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THE LANCET.

LONDON: SATURDAY, SEPTEMBER 25, 1858.

ADDRESS TO STUDENTS.

WE have always regarded the opportunity afforded byour " Students’ Number," of annually addressing a few wordsto those about commencing their hospital duties, with whatmay be termed a serious satisfaction. On the one hand it has

gratified us to be able to prove the interest we take in the stu-dent’s educational welfare, and on the other hand it has causedus some anxiety that the advice we might feel called upon tooffer should be that which was most suitable to him at the

entrance of his new career. Upon the present occasion, how-ever, it is clear that there is additional importance connectedwith our duty, arising from the changes lately instituted by the

examining bodies in the programme of the professional course.It is highly necessary that our young friends should have aclear conception of the particular demands which are now madeupon them by certain actual requisitions, and by the wholespirit of the new curriculum, and it behoves us to be particularin pointing out to them the means, by following which theywill the more easily and satisfactorily satisfy its claims. During

I

the last ten years, since the former " course of study" wasissued by the authorities, the attempt has been made to spe-cially fit the student for the prosecution of the practice ofmedicine and of the art of healing, chiefly by a complete thoughrather complex and diffuse system of theoretic teaching. We

. do not mean to say that this was alone the method of education

adopted, nor that this tuition was not more practical than itwas before, but simply that such formed the main element;and this no one can deny. A grounding in all the fundamentalor formative sciences of medicine was deemed requisite, evento a knowledge of their more transcendental phases. It was held

to be the case, that the student would hereafter treat fever

and operate for hernia the more successfully, the more he knewabout the characters of the marsupialia or the odontology of themastodon. The more easily he could explain the atomictheory, the sooner would he be able to seize the signs of peri-carditis ; and the ampler his knowledge of the natural families of the system of DE CANDOLLE, the fuller of course his acquaint-ance with the species of diseases affecting the skin. If there didnot appear some reason in this, there certainly was a great dealof science ; the notion, too, helped to foster the dogma thenfashionable, that the time had at length arrived when we couldafford to laugh at "your so-called practical man." In consis-

tency with the scheme, the schools were called upon to provideall sorts of courses of systematic lectures, and the students wereordered to attend them, in some instances two or three timesover ! This system became carried to such an extreme in some

institutions, from the peculiar way in which the mode of teach-

ing scientific medicine was carried on, that it appeared as if thelast thing for which the student was being educated was the

practice of his profession. He might become a pure chemist,a good physiologist, a transcendental or a microscopic ana-

tomist, or, if such was not his aim, botany, zoology, geology,and physics were open to him. But everywhere his chief dutywas to attend lecture after lecture, during winter after winter,

of various systematic courses, as they were termed. To learn

the physiognomy of disease by constantly looking at it, and tobecome possessed of a knowledge of the means for opposingit, by watching others put these means in force, were things un-fortunately made entirely subservient to this systematic lecturingupon pure science. Even in that branch-viz., anatomy, whichis most demonstrative, and which the student was bound toillustrate for himself by dissecting pari passu with attendanceupon the systematic courses, he was often terribly neglectfuland neglected, depending mainly for his knowledge upon booksrather than upon personal experience. The result of this at-

tempt to displace the knowledge of a practical art (for suchmedicine undoubtedly must be to a vast majority of all stu-dents) by the theoretic study of biology, chemistry, and physics,has turned out, we are sorry though not surprised to see, afailure. Let people say what they like, let them talk about’’ science and scientific education, " a physiological and patho-

logic basis,’’-let them put the microscope and the test-tube with! a transcendental pathology against seeing as many sick people

as possible, and watching the influence of remedies in modifyingtheir diseases,-the former are almost valueless in themselvesalone for the future purposes of ninety-nine out of every hun-dred students at our hospitals; whilst the latter in themselvesalone (supposing the two cannot be combined, which we doubt,)will fit them pretty effectually for a very important duty. Themain purpose for which the student arrives at the hospital andits school is to learn the nature of disease, and how to recogniseit; to learn what patients suffer from, and how to ease them oftheir pain. Anything that falls short of instructing him in thismust turn out a failure, as the result will be the farthest fromwhat has been required. If the student had ten years, instead

of between three and four, to spend upon his education, itmight assuredly be different; for the first five years he mightsolely prosecute chemistry, physiology, and minute anatomy,and be working with the test-tube and microscope with advan-tage. He would then have other five years before him for

prosecuting the study of practical medicine at the bedside ofthe sick. But whatever opinion may be held as regards theright system of education to be adopted for the future medicalpractitioner, (not the future physiologist or botanist, &c.,) one

thing is clear, -that the past method has not been productive ofthe desired result. To use the expression of the College Council intheir late Report, "the benefits which former Councils seem to’’ have anticipated, as the result of more numerous and extendedcourses of lectures, have certainly not been realized ;" and" however important lectures may be, as giving a proper direc-tion to the minds of the students, it is found that this mode" of instruction will do little towards making skilful and accom-" nlished nractitioners."

