THE LIBRARY 
 
 OF 
 
 THE UNIVERSITY 
 
 OF CALIFORNIA 
 
 LOS ANGELES 
 
 N 
 
 Ex Lihris 
 
 SIR MICHAEL SADLER 
 
 ACQUIRED 1948 
 
 WITH THE HELP OF ALUMNI OF THE 
 
 SCHOOL OF EDUCATION
 
 BY PROFESSOR T. CLIFFORD ALLBUTT. 
 
 Notes on the Composition of Scientific 
 Papers. Crown 8vo. 3s. net. 
 
 The Historical Relations of Medicine 
 and Surgery. Crown 8vo. 2s. 6d. net. 
 
 LONDON: MACMILLAN AND CO., Ltd.
 
 ON PEOFESSIONAL EDUCATION
 
 ' ' La puissance de I'tducatimi coiisistc A aiigmenter 
 le Tunnhre des motifs dans V esprit de I'vidividu." 
 
 hlTlRt.
 
 ON 
 
 PEOFESSIONAL EDUCATION 
 
 WITH SPECIAL REFEEEXCE TO MEDICINE 
 AN ADDRESS 
 
 DELIVERED AT KING'S COLLEGE, LONDON 
 ON OCTOBER 3, 1905 
 
 BY 
 
 T. CLIFFOKD ALLBUTT, M.A., M.D., F.IJ.S. 
 
 HON. D.SC. OXOX., ETC. ETC. 
 
 REGIUS PROFESSOR OF PHYSIC IN THE UNIVERSITY OF CAMBRIDGE 
 
 ILontion 
 MACMILLAN AND CO., Limited 
 
 NEW YORK : THE MACMILLAX COMPANY 
 1906 
 
 All rights resen-ed
 
 
 PREFACE 
 
 The request for the publication of this Address is 
 so general that I trust it may prove on reflection 
 to be not unworthy of its great theme. I have 
 ventured to publish the wliole of the manuscript, of 
 which about two- thirds was delivered. 
 
 My thanks are due to the editors of the Lancet and 
 of the British Medical Journal for their excellent 
 reports, of which I have ventured to avail myself. 
 I am indebted also for valuable information to the 
 columns of these and other professional journals of 
 various dates, and finally to Dr. Squire Sprigge for 
 his book on Medicine and the Public (Heiuemann, 
 1905), which indeed was published after the date 
 of my Address at King's College, but is based upon 
 his thesis for the degree of M.D. at Cambridge, of 
 which I had official cognisance. 
 
 As these sheets are finished for the press, we 
 are all bereaved of a leader in University and 
 State education, and of a great personal teacher ; 
 not a few of us of a dear friend. I have now 
 learned tliat Sir Kichard Jebb addressed the British 
 
 623093
 
 vi ON PEOFESSIONAL EDUCATION 
 
 Association in South Africa on the subject which was 
 occupying our thoughts about the same time at King's 
 College. If my argument, however imperfectly, be 
 in concord with his (I have not yet seen his Address 
 even in abstract) I shall be grateful, — grateful to 
 be a humble servant in a cause in which he was 
 so illustrious a master. Had he lived he would 
 have read my words with indulgence ; I dare not 
 dedicate so slight an offering to his memory. 
 
 T. C. A. 
 
 Cambridge, Deceynher 11, 1905.
 
 ON PROFESSIONAL EDUCATION^ 
 
 GentlemI'^n — When the distinguished iuvitatiou 
 of yovir Medical Board to open this session was 
 conveyed to me, my responsibility was lightened by 
 a proposal of the subject of my address — namely, 
 Medical Education in London. London, like every 
 other great centre of education, has its own problems 
 and its own difficulties, but these problems and 
 these difficulties cannot be solved without the 
 illumination of the principles which are true for 
 education everywhere and always. If in England 
 these principles are little heeded by the public, 
 and if accordingly secondary education in England 
 is in grievous defect, it is not for want of preaching. 
 From Matthew Arnold and Michael Sadler to the 
 humble empiric who ventures into the pulpit to-day, 
 of preachers there has been no lack. If I am quali- 
 fied to deal with the subject yet again, it is that 
 all my adult life I have been engaged in teaching, 
 in centres so different as Leeds and Cambridge, and 
 ought from such conflict of conditions to have 
 
 ^ An Address delivered at King's College Hospital, under the 
 title of "Medical Education in London," on October 3, 1905, the 
 opening of the Medical Session. 
 
 B
 
 2 ON PEOFESSIONAL EDUCATION 
 
 harvested some wisdom. If without the added 
 dignity of my office I should scarcely dare to 
 address you, on the other hand I must beware lest 
 I give an official colour to my opinions, lest 
 I seem to engage my University in doctrines which 
 it may have no mind to. Cucullns non facit 
 mo7iaclium ; whatsoever then may be inconveniently 
 said by the professor pray write down quickly 
 to the account of the individual. This at least I 
 may plead, that I will say nothing lightly ; my 
 convictions are not of yesterday. 
 
 Education and instruction. — Education, as 
 contrasted with instruction, is a drawing forth of 
 faculties, a quickening, enlarging, and refining 
 of them when brought out, and an establish- 
 ment of them in habits ; so that virtue and reason 
 become easy and pleasant to us. The word is 
 used of mind rather than of morals, or of the 
 powers of the body; but by mind we signify both 
 intellect and imagination, and their issue in right 
 action. The more complex the organism can become 
 the more stable it will be, the more it will be in 
 touch with outward contingencies ; the more it can 
 use and modify these conditions, the more will be 
 the play at the periphery of the organism, the 
 more, in a word, the life. Education, then, is not 
 the formation of a rigid framework, but of a 
 capacity for ideas and for various and supple 
 adaptations. But, speaking generally, and within 
 civil societies, individuals vary more than circum- 
 stances, in other words, out of similar circumstances 
 individuals draw widely different advantages; so that
 
 ON PKOFESSIONAL EDUCATION 3 
 
 although up to a certain period of life education 
 may be laid out on broad indiscriminate lines 
 proper for all young persons, yet for adolescents 
 by rapid decrees it must become more and more 
 diverse and several, dividing itself into the educa- 
 tion of classes, of groups, and of individuals. Now, 
 such specific or technical educations are difficult 
 only in the sense of the difficulty of persuading 
 the English parent of the value of any education 
 whatever ; the ends and the methods are pretty 
 clearly seen ; the means it is which are wanting, 
 the means of money, of equipment, and of time, 
 which is money, and the provision and endowment 
 of those engines for making knowledge, called 
 universities, without which sources the technical 
 colleges would soon dry up. 
 
 The problem of education in modern England 
 is that of general schooling, of ascertaining the 
 modes which shall prove most valuable to put 
 each person during his youth in touch with the 
 sum of conditions under which he is to lead the 
 best life possible to him ; this done he may the 
 more efficiently be adapted to specific or personal 
 functions. Although these personal and specific 
 conditions are never so narrow and so specific as 
 to prevent some occupation with those wider 
 conditions which were held in view during his 
 general education, yet without a somewhat fuller 
 sense of the sum of the conditions of life he cannot 
 measure the relative values of things ; he will, as 
 we say, lack common sense. Now the larger and 
 more copious the ideas the more difficult are they
 
 4 ON PROFESSIONAL EDUCATION 
 
 to handle, the more difficult it is to order them in 
 their relative values, that is to say, with " common 
 sense," for this quality is the easier the meaner the 
 range of thought. When the ideation is high some 
 defect of common sense is readily forgiven. The 
 importance of a universal training of the instrument 
 of mind, before the adaptation of it to special engage- 
 ments, will be better understood when we realise that 
 truth is neither wholly without us nor wholly within 
 us, but is a function of fact and temperament. 
 Now temperament is partly native, but largely also 
 the creature of habit, and habits — such as the 
 habit of virtue and of comprehensive and precise 
 thinking — are the creatures of education, and 
 especially of education in the plastic years of life. 
 Thus the man whose mind has been built up on 
 universal lines, whatsoever his calling, is enabled 
 to free himself from the conventions and temporary 
 notions of the mere " practical man," to distinguish 
 the important from the unimportant truths, and to 
 drop swiftly upon cardinal features — upon the facts 
 which matter. 
 
 Secondaky education. — Now — to begin with 
 secondary education — to teach every boy every- 
 thing is obviously impossible ; the difficulty is 
 so to select certain things from the whole of 
 things as best to educe universal conceptions or 
 ideas. That we liave been successful in creating 
 such a general education no one will be hardy 
 enough to assert. From our public schools our 
 young men derive many fine qualities. As 
 Herodotus says of the Persian youths, they are
 
 ON PROFESSIONAL EDUCATION 5 
 
 taught to ride and to speak the truth ; and, indeed, 
 when our country loses its manliness and its 
 veracity it will lose all things. But these fine 
 qualities do not meet the sum of conditions under 
 which the Englishman has to live ; he has to do 
 more than to speak and to act with spirit and 
 uprightness, and to read the sporting papers with 
 intelligence. If he is to be equal to the conflict 
 of modern life he must be able to reason both on 
 man and on nature, to measure his own capacities, to 
 read the hearts and habits of men, and to foresee 
 the trend of natural laws. For these ends, besides 
 energy and will, he must have a curiosity for know- 
 ledge, some intellectual seriousness and flexibility, 
 some endurance of attention, some self-possession, 
 and some ideas : qualities eminently in defect in the 
 average products of our public schools. 
 
 That the seeds of these qualities are within us 
 we may know by this that they are far more evident 
 in young women, who do not go to public schools ; 
 and in the long run not brains only but morals also 
 depend on these more generous features. Too many 
 of our manly and honest young fellows fall into a 
 good-natured, well-mannered selfishness ; into acqui- 
 escence in common standards; into contentment with 
 very scanty mental furniture. If, then, the public 
 school does much for our boys, it is at the cost of 
 certain virtues. The faults of which I have spoken 
 depend in part on a weakening of the family life 
 and of the family bond, with a consequent loss of 
 much of the variety and many of the gentlenesses 
 which are nurtured in the home, and with an
 
 6 ON PEOFESSIONAL EDUCATION 
 
 aggravation of caste distinctions. The American 
 common schools, which do not break into the home, 
 and which bring classes together, have in this 
 respect a great advantage over our own. I think 
 no " educationalist " has noted how much our public 
 school system depends upon a foolish horror of 
 dialects, an intolerance unknown in France and 
 Germany. Even in our own kingdom the Scotch 
 and the Irish tongues are acceptable ; but in England 
 for a father to permit his son to associate with the 
 lads of his province so as to catch the dialect, of 
 Yorkshire, let us say, or of Suffolk or Somersetshire, 
 is, as things are, to consent to his social failure. A 
 Frenchman and an Italian may drop h's with im- 
 punity, but the English boy who does it will find 
 advancement closed against him. In this respect 
 our public schools thrive on a folly. With the outcry 
 against athletics I have little sympathy : it is not the 
 athletics which do harm, but the publicity and the 
 noise of them. If the University Boat-race and 
 the " Eton v. Harrow " cannot be helped, no other 
 public school or university games should be the 
 sport of the public. 
 
 The salient defect of the boy, as he leaves school, 
 is his subservience to a wooden routine or conven- 
 tion which seems there to be perpetuated, and 
 prolongs the imitative stage of childhood into early 
 manhood. It is sad to see a lad with a frank, 
 bright, affectionate habit — nn hon naturcl — falling 
 under this awkward compound of self-distrust and 
 self-consciousness, which is, I think, peculiar to the 
 English youth, and generates a reserve which.
 
 ON PEOFESSIONAL EDUCATION 7 
 
 although consistent with modesty, is not modesty. 
 Its nature is not easy to read, and the subjects of 
 it are least able to read it; but it appears to be 
 no chrysalid stage before a transformation, but the 
 negative posture of minds deficient in ideas, and 
 ungainly in the use of the few they have. It comes 
 in great part, I think, of what we may call, as truly 
 as paradoxically, tlie secluded life of the public 
 school. The tendency of the units of all aggregates, 
 if not animated and developed by external provoca- 
 tions, is towards the mean position ; that is, in the 
 public school, to the monotonous pattern of Smith 
 major. By the crust of this custom the boy's 
 initiative is palsied, his manners are embarrassed, 
 and he has not moral courage to express himself 
 frankly — ' lest he give himself away ' as he calls it, 
 lest this precious convention, which he admires in 
 Smith major, be disturbed ; so he tries to put on a 
 cloak of indifference in which he is absurdly untrue 
 to himself. With the spirit of Greek he is as deeply 
 imbued as with Chinese.^ Now unhappily this frost 
 
 ^ After the return of the revise sheets of this tract to the 
 printer that delightful book the Upton Letters came into my 
 hands. I cannot forbear to despatch one short extract from it, 
 though I am well aware how it puts my poor argument into 
 the shade. Yet is tliere not in the last sentence a note of 
 dispirited acquiescence, a want of vehement revolt, which makes 
 one think perhaps we need other schoolmasters, and need them 
 different ? Or are the Upton Letters the ironical smile of a man 
 about to spring ? 
 
 " I declare that it makes me very sad sometimes to see these 
 well-groomed, well-mannered, rational, manlj' boys all taking the 
 same view of things, all doing the same things, smiling politely 
 at the eccentricity of anj^ one who finds matter for serious interest
 
 8 ON PEOFESSIONAL EDUCATION 
 
 sets in at the plastic age when mental expansion 
 and freedom of thought and emotion are most 
 precious, and in the shell of it the youth withdraws 
 himself from the influence of men from whom he 
 might be led to a wider outlook. In those who 
 come under more generous and formative influ- 
 ences, as in a university for example, this shell 
 begins to chip, in Cambridge usually by the end of 
 the second year of residence ; then, discovering his 
 own mind and character, the unit becomes a person, 
 and often a very interesting person, one no longer 
 tired at the very notion of continuous thought. If, 
 on the other hand, the youth passes into common 
 society undisciplined by any such influences, as the 
 reserve of the school cloister gets rubbed off, his 
 scantiness in ideas, contentment in stereotyped 
 phrases and purposes, and intolerance of all mental 
 effort, intellectual or imaginative, lie exposed and 
 untransformed. Thus but too often men reach 
 the prime of life common -minded, incapable, and 
 even intolerant of ideas, that is of large and 
 
 in books, in art, or music : all splendidly reticent about their 
 inner thoughts, with a courteous respect for the formalities of 
 religion, and the formalities of work : perfectly correct, perfectly 
 complaisant, with no irregularities or angular preferences of their 
 own, with no admiration for anything but athletic successes, and 
 no contempt for anything except originality of ideas. They are 
 so nice, so gentlemanly, so easy to get on with, and yet, in 
 another region, they are so dull, so unimaginative, so narrow- 
 minded. They cannot of course be all intellectual or cultivated, 
 but they might be more tolerant, more just, more wise. They 
 ought to be able to admire vigour and enthusiasm in every 
 department instead of in one or two, and it is we who ought 
 to make them feel so, and we have already too much to do."
 
