Science & Education by Thomas H. Huxley
Part 4 out of 6
is from no light estimate of the value or importance of such studies in
themselves. It may be taken for granted that I should be the last
person in the world to object to the teaching of zoology, or
comparative anatomy, in themselves; but I have the strongest feeling
that, considering the number and the gravity of those studies through
which a medical man must pass, if he is to be competent to discharge
the serious duties which devolve upon him, subjects which lie so remote
as these do from his practical pursuits should be rigorously excluded.
The young man, who has enough to do in order to acquire such
familiarity with the structure of the human body as will enable him to
perform the operations of surgery, ought not, in my judgment, to be
occupied with investigations into the anatomy of crabs and starfishes.
Undoubtedly the doctor should know the common poisonous plants of his
own country when he sees them; but that knowledge may be obtained by a
few hours devoted to the examination of specimens of such plants, and
the desirableness of such knowledge is no justification, to my mind,
for spending three months over the study of systematic botany. Again,
materia medica, so far as it is a knowledge of drugs, is the business
of the druggist. In all other callings the necessity of the division of
labour is fully recognised, and it is absurd to require of the medical
man that he should not avail himself of the special knowledge of those
whose business it is to deal in the drugs which he uses. It is all very
well that the physician should know that castor oil comes from a plant,
and castoreum from an animal, and how they are to be prepared; but for
all the practical purposes of his profession that knowledge is not of
one whit more value, has no more relevancy, than the knowledge of how
the steel of his scalpel is made.
All knowledge is good. It is impossible to say that any fragment of
knowledge, however insignificant or remote from one's ordinary
pursuits, may not some day be turned to account. But in medical
education, above all things, it is to be recollected that, in order to
know a little well, one must be content to be ignorant of a great deal.
Let it not be supposed that I am proposing to narrow medical education,
or, as the cry is, to lower the standard of the profession. Depend upon
it there is only one way of really ennobling any calling, and that is
to make those who pursue it real masters of their craft, men who can
truly do that which they profess to be able to do, and which they are
credited with being able to do by the public. And there is no position
so ignoble as that of the so-called "liberally-educated practitioner,"
who may be able to read Galen in the original; who knows all the
plants, from the cedar of Lebanon to the hyssop upon the wall; but who
finds himself, with the issues of life and death in his hands,
ignorant, blundering, and bewildered, because of his ignorance of the
essential and fundamental truths upon which practice must be based.
Moreover, I venture to say, that any man who has seriously studied all
the essential branches of medical knowledge; who has the needful
acquaintance with the elements of physical science; who has been
brought by medical jurisprudence into contact with law; whose study of
insanity has taken him into the fields of psychology; has _ipso facto_
received a liberal education.
Having lightened the medical curriculum by culling out of it everything
which is unessential, we may next consider whether something may not be
done to aid the medical student toward the acquirement of real
knowledge by modifying the system of examination. In England, within my
recollection, it was the practice to require of the medical student
attendance on lectures upon the most diverse topics during three years;
so that it often happened that he would have to listen, in the course
of a day, to four or five lectures upon totally different subjects, in
addition to the hours given to dissection and to hospital practice: and
he was required to keep all the knowledge he could pick up, in this
distracting fashion, at examination point, until, at the end of three
years, he was set down to a table and questioned pell-mell upon all the
different matters with which he had been striving to make acquaintance.
A worse system and one more calculated to obstruct the acquisition of
sound knowledge and to give full play to the "crammer" and the
"grinder" could hardly have been devised by human ingenuity. Of late
years great reforms have taken place. Examinations have been divided so
as to diminish the number of subjects among which the attention has to
be distributed. Practical examination has been largely introduced; but
there still remains, even under the present system, too much of the old
evil inseparable from the contemporaneous pursuit of a multiplicity of
diverse studies.
Proposals have recently been made to get rid of general examinations
altogether, to permit the student to be examined in each subject at the
end of his attendance on the class; and then, in case of the result
being satisfactory, to allow him to have done with it; and I may say
that this method has been pursued for many years in the Royal School of
Mines in London, and has been found to work very well. It allows the
student to concentrate his mind upon what he is about for the time
being, and then to dismiss it. Those who are occupied in intellectual
work, will, I think, agree with me that it is important, not so much to
know a thing, as to have known it, and known it thoroughly. If you have
once known a thing in this way it is easy to renew your knowledge when
you have forgotten it; and when you begin to take the subject up again,
it slides back upon the familiar grooves with great facility.
Lastly comes the question as to how the university may co-operate in
advancing medical education. A medical school is strictly a technical
school--a school in which a practical profession is taught--while a
university ought to be a place in which knowledge is obtained without
direct reference to professional purposes. It is clear, therefore, that
a university and its antecedent, the school, may best co-operate with
the medical school by making due provision for the study of those
branches of knowledge which lie at the foundation of medicine.
At present, young men come to the medical schools without a conception
of even the elements of physical science; they learn, for the first
time, that there are such sciences as physics, chemistry, and
physiology, and are introduced to anatomy as a new thing. It may be
safely said that, with a large proportion of medical students, much of
the first session is wasted in learning how to learn--in familiarising
themselves with utterly strange conceptions, and in awakening their
dormant and wholly untrained powers of observation and of manipulation.
It is difficult to over-estimate the magnitude of the obstacles which
are thrown in the way of scientific training by the existing system of
school education. Not only are men trained in mere book-work, ignorant
of what observation means, but the habit of learning from books alone
begets a disgust of observation. The book-learned student will rather
trust to what he sees in a book than to the witness of his own eyes.
There is not the least reason why this should be so, and, in fact, when
elementary education becomes that which I have assumed it ought to be,
this state of things will no longer exist. There is not the slightest
difficulty in giving sound elementary instruction in physics, in
chemistry, and in the elements of human physiology, in ordinary
schools. In other words, there is no reason why the student should not
come to the medical school, provided with as much knowledge of these
several sciences as he ordinarily picks up in the course of his first
year of attendance at the medical school.
I am not saying this without full practical justification for the
statement. For the last eighteen years we have had in England a system
of elementary science teaching carried out under the auspices of the
Science and Art Department, by which elementary scientific instruction
is made readily accessible to the scholars of all the elementary
schools in the country. Commencing with small beginnings, carefully
developed and improved, that system now brings up for examination as
many as seven thousand scholars in the subject of human physiology
alone. I can say that, out of that number, a large proportion have
acquired a fair amount of substantial knowledge; and that no
inconsiderable percentage show as good an acquaintance with human
physiology as used to be exhibited by the average candidates for
medical degrees in the University of London, when I was first an
examiner there twenty years ago; and quite as much knowledge as is
possessed by the ordinary student of medicine at the present day. I am
justified, therefore, in looking forward to the time when the student
who proposes to devote himself to medicine will come, not absolutely
raw and inexperienced as he is at present, but in a certain state of
preparation for further study; and I look to the university to help him
still further forward in that stage of preparation, through the
organisation of its biological department. Here the student will find
means of acquainting himself with the phenomena of life in their
broadest acceptation. He will study not botany and zoology, which, as I
have said, would take him too far away from his ultimate goal; but, by
duly arranged instruction, combined with work in the laboratory upon
the leading types of animal and vegetable life, he will lay a broad,
and at the same time solid, foundation of biological knowledge; he will
come to his medical studies with a comprehension of the great truths of
morphology and of physiology, with his hands trained to dissect and his
eyes taught to see. I have no hesitation in saying that such
preparation is worth a full year added on to the medical curriculum. In
other words, it will set free that much time for attention to those
studies which bear directly upon the student's most grave and serious
duties as a medical practitioner.
Up to this point I have considered only the teaching aspect of your
great foundation, that function of the university in virtue of which it
plays the part of a reservoir of ascertained truth, so far as our
symbols can ever interpret nature. All can learn; all can drink of this
lake. It is given to few to add to the store of knowledge, to strike
new springs of thought, or to shape new forms of beauty. But so sure as
it is that men live not by bread, but by ideas, so sure is it that the
future of the world lies in the hands of those who are able to carry
the interpretation of nature a step further than their predecessors; so
certain is it that the highest function of a university is to seek out
those men, cherish them, and give their ability to serve their kind
full play.
I rejoice to observe that the encouragement of research occupies so
prominent a place in your official documents, and in the wise and
liberal inaugural address of your president. This subject of the
encouragement, or, as it is sometimes called, the endowment of
research, has of late years greatly exercised the minds of men in
England. It was one of the main topics of discussion by the members of
the Royal Commission of whom I was one, and who not long since issued
their report, after five years' labour. Many seem to think that this
question is mainly one of money; that you can go into the market and
buy research, and that supply will follow demand, as in the ordinary
course of commerce. This view does not commend itself to my mind. I
know of no more difficult practical problem than the discovery of a
method of encouraging and supporting the original investigator without
opening the door to nepotism and jobbery. My own conviction is
admirably summed up in the passage of your president's address, "that
the best investigators are usually those who have also the
responsibilities of instruction, gaining thus the incitement of
colleagues, the encouragement of pupils, and the observation of the
public."
At the commencement of this address I ventured to assume that I might,
if I thought fit, criticise the arrangements which have been made by
the board of trustees, but I confess that I have little to do but to
applaud them. Most wise and sagacious seems to me the determination not
to build for the present. It has been my fate to see great educational
funds fossilise into mere bricks and mortar, in the petrifying springs
of architecture, with nothing left to work the institution they were
intended to support. A great warrior is said to have made a desert and
called it peace. Administrators of educational funds have sometimes
made a palace and called it a university. If I may venture to give
advice in a matter which lies out of my proper competency, I would say
that whenever you do build, get an honest bricklayer, and make him
build you just such rooms as you really want, leaving ample space for
expansion. And a century hence, when the Baltimore and Ohio shares are
at one thousand premium, and you have endowed all the professors you
need, and built all the laboratories that are wanted, and have the best
museum and the finest library that can be imagined; then, if you have a
few hundred thousand dollars you don't know what to do with, send for
an architect and tell him to put up a façade. If American is similar to
English experience, any other course will probably lead you into having
some stately structure, good for your architect's fame, but not in the
least what you want.
It appears to me that what I have ventured to lay down as the
principles which should govern the relations of a university to
education in general, are entirely in accordance with the measures you
have adopted. You have set no restrictions upon access to the
instruction you propose to give; you have provided that such
instruction, either as given by the university or by associated
institutions, should cover the field of human intellectual activity.
You have recognised the importance of encouraging research. You propose
to provide means by which young men, who may be full of zeal for a
literary or for a scientific career, but who also may have mistaken
aspiration for inspiration, may bring their capacities to a test, and
give their powers a fair trial. If such a one fail, his endowment
terminates, and there is no harm done. If he succeed, you may give
power of flight to the genius of a Davy or a Faraday, a Carlyle or a
Locke, whose influence on the future of his fellow-men shall be
absolutely incalculable.
