292

THE LANCET.

LONDON: SATURDAY, SEPTEMBER 25, 1852.

ADDRESS TO STUDENTS.

IN all the important occupations of life there are certainprominent principles, the cultivation of which may be lookedupon as essentially conducive to success. That the Profession

of Medicine forms no exception to this rule, is certainly true,though it may be doubted whether these landmarks are asclear, or at all events so easily defined, as those which indicatethe path of fame in the other learned avocations. It may,

however, be asserted as an established truth, that no walk oflife demands so comprehensive a mind in its followers as thatof Medicine; that in none is it necessary to cultivate with

greater care the talents of observation and attention; remem-bering that observation does not consist in the mere habitualsight of objects,-in a kind of vagne looking-on, so to speak,-but in the power of comparing the known with the unknown,of contrasting the similar and dissimilar, in justly appreciatingthe connexion between cause and effect, and in correctly appre-ciating established facts. The great NEWTON has assured usthat lie knew of no difference between himself and other men,but in his habits of observation and attention; and almost thesame encouraging remark was made by LocKE.

It is one of the happiest qualities of youth, that the mindis then fresh and ductile, and ever ready to -receive impres-sions ; by an early culture of the mental faculties, by attemptingto think correctly, by carefully training the intellect, wisdomis to be acquired. Wisdom! so difficult and slow of attain-

ment-so distinct from knowledge, yet dependent uponit-so GoD-like an attribute, that it is to be early and ardentlysought for as forming the brightest ingredient in the characterof every man, in whatever degree it may exist. In the lan-

guage of COWPER, the high-minded but afflicted poet, whosevery sufferings, as they can be more readily appreciated byour profession, so lead us probably to regard him in a moreexalted light,-we would say:

" Knowledge dwellsIn heads replete with thoughts of other menWisdom in minds attentive to their own.

Knowledge, a rude unprofitable mass,The mere materials with which wisdom builds,Till smooth’d, and squared, and fitted to its place,Does but encumber whom it seems to enrich.

Knowledge is proud, that he has learnt so much ;Wisdom is humble, that he knows no more." ’

In the choice of a profession, young men are doubtless in-fluenced by different motives, some being led by idleness toselect that requiring the least exertion, some by ambition to

adopt that most conducive to popularity and fame, some byavarice to prefer that offering the greatest amount of emolu-ment, or, by their possession of interest and influence, mostlikely to lead to wealth. Others, again, are guided by theirhaving a certain aptitude for peculiar researches and pursuits.We trust that the majority of those now about to commencethe study of Medicine belong to the latter class. It is in our

judgment most important that the student should adopt theprofession of Medicine of his own free will, from his having apredilection for its studies, after he has enjoyed, if possible,

Without a real love for the occupation and its duties, his after-career, and even his career as a pupil, will be deficient in thathealthy and virtuous enthusiasm which has, in all ages, ani-mated men to the greatest exertions. That enthusiasm consistsin the firm, permanent, and resolute action of the will in obe-dience to the impulse of moral conviction, or to the dictates of awell-regulated understanding. It will, moreover, help to that Irenunciation of self, and devotion to the interests of others, so imperiously demanded from the practitioner of Medicine. It

ought to be superfluous to say, that those about to enter thetemple of ÆSCULAPIUS should be gentlemen, and, as such, thateach one should be careful to regulate his conduct by honour,good-feeling, and a love of truth. As a student he should be

careful in the choice of his associates, avoiding the idle andthoughtless. The man who will embark ia a calling havingfor its end the care of human life, without adequate prepara-tion, must indeed be thoughtless, if his conduct does not

deserve a harsher term. And as in after-life he would blush

to hold any kind of intercourse with the knaves and quackswho prey upon the public, so, during his state of pupilage, wewould advise him to be wary of forming personal intimacieswith those who prove by their daily conduct that they arelikely, in their ignorance, to become empirics and impostors.He may rest assured, that not only will such associations bedebasing and contaminating-be like touching pitch-but.almost criminal, if we may believe the aphorism of SENECA," Nil interest faveas sceleri, an illud facias."With regard to the education which he should possess prior

to commencing his medical studies, we would recommend asespecially important that he should be a good classical scholar;that is to say, he should possess a sound knowledge of theLatin language, and be tolerably well acquainted with theGreek. The former is indispensable ; the latter will be advan-tageous, though hardly of the same degree of importance.Still, we are not unmindful of the opinion expressed by thelearned ERASMUS, and still entertained by many Universityauthorities, that no one can arrive at eminence in literaturewithout an acquaintance with that of ancient Greece. It is

impossible to overrate the utility of a knowledge of the

modern languages, every new language being a new instrumentof power, and affording an increased fund of mental enjoyment.This will be found especially true of the German language, theGermans, as a nation, being probably more highly educatedthan any other people, while in every department of literaturethey possess men of the highest eminence. As the name of