 ON PROFESSIONAL EDUCATION 9 
 
 systematic couceptious of present and coming events ; 
 and consequently are incurable empirics, and have no 
 higher philosophy than that of muddling through.^ 
 
 Compulsory Greek. — It was mainly because of 
 the dialectical and mechanical methods of it, and of 
 its exclusiveness, that I joined those in Cambridge 
 who opposed " Compulsory Greek," a liberal move- 
 ment arrested once more, as the old story goes, by 
 reactionary clergy. The current teaching of Greek 
 and Latin is a parody of education ; not only does 
 it restrict the range of teacher and pupil, but the 
 imaginations of both are stunted. Until they begin 
 grammars — begin them, that is, without any appre- 
 hension of the language and ideas of which the gram- 
 mars are arid abstractions — the bent of children is 
 quick and real ; but under this inculcation their 
 imaginative conception of reality begins to wither, 
 and its place is taken by formulas, rhetorical words 
 and philological bones ; their fancy is discouraged, 
 and they discover that, after all, things are not in- 
 teresting. As research keeps science-teaching alive, 
 so classical training, if divorced from history, litera- 
 ture, and philosopliy, must starve. That such teach- 
 ing of Greek will be changed from within I see no 
 sign ; never in any age have reforms in education 
 come from the schoolmaster, but from new conditions 
 and demands in an enlightened society ; the school- 
 master has always been not the reformer but the 
 reformed. There is no state so perilous as that 
 
 ^ To " muddle " is to mop up etlects without analysis, apprecia- 
 tion, and government of causes — to act, for example, as we are 
 now doing with the "unemployed."
 
 10 ON PEOFESSIONAL EDUCATION 
 
 in which things seem good to us, and at present in 
 England the schoolmaster is complacent, the public is 
 indifferent.^ In the sixteenth century the humanist, 
 lacking in the historic sense, believed the literatures 
 of Latin and Greek to contain all that could be 
 useful to man in all departments of life ; as 
 the medievalist believed that the sources of 
 knowledge were to be found not in origins 
 but in disputations. Yet the medievalist, in his 
 zealous search for a universal idea, a unifying 
 cause, or a key to the world's secrets, aimed at a 
 complete cultivation of all fields of knowledge ; and 
 in the early renaissance the classics were welcomed 
 not so much as language and philology but as the 
 sources of new ideas. Gradually, however, edu- 
 cational like ecclesiastical machinery closed in upon 
 and stifled the spirit which created it. Now, by a 
 curious inversion of things, the scientific study of 
 facts is the lever by which liberal culture has been 
 reawakened, and we are beginning to see that the 
 ideas and methods of natural science, instead of 
 being merely curious or commercial, are, if not the 
 flower of education, at any rate the stem and 
 branches. Though analysis can never be form, it 
 is by scientific methods that the new power is 
 entering into letters and philosophy ; for as we ob- 
 serve fully and accurately we must soon begin to 
 select, and then the imagination must conspire to 
 suf'gest the directions in which truths may lie. As 
 
 1 It is fair to add that in tlie Perse school at Cambridge 
 Dr. Rouse seems to be creating a new method and awakening 
 new interests in his classical pupils.
 
 ON PEOFESSIONAL EDUCATION 11 
 
 the poet must liave his own organising intelligence, 
 so the man of science must grow his own visions. 
 
 Development of imagination. — And yet in 
 most schools, if not in all, far from an amalgamation 
 of science and letters, these hemispheres of educa- 
 tion are cleft asunder. The school is cleft into 
 a " modern " and an antique (?) side : as if all 
 education were not to be modern, as if there could 
 be two essentially different ways of educating boys ! 
 I question if there are three headmasters in England 
 who govern and inspire their " modern side," to say 
 nothino- of so co-ordinatincj letters and science that 
 eacli shall supplement the other, and both unite in 
 fertility. And on both " sides," while the memory is 
 exercised, and the intellect somewhat called upon, 
 the imagination, the centre of creative life, the 
 source of great action, is left out in the cold. 
 
 One of the ablest of our headmasters said to 
 me that if he were called upon to educate the 
 imaginations of his boys he would scarcely know 
 how to begiu.^ By some thoughtful men it is said 
 that a contemplation of the " laws " of nature 
 suffices to kindle and feed the imagination ; that a 
 study of gravitation, for example, of the theory 
 of ions, or of natural selection, has this effect ; an 
 opinion which even in the adult I hesitate to 
 support. The imaginative or making faculty of 
 
 ^ In his address to the Royal Society on November 30, 1905, 
 Sir William Huggins lamented the failure of modern education 
 to foster the sentiments of wonder and admiration. I ought 
 here, however, to recall the admirable training of the young 
 imagination by the plays at Bradfield College.
 
 12 ON PROFESSIONAL EDUCATION 
 
 man is fed, not by abstractions or summaries of 
 analytic processes attained by observation from tlie 
 outside, but by images ; not by watching things but 
 by living in them. To be in love and to trace the 
 psychology of lovers are in polar difference. Baude- 
 laire touched the heart of the matter, if with im- 
 perfect truth, when he said, " It would be prodigious 
 for a critic to become a poet, but it is impossible for 
 a poet not to contain a critic." Tlie greater the 
 images — creations and deeds — the more intense the 
 life in them, the stronger the imagination. A sense 
 of natural order has its impressiveness, but scarcely 
 makes the glory and dominion of the heavens as 
 did the belief, chimera as it was, that stars bore in 
 their orbits the fate of kings or of men unborn. 
 
 Some consequence yet hanging in the stars 
 Shall bitterly begin his fearful date. 
 
 By scientific analysis, it is true, we disintegrate 
 the imperfect images of the past, such as those of 
 astrology, and clear the ground for new ideas ; but 
 the laws thus discovered are not the new ideas : no 
 theory of colours will make a Titian. By calling his 
 ultimate analysis, his remotest abstraction, a syn- 
 thesis, Spencer hoodwinked us all : such is the 
 power of a word. 
 
 Specialisation. — In the discussion of educational 
 problems we hear much of the baneful effects of this 
 process, and have worked ourselves up into an alarm 
 about it. Yet is it not better that a young man 
 should know something well, should realise what 
 knowledge costs to get, and learn to look below
 
 ON PEOFESSIONAL EDUCATION 13 
 
 superficial plausibilities, than pride himself on 
 acquirements, general enough no doubt, but general 
 in their vagueness, shallowness, and inaccuracy ? 
 
 Too often, indeed, with this rather ugly noun we 
 console ourselves for our ignorance of some depart- 
 ment of knowledge with which we find another 
 person is conversant. Yet surely by what gate 
 soever we enter into the kingdom of nature and 
 man, by the East or by the West, by the North or 
 by the South, her kingdom is boundless in domain, 
 sensitive in every direction, and in riches inexhaust- 
 ible. If then the " specialisation " be narrow the 
 contraction is not in nature herself, but in the mind 
 of teacher, or of pupil, or of both of them. A uniform 
 development of all the faculties, as we have seen, 
 can belong only to the earlier stages even of school 
 life; the abilities of the older boy as he matures 
 will, if he is worth much, betray a bias in one or 
 more directions ; and I am satisfied that if the two 
 main coefficients of mind — the intellect and the 
 imagination — are fostered, it proves best in the end 
 to promote development in each person on the 
 lines of his own nature. 
 
 To whip up the weaker faculties to keep pace 
 with the stronger, hinders these and really forces 
 the weaker to little ultimate purpose ; whereas to 
 promote a generous growth of the more powerful 
 gifts of the individual mind so enlightens and 
 animates the whole that subordinate faculties are 
 drawn onward with the rest. Otherwise the march 
 must be set at the rate of the slowest factors. In 
 adolescence and at the university the same principles
 
 14 ON PROFESSIONAL EDUCATION 
 
 hold good. A youug man who in certain directions 
 begins to feel his strength is encouraged ; and 
 by mastering the subject or subjects for which he is 
 best adapted, he forms as he progresses truer and 
 truer conceptions of what knowledge is, and what 
 methods are ; and will not fail by this measure to 
 test and to call into play such other faculties he may 
 possess. As I have already insisted — it is not so 
 much what a man is taught as hoio he is taught it ; 
 but I will reiterate the compensatory truth which is 
 most neglected, that there is one kind of "specialism" 
 which to some men is ruinous, and is mischievous to 
 all ; namely, to cultivate apart either intellect or 
 imagination. " Specialise " each as you please, but 
 do not sunder them, nor neglect either of them. 
 
 The power of ideas. — When we declare, as 
 continually we do, that reality and strength lie in 
 facts, we deceive ourselves : the strong and the real 
 are to be found in ideas and, to use the word of 
 science, in theory. Until it is built into theory or 
 idea a fact is of no more use than a brick — to be 
 wasted on any passing stranger. By ideas it is 
 that men lead, nations prosper, and dominions are 
 established ; by ideas dynasties are overthrown, 
 nations convulsed, and peoples scattered ; by them 
 the tyranny of custom and the dogmas of schools 
 are broken up ; by them we interpret, we work, 
 and we prophesy. But an idea is something far 
 more than an intellectual abstraction ; it is a growth 
 and integration of racial experience, functioning 
 through intellect and imagination together. In 
 his desire that his mind should be " a clear, cold
 
 ON PEOFESSIONAL EDUCATION 15 
 
 logic-engine in sniootli working order," Huxley was 
 not perhaps wholly serious ; at any rate he himself 
 was a lively instance to the contrary. Temperance, 
 order, lucidity, are precious conditions, but they 
 are not creative. Into the creative process of 
 making knowledge and purpose, imagination enters 
 as well as intellect. Imagination may, it is true, 
 be nurtured on fables and chimeras ; yet even 
 then, if in due time it be purged and braced 
 by a strong understanding, it will be more potent 
 as a source of creative energy than if it had been 
 starved. The more the passion, the more it is 
 under intellectual control and information, the 
 more intimately the imagination and the intellect 
 are fused together, and the more verifiable the 
 ideals, the larger and the higher the practical 
 efficacy. And yet the man in the street who acts 
 by ideas, if by no means by the best at his service, 
 ignorantly and ungratefully regards ideas with in- 
 difference, or even with aversion. To this subject 
 I shall return under the head of " Standards." 
 
 Again, if progress consists in seeing beyond 
 where we stand, it must consist not only in antici- 
 pation of new ideas, but also in timely apprehension 
 of the passing of them, and a readiness to shed 
 them — to shed them betimes, not catastrophically, 
 but as a growing tree periodically sheds its leaves ; 
 otherwise we lose sight of their main form, we 
 muddle on — for go we must, we get angry with 
 any one but ourselves, and finding ourselves house- 
 less know not how to rebuild, how to convert 
 the old materials to new needs.
 
 16 ON PEOFESSIONAL EDUCATION 
 
 The power of science. — On behalf of the 
 part of science in education we men of science 
 declare that we need not only a " criticism " of man 
 and affairs, which we admit to be a chief end of 
 knowledge and insight, but also a criticism of nature 
 which, if not so final, is no less essential. We need 
 it not merely to make nature our slave, and to pre- 
 pare the ground for vaster and vaster aggregations 
 of human societies, but also, and rather, to exercise 
 ourselves in the rigid verification of facts, the 
 incessant testing of axioms, and the continual dis- 
 covery of " laws " which not only prove themselves 
 as we go on, but also afford degrees by which further 
 ascents are made possible. Thus research is its 
 own organon. By virtue of the natural sciences 
 only can this mental discipline be had ; so that their 
 study is not only an end in itself but also the 
 means, and the only means, of providing canons 
 for history, politics, and ethics. To these more 
 complex studies — higher studies, if you will — 
 the scientific habit of mind is essential ; but it 
 is a habit which the study of literature and even 
 of philosophy alone cannot compass ; so that 
 for lack of it humanists and philosophers have 
 too often spent themselves on chimeras : without 
 it the criticism of man in the realms of his 
 thought and imagination have been, not in the 
 Middle Ages only, wayward, unreal, and perverse. 
 With pardonable pride I may recall an early 
 advocate of scientific methods in education in the 
 person of my great-grandfather, John Allbutt, a 
 successful schoolmaster in his day, who wrote a
 
 ON PKOFESSIONAL EDUCATION 17 
 
 primer lor this purpose which had some vogue. I 
 quote from the twelth edition (1817): "I am 
 convinced by experience that children might be 
 taught much earlier than they are the elementary 
 principles of many sciences if these were sufficiently 
 simplified and divested of technical phrases, and 
 these," he adds, " would give correct ideas of things 
 with which men are daily conversant." 
 
 The power of the hand. — In my Historical 
 Relations of Medicine and Surgery ^ I urged at 
 length, and with illustrations from two thousand 
 years of medical history, that we have always 
 been prone, and not in universities only or chiefly, 
 to forget that the temple of education cannot 
 be built without hands. These subtle ministers 
 are directed by the mind, but by the mind 
 which they themselves have created ; as in the 
 state we are directed by the government we our- 
 selves have established. So long as nerve and 
 muscle are growing, the hand — and by the hand I 
 now signify every instrumental limb of the body — 
 seems to achieve a little more than the mental sug- 
 gestion; it explores, and often in each new use or 
 adventure discovers, a little wider range of function 
 than the will had dictated. Of these gains of ex- 
 perience time after time conceptions are returned to 
 the brain, and there registered in multiplications of 
 structure ; and thus, gradually from the beginning, by 
 each successive function of such limbs — by practice 
 as we say — both ability and capacity are tentatively 
 
 ^ The title of my Address on Inner Medicine at St. Louis in 
 1904. (Macmilhin and Co. ) 
 
 C
 
 18 ON PEOFESSIONAL EDUCATION 
 
 developed : — " and things outward do draw the 
 inward quality after them." Thus the periphery or 
 growing edge of the whole sphere of bodily function 
 is the mind's workshop. Now by reading or hearing 
 of things only, not making these tentative excur- 
 sions, it seems certain that this development either 
 does not occur, or occurs in very much less sub- 
 stance and degree. Here then the self-made man 
 has an advantage ; and if he has great abilities and 
 comes just at a time when he is wanted, he goes to 
 the front. But such men are rather improvised 
 than made. Forgive me if I recall to you the well- 
 known illustration of Aristotle (in the last chapter 
 of the SophisHci Menchi), where that teacher is 
 condemned who, professing to shew how the feet 
 may be comfortably covered, instead of shewing his 
 pupil how to make shoes, presented him with a 
 good stock of shoes ready-made. Thus a language, 
 for instance, if it is to be a fundamental and 
 comprehensive means of education, must be sj^oken 
 as well as read, and, in the order of thought at any 
 rate, spoken before it is read. 
 
 The value of formula. — Formulas and con- 
 ventions are not by any means wholly for evil. 
 They have their necessary and organic place in 
 the order of progress ; by them tradition is handed 
 on in times of failing effort, steadfastness of pur- 
 pose is assured, and in times of activity mental 
 interference and regulation are economised. Thus 
 by the delegation of duties of inferior range 
 to subordinate centres the tension of conscious 
 adaptation is relaxed ; and new and unfamiliar
 
 ON PROFESSIONAL EDUCATION 19 
 
 ideas are made handy for use. The danger begins 
 when, instead of using these steps as a irov (ttm by 
 which to rise higher and higher, we use them as 
 easy-chairs ; for the man who would crucify any 
 new idea whatever, as a new idea, when he has 
 come to rest in it will defend it as a fortress. Yet 
 if life consists in continual new adaptations, surely 
 in a stable society our prejudice should be, prima 
 facie, not against the new but against the old. 
 