You have enunciated the principle that "the glory of the university
should rest upon the character of the teachers and scholars, and not
upon their numbers or buildings constructed for their use." And I look
upon it as an essential and most important feature of your plan that
the income of the professors and teachers shall be independent of the
number of students whom they can attract. In this way you provide
against the danger, patent elsewhere, of finding attempts at
improvement obstructed by vested interests; and, in the department of
medical education especially, you are free of the temptation to set
loose upon the world men utterly incompetent to perform the serious and
responsible duties of their profession.
It is a delicate matter for a stranger to the practical working of your
institutions, like myself, to pretend to give an opinion as to the
organisation of your governing power. I can conceive nothing better
than that it should remain as it is, if you can secure a succession of
wise, liberal, honest, and conscientious men to fill the vacancies that
occur among you. I do not greatly believe in the efficacy of any kind
of machinery for securing such a result; but I would venture to suggest
that the exclusive adoption of the method of co-optation for filling
the vacancies which must occur in your body, appears to me to be
somewhat like a tempting of Providence. Doubtless there are grave
practical objections to the appointment of persons outside of your body
and not directly interested in the welfare of the university; but might
it not be well if there were an understanding that your academic staff
should be officially represented on the board, perhaps even the heads
of one or two independent learned bodies, so that academic opinion and
the views of the outside world might have a certain influence in that
most important matter, the appointment of your professors? I throw out
these suggestions, as I have said, in ignorance of the practical
difficulties that may lie in the way of carrying them into effect, on
the general ground that personal and local influences are very subtle,
and often unconscious, while the future greatness and efficiency of the
noble institution which now commences its work must largely depend upon
its freedom from them.
* * * * *
I constantly hear Americans speak of the charm which our old mother
country has for them, of the delight with which they wander through the
streets of ancient towns, or climb the battlements of mediaeval
strongholds, the names of which are indissolubly associated with the
great epochs of that noble literature which is our common inheritance;
or with the blood-stained steps of that secular progress, by which the
descendants of the savage Britons and of the wild pirates of the North
Sea have become converted into warriors of order and champions of
peaceful freedom, exhausting what still remains of the old Berserk
spirit in subduing nature, and turning the wilderness into a garden.
But anticipation has no less charm than retrospect, and to an
Englishman landing upon your shores for the first time, travelling for
hundreds of miles through strings of great and well-ordered cities,
seeing your enormous actual, and almost infinite potential, wealth in
all commodities, and in the energy and ability which turn wealth to
account, there is something sublime in the vista of the future. Do not
suppose that I am pandering to what is commonly understood by national
pride. I cannot say that I am in the slightest degree impressed by your
bigness, or your material resources, as such. Size is not grandeur, and
territory does not make a nation. The great issue, about which hangs a
true sublimity, and the terror of overhanging fate, is what are you
going to do with all these things? What is to be the end to which these
are to be the means? You are making a novel experiment in politics on
the greatest scale which the world has yet seen. Forty millions at
your first centenary, it is reasonably to be expected that, at the
second, these states will be occupied by two hundred millions of
English-speaking people, spread over an area as large as that of
Europe, and with climates and interests as diverse as those of Spain
and Scandinavia, England and Russia. You and your descendants have to
ascertain whether this great mass will hold together under the forms of
a republic, and the despotic reality of universal suffrage; whether
state rights will hold out against centralisation, without separation;
whether centralisation will get the better, without actual or disguised
monarchy; whether shifting corruption is better than a permanent
bureaucracy; and as population thickens in your great cities, and the
pressure of want is felt, the gaunt spectre of pauperism will stalk
among you, and communism and socialism will claim to be heard. Truly
America has a great future before her; great in toil, in care, and in
responsibility; great in true glory if she be guided in wisdom and
righteousness; great in shame if she fail. I cannot understand why
other nations should envy you, or be blind to the fact that it is for
the highest interest of mankind that you should succeed; but the one
condition of success, your sole safeguard, is the moral worth and
intellectual clearness of the individual citizen. Education cannot give
these, but it may cherish them and bring them to the front in whatever
station of society they are to be found; and the universities ought to
be, and may be, the fortresses of the higher life of the nation.
May the university which commences its practical activity to-morrow
abundantly fulfil its high purpose; may its renown as a seat of true
learning, a centre of free inquiry, a focus of intellectual light,
increase year by year, until men wander hither from all parts of the
earth, as of old they sought Bologna, or Paris, or Oxford.
And it is pleasant to me to fancy that, among the English students who
are drawn to you at that time, there may linger a dim tradition that
a countryman of theirs was permitted to address you as he has done
to-day, and to feel as if your hopes were his hopes and your success
his joy.
* * * * *
Footnotes:
[1] Delivered at the formal opening of the Johns Hopkins University at
Baltimore, U.S., September 12. The total amount bequeathed by Johns
Hopkins is more than 7,000,000 dollars. The sum of 3,500,000 dollars is
appropriated to a university, a like sum to a hospital, and the rest to
local institutions of education and charity.
X
ON THE STUDY OF BIOLOGY
[1876]
It is my duty to-night to speak about the study of Biology, and while
it may be that there are many of my audience who are quite familiar
with that study, yet as a lecturer of some standing, it would, I know
by experience, be very bad policy on my part to suppose such to be
extensively the case. On the contrary, I must imagine that there are
many of you who would like to know what Biology is; that there are
others who have that amount of information, but would nevertheless
gladly hear why it should be worth their while to study Biology; and
yet others, again, to whom these two points are clear, but who desire
to learn how they had best study it, and, finally, when they had best
study it.
I shall, therefore, address myself to the endeavour to give you some
answer to these four questions--what Biology is; why it should be
studied; how it should be studied; and when it should be studied.
In the first place, in respect to what Biology is, there are, I
believe, some persons who imagine that the term "Biology" is simply a
new-fangled denomination, a neologism in short, for what used to be
known under the title of "Natural History;" but I shall try to show
you, on the contrary, that the word is the expression of the growth of
science during the last 200 years, and came into existence half a
century ago.
At the revival of learning, knowledge was divided into two kinds--the
knowledge of nature and the knowledge of man; for it was the current
idea then (and a great deal of that ancient conception still remains)
that there was a sort of essential antithesis, not to say antagonism,
between nature and man; and that the two had not very much to do with
one another, except that the one was oftentimes exceedingly troublesome
to the other. Though it is one of the salient merits of our great
philosophers of the seventeenth century, that they recognised but one
scientific method, applicable alike to man and to nature, we find this
notion of the existence of a broad distinction between nature and man
in the writings both of Bacon and of Hobbes of Malmesbury; and I have
brought with me that famous work which is now so little known, greatly
as it deserves to be studied, "The Leviathan," in order that I may put
to you in the wonderfully terse and clear language of Thomas Hobbes,
what was his view of the matter. He says:--
"The register of knowledge of fact is called history. Whereof there be
two sorts, one called natural history; which is the history of such
facts or effects of nature as have no dependence on man's will; such as
are the histories of metals, plants, animals, regions, and the like.
The other is civil history; which is the history of the voluntary
actions of men in commonwealths."
So that all history of fact was divided into these two great groups of
natural and of civil history. The Royal Society was in course of
foundation about the time that Hobbes was writing this book, which was
published in 1651; and that Society was termed a "Society for the
Improvement of Natural Knowledge," which was then nearly the same thing
as a "Society for the Improvement of Natural History." As time went on,
and the various branches of human knowledge became more distinctly
developed and separated from one another, it was found that some were
much more susceptible of precise mathematical treatment than others.
The publication of the "Principia" of Newton, which probably gave a
greater stimulus to physical science than any work ever published
before, or which is likely to be published hereafter, showed that
precise mathematical methods were applicable to those branches of
science such as astronomy, and what we now call physics, which occupy a
very large portion of the domain of what the older writers understood
by natural history. And inasmuch as the partly deductive and partly
experimental methods of treatment to which Newton and others subjected
these branches of human knowledge, showed that the phenomena of nature
which belonged to them were susceptible of explanation, and thereby
came within the reach of what was called "philosophy" in those days; so
much of this kind of knowledge as was not included under astronomy came
to be spoken of as "natural philosophy"--a term which Bacon had
employed in a much wider sense. Time went on, and yet other branches of
science developed themselves. Chemistry took a definite shape; and
since all these sciences, such as astronomy, natural philosophy, and
chemistry, were susceptible either of mathematical treatment or of
experimental treatment, or of both, a broad distinction was drawn
between the experimental branches of what had previously been called
natural history and the observational branches--those in which
experiment was (or appeared to be) of doubtful use, and where, at that
time, mathematical methods were inapplicable. Under these circumstances
the old name of "Natural History" stuck by the residuum, by those
phenomena which were not, at that time, susceptible of mathematical or
experimental treatment; that is to say, those phenomena of nature which
come now under the general heads of physical geography, geology,
mineralogy, the history of plants, and the history of animals. It was
in this sense that the term was understood by the great writers of the
middle of the last century--Buffon and Linnaeus--by Buffon in his great
work, the "Histoire Naturelle Générale," and by Linnaeus in his
splendid achievement, the "Systema Naturae." The subjects they deal
with are spoken of as "Natural History," and they called themselves and
were called "Naturalists." But you will observe that this was not the
original meaning of these terms; but that they had, by this time,
acquired a signification widely different from that which they
possessed primitively.
The sense in which "Natural History" was used at the time I am now
speaking of has, to a certain extent, endured to the present day. There
are now in existence in some of our northern universities, chairs of
"Civil and Natural History," in which "Natural History" is used to
indicate exactly what Hobbes and Bacon meant by that term. The unhappy
incumbent of the chair of Natural History is, or was, supposed to cover
the whole ground of geology, mineralogy, and zoology, perhaps even
botany, in his lectures.
But as science made the marvellous progress which it did make at the
latter end of the last and the beginning of the present century,
thinking men began to discern that under this title of "Natural
History" there were included very heterogeneous constituents--that, for
example, geology and mineralogy were, in many respects, widely
different from botany and zoology; that a man might obtain an extensive
knowledge of the structure and functions of plants and animals, without
having need to enter upon the study of geology or mineralogy, and
_vice versâ_; and, further as knowledge advanced, it became clear
that there was a great analogy, a very close alliance, between those
two sciences, of botany and zoology which deal with human beings, while
they are much more widely separated from all other studies. It is due
to Buffon to remark that he clearly recognised this great fact. He
says: "Ces deux genres d'êtres organisés [les animaux et les végétaux]
ont beaucoup plus de propriétés communes que de différences réelles."
