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London

MEDICAL GAZETTE;

BEING A

Weekly Journal

OF

MEDICINE AND THE COLLATERAL SCIENCES.

VOL. XIII.

(VOL. I. FOR THE SESSION 1833-34.)

LONDON:

PRINTED FOR LONGMAN, REES, ORME, BROWN, GREEN, & LONGMAN,

PATERNOSTER-ROW.

1834.

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GENTLEMEN,-We are met together to commence, for the third time, the medical session of this college. Many of you are not strangers in our schools, but return, after the customary interval of rest and refreshment, to resume the studies in which they have already made some progress. Others are here for the first time, about to begin the stated course of preparation for the duties of their professional lives. I take it for granted, that all are sincerely bent upon qualifying themselves effectually for those most serious duties. If any be not thus in earnest, their presence amongst us will involve a foolish waste of time and expense, a sad mockery of the hopes and affections of their friends, and a fearful disregard of the most solemn obligations. But I will not entertain the unpleasing supposition, that among the numbers who now fill the benches before me, even a single student can be found so weak, or so vicious, as to propose to himself the high offices of physic, with a declared indif. ference about his capacity to discharge them well and faithfully.

The blind desire of knowledge, however, is not all that is necessary for your success. The period of scholastic education, so far as it regards medicine, and is enjoined by authority, is unhappily short. The science itself is vast and difficult. Very many (I am sorry to say) of those who profess to be its followers, content themselves, from choice or from necessity, with the smallest measure of formal study permitted by the 305.-XIII.

regulations to which they are subject. But it is a thing impossible that even the readiest intellect should gather up, in that brief and most inadequate period-much more that it should set in order and digest for practical use-the varied mass of information required to fit a man for interfering with disease. Much has been done of late years towards raising the character of that large and influential class of men who are engaged in the general practice of physic and surgery throughout the country. New and very important branches of science have been included in the prescribed curriculum of study; and the extent and order of the whole have been enlarged, and more exactly defined. But while an increased amount of knowledge is thus demanded from the student, the space of time allotted for its acquisition remains the same as before; and the beneficial tendency of regulations, which in themselves are wise and salutary, is thus miserably cramped and defeated. I am not ignorant, indeed, of the difficulties by which, in legislating on this subject, the Society of Apothecaries are embarrassed. I

know, and am glad to acknowledge, how much they deserve the thanks of the profession and of the public, for the improvements they have already effected, and for those which they are willing, though not yet able, to effect. But their praiseworthy intentions can never receive their full accomplishment, until the term of study, as well as the measure of knowledge, is more accurately adjusted to the true dimensions of the science. I trust that the time is approaching when this change, so requisite for the public welfare and security, will be brought about. The most easy and natural mode of executing it (as it seems to me) would be by deducting some years from the period of apprenticeship, and adding them to the regulated course of academical study. This would enlarge the present scanty minimum, without necessarily imposing any fresh restraint upon the stu

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dent, in respect of time, age, or cost. I would fain hope, that many of those who resort to this college for instruction, will be found both able and desirous to extend the term of their pupillage beyond the narrow requirements of the law. But however this may be, the shortness of the time which is supposed to suffice for the majority, increases the obligation to husband it carefully, and to employ it to the best advantage. I deem it, therefore, of much importance, that you should clearly perceive, beforehand, what it is that you are to expect and to do in this biennial course. The science of medicine is made up of many distinct parts, variously connected, differing considerably in their nature, and (what is more to my present pur. pose) requiring a different kind and measure of your attention now. Some things there are which you may master completely here, and of which, if you do not so master them, you will scarcely be able to supply the defect hereafter. Of others you can only possess yourselves of the outline and principle; they are to be perfected after you leave this place; and they require, for their full attainment, the continued labour of many years-aye, of your whole life. Yet the mode of pursuing them-the entrance upon the right path of inquiry-the clue to their profitable investigation, you may, you must, learn now. I do not know that I can more usefully fulfil the task with which it has been the pleasure of my colleagues to honour me to-day, than by endeavouring to place distinctly before you the nature and objects of the several departments of science which we profess to teach, and which you are invited to learn to explain their relative importance and requirements- the order and dependancy in which they should be followed out-the manner in which they concur to form the skilful practitioner-the spirit in which they deserve to be culti vated-and the noble ends to which, by God's blessing, they may be made subser

vient.

None of you require to be told, that the broad and avowed aim of your studies is to qualify you to exercise the art of physic: which is, to alleviate the sufferings of your fellow men-to cure or prevent disease-and in so far as mortal skill may achieve purposes so great, to prolong life, and to render death easy. You want to know the means, and the way to use them, of correcting the disturbances and and repairing the defects of the living human body.

Now it seems very obvious that in order to rectify what may be amiss in the bodily frame, the first thing necessary is that we comprehend its structure. Yet plain as

this necessity appears to be, it is singular how long the superstition, the prejudices, and the ignorance of mankind, led them to overlook or deny it. Some there are even yet, I believe, though but few, who persuade themselves that medicine may be learned, and practised with sufficient success, by men who know little or nothing of the composition of that body with which they deal. I shall not now stay to examine this opinion; its futility will become apparent to you hereafter. For the present I must beg any of you who may entertain doubts upon the subject to take upon trust my assertion, that if we would mend the animal machine, we must, in most cases, be able to ascertain where and how it labours; and that we can discover this only by a knowledge of its parts, and their connexion and action, of its full and perfect play.