 Maintenance of standakds. — Let me repeat 
 that intellect and imagination though, like other 
 attributes, very variously distributed to individuals, 
 and in them very variously cultivated, in life are 
 organically integrated ; in psychological analysis 
 only are they separable. Neither in art nor even 
 in science can we say — here intellect ends and 
 here imagination begins ; or contrariwise. Of 
 the conjugation of these parents all true and 
 good work is born ; without more or less self- 
 conscious analysis and control creative impulse 
 bombinates in the void ; the " intellectuels," on 
 the other hand, if such people there be, never did 
 anything, not even for anarchy. The current 
 phrase of " intellectuels ardents " or " zeles " is 
 unmeaning ; their energy is generated not of 
 intellect but of passionate ideas. I have said that 
 Huxley did not see how emasculated his own genius 
 would have been had his desire been granted him, 
 even in scientific concerns only, for a clear, 
 cold logic-engine in smootli working order. That 
 best part of memory, the memory of action, is 
 largely imaginative ; and its mansions are built up
 
 20 ON PEOFESSIONAL EDUCATION 
 
 by the hands. Whether in art or science, sobriety 
 and wisdom consist, then, not in the banishment of 
 ideas, nor even in their abatement or subjection, 
 but in the edification and chastening of them. To 
 be barren of ideas, of imagination, is to drift away 
 from our proper selves, from our traditions, from 
 our historical and developmental continuity ; to 
 drop into imitation, and to be reduced to picking 
 up notions made in Germany. 
 
 Our ideation, therefore, must not only be 
 awakened but also sustained, as our intellects are 
 sustained ; and ideation or imagination is sustained 
 by the contemplation of standards, or, in physiological 
 language, by the maintenance of the corresponding 
 "conductive and reciprocative patterns" in the brain. 
 As by converse with the well-bred we maintain good- 
 breeding, so for the maintenance of the more exalted 
 ideas we must occupy ourselves continually with 
 great traditions, that is to say, with great standards. 
 How difficult it is to keep a standard in the 
 memory, whether of the works of others or of 
 our own, is well known to every critic. A fine 
 horseman once told me he never realised how bad 
 a judge he was of a horse until one day when he 
 found himself looking unawares at " Cremorne." 
 Bol and Van der Heist are pre-eminent till we 
 come into the presence of Rembrandt ; or we think 
 this painter or that worthy to rank with Eeynolds 
 or Watteau till we find ourselves in the National 
 Gallery or at Hertford House, to repent at leisure. 
 Again a fine copy prevails with us as a genuine work 
 till the original and the copy are brought side by
 
 ON PROFESSIONAL EDUCATION 21 
 
 side, as was done with the two " Conde de Olivares " 
 at the Guildhall in 1 90 1, and with the two " liabbis" 
 in a recent Eembrandt exhibition. And if this 
 be so in the spheres to which I have alluded as 
 illustrations, so it is with the great masters of prose 
 or poetry, with great musicians, with great dis- 
 coverers in science, and so forth ; and thus it is 
 that we should depend upon a classical education, 
 in no pedantic or merely linguistic sense, but as a 
 contemplation of masterpieces. If we cannot 
 maintain, or but few of us, a perfect memory of 
 standards, we learn at least " to approve the things 
 that are excellent," to distrust our own judgment, 
 and to get some abiding sense of what has been, 
 and so may be, and ought to be. It is not the 
 least of the advantages of the scientific element 
 in education that the categorical consensus and 
 continuity of this kind of research make a high 
 standard easier to comprehend and to maintain. 
 Thus we discern another function of universities, 
 that they are not only engines for the advancement 
 of knowledge civil and individual, two parts of one 
 function, but also the stewards and ministers of 
 standards — that is, of masterpieces in all kinds. A 
 university is a " standardising institution." 
 
 Now an intimate conversation with masterpieces 
 in science and art cannot well be attained without 
 some attempt at any rate to make in the same 
 kind ; surely it cannot be attained by " driving 
 students, in herds, past the monuments of genius 
 and learning." To judge well of painting one must 
 at least have handled the brush ; the scalpel only
 
 22 ON PROFESSIONAL EDUCATION 
 
 can make the anatomist ; and he who has never 
 stood at the wicket can be no great judge of cricket. 
 And so with tongues ; he who cannot speak a 
 language, such as Latin, for instance, does not 
 think in it, and so, in a sense, never intimately 
 knows it. On the literary side of my own educa- 
 tion I owe a greater debt to the practice of 
 Latin verses than to any other single discipline ; 
 yet, yielding to clamour where we ought to resist, 
 and resisting where we ought to yield, verse-making 
 was slackened, and the practice of form and con- 
 cision in composition fell away. Without develop- 
 ment of the effector, if not pari passu at any 
 rate in some approximate proportion, the receptor 
 machinery cannot be completed. 
 
 Yet great traditions with their inspiration have 
 their perils also. The problem in all ancient and 
 picturesque foundations is to temper admiration 
 of the past with hope and faith in the future ; to 
 realise that what has been done in any kind can 
 never be so done again ; that the old works cannot 
 be reached and can scarcely be approached by 
 copying them ; and that the illumination of the 
 past must be used to discover paths ever new. 
 Happily we can meditate on masterpieces without 
 fixing our eyes backwards : as did their creators so 
 we likewise must press on to new interpretations, 
 new conceptions ; from our forerunners we must 
 learn their prophetic vision, seeing in them the love 
 of truth which prevailed over the fear of error and 
 the shackles of conventions, and the method of 
 discipline and renunciation by which we also, re-
 
 ON PROFESSIONAL EDUCATION 23 
 
 presenting the large and vital lines of nature, nature 
 which never halts and never forgets, may endeavour 
 to rise above the reach of Time. 
 
 How great teachers, artists, and other masters of 
 truth have chafed against the lack of standards in 
 the people of their age, history tells us on every 
 page. They are by nature before their generation ; 
 that is, they are mixing with men who are without 
 the corresponding psychic organ, the "conductive 
 patterns " in their brains to which I have referred. 
 A few of the very greatest of them, such as Charles 
 Darwin, have dwelt in serene assurance of the 
 ripening of time : but most of them were 
 fretted and torn by controversies which did indeed 
 imply some ideals, if not their own ; or were 
 suffocated in the damp of indifference, which means 
 none. If we hastily accuse such men — men such 
 as the scholars of the sixteenth century — of abnormal 
 sensitiveness, even of vanity and brag ; and if we 
 physicians, affronted by quackeries and pretence, 
 are accused of fretfuluess and spitefulness, may a 
 gentler public judge them and us as jealous rather 
 for tlie standards which it knows not, but which 
 those scholars cherished and we cherish, than for 
 personal ascendancy or adulation. 
 
 A statesman whom we hear always with admira- 
 tion, seldom with dissent, speaking on a recent and 
 eminent occasion, made certain comparisons between 
 the old and the new universities, against which, how- 
 ever unwillingly, I must make some remonstrance. 
 Lord Itosebery, addressing the London University 
 on the 5th of October last, is reported as follows : —
 
 24 ON PEOFESSIONAL EDUCATION 
 
 " The University of London is a young university. 
 It deals with comparatively new branches of learn- 
 ing. It deals with the practical and the concrete, 
 rather than with the ancient and the abstract. In 
 that respect there is a marked difference between it 
 and those ancient universities to which some of us 
 owe a loyal and filial allegiance which cannot be 
 obliterated by any newer loyalty or allegiance. The 
 newer universities must be content, and wisely con- 
 tent, with something which is not antiquity, and is 
 not tradition, but may be more immediately useful 
 and practical than either antiquity or tradition. 
 We, placed in the largest community in the world, 
 with our hands, so to speak, on the very heart of 
 the Empire, living among new wants and new aspir- 
 ations, meeting new needs and new acquirements, 
 ready, as I hope, to face the exigencies of to-day and 
 to-morrow, are the university of the future, though 
 we cannot trace our antiquity back to the hoary 
 past." 
 
 These counsels, as it appears to me, would dis- 
 integrate the best ideals of the higher education ; 
 would lead to degradation of the new and petri- 
 faction of the old universities. We are told that 
 the "ancient and abstract" is incongruous with 
 the " practical and concrete " ; that the new uni- 
 versities, by a wise renunciation of antiquity and 
 tradition, must be content in a useful and practical 
 life ; that they are, however, the universities of the 
 future, while the old, on the other hand, are to in- 
 spire loyal and filial allegiance by the sentiments of 
 the past. This is to make one lay down the pen in
 
 ON PEOFESSIONAL EDUCATION 25 
 
 despair. If the Chancellor of the University of London 
 says this, and counsels thus, what hope have we of 
 the enlightenment of vulgar opinion ? How can we 
 hope to convince it that all education must be, not 
 for the past and not for an elegant retirement, but 
 for the present and the future, and all seats of 
 learning therefore continually inseminated and re- 
 newed for this growth ! A certain man of the future, 
 if ever one there was — namely, Eudolf Virchow — 
 said many profound things, but none more profound 
 than this — " Alles wissenschaftliche Arbeiten ist ein 
 litterarisches." Is not Lord Eosebery's contrast the 
 false contrast of antique and modern " sides " spring- 
 ing out upon us in another guise ? But it may be 
 urged, if it is true that for boys there can be but 
 one best education, whatever this may prove to be, 
 for adults in a university a process of advancing 
 differentiation must go on. This we must grant ; 
 yet if these methods are to be sound and useful, 
 they must be taken not as superficial slices from 
 the sphere of knowledge, or they will shrivel for 
 want of inward nourishment, but as wedges or 
 cones with their roots still in the core. The 
 " immediately useful " or ephemeral is either such 
 a film, here for an hour and spent in an hour, or is 
 the growing edge of faculties which have their 
 origin, development, and continual nourishment 
 from the past, even from the remotest past, but 
 which know not Time. Even the " immediately 
 useful," if useful it be, has inevitably some content 
 of the past ; and if it is to thrive for future upon 
 future, it must be by that assimilation of the past
 
 26 ON PEOFESSIONAL EDUCATION 
 
 which makes past present, and by a constant 
 reference, deliberate or automatic, to the standards 
 of all ages in one. The useful of to-day then, as 
 it draws its deepest life from the bosom of the 
 eternal mother, must itself be but a link from that 
 life to the useful of to-morrow. So far as the new 
 universities have these sources of life, they must 
 draw them, directly or indirectly, from the store- 
 houses of the past ; and on every side we see that 
 they are dependent for their teaching on the old 
 universities, or on what these represent. If the 
 love of these by their children have henceforth no 
 deeper root than admiration of a gracious and 
 picturesque matronhood — " the beauty of the grey 
 head " with its gentle disillusions — their time is 
 come ; erelong they must be decently buried. But, 
 happily, universities are not as men and women, to 
 be cast into the oven; or, if all living things must 
 die, their term will be infinitely long, unless, like 
 some other dynasties, learning nothing and forgetting 
 nothing, they are led to their death by the affection 
 of sons who flatter them only with sentimental 
 adorations. Between the ancient and the modern, 
 then, there can be no sundering, without a petri- 
 faction of the channels by which the riches of the 
 past are welling up the present. 
 
 Again, concerning the contrast of " abstract and 
 concrete " ; surely by abstraction, or theory, we mean 
 the rules by which present or concrete problems 
 are most rapidly and economically solved ; so that 
 he who has the largest possessions in theory will 
 solve these problems most quickly and efficiently.
 
 ON PROFESSIONAL EDUCATION 27 
 
 A theory, or "abstraction," is indeeil a summation 
 of that experience of tlie race on which the future 
 must be built. The "concrete," on the other hand, 
 means, I presume, rule of thumb ; I fail to attacli 
 any other meaning to the word, for a " fact " is 
 useless until put into a rule, however narrow and 
 provisional the rule may be. It is evident then 
 that if a technical school may live from hand to 
 mouth on narrower rules it must be fed continually 
 from a university which discovers rules more widely 
 valid, or the technical school will fall into an atrophy. 
 Indeed if the new universities are to trust wholly 
 in current rules, and to fail to provide for the 
 wider abstractions; if, in other words, while dis- 
 tributing mere " concrete " knowledge, they fail to 
 provide for the advance of theory, they likewise must 
 quickly descend to the level of the technical schools. 
 What will be the relative positions of the " concrete " 
 and the " abstract " universities then ? The con- 
 clusion is that the first business of a new university 
 is to become an old one as soon as it can ; to kindle 
 the imagination as well as to inform the intellect. 
 Its youth is its misfortune, a misfortune to be 
 repaired only by alliance with its elders, and by 
 enriching itself from their stores and their edu- 
 cational capital. Happily this is a capital which 
 increases even by lavish distribution. 
 
 The truth in the Chancellor's warning seems to 
 be this : that there is a danger in an academic 
 severity, even in the work of the laboratory, lest 
 in expansion of analysis it be forgotten that the 
 student may soar too long above the earth, may
 
 28 ON PKOFESSIONAL EDUCATION 
 
 glory too much in the " uselessuess " of his pursuit 
 — that is, in its purely prospective profit. In his 
 ardour for the long run he may forget that most 
 of us, while admiring the loftiness and even the 
 aloofness of " pure " research, that which no doubt 
 will tell some day, and may indeed break into 
 amazing effect even to-morrow, have yet day by 
 day to live on a homelier trot, and need not so 
 much a brilliant orbit for our wings as a lantern 
 for our feet. But there is a graver fault than this, 
 for indeed the pursuit of verification on the lines 
 of great speculations is no error but the noblest 
 service. Our danger is not that advanced students 
 are splendidly impracticable, these men will not 
 overrun our academies, but lest they be convicted 
 of a less splendid ineffectiveness. Eoberts-Austin 
 was angered, and justly, by the indiscriminate 
 phrase " applied science." Applied science is 
 experimental science, and the scientific student 
 whose argument is too high for the common 
 occupations of men, for " the brewer, the baker, and 
 the candlestick-maker," is untrue to the principles 
 of the experimental method on which all science 
 directly depends, and for which nothing is common 
 or unclean. It is in every-day life, in things as 
 they are falling out around us every hour and every 
 moment, that principles are to be tested, problems 
 discovered, results sifted, processes improved, know- 
 ledge increased, and standards established. 
 
 If, then, in their maturity, the older universities 
 begin to lose the spirit of adventure ; if they cease 
 to vibrate with life to the innermost ; if they nurse
 
 ON PKOFESSIONAL EDUCATION 29 
 
 themselves more in fear of error than in love of 
 truth ; if, wistfully cherishing their " enchant- 
 ments," they gather their robes aside from the 
 vulgar touch ; if in fastidious study they shrink 
 from putting their doctrines to the harsh and common 
 tests of things as they occur — nay, if they fail to 
 seek in modern life new problems and new worlds 
 to conquer; if they think science is not science when 
 it concerns the factory and the market-place, or 
 that art and letters are not for the people, but for 
 the delicate adept; if Oxford and Cambridge are 
 not anticipating "new wa.nts and new aspirations, 
 meeting new needs and new acquirements, ready to 
 face the exigencies of to-day and to-morrow " ; if, 
 indeed, they are not by very virtue of their great 
 inheritance fulfilling these masterful purposes with 
 the greater power and the greater ascendancy, then 
 true enough they are the universities of the past, 
 and the dead must bury their dead. The old 
 universities have to-day a nobler calling than ever 
 before, to bear the flower of the experience of the 
 world. The second-rate comes and goes, rises and 
 falls, is courted and neglected ; the first-rate rises 
 slowly, but abides, surely withstanding not only the 
 treachery and indifference of men, but fire also, the 
 moth, and the edge of the sword. The works of 
 the men who, seeing beyond the accidents of their 
 own day and place, by their vitality have penetrated 
 every age and liindrance, speak, therefore, still to all 
 times and to all peoples ; by some miracle they 
 never die — nay, never grow old. 
 