SIIAKESPEARE alone should induce every stranger who valuesthe poetical and beautiful to study the English language, so,though in a less degree, the name of GoETHE, the delight andhonour of his countrymen, should be sufficient to inspire everyyouth with the desire to read his works in their originallanguage. To say that we are indebted to the Germans for

much that is valuable in medical science, is but giving themthat praise which they have long since received; and thoughwe possess translations of many of the most useful works ofthis class, still they are, as all translations must necessarilybe, but imperfect reflections of the originals. In addition to

these branches of knowledge, it is essential that the studentshould be a fair mathematician-at least to such an extent as

may enable him to pass the matriculation examination of the

University of London; that he should be well grounded in theelements of natural philosophy; and that he should be as well

293ADDRESS TO STUDENTS.

read in history and general literature-especially that of hisown country-as any educated youth in the present day isexpected to be. The general diffusion of knowledge, and thecomparative ease with which instruction may now be

obtained, render it the more disgraceful to be ignorant, atthe same time that it increases the difficulty of excelling. It

is also to be remembered, that that which has cost a life oflabour in the original attainment, may often be subsequentlyacquired with ease. The path has been pointed out, andcleared of impediments and difficulties; so that a boy ofseventeen, of ordinary talent and industry, may now know allthat the utmost stretch of the abilities of NEWTON discovered

in forty years.In the selection of a Medical School, our young friends must

be guided more by the advice of senior students of their ac-quaintance than by any direct recommendations we can feeljustified in giving. From the preceding pages, ample infor-mation may be obtained of the general scope of each institu-tion, of the number of patients and ordinary accommodationat each hospital, and of the physicians, surgeons, and

lecturers attached thereto. We believe that most of them

are efficiently conducted, and that a sound education maybe obtained at any one of them; but, as might be expected,they are distinguished for excellence in different depart-ments, some being preferable on account of the superiorityof their staff, some for the skill of a particular physician orsurgeon, and some for their management or accommoda-tions for teaching. Much more, however, depends uponthe student himself than upon his school. His choice is

immaterial, provided he selects one where attention is reallypaid to clinical instruction. The size of the hospital, theextent of the school, or the number of temptations offered inthe shape of scholarships and prizes, should not be allowed tobias his judgment. Prizes and medals are frequently pur-chased at too dear a rate. Many a student has sunk underthe struggle to distinguish himself as a prizeman. But the

prize, as now awarded, is no evidence of the actual ability ofthe man who gains it. He may be

" crammed" for the occa-

sion. A good memory may avail him in the contest morethan true merit. Hence it is that prizemen’seldom becomeeminent. They have sacrificed the more important duties ofobservation and practical knowledge to the mere learning ofwords. The class examinations are of much practical value,and should never be neglected.The object of all medical science is, strictly speaking, the

prevention and cure of disease; but in order thoroughly tounderstand the nature of disease, it is necessary that the

structure and functions of the various parts and organs of thehuman body in a state of health be rightly comprehended.Thus the course of education on which those for whom we

write are about to enter may be divided into three parts-the first, consisting of Anatomy and Physiology; the second, ofPathology, or the Science of Disease; and the third, of theMedical and Surgical Treatment of Disease. It is clear, there-fore, that the ensuing three or four years of their lives are tobe chiefly devoted to the dissecting-room, and to the wardsand dead-house of the hospital; and though we advise themby no means to neglect their attendance upon lectures, yetwe would have these regarded in their true light, as butmeans to an end, and not to be compared in importance withthe investigation of disease at the bed-side. A career of hard

work may be closed by obtaining a load of prizes, and byknowing "the practice of physic" by heart from books. Theywill make but sorry practitioners, however, who have

neglected to watch closely the progress and termination ofdisease, with the daily effects of the remedies and treatmentemployed. The value of actual dissection cannot be too