Such being the case, the old curriculum has been altered,and a new direction attempted to be given to the studies ofour professional noviciates. The students commencing theireducation this October should thankfully remember, then, thatthey have the great advantage of reaping at their onset thebenefit of many years of dear-bought experience. Let them

weigh well what this experience discloses; let them trust toit and accept it in all good faith and gratitude. No desire to

heap fresh burdens upon them, no fanciful theorisings thistime, have led those who are placed in authority to make merespeculative alterations in the course of study, nor in the charac-ter of the tests by which the mental qualifications will be

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ADDRESS TO STUDENTS.

judged. On the contrary, a consideration for the genera]calibre of intellectual power, the objects which should be heldin view, and the limited time to accomplish the latteI

have, along with the experience of the past, solely promptedto the alterations in question. In our opinion, these altera-tions might have been further increased with advantage, andstill more stress laid upon practical medicine and practical sur-gery. We could have wished, also, to have found that, at theexamination upon these topics, means would be taken to testat the bedside of the sick man the real knowledge of the can-didate, somewhat after the manner of certain of the examina-tions adopted by the University of London. However, all this

may come in time, perhaps; as it may have been thought thatat first poco a poco was an imperative principle.The student must bear in mind, then, that the main object

of the new course of study is to bestow a more demonstrativeand practical character than before upon the knowledge com-municated to him. That this may be attained,- the curriculumdiminishes the number of theoretic or systematic courses to befollowed, and urges a practical and personal attendanceupon clinical pursuits. It no longer necessitates attendance,e. g., upon three winter courses of physiology-it requires buttwo, and of which not more than two lectures need be givenin a week; but then it requires attendance upon a distinctcourse of clinical medicine. It no longer obliges the studentto attend anatomy for three sessions; but then it compels himto have personally assisted at not less than twenty cases of child-birth. We must impress, too, upon the student the importantfact that the measures which will be adopted to prove thenature and amount of his acquirements will be different fromthose employed hitherto. Until now, he was chiefly lectured ina theoretic style, and he was afterwards examined much in thesame manner. With but limited exceptions he might seem tohave a real knowledge of things, whilst all the time he hadnothing but a fluency of words. He might appear to theexaminers to offer the results of his own observation and ex-

perience, when in truth all he did was to retail glibly thegrinder’s promptings. Much of this will now be put a stop to.He will be examined by each Board twice, instead of once, andthe tests will be made (as his studies are expected to havebeen) upon certain topics as practical and demonstrative aspossible. Before the College Council the first examination

"will be upon the recently-dissected subject and upon pre.pared parts of the human body;" the second " will be partly

"written and partly oral, and the written part of this exami- C nation will have the preference." Moreover, by each Boardcare will be taken that the nature of the examinations shall be

such as " will tend to get rid of the practice vulgarly called"cramming," a practice, as the Council rightly observe, "in" which a knowledge of words is substituted for a knowledge"of things, and which is no less discreditable than it is inju-"rious to the intellectual character of those who resort to it."

To sum up, then, we anxiously impress upon the student,that for the future means will be taken (however imperfectlythey may at first be carried out) to become satisfied that he

really knows thi. which he believes he does, and that what Ihe is expected to acquire must be knowledge more of a

practical than of a theoretic character. Henceforth the

student must personally observe and work out things prac-tically himself much more than he has yet been obliged to do.Hitherto he might neglect the systematic lectu s he found

from three to six months’ ’’ grinding" would accomplish whathe wanted. Comparatively, he might shut his eyes to the

practice of the ’-’healing art," if he only opened them wideenough to "scientific medicine." It was scarcely requisitefor him to know how to properly open the heart, if he

could talk about cells, nuclei, and nucleoli. To be able to

diagnose herpes from impetigo was too much to require, if hecould, as a "scientific pathologist," show by words how in.flammation is, after all, only "a lesion of nutrition." Now,much of this urgently cried for alteration. The student should

know the palmar ccrclz as well as the " homologies "-a. granularL-id)zey when he sees it as well as to be able to write down the