 Is THE Englishman stupid ? — One of the
 
 30 ON PROFESSIONAL EDUCATION 
 
 greatest men of the generation just passed away 
 was wont to say sadly, " The English people have 
 some rare capacity for throwing up great men 
 now and then, here and there ; probably by some 
 occasional blend of mixed races, but of its own 
 nature England is stupid. With a beaver -like 
 instinct it has piled up great works for which 
 hands were sufficient ; but as the age of hands 
 alone is passing or past, and as the English- 
 man does not make mind, he must recede before 
 nations which in the mass are more intellectual." 
 I am not inclined to admit, with my late friend 
 and other wise men of this opinion — with Meritnee 
 before him, and Mr. Wells after him, that the 
 Englishman (I speak now of England in the 
 stricter sense) is naturally stupid. Ordinarily 
 he does seem stupid, it is true ; but I think 
 with an artificial stupidity, a quality bred of his 
 faulty education. Even in imagination I would 
 argue that he is by nature virile, and even rich ; 
 but from the nursery this faculty is persistently 
 abated in him. Like a Spartan, he admires self- 
 control ; but instead of cherishing it, forming it, 
 and directing it, he chooses to display this control 
 rather by disowning all emotion, so that he may be 
 bothered the less with either faculty. Yet in the 
 field of politics — to use the word in the widest 
 sense — the Englishman is a great creator ; and his 
 wisdom, patience, and efficiency must be rooted 
 in an imaginative power as strong as his practical 
 expediency. If India was made " in a fit of 
 absent-mindedness," the Egypt of to-day is a
 
 ON PROFESSIONAL EDUCATION 31 
 
 monument of deliberate intelligence, imagination, 
 and achievement ; a monumental record not of 
 material progress only but of this as a foundation 
 for freedom and righteousness. And even if we 
 take our illustrations from science, the great 
 mathematical physicists of our own country — not 
 only as rare individuals but as a school — present 
 the same qualities. The English engineer who in 
 the age of rule of thumb kept the lead will not 
 now lose it, for he is awakening to the imperative 
 need of theory. As his theory deals with simpler 
 conditions, it has been more quickly consolidated 
 than in more complex spheres of practice, such 
 as our own. The atmosphere which still befogs 
 the Army happily lifted off the Navy long ago ; 
 and indeed in chemistry and medicine it is not 
 the leaders who are wanting ; but in these quarters 
 the cloud over the public intelligence has not yet 
 rolled away. The laboratories turn out efficient 
 young chemists, " but in England nobody wants 
 them." And in my medical experience I can 
 testify that when the young Englishman can be 
 withdrawn from the upper and the lower vulgar, 
 and will give his time to come under university 
 influence so as to shed his awkward affectations, 
 and to release his more generous instincts for a 
 larger and higher life, he proves to have both 
 brains and imagination, and, to boot, a notable 
 sagacity of his own. Boys are not so dead to 
 intelligent interests as the weary schoolmaster 
 supposes. Towards the close of a medical educa- 
 tion I see him as one who has developed slowly,
 
 32 ON PROFESSIONAL EDUCATION 
 
 whose qualities have not been well understood at 
 school, and who has suffered accordingly under a 
 short-sighted, ill-planned, and dislocated secondary 
 education ; but who, if rescued in time, which too 
 often is not his luck, hatches out at length as a 
 man of character, and often of distinction. In 
 medicine we fear no comparisons with foreign 
 discovery ; and when a defectively educated public, 
 ignorant of standards, rises higher than to copy 
 foreign nations, and is prepared to make public use 
 of our students, it will find us ready with efficient 
 methods to strengthen our people at home, and to 
 plant healthy and thriving nations in lands now 
 devastated by pestilence. 
 
 The sense of contingency. — But there is some- 
 thing more to be said : if an a})pearance of natural 
 stupidity is produced by the intellectual chill and 
 the rather ignoble ideals of the public schoolboy, it 
 is generated also by a more respectable quality, in 
 its due degree valuable and even precious, but which, 
 by an overgrowth unchecked by a larger intelligence, 
 has pushed both intellect and imagination into the 
 background. The Englishman is dogged by the 
 sense of contingency, by the truth that the ap- 
 plication of principles to practice is thwarted at 
 every turn by incalculable incidents which in the 
 laboratory cannot be foreseen. Man is composite, 
 things are composite ; things must be taken as they 
 come, man must be illogical. Now it is in the 
 field of politics that this eye for compromise is 
 most useful, this mistrust of principles least 
 perilous ; in politics he is therefore supreme,
 
 ON PROFESSIONAL EDUCATION 33 
 
 though he does not owe much of this faculty to " the 
 playing fields of Eton." Thus it is that he throws 
 himself into the unbounded worship of rule of 
 thumlx If he can outwit contingencies he is proud 
 of himself; how wastefully he does it he cares little, 
 and the inert spirits are all proud of him. Because 
 in an academic aloofness, in an exclusive occupation 
 with comprehensive scientific laws, there is, as we 
 have just seen, a kind of ignorance, he presumes that 
 in practical work there are no such things as principles. 
 No doubt by adaptiveness and adroitness he wins 
 for a time, but only to give way later to those 
 who, to this contest with contingencies, bring minds 
 better educated in principles and ideas. A professor 
 in a large technical school told me, about a year 
 ago, that while in his district the manufacturers 
 in a certain trade were bemoaning hard times, he 
 as an expert was noting in their processes from 
 fifteen to twenty per cent of waste. And yet these 
 masters would neither come themselves to his classes 
 nor send their sons nor theii' foremen. What, cried 
 they, could an academic professor know about manu- 
 facturing ! 
 
 Opportunists by all means let us be, but 
 without denying the validity of principles. The 
 man of affairs without science is like the 
 physician who has fallen out of the anatomy and 
 physiology he may once have known ; within 
 limits he may be a shrewder and abler practitioner 
 than an academic professor ; but this he will be at 
 the cost of l)eiug stationary. We shall use rule of 
 thumb, then, and other empirical and semi-empirical 
 
 D
 
 34 ON PEOFESSIONAL EDUCATION 
 
 rules based on vigilant and successful experience, 
 but only as provisionally taking the place of 
 theory. The theorist has mastered the principles 
 which in the long run will prevail, yet he is 
 apt, it is true, to forget that there are tlieories 
 within theories, axioms of lower validity and 
 smaller scope which in the short run will be 
 found to complicate action ; to these practical com- 
 plexities proximate rules and middle rules are 
 better adapted ; they are easier to work, and are 
 kept in order by the incessant check of results. 
 But the main principles, or theories, are never thus 
 superseded or invalidated. To principles, sooner 
 or later, the suljtlest craftsman has to bow his 
 head, or be left behind ; for, even wliile his hand 
 is on his tools, by theory contingencies and com- 
 plications are being detected and eliminated, and 
 processes shortened and economised. 
 
 University education. — But even if your 
 start in life from school may have been a poor one, 
 you have now before you in the education of a 
 physician a training no less manly, and one 
 whicli, as a moral and intellectual training, I had 
 almost said is incomparable. Even for those of 
 you who are unable to undertake the more 
 arduous and more costly course of a university 
 education, the education of the hospital and technical 
 school is still one to develop the highest qualities of 
 the mind, and to kindle them in the warmth of hope 
 and charity. With all men you will learji the evil 
 in the world, but you will go from strength to 
 strength in the faitli of making it better.
 
 ON PEOFESSIONAL EDUCATION 35 
 
 The word "uuiversily" meant originally a corpora- 
 tion ; but now it signifies an education dealing 
 chiefly with universals — with habits of coniniou 
 sense and breadth of faculties, without which even 
 multifarious learning will be disfigured by pedantry 
 or crankiness, as in the great IJoman scholar who, 
 when discussing with Erasmus the immortality of 
 the soul, rested his denial of a future life on the 
 authority of the elder Pliny. Every man has to 
 be educated for more than one set of duties. No 
 two men are alike, and as civilisation advances they 
 diverge more and more ; each of us can expand 
 and vary only within a certain pre-ordained cpiality 
 or scheme, about his own possibility of development. 
 In most people, perhaps in all of us, some of the 
 innate capacities must be sacrificed — an uneasy 
 reflection ; but, if so, then which or how much of 
 them ? The all of each of us is not wanted : which 
 part of us shall be renounced ? About this, at some 
 stage, teachers and pupil may begin to disagree ; 
 but out of it the pupil should learn at least the 
 chief of lessons — the lesson of humility. Sacrifice is 
 one of the laws of life, yet it must be sacrifice for 
 some higher end. Admirable, for instance, as is an 
 equable education of all the faculties — " culture " as 
 we are wont to call it — yet culture turns into a 
 selfish conceit if no part of it is subordinated to 
 education in good citizenship ; for an aggregation of 
 cultured and consummate persons without some 
 higher unifying infiuence would not make for a high 
 national life. The sacrifice of culture for the more 
 specific, and often indeed duller and narrower pur-
 
 36 ON PEOFESSIONAL EDUCATION 
 
 poses of a trade or profession — the grim Ervxrlsfragc 
 — is more common and painful. And unhappily 
 only too frequently it is a wasteful sacrifice ; for 
 want of private means, or of public assistance, the 
 pupil at a critical age is compelled to renounce 
 extent of learning, and the training of some of his 
 higher faculties, for a brief and technical instruction 
 which may narrow his outlook on life and starve 
 those potential qualities for the rest of his days. 
 Yet even such renunciations, if inevitable, are 
 sanctified by a submission to duty, and accepted in 
 the faith that after all each individual is his own best 
 educator. 
 
 We can scarcely hope that the time is at hand 
 when most people will be able to devote time to 
 general training in all three stages of education ; 
 many of us must turn to special duties even after 
 the primary school, and many after the secondary 
 school ; so the students who for the larger develop- 
 ment of their faculties can proceed to a university 
 must, so far as we can see, be comparatively 
 few ; still fewer they who can spare time to 
 complete a disinterested university course before 
 turning aside on the narrower lines of professional 
 or commercial instruction. The man who can do 
 this will go much farther in later life than he could 
 have done had he turned aside into technical lines 
 at an earlier stage ; still, as things are, most men 
 have to sacrifice more or less of their future to 
 the needs of present liveliliood. And happily the 
 alternatives are not so deeply separated as at first 
 they may seem to be ; it is found, as we might
 
 ON PROFESSIONAL EDUCATION 37 
 
 expect — such are the teeming wealth, the infinite 
 interweaving, and the essential analogies in men 
 and things — that there is no difficulty, at any 
 rate in university education, in using for general 
 training the broader principles of any one of the 
 professional faculties ; so that, for liim whose 
 technical instruction must begin prematurely, a 
 general or " semi-professional " training may still be 
 continued on principles of the kind which in their 
 more and more special application will form the 
 substance of his calling in life. For university 
 training differs from technical, not so much in the 
 kind or field of the subjects taught as in the more 
 comprehensive, more deliberate, and more disinter- 
 ested methods of teaching them ; in the wider out- 
 look upon them, and the awakening of curiosity and 
 research. Thus, I reiterate, it is not so much what 
 is taught as how it is taught. Nevertheless, within 
 limits it remains true, and even obvious, that for the 
 best education a completer general training in fields 
 other than those of the future calling must bring 
 about a richer result. 
 
 It is freely said of the abler men in our 
 laboratories that those who enter them with minds 
 already expanded on other kinds of study, such as 
 language and literature, bring to the sphere of scientific 
 studies a riper understanding, and draw from them 
 larger immediate powers and a richer endowment 
 for later life. Professor Ostwald once told me that 
 it is the good custom 'of students in the German 
 universities to attend other lectures than their 
 "Each"; so that in every university there are
 
 38 ON PKOFESSIONAL EDUCATION 
 
 always oue or two professors whose lectures on 
 some such suhjects perhaps as history, literature, or 
 philosophy, attract large bodies of students from all 
 faculties. By these undergraduates to stick wholly 
 to one's own subject is regarded as a poor and 
 narrow thing. How lamentably the prevalent 
 literary education fails even in that " exigua coynilio 
 naturae" which the very humanists themselves 
 prescribed, 1 have argued already. 
 
 Once more, if the enrichments of a university 
 education consist in its own breadth and variety, 
 and in the maturing of the student's under- 
 standing, it confers another endowment no less 
 precious: it establishes the habit of study — a 
 habit which rarely gains any strength or fixity at 
 school or technical college, but, once established, 
 belongs to a man for the rest of his life. In the 
 university tlie student sees maturer men devoting 
 themselves to a disinterested love of knowledge, to 
 a steady and faithful pursuit and furtherance of it 
 for its own sake ; he sees, also, the infinite variety 
 of intellectual operations, and perceives that know- 
 ledge and wisdom are not summaries, schemes, 
 or mysteries, but are quick and glowing witli a 
 manifold arid many-coloured life. And not only 
 does he admire the leaders of research, he is also 
 shoulder to shoulder, especially in a residential 
 university, with other eager undergraduates, them- 
 selves pressing forwards not on one only but on an 
 infinite variety of pursuits and interests, with the 
 general bearings of which he too gains some 
 familiarity.
 
 ON PKOFESSIONAL EDUCATION 39 
 
 It appears, then, that the function of university 
 education is not special instruction in the lines of 
 a profession or trade, however these ends may 
 substantively be promoted, but in expanding and 
 enlarging the mind and making it a more and more 
 perfect instrument of knowledge and progress, 
 whatsoever its destination. The mind so educated 
 will regard whatever is laid Ijefore it more truly, 
 and will think upon it more truly ; it becomes 
 analogous and assimilated to a wide horizon of 
 the world in which it is to live and work. 
 Christopher Wordsworth (Scholac Acadcmicae, p. I7l) 
 writes that a university " while aiming at educating 
 professional men never pretended to give tlie final 
 practical training which is required for every 
 profession. Even in the education of the clergy, to 
 which they gave special attention, the universities 
 attempted to educate them in scientific theology 
 rather than to impart even the elements of the pastoral 
 profession," and so, he adds, " it was with medicine 
 (and, as we may now add, with engineering) ; the 
 student received the grounds of a valuable education 
 and some theoretical instruction, but was sent to 
 look elsewliere " for the technical work of quali- 
 fication. Again, in a report on university education 
 Roundell Palmer (as the Chancellor then was known) 
 says : " Of the value of an academical education, even 
 in a strictly professional point of view, when given on 
 a sufficiently comprehensive system, I entertain no 
 doubt. Superior mental cultivation tells very nmch 
 in every profession ; it enlarges the views, improves 
 the judgment, and obtains for its possessor con-
 
 40 ON PEOFESSIONAL EDUCATION 
 
 sideration and influence in the ordinary intercourse 
 of mankind." If this be so, and no one will seriously 
 contend to the contrary, a university which adapts 
 itself closely to instruction in the technical attain- 
 ments of a trade or profession departs from its proper 
 function of training the mind and of increasing- 
 knowledge, and enters into competition with schools 
 of technical instruction ; such as the hospitals, the 
 Inns of Court, the workshops, and the many other 
 various special institutions.^ 
 
 In testing, then, from stage to stage the progress 
 of its students, the university will look not so 
 much for technical and empirical knowledge and 
 adroitness, or to the amassing of detail for par- 
 ticular uses, as to the training of their minds, 
 and their grasp of principles. And for these 
 
 ^ Here I may quote some sentences from the evidence which I 
 gave in tlie inquiry on the division of the Victoria University : — 
 "To multiply qualifying bodies, and to make them out of the 
 material of universities, tempts these institutions to identify 
 themselves with the more ordinary aspirations, and to hold out 
 false standards of education in the higher faculties. That thus 
 universities have been disposed to facilitate the more direct and 
 utilitarian methods of qualification, and to do what it is the part 
 of the hospital school to do, is sufficiently notorious. Indeed it 
 is remarkable that many university teachers have lost sight of 
 the distinction between qualification for practice, and liberal 
 education in the institutes of a profession for an academical 
 degree. To hint that teachers would conspire to lower standards, 
 or even to be privy to a deterioration of them, meets, of course, 
 with indignant remonstrance ; but the indignation is not quite 
 justifiable. Such complacencies have their degrees, as they 
 hold out greater or less facility for a diploma ; moreover the 
 governors of universities are not by any means all of them 
 teachers, or even graduates ; not a few of tlicm are laymen with 
 very material standards indeed."
 
