The sense in which "Natural History" was used at the time I am now speaking of has, to a certain extent, endured to the present day. There are now in existence in some of our northern universities, chairs of "Civil and Natural History," in which "Natural History" is used to indicate exactly what Hobbes and Bacon meant by that term. The unhappy incumbent of the chair of Natural History is, or was, supposed to cover the whole ground of geology, mineralogy, and zoology, perhaps even botany, in his lectures.

But as science made the marvellous progress which it did make at the latter end of the last and the beginning of the present century, thinking men began to discern that under this title of "Natural History" there were included very heterogeneous constituents—that, for example, geology and mineralogy were, in many respects, widely different from botany and zoology; that a man might obtain an extensive knowledge of the structure and functions of plants and animals, without having need to enter upon the study of geology or mineralogy, and vice versa; and, further as knowledge advanced, it became clear that there was a great analogy, a very close alliance, between those two sciences, of botany and zoology which deal with human beings, while they are much more widely separated from all other studies. It is due to Buffon to remark that he clearly recognised this great fact. He says: "Ces deux genres d'etres organises [les animaux et les vegetaux] ont beaucoup plus de proprietes communes que de differences reelles." Therefore, it is not wonderful that, at the beginning of the present century, in two different countries, and so far as I know, without any intercommunication, two famous men clearly conceived the notion of uniting the sciences which deal with living matter into one whole, and of dealing with them as one discipline. In fact, I may say there were three men to whom this idea occurred contemporaneously, although there were but two who carried it into effect, and only one who worked it out completely. The persons to whom I refer were the eminent physiologist Bichat, and the great naturalist Lamarck, in France; and a distinguished German, Treviranus. Bichat [1] assumed the existence of a special group of "physiological" sciences. Lamarck, in a work published in 1801, [2] for the first time made use of the name "Biologie," from the two Greek words which signify a discourse upon life and living things. About the same time, it occurred to Treviranus, that all those sciences which deal with living matter are essentially and fundamentally one, and ought to be treated as a whole; and, in the year 1802, he published the first volume of what he also called "Biologie." Treviranus's great merit lies in this, that he worked out his idea, and wrote the very remarkable book to which I refer. It consists of six volumes, and occupied its author for twenty years—from 1802 to 1822.

That is the origin of the term "Biology"; and that is how it has come about that all clear thinkers and lovers of consistent nomenclature have substituted for the old confusing name of "Natural History," which has conveyed so many meanings, the term "Biology" which denotes the whole of the sciences which deal with living things, whether they be animals or whether they be plants. Some little time ago—in the course of this year, I think—I was favoured by a learned classic, Dr. Field of Norwich, with a disquisition, in which he endeavourved to prove that, from a philological point of view, neither Treviranus nor Lamarck had any right to coin this new word "Biology" for their purpose; that, in fact, the Greek word "Bios" had relation only to human life and human affairs, and that a different word was employed by the Greeks when they wished to speak of the life of animals and plants. So Dr. Field tells us we are all wrong in using the term biology, and that we ought to employ another; only he is not sure about the propriety of that which he proposes as a substitute. It is a somewhat hard one—"zootocology." I am sorry we are wrong, because we are likely to continue so. In these matters we must have some sort of "Statute of Limitations." When a name has been employed for half a century, persons of authority [3] have been using it, and its sense has become well understood, I am afraid people will go on using it, whatever the weight of philological objection.

Now that we have arrived at the origin of this word "Biology," the next point to consider is: What ground does it cover? I have said that in its strict technical sense, it denotes all the phenomena which are exhibited by living things, as distinguished from those which are not living; but while that is all very well, so long as we confine ourselves to the lower animals and to plants, it lands us in considerable difficulties when we reach the higher forms of living things. For whatever view we may entertain about the nature of man, one thing is perfectly certain, that he is a living creature. Hence, if our definition is to be interpreted strictly, we must include man and all his ways and works under the head of Biology; in which case, we should find that psychology, politics, and political economy would be absorbed into the province of Biology. In fact, civil history would be merged in natural history. In strict logic it may be hard to object to this course, because no one can doubt that the rudiments and outlines of our own mental phenomena are traceable among the lower animals. They have their economy and their polity, and if, as is always admitted, the polity of bees and the commonwealth of wolves fall within the purview of the biologist proper, it becomes hard to say why we should not include therein human affairs, which, in so many cases, resemble those of the bees in zealous getting, and are not without a certain parity in the proceedings of the wolves. The real fact is that we biologists are a self-sacrificing people; and inasmuch as, on a moderate estimate, there are about a quarter of a million different species of animals and plants to know about already, we feel that we have more than sufficient territory. There has been a sort of practical convention by which we give up to a different branch of science what Bacon and Hobbes would have called "Civil History." That branch of science has constituted itself under the head of Sociology. I may use phraseology which, at present, will be well understood and say that we have allowed that province of Biology to become autonomous; but I should like you to recollect that that is a sacrifice, and that you should not be surprised if it occasionally happens that you see a biologist apparently trespassing in the region of philosophy or politics; or meddling with human education; because, after all, that is a part of his kingdom which he has only voluntarily forsaken.

Having now defined the meaning of the word Biology, and having indicated the general scope of Biological Science, I turn to my second question, which is—Why should we study Biology? Possibly the time may come when that will seem a very odd question. That we, living creatures, should not feel a certain amount of interest in what it is that constitutes our life will eventually, under altered ideas of the fittest objects of human inquiry, appear to be a singular phenomenon; but at present, judging by the practice of teachers and educators, Biology would seem to be a topic that does not concern us at all. I propose to put before you a few considerations with which I dare say many will be familiar already, but which will suffice to show—not fully, because to demonstrate this point fully would take a great many lectures—that there are some very good and substantial reasons why it may be advisable that we should know something about this branch of human learning.

I myself entirely agree with another sentiment of the philosopher of Malmesbury, "that the scope of all speculation is the performance of some action or thing to be done," and I have not any very great respect for, or interest in, mere knowing as such. I judge of the value of human pursuits by their bearing upon human interests; in other words, by their utility; but I should like that we should quite clearly understand what it is that we mean by this word "utility." In an Englishman's mouth it generally means that by which we get pudding or praise, or both. I have no doubt that is one meaning of the word utility, but it by no means includes all I mean by utility. I think that knowledge of every kind is useful in proportion as it tends to give people right ideas, which are essential to the foundation of right practice, and to remove wrong ideas, which are the no less essential foundations and fertile mothers of every description of error in practice. And inasmuch as, whatever practical people may say, this world is, after all, absolutely governed by ideas, and very often by the wildest and most hypothetical ideas, it is a matter of the very greatest importance that our theories of things, and even of things that seem a long way apart from our daily lives, should be as far as possible true, and as far as possible removed from error. It is not only in the coarser, practical sense of the word "utility," but in this higher and broader sense, that I measure the value of the study of biology by its utility; and I shall try to point out to you that you will feel the need of some knowledge of biology at a great many turns of this present nineteenth century life of ours. For example, most of us attach great importance to the conception which we entertain of the position of man in this universe and his relation to the rest of nature. We have almost all been told, and most of us hold by the tradition, that man occupies an isolated and peculiar position in nature; that though he is in the world he is not of the world; that his relations to things about him are of a remote character; that his origin is recent, his duration likely to be short, and that he is the great central figure round which other things in this world revolve. But this is not what the biologist tells us.