symbolic formula of uric acid. Let the student be cautious,then, how he begins the great work of his education; let himnot neglect a day, from the first week he enters the hospital,to see something he has not looked at before, or to verify bydemonstration that which he has hitherto known only in theory.He must work now, and in the way we have indicated. If he

does not, he may depend upon it he will be rejected. He

must give his heart and soul to the work, his eyes as well ashis memory and ears. Fun and idleness for three-quarters ofhis time-the grinder and sitting up until two in the morningfor the other quarter, with the Decompositions of the Phar-macopoeia" and the "Dublin Dissector" before him, will notpermit of what was once possible. Chemistry and the "student’s

microscope" may be all very well, but there must be such thingsas "practical surgery" and "clinical medicine." Becoming adispensing assistant to a medical man every session may diminisha trifle the annual expenditure, but we believe and hope it willbe found that it will not answer, and that the school and hospitalmust be properly attended. The student must be made to feel

that from the first week in October to the last in July, he hashis own work to do, with plenty of it, instead of the com-pounding and the book-keeping of other people.

Pursuing, then, his own course, fully and strictly, shirkingnothing of his work, the pupil has a right to demand of histeachers the rigid fulfilment of their offices and professions.Let the former look to this; two sets of hands are required forthe work, those of the teacher as well as those of the taught.If the former are first offered and afterwards withdrawn, letan appeal be made here, and justice shall open these pages tothe complainant. If the student will not look to see he has

full weight, he has no right to complain if he should re-

ceive a short quantity. In selecting his hospital, &o., for future

studies, let him look chiefly to this point-where tlte education

is most demonstrative, clinical, and practical. Never mind-

we say to him-an eminent lecturer at this or that school,who deals in nothing but chemical refinements; turn a deaf earto that profound pathologist at the other school, who makes

nothing but " lesions of nutrition" and various " metamor-phoses" out of the practice of medicine. These things will not

altogether suit your purpose. Look, then, at this; where are thedemonstrators always in the dissecting-room, and where are theysufficient in number ? Where is the chemist in the laboratory?Where the pathologist in the dead-house? and the physicians andsurgeons, regular and frequent in their visits through the wards ? Wherever these desiderata are to be found, you may pause andmake one more inquiry, which is, what is the real character ofthe direct clinical teaching that appears to be offered? Whereverthe last is not to be found, depend upon it the place willnot suit you; you will have to practise the healing art,

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and not become simply the man of theoretic science. Be Ithoroughly convinced, then, of the quality of the clinicalteaching. There may be no quantitative fault about it, but it

may not be that most worthy of selection. Are the teachers in

repute as practical men as well as persons of physiologic andpathologic learning ? Are the clinical physicians relatively as

good treaters of disease as they are profound morbid anatomists ?Are the clinical surgeons as able men at conservative surgeryas they are with the bistoury and scalpel ? Has the lecturer

on obstetrics a true midwifery practice, as well as a lot of

specula and uterine sounds? Let the student be satisfied uponthese matters; and let him bring his inquiry to a conclusionby making a visit to the medical and surgical wards.

Quantitative as well as qualitative faults may exist. If the

beds are half empty, the medical officers with little or nothing to do, the dressers and clerks’ duties imperfectly and irre-gularly performed, if there are no case-books to refer to, &c.,the student may be sure that when he has bought the articlehe will find out that-to use a common phrase-it wont suit.For the last ten years we have been trying rather the schoolthan the hospital system; for the next it is proposed to reversethe procedure, and to teach the practice of the profession. In

parting from our young friends, let us, then, beg of themto bear this carefully in mind whilst forming any plans foitheir future settlement and procedure.

MEDICAL REGISTRATION.To the Editor of THE LANCET.

SIR,-The army which Wellington led,"Fighting, o’er the rough Pyrenees,"

in 1814, was one with which that great commander said "hecould do anything or go anywhere." Permit me very respect-fully to ask you, the veteran political leader of the profession,whether, after thirty years’ hard and successful campaigning,you also can rely upon those troops to which, in the last threeLANCETS, you have issued both general and particular instruc-tions to close with the quacks on the field of Medical Registra-tion ? If so, the vermin will certainly receive their coup degrâce. ’

But I observe, with some misgiving, that the doubly-quali-fied men are beginning to fire their extra barrels into the ranksof their singly-qualified brethren, and if this goes on, the

common enemy may perhaps escape that fatal peppering withwhich we hope to give him his quietus. This would be a greatmistake, and simply suicidal to the good cause.

