OXFORD OPINIONS ON MEDICAL EDUCATION.

708 word must be taken for what it is worth-that the system of medical education, here and everywhere, is somewhat too much of a professorial character, and too little tutorial. I will now explain what the tutor does. I have said that the professor takes in hand his particular subject. I will now say that the ST. MARY’S HOSPITAL MEDICAL SCHOOL. tutor takes in hand not so much a particular subject as a particular man. The tutor is a person who looks after the educaDISTRIBUTION OF PRIZES : ADDRESS OF THE tion of the pupils. No doubt he knows every subject of the ARCHBISHOP OF YORK. whole word which is spoken in the lecture-room; THE annual summer distribution of prizes took place at the but thecourse, every of the tutor is not the same as that of the proobject above school on Wednesday, the 18th instant--his Grace the fessor., who knows his own subject better than anyone else, is Lord Archbishop of York in the chair. The Dean of the acquainted with the latest discoveries in it, and can explain school—Mr. Ernest Hart-read a report expressing the satis- them in the most gracolul language to his audience. The business faction of the Committee of Lecturers at the progressive pro- of the tutor is a totally different one. He assembles round him a small number of men. The number varies according to sperity and efficiency of the school, and the unusual excellence the attraction of the subject, from five to perhaps as many as of many of the papers this year submitted by the students in twenty in a class; though twenty is above the average, and competition for the prizes. He had laid before the Arch. is reckoned at Oxford rather an unwieldy class. He gathers men round him in a room, opens a text book, and explabishop-who was a most distinguished authority on the subject these of high class education, late the very eminent head of Queen’s nations out of this book are given ; but from the very first, questions to the pupils go hand in hand with explanations from College, Oxford, and one of the most accomplished scholars the tutor. In this particular thing lies the point and essence of and able logicians of the University-an account of the whole the whole system- in the particular fact that the attention is system of medical education as at present carried out; and they what I may call active attention, as distinguished from passive would feel great interest in listening to the opinions on this attention, from the very first. No sooner has a man had a quarter of an hour’s instruction from me than I ask him for subject which by his great experience and capacity he was so some return in the shape of questions to which he has to give well qualified to give. answers to me. The term lasts for eight or nine weeks, and a The following prizes were bestowed by his Grace :particular subject or section is exhausted in the course which Winter Session, 1863-64.-Seholarship in Anatomv (value takes place. When a term is drawing towards an end,-I am .625): Mr. Philip George Philps. Prosectorships and Prizes of supposing myself in the position of a tutor,-I can single out £5each : Mr. R. S. P. Griffith, Mr. Land. Prize for students the man who knows the subject very well from the average of the first year (.620), Mr. Henry Franklin Parsons; Certifi- man; or, at the other end of the scale, from the man who recate of honour, Mr. Edmund Blackett Owen. Prize for stu- quires a little whipping and spurring to bring him up to the dents of the second year, Mr. Augustus Muller, Mr. William avexage level. It is plain that the treatment of a conscientious Summer Session, 1863.-Prize for students of tutor of those three classes of men will be quite different. With John Land. the first year, Mr. W. J. Land; Certificate of honour, Mr. those who are behind he has to speak to them privately, warn Theodore Thomas Taylor. Prize for students of the second them, and put them in the way of reading something extra, so year, Mr. Francis John Marshall, Mr. Augustus Miiller; Cer- as to make up lee-way. With those who are in advance he tificates of honour, Mr. P. G. Philps, Mr. Hamilton de Tatham. takes the greatest possible pleasure in carrying them a little - Comparative Anatomy, 1863 : Prize, Mr. Henri Bertin. higher in the subject. He has them in his room, and over the Natural Philosophy, 1863: Prize, Mr. James Forbes Sargent ; tea-table explains things which they ask him, or which he Certificate of honour, Mr. J. H. Webb. Practical Anatomy, wishes to put before them; or he takes them out for a walk Practical Anatomy, 186364: along the banks of the river, and turns the walk into a kind of 1862-63 : Mr. Henri Bertin. Mr. N. Bisdee Major. peripatetic lecture; so