At the present moment you will be kind enough to separate me from them, because it is in no way essential to my present argument that I should advocate their views. Don't suppose that I am saying this for the purpose of escaping the responsibility of their beliefs; indeed, at other times and in other places, I do not think that point has been left doubtful; but I want clearly to point out to you that for my present argument they may all be wrong; and, nevertheless, my argument will hold good. The biologists tell us that all this is an entire mistake. They turn to the physical organisation of man. They examine his whole structure, his bony frame and all that clothes it. They resolve him into the finest particles into which the microscope will enable them to break him up. They consider the performance of his various functions and activities, and they look at the manner in which he occurs on the surface of the world. Then they turn to other animals, and taking the first handy domestic animal—say a dog—they profess to be able to demonstrate that the analysis of the dog leads them, in gross, to precisely the same results as the analysis of the man; that they find almost identically the same bones, having the same relations; that they can name the muscles of the dog by the names of the muscles of the man, and the nerves of the dog by those of the nerves of the man, and that, such structures and organs of sense as we find in the man such also we find in the dog; they analyse the brain and spinal cord and they find that the nomenclature which fits, the one answers for the other. They carry their microscopic inquiries in the case of the dog as far as they can, and they find that his body is resolvable into the same elements as those of the man. Moreover, they trace back the dog's and the man's development, and they find that, at a certain stage of their existence, the two creatures are not distinguishable the one from the other; they find that the dog and his kind have a certain distribution over the surface of the world, comparable in its way to the distribution of the human species. What is true of the dog they tell us is true of all the higher animals; and they assert that they can lay down a common plan for the whole of these creatures, and regard the man and the dog, the horse and the ox as minor modifications of one great fundamental unity. Moreover, the investigations of the last three-quarters of a century have proved, they tell us, that similar inquiries, carried out through all the different kinds of animals which are met with in nature, will lead us, not in one straight series, but by many roads, step by step, gradation by gradation, from man, at the summit, to specks of animated jelly at the bottom of the series. So that the idea of Leibnitz, and of Bonnet, that animals form a great scale of being, in which there are a series of gradations from the most complicated form to the lowest and simplest; that idea, though not exactly in the form in which it was propounded by those philosophers, turns out to be substantially correct. More than this, when biologists pursue their investigations into the vegetable world, they find that they can, in the same way, follow out the structure of the plant, from the most gigantic and complicated trees down through a similar series of gradations, until they arrive at specks of animated jelly, which they are puzzled to distinguish from those specks which they reached by the animal road.

Thus, biologists have arrived at the conclusion that a fundamental uniformity of structure pervades the animal and vegetable worlds, and that plants and animals differ from one another simply as diverse modifications of the same great general plan.

Again, they tell us the same story in regard to the study of function. They admit the large and important interval which, at the present time, separates the manifestations of the mental faculties observable in the higher forms of mankind, and even in the lower forms, such as we know them, from those exhibited by other animals; but, at the same time, they tell us that the foundations, or rudiments, of almost all the faculties of man are to be met with in the lower animals; that there is a unity of mental faculty as well as of bodily structure, and that, here also, the difference is a difference of degree and not of kind. I said "almost all," for a reason. Among the many distinctions which have been drawn between the lower creatures and ourselves, there is one which is hardly ever insisted on, [4] but which may be very fitly spoken of in a place so largely devoted to Art as that in which we are assembled. It is this, that while, among various kinds of animals, it is possible to discover traces of all the other faculties of man, especially the faculty of mimicry, yet that particular form of mimicry which shows itself in the imitation of form, either by modelling or by drawing, is not to be met with. As far as I know, there is no sculpture or modelling, and decidedly no painting or drawing, of animal origin. I mention the fact, in order that such comfort may be derived therefrom as artists may feel inclined to take.

If what the biologists tell us is true, it will be needful to get rid of our erroneous conceptions of man, and of his place in nature, and to substitute right ones for them. But it is impossible to form any judgment as to whether the biologists are right or wrong, unless we are able to appreciate the nature of the arguments which they have to offer.

One would almost think this to be a self-evident proposition. I wonder what a scholar would say to the man who should undertake to criticise a difficult passage in a Greek play, but who obviously had not acquainted himself with the rudiments of Greek grammar. And yet, before giving positive opinions about these high questions of Biology, people not only do not seem to think it necessary to be acquainted with the grammar of the subject, but they have not even mastered the alphabet. You find criticism and denunciation showered about by persons who not only have not attempted to go through the discipline necessary to enable them to be judges, but who have not even reached that stage of emergence from ignorance in which the knowledge that such a discipline is necessary dawns upon the mind. I have had to watch with some attention—in fact I have been favoured with a good deal of it myself—the sort of criticism with which biologists and biological teachings are visited. I am told every now and then that there is a "brilliant article" [5] in so-and-so, in which we are all demolished. I used to read these things once, but I am getting old now, and I have ceased to attend very much to this cry of "wolf." When one does read any of these productions, what one finds generally, on the face of it is, that the brilliant critic is devoid of even the elements of biological knowledge, and that his brilliancy is like the light given out by the crackling of thorns under a pot of which Solomon speaks. So far as I recollect, Solomon makes use of the image for purposes of comparison; but I will not proceed further into that matter.

Two things must be obvious: in the first place, that every man who has the interests of truth at heart must earnestly desire that every well-founded and just criticism that can be made should be made; but that, in the second place, it is essential to anybody's being able to benefit by criticism, that the critic should know what he is talking about, and be in a position to form a mental image of the facts symbolised by the words he uses. If not, it is as obvious in the case of a biological argument, as it is in that of a historical or philological discussion, that such criticism is a mere waste of time on the part of its author, and wholly undeserving of attention on the part of those who are criticised. Take it then as an illustration of the importance of biological study, that thereby alone are men able to form something like a rational conception of what constitutes valuable criticism of the teachings of biologists. [6]

Next, I may mention another bearing of biological knowledge—a more practical one in the ordinary sense of the word. Consider the theory of infectious disease. Surely that is of interest to all of us. Now the theory of infectious disease is rapidly being elucidated by biological study. It is possible to produce, from among the lower animals, examples of devastating diseases which spread in the same manner as our infectious disorders, and which are certainly and unmistakably caused by living organisms. This fact renders it possible, at any rate, that that doctrine of the causation of infectious disease which is known under the name of "the germ theory" may be well-founded; and, if so, it must needs lead to the most important practical measures in dealing with those terrible visitations. It may be well that the general, as well as the professional, public should have a sufficient knowledge of biological truths to be able to take a rational interest in the discussion of such problems, and to see, what I think they may hope to see, that, to those who possess a sufficient elementary knowledge of Biology, they are not all quite open questions.

Let me mention another important practical illustration of the value of biological study. Within the last forty years the theory of agriculture has been revolutionised. The researches of Liebig, and those of our own Lawes and Gilbert, have had a bearing upon that branch of industry the importance of which cannot be over-estimated; but the whole of these new views have grown out of the better explanation of certain processes which go on in plants; and which, of course, form a part of the subject-matter of Biology.

I might go on multiplying these examples, but I see that the clock won't wait for me, and I must therefore pass to the third question to which I referred:—Granted that Biology is something worth studying, what is the best way of studying it? Here I must point out that, since Biology is a physical science, the method of studying it must needs be analogous to that which is followed in the other physical sciences. It has now long been recognised that, if a man wishes to be a chemist, it is not only necessary that he should read chemical books and attend chemical lectures, but that he should actually perform the fundamental experiments in the laboratory for himself, and thus learn exactly what the words which he finds in his books and hears from his teachers, mean. If he does not do so, he may read till the crack of doom, but he will never know much about chemistry. That is what every chemist will tell you, and the physicist will do the same for his branch of science. The great changes and improvements in physical and chemical scientific education, which have taken place of late, have all resulted from the combination of practical teaching with the reading of books and with the hearing of lectures. The same thing is true in Biology. Nobody will ever know anything about Biology except in a dilettante "paper-philosopher" way, who contents himself with reading books on botany, zoology, and the like; and the reason of this is simple and easy to understand. It is that all language is merely symbolical of the things of which it treats; the more complicated the things, the more bare is the symbol, and the more its verbal definition requires to be supplemented by the information derived directly from the handling, and the seeing, and the touching of the thing symbolised:—that is really what is at the bottom of the whole matter. It is plain common sense, as all truth, in the long run, is only common sense clarified. If you want a man to be a tea merchant, you don't tell him to read books about China or about tea, but you put him into a tea-merchant's office where he has the handling, the smelling, and the tasting of tea. Without the sort of knowledge which can be gained only in this practical way, his exploits as a tea merchant will soon come to a bankrupt termination. The "paper-philosophers" are under the delusion that physical science can be mastered as literary accomplishments are acquired, but unfortunately it is not so. You may read any quantity of books, and you may be almost as ignorant as you were at starting, if you don't have, at the back of your minds, the change for words in definite images which can only be acquired through the operation of your observing faculties on the phenomena of nature.