In such an affair we should look upon each other rather asbranches of the one service than as in any way antagonistic.Most gentlemen who hold but one qualification will, doubtless,obtain both, when they see the advantages the new Act con-fers on those holding both. The quacks will never qualify atall, and for the worst of reasons-they never can. They aremere impostors-sturdy rogues who live by getting moneyunder false pretences. Climbing the " endless stair" would betheir worthiest occupation, and some of them, it is to be hoped,will ere long take a course of exercise so beneficial to theirown and public health. We have all grievously suffered fromthese harpies : the reputation of medicine, the private interestsof its practitioners, the lives and property of the public, thecredit even of the nation with her neighbours, as regards carefor human life, have been alike victimized.

Then, in the name of all that is honourable in the profession !that is dear to us as men ! that is due from us to our countryand ourselves ! let this feeling cease ; and as the bats alreadysmell fire, and are on the wing, let the sunshine of just andrighteous legislation smite them before they can hang on tothe new Act.

I am, Sir, your obedient servant,Over, Cheshire, Sept. 26, 1858. HENRY HOLMES, M.D., &e.HENRY HOLMES, M.D., &c.

DEATH FROM EATING POISON-BERRIES.To the Editor of THE LANCET.

SIR,-In your impression of last week there is a paragraphrelating to the death of child, under my care, from eating theberries of the " mountain ash."

In reference to the above paragraph, I beg to state, that upto the time of holding the inquest, I could not ascertain thatthe child had eaten any other berries than those of the moun-tain ash; and nnding some reddish-yellow pulp in the stomach,such as the berries of the mountain ash would produce, I be-lieved (though contrary to the generally received opinion ofthis fruit) that death must have resulted from it. On furtherexamination, however, I believe the child to have eaten twoor three different kinds of berries, amongst which are those ofthe woody nightshade, aud which I now believe to have beenthe cause of death.

; Allow me to add, that in this neighbourhood the berries ofthe mountain ash are almost universally said to be poisonous,

’ being known amongst the working classes as " peuson," or’ poison’berries. The child was at the time suffering from the

sequelæ of scarlet fever, there was also evidence of pleurisy andkidney disease, which conditions were proved by post-mortemexamination. I remain, Sir, your obedient servant,

, Armley, September, 1858. ALFRED RICKARDS, M.R.C.S.1 P.S.—Since the inquest, I have eaten several of the berries

of the mountain ash with perfect impunity.

ALFRED RICKARDS, M.R.C.S.

INJECTION OF PSOAS ABSCESS WITHTINCTURE OF IODINE.

To the Editor of THE LANCET.

SIR,-I witnessed this morning, at the Hotel Dieu, in the" service" of M. Broca, an operation, the practical merits ofwhich are not to be questioned-namely, the injection of psoasabscess with tincture of iodine. In this there is nothing novel,but as the instrument with which the injection was effected.was quite new to myself and two medical friends also present,it may perchance be equally so to some of your readers.The instrument in question is a syringe, somewhat on the

principle of the stomach-pump, with. reversible action, render-ing it capable of either sucking or forcing. When the puncturehas been made and the trocar withdrawn, the syringe is fittedto the canula, pressure is exerted on the iliac fossa, (so as todrive the contents of the abscess towards the thigh and orificeof the canula,) and the operator, with a few strokes of thepiston, empties the cavity of its pus. A stop-cock in thecanula is then turned, to prevent the entry of air, and thesyringe, being withdrawn, its action is reversed, enabling thetincture to be injected by the M?7!6 instrument in the usual way.The merit of this apparatus (apart from the ingenuity of its

double action and the convenience of its compactness) is theadvantage afforded of enabling the injected fluid to act morevigorously on the lining membrane of the abscess than wouldbe possible were the sac protected by its adhesive secretion;and I believe in no other way could the cavity be so completelyemptied, and its walls exposed to the beneficial action of the -iodine. This instrument is well known in the Paris hospitals,and, I believe, invented and manufactured by 1i. Mathieu, asurgical instrument maker here.-Yours, &c.,

Paris, Sept. 22nd, 1858. J. D. CHEPMELL, M.R.C.S.J. D. CHEPMELL, M.R.C.S.

THE NEW MEDICAL ACT.ARRANGEMENIS are in progress in the metropolis for the

purpose of forming an Association, to consider the variousclauses of the New Medical Act, and to take such steps as maybe deemed necessary to protect the interests of the profession..We trust that this Association will be supported, by ourbrethren, and that its labours may meet with success.

To Correspondents.IN consequence of the extraordinary demand upon or.r space, we are reluc-

I tantly compelled to omit answers to a very great number of correspondentsThese will appear next week.