and yetknow little of any subject. In that case he will probably beapt to learn, and, under judicious guidance, or sometimes bysheer force of intelligence and industry, search out the

knowledge he needs. On the other hand, he may have ac-cumulated a multitude of facts, thrown together or looselyconnected; he may have mastered enough book lore andgeneral or special knowledge to make a creditable showat the examination table; and yet be so ill-educated thatwhat he knows will count for nothing in the serious and

practical business of life awaiting him. The tendency ofthe educational system now in the ascendancy-backed bya complementary method of examining which tests theextent rather than the depth and thoroughness of a candi-date’s attainments-is to set a false value upon memory andto misrepresent its uses. In real life it is seldom so im-

portant what a man happens to recollect as what he hassome time made his own and can easily recall. The orderlyman of business does not burden his pockets with a bulkycorrespondence; his letters, after being read and ticketed,are put carefully away. The secret of his success lies in the

fact that he knows what to look for and where to find it

when wanted. The well-advised student will think less of

the examinations he must undergo than of the work in whichhe will to have to engage when these episodes in his careerare past and forgotten. If he strives to prepare himself for

the greater ordeal, he need have no fear of the lesser; if he

is too much engrossed with the nearer and smaller object, itis more than possible he will fail in regard to both.One of the earliest lessons the student will learn in the

department of physiology is that every organ grows by use,and, if unduly exercised, will probably attain unnatural

and disorderly proportions. He will not be long in recog-nising the cognate fact that when any part of the organismis thus monstrously developed it consumes more than itsown share of the nutriment available for the body as awhole, and some one, or it may be several, of the other

organs will suffer from the deprivation, and may evenwaste for want. These principles of growth and sustenanceare also applicable to the mind. If any one faculty 9fthe intellectual system is taxed and cultivated beyond

350

the limits laid down by the natural law of proportion, natural science, the learner will seem to grope in the dark,some other mental power is commonly allowed to fall into dis- storing up facts of which he can hardly perceive the worth.use, and becomes enfeebled. The man who is always remem- Have patience; not a particle is without its value; the use

bering, seldom thinks. He may produce out of his treasure- will appear presently. The faculty the medical student willbag old things and new, but they are facts or fancies-perhaps be first called to exercise is observation. He will do wiselyfallacies-he has previously put away, and they come to light to cultivate this special form of intelligence at once ; it will

pretty much as he buried them. The mind of such a being, always constitute his chief and often his only divining rodbe he book-worm or busy collector, will be a wonderful in the search for truth in science. All the greatest dis-

curiosity-shop, and he may pass for a profound and recondite coveries have been made with the simplest agents and thephilosopher; but there is no laboratory work going on within- lowest powers. Happily the faculty of observation is oneHe picks up knowledge ready-made, and, like the dispenser the student can begin to use with advantage the first hourwho obtains his drugs prepared and labelled, he has no use of his new career, and it may so happen that something hefor the botany and chemistry indispensable to the apothe- observes-a case, a symptom, a pathological appearance-forcary who collects and compounds his own simples. the moment unintelligible, will come back to him a score of

This single-power method of pursuing the so-called study years afterwards, and supply the clue to some enigma which,of science, in which memory plays the leading and almost but for the help thus rendered, might have remained un-the only part, is the worst possible training for practical solved. Ply this talisman of the ancient philosophers withwork. By cultivating the memory we seem to acquire all the zeal and reverence the vast historic work it has

facility in taking up facts. After a while an enlarged capacity accomplished should inspire.rewards, and in a certain way relieves, the toil of the What is observation ? It is not a prying, restless

learner, who, by putting high-pressure on his attention, curiosity. It has nothing in common with the im-" reading hard," and "pegging into it," succeeds in covering patient, almost peevish, quest for causes and "reasons

a wide range of subjects-as the lens of a photographic why" known as a 11 athirst for knowledge," often more use-camera covers an extensive landscape,-and, so to say, taking fully quenched with a cooling draught than an over-dose ofa rapid mental picture of the whole. The picture is fixed, for information. Feverish anxiety to get to the bottom of

the time at least. It can be called up, and-what some persons everything-a delirium of industry-is a bad form of energy,think even more important-exhibited, at will; but the man and frequently issues in exhaustion and disgust. The featwho has accomplished this intellectual feat is not, in any real is found impracticable, and the beginner falls back breath-sense of the term, a student-just as the photographer less and weary, before the work is well in hand. To observe

