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Introductory Lecture OF THE ELEVENTH SESSION OF THE ARMY MEDICAL SCHOOL.
OCTOBER 14, 1865. expressions of regret that those opportunities have been of
Introductory Lecture OF THE
ELEVENTH SESSION OF
THE ARMY MEDICAL Delivered at
BY T. DEPUTY
Netley
on
October
SCHOOL.
3rd, 1865,
LONGMORE, ESQ.,
INSPECTOR-GENERAL,
AND PROFESSOR OF MILITARY SURGERY.
GENTLEMEN,—A few sessions ago it was determined that the formal introductory lectures which were thought to be necessary in the early days of the Army Medical School should be discontinued, and that at the commencement of each fresh session the business for which the school was established should be directly entered upon. It was considered, on the one hand, that a knowledge of the objects of the school had become sufficiently diffused to prevent misunderstanding on the part of those who, under other circumstances, might have regarded it with jealousy from a belief that the Government had organized an establishment which would interfere with the civil medical schools of the country; and, on the other hand, it was thought that the irksomeness to the Professors of seeking new topics of discourse for two introductory lectures annually was not balanced by any corresponding advantages to those for whose benefit the school was maintained. But practically we find it scarcely possible-with a new set of faces looking at us-with the benches of this theatre occupied by gentlemen to whom everything around is new, not merely the place itself, but the system, duties, and conduct of the school, and of the hospital with which it is connected-on whom the restraints of military discipline are suddenly imposed, instead of the selfregulated conduct of their time and its work to which they have been habituated at civil schools, and to whom the varied uniforms, according to duty and rank of the officers and men by whom they are surrounded, nay, the very uniform they themselves are wearing, are all strange--to whom we know from experience there are many things difficult at first to be understood and liable to be misinterpreted,-practically, I say, under these circumstances, we find it scarcely possible to begin the work before us without some introductory observations by way of establishing mutual acquaintance and encouragement, and considering in general terms the road we are about to travel over together. Moreover, as each session passes and time advances, we meet with occurrences and changes to which reference seems desirable, in order that the interests of the school may be further advanced, and the character, standing, and efficiency of those who proceed from it promoted. Firstly, then, in welcoming you to the Army Medical School, let me beg of you to dismiss from your minds the prejudiced remarks which are put forth from time to time respecting your being kept at school notwithstanding you are holding licences
for practice from colleges and universities; and let me ask you to wait until you know by experience what the nature of the work done here is, and can form for yourselves a fair idea of its probable value to you in the career you have selected, before you allow such notions to have any influence on your minds. Such disparaging remarks are, of course, made for the purpose of deterring professional men from competing for appointments in the medical service of the army; but, as far as I know, they have only been made by persons practically unacquainted with the school, who allow their own conceptions to take the place of knowledge of the work which is really done, and who build upon this false foundation an equally false and untenable superstructure ; and generally also by persons who are impressed with the notion that the duties of a military surgeon do not differ from those of practitioners in civil life. I have never known such remarks made by anyone who had gone through the courses of instruction here; but, on the contrary, I have constantly heard at the close of sessions, and that, too, from candidates who have been distinguished for the zeal with which they have taken advantage of the opportunities afforded them, No. 2198.
such, short duration. Wait, then, I say, till the end of the session, and then form your own opinions, and place no dependence on. those of others. Even some who have been employed in the duties of the hospital, in connexion with which the school i& placed, go away with but imperfect notions of the work which is done in it, because they do not frequent the lecture-room or demonstrations in the post-mortem theatre, nor care to benefit by the splendid opportunities of improvement in hygienic and microscopical investigations and the other studies which may be pursued here with so much advantage. Some, on the other hand, and generally those who in the first instance are the most able officers, take advantage of all occasions of improvement which their occupations allow, and these alone ctn fairly esti-mate the advantages afforded to you by her Majesty’s Government in this establishment. I and many others who receivecl’ commissions in the army medical service at a time when no, such school existed, are able fully to appreciate its importance, and can honestly testify to its value from our own experience’ of the want at starting on our duties of much of the informa.. tion which you are now enabled to obtain so easily. It would be mere labour of repetition, were I to take up your time with an account of the history of the Army Medical School, the causes and considerations which led to its establishment, the system on which it is constituted, or the purposes aimed at in the constitution so given. You may find’ full particulars on these matters in the Warrant issued by the! Secretary of State for War in March, 1860, and in the introductory lecture delivered at the opening of the school in, presence of the lamented Lord Herbert, who took so active a. part in its foundation. The lecture, and Lord Herbert’s’ address on that occasion, are printed in the first of the published volumes of the Army Medical Reports I recommend’ you to peruse them, as they will probably enable you to understand your position and liabilities while you remain under the direct authority of the School Senate better than you may otherwise do. Neither do I propose to lay before you any systematic exof the work you will be engaged in during the coming position session. Each professor in the opening lecture of his course will explain the special objects of his department, and the. plan on which they are to be pursued. In addition to thisprogramme, it will be my duty to explain to you at starting the general system of organization given to the Army Medical Department for admission into which you are now candidates, and into which it must be your own fault if you do not enter at the close of the session-its relations to all the other denartments of the military service-the plan on which pitals, including regimental hospitals and general hospitals, such: as this, the Victoria Hospital, are ordered to be carried on;, the functions of those in whom rest the military command and responsibility for discipline and order of the whole establish-ment, and of those in whom the professional direction is vested, as well as to explain to you the nature of the multifarions’duties- professional, sanitary, and statistical -which willhereafter devolve on you as medical officers in the publicservice. I will, therefore, not further refer to these matters, beyond saying, that hereafter you must not forget you are now voluntarily entering an establishment, and adopting for your career in life a service, which has been systematically organized. by the highest authorities of the realm, and that any unsanctioned departure from its established rules will certainly lead to’ trouble as regards the individuals attempting to set them. aside, as well as to interruption of that co-operation of different official departments, and steady progress of the train of publicbusiness which the regulations have been designed to ensure. Without more allusion to the particular kind of work doneat the school, I wish now to try and impress on you the necessity of making the most use you can of the few months during which the session lasts, and I will further ask you to bear with me. while I call your attention to some points which may help to enhance the advantages of your studies, and to further yourfuture advancement. At the commencement, let me tell you,. it will greatly depend on yourselves whether the instructionoffered you at Netley, practical as it is all attempted to be made, is turned to permanent account, or whether its benefit’ is little more than temporary and nominal. You may go through your clinical duties in the wards; you may go through the practical courses of instruction in the hygienic laboratoryand microscopical rooms; you may attend the lectures and demonstrations in this theatre; you may, at the examination at. the close of the session, get enough marks to enable the professors to report you qualified for a commission as an assistantsurgeon in the army; but if all along your mind has not bee’c.:’ ’
military hos-
Royal
422