 ON PEOFESSIONAL EDUCATION 41 
 
 results, for the breadtli, ease, aud naturalness with 
 which they have learned to think and to conceive, 
 will its degrees and distinctions be bestowed. It 
 is too commonly supposed, and very erroneously 
 supposed, even by some who ought to know better, 
 that if a professional or technical instruction 
 be screwed up a little higher, and examina- 
 tion made somewhat stiffer, the successful candi- 
 date should have a claim for a university degree 
 — for the degree of M.D. let us say. Or men 
 will submit that twelve or fifteen years in the 
 practice of a profession should give them claims to 
 such university stamp. But we have seen that the 
 function of the university is not qualification for 
 the practice of any art or trade, but is a training of 
 the mind, a formation of habits of study, of insight, 
 of easy handling of ideas, and of methodical research, 
 whether by the principles of the future profession 
 or of any other department of knowledge ; an 
 opportunity which is available before, and unless 
 in excei^tional cases only before, the technical 
 stage of study is entered upon. After our plastic 
 years, and under the pressure and cares of after life, 
 such a training may be, but rarely is, achieved. In 
 this respect education reminds me of fresco-painting, 
 it must be accomplished swiftly and truly while the 
 plaster is wet ; when the plaster sets the false and 
 true lines set with it; the time for correction 
 is past. 
 
 The universities of the United Kingdom then 
 step out of their function when they undertake, as 
 they do, to issue with their degrees in medicine a
 
 42 ON PEOFESSIONAL EDUCATION 
 
 licence to practise.^ In my own university the 
 M.D. degree is often bestowed, and is properly 
 bestowed, on persons who never intend to practise 
 medicine, and who would be embarrassed if in any 
 emergency they were called upon for this office. 
 Nor should it be any specific concern of the 
 university how well or how ill its graduates may 
 practise medicine; all that the university should be 
 responsible for is that its graduates should have a 
 certain development of mind and imagination. And, 
 as a matter of practice, its tests for these results 
 are much hampered by its incongruous responsibility 
 for the lives of His Majesty's subjects ; its 
 examinations have consequently to deal with many 
 matters of memory and mechanical device which 
 throw little or no light upon the breadth or depth 
 of training, or upon the formation of habits of study 
 or research ; indeed, they crowd out more or less 
 the proper tests for such edification. Now the 
 safety of the public being a State concern, the testing 
 of medical efficiency is the duty of the State itself; 
 and this responsibility the State assumes in practi- 
 cally all otlier European countries. For our nation 
 I think a State portal, in the directest sense, is too 
 cold-blooded, and might become too rigid for us ; 
 we desire more spontaneity and more variation. In 
 the United Kingdom, then, the State should entrust 
 this function, in each of the three kingdoms, to 
 certain medical corporations, under the supervision 
 
 ' Their bestowal of a qualilication arose when — outside Italy, 
 at any rate — the higher medical education consisted in what was 
 improperly called "theory," but was only book-learning.
 
 ON PEOFESSIONAL EDUCATION 43 
 
 of the General Medical Council ; and its tests should 
 be for safe practice rather tlian for large attainments. 
 Again, gentlemen, I know and regret that you 
 cannot all have university educations — at any rate, 
 not in any near future ; more's the pity. Many of 
 you on leaving school have no choice but to com- 
 plete your professional education in the five years' 
 minimum, a period shorter by a year than in other 
 chief European countries. In this case you have 
 to be satisfied with wliat your school may have 
 done for your general education — too often, I fear, 
 a paltry result enough; not so much by your fault 
 or even by the fault of your masters, but of those 
 defective methods of secondary education which I 
 have lamented. To learn your profession in five 
 years means that you will get some education, and 
 suffer inevitably nnich cram. You cannot thus 
 make yourselves into philosophers or investigators, 
 unless by a happy turn of nature you contain 
 some rare capacities and aspirations which by 
 cliance were not choked by the public school ; 
 such an one must be content, then, with the 
 honourable ambition to become at any rate a com- 
 petent practical physician, shrewd, resourceful, and 
 unselfish ; a guide to health and a stay in adver- 
 sity. For even in the narrower field of professional 
 instruction — I am speaking of the ordinary medical 
 student — a liberal scientific education is not to be 
 had in five years. Let us think for a moment what 
 it must contain : the elements of physics, something 
 more than the elements of chemistry, a large and 
 minute knowledge of anatomy and physiology — so
 
 44 ON PEOFESSIONAL EDUCATION 
 
 far no mean education ; then on this foundation to 
 build the superstructure of pathology, medicine, and 
 midwifery; to spend a few weeks in a fever hospital, 
 in a children's hospital, in a dispensary, in several 
 institutions for diseases of the eyes, ears, throat, 
 and skin ; to practise anaesthesia ; to obtain some 
 knowledge of diseases of the mind, and to add to 
 these the elements at any rate of medical juris- 
 prudence, hygiene, and public health, is formidable 
 indeed. Yet still upon this burden of subjects many 
 enthusiasts are yearning to pile more and more, such 
 as fuller courses on biology, chemical physiology, 
 bacteriology, and pharmacology ; not to mention 
 such subjects as the history of medicine, in the 
 absence of which it is said, truly enough, that the 
 education of a physician cannot be complete. 
 
 But it is in the all-round or university sense 
 that this is true ; without these subjects, and with- 
 out a considerable familiarity with the principles 
 of them, a university ought not to grant its degree 
 of M.B. or M.D. But, happily, there are among us 
 men loved and respected as members of our bene- 
 ficent profession who have never been grounded in 
 these principles, furnished with these ideas, or 
 stored with all this knowledge. None of us are 
 more ready to lament this deficiency than such 
 men themselves ; yet when we fall sick we thank- 
 fully avail ourselves of their aid and consolation. 
 Nay, may we not go still farther and admit — we 
 university men and consultants — that, when it 
 comes to the cure of disease, it is by the closer 
 converse with the patient, the little daily dexterities,
 
 ON PROFESSIONAL EDUCATION 45 
 
 the cautious but shrewd euipiricisui, the tact and 
 attention which, by easing and modifying abstract 
 lines of the treatment, adapt them to the peculiarities 
 of the individual, day by day meeting quickly ev^ery 
 new symptom and contingency by this incidental 
 drug or that little change in diet, that a family 
 physician, who may have enjoyed little beyond the 
 ordinary advantages of a technical training, never- 
 theless compasses the cure of the individual case on 
 which the consultant can but advise in general 
 terms { Each has need of the other ; the practi- 
 tioner who had not the advantage of a university 
 education desires the easier grasp of coordinating 
 principles of the university graduate, the wider range 
 of his experience and of his outlook on facts, his 
 richer knowledge and his keener recognition of the 
 mists of ignorance ; the graduate, on the other 
 hand, admires the ingcnium rersatile, the more 
 homely but not less indispensable and even more 
 varied abilities and deftnesses of the country 
 doctor. The most accomplished physician is, of 
 course, he who has combined both real and practical 
 education, who is armed with technical dexterity, 
 versatility, and resource, as well as illumined by 
 the ideas and guided by the mental and imaginative 
 discernment which are born of a large, deliberate, 
 and inventive education. How the unhappy division 
 of our profession into medicine and surgery has 
 defeated this integration of faculties I need not 
 repeat here, as I have set this aspect of our 
 education forth at length in my Historical Relations 
 of Medicine and Biirgery.
 
 46 ON PKOFESSIONAL EDUCATION 
 
 Too often, I fear, the cry for university advan- 
 tages is rather for the marketable degree than 
 for the mental increase I have dwelt upon. This 
 increase is dearer to the Scotchman than to the 
 Englishman. But, until we all learn to desire it for 
 its own sake, we shall still have to regret that 
 among educated men the respect given to our 
 profession is for its benevolence and cleverness in 
 a special sphere rather than for broad and accurate 
 notions of things. We are accused of want of touch 
 with other faculties, of a blunted sense of relative 
 values. In our defence, indeed, it may be said that 
 we give hostages to fortune in that we look forwards 
 to the unknown future, while the lawyer fixes his eyes 
 backwards on the past, and the parson tries to stand 
 still on the shifting present ; moreover, that in a large 
 part of our field of work, if it be a diminishing part, 
 the best of us must still be empirics, and empirics 
 in a very complex and obscure subject : still, we 
 shall not mend ourselves by making excuses. It may 
 be retorted indeed that, the more we have to act on 
 probabilities only, the more there is need of trained 
 observation and large and sagacious thought. And 
 to these there is but the one way of attainment, the 
 broadening and deepening of learning and of our 
 love of it ; not of book-learning only, but of that 
 large sympathy with men which lies in letters, in 
 science, and in life. Wisdom is not learning only, 
 nor practice only, but cruditio in vsv. So long, 
 however, as the Englisli father for his son aims but 
 at the facility of tlie artisan, and regards wisdom, 
 which is more precious than rubies and to be had
 
 ON rROFESSIONAL EDUCATION 47 
 
 only witli pain and labour, as but an elegance or 
 even a will-o'-the-wisp, so long (whatever our pro- 
 fession) we shall fail to win respect by lil)eral ideas. 
 It is not fur me, who have given much time and 
 pains to urge that by skilful craftsmanship only can 
 the brain Ije adequately built, and that the finer 
 craftsmaiisLip comes only by pains and fasting, to 
 depreciate craft ; yet craft is not all. If lather and 
 sou togetlier, so long as a little meal remains in 
 the ark, will strive, at all possible sacrifice, to add 
 to the mere technical instruction of the diploma the 
 broader, fuller, and riper education of the university 
 and of the world, they will have their reward. 
 
 When, as things are, I try to defend my pro- 
 fession from the accusation of narrowness or 
 provincialism, I lose heart when I stumble upon 
 crudities which fall not only from the un- 
 distinguished of us, in whom they may be forgiven, 
 but even from our most eminent colleagues. 
 Strictl}^ between ourselves, let me select an 
 example or two from essays at hand. We shall 
 not be found out. A brilliant specialist says, with a 
 peculiar sense of proportion, " Of all the evils which 
 befall man in the civilised state the evil of disease 
 is incomparably the greatest.'" Alas for iraOi^fiaTa 
 liaOrjixara ! To impute insanity to Hamlet, or to 
 read King Lenr with an eye on arterio -sclerosis, 
 by substituting disease for confiicts of the mind, 
 annihilates the play. Or, would the fate of Hetty 
 Sorrel have been more tragical had she died of 
 consumption before meeting Arthur Donnithorne ? 
 Another physician, who regards not the ethics of
 
 48 ON PEOFESSIONAL EDUCATION 
 
 punishment, says that criminals ought to be handed 
 over to the experimental physiologist ! The 
 affronted physiologist, saving himself from his 
 friends, would cry " ov roc awe'^Oeiv dWa o-vficfiL- 
 \€iv e(j)vv." Another says, " We cannot have the 
 mens sana without the corpus sanum"l — surely a 
 stodgy sentiment. And another assures us that 
 " science is useful, but classics are at best purely 
 ornamental " — can we not put this more prettily ? 
 " Unter alien Volkerschaften haben die Griechen 
 den Traum des Lebens am schonsten getraumt." 
 A somewhat wider survey even of professional 
 knowledge would prevent much impatience with 
 the labouring man for keeping his windows shut, 
 and plugging up his chimney ; for we should recol- 
 lect that colder air means more clothes and nourish- 
 ment, and it is with difficulty that he provides such 
 food and blankets as he has. But this is an un- 
 grateful task, and the more so as, for example's 
 sake, I am obliged to cull these flowers from the 
 writings of leaders in medicine to whom other- 
 wise my debt is too deep for criticism. I would 
 only pause to warn medical hierophants lest 
 they get as far out of value as the ecclesiastical 
 have done. 
 
 The medical curriculum. — If, then, it is a 
 heavy task to get into five years even a technical 
 education, let alone a more liberal and extended 
 training of the mind ; to get into five years an 
 instruction to which in Germany, France, Italy, 
 Holland, Belgium, or Switzerland six years at 
 least are devoted, which in a university course,
 
 ON PROFESSIONAL EDUCATION 49 
 
 modelled from the beginning on larger lines, must 
 occupy from six years to seven, how are we to use 
 to the best purpose this five years' course for the 
 man who has not the means, or perhaps not the 
 kind of ability, to enable him to enter upon a full 
 university career ? One way of doing it is to drag 
 the university training down to the level of the 
 technical ; to give the M.B. and M.D. degrees for a 
 course which scarcely pretends to rise much above the 
 ordinary five years' professional instruction, however 
 crowded and crammy this may be. Or, if we resign 
 the university to more fortunate men, what are we 
 to think in our serious moments of a technical 
 instruction in which, as now arranged, medicine, 
 surgery, and midwifery, in all the many branches 
 which we have enumerated, are to be taught in part 
 of the fourth year and the fifth — in sixteen to twenty 
 months ! No wonder at the development of coaching 
 — that is, not of making men but of stuffing them ; no 
 wonder at the stream of cram-books pouring from 
 the printing offices ; no wonder at the " window 
 dressings " for examination ; our wonder we will 
 keep for the young men who, under such a drill, 
 come out of it with any freshness of mind left, and 
 with any better mental furniture than trite pro- 
 fessional formulas. 
 