that you see he has from the first not so The ARCHBISHOP OF YORK then rose and said,-Ladies and much the charge of the subject as charge of the men who are doing the subject. I am afraid perhaps that I am prejudiced gentlemen : Having concluded a very pleasant part of my duty, in favour of this method; but I am quite sure that this kind of I now proceed to address a few remarks to you upon a subject active attention is very easy on the part of the pupil, whereas with which I am afraid I must at once confess that I am by no - and this I would commend to the consideration of those who means deeply conversant. At the same time, having passed have had more experience than myself here-what I call pasthe best years of my life in the work of education, in an eminent sive attention, the attention which receives and gives nothing is extraordinarily difficult to maintain. I could not un. place of learning, I have, of course, acquired an impression as back, dertake to sit on this hot day for two or three hours in succes. to the methods of education, and it is not impossible that some sion, and listen even to the most brilliant lecturer, remaining light may be thrown on the present discussions with regard to passive the whole time, and say that at the end I could remedical education by one who approaches from a totally different member all that he had told me, or even half of it. In fact, if point of view, and who brings to bear on them observation ad- I were one of a large attendance at lectures, I would not underduced from a totally different class of studies. I have passed ’, take to say that some of those listeners might not towards the my life in the University of Oxford, and there the system of ’, end have declined into sleep. Such a state of things would have teaching is essentially a mixed system. We have professors nothing to do even with the brilliance of the lecturer. It is a who, in their different lines, I believe it will be admitted are law of nature that my mind can be acted upon if it is allowed to react. If you asked me to put myself into a kind of trance, second to those of no University. But the staple education the place does not proceed from these professors. We have ! and be acted on solely, I should be disposed to say, " Give me a little of that, and then allow me in my turn to act, because a besides, scattered through all the Colleges, a class of called tutors, upon whom, in reality, devolves the real work of passive state is not natural." You will observe, no doubt, that education. I am not for a moment depreciating the labours of I am taking a very one-sided view of the subject. I am mainthe professors-far from it. The function of the professor is taining the cause of the tutorial system wholly against that of this, that he takes under his charge a particular subject, works the professorial system; and why? Not that I do not see great at that, carries his studies in it as far as he can carry them, and advantages also in the professorial system of other kinds, but gives lectures in it to all who approach him. The consequence that I do think, on the whole, for a place where subjects are to is, that he undoubtedly keeps up the standard of his particular be taught to the average run of men, where you consider the subject in the place. It happens, therefore, that very fre- man more than the subject, the tutorial system, in some of its quently an eminent professor will see gathered in his lecture- modifications, is the system most profitable to be employed. The lectures of the professor I have heard from your excellent Dean that the number of lec. room as many tutors as pupils. tures given tn the students is extremely great. I forget how are usually fixed when the College lectures are not going on, because the College tutors themselves are quite willing to come many in the week the student is expected to attend. and sit at the feet of the professors, and keep up their knowMr. HART : From fourteen to twenty-one. The ARCHBISHOP : From fourteen to twenty one in the week! ledge of the subject, perhaps without any ulterior object, but from the mere pleasure of hearing an able man discuss and That is something exceedingly great. At Oxford, where the explain that with which he is most conversant. Now I come- lectures, 1 think, are easier, we consider twelve in the week a and I think it will be admitted to bear upon the studies of a very good average; and at the end of a student’s course, he place like this-to explain what it is the tutor does. I have will often come to the tutor and say, " I am pursuing my own got a kind of impression-it may be quite wrong, so that every studies, reading this and that book, and have attended lectures