strongly insisted upon. It is the very foundation of all suc-

cess, whether in the physician or the surgeon. All those who

have risen to eminence, either as physicians or surgeons, havebeen great anatomists. The immortal HARVEY revolutionized

the entire practice of physic by his knowledge of anatomy.The incessant labours of HUNTER in the dissecting-roomenabled him, aided by the light of genius, to confer suchhonour upon our profession, and so many benefits uponmankind. Sir A. COOPER boasted that he never passed a day,even in the zenith of his practice, " without dissecting somepart of the body." - The facile and unerring incision of thelate Mr. LISTON was practised originally in the dissecting-room. These examples only amongst many. In his attend-

ance upon the physician or surgeon during his "rounds," thetyro will find much that is novel to him, and very much thatit is impossible for him’to understand. He must not on thisaccount allow himself to be discouraged. Let him remember

that his teachers have gone through the same course of studythat he is commencing; let him still persevere, taking suchnotes of the cases as he can, obtaining all possible informa-tion, and in the evening of each day elucidating the difficultpoints by reference to such standard works on the practice ofmedicine or surgery as have been recommended to him. Ifthis course be pursued steadily and thoroughly for a fewmonths, he will find that he is gaining much knowledge, andhis attendance in the wards will become one of his most

pleasing and attractive duties. He will derive great benefitfrom selecting two or three cases, both in the surgical andmedical wards; of these he should carefully note the history,diagnosis, and prognosis, and then watch the patients, eitherday by day, or at longer intervals, according to the nature ofthe disease. By accurately describing the progress of thecase, the effects of medicines, of stimulants or low diet, withthe more or less favourable results of the treatment, lie will

acquire the habit of observing pathological phenomena, andbecome, in time, intimately acquainted with the numerousmorbid manifestations presented in our large hospitals. But

let the student beware! The mere noting of the pulse, stateof the bowels, amount of sleep, quality of the secretions,mechanically written down without making these syntheticallybear upon the disease under consideration-without reference

to the pathological changes going on-without inquiringwhether the phenomena which are recorded are to be lookedupon as cause or effect-is merely the work of a schoolboy,which the sister of the ward could perform equally well.Observe, note regularly and systematically, and think overthe phenomena which have been seen. In a kindly mannerinvestigate the symptoms which have preceded and accom-panied the attack; give the patient time, and he will acquaintyou with his sensations, the probable cause of his complaint,the peculiarities of his constitution, &c.-facts which will be

of great value to you in the investigation of other cases ofa similar nature. Examine all extraordinary cases, but donot be too anxious for them; do not exclusively thirst for the

[ excitement of very rare diseases and unusual operations, but

294

try to become thoroughly acquainted with the more ordinaryforms of disease, so that you may see the application of prin-ciples to individual cases, and learn your profession upon asscientific a basis as its present state will allow. Treating ofhospital practice, we cannot avoid mentioning our own laboursin that department. We have endeavoured, in the " Mirror ofthe Hospitals," to present the profession and alumni with themost useful facts which are observed in the vast nosocomial

field of this metropolis, "reflecting" the practice of our lead-ing physicians and surgeons, and endeavouring, by remarksand comments, to awaken attention, and set the mind at work

upon the all-important practical subjects which daily comeunder consideration; and no pains will be spared to maintainthe deservedly high character which our "Mirror" has

acquired.Let the student especially beware of learning his profession

empirically, as one who acknowledges no principles, but onlyrules derived from experience. An empiric only inquireswhether a remedy had a good or a bad effect in any givencase, never asking why? never seeking for the cause of whathe observes. It has been well remarked by LIEBiG, that weshould contemplate the diseased conditions of the human bodyfrom a very different point of view, if we were first thoroughlyacquainted with its normal conditions-if we had establishedthe science of physiology upon a satisfactory basis. How

differently would the treatment of diseases be conducted ifwe had perfectly clear notions of the processes of digestion,assimilation, and excretion. Without just views of force,cause, and effect,--without a clear insight into the veryessence of natural phenomena,-without a solid physiologicaland chemical eduoation, is it extraordinary that men, inother respects rational, should defend the most absurd notions?- !-that the doctrines of an impostor should prevail in Ger-many, and find disciples in other countries ? Reason alone will

not prevent whole nations from falling into the most abjectsuperstitions; whilst even a child, whose mind has been dulydeveloped and instructed, will repudiate the fear of ghostsand hobgoblins.In looking back through years that have gone, into a retro-

