ADDRESS TO MEDICAL STUDENTS.

SEPTEMBER 3, 1892. The addition of the extra year of which has become obligatory on every medical student

been devoted to the work.

study

THE LANCET. LONDON:

SATURDAY, SEPTEMBER 3, 1892.

ADDRESS TO MEDICAL STUDENTS. HOWEVER high may be the standard of professional learning and conduct at which those who are about to commence the study of medicine should be exhorted to aim, it must not be forgotten that the primary objects of medical students in the acquisition of knowledge are to pass their

examinations at the proper time and to be able to

living

as

honourable and

capable practitioners

gain their

of the healing alike to their

The former is a duty which they owe friends and to themselves : to their friends especially by reason of the outlay on their education, which presses severely upon those who have experience of the res angusta d6,?ni ; and to themselves because frequent failure often terminates either in their having to earn their livelihood in the undesirable capacity of unqualified assistants or in an inability to earn a livelihood at all. Doubtless the successful attainment of the end in view will depend mainly upon the exertions of the students themselves, but the kind and the degree of success will be determined also by the exercise of forethought on the part of their friends and sound judgment in selecting the most favourable fields for prosecuting the campaign. A preliminary survey of the whole ground to be occupied, a careful and complete study of the regulations of the universities and licensing bodies and of the advantages offered at each stage of the student’s career by the various medical art.

who commenced his medical studies after Jan. 1st, 1892, tends to harmonise the curriculum for the diplomas of the

corporations with the curriculum for the University ofLondon, and ought to facilitate the acquisition of medical and surgical degrees at that University. The first year of the five years may be passed at a university or teaching institution recognised by any of the licensing bodies where the subjects of physics, chemistry and biology are taught. It would be too sanguine to anticipate that these regulations will altogether ’, meet the demand for increased facility of medical graduation in London, but it must assist in lessening the disabilities of the London students and remove one of the stumbling blocks which havebeen lying in their path. The question of a proposed Teaching University in London is fully dealt with in another part of our present issue. We may avail ourselves of this opportunity to point out that some of the prospectuses of the medical schools contain all the information which the intending student requires in regard to examinations, diplomas, and degrees, coupled with very useful advice

as

to the order and methods of medical

study. Application may therefore be made to every medical school for a prospectus. Moreover, at almost every school warden-who may be consulted, who is ready to smooth the path of the student, to make the crooked ways straight and the rough places plain. Within the space at our disposal it is impossible to

there is someone-be he dean

or

touch upon the many subjects of interest which are suggested by the entrance of many hundreds of students on Oct. lst upon the business and work of a lifetime, or to offer all the counsel which

grave and important an occasion demands. A few points only in connexion with the duty of preparation for examinations and for practice can here be noticed. so

As lectures are indispensable, owing to the regulations of schools, coupled with the advice of friends well qualified to the of the the should first student’s career. precede stage judge, licensing bodies, the student should attend them heartily At the present day, when the possession of a university and in earnest, supplementing the lecture of the day with degree is regarded as a highly desirable acquisition for the the perusal of his notes and the subject of the lecture in his medical practitioner, this forethought and prevision are all- text-book. The mastery of one good text-book is better than

for students whose medical education is to be obtained in the metropolis. We have known men, who would have greatly distinguished themselves at the severe examina-

important

desultory consultation of many authorities ; but on disputed points and matters on which recent research has thrown new light the text-book may not contain all that is required. tions of the University of London and who might have Some of the deficiencies may be made good by reference to occupied leading positions, to be debarred from rising current medical literature, by studying the reports of the to their proper place in the profession because their know- medical societies, and by conversation with medical tutors, ledge of examining bodies and examinations was acquired registrars, or members of the staff, or the lecturers themwhen circumstances rendered it too late to remedy the selves. It is a great art to obtain information by judicious omission. A young man who is just leaving a good school questions, although the Socratic method cannot always be ought not to find it a difficult task to pass the Matri- adopted without earning for the student the character and culation Examination at the University of London, and penalties of a bore. this course, under present circumstances, cannot be too Reading should be supplemented with the book of nature, strongly urged upon those who are intending to complete some pages of which will be open in every well-stocked their whole curriculum in extension of the period of

London school.

Before the

professional study

from four to

a

of the medical school does not, suffice, the museum of the Royal College of Surgeons presents ever-increasing facilities for objective study. Regular work should be undertaken daily. The practice of museum, and if the

museum

five years, the most advantageous course was to pass both the Matriculation and the Preliminary Scientific Examinations of the University before entrance at the LINNaeUS in regard to his magnum opus—nulla dies sine linetzJ!1edical school; for it was found that preparation for the latter furnishes a good example of the efficacy of a little labour clashed with the ordinary professional curriculum, and failure regularly performed. It is continual dropping that wearx at this examination-the pons asinorum of the imbitious away the stone-gutta carat lapidem non vi sed scrpe cadendu. student-resulted in an absolute loss of the time which had Of all the qualities which contribute to command success No 3601