Therefore, it is not wonderful that, at the beginning of the present
century, in two different countries, and so far as I know, without any
intercommunication, two famous men clearly conceived the notion of
uniting the sciences which deal with living matter into one whole, and
of dealing with them as one discipline. In fact, I may say there were
three men to whom this idea occurred contemporaneously, although there
were but two who carried it into effect, and only one who worked it out
completely. The persons to whom I refer were the eminent physiologist
Bichat, and the great naturalist Lamarck, in France; and a
distinguished German, Treviranus. Bichat [1] assumed the existence of a
special group of "physiological" sciences. Lamarck, in a work published
in 1801, [2] for the first time made use of the name "Biologie," from
the two Greek words which signify a discourse upon life and living
things. About the same time, it occurred to Treviranus, that all those
sciences which deal with living matter are essentially and
fundamentally one, and ought to be treated as a whole; and, in the year
1802, he published the first volume of what he also called "Biologie."
Treviranus's great merit lies in this, that he worked out his idea, and
wrote the very remarkable book to which I refer. It consists of six
volumes, and occupied its author for twenty years--from 1802 to 1822.
That is the origin of the term "Biology"; and that is how it has come
about that all clear thinkers and lovers of consistent nomenclature
have substituted for the old confusing name of "Natural History," which
has conveyed so many meanings, the term "Biology" which denotes the
whole of the sciences which deal with living things, whether they be
animals or whether they be plants. Some little time ago--in the course
of this year, I think--I was favoured by a learned classic, Dr. Field
of Norwich, with a disquisition, in which he endeavourved to prove
that, from a philological point of view, neither Treviranus nor Lamarck
had any right to coin this new word "Biology" for their purpose; that,
in fact, the Greek word "Bios" had relation only to human life and
human affairs, and that a different word was employed by the Greeks
when they wished to speak of the life of animals and plants. So Dr.
Field tells us we are all wrong in using the term biology, and that we
ought to employ another; only he is not sure about the propriety of
that which he proposes as a substitute. It is a somewhat hard
one--"zootocology." I am sorry we are wrong, because we are likely to
continue so. In these matters we must have some sort of "Statute of
Limitations." When a name has been employed for half a century, persons
of authority [3] have been using it, and its sense has become well
understood, I am afraid people will go on using it, whatever the weight
of philological objection.
Now that we have arrived at the origin of this word "Biology," the next
point to consider is: What ground does it cover? I have said that in
its strict technical sense, it denotes all the phenomena which are
exhibited by living things, as distinguished from those which are not
living; but while that is all very well, so long as we confine
ourselves to the lower animals and to plants, it lands us in
considerable difficulties when we reach the higher forms of living
things. For whatever view we may entertain about the nature of man, one
thing is perfectly certain, that he is a living creature. Hence, if our
definition is to be interpreted strictly, we must include man and all
his ways and works under the head of Biology; in which case, we should
find that psychology, politics, and political economy would be absorbed
into the province of Biology. In fact, civil history would be merged in
natural history. In strict logic it may be hard to object to this
course, because no one can doubt that the rudiments and outlines of our
own mental phenomena are traceable among the lower animals. They have
their economy and their polity, and if, as is always admitted, the
polity of bees and the commonwealth of wolves fall within the purview
of the biologist proper, it becomes hard to say why we should not
include therein human affairs, which, in so many cases, resemble those
of the bees in zealous getting, and are not without a certain parity in
the proceedings of the wolves. The real fact is that we biologists are
a self-sacrificing people; and inasmuch as, on a moderate estimate,
there are about a quarter of a million different species of animals and
plants to know about already, we feel that we have more than sufficient
territory. There has been a sort of practical convention by which we
give up to a different branch of science what Bacon and Hobbes would
have called "Civil History." That branch of science has constituted
itself under the head of Sociology. I may use phraseology which, at
present, will be well understood and say that we have allowed that
province of Biology to become autonomous; but I should like you to
recollect that that is a sacrifice, and that you should not be
surprised if it occasionally happens that you see a biologist
apparently trespassing in the region of philosophy or politics; or
meddling with human education; because, after all, that is a part of
his kingdom which he has only voluntarily forsaken.
Having now defined the meaning of the word Biology, and having
indicated the general scope of Biological Science, I turn to my second
question, which is--Why should we study Biology? Possibly the time may
come when that will seem a very odd question. That we, living
creatures, should not feel a certain amount of interest in what it is
that constitutes our life will eventually, under altered ideas of the
fittest objects of human inquiry, appear to be a singular phenomenon;
but at present, judging by the practice of teachers and educators,
Biology would seem to be a topic that does not concern us at all. I
propose to put before you a few considerations with which I dare say
many will be familiar already, but which will suffice to show--not
fully, because to demonstrate this point fully would take a great many
lectures--that there are some very good and substantial reasons why it
may be advisable that we should know something about this branch of
human learning.
I myself entirely agree with another sentiment of the philosopher of
Malmesbury, "that the scope of all speculation is the performance of
some action or thing to be done," and I have not any very great respect
for, or interest in, mere knowing as such. I judge of the value of
human pursuits by their bearing upon human interests; in other words,
by their utility; but I should like that we should quite clearly
understand what it is that we mean by this word "utility." In an
Englishman's mouth it generally means that by which we get pudding or
praise, or both. I have no doubt that is one meaning of the word
utility, but it by no means includes all I mean by utility. I think
that knowledge of every kind is useful in proportion as it tends to
give people right ideas, which are essential to the foundation of right
practice, and to remove wrong ideas, which are the no less essential
foundations and fertile mothers of every description of error in
practice. And inasmuch as, whatever practical people may say, this
world is, after all, absolutely governed by ideas, and very often by
the wildest and most hypothetical ideas, it is a matter of the very
greatest importance that our theories of things, and even of things
that seem a long way apart from our daily lives, should be as far as
possible true, and as far as possible removed from error. It is not
only in the coarser, practical sense of the word "utility," but in this
higher and broader sense, that I measure the value of the study of
biology by its utility; and I shall try to point out to you that you
will feel the need of some knowledge of biology at a great many turns
of this present nineteenth century life of ours. For example, most of
us attach great importance to the conception which we entertain of the
position of man in this universe and his relation to the rest of
nature. We have almost all been told, and most of us hold by the
tradition, that man occupies an isolated and peculiar position in
nature; that though he is in the world he is not of the world; that his
relations to things about him are of a remote character; that his
origin is recent, his duration likely to be short, and that he is the
great central figure round which other things in this world revolve.
But this is not what the biologist tells us.
At the present moment you will be kind enough to separate me from them,
because it is in no way essential to my present argument that I should
advocate their views. Don't suppose that I am saying this for the
purpose of escaping the responsibility of their beliefs; indeed, at
other times and in other places, I do not think that point has been
left doubtful; but I want clearly to point out to you that for my
present argument they may all be wrong; and, nevertheless, my argument
will hold good. The biologists tell us that all this is an entire
mistake. They turn to the physical organisation of man. They examine
his whole structure, his bony frame and all that clothes it. They
resolve him into the finest particles into which the microscope will
enable them to break him up. They consider the performance of his
various functions and activities, and they look at the manner in which
he occurs on the surface of the world. Then they turn to other animals,
and taking the first handy domestic animal--say a dog--they profess to
be able to demonstrate that the analysis of the dog leads them, in
gross, to precisely the same results as the analysis of the man; that
they find almost identically the same bones, having the same relations;
that they can name the muscles of the dog by the names of the muscles
of the man, and the nerves of the dog by those of the nerves of the
man, and that, such structures and organs of sense as we find in the
man such also we find in the dog; they analyse the brain and spinal
cord and they find that the nomenclature which fits, the one answers
for the other. They carry their microscopic inquiries in the case of
the dog as far as they can, and they find that his body is resolvable
into the same elements as those of the man. Moreover, they trace back
the dog's and the man's development, and they find that, at a certain
stage of their existence, the two creatures are not distinguishable the
one from the other; they find that the dog and his kind have a certain
distribution over the surface of the world, comparable in its way to
the distribution of the human species. What is true of the dog they
tell us is true of all the higher animals; and they assert that they
can lay down a common plan for the whole of these creatures, and regard
the man and the dog, the horse and the ox as minor modifications of one
great fundamental unity. Moreover, the investigations of the last
three-quarters of a century have proved, they tell us, that similar
inquiries, carried out through all the different kinds of animals which
are met with in nature, will lead us, not in one straight series, but
by many roads, step by step, gradation by gradation, from man, at the
summit, to specks of animated jelly at the bottom of the series. So
that the idea of Leibnitz, and of Bonnet, that animals form a great
scale of being, in which there are a series of gradations from the most
complicated form to the lowest and simplest; that idea, though not
exactly in the form in which it was propounded by those philosophers,
turns out to be substantially correct. More than this, when biologists
pursue their investigations into the vegetable world, they find that
they can, in the same way, follow out the structure of the plant, from
the most gigantic and complicated trees down through a similar series
of gradations, until they arrive at specks of animated jelly, which
they are puzzled to distinguish from those specks which they reached by
the animal road.
Thus, biologists have arrived at the conclusion that a fundamental
uniformity of structure pervades the animal and vegetable worlds, and
that plants and animals differ from one another simply as diverse
modifications of the same great general plan.
Again, they tell us the same story in regard to the study of function.
They admit the large and important interval which, at the present time,
separates the manifestations of the mental faculties observable in the
higher forms of mankind, and even in the lower forms, such as we know
them, from those exhibited by other animals; but, at the same time,
they tell us that the foundations, or rudiments, of almost all the
faculties of man are to be met with in the lower animals; that there is
a unity of mental faculty as well as of bodily structure, and that,
here also, the difference is a difference of degree and not of kind. I
said "almost all," for a reason. Among the many distinctions which have
been drawn between the lower creatures and ourselves, there is one
which is hardly ever insisted on, [4] but which may be very fitly
spoken of in a place so largely devoted to Art as that in which we are
assembled. It is this, that while, among various kinds of animals, it
is possible to discover traces of all the other faculties of man,
especially the faculty of mimicry, yet that particular form of mimicry
which shows itself in the imitation of form, either by modelling or by
drawing, is not to be met with. As far as I know, there is no sculpture
or modelling, and decidedly no painting or drawing, of animal origin. I
mention the fact, in order that such comfort may be derived therefrom
as artists may feel inclined to take.
If what the biologists tell us is true, it will be needful to get rid
of our erroneous conceptions of man, and of his place in nature, and to
substitute right ones for them. But it is impossible to form any
judgment as to whether the biologists are right or wrong, unless we are
able to appreciate the nature of the arguments which they have to
offer.
One would almost think this to be a self-evident proposition. I wonder
what a scholar would say to the man who should undertake to criticise a
difficult passage in a Greek play, but who obviously had not acquainted
himself with the rudiments of Greek grammar. And yet, before giving
positive opinions about these high questions of Biology, people not
only do not seem to think it necessary to be acquainted with the
grammar of the subject, but they have not even mastered the alphabet.