It may be said:—"That is all very well, but you told us just now that there are probably something like a quarter of a million different kinds of living and extinct animals and plants, and a human life could not suffice for the examination of one-fiftieth part of all these." That is true, but then comes the great convenience of the way things are arranged; which is, that although there are these immense numbers of different kinds of living things in existence, yet they are built up, after all, upon marvellously few plans.

There are certainly more than 100,000 species of insects, and yet anybody who knows one insect—if a properly chosen one—will be able to have a very fair conception of the structure of the whole. I do not mean to say he will know that structure thoroughly, or as well as it is desirable he should know it; but he will have enough real knowledge to enable him to understand what he reads, to have genuine images in his mind of those structures which become so variously modified in all the forms of insects he has not seen. In fact, there are such things as types of form among animals and vegetables, and for the purpose of getting a definite knowledge of what constitutes the leading modifications of animal and plant life, it is not needful to examine more than a comparatively small number of animals and plants.

Let me tell you what we do in the biological laboratory which is lodged in a building adjacent to this. There I lecture to a class of students daily for about four-and-a-half months, and my class have, of course, their text-books; but the essential part of the whole teaching, and that which I regard as really the most important part of it, is a laboratory for practical work, which is simply a room with all the appliances needed for ordinary dissection. We have tables properly arranged in regard to light, microscopes, and dissecting instruments, and we work through the structure of a certain number of animals and plants. As, for example, among the plants, we take a yeast plant, a Protococcus, a common mould, a Chara, a fern, and some flowering plant; among animals we examine such things as an Amoeba, a Vorticella, and a fresh-water polype. We dissect a star-fish, an earth-worm, a snail, a squid, and a fresh-water mussel. We examine a lobster and a cray-fish, and a black beetle. We go on to a common skate, a cod-fish, a frog, a tortoise, a pigeon, and a rabbit, and that takes us about all the time we have to give. The purpose of this course is not to make skilled dissectors, but to give every student a clear and definite conception, by means of sense-images, of the characteristic structure of each of the leading modifications of the animal kingdom; and that is perfectly possible, by going no further than the length of that list of forms which I have enumerated. If a man knows the structure of the animals I have mentioned, he has a clear and exact, however limited, apprehension of the essential features of the organisation of all those great divisions of the animal and vegetable kingdoms to which the forms I have mentioned severally belong. And it then becomes possible for him to read with profit; because every time he meets with the name of a structure, he has a definite image in his mind of what the name means in the particular creature he is reading about, and therefore the reading is not mere reading. It is not mere repetition of words; but every term employed in the description, we will say, of a horse, or of an elephant, will call up the image of the things he had seen in the rabbit, and he is able to form a distinct conception of that which he has not seen, as a modification of that which he has seen.

I find this system to yield excellent results; and I have no hesitation whatever in saying, that any one who has gone through such a course, attentively, is in a better position to form a conception of the great truths of Biology, especially of morphology (which is what we chiefly deal with), than if he had merely read all the books on that topic put together.

The connection of this discourse with the Loan Collection of Scientific Apparatus arises out of the exhibition in that collection of certain aids to our laboratory work. Such of you as have visited that very interesting collection may have noticed a series of diagrams and of preparations illustrating the structure of a frog. Those diagrams and preparations have been made for the use of the students in the biological laboratory. Similar diagrams and preparations illustrating the structure of all the other forms of life we examine, are either made or in course of preparation. Thus the student has before him, first, a picture of the structure he ought to see; secondly, the structure itself worked out; and if with these aids, and such needful explanations and practical hints as a demonstrator can supply, he cannot make out the facts for himself in the materials supplied to him, he had better take to some other pursuit than that of biological science.

I should have been glad to have said a few words about the use of museums in the study of Biology, but I see that my time is becoming short, and I have yet another question to answer. Nevertheless, I must, at the risk of wearying you, say a word or two upon the important subject of museums. Without doubt there are no helps to the study of Biology, or rather to some branches of it, which are, or may be, more important than natural history museums; but, in order to take this place in regard to Biology, they must be museums of the future. The museums of the present do not, by any means, do so much for us as they might do. I do not wish to particularise, but I dare say many of you, seeking knowledge, or in the laudable desire to employ a holiday usefully, have visited some great natural history museum. You have walked through a quarter of a mile of animals, more or less well stuffed, with their long names written out underneath them; and, unless your experience is very different from that of most people, the upshot of it all is that you leave that splendid pile with sore feet, a bad headache, and a general idea that the animal kingdom is a "mighty maze without a plan." I do not think that a museum which brings about this result does all that may be reasonably expected from such an institution. What is needed in a collection of natural history is that it should be made as accessible and as useful as possible, on the one hand to the general public, and on the other to scientific workers. That need is not met by constructing a sort of happy hunting-ground of miles of glass cases; and, under the pretence of exhibiting everything putting the maximum amount of obstacle in the way of those who wish properly to see anything.

What the public want is easy and unhindered access to such a collection as they can understand and appreciate; and what the men of science want is similar access to the materials of science. To this end the vast mass of objects of natural history should be divided into two parts—one open to the public, the other to men of science, every day. The former division should exemplify all the more important and interesting forms of life. Explanatory tablets should be attached to them, and catalogues containing clearly-written popular expositions of the general significance of the objects exhibited should be provided. The latter should contain, packed into a comparatively small space, in rooms adapted for working purposes, the objects of purely scientific interest. For example, we will say I am an ornithologist. I go to examine a collection of birds. It is a positive nuisance to have them stuffed. It is not only sheer waste, but I have to reckon with the ideas of the bird-stuffer, while, if I have the skin and nobody has interfered with it, I can form my own judgment as to what the bird was like. For ornithological purposes, what is needed is not glass cases full of stuffed birds on perches, but convenient drawers into each of which a great quantity of skins will go. They occupy no great space and do not require any expenditure beyond their original cost. But for the edification of the public, who want to learn indeed, but do not seek for minute and technical knowledge, the case is different. What one of the general public walking into a collection of birds desires to see is not all the birds that can be got together. He does not want to compare a hundred species of the sparrow tribe side by side; but he wishes to know what a bird is, and what are the great modifications of bird structure, and to be able to get at that knowledge easily. What will best serve his purpose is a comparatively small number of birds carefully selected, and artistically, as well as accurately, set up; with their different ages, their nests, their young, their eggs, and their skeletons side by side; and in accordance with the admirable plan which is pursued in this museum, a tablet, telling the spectator in legible characters what they are and what they mean. For the instruction and recreation of the public such a typical collection would be of far greater value than any many-acred imitation of Noah's ark.