 Now, although universities must be designed 
 from beginning to end on other and more deliberate 
 lines, yet for those students who cannot afford a 
 university education, what they have time for may 
 and ought to partake of a university character; 
 and, generally speaking, this for the Institutes 
 
 E
 
 50 ON PEOFESSIONAL EDUCATION 
 
 of Medicine means some teaching in universities, 
 and by university professors. A few exceptional 
 teachers, men of remarkable natural endowments, 
 may teach admirably a subject which is not to be 
 the business of their lives, but this can rarely be the 
 case ; moreover, a teacher who devotes an inconsider- 
 able part, or none, of his best hours to research 
 cannot long continue to be fertile and effective. 
 Again, if I may contribute my dole to a current 
 controversy, I would opine that no teacher reaches 
 his best till middle life. Not till then does he 
 gather the fruits of experience, or attain to a rich 
 and vital sense of our ignorance ; not till then does 
 he wholly escape from formula and routine ; not till 
 then does he learn what to leave unsaid ; then it is 
 that erudition and experience mellow into wisdom.^ 
 For the teacher to be glancing ahead of him and 
 beside him at other purposes, other ambitions in 
 life, than those with which he is immediately and 
 provisionally concerned, is fVital to good work. 
 Teaching* then, if it is to be of a university char- 
 acter — if, that is, it is to be education as well as 
 instruction — must be in the hands of men whose 
 lives are devoted to the subject. If it is to be a 
 development of mental faculties, and to penetrate 
 to the principles of its subjects, it must give time 
 for reflection, for earnest investigation, and for 
 
 ^ It is some thirty years since I icad a ]ia]Kr to tlie Leeds 
 Piiilosophical Society to illustrate what I jjclieve to be the truth — 
 namely, that the greatest achievements of the human mind have 
 nearly always found their consummation not in the earlier but in 
 the riper decades of life. Thus Regius professors may supplement 
 each other's researches.
 
 ON PKOFESSIONAL EDUCATION 51 
 
 surrender to tlie personality of- the teacher. Yet 
 it is this very time element which is wantmg — 
 time in wliich we are to learn medicine, surgery, 
 midwifery, time for fevers and mental diseases, 
 time for the elements of ophtlialmology, otology, 
 laryngology, dermatology, and all the rest of them, 
 not forgetting the many elaborated methods of 
 moilern diagnosis of whicli the family physician 
 — often far from expert help — cannot afford 
 to be ignorant, yet wliich, after he has left the 
 special fields in which such instruction is provided, 
 he cannot easily learn ; time for a firmer grasp 
 of ideas, time for the influence of the teacher to 
 sink in ! I repeat that to devote, as at present, 
 but something less than two years to these mani- 
 fold thial professional classes is, on the face of it, 
 absurd. Surely one moiety of his whole period — 
 two years and a half — is barely enough to devote 
 to the matter which is to be the main business of 
 his life. 
 
 [n the summary education for a diploma 
 then we have been moving on the wrong tack, 
 and moving away from the stouter and truer 
 methods of two generations ago. For two genera- 
 tions we have Ijeen loading and loading this brief 
 curriculum as if our ambition w^ere to teach many 
 things ill rather than a few things well. And we 
 luive seen how one may spend a lifetime on many 
 accpiirements, and yet be uneducated. Our fore- 
 fathers thought, and T agree with them, that the 
 backbone of medical education is anatomy ; that the 
 right way to educate is to teach a few subjects
 
 52 OX PEOFESSIOXAL EDUCATION 
 
 broadly and deeply, and that the right way to build 
 is to begin with the backbone. Young men love to 
 do something with their fingers, and their instinct 
 is a true one. Finger-work does more than add 
 itself to thought and memory, it multiplies them. 
 The fingers are the busy buUders of the brain. How 
 admirable a discipline is anatomy for the young 
 student ; how it confirms him in quickness of eye, 
 in accuracy of fact, and in coordination of facts ; 
 how it disj)lays to him the marvellous contrivances 
 and adjustments of organised bodies ; and, with 
 the sidelights of modern biology and embryology, 
 the stupendous achievements of mutation and 
 selection ! As an initial training anatomy is 
 better suited to youth than the more abstract 
 principles of chemistry and physics ; and, as 
 modern research is integrating physiology more 
 and more with anatomy, so structure and function 
 — two aspects of one subject-matter — are becoming 
 more and more associated, to the advantage and 
 enlightenment of the student. The movement 
 towards university teaching of these cardinal 
 subjects, a movement which I am in King's College 
 to-day to celebrate, has then my cordial goodwill 
 and advocacy. 
 
 In his first two years the student who only 
 seeks a diploma should make his own a knowledge 
 of anatomy and physiology, as broad and thorough 
 as university professors and university dimensions 
 can make it ; a discipline to be broken into as 
 little as possible by intercurrent diversions. The 
 elements of physics the student should bring
 
 ON PKOFESSIONAL EDUCATIOX 53 
 
 \vith him from school, whei'e mechanics should 
 form a (juickening part of his mathematics ; 
 the advanced physics, which are to be of 
 practical service to the physician, are even now 
 necessarily omitted ; such as optics, photometry, high 
 frequency and other advanced modes of electricity. 
 X-rays, and much knowledge on the borders 
 between physics and chemistry. "With chemistry 
 the case is different: I agree with Sir William 
 Eamsay that this is not a good subject for boys ; 
 nor, indeed, in the course for a diploma has it 
 proved possible to teach chemistry on the scale 
 of a pure science, to teach it comprehensively 
 for its own sake, and as mental training. In a 
 live years' course it is, and perhaps can only be, 
 taught as a technical department — introduced, that 
 is to say, partially and incidentally as immediate 
 utility requires, and not as an education ; but 
 after this manner, as pharmaceutical chemistry, 
 as physiological chemistry, as an instrument of 
 clinical diagnosis, and so forth, it should accompany 
 the paramount and thorough training in anatomy 
 and physiology, and be carried forward, as now it 
 scarcely is, with the whole course of medical in- 
 struction. In place of formal examination in 
 chemistry for a diploma I am disposed to prefer 
 — at any rate in great part — the submission of 
 laboratory books, initialled weekly or monthly 
 by a demonstrator. Under present methods the 
 first -year student fags up some rule -of- thumb 
 chemistry, with no great mental or scientific advan- 
 tage, and on no comprehensive scale ; and when his
 
 54 ON PROFESSIONAL EDUCATION 
 
 first examination is over lie is apt to dismiss this 
 subject from his mind : receptiveness has its limits 
 and the ship must be lightened. This kind of 
 education is not edifying ; so the more reason 
 that at least anatomy and physiology should 
 be taught scientifically and for their own sakes — 
 taught, that is, on university methods, taught as 
 education for universal as well as for technical 
 ends ; and, seeing that at least as much chemistry 
 would be learned in this utilitarian way as is 
 learned at present, in two full years a really solid 
 scientific foundation would be laid ; then the 
 three following years would give more adequate 
 time for the medical studies of men whose minds 
 had received this sound training, and the anxious 
 candidate would not have to spend his last and 
 most precious year with his nose in his books. 
 
 The suggestion has been made that the medical 
 student should engage in some occasional hospital 
 work during his scientific period. I understand, 
 however, engineers are by no means agreed that 
 to go from the university to the works, with a 
 view of returning to the university, is an advan- 
 tage : continuity is broken and habits of study are 
 lost. I have observed the same disadvantages in 
 medical study thus broken. The university medical 
 student does well, then, to postpone serious work 
 in a hospital until he has mastered his scientific 
 subjects, up to pharmacology and general pathology. 
 The professors of the institutes of medicine are, 
 I think, all agreed that the best men have 
 been those who up to the age of twenty-two or
 
 ON PEOFESSIONAL EDUCATION 55 
 
 twenty-three had pursued an unbroken university 
 career. 
 
 Fintilly, is the student when just released from 
 the wards of a hospital at the end of liis fifth year, 
 quite fit for private practice ? We are assured 
 that he is not, not even if after qualification he 
 has held the usual " house appointments "; that for 
 private practice there is still much in which even 
 a highly educated student is ignorant or unskilled. 
 My old friend and colleague, Mr. C. G. Wheelhouse, 
 used to impress this upon us time after time, and 
 on the ground of such deficiencies to lament the 
 abolition of apprenticeship. More recently, Mr. M. A. 
 Wardle, of Bishop Auckland, has temperately and 
 persuasively expressed the same opinions.^ For my 
 own part, while I admit how much the young 
 diphnne or graduate has to learn in the way of tact 
 and little adroitnesses in the management of private 
 patients, in the conduct of trivial or tedious disorders 
 wliich do not find their way into hospitals, in the 
 dispensing of medicines, and so forth, yet surely to 
 revive the bond of apprenticeship for these minor 
 accomplishments is to burn a house for roast pig. 
 ]\Ianual dexterity, it is true, can be gained only in 
 early life, but this would come with the earlier 
 application to anatomy which I advocate. The 
 apprentice did not always get the best or most 
 conscientious of masters ; in any case he was liable 
 to be infected, at a critical time of his life, and too 
 often was infected, with an incurable empiricism, 
 and became habituated to a narrow routine. A 
 1 Brii. Med. Journal, Sept. 27, 1902.
 
 56 ON PEOFESSIONAL EDUCATION 
 
 convenient and elastic routine and a wise and 
 discriminating empiricism are good, but these 
 resources should not be the beginning of wisdom ; 
 after the scientific habit of mind is established 
 they can be added to it ; and I agree that six 
 months' occupation with an able and intelligent 
 family physician would prove an invaluable finish 
 to hospital instruction. But I think that such 
 residence should be with masters registered for their 
 special fitness by the General Medical Council. 
 
 Graduate wokk. — There are not a few physicians 
 who, unable to avail themselves of a fuller education 
 at the commencement of professional study, would 
 gladly enlarge their education at a later time of life : 
 what facilities do we offer them for advanced study ? 
 Graduate or advanced work, both in the fields of 
 instruction and research, has received of late some 
 of the attention which its great importance demands, 
 and I think our profession does not quite realise 
 the debt we owe to Mr. Jonathan Hutchinson for 
 his enthusiastic and indefatigable exertions in the 
 development of such advantages for qualified practi- 
 tioners who have still much to learn, a class indeed 
 coextensive with us all. We ought not to be 
 satisfied until the advanced studies are so organised 
 as to lead up to a university degree ; though it 
 follows from what I have said before that in 
 this case they must include subjects, such as 
 history, philosophy, or literature, to enlarge and 
 enrich the mind beyond the scope of medicine, and 
 indeed beyond the wider but yet far from catholic 
 domain of science itself.
 
 ON PEOFESSIONAL EDUCATION 57 
 
 Examinations.^ The undergraduates who are 
 listening to nie will expect nie to touch upon the 
 distressing sul)ject of examinations. It has been in- 
 ferred no doubt from what I have already said that, 
 like other disinterested observers of medical educa- 
 tion, I am in favour of that " one portal " which is 
 established in virtually all the other nations of 
 Western Europe, and the advent of which is certain 
 in our own, though as usual we shall waste much 
 time in trying to apprehend an idea before it is 
 materialised in custom. To all persons thus qualified 
 the appellation of "Doctor" has so long been granted 
 by English custom that official recognition of this 
 title can hardly be withheld ; moreover, the Conjoint 
 qualification should carry with it the Membership, 
 not of one only, but of both the Colleges. The 
 multiplication of modern universities in England — 
 one of the most inspiriting features of our day — 
 must compel the institution of one portal ; the 
 steam-roller of the General Medical Council cannot 
 even pretend to equalise so multiform a system. In 
 my university I find that the one portal is virtually 
 in force, for from 70 to 80 per cent of our men 
 take the diploma of the Colleges before presenting 
 themselves for our more advanced graduation. 
 Sometimes I say to them, " Get qualified and then 
 we can get on with your education." But, as this 
 proceeding of theirs is not universal or compulsory, 
 we do not derive the benefit of it ; still are we obliged 
 to load our examinations with tests of the memory, 
 sharpness, fluency, and "dodginess" of our candidates, 
 which indeed tend perhaps to stifle real study, or at
 
 58 ON PEOFESSIONAL EDUCATION 
 
 any rate testify in no direct way to the broader 
 training and enlarged capacities which are particu- 
 larly our concern. For qualification I regard the 
 Conjoint examination as excellent : the examination 
 of a university, however, ought to have a somewhat 
 different aim and method from a test of conventional 
 equipment and efficiency ; it ought to be much less 
 inquisitive and exacting, much more of a leisurely, 
 thoughtful, and individual appreciation. We want 
 to move away from tests of results without methods, 
 of practical habits which stand still while knowledge 
 is progressing, of bookish acquirements without 
 experience, of seedlings on stony ground which 
 have no root in themselves and so endure but for a 
 time ; to move away from the reproduction of other 
 men's notions, and towards the recognition of a 
 critical and flexible judgment, of the habit of 
 looking problems fully and intelligently in the 
 face, and appreciating the relative values of itleas 
 both in the present and in the past. It is for 
 these qualities that a university degree should be 
 conferred ; and to this end it is tliat in Cambridge — 
 I believe with the loyal consent of all our medical 
 graduates — we retain our thesis for M.B., and attach 
 a cardinal importance to it. In his thesis for M.B. 
 the student — too often for the first time — realises 
 that he, too, can grapple with the interpretation of 
 things; that he has got beyond the stage of beseech- 
 ing his coach " to tell him how to answer, but not for 
 heaven's sake to explain the reasons of the answer." 
 If education consists in adventuring, encouraging, 
 and Ijuilding up the faculties of pupils, and, so far
 
 ON PROFESSIONAL EDUCATION 59 
 
 as may be, the peculiar faculties of each — for 
 " originality " consists ia that by which each man 
 differs from his fellows — it is clear that, in a uni- 
 versity at any rate, an external examiner, unless he 
 be the assessor rather than the administrator of the 
 tests, is a dangerous person, and the more dangerous 
 the maturer the student. For children, by judicious 
 and sympathetic inspectors, uniform examinations 
 may be so managed as to be harmless. ]jut it is 
 to the teacher that the value of each pupil is best 
 known ; and the proper safeguard against pre- 
 possession, or slackness of method in him, is not 
 the external examiner but inspection of internal 
 examinations by wise and experienced visitors. 
 The professional examiner, he who makes it his 
 business to range from place to place imposing 
 mechanical tests wholesale, is one of the new 
 terrors of life. For it is unkind to puzzle him 
 with miscellaneous companies of young persons, each 
 eager after his own fashion, each assimilating the 
 common nutriment to ends which are various, each 
 conceiving things in his own way. The professional 
 examiner knows nothing of the many colours of 
 the pupils, nothing of their several endowments, 
 nothing of the inspiration of their teachers ; for his 
 purposes, then, they must be ruled into uniform 
 lines, and he must bring with him tests on uniform 
 systems, as he cannot be expected to invent new 
 tests for each scat of learning, not to mention each 
 several boy and girl. Thus for such an examiner the 
 pupil may not be taught to think, because he may 
 think wrong ; or at any rate he may think outside
 
 60 ON PROFESSIONAL EDUCATION 
 
 the schedule. And so examiuations drive on; 
 those subjects only being chosen, and that treatment 
 of them prescribed^ which promote not enlargement 
 of the mind but the convenience of examining : 
 the '■' Who blew what, how many times, round the 
 walls of where ? " kind of question. So the teacher 
 too must be tethered, lest he lead some of his pupils 
 to browse in pastures, sweet it may be, but incon- 
 venient and nnexpected. The teacher may desire 
 to interest his pupils in fresh subjects, to open the 
 windows of their imaginations as well as to 
 strengthen their understandings, in which case he 
 will be accused of a preference for " soft options " — 
 a euphemism for unexaminable subjects. Sentiment 
 may be ill-informed or vaporous, yet surely in 
 real knowledge or true ideas no one subject can 
 be softer than another. I am far from suggesting 
 that boys and girls should study what and how 
 they will, or be left passively to receive impressions ; 
 the discipline of study, attaining gradually to a 
 systematic and even severe intellectual occupation, 
 if an indirect fruit of learning, is one of the chief. 
 P>ut, in my experience, " soft options " usually 
 stands for soft teachers, soft methods, or matter which 
 cannot be sawn into planks for the examination 
 platform. A visitor of examinations, on the other 
 hand, is not tempted to save his own labours by 
 examining to pattern; on the contrary, in newness 
 of methods and diversity of results, in tlie evidences 
 of lively conception, free initiative, and original 
 aptitudes, he finds refreshment. In urging these 
 truths, however, it must be remembered that I am
 