engaged in the work you have been doing, you will be far below causes, effects, and deductions in particular instances are anathe distance which may be indicated by the mere difference in lyzed and explained, that the understanding has been edunumber of marks between yourself and some other who has cated, and that the written paper is the offspring of a knowworked with a will; who has earnestly tried to teaoh himself, ledge which has become a fixed possession of the writer. There is one part of our future work which I wish to say a -not merely to get by heart, but to fix in his understandingeach step of the course he has been pursuing. A man may few words upon, and that is the clinical instruction which will languidly accomplish a chemical process at the dictation of an be given by the professors and assistant-professors in the wards of or listlessly open his ears to an account of the special hospital. Some whom I am addressing have, doubtless, features presented by a given object.microscopically observed, been dressers or clinical clerks in civil hospitals, or perhaps and possibly at the end may imagine he has imbibed thoroughly assistants to gentlemen in private practice, and have thus bethe instruction imparted to him. Let him try, after the lapse come acquainted with the actual features of certain examples of a week or so, to ascertain for himself, by practical tests, of disease and injury, and practically acquainted with their how much of the instruction so received he retains. If the discrimination. But some others, and, as we have found by trial be sincerely and thoroughly made, he will probably come experience, not a few among those who have come here to the conclusion, that although he had used his ears, his hitherto, have had no such advantages, or have had them only hands, his eyes, and had occupied a certain time in so doing, to a very limited extent. Not having obtained any -insight So with the lectures given into the features of diseases before no real knowledge had resulted. to attend the here : a discourse or demonstration may be torpidly followed; courses of instruction at the established medical schools, such notes, or portions of it, may be jotted down from time to time, as was formerly acquired when the system of apprenticeship these notes afterwards committed to memory, rewritten on existed, and, at the hospitals to which the schools are attached, examination-papers, and yet no useful knowledge have been having been confined to looking on the patients from a disgained. The outer senses have been ostensibly awake, but the tance, as it were, to hearing the casual intermitting remarks mind has been asleep in the first instance; in the second, of surgeons and physicians as they went round the wards to memory has been employed, but its treacherous character visit their patients, without having any active concern in their has not been guarded against by arming the understanding care or treatment, - " walking the hospitals, "-they have come for its keeper. Contrast such a student, if a student he here with only that theoretical information and those crude ean be called, with another who has used his time and opporgeneral notions of diagnosis and therapeutics which entail, tunities more wisely. Let us suppose his time spent in the as a necessary result, endless unexpected doubts and difficulties occupations I just now referred to. In using the microscope, when they are first applied to the actual work of practice. having neglected no opportunity of training himself in the Some gentlemen have told me that they have never had a of his instrument, having educated his eye to patient under their care and treatment before they came to appreciate the appearances presented to it, in distinguishing Netley, have never even been called upon practically to diathose which are true from those which are fallacious, he notes gnose a case of disease or injury until they were required to do the features of the structural object presented and described so in their competitive examination in London. They have to him, compares them with those of other objects previously never had to watch the course of a disease through its varying observed, estimates their differences, and at last, by careful phases, to appreciate its modifications of form and character observation, contrast, and comparison, establishes such a know- according to age, habits, and constitution, or to feel the reledge of its nature and definite characters that, under whatever sponsibility of its treatment, during the whole of their profescircumstances he may again meet with it, he will not fail to sional education. What wonder, then, that those who are recognise it, or, if not present, to speak positively of its ab- practically unacquainted with the shades of distinction which sence. But with such knowledge he will be able to do more: require to be so carefully observed in order to determine diffehe will not merely be able to recognise the simple object itself rences in type of disease, who have never felt the necessity of with which he has thus become acquainted, but he will be in a the close and careful observation which is frequently required position to trace it even when modified to suit modified pur- to decide with exactness upon the results of injury to some poses, or when altered in some of its features by connexion intricate portion of the human frame,-what wonder that they with other structures. According to the nature of the struc- should occasionally make the most startling mistakes in diature he has studied, the knowledge he has gained will assist gnosis, the most faulty suggestions as to practice, when they him in unravelling the nature of some object previously uncer- are first brought into contact with disabled patients ? I know tain, in deciding the nature of a doubtful diseased growth, in that in some hospitals steps are being taken to insure that discussing the function of an organ presented to his notice for every student shall have a certain share of medical and surthe first time; and thus he will be enabled to apply the in- gical practice by introducing a polyclinic system, such as was formation he has acquired to practical uses in the exercise of so strongly advocated by Sir James Clark many years ago in his professional functions, or in the advancement of scientific his published writings ; but it is yet far from being as general pursuits. Equally so with the analytical process in the as circumstances have shown it desirable that it should be. The clinical teachers of this hospital are placed in a position hygienic laboratory. Having made himself acquainted with the actions, reactions, and combinations of the several articles in which no other persons in the kingdom, perhaps, are placed employed in the investigation, having got a full comprehension as regards opportunities of observing the attainments of those of the " whyand " because" of what he has done, he has gained who are just launched from professional training into profespossession of a knowledge which can be applied not merely sional practice. Gentlemen who have recently received licences to the particular purpose through means of which he has acquired to practise from authorized bodies established in all parts of it, but to the determination of others of like importance. The the three great divisions of the kingdom, are gathered together individual steps of the process may be varied, may be joined here. The teachers have to watch the manner in which these with parts of other processes, and turned to endless account. gentlemen deal practically with the treatment of disease; to So in the lecture-room. The listener with thought and under- observe their qualifications for the discharge of those professtanding, who reasons on the facts presented to him, and on sional duties the right performance of which has been the ultithe principles or rules of guidance in practice deduced from mate object of their education. They ascertain their amount them, acquires knowledge which is capable of application not of real knowledge of the human frame, its conformation, and merely to the particular expressions of disease in connexion the effects of injuries and diseases upon it, not by word-ofwith which the remarks of the lecturer have been made, but mouth examination, but by their manner of proceeding to deal to a variety of others, perhaps not contemplated by the in- with the very things themselves. Now, while it is a pleasure to structor, which will afterwards occur to him in his professional observe the practised dexterity of some, and their acquaintance with the right methods of arriving at sound conclusions as to practice. It is impossible to examine the written replies to the ques- the nature of the cases placed under their charge, I should be tions which are put at the examinations at the close of each telling only part of the truth if I were not to add that it is session without observing tkat there have been two such classes occasionally a subject of surprise that others should be so comof workers as I have described. Some replies contain formal pletely adrift, so unable to distinguish common conditions of statements, more or less correct, more or less complete, but disease or effects of injuries, and so ignorant of the common stamped with the evidence of being mere transcripts from manipulations necessary amongst the patients in the medical memory, reproductions of written notes of expressions caught and surgical wards as they have shown themselves to be. Inat the moment they were delivered, but neither considered nor stances have occurred where it has been almost impossible to digested afterwards, and consequently having found no place understand how the colleges which had presented those conin the understanding; while others; on the contrary, show by cerned with their licences could have passed them as qualified, their clear arrangement and rational exposition of facts, by the or what tests they applied to ascertain their fitness for pracgeneral views by the manner in which the relations of tice. And these gentlemen who caused these impressions
the
instructor,
proceeding
manipulation
taken,
423