You find criticism and denunciation showered about by persons who not
only have not attempted to go through the discipline necessary to
enable them to be judges, but who have not even reached that stage of
emergence from ignorance in which the knowledge that such a discipline
is necessary dawns upon the mind. I have had to watch with some
attention--in fact I have been favoured with a good deal of it
myself--the sort of criticism with which biologists and biological
teachings are visited. I am told every now and then that there is a
"brilliant article" [5] in so-and-so, in which we are all demolished. I
used to read these things once, but I am getting old now, and I have
ceased to attend very much to this cry of "wolf." When one does read
any of these productions, what one finds generally, on the face of it
is, that the brilliant critic is devoid of even the elements of
biological knowledge, and that his brilliancy is like the light given
out by the crackling of thorns under a pot of which Solomon speaks. So
far as I recollect, Solomon makes use of the image for purposes of
comparison; but I will not proceed further into that matter.
Two things must be obvious: in the first place, that every man who has
the interests of truth at heart must earnestly desire that every
well-founded and just criticism that can be made should be made; but
that, in the second place, it is essential to anybody's being able to
benefit by criticism, that the critic should know what he is talking
about, and be in a position to form a mental image of the facts
symbolised by the words he uses. If not, it is as obvious in the case
of a biological argument, as it is in that of a historical or
philological discussion, that such criticism is a mere waste of time on
the part of its author, and wholly undeserving of attention on the part
of those who are criticised. Take it then as an illustration of the
importance of biological study, that thereby alone are men able to form
something like a rational conception of what constitutes valuable
criticism of the teachings of biologists. [6]
Next, I may mention another bearing of biological knowledge--a more
practical one in the ordinary sense of the word. Consider the theory of
infectious disease. Surely that is of interest to all of us. Now the
theory of infectious disease is rapidly being elucidated by biological
study. It is possible to produce, from among the lower animals,
examples of devastating diseases which spread in the same manner as our
infectious disorders, and which are certainly and unmistakably caused
by living organisms. This fact renders it possible, at any rate, that
that doctrine of the causation of infectious disease which is known
under the name of "the germ theory" may be well-founded; and, if so, it
must needs lead to the most important practical measures in dealing
with those terrible visitations. It may be well that the general, as
well as the professional, public should have a sufficient knowledge of
biological truths to be able to take a rational interest in the
discussion of such problems, and to see, what I think they may hope to
see, that, to those who possess a sufficient elementary knowledge of
Biology, they are not all quite open questions.
Let me mention another important practical illustration of the value of
biological study. Within the last forty years the theory of agriculture
has been revolutionised. The researches of Liebig, and those of our own
Lawes and Gilbert, have had a bearing upon that branch of industry the
importance of which cannot be over-estimated; but the whole of these
new views have grown out of the better explanation of certain processes
which go on in plants; and which, of course, form a part of the
subject-matter of Biology.
I might go on multiplying these examples, but I see that the clock
won't wait for me, and I must therefore pass to the third question to
which I referred:--Granted that Biology is something worth studying,
what is the best way of studying it? Here I must point out that, since
Biology is a physical science, the method of studying it must needs be
analogous to that which is followed in the other physical sciences. It
has now long been recognised that, if a man wishes to be a chemist, it
is not only necessary that he should read chemical books and attend
chemical lectures, but that he should actually perform the fundamental
experiments in the laboratory for himself, and thus learn exactly what
the words which he finds in his books and hears from his teachers,
mean. If he does not do so, he may read till the crack of doom, but he
will never know much about chemistry. That is what every chemist will
tell you, and the physicist will do the same for his branch of science.
The great changes and improvements in physical and chemical scientific
education, which have taken place of late, have all resulted from the
combination of practical teaching with the reading of books and with
the hearing of lectures. The same thing is true in Biology. Nobody
will ever know anything about Biology except in a dilettante
"paper-philosopher" way, who contents himself with reading books on
botany, zoology, and the like; and the reason of this is simple and
easy to understand. It is that all language is merely symbolical of the
things of which it treats; the more complicated the things, the more
bare is the symbol, and the more its verbal definition requires to be
supplemented by the information derived directly from the handling, and
the seeing, and the touching of the thing symbolised:--that is really
what is at the bottom of the whole matter. It is plain common sense, as
all truth, in the long run, is only common sense clarified. If you want
a man to be a tea merchant, you don't tell him to read books about
China or about tea, but you put him into a tea-merchant's office where
he has the handling, the smelling, and the tasting of tea. Without the
sort of knowledge which can be gained only in this practical way, his
exploits as a tea merchant will soon come to a bankrupt termination.
The "paper-philosophers" are under the delusion that physical science
can be mastered as literary accomplishments are acquired, but
unfortunately it is not so. You may read any quantity of books, and you
may be almost as ignorant as you were at starting, if you don't have,
at the back of your minds, the change for words in definite images
which can only be acquired through the operation of your observing
faculties on the phenomena of nature.
It may be said:--"That is all very well, but you told us just now that
there are probably something like a quarter of a million different
kinds of living and extinct animals and plants, and a human life could
not suffice for the examination of one-fiftieth part of all these."
That is true, but then comes the great convenience of the way things
are arranged; which is, that although there are these immense numbers
of different kinds of living things in existence, yet they are built
up, after all, upon marvellously few plans.
There are certainly more than 100,000 species of insects, and yet
anybody who knows one insect--if a properly chosen one--will be able
to have a very fair conception of the structure of the whole. I do not
mean to say he will know that structure thoroughly, or as well as it is
desirable he should know it; but he will have enough real knowledge to
enable him to understand what he reads, to have genuine images in his
mind of those structures which become so variously modified in all the
forms of insects he has not seen. In fact, there are such things as
types of form among animals and vegetables, and for the purpose of
getting a definite knowledge of what constitutes the leading
modifications of animal and plant life, it is not needful to examine
more than a comparatively small number of animals and plants.
Let me tell you what we do in the biological laboratory which is lodged
in a building adjacent to this. There I lecture to a class of students
daily for about four-and-a-half months, and my class have, of course,
their text-books; but the essential part of the whole teaching, and
that which I regard as really the most important part of it, is a
laboratory for practical work, which is simply a room with all the
appliances needed for ordinary dissection. We have tables properly
arranged in regard to light, microscopes, and dissecting instruments,
and we work through the structure of a certain number of animals and
plants. As, for example, among the plants, we take a yeast plant, a
_Protococcus_, a common mould, a _Chara_, a fern, and some
flowering plant; among animals we examine such things as an _Amoeba_,
_a Vorticella_, and a fresh-water polype. We dissect a star-fish,
an earth-worm, a snail, a squid, and a fresh-water mussel. We
examine a lobster and a cray-fish, and a black beetle. We go on to a
common skate, a cod-fish, a frog, a tortoise, a pigeon, and a rabbit,
and that takes us about all the time we have to give. The purpose of
this course is not to make skilled dissectors, but to give every
student a clear and definite conception, by means of sense-images, of
the characteristic structure of each of the leading modifications of
the animal kingdom; and that is perfectly possible, by going no further
than the length of that list of forms which I have enumerated. If a man
knows the structure of the animals I have mentioned, he has a clear and
exact, however limited, apprehension of the essential features of the
organisation of all those great divisions of the animal and vegetable
kingdoms to which the forms I have mentioned severally belong. And it
then becomes possible for him to read with profit; because every time
he meets with the name of a structure, he has a definite image in his
mind of what the name means in the particular creature he is reading
about, and therefore the reading is not mere reading. It is not mere
repetition of words; but every term employed in the description, we
will say, of a horse, or of an elephant, will call up the image of the
things he had seen in the rabbit, and he is able to form a distinct
conception of that which he has not seen, as a modification of that
which he has seen.
I find this system to yield excellent results; and I have no hesitation
whatever in saying, that any one who has gone through such a course,
attentively, is in a better position to form a conception of the great
truths of Biology, especially of morphology (which is what we chiefly
deal with), than if he had merely read all the books on that topic put
together.
The connection of this discourse with the Loan Collection of Scientific
Apparatus arises out of the exhibition in that collection of certain
aids to our laboratory work. Such of you as have visited that very
interesting collection may have noticed a series of diagrams and of
preparations illustrating the structure of a frog. Those diagrams and
preparations have been made for the use of the students in the
biological laboratory. Similar diagrams and preparations illustrating
the structure of all the other forms of life we examine, are either
made or in course of preparation. Thus the student has before him,
first, a picture of the structure he ought to see; secondly, the
structure itself worked out; and if with these aids, and such needful
explanations and practical hints as a demonstrator can supply, he
cannot make out the facts for himself in the materials supplied to him,
he had better take to some other pursuit than that of biological
science.
I should have been glad to have said a few words about the use of
museums in the study of Biology, but I see that my time is becoming
short, and I have yet another question to answer. Nevertheless, I must,
at the risk of wearying you, say a word or two upon the important
subject of museums. Without doubt there are no helps to the study of
Biology, or rather to some branches of it, which are, or may be, more
important than natural history museums; but, in order to take this
place in regard to Biology, they must be museums of the future. The
museums of the present do not, by any means, do so much for us as they
might do. I do not wish to particularise, but I dare say many of you,
seeking knowledge, or in the laudable desire to employ a holiday
usefully, have visited some great natural history museum. You have
walked through a quarter of a mile of animals, more or less well
stuffed, with their long names written out underneath them; and, unless
your experience is very different from that of most people, the upshot
of it all is that you leave that splendid pile with sore feet, a bad
headache, and a general idea that the animal kingdom is a "mighty maze
without a plan." I do not think that a museum which brings about this
result does all that may be reasonably expected from such an
institution. What is needed in a collection of natural history is that
it should be made as accessible and as useful as possible, on the one
hand to the general public, and on the other to scientific workers.
That need is not met by constructing a sort of happy hunting-ground of
miles of glass cases; and, under the pretence of exhibiting everything
putting the maximum amount of obstacle in the way of those who wish
properly to see anything.
What the public want is easy and unhindered access to such a collection
as they can understand and appreciate; and what the men of science want
is similar access to the materials of science. To this end the
vast mass of objects of natural history should be divided into two
parts--one open to the public, the other to men of science, every day.
The former division should exemplify all the more important and
interesting forms of life. Explanatory tablets should be attached to
them, and catalogues containing clearly-written popular expositions of
the general significance of the objects exhibited should be provided.