520 self-reliance is one of the most

The most successful men have been the most self-reliant. The maxim of HORACE not to pin’s one faith on anyone—nullius jurare in verba magistri—is a branch of the self-reliant spirit. There is often on a medical or surgical staff some brilliant man-a favourite and successful because a dogmatic teacher, a

important.

we

regret to add, invariably proportionate to the amount of

good which the practitioner has done. We must

now

for

a

time take leave of those who

are

crossing the threshold of professional work. All of them are looking forward to what the future may bring. To some may come fame, to some success, to some perhaps only a mere hardly earned livelihood, to some, alas, perhaps man distinguished as a clinician or an operator, prone to enunciate theories and fond of philosophising-who nothing but disappointment and failure-still to all we would gains the ear of the students. For a time, perhaps, say, Do your best." ‘° Who does the best his circumstance allows every word is received as gospel and all his maxims Does well, acts nobly : angels could no more." and methods of practice are regarded as the source of all professional wisdom-the only true maxims and only right THE PROPOSED NEW TEACHING UNIVERSITY IN The student knows not that there may be many and it is LONDON. the of at same result, only equally good ways arriving time or some error on the part of the idol which cannot be conIN our Students’ number of 1891 we expressed a hope cealed that occasions his disenchantment. To avoid these that before another year had elapsed a Teaching Uni. snares the student should listen to more than one oracle and versity for London would have been established and that witness a variety of practice. Let him learn the views of London medical students would have been placed in different physicians and different surgeons, and be in constant such a position through its formation that they would attendance both among in-patients and out-patients. Let him be able to obtain degrees on the same fair and equitable prove all things and hold fast that which is good. And with terms as are now granted in the other great centres of regard to practice, that which is equally necessary for success medical education in Great Britain. We regret to say at examinations and in future practice is for students to per- that we have been disappointed in this expectation, and form for themselves all the minutias of work at the bedside, London students must still go through the ordeal of an all the steps of operations, each detail in minor surgery. honours’ examination although they only wish to obtain an

methods.

things must be done until the habit of doing them well ordinary pass degree. The first Royal Commission definitely comes mechanically. There is a great gap between a most laid down in its report that this was the practical outcome of of every step in an operation and the present high standard insisted on by the University of perfect knowledge the power of doing them smoothly, successfully and London, and suggested a scheme for the removal of such an Constant practice abolishes effort. without effort. To anomaly. During the summer session of 1891 the Lords of have to stop and think at each step of a surgical pro- the Privy Council actively concerned themselves with the cedure is always necessary for anyone who has not enjoyed question of providing a real University, and not a mere a sufficiency of practice. Equally for rapid and successful Imperial examining board, in London, in consequence of the constant and abundant diagnosis practice can alone be of avail; failure of the University of London to adapt itself to the new and the rapid and successful diagnosis then begins to wear the position which the Royal Commission recommended and to aspect of inspiration and intuition. Another reason for the make the necessary changes in its constitution and working. student’s perfecting himself in all minor details of medical As the outcome of their deliberations a Draft Charter for anew and surgical practice is this, that it will be the minor cases of University, to be called the Albert University, which should inwhich his private practice will be the most largely composed clude King’s and University Colleges, and the London Medicd and which will be the foundation of his repute and fortune. Schools, with power to admit other institutions of a similar Minor surgery will be far more useful to the general practi- standing, and this was sanctioned both by their lordships and tioner than the major operations. There will be many casesof by the law officers of the Crown. In order to become valid this nævi ; many cases will require catheterism ; the arrest of Charter had to be laid on the table of both Houses of Parliaepistaxis will be urgent ; many hydroceles may require ment for thirty days, and on their reassembling in February tapping ; but how few limbs will require amputation and how last this step was complied with, permission in the meanwhile few arteries will have to be tied in their continuity. Not thatj having been granted for a change of name from "Albert"to the student should neglect his opportunities of witnessing andd " Gresham. " But during the Parliamentary recess a very fordoing these great things; by all means let students flock too midable opposition had arisen to the scheme approved by the r the theatre for an amputation at the hip or an entire upper Lords of the Privy Council. The authorities of the Victoria but them never lose a chance of for let themselves s limb, doing University and of the provincial Schools of Medicine had not the minor details on which their daily bread may depend.. opposed the petition of King’s and University Colleges to be In all practice it must be recollected that our primary duty constituted into a University for London, but they immeis to save life or to prolong it. To save life we must be able diately changed their attitude and became actively hostile to act in emergencies with promptitude and decision. Ever3y when the other medical schools in London were included practitioner should be able to arrest hæmorrhage in any par:t and so took every means to prevent the Charter being of the body, on an emergency to operate for hernia or ini- passed through the House of Commons For diverse reason or testinal obstruction, and to open the trachea larynx—iit many of the Senate and a large number of the members of a to be with overcome a stoppage respiraa,- Convocation of the University of London, the authorities of may penknife-to Bedford College and other institutions, such as the Workin others-th tion. In these respects-and fortunately interest and advantage of patients and practitioners will g ing Men’s College and the Birkbeck Institution, joined in is not rt, the opposition, and to these were added the objections of hand in hand, although the gratitude of patients These

,