Critiques and Addresses

IN UNIVERSITY COLLEGE, LONDON, MAY 18, 1870, ON THE O

going on in my mind all the time for those who have not been successful, for those valiant knights who have been overthrown in your tourney, and have not made their appearance in public. I trust that, in accordance with old custom, they, wounded and bleeding, have been carried off to their tents, to be carefully tended by the fairest of maidens; and in these days, when the chances are that every one of such maidens will be a qualified practitioner, I have no doubt that all the splinters will have been carefully extracted, and that they are now physically healed. But there may remain some little fragment of moral or intellectual discouragement, and therefore I will take the liberty to remark that your chairman to-day, if he occupied his proper place, would be among them. Your chairman, in virtue of his position, and for the brief hour that he occupies that position, is a person of importance; and it may be some consolation to those who have failed if I say, that the quarter of a century which I have been speaking of, takes me back to the time when I was up at the University of London, a candidate for honours in anatomy and physiology, and when I was exceedingly well beaten by my excellent friend Dr. Ransom, of Nottingham. There is a person here who recollects that circumstance very well. I refer to your venerated teacher and mine, Dr. Sharpey. He was at that time one of the examiners in anatomy and physiology, and you may be quite sure that, as he was one of the examiners, there remained not the smallest doubt in my mind of the propriety of his judgment, and I accepted my defeat wi

d come too close to this locality. What has struck me, then, in this long experience of the men best instructed in physiology from the medical schools of London, is (with the many and brilliant exceptions to which I have referred), taking it as a whole, and broadly, the singular unreality of their knowledge of physiology. Now, I use that word "unreality" advisedly: I do not say "scanty;" on the contrary, there is plenty of it-a great deal too much of it-but it is the quality, the nature of the knowledge, which I quarrel with. I know I used to have-I don't know whether I have now, but I had once upon a time-a bad reputation among students for setting up a very high standard of acquirement, and I dare say you may think that the standard of this old examiner, who happily is now very nearly an extinct examiner, has been pitched too high. Nothing of the kind, I assure you. The defects I have noticed, and the faults I have to find, arise entirely from the circumstance that my standard is pitched too low. This is no paradox, gentlemen, but quite simply the fact. The knowledge I have looked for was a real, precise, thorough, and practical knowledge of fundamentals; whereas that which the best of the candidates, in a large proportion of cases, have had to give me was a large, extensive, and inaccurate knowledge of superstructure; and that is what I mean by saying that my demands went too low, and not too high. What I have had to complain of is, that a large proportion of the gentlemen who come up for physiology to the University of London do not know it as they know their anatomy, and have not been taught it as they have been taught their anatomy. Now, I should not wonder at all if I heard a great many "No, noes" here; but I am not talking about University College; as I have told you before, I am talking about the average education of medical schools. What I have found, and found so much reason to lament, is, t

ants to have it kept in good order, comes to a professor of the medical art for the purpose of having it set right, believing that, by deduction from the facts of structure and from the facts of function, the physician will divine what may be the matter with his bodily watch at that particular time, and what may be the best means of setting it right. If that may be taken as a just representation of the relation of the theoretical branches of medicine-what we may call the institutes of medicine, to use an old term-to the practical branches, I think it will be obvious to you that they are of prime and fundamental importance. Whatever tends to affect the teaching of them injuriously must tend to destroy and to disorganize the whole fabric of the medical art. I think every sensible man has seen this long ago; but the difficulties in the way of attaining good teaching in the different branches of the theory, or institutes, of medicine are very serious. It is a comparatively easy matter-pray mark that I use the word "comparatively"-it is a comparatively easy matter to learn anatomy and to teach it; it is a very difficult matter to learn physiology and to teach it. It is a very difficult matter to know and to teach those branches of physics and those branches of chemistry which bear directly upon physiology; and hence it is that, as a matter of fact, the teaching of physiology, and the teaching of the physics and the chemistry which bear upon it, must necessarily be in a state of relative imperfection; and there is nothing to be grumbled at in the fact that this relative imperfection exists. But is the relative imperfection which exists only such as is necessary, or is it made worse by our practical arrangements? I believe-and if I did not so believe I should not have troubled you with these observations-I believe it is made infinitely worse by our practical arrangements, or rather, I ought to say, our very unpractical arrangements. Some very wise man long ago affirmed that every qu

men of ability join our medical schools with an eye to the future. They take the Chairs of Anatomy or of Physiology; and by and by they leave those Chairs for the more profitable pursuits into which they have drifted by professional success, and so they become clothed, and physiology is bare. The result is, that in those schools in which physiology is thus left to the benevolence, so to speak, of those who have no time to look to it, the effect of such teaching comes out obviously, and is made manifest in what I sp

than that which I have been depicting should obtain. Professors must live; to live they must occupy themselves with practice, and if they occupy themselves with practice, the pursuit of the abstract branches of science must go to the wall. All this is a plain and obvious matter of common-sense reasoning. I believe you will never alter this state of things until, either by consent or by force majeure-and I should be very sorry to see the latter applied-but until there is some new arrangement, and until all the theoretical branches of the profession, the institutes of medicine, are taught in London in not more than one or two, or at the outside three, central institutions, no good will be effected. If that large body of men, the medical students of London, were obliged in the first place to get a knowledge

a great deal; you are getting rid of botany and zoology to begin with." I have not a doubt that they ought to be got rid of, as branches of special medical education; they ought to be put back to an earlier stage, and made branches of general education. Let me say, by way of self-denying ordinance, for which you will, I am sure, give me credit, that I believe that comparative anatomy ought to be absolutely abolished. I say so, not without a certain fear of the Vice-Chancellor of the University of London who sits upon my left. But I do not think the charter gives him very much power over me; moreover, I shall soon come to an end of my examinership, and therefore I am not afraid, but shall go on to say what I was going to say, and that is, that in my belief it is a downright cruelty-I have no other word for it-to require from gentlemen who are engaged in medical studies, the pretence-for it is nothing else, and can be nothing else, than a pretence-of a knowledge of comparative anatomy as part of their medical curriculum. Make it part of their Arts teaching if you like, make it part of their general education if you like, make it part of their qualification for the scientific degree by all means-that is its proper place; but to require that gentlemen whose whole faculties should be bent upon the acquirement of

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rs upon my supposition? Physics applied to physiology; chemistry applied to physiology; physiology; anatomy; surgery; medicine (including therapeutics); obstetrics; hygiene; and medical jurisprudence-nine subjects for four years! And when you consider what those subjects are, and that the

ithin your own field of action,-whether the bills of mortality of your district are increased or diminished; and that, gentlemen, is a very serious consideration indeed. And, under those circumstances, the subjects with which you have to deal being so difficult, their extent