considerably superior to others who had passed patient, an examination is conducted, still practically by the practice; for, in competing for their army appoint- candidates themselves, under the directions of the professor of ments, they had left others behind who had not been considered ’, pathology, so that not only the conclusions arrived at regardadmissible. The same absence of practical knowledge has been ing the nature of the disease each patient may have laboured from time to time exhibited in the post-mortem examination I under may be subjected to the test of actual inspection, but, The manner of proceeding even to open the body for at the same time, that the habit may be acquired of examinroom. the display of its cavities and their contents, still more of in- ing every part of the body with the care and minuteness with vestigating or expounding their condition, has been quite which such investigations are now required to be conducted strange to some; they had never had the operation to perform. to be of real value, as well as of lucidly describing the results There must be something bad in the system of teaching at in the established records. The importance of such clinical those places whence such instances of deficiency come; and it practice as I have sketched out cannot be overrated, especially is a serious matter for those to whom the regulation of profes- as regards any who have never had such responsibility thrown sional education is entrusted to consider what must be occa- on them before; and even in respect to those who have already sionally the consequences of authorizing for practice persons had some share of practice in England, the peculiar diseases I which occur in such large proportion among the invalids at so unacquainted with the practical work of their profession. am well aware that experience can only be attained with years; this hospital-diseases originating in or modified by tropical that under any system of education the experience of those climates-present materials for study calculated to be most who have recently received licences of practice must be inferior valuable in their future military practice. to that of others who have had opportunities of extensive obserOne of the earliest indications of the good character and of vation ; but it is to be remembered that in the remarks I have the probable high position that will be taken by any one been making I have referred to the difference in attainments among the gentlemen who arrive at Netley, as each fresh set which has been exhibited amongst men of about the same pro- comes, as far as my observation has gone, is industry. It fessional standing as to years, and that there is little reason to seems to be only in the nature of things that, among a number doubt, therefore, if some amongst them, under one system of of candidates collected from all parts of the kingdom, there education, have gained solidly practical knowledge, others, must be very varied degrees of acquirements. It might be who have been so deficient as I have mentioned, might equally supposed that those gentlemen whohad already proved their have gained it under a like system. superiority, who were aware that their store of knowledge was Do not let me be misunderstood when I make these remarks. much greater than that of others, would be inclined to relax They are applicable only to exceptional instances which have their efforts after further improvement, and to exhibit less come to notice. The attempts which have been publicly made diligence in acquiring fresh stores, than their neighbours. We to depreciate universally, without distinction, the attainments have not found it to be so. The general rule has been that of the gentlemen who have been of late entering the medical those who have held the first places on coming to this school service of the army, by stigmatizing them as third-class stu- have been the most industrious after they have come to it. dents, for the sake of achieving certain objects of general Perhaps the industry which had led to the position previously policy, has been most unfair and unworthy. At all events, taken had become so habitual as not to be readily given -tzp9. every gentleman who has entered the public service has or, perhaps, as I rather believe, the knowledge already gained passed through a competitive examination, which others had enabled them to appreciate better the value and importance of tried to do and failed in, and which probably more had thought further extending it, and so formed a stimulus for continued fit not to face from a consciousness of probability of failure. perseverance, just as the desire grows to mount higher and. Those who have published such charges should inspect their higher when ascending a hill for the sake of the prospect. 1, own ranks, for it may fairly be presumed that the candidates am informed that one of the gentlemen of the last session, who have not succeeded at the competitive examinations have whose name will be placed on the tablet on the adjoining wall, passed into civil practice. The division into three classes of made it a rule to shut himself up in his room for three hours those who passed through the competitive examination in daily to study and reflect on the occupations he had been London gave the opportunity for this erroneous stigma being actively engaged in during the morning ; and I know from ob,propagated. This classification really corresponded with the servation that the other gentleman, whose name will also, separation into classes of those who have undergone an exami- appear there, was conspicuous during the whole time he was nation for honours in a university. But it was interpreted by at Netley for his constant diligence.* Without industry, those who did not understand it, or did not choose to under- capacity can avail nothing in our profession ; with it, inferior stand it, to signify the general attainments of those concerned capacity may be compensated, if not removed. Labour con-to comprehend degrees ot comparison with the whole of the quers all things," is an old motto. One of the greatest lyrical passed students of Great Britain. Those who were in the third poets of this country, in writing the life of the eloquent statesof these three classes were publicly called students of third- man and witty dramatist, Sheridan, refers to the industry rate ability. As well might a Master of Arts who had come which was the real source of what was usually regarded as the out in the second class in the competition for classical honours impromptu produce of natural talent, and remarks that at Oxford be stamped for life as a man of second-rate ability. nothing great and conspicuous has ever been achieved, whether Unfounded, however, as the assumption was, on which the it be a poem or a pyramid, but by dint of labour. At the appellation of third-class students was given to those who same time, however, that I thus dwell on the importance of were entering the medical department of the army, it had an earnest work, I would not be supposed to exclude judicious injurious effect among many who were not acquainted with recreation : on the contrary, a proper amount of relaxation is the circumstances whence it sprang, and was a source of pain required in order that the work may be done. to those to whom it was applied. Hence it became necessary, Some who are listening to me have possibly not thought of in order to prevent this abuse of terms, to abandon the division the value of a high place in the list of names which appears in into classes of those who had successfully passed through the the Gazette after the session, when your appointments as assistcompetitive examination in London, and to arrange the list of ant-surgeons are publicly announced. It is only some years names simply according to order of merit, as is done in all afterwards that you will feel all the value, when you are apother army competitive examinations. proaching what is, perhaps, the most important step in an was led into this digression when speaking of the deficiency army medical officer’s career-the promotion from assistantI in practical knowledge of some who have nevertheless been surgeon to the rank of surgeon. These promotions are made, licensed as practitioners. To those gentlemen who have not as a rule, according to seniority, and it is only on extraordinary had the advantages of professional practice, the clinical work occasions of distinguished conduct, or particular merit, that here, brief as the period for it is, is a great boon, as it is also a this rule is departed from. When that time approaches, and great safeguard to the public service ; and I will briefly men- you are watching anxiously the gradual move upwards, as tion the manner in which it is performed. Each candidate is vacancies happen to occur, you will find what a difference placed in professional charge, under the directions of the pro- there is in the dates of promotion amongst the medical officera fessors, of a certain number of patients ; he is required to form whose names appear in the same sessional list with your own. his own diagnosis by personal examination, and to place on You will find the assistant-surgeon at the top of the list, steprecord in his case-book the local and general symptoms of each ping into a vacancy, it may be, months before some of the adcase, and the interpretation he gives to them-to prescribe the joining names; it may be years before the last, when the list treatment, and to order the diets according to the authorized contains as many names as some have since the school has scale of military hospitals. While engaged in this duty, he is been in operation. And the importance of promotion in milimade acquainted with the special relations of each case as reThe tablet referred to bears the names of gentlemen who have taken gards its military bearings, both as respects the public service the highest positions at the successive competitive examinations for medieal must have been
into civil
*
"
*
and the soldier himself.