spect of many happy days passed in the practical study of dis- ease, many now in the full practice of their profession still

remember the feelings of awe with which they contemplatedthe numerous sciences they had to study, the lectures theywere doomed to attend, and the apparent impossibilities whichhad to be overcome, before they could throw aside the title ofstudent, and emerge as medical practitioners from Hall andCollege. For the encouragement of those about to tread inthe same path, let us add, that by moderate industry andperseverance all those difficulties were vanquished. Students

may be assured that, with average talents, assiduity, and steadydiligence, they may surmount all that now appears intricateor impracticable. There is no royal road to fame; the pathis open to all, but it requires assiduous application to passthrough it. By working well, an ample number of pleasuresand recreations will be won. In the delights of social

intercourse, and in the broad fields of general literature,medical pupils will find inexhaustible sources of gratification.We would especially recommend them to cultivate a taste forreading. Knowledge has been aptly compared to a tree, whichruns straight for some time, and then parts itself into branches.These branches are laden with fruit, which requires but the

labour of gathering, a labour which should prove one of love.Whoever has eaten of the fruit in the morning of life willreturn to the tree with increased zest in the heat, the burden,and the decline of the day.

Comforts, yea ! joys ineffable they find,Who seek the prouder pleasures of the mind."

Literature and Philosophy, sincerely cherished, are friends-for life; they multiply and refine our pleasures, soothe ourafflictions, soften the pangs of sickness, and embellish andirradiate the most toilsome career. They must be pursuedand cultivated, however, in a proper spirit, always reinem-bering that the great Lord BACON has said,-

The greatest error of all the rest, is the mistaking or mis-placing of the last or farthest end of knowledge: for men haveentered into a desire of learning and knowledge, sometimesupon a natural curiosity, and inquisitive appetite; sometimesto entertain their minds with variety and delight; sometimesfor ornament and reputation; and sometimes to enable themto victory of wit and contradiction; and most times for lucreand profession; and seldom sincerely to give a true accountof their gift of reason, to the benefit and use of men: as if therewere sought in knowledge a couch, whereupon to rest a

searching and restless spirit; or a terrace, for a wandering andvariable mind to walk up and down with a fair prospect; or atower of state, for a proud mind to raise itself upon; or a fortor commanding ground for strife and contention; or a shop forprofit or sale; and not a rich storehouse, for the glory of theCreator, and the relief of man’s estate."

SINCE the publication in our columns of the article relative

to the Board of Ilealth and College of Physicians, communi-cations on the subject of Cholera have passed between thesebodies and the Secretary of State for the Home Department.

It is now arranged that all medical questions relating tocholera and other epidemics are to be referred to the Collegeof Physicians. The Cholera Committee is again holding itsmeetings, and was summoned for the second time yesterdayA report was presented for approval; it is intended, we under-stand, for publication.

TO CORRESPONDENTS.

IN consequence of the extraordinary pressure upon our space, we have beenunder the necessity of excluding a great variety of articles this week, andamongst them, the regulations issued by the Army and Navy MedicalBoards. These and other omitted papers will be published next week, andalso numerous advertisements, which we have been compelled to post-pone.

Mr. Albany Parke?-.-It is quite impossible to arrive at the information re-quired without communicating with every licensing body in the threekingdoms.

Mr. H. B. Rump, (Wells.)-The communication was received.Studens.-The works of John Hunter, by Palmer, may be had of Kimpton,Wardour-street, Soho.

B. C., (Guernsey.)-Consult the works of Harvey.P. M., (Wolverhampton.)-There is no doubt that the circumstance men-tioned has a tendency to produce debility. It is always better, however,to state such a case fully to some respectable surgeon, who will find aremedy. Avoid advertising quacks.

A Medical Man.-It is clearly contrary to the law for a person, not beingan apothecary, to prescribe and dispense medicine for gain, under what-ever name he may designate himself. It would be very difficult to dealwith the case mentioned. A foreign diploma does not entitle its possessorto practise in this country.

A Country Subscriber. - The work is published by J. W. Parker, WestStrand, London. We cannot answer the other question.

Studens.-It is necessary that the indentures should be produced.B. A.-The subject shall receive attention.A Young Practitioner.-Our opinion has already been given on the case.Without doubt it was an unpardonable breach of professional etiquette.

IT is absolutely unavoidable that answers to a great number of corre-spondents are deferred to a future occasion.