 ON PEOFESSIONAL EDUCATION 61 
 
 speaking of education, not of technical equipment. 
 For instance, the Medical Council, from the exclusive 
 point of view of (jualification, might condemn an 
 examination, — let us say, of Oxford or Cambridge, — 
 which, however educative, did not make an inventory 
 of the mental furniture ; wliich did not call for those 
 empirical facts and axioms on whicli physicians, 
 like engineers, have to work provisionally until 
 larger principles are attained. For if in education 
 memory and drill must be subordinate, in technical 
 instruction they must have a high place. In 
 education the teacher must act with his whole mind 
 on the pupil's whole mind, therefore he cannot be 
 dogmatic ; he will prosper by methods rather than 
 by doctrines : in technical instruction, on the other 
 hand, he has to act with parts of his mind on parts 
 of the pupil's mind, and therefore must seem to fix 
 principles which ought to be transitory, and must 
 reiterate doctrines which get out of connection with 
 facts and truths almost as fast as they are inculcated. 
 We permit ourselves to rail at examinations, 
 because at least they are liable to much abuse ; 
 perhaps more than any other machinery they are 
 open to the faults of routine, of crushing the minds 
 they should educate, of substituting formula for 
 thought, of setting glibness and handbook acquire- 
 ments above originality and development of the 
 understaiuling. By our railing we keep these 
 inherent dangers of examinations always before us, 
 we guard against tlie abuses of tests which can 
 scarcely be dispensed witli in any kind of graduation, 
 certainlv not in medicine. We sliall thus be on
 
 62 ON PROFESSIONAL EDUCATION 
 
 the watch to keep these appreciations moving in 
 the direction of freedom and eLasticity, of discover- 
 ing enlaroenient of mind and ideas rather than 
 demanding the repetitions of task-work. Still, in 
 medicine, such is the absence in the public mind 
 of any right standard of medical knowledge and 
 competence, and such therefore its liability to 
 capture by any vain or designing person, whether 
 in possession of a qualification or not, who lies in 
 wait to exploit novel methods of therapeutics, whether 
 in principle sound or unsound, and so long may 
 such adventures flourish, that for the practice of 
 our profession tests of competence must be strict, 
 even to some meticulous degree. A man may be a 
 bad lawyer, a bad engineer, or a bad shoemaker, 
 and little harm ensue but to himself and his own 
 fortunes ; the harm of a pretentious physician is 
 not so soon found out, and while it endures falls 
 upon others rather than upon himself. 
 
 Kesearch. — In addressing a university, as virtu- 
 ally I do to-day, I cannot forbear to warn my brother 
 professors that even the blessed word " research " 
 does not deliver us from the bondage of formula and 
 routine. Much that goes to-day by this name is 
 mechanical routine, of the more deadening effect in 
 that it is a corrui^tio optimi. The mere plotting of 
 curves, the mere watching of levers or thermometers, 
 the mere piling up of undigested or promiscuous 
 statistics, is clerk's work which may provide 
 material for a professor, but — as we may read 
 in many a published thesis — do not develop, 
 perhaps scarcely stimulate, that germ of origin-
 
 ON PROFESSIONAL EDUCATION 63 
 
 ality in whicli every normal man varies from his 
 kind. 
 
 Another common error in " heuristic " methods, 
 at all stages, is to tell the pupil what he is to dis- 
 cover; for he is then apt either to drop the research 
 as soon as the end is in sight, and thus to fail in 
 thoroughness, or his " cerebral eye " will persuade 
 liis " retinal eye " that the result, whatever it be, is 
 that which he was told to look for. And if these 
 be the defects of research in the inorganic sciences, 
 they are still more apparent in the sciences of life, 
 wliere the phenomena are more Heeting and less 
 sharply distinguisliable. We are prone to forget that 
 researcli has two purposes, results being but one of 
 them ; the other purpose is method, which is itself 
 an education in flexibility, ingenuity, dexterity, and 
 perseverance. The more dogged the investigator, 
 if he lacks openness and sensitiveness of appre- 
 hension, the farther he may err. Ingenuity, again, 
 if partly original, may be quickened by practice and 
 exam])le. To see how, in his best days, the late 
 Professor Poy would pounce on a machine which 
 would not work, and with a few bits of stick, quill, 
 string, and indiarubljer set it a-croiufr, was a brilliant 
 lesson to all his pupils ; a lesson which for his own 
 part he used gratefully to attribute to Ludwig and 
 Cohnheiin. 
 
 Although thus the perils of didactical and dia- 
 lectical modes of education have happily become 
 manifest, yet by no means does it follow that all 
 teaching can be experimental and socratic. Much 
 teaching, especially of children, must be didactic
 
 G4 ON PEOFESSIONAL EDUCATION" 
 
 still ; children must be tcaiight habits by rule and 
 authority. To take a plain example, the rules of 
 health must be inculcated as habits long before a 
 physiological inquiry into their validity ; that is to 
 say, long before adolescence : and from this instance 
 we may reflect upon the scope of didactic teaching 
 in other departments of knowledge. If, besides this 
 training and drilling, the methods of research and 
 verification are pursued also, and the principles of 
 the kindergarten carried on through all stages, the 
 pioneer qualities of the mind and imagination will 
 be developed to no little extent, and the acquired 
 didactic formulas will be quickened. And even con- 
 cerning logic, intolerable as its tyranny became, and 
 deadening as was its supremacy upon the spon- 
 taneous energies of the mind, yet in our revolt for 
 originality we must forbear to throw sequence and 
 symmetry out of the window. 
 
 Clinical instruction. — The clinical teaching of 
 the hospitals is so much improved of late years that 
 on this subject I have little advice to give either to 
 teacher or to student. But there is still too much 
 trooping after eminent professors, too little quiet study 
 of the patient. Reading of text-books at home is 
 eating sawdust : I counsel you to carry your treatise 
 into the wards, moving from bed to bed as you 
 read ; thus you will get living knowledge, to make 
 you into another man. The close neighbourhood 
 of the clinical laboratory, whereby disease is studied, 
 in its dynamic aspects, from rudimentary perturba- 
 tions to perilous storm and even to wreck, will 
 teach you a lesson, which the lay managers of a
 
 ON TKOFESSIONAL EDUCATION 65 
 
 hospital apprehend with diliiculty, and never learn ; 
 namely, that Medicine is not a Summa or Corpus of 
 fixed principles or aphorisms, better or worse applied 
 by this physician or that, nor again consists in 
 " surgery and placebos," but is a living and progressive 
 organ, only to be kept vigorous by incessant growth 
 and renewal. And is not this living medicine 
 educating not us only, but also the butcher and the 
 milkman, the family and the Councils, nay, the State 
 itself and its rulers ; shaming the complacencies of 
 the unidea'd and dissolving the customs and formulas 
 of the " practical man " ? For clinical medicine has 
 always been not only itself a sphere of scientific 
 discovery but also the cause of discovery in other 
 spheres. Over and over again clinical medicine 
 leads the way for the physiologist as well as for 
 the pathologist, and day by day is demonstrating 
 interlockings of processes and sequences of events 
 which no experimental work could compass, even 
 if such combinations could be foreseen. Every 
 hospital, large or small, if its work is to thrive, and 
 its patients are to reap the benefit, should be open 
 to students. In teaching his pupils the teacher 
 educates himself — reveals to himself his own latent 
 capacities. Thus not only should the London hospitals 
 enter into a union of free interchange of students, but 
 the larger country hospitals also should be gathered 
 into the system. I often urge our own men to escape 
 for a few weeks from the hustle of a great metro- 
 politan hospital into the quiet wards of a county 
 institution where a few cases can be thoughtfully 
 considered, and not rarely are shrewdly interpreted 
 
 F
 
 66 ON PEOFESSIONAL EDUCATION 
 
 by ail efficient and unassuming physician or surgeon 
 of the staff who is glad of an intelligent hearer. 
 
 The outlook of modern medicine. — Never 
 was there a time when the study of medicine 
 offered such visions of reward — social, scientific, 
 and beneficent — as at present. From these 
 manifold visions it is bewildering even to choose 
 a few illustrative glimpses. As from the molecule 
 and the atom to the electron the physicist is 
 hunting down the secret of matter itself, so the 
 biologist, having searched the organ and the tissue, 
 is ardently pursuing the secret of life in the 
 cell. And already his search is rewarded. This 
 tiny universe is a microcosm of various activities, 
 which we may well call wonderful if we do not 
 forget that it is wonderful only as all things are 
 wonderful. A recent address by Sir John Burdon 
 Sanderson revealed to us a far wider significance 
 of oxidation in the animal body. Each in his 
 own direction, physiologists such as Langley and 
 Sherrington, have traced the intricacies and yet 
 the integration of parts and functions ; while others 
 such as Starling and Bayliss, have pursued the 
 subtle functions and reciprocities of internal 
 secretions. Allied to these are the specific products 
 of cells, every cell of the body a microbe with its 
 own juice — its toxin, if you will — each playing 
 against all, in mutual attractions and repulsions, 
 and not thus only but, in marvellous fore-ordination, 
 with extrinsic agents capable of coition with this or 
 that specific tissue or cell, for good or evil ; and, if 
 we can but tame them to our uses, potent for
 
 ON TEOFESSIONAL EDUCATION 67 
 
 therapeutical euds. We are shown how digestion is 
 but one phase of these equivocal processes — food or 
 poison as conditions may determine ; and, by Croft 
 Hill, how a ferment in one phase undoing molecules, 
 in another is no less efficient in constructing them. 
 The busy, curious spirit of modern physiology is 
 not arrested even before the riddle of the albuminous 
 molecules, probably a finite series ; and is inter- 
 preting them, as Ehrlich, Fischer, and Hopkins are 
 doing, by analysis or synthesis, reading not their own 
 constitution only but, as Pavy also is demonstrating, 
 their relation to the molecules of carbohydrate and 
 fat. How, again, with the disappearance of foolish 
 medieval schisms of the practice of our profession, 
 the influence of workers in all branches will 
 reinforce each other, is remarkably illustrated by 
 the light thrown upon some of the gravest problems 
 of general disease in the sessions of the new 
 Dental Section of the British Medical Association. 
 Dietetics again, which had made some indefinite 
 advance by the empirical observations of the 
 physician, has been raised nearer to the rank of 
 a scientific study by the investigations of food 
 values by Chittenden and Atwater, and of the 
 purin bodies by Fischer, Walker Hall, and others. 
 And if these brilliant prospects are opened out to 
 the private physician, how far more dazzling are 
 the promises of preventive and public medicine. 
 By the hands of Koch, Manson, Ross, Bruce, 
 Leishman, and their peers, plague -swept areas 
 of the world are being restored to culture and 
 civilisation ; by the work of Nuttall and Haldane
 
 68 ON PEOFESSIONAL EDUCATION 
 
 and many others, as chronicled in the Journal 
 of Hygiene, the standard of health is raised, 
 dangerous occupations are made wholesome, and the 
 conditions of childlife and education are moulded for 
 infinite good by the physician who thus, from the 
 private duties and modest social ambitions of a 
 healer of the ailing individual, is rising to the 
 functions and dignity of the statesman. Could I but 
 touch, as hitherto I have failed to do, the imagination 
 of a rich man, that he might see how much this 
 progress would be accelerated if we could rise 
 above our present anthropocentric medicine and 
 establish a laboratory and professor of comparative 
 medicine ! For in disease, as in generation, all 
 life is kin, and by a universal pathology our 
 conception of these problems of the perversions 
 of health would be infinitely enlarged, and our 
 knowledge of them increased, not for man only 
 but for our herds, our fish, and the fruits of the 
 earth. The evil whose causes we know is half 
 cured already. But no ; the unimaginative English- 
 man is content to blunder along knowing little of 
 the natural world about him, and content to 
 bequeath his money in charity to mitigate calamity 
 and suffering which by more timely aid he 
 might have prevented. " For knowledge," said Sir 
 William Wharton shortly before he was taken from 
 us, " money is hard to get until the necessity for its 
 expenditure is patent to the smallest intelligence." ^ 
 
 ' For two years past I have noted the beijuests for public 
 purposes, as recorded in The Times. Twice only, and for small 
 sums, have I discovered a bequest for education, or research into
 
 ON PEOFESSIONAL EDUCATION 69 
 
 But our progress is no suiunier's day sailing ; 
 when from year to year — I liad almost said 
 from hour to hour — science is swiftly on the 
 march, customs are continually disturbed by bold 
 speculations and great shiftiugs of opinion ; the 
 profession of medicine, and the public also, are 
 agog for novelties of cure. To take advantage of 
 this wayward excitement busy agents spring up in 
 many directions, and large are the promises, true 
 or false, which they hold out. Now it is true 
 that as pathology penetrates more and more deeply 
 into vital processes, therapeutics will follow a like 
 elaboration, so that the humbler means of our 
 fathers, the pill and the bottle, are menaced by 
 new-fangled methods — by such methods as massage, 
 the more intricate modes of electricity, hydropathy, 
 the sanatorium, the Nauheim business, and so 
 forth ; methods which, both in their application and 
 in the refinements of diagnosis which they imply, 
 often exceed the scope of the family physician. 
 Whether vaunted by enthusiasts, exploited by 
 adventurers, or scrupulously and sagaciously practised 
 by competent persons, these methods require special 
 and costly plant, so that the patient is often invited 
 to retire to some sort of diagnostical and thera- 
 peutical factory. Now such institutions, however 
 beneficent, must in the first place be made to pay : 
 and therefore, unless guided by independent ad- 
 visers, and guided discreetly, they are liable to 
 
 the conditions under which we spend our lives. Thus we lack 
 enlightenment even in our selfishness ; we cannot even say, 
 " naturam colimus, inviti qtioque."
 
 70 ON PEOFESSIONAL EDUCATION 
 
 capture by the commercial interests. The number 
 of sufferers who can be persuaded to enter them 
 will become at least as important to the manager 
 as a precise selection of cases. Yet if, after any 
 fashion, these agencies meet a public need they 
 will not be quenched by the frowns of pro- 
 priety ; we must expect them to prevail more 
 and more, and for good and evil they will collect 
 more and more patients from the ordinary circles 
 of practice. It is of pressing moment, then, that 
 the Eoyal Colleges, rising above a policy of solemn 
 opportunism, should with a wise foresight recognise 
 that some such imdertakings are necessary and in- 
 evitable, should distinguish what is good and useful in 
 them from the speciousness of trade and charlatanry, 
 and define broadly and clearly their scientific and 
 ethical relations to the profession at large. 
 