is not an artist. Test him rigorously and closely-not by a calmly, steadily, carefully, gleaning all that maybe gleaned,few show questions and hackneyed experiments-in respect to examining and re-examining the smallest fact learnt, is anany of the subjects so impressed on memory, and of all that art which each man must perfect for himself. The instant

may be represented by such words as form, light, shade, and ceaseless exercise of this function will be the main

colour, and quality, he will possibly be found as ignorant as the business, and should be the chief concern, of the student’s

professor of portraiture whose knowledge of art is limited early days in the dissecting-room, the laboratory, the out.to a practical acquaintance with the approved manner of patient room, the casualty ward, and by the bedside of themanipulating a collodion plate and focussing a sitter. If cases he is privileged to observe. Nothing will astonish thethe subject studied in this fashion-with the aid of a sensitive wisely-observant man more than the stock of knowledge hemental prospect-glass and what is called"‘ a good memory"- has accumulated in six months with scarcely appreciablebe physiology or anatomy, the ""student" will no more effort, if the practice of intelligent observation is persistentlybecome a physiologist or anatomist than the artificer who carried out. Let him, however, remember one point of

mounts his specimens or the useful tradesman who supplies cardinal importance, which marks a rock whereon

him with bones. It is not in this way the treasures of many good intentions have suffered shipwreck: observationscience are to be appropriated. Dame Nature is a stern is safe and successful because it deals exclusively with facts.disciplinarian, and those who wish to be taken into her con- It is the study of facts-it knows nothing of theories exceptfidence and win her secrets must dig out the hard facts by those which facts teach.

sober, plodding industry, and learn to assort and piece them If the student has the wit to form a habit of sound practicaltogether for themselves. observation, he will hardly need to be told that no one of the

Let us deal with this matter a little more in detail; it is so-called " sciences" set down for study is superfluous,germane to the purpose and work of student-life from or may be safely treated with neglect. Every object inbeginning to end, and, for the help it may give, is worth the nature is endowed with an infinite variety of qualities, which,trouble of mastering. The business before you is great, but in fact, compose it, and together make up the phenomenonnot greater than may be effected with pleasure and con- observed. The several branches or departments of sciencefidence. It will try your ability and perseverance, but not grouped under the generic term " medicine " are so manytoo severely. The branches of knowledge in which you must phases of the effort to examine the object or phenomenon allattain some proficiency are numerous, but they are so linked round. In studying the sciences you are learning the various

together by obvious connexions-throwing light on each of methods of observing, from each necessary standpoint, inthe subjects brought into relation,-that every one helps to detail. And the great advantage of grouping these sciences,explain the others, and all are simplified by being grouped. as you will find them grouped, is, that while learning theFor a time, in the study of medicine, as of every specialty in methods, you are at the same moment studying the facts.

351

You are not first sent into the wilderness to learn chemistry, elementary bodies and their compounds, to the physical,anatomy, physiology, and then called back to be taught how chemical, or what, for want of a better term, is sometimes

these branches of knowledge bear on the business of healing designated the dynamical, action of materials, vegetablewounds and curing diseases : the normal is made to illustrate or mineral, taken as poisons or employed as remedies.

the abnormal; processes and results are investigated together. Without some practised skill in reasoning the studentUnless, therefore, the student would run the risk of finding will find his task beset with difficulties; indeed, it is not

himself unable to examine some important fact before him easy to see how it can be intelligently performed. The

from, perhaps, a vital point of view, he will not presume to three faculties indicated are powers of the mind which,ftit or neglect the full study of every one of his subjects. let us hope, it has been the main object of the student’sIt would be short-sighted to do this, because each branch of preliminary education to develop. If the effort has been

knowledge included in’ the curriculum helps the others, and fairly successful, he need be harassed by no misgivings.the extra labour entailed by leaving any in arrear-owing to The study of medicine must be something widely differentthe loss of its aid in studying the rest-must render the from the mere heaping together of information, crammed into

bargain an exceedingly bad one. the smallest compass, and carried, porter-like, by Memory,The complement of the faculty of observation is comparison. to be deposited at will on some examination-table, or else-

To note the resemblance of objects observed, to mark their where.