OXFORD OPINIONS ON MEDICAL EDUCATION.

of

persons

709 this and that subject before; could you not let me off the lo:tures which call me out of my room and interrupt my course of study considerably ?-could you not trust me a little by my self during my last term ?" It is a peculiarity of the systen "Audi alteram partem:’ that when a man is known to be at work, and comes to his tutor and says, " This is my last term. I am going up for ex amination next term, and I wish to be excused some of th< FEES FOR PHYSICIANS AND GENERAL lectures," his request is granted as a matter of course. Yot PRACTITIONERS. will see that there is a very great difference between your sys To the Editor of THE LANCET. tem and ours with respect to the number of lectures. I con. fess my ignorance of the whole matter as regards you; but stil SiR,-I beg to tender you my sincere thanks for the manner having formed my own impressions of human nature, I am dis in which you have responded to the request expressed by myposed to say a word in favour of mercy with regard to thE self and some of my professional brethren, that you would furnumber of lectures. (Cheers.) I said just now that it seemed nish the general practitioners with a scale of medical charges. to me almost impossible that a man could sit three or fou) This you have done in last week’s LANCET, in a masterly article hours constantly receiving and giving nothing back without on the subject, in a way at once calculated to secure remunerawasting a considerable portion of that time. I believe that tion for our services, and to divest the bills of medical practhe habit of attending lectures is not a thing given by nature. titioners of the mercantile affinity which those impart to them It must be acquired; and I do not know that we are always who charge for medicines. Is it to be wondered at that the willing to give much trouble to acquire it. The consequence skill and time of the doctor, thus ignored by himself, should is that a good deal of information which is poured in must not be at all appreciated by the patient ? Nor have the banebubble out again, and be entirely lost. It seems to me quite ful effects of this degrading charge-for. physic system been conpossible that a hint from our system may profitably be taken fined to those who practise it, as the following case from my by an excellent institution such as this is. Be sure that the own practice will exemplify. I lately attended the son of a minds of the young men are in active operation ; and then, when farmer in this neighbourhood for injury to his head, implicating you know your men,-when the tutor can see that they are doing the brain. This being a case where more vigilance than meditheir work in his section or class,-let him trust them a little cine was called for, my bill, charging for attendance only, and more, and not exact so many lectures. (Cheers.) Of course it is quite within the standard you give, exceeded the expectation understood that the lecturer knows what they are doing when of my patient’s father, who took umbrage at it, and seized they are not in his room, and still in the way of the subject. the next opportunity of sickness occurring in his family to call The lecturer should have a kind of picture of each of the pupils in a cheaper doctor, albeit more remote and a F.R.C.S., who. in his mind, and be able to say of them, " This is an active it appears, keeps up the old style of charging for physic. I man, who can take care of himself. This man wants a little may briefly mention another instance in point. At the end of whipping up; I must privately lead him on. This man is very last year I was called upon to attend a journeyman blacksmith idle ; I must give him warning." When we have got that kind for blind external fistula. in ano, on which I operated successof picture of each man in our minds, it is not necessary to fully. My bill for attendance on this patient, also for attendchain and fetter by lectures quite so much. But observe, what ance upon his wife for opacity of the cornea, amounted to I would put in the place of a number of lectures is the constant X318s. 6d. As my patient, as soon as he was well, fled from habit of examining the men in what they have been doing. this locality without paying me, I sued him in the County (Cheers.) I do not mean that kind of examination in which Court, where, on the 6th instant, he appeared to object to my the lecturer would make a return of the twenty, thirty, or account, because "he had had no medicine!" His Honour forty marks which each pupil had obtained for his examination. very properly remarked that " the charge was very low; that I mean that preliminary kind of examination for the satisfaction he had undergone a very serious surgical operation ; and that, of the lecturer only, that he may see what his class are really medicine or no medicine, he must pay his medical attendant doing. He should begin by examining them on the first day. for his skill." It is quite possible that in this way he will, by some question Again thanking you for the boon conferred on the general that he puts, demonstrate to a young man that whereas he practitioners,-I remain, Sir. yours much obliged, T. OSBORNE WALKER. M.R.C.S. &c. thought he had been listening, he really had not. I am persuaded that this habit of examination, this turning the attention from passive into active attention, is a most important To the Editor of THE LANCET. instrument in the way of study. I do not for a moment expect that hints like these, given so crudely, and coming from quite SiR,-The question of professional charges, to which you referred in a leading article on the llth instant, is one of great a different element, should have great authority here; but still they will throw out seeds of thought which may hereafter be importance and interest, and deserves more attention from fruitful. (Cheers ) If I am not mistaken, there are even those members of the profession whose opinions would be restronger reasons, in regard to the studies pursued here, for spected than it has yet received in your pages. I should be leaving the students somewhat to themselves, than with regard glad to hear what our leading London and provincial general to us at Oxford. Our business is with books, and when a man practitioners have to say on the subject. Meanwhile I, as a less is summoned to lectures, he can put a mark on the book he is distinguished London practitioner, will mention the charges I studying, come back, and take up the subject where he left off. am myself in the habit of considering just and equitable. The necessity for making more than one scale of remuneraNothing is changed after his lecture is over. But I take it, though I know but little of chemistry, that in the case of che- tion is, I think, sufficiently obvions; but whereas you propose mistry you cannot leave all your test tubes and retorts simmer- two classes, I find it absolutely necessary to make three. In ing and fizzing, go off to lectures and return, without a certain Class A, I charge 5s. a visit, exclusive of medicines, which I interruption and loss of time and material, and without a cer- supply at a rate varying according to circumstances, but in tain fret and worry of one’s thoughts. I presume the same is general about 2s. 6d. or 3s. 6d. a bottle. In Class B, a visit the case with regard to dissection, and, to a certain extent, with without medicine is 3s. 6d. ; or including medicine, 5s. In regard to everything requiring the use of hands and instruments. Class C, I charge 3s. 6d. a visit, inclusive of medicine. I do not think a general practitioner in London can charge If you can trust your pupil, and be sure that he is at work, better let him do it, and not tease and worry him to come differently according to distance. Patients expect that if you backwards and forwards to be instructed. These are the only undertake to attend them you will do so at the same rate as hints I am disposed to give on the subject of education. I that which a medical man in their own neighbourhood would would commend to those persons, for whom I have the greatest charge. This as a rule; there are of course exceptions. I cannot agree with you in considering that two guineas is the most respect as a class, who are instructing our youth in important science of medicine, to consider whether the tutorial the proper ordinary fee for a physician visiting a patient in consystem does in fact supply the most important want which is sultation. I have found very few physicians, however eminent, who expect more than one guinea, unless the distance to be beginning to make itself felt in the system pursued here. His Grace then proceeded to discourse with remarkable elo- traversed be considerable, as three or four miles. I think the Medical Council would do us good service by quence and force upon the difficulties of medical science, the necessity for something more than mere physical education, and fixing a scale or scales of charges which they consider " reasonexpressed his desire that every medical man should fulfil his able ;" this scale of course would not be binding, but merely a duties with a sense of devoutness, and a willingness to say guide to both doctor and patient. 99 a word in season," which might make him, in time of I should like to know the opinion of yourself and the profession as to the charges which should be made when a patient sity, the minister of even more than corporeal consolation. on

Correspondence.

neces-