On the
occurrence
of the death of
a
commissions in the British and Indian armies.
424
tary service does not end with the advantages merely resulting -from increased rank, but, in addition, the promotion immediately widens your opportunities of attaining a higher elevation. The gain of a single place in the list at the end of the session may consequently have a material influence in improving your future prospects in the service. During the year comprehended between March 31st, 1864, and March 31st, 1865, 114 candidates for commissions passed through the school, and were gazettecl to assistant -surgeoncies in the Queen’s British service, while twenty assistant-surgeons were promoted to surgeoncies. Since the 1st of April of the present year there have been already more than that number of promotions-viz., twenty-five ; but even if the number were ,-doubled, it would still show the importance of gaining even a single place in the examination list. I will refer to one other topic which, though not forming ’part of our work here, has an important bearing on it. I allude to the subject of general education. We have had a few in.stances in which there has been such a deficiency in some ’branches of general education-even in knowledge of grammar, spelling, and the meaning of ordinary English terms-as to threaten to lessen materially the usefulness of those concerned - in the public service. It is not part of the duties of the examiners for the medical department of the army, either in London or here, to inquire into general education : professional .-qualifications are the subject of their inquiries. But even here a knowledge of the right signification of words, and of their proper arrangement in composition, becomes important. Want - of it causes, on the one hand, frequent misapprehension of the ’language used in the lecture-room, and, on the other, leads to unintentional but often serious errors in professional documents. The absence of rightly selected terms and expressions, as well as of care in the grammatical construction of sentences, is a frequent source of difficulty to the examiners when they are trying to determine the amount of professional knowledge possessed by the writer of some particular paper under examination. But it is not only in the examination papers that this defective composition creates difficulties : it equally forces itself upon the attention while inspecting the records made of the histories, symptoms, and progress of diseases in the Casebooks. Not only scrupulous exactitude in observation of the minutest details of facts, but also equal accuracy in the expressions employed to record them, are absolutely essential to give to scientific records the stamp of truth. To form a just exposition of a case of disease or injury, or to give a fair reply to a question proposed for the purpose of testing professional acquirements, there should be, in the first place, a correct knowledge and appreciation of the facts involved; then an orderly arrangement of them in the mind; and, lastly, appropriate language for their description. The extreme importance of attention to literary truth and exactitude in a professional career is hardly, I think, sufficiently estimated by medical ob- servers and practitioners in general. It appears to me that, in the test of general education which is now required before the study of the mectical profession can be regularly commenced, more particular inquiries should be made on this subject than are evidently occasionally instituted. I would not ask for any fine writing, but I would consider it an essential ingretlient of fitness for commencing the study of medicine, that - the student should demonstrate that he thoroughly under-stands, and is able to write, plain English. Let me urge those among you who are now preparing for a career in the public service, if you wish to attain eminence in it, not to neglect the - cultivation of exactness in language. There is one other aspect in which this matter may be regarded. It is by the general education of an individual that non-professional persons are apt to estimate the amount of his professional education. Now, where so much depends upon the persons among whom a medical practitioner exercises his profession having confidence in his ability and judgment, it is essential that nothing should be neglected which is calculated to create a favourable impression regarding these qualities. I see it argued in some professional publications that it is injudicious to insist on a liberal general education for medical practitioners, for medical men would not be found to attend upon the poor if it were so. This I believe to be a libel on our profession. We see clergymen of liberal education visiting the poor in all districts, and receiving them into their houses for instruction and advice ; and there seems to me no more diffi-culty in supposing that medical men of liberal education would do the same, than there is in understanding why, under present - circumstances, the curate, however limited his income, or however pauperized the sphere of his avocations may be, .usually takes a higher social status than that of his medical
neighbour. But in the army, at any rate, it is essential, if medical officers intend to maintain the dignity of their pro. fession, and to gain personal respect, that they should be the equals of their brother officers in general education. It is not now as it was formerly with combatant officers, when no test of general education was required before commissions were conferred-when ignorance was often overlooked in favour of interest; all combatants are now required to give proofs of possessing a good general education, and some of a fair knowledge of the natural sciences, before they can hope to obtain a commission in the public service. If the medical officers are to preserve their old distinction of being the men of education and science in the ranks of the army, they must not rest passive, but must exert themselves to advance in the race proportionably with the progress of their neighbours. I have not been exposing to you the brighter aspects of our school affairs. It would have been more agreeable to have looked only at those portions of our work and its progress which are all that can be desired; but it is more profitable to notice and consider the defects which are made apparent from time to time, with the object of effecting their removal, or at least their improvement. I have been trying in the short space of this lecture to offer some advice to those who are commencing their preparations for the practice of their profession in the army, which may be useful in clearing away impediments to their future usefulness, if not distinction. We have reason to know that great good has been gathered by some who have attended this school, and that the good seed gathered is now being sown far and wide, increasing and multiplying. To urge on and improve the work we must weed as well as plant. And I trust I have not been speaking to anyone whose object in entering the public service is merely to confine himself to the narrow limits of just getting through its necessary duties; who is not animated by ambition of continuing to improve himself, and to do as much good to others as his future opportunities will allow ; and who is not prepared and desirous of personally exerting himself to achieve these worthy objects. Even the honours which are now to be gained in the army medical service should act as incentives to such exertions, even if higher motives did not exist. Look at the distinctions which have been won and conferred on the surgeons and assistantsurgeons lately in New Zealand; honours have been more liberally bestowed there in proportion to the numbers employed than they have ever been in any previous campaign. If, then, the intentions I have supposed are really prompting you ; if you regard the short time which you are about to pass here as merely one of preparation for the responsible career which will open before you when you find yourself placed amongst those who, when they are visited by disease or wounds, can come only to their appointed surgeons for aid, and when you yourselves will be thrown, as regards their welfare, so much on your own resources of acquired knowledge; if you are sensible of the benefits which may result to the public service, and satisfaction that may be gained for yourselves, if the trust which will be imposed on you of preserving the health of those entrusted to your sanitary care be turned to full and proper account, I shall have no doubt of your employing your time industriously and profitably during the present session. By doing so you will be not only adding to your knowledge, but will be strengthening those habits of industry and powers of observation which will hereafter be of inestimable service in your course of life, and you will give the greatest satisfaction that can be given to those who have organized and to those who are engaged in carrying out the work of this establishment. —-
PARISH LUNATICS
AND
THEIR
EXAMINATION.-On
at the Clerkenwell Police-court, Mr. Barker, the magistrate, made an order for the removal of a woman who was brought from Clerkenwell Workhouse as an alleged lunatic. It was stated that the woman had been previously examined by Mr. D’Eyncourt, who had refused to make the order for her removal. Although a great many persons are sent from this court to lunatic asylums, these examinations are made in a very cursory way. The alleged lunatics are driven to the court in a cab ; the doctor explains the nature of the case privately to the magistrate ; the magistrate then leaves the court, looks at the alleged lunatic, and having done so, signs the papers, the whole transaction not having taken more than five minutes, and the person is then removed to a lunatic asylum. It is to be presumed that the medical gentlemen who examine the cases do so with the utmost
Friday last,
caution.