The latter should contain, packed into a comparatively small space, in
rooms adapted for working purposes, the objects of purely scientific
interest. For example, we will say I am an ornithologist. I go to
examine a collection of birds. It is a positive nuisance to have them
stuffed. It is not only sheer waste, but I have to reckon with the
ideas of the bird-stuffer, while, if I have the skin and nobody has
interfered with it, I can form my own judgment as to what the bird was
like. For ornithological purposes, what is needed is not glass cases
full of stuffed birds on perches, but convenient drawers into each of
which a great quantity of skins will go. They occupy no great space and
do not require any expenditure beyond their original cost. But for the
edification of the public, who want to learn indeed, but do not seek
for minute and technical knowledge, the case is different. What one of
the general public walking into a collection of birds desires to see is
not all the birds that can be got together. He does not want to compare
a hundred species of the sparrow tribe side by side; but he wishes to
know what a bird is, and what are the great modifications of bird
structure, and to be able to get at that knowledge easily. What will
best serve his purpose is a comparatively small number of birds
carefully selected, and artistically, as well as accurately, set up;
with their different ages, their nests, their young, their eggs, and
their skeletons side by side; and in accordance with the admirable plan
which is pursued in this museum, a tablet, telling the spectator
in legible characters what they are and what they mean. For the
instruction and recreation of the public such a typical collection
would be of far greater value than any many-acred imitation of Noah's
ark.
Lastly comes the question as to when biological study may best be
pursued. I do not see any valid reason why it should not be made, to
a certain extent, a part of ordinary school training. I have long
advocated this view, and I am perfectly certain that it can be carried
out with ease, and not only with ease, but with very considerable
profit to those who are taught; but then such instruction must be
adapted to the minds and needs of the scholars. They used to have a
very odd way of teaching the classical languages when I was a boy. The
first task set you was to learn the rules of the Latin grammar in the
Latin language--that being the language you were going to learn! I
thought then that this was an odd way of learning a language, but
did not venture to rebel against the judgment of my superiors. Now,
perhaps, I am not so modest as I was then, and I allow myself to think
that it was a very absurd fashion. But it would be no less absurd, if
we were to set about teaching Biology by putting into the hands of
boys a series of definitions of the classes and orders of the animal
kingdom, and making them repeat them by heart. That is so very
favourite a method of teaching, that I sometimes fancy the spirit of
the old classical system has entered into the new scientific system, in
which case I would much rather that any pretence at scientific teaching
were abolished altogether. What really has to be done is to get into
the young mind some notion of what animal and vegetable life is. In
this matter, you have to consider practical convenience as well as
other things. There are difficulties in the way of a lot of boys making
messes with slugs and snails; it might not work in practice. But there
is a very convenient and handy animal which everybody has at hand, and
that is himself; and it is a very easy and simple matter to obtain
common plants. Hence the general truths of anatomy and physiology can
be taught to young people in a very real fashion by dealing with the
broad facts of human structure. Such viscera as they cannot very well
examine in themselves, such as hearts, lungs, and livers, may be
obtained from the nearest butcher's shop. In respect to teaching
something about the biology of plants, there is no practical
difficulty, because almost any of the common plants will do, and plants
do not make a mess--at least they do not make an unpleasant mess; so
that, in my judgment, the best form of Biology for teaching to very
young people is elementary human physiology on the one hand, and the
elements of botany on the other; beyond that I do not think it will be
feasible to advance for some time to come. But then I see no reason,
why, in secondary schools, and in the Science Classes which are under
the control of the Science and Art Department--and which I may say, in
passing, have in my judgment, done so very much for the diffusion of a
knowledge of science over the country--we should not hope to see
instruction in the elements of Biology carried out, not perhaps to the
same extent, but still upon somewhat the same principle as here. There
is no difficulty, when you have to deal with students of the ages of
fifteen or sixteen, in practising a little dissection and in getting a
notion of, at any rate, the four or five great modifications of the
animal form; and the like is true in regard to the higher anatomy of
plants.
While, lastly, to all those who are studying biological science with
a view to their own edification merely, or with the intention of
becoming zoologists or botanists; to all those who intend to pursue
physiology--and especially to those who propose to employ the working
years of their lives in the practice of medicine--I say that there is
no training so fitted, or which may be of such important service to
them, as the discipline in practical biological work which I have
sketched out as being pursued in the laboratory hard by.
* * * * *
I may add that, beyond all these different classes of persons who may
profit by the study of Biology, there is yet one other. I remember, a
number of years ago, that a gentleman who was a vehement opponent of
Mr. Darwin's views and had written some terrible articles against them,
applied to me to know what was the best way in which he could acquaint
himself with the strongest arguments in favour of evolution. I wrote
back, in all good faith and simplicity, recommending him to go through
a course of comparative anatomy and physiology, and then to study
development. I am sorry to say he was very much displeased, as people
often are with good advice. Notwithstanding this discouraging result, I
venture, as a parting word, to repeat the suggestion, and to say to all
the more or less acute lay and clerical "paper-philosophers" [7] who
venture into the regions of biological controversy--Get a little sound,
thorough, practical, elementary instruction in biology.
* * * * *
Footnotes:
[1] See the distinction between the "sciences physiques" and the
"sciences physiologiques" in the _Anatomie Générale_, 1801.
[2] _Hydrogéologie_, an. x. (1801).
[3] "The term _Biology_, which means exactly what we wish to
express, _the Science of Life_, has often been used, and has of
late become not uncommon, among good writers."--Whewell, _Philosophy
of the Inductive Sciences_, vol. i. p. 544 (edition of 1847).
[4] I think that my friend, Professor Allman, was the first to draw
attention to it.
[5] Galileo was troubled by a sort of people whom he called "paper
philosophers," because they fancied that the true reading of nature was
to be detected by the collation of texts. The race is not extinct, but,
as of old, brings forth its "winds of doctrine" by which the
weathercock heads among us are much exercised.
[6] Some critics do not even take the trouble to read. I have recently
been adjured with much solemnity; to state publicly why I have "changed
my opinion" as to the value of the palaeontological evidence of the
occurrence of evolution.
To this my reply is, Why should I, when that statement was made seven
years ago? An address delivered from the Presidential Chair of the
Geological Society, in 1870, may be said to be a public document,
inasmuch as it not only appeared in the _Journal_ of that learned
body, but was re-published, in 1873, in a volume of _Critiques and
Addresses_, to which my name is attached. Therein will be found a
pretty full statement of my reasons for enunciating two propositions:
(1) that "when we turn to the higher _Vertebrata_, the results of
recent investigations, however we may sift and criticise them, seem to
me to leave a clear balance in favour of the evolution of living forms
one from another;" and (2) that the case of the horse is one which
"will stand rigorous criticism." Thus I do not see clearly in what way
I can be said to have changed my opinion, except in the way of
intensifying it, when in consequence of the accumulation of similar
evidence since 1870, I recently spoke of the denial of evolution as not
worth serious consideration.
[7] Writers of this stamp are fond of talking about the Baconian
method. I beg them therefore to lay to heart these two weighty sayings
of the herald of Modern Science:--
"Syllogismus ex propositionibus constat, propositiones ex verbis, verba
notionum tesserae sunt. Itaque si notiones ipsae (_id quod basis rei
est_) confusae sint et temere a rebus abstractae, nihil in iis quae
superstruuntur est firmitudinis."--_Novum Organon_, ii. 14.
"Huic autem vanitati nonnulli ex modernis summa levitate ita
indulserunt, ut in primo capitulo Geneseos et in libro Job et aliis
scripturis sacris, philosophiam naturalem fundare conati sint; _inter
vivos quaerentes mortua_."--_Ibid_. 65.
XI
ON ELEMENTARY INSTRUCTION IN PHYSIOLOGY
[1877]
The chief ground upon which I venture to recommend that the teaching of
elementary physiology should form an essential part of any organised
course of instruction in matters pertaining to domestic economy, is,
that a knowledge of even the elements of this subject supplies those
conceptions of the constitution and mode of action of the living body,
and of the nature of health and disease, which prepare the mind to
receive instruction from sanitary science.
It is, I think, eminently desirable that the hygienist and the
physician should find something in the public mind to which they can
appeal; some little stock of universally acknowledged truths, which may
serve as a foundation for their warnings, and predispose towards an
intelligent obedience to their recommendations.
Listening to ordinary talk about health, disease, and death, one is
often led to entertain a doubt whether the speakers believe that the
course of natural causation runs as smoothly in the human body as
elsewhere. Indications are too often obvious of a strong, though
perhaps an unavowed and half unconscious, under-current of opinion that
the phenomena of life are not only widely different, in their
superficial characters and in their practical importance, from other
natural events, but that they do not follow in that definite order
which characterises the succession of all other occurrences, and the
statement of which we call a law of nature.
Hence, I think, arises the want of heartiness of belief in the value of
knowledge respecting the laws of health and disease, and of the
foresight and care to which knowledge is the essential preliminary,
which is so often noticeable; and a corresponding laxity and
carelessness in practice, the results of which are too frequently
lamentable.
It is said that among the many religious sects of Russia, there is one
which holds that all disease is brought about by the direct and special
interference of the Deity, and which, therefore, looks with repugnance
upon both preventive and curative measures as alike blasphemous
interferences with the will of God. Among ourselves, the "Peculiar
People" are, I believe, the only persons who hold the like doctrine in
its integrity, and carry it out with logical rigour. But many of us are
old enough to recollect that the administration of chloroform in
assuagement of the pangs of child-birth was, at its introduction,
strenuously resisted upon similar grounds.
I am not sure that the feeling, of which the doctrine to which I have
referred is the full expression, does not lie at the bottom of the
minds of a great many people who yet would vigorously object to give a
verbal assent to the doctrine itself. However this may be, the main
point is that sufficient knowledge has now been acquired of vital
phenomena, to justify the assertion, that the notion, that there is
anything exceptional about these phenomena, receives not a particle of
support from any known fact. On the contrary, there is a vast and an
increasing mass of evidence that birth and death, health and disease,
are as much parts of the ordinary stream of events as the rising and
setting of the sun, or the changes of the moon; and that the living
body is a mechanism, the proper working of which we term health; its
disturbance, disease; its stoppage, death. The activity of this
mechanism is dependent upon many and complicated conditions, some of
which are hopelessly beyond our control, while others are readily
accessible, and are capable of being indefinitely modified by our own
actions. The business of the hygienist and of the physician is to know
the range of these modifiable conditions, and how to influence them
towards the maintenance of health and the prolongation of life; the
business of the general public is to give an intelligent assent, and a
ready obedience based upon that assent, to the rules laid down for
their guidance by such experts. But an intelligent assent is an assent
based upon knowledge, and the knowledge which is here in question means
an acquaintance with the elements of physiology.
It is not difficult to acquire such knowledge. What is true, to
a certain extent, of all the physical sciences, is eminently
characteristic of physiology--the difficulty of the subject begins
beyond the stage of elementary knowledge, and increases with every
stage of progress. While the most highly trained and the best furnished
intellect may find all its resources insufficient, when it strives to
reach the heights and penetrate into the depths of the problems of
physiology, the elementary and fundamental truths can be made clear to
a child.