Lastly comes the question as to when biological study may best be pursued. I do not see any valid reason why it should not be made, to a certain extent, a part of ordinary school training. I have long advocated this view, and I am perfectly certain that it can be carried out with ease, and not only with ease, but with very considerable profit to those who are taught; but then such instruction must be adapted to the minds and needs of the scholars. They used to have a very odd way of teaching the classical languages when I was a boy. The first task set you was to learn the rules of the Latin grammar in the Latin language—that being the language you were going to learn! I thought then that this was an odd way of learning a language, but did not venture to rebel against the judgment of my superiors. Now, perhaps, I am not so modest as I was then, and I allow myself to think that it was a very absurd fashion. But it would be no less absurd, if we were to set about teaching Biology by putting into the hands of boys a series of definitions of the classes and orders of the animal kingdom, and making them repeat them by heart. That is so very favourite a method of teaching, that I sometimes fancy the spirit of the old classical system has entered into the new scientific system, in which case I would much rather that any pretence at scientific teaching were abolished altogether. What really has to be done is to get into the young mind some notion of what animal and vegetable life is. In this matter, you have to consider practical convenience as well as other things. There are difficulties in the way of a lot of boys making messes with slugs and snails; it might not work in practice. But there is a very convenient and handy animal which everybody has at hand, and that is himself; and it is a very easy and simple matter to obtain common plants. Hence the general truths of anatomy and physiology can be taught to young people in a very real fashion by dealing with the broad facts of human structure. Such viscera as they cannot very well examine in themselves, such as hearts, lungs, and livers, may be obtained from the nearest butcher's shop. In respect to teaching something about the biology of plants, there is no practical difficulty, because almost any of the common plants will do, and plants do not make a mess—at least they do not make an unpleasant mess; so that, in my judgment, the best form of Biology for teaching to very young people is elementary human physiology on the one hand, and the elements of botany on the other; beyond that I do not think it will be feasible to advance for some time to come. But then I see no reason, why, in secondary schools, and in the Science Classes which are under the control of the Science and Art Department—and which I may say, in passing, have in my judgment, done so very much for the diffusion of a knowledge of science over the country—we should not hope to see instruction in the elements of Biology carried out, not perhaps to the same extent, but still upon somewhat the same principle as here. There is no difficulty, when you have to deal with students of the ages of fifteen or sixteen, in practising a little dissection and in getting a notion of, at any rate, the four or five great modifications of the animal form; and the like is true in regard to the higher anatomy of plants.

While, lastly, to all those who are studying biological science with a view to their own edification merely, or with the intention of becoming zoologists or botanists; to all those who intend to pursue physiology—and especially to those who propose to employ the working years of their lives in the practice of medicine—I say that there is no training so fitted, or which may be of such important service to them, as the discipline in practical biological work which I have sketched out as being pursued in the laboratory hard by.

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I may add that, beyond all these different classes of persons who may profit by the study of Biology, there is yet one other. I remember, a number of years ago, that a gentleman who was a vehement opponent of Mr. Darwin's views and had written some terrible articles against them, applied to me to know what was the best way in which he could acquaint himself with the strongest arguments in favour of evolution. I wrote back, in all good faith and simplicity, recommending him to go through a course of comparative anatomy and physiology, and then to study development. I am sorry to say he was very much displeased, as people often are with good advice. Notwithstanding this discouraging result, I venture, as a parting word, to repeat the suggestion, and to say to all the more or less acute lay and clerical "paper-philosophers" [7] who venture into the regions of biological controversy—Get a little sound, thorough, practical, elementary instruction in biology.

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Footnotes:

[1] See the distinction between the "sciences physiques" and the "sciences physiologiques" in the Anatomie Generale, 1801.

[2] Hydrogeologie, an. x. (1801).

[3] "The term Biology, which means exactly what we wish to express, the Science of Life, has often been used, and has of late become not uncommon, among good writers."—Whewell, Philosophy of the Inductive Sciences, vol. i. p. 544 (edition of 1847).

[4] I think that my friend, Professor Allman, was the first to draw attention to it.

[5] Galileo was troubled by a sort of people whom he called "paper philosophers," because they fancied that the true reading of nature was to be detected by the collation of texts. The race is not extinct, but, as of old, brings forth its "winds of doctrine" by which the weathercock heads among us are much exercised.

[6] Some critics do not even take the trouble to read. I have recently been adjured with much solemnity; to state publicly why I have "changed my opinion" as to the value of the palaeontological evidence of the occurrence of evolution.

To this my reply is, Why should I, when that statement was made seven years ago? An address delivered from the Presidential Chair of the Geological Society, in 1870, may be said to be a public document, inasmuch as it not only appeared in the Journal of that learned body, but was re-published, in 1873, in a volume of Critiques and Addresses, to which my name is attached. Therein will be found a pretty full statement of my reasons for enunciating two propositions: (1) that "when we turn to the higher Vertebrata, the results of recent investigations, however we may sift and criticise them, seem to me to leave a clear balance in favour of the evolution of living forms one from another;" and (2) that the case of the horse is one which "will stand rigorous criticism." Thus I do not see clearly in what way I can be said to have changed my opinion, except in the way of intensifying it, when in consequence of the accumulation of similar evidence since 1870, I recently spoke of the denial of evolution as not worth serious consideration.

[7] Writers of this stamp are fond of talking about the Baconian method. I beg them therefore to lay to heart these two weighty sayings of the herald of Modern Science:—

"Syllogismus ex propositionibus constat, propositiones ex verbis, verba notionum tesserae sunt. Itaque si notiones ipsae (id quod basis rei est) confusae sint et temere a rebus abstractae, nihil in iis quae superstruuntur est firmitudinis."—Novum Organon, ii. 14.

"Huic autem vanitati nonnulli ex modernis summa levitate ita indulserunt, ut in primo capitulo Geneseos et in libro Job et aliis scripturis sacris, philosophiam naturalem fundare conati sint; inter vivos quaerentes mortua."—Ibid. 65.



XI

ON ELEMENTARY INSTRUCTION IN PHYSIOLOGY

[1877]

The chief ground upon which I venture to recommend that the teaching of elementary physiology should form an essential part of any organised course of instruction in matters pertaining to domestic economy, is, that a knowledge of even the elements of this subject supplies those conceptions of the constitution and mode of action of the living body, and of the nature of health and disease, which prepare the mind to receive instruction from sanitary science.

It is, I think, eminently desirable that the hygienist and the physician should find something in the public mind to which they can appeal; some little stock of universally acknowledged truths, which may serve as a foundation for their warnings, and predispose towards an intelligent obedience to their recommendations.

Listening to ordinary talk about health, disease, and death, one is often led to entertain a doubt whether the speakers believe that the course of natural causation runs as smoothly in the human body as elsewhere. Indications are too often obvious of a strong, though perhaps an unavowed and half unconscious, under-current of opinion that the phenomena of life are not only widely different, in their superficial characters and in their practical importance, from other natural events, but that they do not follow in that definite order which characterises the succession of all other occurrences, and the statement of which we call a law of nature.

Hence, I think, arises the want of heartiness of belief in the value of knowledge respecting the laws of health and disease, and of the foresight and care to which knowledge is the essential preliminary, which is so often noticeable; and a corresponding laxity and carelessness in practice, the results of which are too frequently lamentable.

It is said that among the many religious sects of Russia, there is one which holds that all disease is brought about by the direct and special interference of the Deity, and which, therefore, looks with repugnance upon both preventive and curative measures as alike blasphemous interferences with the will of God. Among ourselves, the "Peculiar People" are, I believe, the only persons who hold the like doctrine in its integrity, and carry it out with logical rigour. But many of us are old enough to recollect that the administration of chloroform in assuagement of the pangs of child-birth was, at its introduction, strenuously resisted upon similar grounds.

I am not sure that the feeling, of which the doctrine to which I have referred is the full expression, does not lie at the bottom of the minds of a great many people who yet would vigorously object to give a verbal assent to the doctrine itself. However this may be, the main point is that sufficient knowledge has now been acquired of vital phenomena, to justify the assertion, that the notion, that there is anything exceptional about these phenomena, receives not a particle of support from any known fact. On the contrary, there is a vast and an increasing mass of evidence that birth and death, health and disease, are as much parts of the ordinary stream of events as the rising and setting of the sun, or the changes of the moon; and that the living body is a mechanism, the proper working of which we term health; its disturbance, disease; its stoppage, death. The activity of this mechanism is dependent upon many and complicated conditions, some of which are hopelessly beyond our control, while others are readily accessible, and are capable of being indefinitely modified by our own actions. The business of the hygienist and of the physician is to know the range of these modifiable conditions, and how to influence them towards the maintenance of health and the prolongation of life; the business of the general public is to give an intelligent assent, and a ready obedience based upon that assent, to the rules laid down for their guidance by such experts. But an intelligent assent is an assent based upon knowledge, and the knowledge which is here in question means an acquaintance with the elements of physiology.