 We learn, that we may do. — In all this 
 cry about learning you may ask me, Where is 
 the wool ? Where does action come in ? Now, 
 if I am earnest with you for learning, I would 
 be even more robust with you for action ; for the 
 end of education is action. St. Francis, ecstatic 
 as you may call him, spent all his ardour, and far 
 more than his strength, in passionate labour for 
 man. Even in the very thought of a new pui-pose 
 he would spring forward, crying, " Here am I." 
 Eevolve, agitate, test continually the stuff of your 
 knowledge till you have to act ; tlien ponder no more. 
 If you have made a good machine of yourself you 
 will act better by your acquired nature, by the 
 instincts you have truly constructed, than by looking
 
 ON PKOFESSIONAL EDUCATION 71 
 
 back for your learning. The man who has to 
 walk a narrow plank across a ravine must fix his 
 eyes on the other side and walk automatically. If 
 he peers about him and below him, and interrogates 
 his cerebellum, he is likely to fall. Whether as 
 teacher or practitioner, come to a decision, and then 
 stick to your course dogmatically and imperiously. 
 The patient does not come to the phy.sician to be 
 consulted, nor the pupil to be the teacher. Whatever 
 he may profess, the patient knows it is best for 
 him to be told plainly, so far as discretion 
 permits, what ails him, and to have his course 
 dictated to him. In the discussion of doubtful 
 points of diagnosis or treatment, do not lean 
 upon the patient, but state alternatives categori- 
 cally, and the modes by which a decision is to be 
 arrived at. An ailing man is tired, and must be 
 spared all puzzles. To pretend to know more than 
 we do is one thing ; to be vague and indecisive in 
 counsel or action is another. Vacillation spells 
 failure. Doubt breeds diffidence. Study without 
 enforced experience of the operative values of things, 
 thoughts too fine to work, will not stand the test 
 of God or man. There are few stories so strange 
 and pathetic as that in the life of St. Catherine 
 of Siena, when this saint, thwarted by the wiles of 
 the Papal Court and abhorrent of its vices and its 
 pride, called to the convent and to the wilderness, 
 for the succour of holy men who had devoted their 
 lives to the contemplation of righteousness and 
 wisdom. Many of them found themselves too inert, 
 or too diffident, even to answer the call ; those that
 
 72 ON PROFESSIONAL EDUCATION 
 
 painfully gathered themselves together became to 
 her a new burden rather than a succour ; sad-eyed 
 grey shadows, halting and hesitating, yearning in 
 sympathy, pure in desire, but for practical help as 
 ineffectual as moths. 
 
 When tried by an anxious case do not keep 
 turning it over and over again in your mind. 
 To carry a second best course through is better 
 than to falter in the best. Professor Bradley says : 
 " The actor who plays Hamlet must make up his 
 mind as to the interpretation of every word and 
 deed of the character. Even if at some point he 
 feels no certainty as to which of two interpreta- 
 tions is right, he must still choose one or the other. 
 The mere critic is not obliged to do this." To let the 
 case hang about your mind while neither observing it 
 nor reading it up, and especially to do this by night, 
 throws the facts out of perspective, and harasses you, 
 when your mind with a little rest would create a 
 truer conception by itself. If you want more 
 information, if events be not as expected, seek more 
 light by book or Ijedside. If after all you are 
 in doubt, go back formally to the beginning; 
 examine the patient without bias as if you had 
 . never seen him before, if possible with an intelligent 
 medical friend. Some forgotten fact of the early 
 history, or some elusive sign, such as a round, 
 white, depressed scar not so big as a threepenny 
 bit, may thus be brought to light, and bear signifi- 
 cantly upon the subsequent events. 
 
 Education and Ethics. — We have dwelt upon 
 education as progress from ignorance to knowledge,
 
 ON PEOFESSIONAL EDUCATION 73 
 
 from ieebleuess to strength ; but us we could not 
 regard intellect apart from imagiuation so we 
 cannot separate the mental from the moral part 
 of man. Either without its supplement is incom- 
 plete. None knows better than the physician that 
 emotion, religious or other, must have a strong 
 skeleton of intellectual principles ; conscientiousness 
 without enlightenment has to account for some of 
 the darkest chapters of human history. At my time 
 of life I feel that I may never again address so 
 important a body of students as those of this great 
 college, and if I do not thrust upon you thoughts of a 
 kind which at the moment we may scarcely be in the 
 mood for, I cannot conclude without touching upon 
 some matters of that higher life without which we 
 can never prosper either as a nation or as individuals. 
 It was by what Sir Philip Sidney called " the ancient 
 piety and integrity of the English people," rather 
 than by far-seeing wisdom, that this nation weathered 
 the storms of the last two centuries. There are 
 now many rich men among us, and there has never 
 been a time when in their monotonous amusements 
 they have seemed — to us poor men — farther from the 
 kingdom of heaven. But as a nation England will 
 never dance to the pipe of Omar Khayyam, nor take 
 for its motto— 
 
 Sapias, vina liques, et spatio brevi 
 Speiu longam reseces. 
 
 If tliere be some ominous signs about us of 
 corruption of moral habits, on the other hand we 
 may see still more vividly the signs of a new ethical 
 earnestness and insight as pure and intense as the
 
 74 ON PEOFESSIONAL EDUCATION 
 
 awakening of Wesley and Newman, and far more 
 permanent in its elements. It is your great 
 privilege to be born in a time of breaking up of 
 dogma, of the deliverance of the spirit from the 
 bondage of the letter, of the scrapping of the 
 machinery of religion for the recovery of its essence, 
 and for a new embodiment of it. Such was the 
 breaking up of ancient ritual by Christ himself, 
 and, in their measure, by Wycliffe and Luther. 
 The form is so easy, the spirit is so difficult ! Now 
 in this our time we are set free to return not to the 
 sixth century but to the first, to the original source 
 of the Christian life. The notion that Christianity 
 consists not so much in a life as in doctrines was 
 the notion of hellenistic philosophers. As to dogma, 
 then, hear what all men say, but follow no man ; 
 follow the light which you will find within you. In 
 the growing purity of your hearts you will not fail 
 of your revelation, and by this touchstone you will 
 distinguish, even in your contemplation of nature, 
 the true from the false ; you will interpret that 
 higher secret which by her eyes you see that she 
 knows but cannot express, and will read into her 
 message ideas whicli no analysis, scientific or even 
 philosophic, can reveal. Remember, if you are ever 
 bored with your own self there is something wrong 
 with you. Physiology tells you that you must 
 always be growing or must degenerate ; no impure, 
 petty, or rancorous thought but makes a mark not 
 to be undone, and weakens the habit of virtue. 
 Our decisive moments, George Eliot says, are not 
 those of our better hours, protected by wholesome
 
 ON PEOFESSIONAL EDUCATION 75 
 
 happier dispositions, but when wu have in us less 
 devotion — for so we vary, when we give way to 
 little insincerities, little uncharitablenesses, shifti- 
 nesses, low standards, tampering with worldly folk, 
 little tempers, and jealousies. Let us desire, then, 
 hi'dier motives and worthier interests ; let us fill 
 our minds with more and more jirecious contents. 
 it has been said, and with some truth, tliat 
 men of science are apt to forget we cannot play 
 curiously with base and shameful things and then 
 wipe them away as if we had never been occupied 
 with them. Upon those physicians then whose 
 painful duty it may be to turn over psychological 
 garbage rests the heavier responsibility of a jealous 
 concern for the purity of their own hearts, lest 
 they should seem to make terms with uncleanness. 
 
 To a certain temptation which besets us, but rather 
 the richer and more self-indulgent of us, I can do no 
 more than allude — I mean the temptation to profess 
 easy morals, to be facile in condoning vicious habits, 
 to give or imply immoral medical counsels, to be 
 " wise men after the ilesli." Now to teach ethics is 
 not our business, and to pretend to it may disconcert 
 a visitor who comes to us for medicine, and reason- 
 ably expects an undivided attention to his bodily 
 ailments. But although in this he is reasonable, and 
 ethics is not our purpose, we shall do ill if we empty 
 our advice of ethical contents ; and if, in a weak com- 
 pliance, we insinuate immoralities, or even acquiesce 
 in them, we shall do wickedly. " Feed no man in 
 his sinnes." Minister honestly to the poor rather 
 than render ignoble service to men of pleasure.
 
 76 ON PROFESSIONAL EDUCATION 
 
 Let us not go back upon nature herself who is 
 ever striving to weave the uppermost tissues of 
 the brain for the inhibition of the lower. Professor 
 Sherrington tells us there is great competition in 
 the cerebral centres for the path of action ; and 
 if two stimuli — a better and a worse let us 
 suppose — would employ the path, one or other is 
 suppressed ; " there is no compromise." And a fre- 
 quented circuit soon becomes " canalised." 
 
 In the Phacdrus we find the profound truth that 
 if the soul be not destroyed by its own proper evil 
 it cannot be destroyed by any other ; a lesson there 
 enforced by the figure that the soul is the charioteer 
 of two winged horses, the one of noble the other of 
 ignoble breed ; and sooner or later the soul may be 
 dragged to earth by the baseness of the ignoble 
 steed, and there lose its own wings also. 
 
 The opinion is current, since the time of 
 William Henry Green, that spiritual goods are 
 essentially non-competitive ; that the survival of the 
 fittest does not apply to the field of the highest 
 ethics, which is a field rather of inward than of 
 outward occupation. Tliis has always seemed to me 
 a sliallow distinction ; surely a race is set before us, 
 and we run all. Competition is, indeed, now rather 
 between large social than between individual units, 
 but the strongest bond of the parts of the social 
 unit, that indeed by which it survives, is surely the 
 higher ethics. We can no more get out of nature's 
 methods than out of our own skins. That progress 
 comes by adversity has been told to us by Christ and 
 Paul, by Tauler and Herbert, as well as by Darwin
 
 ON PROFESSIONAL EDUCATION 77 
 
 and Haeckel. Taiiler says : " If we were wise and 
 industrious the devil's opposition and his discipline 
 would be more useful to us than those of the good 
 angels ; for were there no conllict there could be 
 no victory," A knowledge of the highest endow- 
 ments, deeds, and creations of man must therefore 
 form not only a part of universal education but also 
 of our personal meditation, whether it be found in 
 Greek, Latin, or Hebrew. 
 
 The physician is wont to hear how noble is his 
 profession, how profound the debt of the public to 
 him, and how devoted society is to his lofty calling, 
 in after-dinner speeches. But it is true that our 
 calling is gentle, unselfish, wise in its intimate 
 converse with nature and mankind ; humanumquc 
 f/enus communi nomine fovit. Hippocrates says in 
 his lofty way, that where there is the love of 
 man there also is the love of art. And we 
 know, with George Herbert, " it is even some 
 relief to a poor body to be heard with patience." 
 Furthermore, our calling teaches us the secret of 
 the " simple life," which for society too often means 
 but a clean slate on which to daub new excite- 
 ments ; for there is no ennui like the e'linui of the 
 man of pleasure. By the " realism " of its daily 
 practice it hardens us against carnal temptations. 
 It saves us from the withering sin of cynicism, 
 for it inspires us with the building of a world 
 ever better and better, a work in which we are 
 the artificers ; if the world may not be very good 
 we rejoice that it is possible for us to make it so. 
 No good physician was ever a misanthrope. Yet
 
 78 ON PROFESSIONAL EDUCATION 
 
 if all professions have their safeguards they have 
 also their temptations, and our own is no exception. 
 Laymen, even those most friendly to us, tell us 
 of our testiness, of our jealousies, of an angularity 
 in our relations with our brethren, especially with 
 those who live near us and ought to be our 
 colleagues, but whom we are too apt to call our 
 "opponents," and so to regard as such. This, to 
 say the least of it, is bad policy; it gives our 
 enemies a handle against us, and grieves even our 
 friends who discern our fault but not our tempta- 
 tions. That members of other professions are free 
 from this mutual distrust comes of the different 
 conditions of their engagements. Unfortunately 
 the game of medicine is played with the cards 
 under the table. Whether a clergyman be a good 
 preacher or pastor, whether a barrister conducts a 
 case well or ill, whether a tradesman sells good soap 
 or bad, is not only a matter of which the public can 
 form some fair judgment, but also these transactions 
 are, so to speak, in market overt. In the intimacies 
 of medical counsels, on the other hand, who is there 
 to note the significant glance, the shrug, the hardly 
 expressed innuendo of one or other of our brethren 
 of whom it might be said, as it was said of Roderick 
 Lopez — Queen Elizabeth's physician — that "he is 
 none of the learnedest or expertest physicians, but 
 one that maketh a great account of himself"? 
 Thus we work not in the light of public opinion 
 but in the secrecy of the chamber ; and perhaps the 
 best of us are apt at times to forget the delicacies 
 and sincerities which under these conditions are
 
 ON PROFESSIONAL EDUCATION 79 
 
 essential to liariuony and honour. But the more 
 careful we make ourselves of these loyalties the 
 less we shall suspect others ; the more candid and 
 sincere we become with our brethren the less they 
 will suspect us. Most of such offences are due 
 not to malevolence but to want of imagination or 
 good-breeding. There is none more prone, when 
 alarmed by illness, to scatter medical etiquette to 
 the winds than the doctor himself ; he will run 
 about between half-a-dozen physicians in a week, 
 keeping his own counsel. Can he not then put him- 
 self in the patient's place ? Life is dear, even to a 
 layman. In any case let us always remember that 
 as we have many benefits, so we must be vigilant 
 and forbearing in the perils to which the temper of 
 the physician is exposed. For such trial and unrest 
 as we must have, let us dwell on the words of 
 Montaigne, that " we have the most sweet and 
 gentle medicine in philosophy ; for of others no 
 man feels the pleasure of them but after his recovery, 
 whereas she pleaseth, easeth, and cureth all at once." 
 Before Chaucer it w^as said that the physician 
 is no ritualist ; in this audience I am addressing 
 men of many creeds, and some, perhaps, who fondh' 
 think they have none. At any rate, the physician 
 learns to follow a true instinct in seeking the ideal 
 not in dreams, emotions, or transcendencies, but in 
 the actual, in the high choice and promise of the real. 
 No delicacy, or remoteness, or fantasy can make a 
 false idea into a true one. Yet Professor Lloyd 
 Morgan has well said, " the prime condition of pro- 
 gress is to believe more than can be demonstrated":
 
 80 ON PROFESSIONAL EDUCATION 
 
 and the condition is true of all natural growths. 
 In the rough and tumble of all callings, however, 
 the higher life gets obscured, and we have to seek 
 quiet moments when we can enter into that inner 
 chamber of the mind wherein dwells that self by 
 which we differ from all otlier individuals, for which 
 we are responsible, and yet wherein, by this differ- 
 ence, even those of us whose hearts are warmest 
 are alone. To this end, whether I could or would 
 go to church or not, I have always " differentiated " 
 my Sundays. If I stay away from a place of 
 worship the greater my responsibility, the more 
 my duty to the higher life. Whether your " studie 
 be then on the Bible," or on Shakespeare, is for each 
 of you to choose — on both perhaps ; but for that one 
 day of the week be thankful to eschew idle books 
 and newspapers, petty cares and business, and even 
 professional usages which can be postponed ; so that 
 we may live one day at least in the presence of 
 men greater and purer than ourselves. And what 
 I say of one day in the week I say also of some 
 minutes in every day ; in that inner chamber store 
 for the day some sweet verse, some line of gentle 
 wisdom or lofty thought which — to repeat a phrase 
 with which I began — shall still make the habit of 
 virtue and reason easy and pleasant to us. Then 
 when the new song is sung we may find ourselves 
 among those who could learn that song, for they 
 were redeemed from the eartli. 
 
 Printed by R. & R. Ci.akk, Limited, Edinburgh,
 
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