Anatomy, then, which teaches this know. ledge, is the "hornbook" of our science, and with anatomy you will accordingly commence. The separate parts of the dead body will be displayed and described before you, and you will unfold and examine them for yourselves under the direetion of those to whom they are familiar. The bony fabric that supports the whole

the muscles, blood vessels, nerves, and viscera, with which it is clothed and filled -the relative situations and connexions of all these-the manner in which they are disposed and packed the materials of which they are formed-these will constitute the objects of your earliest attention. Now all this it is exceedingly easy to learn: a very moderate share of intellect, and scarcely any previous learning, is necessary for its acquisition. Some exertion of memory, and the employment of the eyes and fingers, are sufficient. An illiterate peasant need have no difficulty in learning the anatomy of the body in the limited sense in which I have hitherto considered it. But this is not the manner in which you have to learn it. You cannot, unless you are dull and incurious indeed, advance a single step in this investigation without asking what are the uses of the parts you are examining?-what are the purposes which these exact, though intricate, ar rangements are designed to serve? - to what end is this complication of solid and fluid parts-of pipes, and valves, and reservoirs—of cords, and levers, and hinges? In other words, you cannot commence the study of anatomy without an instant and strong impulse to the study of physiology also: the two, therefore, are from the first interwoven with each other; and that which would else be a dry detail of collo. cation for the memory, becomes instinct with wonder and interest. The mind passes from the dead and flaccid muscle to

the movements of the living limb; the empty vessels are replenished with their vital currents; and the dry bones are made alive in the contemplation of their fitness and proportions. Here, also, much is thoroughly known, and the intellect is exercised and stimulated as the subject opens before it: here, moreover, the uninstructed peasant would soon be at fault: and at once, from the very threshold of your studies, it becomes necessary that we should look back to the period which preceded them, and to inquire what preliminary knowledge may be requisite for their successful prosecution. You will perceive, on a very slight consideration, that there are many things with which you must become acquainted before you can follow even the initial study of anatomy and physiology with any intelligence of their true value and significance, or without perpetual stumbling. The wonderful and multiplied instruments of locomotion obey all the laws of mechanical philosophy. Their uses cannot be under. stood without some knowledge of that beautiful science. Still less may we hope, or dare attempt, to remedy their mechanical derangements. So also the circulation of the fluids through their appointed tubes, and the passage of the very breath of our nostrils, depend in a great and evident degree upon simple principles of hydraulics and pneumatics. And that most admirable microcosm, the eye-not more perfect indeed than other portions of the animal frame, yet to us most admirable, because in all its parts, to an instructed and prepared intellect, so obvious and intelligible is nothing better than a curious toy-a strange, though beautiful puzzle, to one who is ignorant of the properties and phenomena of light, and the ascertained conclusions of the science of optics. With these branches of philosophy, then, it is expedient-it is even indispensably requisite that you should in some degree be conversant. I do not say it is necessary that you should be able to work their more abstruse or delicate problems, or be even skilled in their practical application; but of the general principles of these sciences, and of the simpler truths which they embrace, some previous knowledge is absolutely required, if you would enter, properly equipped, even upon the frontiers of your peculiar province. Again, these very sciences imply and presuppose others. A certain amount-very easily and readily attainable, let me say-but a certain amount at least of pure mathematics, of the methods and principles of analytical and geometrical reasoning, is not only proper and desirable, but essential to your philosophical and satisfactory advancement. And since I have thus touched upon the subject of previous acquirements, I will add, that be

sides and above this acquaintance with natural philosophy, he who would become a master in our useful and honourable art, should also be imbued with some tincture of ancient and modern literature - should at least be able to read without much labour the classical languages of our own and of former ages. He will be ignorant of much that is both instructive and delightful, who cannot trace for himself, and in their own words, the thoughts and the discoveries of famous men whose writings have descended to us from the more splendid periods of antiquity; and he must be far behind the point of actual knowledge, if he is not qualified to drink instruction from the living and copious streams of Italy, Germany, and France. Not only are these accomplishments required for the full understanding of the matters proper to our science; they elevate, also, and dignify its character-throw a grace and charm around its pursuit, and by exercising the mental faculties, invigorate them for the more ready apprehension of the truth.

In this preparatory knowledge I trust you are already more or less instructed. If not, I earnestly advise you to lose no time in supplying the deficiency. Remember that every branch of science and learning which has now been recommended, is fully and systematically taught within these walls. At your age particular defects may be easily remedied in a great degree, by the diligent and regulated employment of a few hours even in every week. It will be well worth your while, if it be in your power, to prolong your residence amongst us for this very purpose. I can confidently assure you, that whatever labour or leisure you may thus expend, will be wisely bestowed, and will be looked back upon with lasting and unalloyed satisfaction in after life.

To return, however, to physiology and to anatomy, which is the handmaid and groundwork of physiology. You must, if you would understand these subjects aright, possess the antecedent knowledge of which I have been speaking. And there is another truth I wish to impress upon you in respect to this, the first step of your progress: you must take that step completely here. If you do not thoroughly learn the structure and functions of the healthy body now, while you are yet students, the probability is small that you will ever know them well or creditably; and if this foundation be laid imperfectly, the whole superstructure raised upon it will assuredly be defective and unsafe. Few of you can ever again command the time, the convenience, the assistance, and appliances, which this large town, and these schools of anatomy, afford you during the season of your pupilage. I say there is small likelihood

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