It is not difficult to acquire such knowledge. What is true, to a certain extent, of all the physical sciences, is eminently characteristic of physiology—the difficulty of the subject begins beyond the stage of elementary knowledge, and increases with every stage of progress. While the most highly trained and the best furnished intellect may find all its resources insufficient, when it strives to reach the heights and penetrate into the depths of the problems of physiology, the elementary and fundamental truths can be made clear to a child.

No one can have any difficulty in comprehending the mechanism of circulation or respiration; or the general mode of operation of the organ of vision; though the unravelling of all the minutiae of these processes, may, for the present, baffle the conjoined attacks of the most accomplished physicists, chemists, and mathematicians. To know the anatomy of the human body, with even an approximation to thoroughness, is the work of a life; but as much as is needed for a sound comprehension of elementary physiological truths, may be learned in a week.

A knowledge of the elements of physiology is not only easy of acquirement, but it may be made a real and practical acquaintance with the facts, as far as it goes. The subject of study is always at hand, in one's self. The principal constituents of the skeleton, and the changes of form of contracting muscles, may be felt through one's own skin. The beating of one's heart, and its connection with the pulse, may be noted; the influence of the valves of one's own veins may be shown; the movements of respiration may be observed; while the wonderful phenomena of sensation afford an endless field for curious and interesting self-study. The prick of a needle will yield, in a drop of one's own blood, material for microscopic observation of phenomena which lie at the foundation of all biological conceptions; and a cold, with its concomitant coughing and sneezing, may prove the sweet uses of adversity by helping one to a clear conception of what is meant by "reflex action."

Of course there is a limit to this physiological self-examination. But there is so close a solidarity between ourselves and our poor relations of the animal world, that our inaccessible inward parts may be supplemented by theirs. A comparative anatomist knows that a sheep's heart and lungs, or eye, must not be confounded with those of a man; but, so far as the comprehension of the elementary facts of the physiology of circulation, of respiration, and of vision goes, the one furnishes the needful anatomical data as well as the other.

Thus, it is quite possible to give instruction in elementary physiology in such a manner as, not only to confer knowledge, which, for the reason I have mentioned, is useful in itself; but to serve the purposes of a training in accurate observation, and in the methods of reasoning of physical science. But that is an advantage which I mention only incidentally, as the present Conference does not deal with education in the ordinary sense of the word.

It will not be suspected that I wish to make physiologists of all the world. It would be as reasonable to accuse an advocate of the "three R's" of a desire to make an orator, an author, and a mathematician of everybody. A stumbling reader, a pot-hook writer, and an arithmetician who has not got beyond the rule of three, is not a person of brilliant acquirements; but the difference between such a member of society and one who can neither read, write, nor cipher is almost inexpressible; and no one nowadays doubts the value of instruction, even if it goes no farther.

The saying that a little knowledge is a dangerous thing is, to my mind, a very dangerous adage. If knowledge is real and genuine, I do not believe that it is other than a very valuable possession, however infinitesimal its quantity may be. Indeed, if a little knowledge is dangerous, where is the man who has so much as to be out of danger?

If William Harvey's life-long labours had revealed to him a tenth part of that which may be made sound and real knowledge to our boys and girls, he would not only have been what he was, the greatest physiologist of his age, but he would have loomed upon the seventeenth century as a sort of intellectual portent. Our "little knowledge" would have been to him a great, astounding, unlooked-for vision of scientific truth.

I really see no harm which can come of giving our children a little knowledge of physiology. But then, as I have said, the instruction must be real, based upon observation, eked out by good explanatory diagrams and models, and conveyed by a teacher whose own knowledge has been acquired by a study of the facts; and not the mere catechismal parrot-work which too often usurps the place of elementary teaching.

It is, I hope, unnecessary for me to give a formal contradiction to the silly fiction, which is assiduously circulated by fanatics who not only ought to know, but do know, that their assertions are untrue, that I have advocated the introduction of that experimental discipline which is absolutely indispensable to the professed physiologist, into elementary teaching.

But while I should object to any experimentation which can justly be called painful, for the purpose of elementary instruction; and, while, as a member of a late Royal Commission, I gladly did my best to prevent the infliction of needless pain, for any purpose; I think it is my duty to take this opportunity of expressing my regret at a condition of the law which permits a boy to troll for pike, or set lines with live frog bait, for idle amusement; and, at the same time, lays the teacher of that boy open to the penalty of fine and imprisonment, if he uses the same animal for the purpose of exhibiting one of the most beautiful and instructive of physiological spectacles, the circulation in the web of the foot. No one could undertake to affirm that a frog is not inconvenienced by being wrapped up in a wet rag, and having his toes tied out; and it cannot be denied that inconvenience is a sort of pain. But you must not inflict the least pain on a vertebrated animal for scientific purposes (though you may do a good deal in that way for gain or for sport) without due licence of the Secretary of State for the Home Department, granted under the authority of the Vivisection Act.

So it comes about, that, in this present year of grace 1877, two persons may be charged with cruelty to animals. One has impaled a frog, and suffered the creature to writhe about in that condition for hours; the other has pained the animal no more than one of us would be pained by tying strings round his fingers, and keeping him in the position of a hydropathic patient. The first offender says "I did it because I find fishing very amusing," and the magistrate bids him depart in peace; nay, probably wishes him good sport. The second pleads, "I wanted to impress a scientific truth, with a distinctness attainable in no other way, on the minds of my scholars," and the magistrate fines him five pounds.

I cannot but think that this is an anomalous and not wholly creditable state of things.



XII

ON MEDICAL EDUCATION

[1870]

It has given me sincere pleasure to be here today, at the desire of your highly respected President and the Council of the College. In looking back upon my own past, I am sorry to say that I have found that it is a quarter of a century since I took part in those hopes and in those fears by which you have all recently been agitated, and which now are at an end. But, although so long a time has elapsed since I was moved by the same feelings, I beg leave to assure you that my sympathy with both victors and vanquished remains fresh—so fresh, indeed, that I could almost try to persuade myself that, after all, it cannot be so very long ago. My business during the last hour, however, has been to show that sympathy with one side only, and I assure you I have done my best to play my part heartily, and to rejoice in the success of those who have succeeded. Still, I should like to remind you at the end of it all, that success on an occasion of this kind, valuable and important as it is, is in reality only putting the foot upon one rung of the ladder which leads upwards; and that the rung of a ladder was never meant to rest upon, but only to hold a man's foot long enough to enable him to put the other somewhat higher. I trust that you will all regard these successes as simply reminders that your next business is, having enjoyed the success of the day, no longer to look at that success, but to look forward to the next difficulty that is to be conquered. And now, having had so much to say to the successful candidates, you must forgive me if I add that a sort of under-current of sympathy has been going on in my mind all the time for those who have not been successful, for those valiant knights who have been overthrown in your tourney, and have not made their appearance in public. I trust that, in accordance with old custom, they, wounded and bleeding, have been carried off to their tents, to be carefully tended by the fairest of maidens; and in these days, when the chances are that every one of such maidens will be a qualified practitioner, I have no doubt that all the splinters will have been carefully extracted, and that they are now physically healed. But there may remain some little fragment of moral or intellectual discouragement, and therefore I will take the liberty to remark that your chairman to-day, if he occupied his proper place, would be among them. Your chairman, in virtue of his position, and for the brief hour that he occupies that position, is a person of importance; and it may be some consolation to those who have failed if I say, that the quarter of a century which I have been speaking of, takes me back to the time when I was up at the University of London, a candidate for honours in anatomy and physiology, and when I was exceedingly well beaten by my excellent friend, Dr. Ransom, of Nottingham. There is a person here who recollects that circumstance very well. I refer to your venerated teacher and mine, Dr. Sharpey. He was at that time one of the examiners in anatomy and physiology, and you may be quite sure that, as he was one of the examiners, there remained not the smallest doubt in my mind of the propriety of his judgment, and I accepted my defeat with the most comfortable assurance that I had thoroughly well earned it. But, gentlemen, the competitor having been a worthy one, and the examination a fair one, I cannot say that I found in that circumstance anything very discouraging. I said to myself, "Never mind; what's the next thing to be done?" And I found that policy of "never minding" and going on to the next thing to be done, to be the most important of all policies in the conduct of practical life. It does not matter how many tumbles you have in this life, so long as you do not get dirty when you tumble; it is only the people who have to stop to be washed and made clean, who must necessarily lose the race. And I can assure you that there is the greatest practical benefit in making a few failures early in life. You learn that which is of inestimable importance—that there are a great many people in the world who are just as clever as you are. You learn to put your trust, by and by, in an economy and frugality of the exercise of your powers, both moral and intellectual; and you very soon find out, if you have not found it out before, that patience and tenacity of purpose are worth more than twice their weight of cleverness. In fact, if I were to go on discoursing on this subject, I should become almost eloquent in praise of non-success; but, lest so doing should seem, in any way, to wither well-earned laurels, I will turn from that topic, and ask you to accompany me in some considerations touching another subject which has a very profound interest for me, and which I think ought to have an equally profound interest for you.