points of difference, to estimate the extent and significance Much, with some men everything, will depend on the wayof discord or harmony in particular instances, to determine of working. There are bees, butterflies, and moles; andthe precise location of the likeness or disagreement, calls for occasionally the moles make the greatest impression on thethe exercise of a judgment which, too frequently, the student mountain. The industry of the bee is exemplary, but hisfinds he does not possess. It is better to face this defect-for habit of seeking honey in every opening flower is equivocal.such it is-at the outset, than to seek refuge in any of the Indiscriminate work involves a waste of energy which few

current sophistries invented to explain away the need of the can spare. The butterfly is brilliant, while in the sun-

special faculty to which we point. The student who has not shine, but he is often a puny creature in the shade; andbeen trained to deal practically with the essentials of diver- there is much shade in life. The worst, the weakest, the

gence and equivalence, by those studies in the mathematical most worthless work is that done for applause. CARLYLE,and the precise sciences so wisely chosen to develop this a robust thinker, speaking of true work, says, "All manner

power of accurate judgment, will do well to set apart a of work and pious response from Men or Nature is

portion of his time for such pursuits as may help to rectify always what we call silent ; cannot speak or come to

the educational error. A short course of "applied logic " light till it be seen, till it be spoken to. Every noblewill do something, at least, to supply the deficiency. work is at first impossible.’" The world will judgeIt is because men engaged in the study of the natural work by the noise and show it makes. There is nothingsciences are lacking in the power of analysis and syn- else it can judge by-except results, which are, if possible,thesis-particularly the latter-we so often find arti- less trustworthy witnesses. Nevertheless, the work thatficial modes of classification substituted’ for the orderly ar- requires to be sought out, and, so to say, " spoken to,"rangement of objects and phenomena, observed in the study because it is too modest to speak for itself, is generally theof organic nature, according to their natural features. The best. None know the baseness, the bitterly disappointing<essential characteristics are not detected, and arbitrary modes character, of bad work so well as those who do it. One of its

of grouping are employed. The consequences are especially least important, but most inconvenient, characteristics is that

conspicuous in the range of the medical sciences. Nosology it seldom lasts long. If it can be patched up in the latterhas utterly collapsed; physiology is in the direst confusion; months of the curriculum so as to put in a passable appear-.a scientific treatment of histology appears at present hopeless. ance before the examiners, it is of no use afterwards, when

The student suffers seriously from these defects. True wisdom the real business of life begins; but it generally breaks downwill prompt him to avoid the repetition in his own person of utterly, and the student who has wasted years in worthlessthe fault from which they spring. worry, is compelled to seek by artifice what he ought to be

After observation and comparison comes the faculty of reason- able to command by merit. All this harass and trouble

ing, by analytical, or synthetical, inference, the former method may be avoided by beginning as you ought to go on.a process of induction, the latter deductive. Observing It will be the function of the lecturer in the schools, and ofcertain peculiarities of form or function, associated with like the clinical and pathological teacher at the hospital, to shapeorgans or tissues occurring in organisms or under conditions the student’s course of reading by an orderly arrangementotherwise dissimilar, the two things found together are, by of his subjects. The master leads, the pupil follows. It is

inductive inference, assumed to stand connected in the rela- a good plan to make each day’s book-, plate-, museum-, andtion of cause and effect. Reasoning by deduction, the student laboratory-work, so far as private study is concerned, the

proceeds to predicate the function of an organ even before counterpart and complement of the instruction received init acts-guided by its structure ;-or, to infer the existence of public. The student should aim to read up to his teachers,as organ from the manifestation of a function, knowing and the latter, if they care to be understood, will take painsa particular organism is essential to produce a particular to render the task as facile as possible, both by perspicuity

,

effect. This is the method of all the so-called medical in treating the topics they discuss, and advice as to thesciences, whether they relate to the knowledge of organs and sources of information to which the student should repair.their functions in health or disease, to the properties of It is certainly better for the beginner to follow loyally

352 ADDRESS TO STUDENTS.

than seek to read in advance, although the more maturestudent may sometimes prefer to prepare the subject of alecture before he hears it expounded. It is no use trying tofix a, lesson in the memory. Give what is learnt the

qualities of indelibility, and it will not be effaced. Make theimpression clear, strong, well-defined, as a graver chisels

the characters deeply on the plate before him, and there willbe little fear of its being rubbed out.A good or a bad memory is a good or bad understanding.

The faculty of recollection, or the power of recallinga piece of knowledge when it happens to be wanted, is

chiefly a matter of method. It is useless throwing de-

tached facts into the mind like loose pebbles into the

sea. That is the way to lose them. Each point must bestudied in detail, and when this is done, a host of sub-

sidiary facts and conditions will be discovered connecting it toother matters of memory with which it should be habituallyassociated. These secondary qualities and properties formthe strings of thought by which Nature has ordained

that the lessons she teaches shall be re-collected. Artificial

memories are miserable substitutes for the natural con-

necting links of knowledge thus provided. If, instead of

wasting precious time and equally precious brain-power,H driving" things into his memory, the student will devotean equal amount of energy to the full and exact compre-hension of his work-for example, the facts and circum-stances that determine the number, shape, and direction ofthe ridges on a bone or the foramina by which it is

perforated, the course and relations of an artery, thenumber and distribution of the branches it gives off-he will not only have the subject fixed more permanently,but he will acquire so much collateral information in thisnatural process of study, that presently he will find him-self making unexpected progress. In short, it is goodpolicy to leave the contingency of remembering alone,and to concentrate the whole attention on the presentduty of learning, with the warning consciousness that

nothing is really learnt which is not thoroughly understood.So much it seemed well to say on the subject of preparation.