Introductory Lecture OF THE
ELEVENTH SESSION OF
THE ARMY MEDICAL Delivered at
BY T. DEPUTY
Netley
on
October
SCHOOL.
3rd, 1865,
LONGMORE, ESQ.,
INSPECTOR-GENERAL,
AND PROFESSOR OF MILITARY SURGERY.
GENTLEMEN,—A few sessions ago it was determined that the formal introductory lectures which were thought to be necessary in the early days of the Army Medical School should be discontinued, and that at the commencement of each fresh session the business for which the school was established should be directly entered upon. It was considered, on the one hand, that a knowledge of the objects of the school had become sufficiently diffused to prevent misunderstanding on the part of those who, under other circumstances, might have regarded it with jealousy from a belief that the Government had organized an establishment which would interfere with the civil medical schools of the country; and, on the other hand, it was thought that the irksomeness to the Professors of seeking new topics of discourse for two introductory lectures annually was not balanced by any corresponding advantages to those for whose benefit the school was maintained. But practically we find it scarcely possible-with a new set of faces looking at us-with the benches of this theatre occupied by gentlemen to whom everything around is new, not merely the place itself, but the system, duties, and conduct of the school, and of the hospital with which it is connected-on whom the restraints of military discipline are suddenly imposed, instead of the selfregulated conduct of their time and its work to which they have been habituated at civil schools, and to whom the varied uniforms, according to duty and rank of the officers and men by whom they are surrounded, nay, the very uniform they themselves are wearing, are all strange--to whom we know from experience there are many things difficult at first to be understood and liable to be misinterpreted,-practically, I say, under these circumstances, we find it scarcely possible to begin the work before us without some introductory observations by way of establishing mutual acquaintance and encouragement, and considering in general terms the road we are about to travel over together. Moreover, as each session passes and time advances, we meet with occurrences and changes to which reference seems desirable, in order that the interests of the school may be further advanced, and the character, standing, and efficiency of those who proceed from it promoted. Firstly, then, in welcoming you to the Army Medical School, let me beg of you to dismiss from your minds the prejudiced remarks which are put forth from time to time respecting your being kept at school notwithstanding you are holding licences
for practice from colleges and universities; and let me ask you to wait until you know by experience what the nature of the work done here is, and can form for yourselves a fair idea of its probable value to you in the career you have selected, before you allow such notions to have any influence on your minds. Such disparaging remarks are, of course, made for the purpose of deterring professional men from competing for appointments in the medical service of the army; but, as far as I know, they have only been made by persons practically unacquainted with the school, who allow their own conceptions to take the place of knowledge of the work which is really done, and who build upon this false foundation an equally false and untenable superstructure ; and generally also by persons who are impressed with the notion that the duties of a military surgeon do not differ from those of practitioners in civil life. I have never known such remarks made by anyone who had gone through the courses of instruction here; but, on the contrary, I have constantly heard at the close of sessions, and that, too, from candidates who have been distinguished for the zeal with which they have taken advantage of the opportunities afforded them, No. 2198.
such, short duration. Wait, then, I say, till the end of the session, and then form your own opinions, and place no dependence on. those of others. Even some who have been employed in the duties of the hospital, in connexion with which the school i& placed, go away with but imperfect notions of the work which is done in it, because they do not frequent the lecture-room or demonstrations in the post-mortem theatre, nor care to benefit by the splendid opportunities of improvement in hygienic and microscopical investigations and the other studies which may be pursued here with so much advantage. Some, on the other hand, and generally those who in the first instance are the most able officers, take advantage of all occasions of improvement which their occupations allow, and these alone ctn fairly esti-mate the advantages afforded to you by her Majesty’s Government in this establishment. I and many others who receivecl’ commissions in the army medical service at a time when no, such school existed, are able fully to appreciate its importance, and can honestly testify to its value from our own experience’ of the want at starting on our duties of much of the informa.. tion which you are now enabled to obtain so easily. It would be mere labour of repetition, were I to take up your time with an account of the history of the Army Medical School, the causes and considerations which led to its establishment, the system on which it is constituted, or the purposes aimed at in the constitution so given. You may find’ full particulars on these matters in the Warrant issued by the! Secretary of State for War in March, 1860, and in the introductory lecture delivered at the opening of the school in, presence of the lamented Lord Herbert, who took so active a. part in its foundation. The lecture, and Lord Herbert’s’ address on that occasion, are printed in the first of the published volumes of the Army Medical Reports I recommend’ you to peruse them, as they will probably enable you to understand your position and liabilities while you remain under the direct authority of the School Senate better than you may otherwise do. Neither do I propose to lay before you any systematic exof the work you will be engaged in during the coming position session. Each professor in the opening lecture of his course will explain the special objects of his department, and the. plan on which they are to be pursued. In addition to thisprogramme, it will be my duty to explain to you at starting the general system of organization given to the Army Medical Department for admission into which you are now candidates, and into which it must be your own fault if you do not enter at the close of the session-its relations to all the other denartments of the military service-the plan on which pitals, including regimental hospitals and general hospitals, such: as this, the Victoria Hospital, are ordered to be carried on;, the functions of those in whom rest the military command and responsibility for discipline and order of the whole establish-ment, and of those in whom the professional direction is vested, as well as to explain to you the nature of the multifarions’duties- professional, sanitary, and statistical -which willhereafter devolve on you as medical officers in the publicservice. I will, therefore, not further refer to these matters, beyond saying, that hereafter you must not forget you are now voluntarily entering an establishment, and adopting for your career in life a service, which has been systematically organized. by the highest authorities of the realm, and that any unsanctioned departure from its established rules will certainly lead to’ trouble as regards the individuals attempting to set them. aside, as well as to interruption of that co-operation of different official departments, and steady progress of the train of publicbusiness which the regulations have been designed to ensure. Without more allusion to the particular kind of work doneat the school, I wish now to try and impress on you the necessity of making the most use you can of the few months during which the session lasts, and I will further ask you to bear with me. while I call your attention to some points which may help to enhance the advantages of your studies, and to further yourfuture advancement. At the commencement, let me tell you,. it will greatly depend on yourselves whether the instructionoffered you at Netley, practical as it is all attempted to be made, is turned to permanent account, or whether its benefit’ is little more than temporary and nominal. You may go through your clinical duties in the wards; you may go through the practical courses of instruction in the hygienic laboratoryand microscopical rooms; you may attend the lectures and demonstrations in this theatre; you may, at the examination at. the close of the session, get enough marks to enable the professors to report you qualified for a commission as an assistantsurgeon in the army; but if all along your mind has not bee’c.:’ ’
military hos-
Royal
422