I presume that the great majority of those whom I address propose to devote themselves to the profession of medicine; and I do not doubt, from the evidences of ability which have been given to-day, that I have before me a number of men who will rise to eminence in that profession, and who will exert a great and deserved influence upon its future. That in which I am interested, and about which I wish to speak, is the subject of medical education, and I venture to speak about it for the purpose, if I can, of influencing you, who may have the power of influencing the medical education of the future. You may ask, by what authority do I venture, being a person not concerned in the practice of medicine, to meddle with that subject? I can only tell you it is a fact, of which a number of you I dare say are aware by experience (and I trust the experience has no painful associations), that I have been for a considerable number of years (twelve or thirteen years to the best of my recollection) one of the examiners in the University of London. You are further aware that the men who come up to the University of London are the picked men of the medical schools of London, and therefore such observations as I may have to make upon the state of knowledge of these gentlemen, if they be justified, in regard to any faults I may have to find, cannot be held to indicate defects in the capacity, or in the power of application of those gentlemen, but must be laid, more or less, to the account of the prevalent system of medical education. I will tell you what has struck me—but in speaking in this frank way, as one always does about the defects of one's friends, I must beg you to disabuse your minds of the notion that I am alluding to any particular school, or to any particular college, or to any particular person; and to believe that if I am silent when I should be glad to speak with high praise, it is because that praise would come too close to this locality. What has struck me, then, in this long experience of the men best instructed in physiology from the medical schools of London is (with the many and brilliant exceptions to which I have referred), taking it as a whole, and broadly, the singular unreality of their knowledge of physiology. Now, I use that word "unreality" advisedly. I do not say "scanty;" on the contrary, there is plenty of it—a great deal too much of it—but it is the quality, the nature of the knowledge, which I quarrel with. I know I used to have—I don't know whether I have now, but I had once upon a time—a bad reputation among students for setting up a very high standard of acquirement, and I dare say you may think that the standard of this old examiner, who happily is now very nearly an extinct examiner, has been pitched too high. Nothing of the kind, I assure you. The defects I have noticed, and the faults I have to find, arise entirely from the circumstance that my standard is pitched too low. This is no paradox, gentlemen, but quite simply the fact. The knowledge I have looked for was a real, precise, thorough, and practical knowledge of fundamentals; whereas that which the best of the candidates, in a large proportion of cases, have had to give me was a large, extensive, and inaccurate knowledge of superstructure; and that is what I mean by saying that my demands went too low and not too high. What I have had to complain of is, that a large proportion of the gentlemen who come up for physiology to the University of London do not know it as they know their anatomy, and have not been taught it as they have been taught their anatomy. Now, I should not wonder at all if I heard a great many "No, noes" here; but I am not talking about University College; as I have told you before, I am talking about the average education of medical schools. What I have found, and found so much reason to lament, is, that while anatomy has been taught as a science ought to be taught, as a matter of autopsy, and observation, and strict discipline; in a very large number of cases, physiology has been taught as if it were a mere matter of books and of hearsay. I declare to you, gentlemen, that I have often expected to be told, when I have asked a question about the circulation of the blood, that Professor Breitkopf is of opinion that it circulates, but that the whole thing is an open question. I assure you that I am hardly exaggerating the state of mind on matters of fundamental importance which I have found over and over again to obtain among gentlemen coming up to that picked examination of the University of London. Now, I do not think that is a desirable state of things. I cannot understand why physiology should not be taught—in fact, you have here abundant evidence that it can be taught—with the same definiteness and the same precision as anatomy is taught. And you may depend upon this, that the only physiology which is to be of any good whatever in medical practice, or in its application to the study of medicine, is that physiology which a man knows of his own knowledge; just as the only anatomy which would be of any good to the surgeon is the anatomy which he knows of his own knowledge. Another peculiarity I have found in the physiology which has been current, and that is, that in the minds of a great many gentlemen it has been supplanted by histology. They have learnt a great deal of histology, and they have fancied that histology and physiology are the same things. I have asked for some knowledge of the physics and the mechanics and the chemistry of the human body, and I have been met by talk about cells. I declare to you I believe it will take me two years, at least, of absolute rest from the business of an examiner to hear the word "cell," "germinal matter," or "carmine," without a sort of inward shudder.

Well, now, gentlemen, I am sure my colleagues in this examination will bear me out in saying that I have not been exaggerating the evils and defects which are current—have been current—in a large quantity of the physiological teaching the results of which come before examiners. And it becomes a very interesting question to know how all this comes about, and in what way it can be remedied. How it comes about will be perfectly obvious to any one who has considered the growth of medicine. I suppose that medicine and surgery first began by some savage more intelligent than the rest, discovering that a certain herb was good for a certain pain, and that a certain pull, somehow or other, set a dislocated joint right. I suppose all things had their humble beginnings, and medicine and surgery were in the same condition. People who wear watches know nothing about watchmaking. A watch goes wrong and it stops; you see the owner giving it a shake, or, if he is very bold, he opens the case, and gives the balance-wheel a push. Gentlemen, that is empirical practice, and you know what are the results upon the watch. I should think you can divine what are the results of analogous operations upon the human body. And because men of sense very soon found that such were the effects of meddling with very complicated machinery they did not understand, I suppose the first thing, as being the easiest, was to study the nature of the works of the human watch, and the next thing was to study the way the parts worked together, and the way the watch worked. Thus, by degrees, we have had growing up our body of anatomists, or knowers of the construction of the human watch, and our physiologists, who know how the machine works. And just as any sensible man, who has a valuable watch, does not meddle with it himself, but goes to some one who has studied watchmaking, and understands what the effect of doing this or that may be; so, I suppose, the man who, having charge of that valuable machine, his own body, wants to have it kept in good order, comes to a professor of the medical art for the purpose of having it set right, believing that, by deduction from the facts of structure and from the facts of function, the physician will divine what may be the matter with his bodily watch at that particular time, and what may be the best means of setting it right. If that may be taken as a just representation of the relation of the theoretical branches of medicine—what we may call the institutes of medicine, to use an old term—to the practical branches, I think it will be obvious to you that they are of prime and fundamental importance. Whatever tends to affect the teaching of them injuriously must tend to destroy and to disorganise the whole fabric of the medical art. I think every sensible man has seen this long ago; but the difficulties in the way of attaining good teaching in the different branches of the theory, or institutes, of medicine are very serious. It is a comparatively easy matter—pray mark that I use the word "comparatively "—it is a comparatively easy matter to learn anatomy and to teach it; it is a very difficult matter to learn physiology and to teach it. It is a very difficult matter to know and to teach those branches of physics and those branches of chemistry which bear directly upon physiology; and hence it is that, as a matter of fact, the teaching of physiology, and the teaching of the physics and the chemistry which bear upon it, must necessarily be in a state of relative imperfection; and there is nothing to be grumbled at in the fact that this relative imperfection exists. But is the relative imperfection which exists only such as is necessary, or is it made worse by our practical arrangements? I believe—and if I did not so believe I should not have troubled you with these observations—I believe it is made infinitely worse by our practical arrangements, or rather, I ought to say, our very unpractical arrangements. Some very wise man long ago affirmed that every question, in the long run, was a question of finance; and there is a good deal to be said for that view. Most assuredly the question of medical teaching is, in a very large and broad sense, a question of finance. What I mean is this: that in London the arrangements of the medical schools, and the number of them, are such as to render it almost impossible that men who confine themselves to the teaching of the theoretical branches of the profession should be able to make their bread by that operation; and, you know, if a man cannot make his bread he cannot teach—at least his teaching comes to a speedy end. That is a matter of physiology. Anatomy is fairly well taught, because it lies in the direction of practice, and a man is all the better surgeon for being a good anatomist. It does not absolutely interfere with the pursuits of a practical surgeon if he should hold a Chair of Anatomy—though I do not for one moment say that he would not be a better teacher if he did not devote himself to practice. (Applause.) Yes, I know exactly what that cheer means, but I am keeping as carefully as possible from any sort of allusion to Professor Ellis. But the fact is, that even human anatomy has now grown to be so large a matter, that it takes the whole devotion of a man's life to put the great mass of knowledge upon that subject into such a shape that it can be teachable to the mind of the ordinary student. What the student wants in a professor is a man who shall stand between him and the infinite diversity and variety of human knowledge, and who shall gather all that together, and extract from it that which is capable of being assimilated by the mind. That function is a vast and an important one, and unless, in such subjects as anatomy, a man is wholly free from other cares, it is almost impossible that he can perform it thoroughly and well. But if it be hardly possible for a man to pursue anatomy without actually breaking with his profession, how is it possible for him to pursue physiology?