No one can have any difficulty in comprehending the mechanism of
circulation or respiration; or the general mode of operation of the
organ of vision; though the unravelling of all the minutiae of these
processes, may, for the present, baffle the conjoined attacks of the
most accomplished physicists, chemists, and mathematicians. To know the
anatomy of the human body, with even an approximation to thoroughness,
is the work of a life; but as much as is needed for a sound
comprehension of elementary physiological truths, may be learned in a
week.
A knowledge of the elements of physiology is not only easy of
acquirement, but it may be made a real and practical acquaintance with
the facts, as far as it goes. The subject of study is always at hand,
in one's self. The principal constituents of the skeleton, and the
changes of form of contracting muscles, may be felt through one's own
skin. The beating of one's heart, and its connection with the pulse,
may be noted; the influence of the valves of one's own veins may be
shown; the movements of respiration may be observed; while the
wonderful phenomena of sensation afford an endless field for curious
and interesting self-study. The prick of a needle will yield, in a drop
of one's own blood, material for microscopic observation of phenomena
which lie at the foundation of all biological conceptions; and a cold,
with its concomitant coughing and sneezing, may prove the sweet uses of
adversity by helping one to a clear conception of what is meant by
"reflex action."
Of course there is a limit to this physiological self-examination. But
there is so close a solidarity between ourselves and our poor relations
of the animal world, that our inaccessible inward parts may be
supplemented by theirs. A comparative anatomist knows that a sheep's
heart and lungs, or eye, must not be confounded with those of a man;
but, so far as the comprehension of the elementary facts of the
physiology of circulation, of respiration, and of vision goes, the one
furnishes the needful anatomical data as well as the other.
Thus, it is quite possible to give instruction in elementary physiology
in such a manner as, not only to confer knowledge, which, for the
reason I have mentioned, is useful in itself; but to serve the purposes
of a training in accurate observation, and in the methods of reasoning
of physical science. But that is an advantage which I mention only
incidentally, as the present Conference does not deal with education in
the ordinary sense of the word.
It will not be suspected that I wish to make physiologists of all the
world. It would be as reasonable to accuse an advocate of the "three
R's" of a desire to make an orator, an author, and a mathematician of
everybody. A stumbling reader, a pot-hook writer, and an arithmetician
who has not got beyond the rule of three, is not a person of brilliant
acquirements; but the difference between such a member of society and
one who can neither read, write, nor cipher is almost inexpressible;
and no one nowadays doubts the value of instruction, even if it goes no
farther.
The saying that a little knowledge is a dangerous thing is, to my mind,
a very dangerous adage. If knowledge is real and genuine, I do not
believe that it is other than a very valuable possession, however
infinitesimal its quantity may be. Indeed, if a little knowledge is
dangerous, where is the man who has so much as to be out of danger?
If William Harvey's life-long labours had revealed to him a tenth part
of that which may be made sound and real knowledge to our boys and
girls, he would not only have been what he was, the greatest
physiologist of his age, but he would have loomed upon the seventeenth
century as a sort of intellectual portent. Our "little knowledge" would
have been to him a great, astounding, unlooked-for vision of scientific
truth.
I really see no harm which can come of giving our children a little
knowledge of physiology. But then, as I have said, the instruction must
be real, based upon observation, eked out by good explanatory diagrams
and models, and conveyed by a teacher whose own knowledge has been
acquired by a study of the facts; and not the mere catechismal
parrot-work which too often usurps the place of elementary teaching.
It is, I hope, unnecessary for me to give a formal contradiction to the
silly fiction, which is assiduously circulated by fanatics who not only
ought to know, but do know, that their assertions are untrue, that I
have advocated the introduction of that experimental discipline which
is absolutely indispensable to the professed physiologist, into
elementary teaching.
But while I should object to any experimentation which can justly be
called painful, for the purpose of elementary instruction; and, while,
as a member of a late Royal Commission, I gladly did my best to prevent
the infliction of needless pain, for any purpose; I think it is my duty
to take this opportunity of expressing my regret at a condition of the
law which permits a boy to troll for pike, or set lines with live frog
bait, for idle amusement; and, at the same time, lays the teacher of
that boy open to the penalty of fine and imprisonment, if he uses the
same animal for the purpose of exhibiting one of the most beautiful and
instructive of physiological spectacles, the circulation in the web of
the foot. No one could undertake to affirm that a frog is not
inconvenienced by being wrapped up in a wet rag, and having his toes
tied out; and it cannot be denied that inconvenience is a sort of pain.
But you must not inflict the least pain on a vertebrated animal for
scientific purposes (though you may do a good deal in that way for gain
or for sport) without due licence of the Secretary of State for the
Home Department, granted under the authority of the Vivisection Act.
So it comes about, that, in this present year of grace 1877, two
persons may be charged with cruelty to animals. One has impaled a frog,
and suffered the creature to writhe about in that condition for hours;
the other has pained the animal no more than one of us would be pained
by tying strings round his fingers, and keeping him in the position of
a hydropathic patient. The first offender says "I did it because I find
fishing very amusing," and the magistrate bids him depart in peace;
nay, probably wishes him good sport. The second pleads, "I wanted to
impress a scientific truth, with a distinctness attainable in no other
way, on the minds of my scholars," and the magistrate fines him five
pounds.
I cannot but think that this is an anomalous and not wholly creditable
state of things.
XII
ON MEDICAL EDUCATION
[1870]
It has given me sincere pleasure to be here today, at the desire of
your highly respected President and the Council of the College. In
looking back upon my own past, I am sorry to say that I have found that
it is a quarter of a century since I took part in those hopes and in
those fears by which you have all recently been agitated, and which now
are at an end. But, although so long a time has elapsed since I was
moved by the same feelings, I beg leave to assure you that my sympathy
with both victors and vanquished remains fresh--so fresh, indeed, that
I could almost try to persuade myself that, after all, it cannot be so
very long ago. My business during the last hour, however, has been to
show that sympathy with one side only, and I assure you I have done my
best to play my part heartily, and to rejoice in the success of those
who have succeeded. Still, I should like to remind you at the end of it
all, that success on an occasion of this kind, valuable and important
as it is, is in reality only putting the foot upon one rung of the
ladder which leads upwards; and that the rung of a ladder was never
meant to rest upon, but only to hold a man's foot long enough to enable
him to put the other somewhat higher. I trust that you will all regard
these successes as simply reminders that your next business is, having
enjoyed the success of the day, no longer to look at that success, but
to look forward to the next difficulty that is to be conquered. And
now, having had so much to say to the successful candidates, you must
forgive me if I add that a sort of under-current of sympathy has been
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 with the most comfortable assurance
that I had thoroughly well earned it. But, gentlemen, the competitor
having been a worthy one, and the examination a fair one, I cannot say
that I found in that circumstance anything very discouraging. I said to
myself, "Never mind; what's the next thing to be done?" And I found
that policy of "never minding" and going on to the next thing to be
done, to be the most important of all policies in the conduct of
practical life. It does not matter how many tumbles you have in this
life, so long as you do not get dirty when you tumble; it is only the
people who have to stop to be washed and made clean, who must
necessarily lose the race. And I can assure you that there is the
greatest practical benefit in making a few failures early in life. You
learn that which is of inestimable importance--that there are a great
many people in the world who are just as clever as you are. You learn
to put your trust, by and by, in an economy and frugality of the
exercise of your powers, both moral and intellectual; and you very soon
find out, if you have not found it out before, that patience and
tenacity of purpose are worth more than twice their weight of
cleverness. In fact, if I were to go on discoursing on this subject, I
should become almost eloquent in praise of non-success; but, lest so
doing should seem, in any way, to wither well-earned laurels, I
will turn from that topic, and ask you to accompany me in some
considerations touching another subject which has a very profound
interest for me, and which I think ought to have an equally profound
interest for you.
I presume that the great majority of those whom I address propose to
devote themselves to the profession of medicine; and I do not doubt,
from the evidences of ability which have been given to-day, that I have
before me a number of men who will rise to eminence in that profession,
and who will exert a great and deserved influence upon its future. That
in which I am interested, and about which I wish to speak, is the
subject of medical education, and I venture to speak about it for the
purpose, if I can, of influencing you, who may have the power of
influencing the medical education of the future. You may ask, by what
authority do I venture, being a person not concerned in the practice of
medicine, to meddle with that subject? I can only tell you it is a
fact, of which a number of you I dare say are aware by experience (and
I trust the experience has no painful associations), that I have been
for a considerable number of years (twelve or thirteen years to the
best of my recollection) one of the examiners in the University of
London. You are further aware that the men who come up to the
University of London are the picked men of the medical schools of
London, and therefore such observations as I may have to make upon the
state of knowledge of these gentlemen, if they be justified, in regard
to any faults I may have to find, cannot be held to indicate defects in
the capacity, or in the power of application of those gentlemen, but
must be laid, more or less, to the account of the prevalent system of
medical education. I will tell you what has struck me--but in speaking
in this frank way, as one always does about the defects of one's
friends, I must beg you to disabuse your minds of the notion that I am
alluding to any particular school, or to any particular college, or to
any particular person; and to believe that if I am silent when I should
be glad to speak with high praise, it is because that praise would 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, that while
anatomy has been taught as a science ought to be taught, as a matter of
autopsy, and observation, and strict discipline; in a very large number
of cases, physiology has been taught as if it were a mere matter of
books and of hearsay. I declare to you, gentlemen, that I have often
expected to be told, when I have asked a question about the circulation
of the blood, that Professor Breitkopf is of opinion that it
circulates, but that the whole thing is an open question. I assure you
that I am hardly exaggerating the state of mind on matters of
fundamental importance which I have found over and over again to obtain
among gentlemen coming up to that picked examination of the University
of London. Now, I do not think that is a desirable state of things. I
cannot understand why physiology should not be taught--in fact, you
have here abundant evidence that it can be taught--with the same
definiteness and the same precision as anatomy is taught. And you may
depend upon this, that the only physiology which is to be of any good
whatever in medical practice, or in its application to the study of
medicine, is that physiology which a man knows of his own knowledge;
just as the only anatomy which would be of any good to the surgeon is
the anatomy which he knows of his own knowledge. Another peculiarity I
have found in the physiology which has been current, and that is, that
in the minds of a great many gentlemen it has been supplanted by
histology. They have learnt a great deal of histology, and they have
fancied that histology and physiology are the same things. I have asked
for some knowledge of the physics and the mechanics and the chemistry
of the human body, and I have been met by talk about cells. I declare
to you I believe it will take me two years, at least, of absolute rest
from the business of an examiner to hear the word "cell," "germinal
matter," or "carmine," without a sort of inward shudder.
Well, now, gentlemen, I am sure my colleagues in this examination will
bear me out in saying that I have not been exaggerating the evils and
defects which are current--have been current--in a large quantity of
the physiological teaching the results of which come before examiners.