engaged in the work you have been doing, you will be far below causes, effects, and deductions in particular instances are anathe distance which may be indicated by the mere difference in lyzed and explained, that the understanding has been edunumber of marks between yourself and some other who has cated, and that the written paper is the offspring of a knowworked with a will; who has earnestly tried to teaoh himself, ledge which has become a fixed possession of the writer. There is one part of our future work which I wish to say a -not merely to get by heart, but to fix in his understandingeach step of the course he has been pursuing. A man may few words upon, and that is the clinical instruction which will languidly accomplish a chemical process at the dictation of an be given by the professors and assistant-professors in the wards of or listlessly open his ears to an account of the special hospital. Some whom I am addressing have, doubtless, features presented by a given object.microscopically observed, been dressers or clinical clerks in civil hospitals, or perhaps and possibly at the end may imagine he has imbibed thoroughly assistants to gentlemen in private practice, and have thus bethe instruction imparted to him. Let him try, after the lapse come acquainted with the actual features of certain examples of a week or so, to ascertain for himself, by practical tests, of disease and injury, and practically acquainted with their how much of the instruction so received he retains. If the discrimination. But some others, and, as we have found by trial be sincerely and thoroughly made, he will probably come experience, not a few among those who have come here to the conclusion, that although he had used his ears, his hitherto, have had no such advantages, or have had them only hands, his eyes, and had occupied a certain time in so doing, to a very limited extent. Not having obtained any -insight So with the lectures given into the features of diseases before no real knowledge had resulted. to attend the here : a discourse or demonstration may be torpidly followed; courses of instruction at the established medical schools, such notes, or portions of it, may be jotted down from time to time, as was formerly acquired when the system of apprenticeship these notes afterwards committed to memory, rewritten on existed, and, at the hospitals to which the schools are attached, examination-papers, and yet no useful knowledge have been having been confined to looking on the patients from a disgained. The outer senses have been ostensibly awake, but the tance, as it were, to hearing the casual intermitting remarks mind has been asleep in the first instance; in the second, of surgeons and physicians as they went round the wards to memory has been employed, but its treacherous character visit their patients, without having any active concern in their has not been guarded against by arming the understanding care or treatment, - " walking the hospitals, "-they have come for its keeper. Contrast such a student, if a student he here with only that theoretical information and those crude ean be called, with another who has used his time and opporgeneral notions of diagnosis and therapeutics which entail, tunities more wisely. Let us suppose his time spent in the as a necessary result, endless unexpected doubts and difficulties occupations I just now referred to. In using the microscope, when they are first applied to the actual work of practice. having neglected no opportunity of training himself in the Some gentlemen have told me that they have never had a of his instrument, having educated his eye to patient under their care and treatment before they came to appreciate the appearances presented to it, in distinguishing Netley, have never even been called upon practically to diathose which are true from those which are fallacious, he notes gnose a case of disease or injury until they were required to do the features of the structural object presented and described so in their competitive examination in London. They have to him, compares them with those of other objects previously never had to watch the course of a disease through its varying observed, estimates their differences, and at last, by careful phases, to appreciate its modifications of form and character observation, contrast, and comparison, establishes such a know- according to age, habits, and constitution, or to feel the reledge of its nature and definite characters that, under whatever sponsibility of its treatment, during the whole of their profescircumstances he may again meet with it, he will not fail to sional education. What wonder, then, that those who are recognise it, or, if not present, to speak positively of its ab- practically unacquainted with the shades of distinction which sence. But with such knowledge he will be able to do more: require to be so carefully observed in order to determine diffehe will not merely be able to recognise the simple object itself rences in type of disease, who have never felt the necessity of with which he has thus become acquainted, but he will be in a the close and careful observation which is frequently required position to trace it even when modified to suit modified pur- to decide with exactness upon the results of injury to some poses, or when altered in some of its features by connexion intricate portion of the human frame,-what wonder that they with other structures. According to the nature of the struc- should occasionally make the most startling mistakes in diature he has studied, the knowledge he has gained will assist gnosis, the most faulty suggestions as to practice, when they him in unravelling the nature of some object previously uncer- are first brought into contact with disabled patients ? I know tain, in deciding the nature of a doubtful diseased growth, in that in some hospitals steps are being taken to insure that discussing the function of an organ presented to his notice for every student shall have a certain share of medical and surthe first time; and thus he will be enabled to apply the in- gical practice by introducing a polyclinic system, such as was formation he has acquired to practical uses in the exercise of so strongly advocated by Sir James Clark many years ago in his professional functions, or in the advancement of scientific his published writings ; but it is yet far from being as general pursuits. Equally so with the analytical process in the as circumstances have shown it desirable that it should be. The clinical teachers of this hospital are placed in a position hygienic laboratory. Having made himself acquainted with the actions, reactions, and combinations of the several articles in which no other persons in the kingdom, perhaps, are placed employed in the investigation, having got a full comprehension as regards opportunities of observing the attainments of those of the " whyand " because" of what he has done, he has gained who are just launched from professional training into profespossession of a knowledge which can be applied not merely sional practice. Gentlemen who have recently received licences to the particular purpose through means of which he has acquired to practise from authorized bodies established in all parts of it, but to the determination of others of like importance. The the three great divisions of the kingdom, are gathered together individual steps of the process may be varied, may be joined here. The teachers have to watch the manner in which these with parts of other processes, and turned to endless account. gentlemen deal practically with the treatment of disease; to So in the lecture-room. The listener with thought and under- observe their qualifications for the discharge of those professtanding, who reasons on the facts presented to him, and on sional duties the right performance of which has been the ultithe principles or rules of guidance in practice deduced from mate object of their education. They ascertain their amount them, acquires knowledge which is capable of application not of real knowledge of the human frame, its conformation, and merely to the particular expressions of disease in connexion the effects of injuries and diseases upon it, not by word-ofwith which the remarks of the lecturer have been made, but mouth examination, but by their manner of proceeding to deal to a variety of others, perhaps not contemplated by the in- with the very things themselves. Now, while it is a pleasure to structor, which will afterwards occur to him in his professional observe the practised dexterity of some, and their acquaintance with the right methods of arriving at sound conclusions as to practice. It is impossible to examine the written replies to the ques- the nature of the cases placed under their charge, I should be tions which are put at the examinations at the close of each telling only part of the truth if I were not to add that it is session without observing tkat there have been two such classes occasionally a subject of surprise that others should be so comof workers as I have described. Some replies contain formal pletely adrift, so unable to distinguish common conditions of statements, more or less correct, more or less complete, but disease or effects of injuries, and so ignorant of the common stamped with the evidence of being mere transcripts from manipulations necessary amongst the patients in the medical memory, reproductions of written notes of expressions caught and surgical wards as they have shown themselves to be. Inat the moment they were delivered, but neither considered nor stances have occurred where it has been almost impossible to digested afterwards, and consequently having found no place understand how the colleges which had presented those conin the understanding; while others; on the contrary, show by cerned with their licences could have passed them as qualified, their clear arrangement and rational exposition of facts, by the or what tests they applied to ascertain their fitness for pracgeneral views by the manner in which the relations of tice. And these gentlemen who caused these impressions
the
instructor,
proceeding
manipulation
taken,
423