I get every year those very elaborate reports of Henle and Meissner—volumes of, I suppose, 400 pages altogether—and they consist merely of abstracts of the memoirs and works which have been written on Anatomy and Physiology—only abstracts of them! How is a man to keep up his acquaintance with all that is doing in the physiological world—in a world advancing with enormous strides every day and every hour—if he has to be distracted with the cares of practice? You know very well it must be impracticable to do so. Our men of ability join our medical schools with an eye to the future. They take the Chairs of Anatomy or of Physiology; and by and by they leave those Chairs for the more profitable pursuits into which they have drifted by professional success, and so they become clothed, and physiology is bare. The result is, that in those schools in which physiology is thus left to the benevolence, so to speak, of those who have no time to look to it, the effect of such teaching comes out obviously, and is made manifest in what I spoke of just now—the unreality, the bookishness of the knowledge of the taught. And if this is the case in physiology, still more must it be the case in those branches of physics which are the foundation of physiology; although it may be less the case in chemistry, because for an able chemist a certain honourable and independent career lies in the direction of his work, and he is able, like the anatomist, to look upon what he may teach to the student as not absolutely taking him away from his bread-winning pursuits.

But it is of no use to grumble about this state of things unless one is prepared to indicate some sort of practical remedy. And I believe—and I venture to make the statement because I am wholly independent of all sorts of medical schools, and may, therefore, say what I believe without being supposed to be affected by any personal interest—but I say I believe that the remedy for this state of things, for that imperfection of our theoretical knowledge which keeps down the ability of England at the present time in medical matters, is a mere affair of mechanical arrangement; that so long as you have a dozen medical schools scattered about in different parts of the metropolis, and dividing the students among them, so long, in all the smaller schools at any rate, it is impossible that any other state of things than that which I have been depicting should obtain. Professors must live; to live they must occupy themselves with practice, and if they occupy themselves with practice, the pursuit of the abstract branches of science must go to the wall. All this is a plain and obvious matter of common-sense reasoning. I believe you will never alter this state of things until, either by consent or by force majeure—and I should be very sorry to see the latter applied—but until there is some new arrangement, and until all the theoretical branches of the profession, the institutes of medicine, are taught in London in not more than one or two, or at the outside three, central institutions, no good will be effected. If that large body of men, the medical students of London, were obliged in the first place to get a knowledge of the theoretical branches of their profession in two or three central schools, there would be abundant means for maintaining able professors—not, indeed, for enriching them, as they would be able to enrich themselves by practice—but for enabling them to make that choice which such men are so willing to make; namely, the choice between wealth and a modest competency, when that modest competency is to be combined with a scientific career, and the means of advancing knowledge. I do not believe that all the talking about, and tinkering of, medical education will do the slightest good until the fact is clearly recognised, that men must be thoroughly grounded in the theoretical branches of their profession, and that to this end the teaching of those theoretical branches must be confined to two or three centres.

Now let me add one other word, and that is, that if I were a despot, I would cut down these branches to a very considerable extent. The next thing to be done beyond that which I mentioned just now, is to go back to primary education. The great step towards a thorough medical education is to insist upon the teaching of the elements of the physical sciences in all schools, so that medical students shall not go up to the medical colleges utterly ignorant of that with which they have to deal; to insist on the elements of chemistry, the elements of botany, and the elements of physics being taught in our ordinary and common schools, so that there shall be some preparation for the discipline of medical colleges. And, if this reform were once effected, you might confine the "Institutes of Medicine" to physics as applied to physiology—to chemistry as applied to physiology—to physiology itself, and to anatomy. Afterwards, the student, thoroughly grounded in these matters, might go to any hospital he pleased for the purpose of studying the practical branches of his profession. The practical teaching might be made as local as you like; and you might use to advantage the opportunities afforded by all these local institutions for acquiring a knowledge of the practice of the profession. But you may say: "This is abolishing a great deal; you are getting rid of botany and zoology to begin with." I have not a doubt that they ought to be got rid of, as branches of special medical education; they ought to be put back to an earlier stage, and made branches of general education. Let me say, by way of self-denying ordinance, for which you will, I am sure, give me credit, that I believe that comparative anatomy ought to be absolutely abolished. I say so, not without a certain fear of the Vice-Chancellor of the University of London who sits upon my left. But I do not think the charter gives him very much power over me; moreover, I shall soon come to an end of my examinership, and therefore I am not afraid, but shall go on to say what I was going to say, and that is, that in my belief it is a downright cruelty—I have no other word for it—to require from gentlemen who are engaged in medical studies, the pretence—for it is nothing else, and can be nothing else, than a pretence—of a knowledge of comparative anatomy as part of their medical curriculum. Make it part of their Arts teaching if you like, make it part of their general education if you like, make it part of their qualification for the scientific degree by all means—that is its proper place; but to require that gentlemen whose whole faculties should be bent upon the acquirement of a real knowledge of human physiology should worry themselves with getting up hearsay about the alternation of generations in the Salpae is really monstrous. I cannot characterise it in any other way. And having sacrificed my own pursuit, I am sure I may sacrifice other people's; and I make this remark with all the more willingness because I discovered, on reading the names of your Professors just now, that the Professor of Materia Medica is not present. I must confess, if I had my way I should abolish Materia Medica [1] altogether. I recollect, when I was first under examination at the University of London, Dr. Pereira was the examiner, and you know that Pereira's "Materia Medica" was a book de omnibus rebus. I recollect my struggles with that book late at night and early in the morning (I worked very hard in those days), and I do believe that I got that book into my head somehow or other, but then I will undertake to say that I forgot it all a week afterwards. Not one trace of a knowledge of drugs has remained in my memory from that time to this; and really, as a matter of common sense, I cannot understand the arguments for obliging a medical man to know all about drugs and where they come from. Why not make him belong to the Iron and Steel Institute, and learn something about cutlery, because he uses knives?