A word, in conclusion, with regard to the object in view andthe future towards which all this toil, and weariness, is tending.You are hereafter to enter the service of Humanity, and dobattle with the subtlest, the deadliest, and sooner or laterthe one invincible, of its foes. You will be required to meetthe enemy in manifold and mysterious guises: physical,psychical; material, mental. You will need to be providedwith every weapon, skilled in all strategy and divers formsof tactics, and to be armed cap-&agrave;-pie for the conflict. The

armoury lies before you. As you pass through, furnishingand training, receiving the counsel and taking the instruc-tions of those who have fought and won in many an encounter,never forget the respect due to their achievements or thesublime purpose of the warfare in which you also will sOQnbe engaged. No nobler, no more benevolent, mission can

engross the mind of man than this struggle to protect and

prolong life-threatened by hydra-headed and treacherouspowers arrayed against it from the first throb of the

heart to the final pulse-beat and the last breath. Nor

is it alone as warriors you will oppose the progress of

disease. It will be your province to teach men how to live,

and preserve the health-losing which they must speedilydie. With one hand you will ward off the enemy, with the

other you will sustain the life assailed.

No words can be needed, no mere words would suffice,to set forth the magnitude of the undertaking and

the responsibilities you are about to share, the ex-

ceeding gravity of the personal obligations to be im-

posed, the solid satisfaction that will attend their honour-able and successful discharge. It must be taken forgranted that, as men resolved to win credit and deserve

success, you have chosen this profession of medicine,not merely as a career but as an enterprise with deep-laid and earnest intent; and that you will carry it

forward courageously, with self-sacrifice if need be, un-

daunted to the end. Youth is the age of stirring thoughts,and high inspiriting forecasts. If there be no enthusiasm,no bright hope of the future, in the minds of men commenc-

ing a life such as that which lies before you, the soul mustbe irresolute, and the heart cold. Let no doubt darken the

outlook. The obstacles that strew the path of the studentare many, but the incentives to press forward and overcome

them are more numerous and more considerable. There will

be much to interest, and sweeten labour, by the way. Eeepthe goal steadily in view. The progress will then be worthyof the end. A good object in life inspires a man with honour,truth, and benevolence ; it moves him with sympathy andkindness towards those around him. The whole being,intellectual and moral, is energised and elevated by theIdeal it worships-towards which it works. "T,oRaItE EST

ORARE-WORK IS WORSHIP." ’

SESSION 1876-77.

GENERAL COUNCIL OF MEDICAL EDUCATIONAND REGISTRATION.

J -

Registration of Medical Students.-The following regulationshave been adopted by the General Medical Council in refer-ence to the registration of students in medicine :-1. Everymedical student shall be registered in the manner prescribedby the General Medical Council. 2. No medical studentshall be registered until he has passed a preliminary exami-nation, as required by the Medical Council. 3. The com-mencement ot the course of professional study recognisedby any of the qualifying bodies shall not be reckoned asdating earlier than fifteen days before the date of registra-tion. 4. The registration of medical students shall be placedunder the charge of the branch registrars. 5. Each of thebranch registrars shall keep a register of medical studentsaccording to the prescribed form. 6. Every person desirousof being registered as a medical student shall apply to thebranch registrar of the division of the United Kingdom inwhich he is residing, and shall produce or forward to thebranch registrar a certificate of his having passed a pre-liminary examination as required by the Medical Council,and a statement of his place of medical study. 7. The branchregistrar shall enter the applicant’s name and other par-ticulars in the Students’ Register, and shall give him acertificate of such registration. 8. Each of the branch re-gistrars shall supply to the several qualifying bodies, medicalschools, and hospitals, in that part of the United Kingdomof which he is registrar, a sufficent number of blank formsof application for the registration of medical students. 9. Theseveral Branch Councils shall have power to admit special

, exceptions to the foregoing regulations as to registration,for reasons which shall appear to them satisfactory. 10. A

copy of the Register of Medical Students, prepared by each