considerably superior to others who had passed patient, an examination is conducted, still practically by the practice; for, in competing for their army appoint- candidates themselves, under the directions of the professor of ments, they had left others behind who had not been considered ’, pathology, so that not only the conclusions arrived at regardadmissible. The same absence of practical knowledge has been ing the nature of the disease each patient may have laboured from time to time exhibited in the post-mortem examination I under may be subjected to the test of actual inspection, but, The manner of proceeding even to open the body for at the same time, that the habit may be acquired of examinroom. the display of its cavities and their contents, still more of in- ing every part of the body with the care and minuteness with vestigating or expounding their condition, has been quite which such investigations are now required to be conducted strange to some; they had never had the operation to perform. to be of real value, as well as of lucidly describing the results There must be something bad in the system of teaching at in the established records. The importance of such clinical those places whence such instances of deficiency come; and it practice as I have sketched out cannot be overrated, especially is a serious matter for those to whom the regulation of profes- as regards any who have never had such responsibility thrown sional education is entrusted to consider what must be occa- on them before; and even in respect to those who have already sionally the consequences of authorizing for practice persons had some share of practice in England, the peculiar diseases I which occur in such large proportion among the invalids at so unacquainted with the practical work of their profession. am well aware that experience can only be attained with years; this hospital-diseases originating in or modified by tropical that under any system of education the experience of those climates-present materials for study calculated to be most who have recently received licences of practice must be inferior valuable in their future military practice. to that of others who have had opportunities of extensive obserOne of the earliest indications of the good character and of vation ; but it is to be remembered that in the remarks I have the probable high position that will be taken by any one been making I have referred to the difference in attainments among the gentlemen who arrive at Netley, as each fresh set which has been exhibited amongst men of about the same pro- comes, as far as my observation has gone, is industry. It fessional standing as to years, and that there is little reason to seems to be only in the nature of things that, among a number doubt, therefore, if some amongst them, under one system of of candidates collected from all parts of the kingdom, there education, have gained solidly practical knowledge, others, must be very varied degrees of acquirements. It might be who have been so deficient as I have mentioned, might equally supposed that those gentlemen whohad already proved their have gained it under a like system. superiority, who were aware that their store of knowledge was Do not let me be misunderstood when I make these remarks. much greater than that of others, would be inclined to relax They are applicable only to exceptional instances which have their efforts after further improvement, and to exhibit less come to notice. The attempts which have been publicly made diligence in acquiring fresh stores, than their neighbours. We to depreciate universally, without distinction, the attainments have not found it to be so. The general rule has been that of the gentlemen who have been of late entering the medical those who have held the first places on coming to this school service of the army, by stigmatizing them as third-class stu- have been the most industrious after they have come to it. dents, for the sake of achieving certain objects of general Perhaps the industry which had led to the position previously policy, has been most unfair and unworthy. At all events, taken had become so habitual as not to be readily given -tzp9. every gentleman who has entered the public service has or, perhaps, as I rather believe, the knowledge already gained passed through a competitive examination, which others had enabled them to appreciate better the value and importance of tried to do and failed in, and which probably more had thought further extending it, and so formed a stimulus for continued fit not to face from a consciousness of probability of failure. perseverance, just as the desire grows to mount higher and. Those who have published such charges should inspect their higher when ascending a hill for the sake of the prospect. 1, own ranks, for it may fairly be presumed that the candidates am informed that one of the gentlemen of the last session, who have not succeeded at the competitive examinations have whose name will be placed on the tablet on the adjoining wall, passed into civil practice. The division into three classes of made it a rule to shut himself up in his room for three hours those who passed through the competitive examination in daily to study and reflect on the occupations he had been London gave the opportunity for this erroneous stigma being actively engaged in during the morning ; and I know from ob,propagated. This classification really corresponded with the servation that the other gentleman, whose name will also, separation into classes of those who have undergone an exami- appear there, was conspicuous during the whole time he was nation for honours in a university. But it was interpreted by at Netley for his constant diligence.* Without industry, those who did not understand it, or did not choose to under- capacity can avail nothing in our profession ; with it, inferior stand it, to signify the general attainments of those concerned capacity may be compensated, if not removed. Labour con-to comprehend degrees ot comparison with the whole of the quers all things," is an old motto. One of the greatest lyrical passed students of Great Britain. Those who were in the third poets of this country, in writing the life of the eloquent statesof these three classes were publicly called students of third- man and witty dramatist, Sheridan, refers to the industry rate ability. As well might a Master of Arts who had come which was the real source of what was usually regarded as the out in the second class in the competition for classical honours impromptu produce of natural talent, and remarks that at Oxford be stamped for life as a man of second-rate ability. nothing great and conspicuous has ever been achieved, whether Unfounded, however, as the assumption was, on which the it be a poem or a pyramid, but by dint of labour. At the appellation of third-class students was given to those who same time, however, that I thus dwell on the importance of were entering the medical department of the army, it had an earnest work, I would not be supposed to exclude judicious injurious effect among many who were not acquainted with recreation : on the contrary, a proper amount of relaxation is the circumstances whence it sprang, and was a source of pain required in order that the work may be done. to those to whom it was applied. Hence it became necessary, Some who are listening to me have possibly not thought of in order to prevent this abuse of terms, to abandon the division the value of a high place in the list of names which appears in into classes of those who had successfully passed through the the Gazette after the session, when your appointments as assistcompetitive examination in London, and to arrange the list of ant-surgeons are publicly announced. It is only some years names simply according to order of merit, as is done in all afterwards that you will feel all the value, when you are apother army competitive examinations. proaching what is, perhaps, the most important step in an was led into this digression when speaking of the deficiency army medical officer’s career-the promotion from assistantI in practical knowledge of some who have nevertheless been surgeon to the rank of surgeon. These promotions are made, licensed as practitioners. To those gentlemen who have not as a rule, according to seniority, and it is only on extraordinary had the advantages of professional practice, the clinical work occasions of distinguished conduct, or particular merit, that here, brief as the period for it is, is a great boon, as it is also a this rule is departed from. When that time approaches, and great safeguard to the public service ; and I will briefly men- you are watching anxiously the gradual move upwards, as tion the manner in which it is performed. Each candidate is vacancies happen to occur, you will find what a difference placed in professional charge, under the directions of the pro- there is in the dates of promotion amongst the medical officera fessors, of a certain number of patients ; he is required to form whose names appear in the same sessional list with your own. his own diagnosis by personal examination, and to place on You will find the assistant-surgeon at the top of the list, steprecord in his case-book the local and general symptoms of each ping into a vacancy, it may be, months before some of the adcase, and the interpretation he gives to them-to prescribe the joining names; it may be years before the last, when the list treatment, and to order the diets according to the authorized contains as many names as some have since the school has scale of military hospitals. While engaged in this duty, he is been in operation. And the importance of promotion in milimade acquainted with the special relations of each case as reThe tablet referred to bears the names of gentlemen who have taken gards its military bearings, both as respects the public service the highest positions at the successive competitive examinations for medieal must have been
into civil
*
"
*
and the soldier himself.
On the
occurrence
of the death of
a
commissions in the British and Indian armies.