But do not suppose that, after all these deductions, there would not be ample room for your activity. Let us count up what we have left. I suppose all the time for medical education that can be hoped for is, at the outside, about four years. Well, what have you to master in those four years upon my supposition? Physics applied to physiology; chemistry applied to physiology; physiology; anatomy; surgery; medicine (including therapeutics); obstetrics; hygiene; and medical jurisprudence—nine subjects for four years! And when you consider what those subjects are, and that the acquisition of anything beyond the rudiments of any one of them may tax the energies of a lifetime, I think that even those energies which you young gentlemen have been displaying for the last hour or two might be taxed to keep you thoroughly up to what is wanted for your medical career.

I entertain a very strong conviction that any one who adds to medical education one iota or tittle beyond what is absolutely necessary, is guilty of a very grave offence. Gentlemen, it will depend upon the knowledge that you happen to possess,—upon your means of applying it within your own field of action,—whether the bills of mortality of your district are increased or diminished; and that, gentlemen, is a very serious consideration indeed. And, under those circumstances, the subjects with which you have to deal being so difficult, their extent so enormous, and the time at your disposal so limited, I could not feel my conscience easy if I did not, on such an occasion as this, raise a protest against employing your energies upon the acquisition of any knowledge which may not be absolutely needed in your future career.

* * * * *

[1] It will, I hope, be understood that I do not include Therapeutics under this head.



XIII

THE STATE AND THE MEDICAL PROFESSION

[1884]

At intervals during the last quarter of a century committees of the Houses of the Legislature and specially appointed commissions have occupied themselves with the affairs of the medical profession. Much evidence has been taken, much wrangling has gone on over the reports of these bodies; and sometimes much trouble has been taken to get measures based upon all this work through Parliament, but very little has been achieved.

The Bill introduced last session was not more fortunate than several predecessors. I suppose that it is not right to rejoice in the misfortunes of anything, even a Bill; but I confess that this event afforded me lively satisfaction, for I was a member of the Royal Commission on the report of which the Bill was founded, and I did my best to oppose and nullify that report.

That the question must be taken up again and finally dealt with by the Legislature before long cannot be doubted; but in the meanwhile there is time for reflection, and I think that the non-medical public would be wise if they paid a little attention to a subject which is really of considerable importance to them.

The first question which a plain man is disposed to ask himself is, Why should the State interfere with the profession of medicine any more than it does, say, with the profession of engineering? Anybody who pleases may call himself an engineer, and may practice as such. The State confers no title upon engineers, and does not profess to tell the public that one man is a qualified engineer and that another is not so.

The answers which are given to the question are various, and most of them, I think, are bad. A large number of persons seem to be of opinion that the State is bound no less to take care of the general public, than to see that it is protected against incompetent persons, against quacks and medical impostors in general. I do not take that view of the case. I think it is very much wholesomer for the public to take care of itself in this as in all other matters; and although I am not such a fanatic for the liberty of the subject as to plead that interfering with the way in which a man may choose to be killed is a violation of that liberty, yet I do think that it is far better to let everybody do as he likes. Whether that be so or not, I am perfectly certain that, as a matter of practice, it is absolutely impossible to prohibit the practice of medicine by people who have no special qualification for it. Consider the terrible consequences of attempting to prohibit practice by a very large class of persons who are certainly not technically qualified—I am far from saying a word as to whether they are otherwise qualified or not. The number of Ladies Bountiful—grandmothers, aunts, and mothers-in-law—whose chief delight lies in the administration of their cherished provision of domestic medicine, is past computation, and one shudders to think of what might happen if their energies were turned from this innocuous, if not beneficent channel, by the strong arm of the law. But the thing is impracticable.

Another reason for intervention is propounded, I am sorry to say, by some, though not many, members of the medical profession, and is simply an expression of that trades unionism which tends to infest professions no less than trades.

The general practitioner trying to make both ends meet on a poor practice, whose medical training has cost him a good deal of time and money, finds that many potential patients, whose small fees would be welcome as the little that helps, prefer to go and get their shilling's worth of "doctor's stuff" and advice from the chemist and druggist round the corner, who has not paid sixpence for his medical training, because he has never had any.

The general practitioner thinks this is very hard upon him and ought to be stopped. It is perhaps natural that he should think so, though it would be very difficult for him to justify his opinion on any ground of public policy. But the question is really not worth discussion, as it is obvious that it would be utterly impracticable to stop the practice "over the counter" even it it were desirable.

Is a man who has a sudden attack of pain in tooth or stomach not to be permitted to go to the nearest druggist's shop and ask for something that will relieve him? The notion is preposterous. But if this is to be legal, the whole principle of the permissibility of counter practice is granted.

In my judgment the intervention of the State in the affairs of the medical profession can be justified not upon any pretence of protecting the public, and still less upon that of protecting the medical profession, but simply and solely upon the fact that the State employs medical men for certain purposes, and, as employer, has a right to define the conditions on which it will accept service. It is for the interest of the community that no person shall die without there being some official recognition of the cause of his death. It is a matter of the highest importance to the community that, in civil and criminal cases, the law shall be able to have recourse to persons whose evidence may be taken as that of experts; and it will not be doubted that the State has a right to dictate the conditions under which it will appoint persons to the vast number of naval, military, and civil medical offices held directly or indirectly under the Government. Here, and here only, it appears to me, lies the justification for the intervention of the State in medical affairs. It says, or, in my judgment, should say, to the public, "Practice medicine if you like—go to be practised upon by anybody;" and to the medical practitioner, "Have a qualification, or do not have a qualification if people don't mind it; but if the State is to receive your certificate of death, if the State is to take your evidence as that of an expert, if the State is to give you any kind of civil, or military, or naval appointment, then we can call upon you to comply with our conditions, and to produce evidence that you are, in our sense of the word, qualified. Without that we will not place you in that position." As a matter of fact, that is the relation of the State to the medical profession in this country. For my part, I think it an extremely healthy relation; and it is one that I should be very sorry to see altered, except in so far that it would certainly be better if greater facilities were given for the swift and sharp punishment of those who profess to have the State qualification when, in point of fact, they do not possess it. They are simply cheats and swindlers, like other people who profess to be what they are not, and should be punished as such.

But supposing we are agreed about the justification of State intervention in medical affairs, new questions arise as to the manner in which that intervention should take place and the extent to which it should go, on which the divergence of opinion is even greater than it is on the general question of intervention.

It is now, I am sorry to say, something over forty years since I began my medical studies; and, at that time, the state of affairs was extremely singular. I should think it hardly possible that it could have obtained anywhere but in such a country as England, which cherishes a fine old crusted abuse as much as it does its port wine. At that time there were twenty-one licensing bodies—that is to say, bodies whose certificate was received by the State as evidence that the persons who possessed that certificate were medical experts. How these bodies came to possess these powers is a very curious chapter in history, in which it would be out of place to enlarge. They were partly universities, partly medical guilds and corporations, partly the Archbishop of Canterbury. Those were the three sources from which the licence to practice came in that day. There was no central authority, there was nothing to prevent any one of those licensing authorities from granting a licence to any one upon any conditions it thought fit. The examination might be a sham, the curriculum might be a sham, the certificate might be bought and sold like anything in a shop; or, on the other hand, the examination might be fairly good and the diploma correspondingly valuable; but there was not the smallest guarantee, except the personal character of the people who composed the administration of each of these licensing bodies, as to what might happen. It was possible for a young man to come to London and to spend two years and six months of the time of his compulsory three years "walking the hospitals" in idleness or worse; he could then, by putting himself in the hands of a judicious "grinder" for the remaining six months, pass triumphantly through the ordeal of one hour's viva voce examination, which was all that was absolutely necessary, to enable him to be turned loose upon the public, like death on the pale horse, "conquering and to conquer," with the full sanction of the law, as a "qualified practitioner."