And it becomes a very interesting question to know how all this comes
about, and in what way it can be remedied. How it comes about will be
perfectly obvious to any one who has considered the growth of medicine.
I suppose that medicine and surgery first began by some savage more
intelligent than the rest, discovering that a certain herb was good for
a certain pain, and that a certain pull, somehow or other, set a
dislocated joint right. I suppose all things had their humble
beginnings, and medicine and surgery were in the same condition. People
who wear watches know nothing about watchmaking. A watch goes wrong and
it stops; you see the owner giving it a shake, or, if he is very bold,
he opens the case, and gives the balance-wheel a push. Gentlemen, that
is empirical practice, and you know what are the results upon the
watch. I should think you can divine what are the results of analogous
operations upon the human body. And because men of sense very soon
found that such were the effects of meddling with very complicated
machinery they did not understand, I suppose the first thing, as being
the easiest, was to study the nature of the works of the human watch,
and the next thing was to study the way the parts worked together, and
the way the watch worked. Thus, by degrees, we have had growing up our
body of anatomists, or knowers of the construction of the human watch,
and our physiologists, who know how the machine works. And just as any
sensible man, who has a valuable watch, does not meddle with it
himself, but goes to some one who has studied watchmaking, and
understands what the effect of doing this or that may be; so, I
suppose, the man who, having charge of that valuable machine, his own
body, wants 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 disorganise 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 question, in the long run, was a
question of finance; and there is a good deal to be said for that view.
Most assuredly the question of medical teaching is, in a very large and
broad sense, a question of finance. What I mean is this: that in London
the arrangements of the medical schools, and the number of them, are
such as to render it almost impossible that men who confine themselves
to the teaching of the theoretical branches of the profession should be
able to make their bread by that operation; and, you know, if a man
cannot make his bread he cannot teach--at least his teaching comes to a
speedy end. That is a matter of physiology. Anatomy is fairly well
taught, because it lies in the direction of practice, and a man is all
the better surgeon for being a good anatomist. It does not absolutely
interfere with the pursuits of a practical surgeon if he should hold a
Chair of Anatomy--though I do not for one moment say that he would not
be a better teacher if he did not devote himself to practice.
(Applause.) Yes, I know exactly what that cheer means, but I am keeping
as carefully as possible from any sort of allusion to Professor Ellis.
But the fact is, that even human anatomy has now grown to be so large a
matter, that it takes the whole devotion of a man's life to put the
great mass of knowledge upon that subject into such a shape that it can
be teachable to the mind of the ordinary student. What the student
wants in a professor is a man who shall stand between him and the
infinite diversity and variety of human knowledge, and who shall gather
all that together, and extract from it that which is capable of being
assimilated by the mind. That function is a vast and an important one,
and unless, in such subjects as anatomy, a man is wholly free from
other cares, it is almost impossible that he can perform it thoroughly
and well. But if it be hardly possible for a man to pursue anatomy
without actually breaking with his profession, how is it possible for
him to pursue physiology?
I get every year those very elaborate reports of Henle and
Meissner--volumes of, I suppose, 400 pages altogether--and they consist
merely of abstracts of the memoirs and works which have been written on
Anatomy and Physiology--only abstracts of them! How is a man to keep up
his acquaintance with all that is doing in the physiological world--in
a world advancing with enormous strides every day and every hour--if he
has to be distracted with the cares of practice? You know very well it
must be impracticable to do so. Our 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 spoke of just now--the unreality, the bookishness of the
knowledge of the taught. And if this is the case in physiology, still
more must it be the case in those branches of physics which are the
foundation of physiology; although it may be less the case in
chemistry, because for an able chemist a certain honourable and
independent career lies in the direction of his work, and he is able,
like the anatomist, to look upon what he may teach to the student as
not absolutely taking him away from his bread-winning pursuits.
But it is of no use to grumble about this state of things unless one is
prepared to indicate some sort of practical remedy. And I believe--and
I venture to make the statement because I am wholly independent of all
sorts of medical schools, and may, therefore, say what I believe
without being supposed to be affected by any personal interest--but I
say I believe that the remedy for this state of things, for that
imperfection of our theoretical knowledge which keeps down the ability
of England at the present time in medical matters, is a mere affair of
mechanical arrangement; that so long as you have a dozen medical
schools scattered about in different parts of the metropolis, and
dividing the students among them, so long, in all the smaller schools
at any rate, it is impossible that any other state of things 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 of the
theoretical branches of their profession in two or three central
schools, there would be abundant means for maintaining able
professors--not, indeed, for enriching them, as they would be able to
enrich themselves by practice--but for enabling them to make that
choice which such men are so willing to make; namely, the choice
between wealth and a modest competency, when that modest competency is
to be combined with a scientific career, and the means of advancing
knowledge. I do not believe that all the talking about, and tinkering
of, medical education will do the slightest good until the fact is
clearly recognised, that men must be thoroughly grounded in the
theoretical branches of their profession, and that to this end the
teaching of those theoretical branches must be confined to two or three
centres.
Now let me add one other word, and that is, that if I were a despot, I
would cut down these branches to a very considerable extent. The next
thing to be done beyond that which I mentioned just now, is to go back
to primary education. The great step towards a thorough medical
education is to insist upon the teaching of the elements of the
physical sciences in all schools, so that medical students shall not go
up to the medical colleges utterly ignorant of that with which they
have to deal; to insist on the elements of chemistry, the elements of
botany, and the elements of physics being taught in our ordinary and
common schools, so that there shall be some preparation for the
discipline of medical colleges. And, if this reform were once effected,
you might confine the "Institutes of Medicine" to physics as applied to
physiology--to chemistry as applied to physiology--to physiology
itself, and to anatomy. Afterwards, the student, thoroughly grounded in
these matters, might go to any hospital he pleased for the purpose of
studying the practical branches of his profession. The practical
teaching might be made as local as you like; and you might use to
advantage the opportunities afforded by all these local institutions
for acquiring a knowledge of the practice of the profession. But you
may say: "This is abolishing 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 a real knowledge of human physiology should worry
themselves with getting up hearsay about the alternation of generations
in the Salpae is really monstrous. I cannot characterise it in any
other way. And having sacrificed my own pursuit, I am sure I may
sacrifice other people's; and I make this remark with all the more
willingness because I discovered, on reading the names of your
Professors just now, that the Professor of Materia Medica is not
present. I must confess, if I had my way I should abolish Materia
Medica [1] altogether. I recollect, when I was first under examination
at the University of London, Dr. Pereira was the examiner, and you know
that Pereira's "Materia Medica" was a book _de omnibus rebus_. I
recollect my struggles with that book late at night and early in the
morning (I worked very hard in those days), and I do believe that I got
that book into my head somehow or other, but then I will undertake to
say that I forgot it all a week afterwards. Not one trace of a
knowledge of drugs has remained in my memory from that time to this;
and really, as a matter of common sense, I cannot understand the
arguments for obliging a medical man to know all about drugs and where
they come from. Why not make him belong to the Iron and Steel
Institute, and learn something about cutlery, because he uses knives?
But do not suppose that, after all these deductions, there would not be
ample room for your activity. Let us count up what we have left. I
suppose all the time for medical education that can be hoped for is, at
the outside, about four years. Well, what have you to master in those
four years 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 acquisition of anything beyond the
rudiments of any one of them may tax the energies of a lifetime, I
think that even those energies which you young gentlemen have been
displaying for the last hour or two might be taxed to keep you
thoroughly up to what is wanted for your medical career.
I entertain a very strong conviction that any one who adds to medical
education one iota or tittle beyond what is absolutely necessary, is
guilty of a very grave offence. Gentlemen, it will depend upon the
knowledge that you happen to possess,--upon your means of applying it
within 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
so enormous, and the time at your disposal so limited, I could not feel
my conscience easy if I did not, on such an occasion as this, raise a
protest against employing your energies upon the acquisition of any
knowledge which may not be absolutely needed in your future career.
* * * * *
[1] It will, I hope, be understood that I do not include Therapeutics
under this head.
XIII
THE STATE AND THE MEDICAL PROFESSION
[1884]
At intervals during the last quarter of a century committees of the
Houses of the Legislature and specially appointed commissions have
occupied themselves with the affairs of the medical profession. Much
evidence has been taken, much wrangling has gone on over the reports of
these bodies; and sometimes much trouble has been taken to get measures
based upon all this work through Parliament, but very little has been
achieved.
The Bill introduced last session was not more fortunate than several
predecessors. I suppose that it is not right to rejoice in the
misfortunes of anything, even a Bill; but I confess that this event
afforded me lively satisfaction, for I was a member of the Royal
Commission on the report of which the Bill was founded, and I did my
best to oppose and nullify that report.
That the question must be taken up again and finally dealt with by the
Legislature before long cannot be doubted; but in the meanwhile there
is time for reflection, and I think that the non-medical public would
be wise if they paid a little attention to a subject which is really of
considerable importance to them.
The first question which a plain man is disposed to ask himself is, Why
should the State interfere with the profession of medicine any more
than it does, say, with the profession of engineering? Anybody who
pleases may call himself an engineer, and may practice as such. The
State confers no title upon engineers, and does not profess to tell the
public that one man is a qualified engineer and that another is not so.
The answers which are given to the question are various, and most of
them, I think, are bad. A large number of persons seem to be of opinion
that the State is bound no less to take care of the general public,
than to see that it is protected against incompetent persons, against
quacks and medical impostors in general. I do not take that view of the
case. I think it is very much wholesomer for the public to take care of
itself in this as in all other matters; and although I am not such a
fanatic for the liberty of the subject as to plead that interfering
with the way in which a man may choose to be killed is a violation of
that liberty, yet I do think that it is far better to let everybody do
as he likes. Whether that be so or not, I am perfectly certain that, as
a matter of practice, it is absolutely impossible to prohibit the
practice of medicine by people who have no special qualification for
it. Consider the terrible consequences of attempting to prohibit
practice by a very large class of persons who are certainly not
technically qualified--I am far from saying a word as to whether
they are otherwise qualified or not. The number of Ladies
Bountiful--grandmothers, aunts, and mothers-in-law--whose chief delight
lies in the administration of their cherished provision of domestic
medicine, is past computation, and one shudders to think of what might
happen if their energies were turned from this innocuous, if not
beneficent channel, by the strong arm of the law. But the thing is
impracticable.
Another reason for intervention is propounded, I am sorry to say, by
some, though not many, members of the medical profession, and is simply
an expression of that trades unionism which tends to infest professions
no less than trades.
The general practitioner trying to make both ends meet on a poor
practice, whose medical training has cost him a good deal of time and
money, finds that many potential patients, whose small fees would be
welcome as the little that helps, prefer to go and get their shilling's
worth of "doctor's stuff" and advice from the chemist and druggist
round the corner, who has not paid sixpence for his medical training,
because he has never had any.