424
tary service does not end with the advantages merely resulting -from increased rank, but, in addition, the promotion immediately widens your opportunities of attaining a higher elevation. The gain of a single place in the list at the end of the session may consequently have a material influence in improving your future prospects in the service. During the year comprehended between March 31st, 1864, and March 31st, 1865, 114 candidates for commissions passed through the school, and were gazettecl to assistant -surgeoncies in the Queen’s British service, while twenty assistant-surgeons were promoted to surgeoncies. Since the 1st of April of the present year there have been already more than that number of promotions-viz., twenty-five ; but even if the number were ,-doubled, it would still show the importance of gaining even a single place in the examination list. I will refer to one other topic which, though not forming ’part of our work here, has an important bearing on it. I allude to the subject of general education. We have had a few in.stances in which there has been such a deficiency in some ’branches of general education-even in knowledge of grammar, spelling, and the meaning of ordinary English terms-as to threaten to lessen materially the usefulness of those concerned - in the public service. It is not part of the duties of the examiners for the medical department of the army, either in London or here, to inquire into general education : professional .-qualifications are the subject of their inquiries. But even here a knowledge of the right signification of words, and of their proper arrangement in composition, becomes important. Want - of it causes, on the one hand, frequent misapprehension of the ’language used in the lecture-room, and, on the other, leads to unintentional but often serious errors in professional documents. The absence of rightly selected terms and expressions, as well as of care in the grammatical construction of sentences, is a frequent source of difficulty to the examiners when they are trying to determine the amount of professional knowledge possessed by the writer of some particular paper under examination. But it is not only in the examination papers that this defective composition creates difficulties : it equally forces itself upon the attention while inspecting the records made of the histories, symptoms, and progress of diseases in the Casebooks. Not only scrupulous exactitude in observation of the minutest details of facts, but also equal accuracy in the expressions employed to record them, are absolutely essential to give to scientific records the stamp of truth. To form a just exposition of a case of disease or injury, or to give a fair reply to a question proposed for the purpose of testing professional acquirements, there should be, in the first place, a correct knowledge and appreciation of the facts involved; then an orderly arrangement of them in the mind; and, lastly, appropriate language for their description. The extreme importance of attention to literary truth and exactitude in a professional career is hardly, I think, sufficiently estimated by medical ob- servers and practitioners in general. It appears to me that, in the test of general education which is now required before the study of the mectical profession can be regularly commenced, more particular inquiries should be made on this subject than are evidently occasionally instituted. I would not ask for any fine writing, but I would consider it an essential ingretlient of fitness for commencing the study of medicine, that - the student should demonstrate that he thoroughly under-stands, and is able to write, plain English. Let me urge those among you who are now preparing for a career in the public service, if you wish to attain eminence in it, not to neglect the - cultivation of exactness in language. There is one other aspect in which this matter may be regarded. It is by the general education of an individual that non-professional persons are apt to estimate the amount of his professional education. Now, where so much depends upon the persons among whom a medical practitioner exercises his profession having confidence in his ability and judgment, it is essential that nothing should be neglected which is calculated to create a favourable impression regarding these qualities. I see it argued in some professional publications that it is injudicious to insist on a liberal general education for medical practitioners, for medical men would not be found to attend upon the poor if it were so. This I believe to be a libel on our profession. We see clergymen of liberal education visiting the poor in all districts, and receiving them into their houses for instruction and advice ; and there seems to me no more diffi-culty in supposing that medical men of liberal education would do the same, than there is in understanding why, under present - circumstances, the curate, however limited his income, or however pauperized the sphere of his avocations may be, .usually takes a higher social status than that of his medical
neighbour. But in the army, at any rate, it is essential, if medical officers intend to maintain the dignity of their pro. fession, and to gain personal respect, that they should be the equals of their brother officers in general education. It is not now as it was formerly with combatant officers, when no test of general education was required before commissions were conferred-when ignorance was often overlooked in favour of interest; all combatants are now required to give proofs of possessing a good general education, and some of a fair knowledge of the natural sciences, before they can hope to obtain a commission in the public service. If the medical officers are to preserve their old distinction of being the men of education and science in the ranks of the army, they must not rest passive, but must exert themselves to advance in the race proportionably with the progress of their neighbours. I have not been exposing to you the brighter aspects of our school affairs. It would have been more agreeable to have looked only at those portions of our work and its progress which are all that can be desired; but it is more profitable to notice and consider the defects which are made apparent from time to time, with the object of effecting their removal, or at least their improvement. I have been trying in the short space of this lecture to offer some advice to those who are commencing their preparations for the practice of their profession in the army, which may be useful in clearing away impediments to their future usefulness, if not distinction. We have reason to know that great good has been gathered by some who have attended this school, and that the good seed gathered is now being sown far and wide, increasing and multiplying. To urge on and improve the work we must weed as well as plant. And I trust I have not been speaking to anyone whose object in entering the public service is merely to confine himself to the narrow limits of just getting through its necessary duties; who is not animated by ambition of continuing to improve himself, and to do as much good to others as his future opportunities will allow ; and who is not prepared and desirous of personally exerting himself to achieve these worthy objects. Even the honours which are now to be gained in the army medical service should act as incentives to such exertions, even if higher motives did not exist. Look at the distinctions which have been won and conferred on the surgeons and assistantsurgeons lately in New Zealand; honours have been more liberally bestowed there in proportion to the numbers employed than they have ever been in any previous campaign. If, then, the intentions I have supposed are really prompting you ; if you regard the short time which you are about to pass here as merely one of preparation for the responsible career which will open before you when you find yourself placed amongst those who, when they are visited by disease or wounds, can come only to their appointed surgeons for aid, and when you yourselves will be thrown, as regards their welfare, so much on your own resources of acquired knowledge; if you are sensible of the benefits which may result to the public service, and satisfaction that may be gained for yourselves, if the trust which will be imposed on you of preserving the health of those entrusted to your sanitary care be turned to full and proper account, I shall have no doubt of your employing your time industriously and profitably during the present session. By doing so you will be not only adding to your knowledge, but will be strengthening those habits of industry and powers of observation which will hereafter be of inestimable service in your course of life, and you will give the greatest satisfaction that can be given to those who have organized and to those who are engaged in carrying out the work of this establishment. —-
PARISH LUNATICS
AND
THEIR
EXAMINATION.-On
at the Clerkenwell Police-court, Mr. Barker, the magistrate, made an order for the removal of a woman who was brought from Clerkenwell Workhouse as an alleged lunatic. It was stated that the woman had been previously examined by Mr. D’Eyncourt, who had refused to make the order for her removal. Although a great many persons are sent from this court to lunatic asylums, these examinations are made in a very cursory way. The alleged lunatics are driven to the court in a cab ; the doctor explains the nature of the case privately to the magistrate ; the magistrate then leaves the court, looks at the alleged lunatic, and having done so, signs the papers, the whole transaction not having taken more than five minutes, and the person is then removed to a lunatic asylum. It is to be presumed that the medical gentlemen who examine the cases do so with the utmost
Friday last,
caution.