The general practitioner thinks this is very hard upon him and ought to
be stopped. It is perhaps natural that he should think so, though it
would be very difficult for him to justify his opinion on any ground of
public policy. But the question is really not worth discussion, as it
is obvious that it would be utterly impracticable to stop the practice
"over the counter" even it it were desirable.
Is a man who has a sudden attack of pain in tooth or stomach not to be
permitted to go to the nearest druggist's shop and ask for something
that will relieve him? The notion is preposterous. But if this is to be
legal, the whole principle of the permissibility of counter practice is
granted.
In my judgment the intervention of the State in the affairs of the
medical profession can be justified not upon any pretence of protecting
the public, and still less upon that of protecting the medical
profession, but simply and solely upon the fact that the State employs
medical men for certain purposes, and, as employer, has a right to
define the conditions on which it will accept service. It is for the
interest of the community that no person shall die without there being
some official recognition of the cause of his death. It is a matter of
the highest importance to the community that, in civil and criminal
cases, the law shall be able to have recourse to persons whose evidence
may be taken as that of experts; and it will not be doubted that the
State has a right to dictate the conditions under which it will appoint
persons to the vast number of naval, military, and civil medical
offices held directly or indirectly under the Government. Here, and
here only, it appears to me, lies the justification for the
intervention of the State in medical affairs. It says, or, in my
judgment, should say, to the public, "Practice medicine if you like--go
to be practised upon by anybody;" and to the medical practitioner,
"Have a qualification, or do not have a qualification if people don't
mind it; but if the State is to receive your certificate of death, if
the State is to take your evidence as that of an expert, if the State
is to give you any kind of civil, or military, or naval appointment,
then we can call upon you to comply with our conditions, and to produce
evidence that you are, in our sense of the word, qualified. Without
that we will not place you in that position." As a matter of fact, that
is the relation of the State to the medical profession in this country.
For my part, I think it an extremely healthy relation; and it is one
that I should be very sorry to see altered, except in so far that it
would certainly be better if greater facilities were given for the
swift and sharp punishment of those who profess to have the State
qualification when, in point of fact, they do not possess it. They are
simply cheats and swindlers, like other people who profess to be what
they are not, and should be punished as such.
But supposing we are agreed about the justification of State
intervention in medical affairs, new questions arise as to the manner
in which that intervention should take place and the extent to which it
should go, on which the divergence of opinion is even greater than it
is on the general question of intervention.
It is now, I am sorry to say, something over forty years since I began
my medical studies; and, at that time, the state of affairs was
extremely singular. I should think it hardly possible that it could
have obtained anywhere but in such a country as England, which
cherishes a fine old crusted abuse as much as it does its port wine. At
that time there were twenty-one licensing bodies--that is to say,
bodies whose certificate was received by the State as evidence that the
persons who possessed that certificate were medical experts. How these
bodies came to possess these powers is a very curious chapter in
history, in which it would be out of place to enlarge. They were partly
universities, partly medical guilds and corporations, partly the
Archbishop of Canterbury. Those were the three sources from which the
licence to practice came in that day. There was no central authority,
there was nothing to prevent any one of those licensing authorities
from granting a licence to any one upon any conditions it thought fit.
The examination might be a sham, the curriculum might be a sham, the
certificate might be bought and sold like anything in a shop; or, on
the other hand, the examination might be fairly good and the diploma
correspondingly valuable; but there was not the smallest guarantee,
except the personal character of the people who composed the
administration of each of these licensing bodies, as to what might
happen. It was possible for a young man to come to London and to spend
two years and six months of the time of his compulsory three years
"walking the hospitals" in idleness or worse; he could then, by putting
himself in the hands of a judicious "grinder" for the remaining six
months, pass triumphantly through the ordeal of one hour's _vivâ voce_
examination, which was all that was absolutely necessary, to
enable him to be turned loose upon the public, like death on the pale
horse, "conquering and to conquer," with the full sanction of the law,
as a "qualified practitioner."
It is difficult to imagine, at present, such a state of things, still
more difficult to depict the consequences of it, because they would
appear like a gross and malignant caricature; but it may be said that
there was never a system, or want of system, which was better
calculated to ruin the students who came under it, or to degrade the
profession as a whole. My memory goes back to a time when models from
whom the Bob Sawyer of the _Pickwick Papers_ might have been drawn
were anything but rare.
Shortly before my student days, however, the dawn of a better state of
things in England began to be visible, in consequence of the
establishment of the University of London, and the comparatively very
high standard which it placed before its medical graduates.
I say comparatively high standard, for the requirements of the
University in those days, and even during the twelve years at a later
period, when I was one of the examiners of the medical faculty, were
such as would not now be thought more than respectable, and indeed were
in many respects very imperfect. But, relatively to the means of
learning, the standard was high, and none but the more able and
ambitious of the students dreamed of passing the University.
Nevertheless, the fact that many men of this stamp did succeed in
obtaining their degrees, led others to follow in their steps, and
slowly but surely reacted upon the standard of teaching in the better
medical schools. Then came the Medical Act of 1858. That Act introduced
two immense improvements: one of them was the institution of what is
called the Medical Register, upon which the names of all persons
recognised by the State as medical practitioners are entered: and the
other was the establishment of the Medical Council, which is a kind of
Medical Parliament, composed of representatives of the licensing bodies
and of leading men in the medical profession nominated by the Crown.
The powers given by the Legislature to the Medical Council were found
practically to be very limited, but I think that no fair observer of
the work will doubt that this much attacked body has excited no small
influence in bringing about the great change for the better, which has
been effected in the training of men for the medical profession within
my recollection.
Another source of improvement must be recognised in the Scottish
Universities, and especially in the medical faculty of the University
of Edinburgh. The medical education and examinations of this body were
for many years the best of their kind in these islands, and I doubt if,
at the present moment, the three kingdoms can show a better school of
medicine than that of Edinburgh. The vast number of medical students at
that University is sufficient evidence of the opinion of those most
interested in this subject.
Owing to all those influences, and to the revolution which has taken
place in the course of the last twenty years in our conceptions of the
proper method of teaching physical science, the training of the medical
student in a good school, and the examination test applied by the great
majority of the present licensing bodies, reduced now to nineteen, in
consequence of the retirement of the Archbishop and the fusion of two
of the other licensing bodies, are totally different from what they
were even twenty years ago.
I was perfectly astonished, upon one of my sons commencing his medical
career the other day, when I contrasted the carefully-watched courses
of theoretical and practical instruction, which he is expected to
follow with regularity and industry, and the number and nature of the
examinations which he will have to pass before he can receive his
licence, not only with the monstrous laxity of my own student days, but
even with the state of things which obtained when my term of office as
examiner in the University of London expired some sixteen years ago.
I have no hesitation in expressing the opinion, which is fully borne
out by the evidence taken before the late Royal Commission, that a
large proportion of the existing licensing bodies grant their licence
on conditions which ensure quite as high a standard as it is
practicable or advisable to exact under present circumstances, and that
they show every desire to keep pace with the improvements of the times.
And I think there can be no doubt that the great majority have so much
improved their ways, that their standard is far above that of the
ordinary qualification thirty years ago, and I cannot see what excuse
there would be for meddling with them if it were not for two other
defects which have to be remedied.
Unfortunately there remain two or three black sheep--licensing bodies
which simply trade upon their privilege, and sell the cheapest wares
they can for shame's sake supply to the bidder. Another defect in the
existing system, even where the examination has been so greatly
improved as to be good of its kind, is that there are certain licensing
bodies which give a qualification for an acquaintance with either
medicine or surgery alone, and which more or less ignore obstetrics.
This is a revival of the archaic condition of the profession when
surgical operations were mostly left to the barbers and obstetrics to
the mid-wives, and when the physicians thought themselves, and were
considered by the world, the "superior persons" of the profession. I
remember a story was current in my young days of a great court
physician who was travelling with a friend, like himself, bound on a
visit to a country house. The friend fell down in an apoplectic fit,
and the physician refused to bleed him because it was contrary to
professional etiquette for a physician to perform that operation.
Whether the friend died or whether he got better because he was not
bled I do not remember, but the moral of the story is the same. On the
other hand, a famous surgeon was asked whether he meant to bring up his
son to his own calling, "No," he said, "he is such a fool, I mean to
make a physician of him."
Nowadays, it is happily recognised that medicine is one and
indivisible, and that no one can properly practice one branch who is
not familiar with at any rate the principles of all. Thus the two great
things that are wanted now are, in the first place, some means of
enforcing such a degree of uniformity upon all the examining bodies
that none should present a disgracefully low minimum or pass
examination; and the second point is that some body or other shall have
the power of enforcing upon every candidate for the licence to practice
the study of the three branches, what is called the tripartite
qualification. All the members of the late commission were agreed that
these were the main points to be attended to in any proposals for the
further improvement of medical training and qualification.
But such being the ends in view, our notions as to the best way of
attaining them were singularly divergent; so that it came about that
eleven commissioners made seven reports. There was one main majority
report and six minor reports, which differed more or less from it,
chiefly as to the best method of attaining these two objects.
The majority report recommended the adoption of what is known as the
conjoint scheme. According to this plan the power of granting a licence
to practise is to be taken away from all the existing bodies, whether
they have done well or ill, and to be placed in the hands of a body of
delegates (divisional boards), one for each of the three kingdoms. The
licence to practise is to be conferred by passing the delegate
examination. The licensee may afterwards, if he pleases, go before any
of the existing bodies and indulge in the luxury of another examination
and the payment of another fee in order to obtain a title, which does
not legally place him in any better position than that which he would
occupy without it.
Under these circumstances, of course, the only motive for obtaining the
degree of a University or the licence of a medical corporation would be
the prestige of these bodies. Hence the "black sheep" would certainly
be deserted, while those bodies which have acquired a reputation by
doing their duty would suffer less.
But, as the majority report proposes that the existing bodies should be
compensated for any loss they might suffer out of the fees of the
examiners for the State licence, the curious result would be brought
about that the profession of the future would be taxed, for all time,
for the purpose of handing over to wholly irresponsible bodies a sum,
the amount of which would be large for those who had failed in their
duty and small for those who had done it.
The scheme in fact involved a perpetual endowment of the "black
sheep," calculated on the maximum of their ill-gained profits. [1] I
confess that I found myself unable to assent to a plan which, in
addition to the rewarding the evil doers, proposed to take away the
privileges of a number of examining bodies which confessedly were doing
their duty well, for the sake of getting rid of a few who had failed.
It was too much like the Chinaman's device of burning down his house to
obtain a poor dish of roast pig--uncertain whether in the end he might
not find a mere mass of cinders. What we do know is that the great
majority of the existing licensing bodies have marvellously improved in
Back to Full Books
|