American Addresses, with a Lecture on the Study of Biology

by Thomas Henry Huxley

Such appear to me to be the broad outlines of the relations which the university, regarded as a place

of education, ought to bear to the school, but a number of points of detail require some consideration, however briefly and imperfectly I can deal with them. In the first place, there is the important question of the limitations which should be fixed to the entrance into the university; or, what qualifications should be required of those who propose to take advantage of the higher training offered by the university. On the one hand, it is obviously desirable that the time and opportunities of the university should not be wasted in conferring such elementary instruction as can be obtained elsewhere; while, on the other hand, it is no less desirable that the higher instruction of the university should be made accessible to every one who can take advantage of it, although he may not have been able to go through any very extended course of education. My own feeling is distinctly against any absolute and defined preliminary examination, the passing of which shall be an essential condition of admission to the university. I would admit to the university any one who could be reasonably expected to profit by the instruction offered to him; and I should be inclined, on the whole, to test the fitness of the student, not by examination before he enters the university, but at the end of his first term of study. If, on examination in the branches of knowledge to which

he has devoted himself, he show himself deficient in industry or in capacity, it will be best for the university and best for himself, to prevent him from pursuing a vocation for which he is obviously unfit. And I hardly know of any other method than this by which his fitness or unfitness can be safely ascertained, though no doubt a good deal may be done, not by formal cut and dried examination, but by judicious questioning, at the outset of his career.

Another very important and difficult practical question is, whether a definite course of study shall be laid down for those who enter the university; whether a curriculum shall be prescribed; or whether the student shall be allowed to range at will among the subjects which are open to him. And this question is inseparably connected with another, namely, the conferring of degrees. It is obviously impossible that any student should pass through the whole of the series of courses of instruction offered by a university. If a degree is to be conferred as a mark of proficiency in knowledge, it must be given on the ground that the candidate is proficient in a certain fraction of those studies; and then will arise the necessity of insuring an equivalency of degrees, so that the course by which a degree is obtained shall mark approximately an equal amount of labour and of

acquirements, in all cases. But this equivalency can hardly be secured in any other way than by prescribing a series of definite lines of study. This is a matter which will require grave consideration. The important points to bear in mind, I think, are that there should not be too many subjects in the curriculum, and that the aim should be the attainment of thorough and sound knowledge of each.

One half of the Johns Hopkins bequest is devoted to the establishment of a hospital, and it was the desire of the testator that the university and the hospital should co-operate in the promotion of medical education. The trustees will unquestionably take the best advice that is to be had as to the construction and administration of the hospital. In respect to the former point, they will doubtless remember that a hospital may be so arranged as to kill more than it cures; and, in regard to the latter, that a hospital may spread the spirit of pauperism among the well-to-do, as well as relieve the sufferings of the destitute. It is not for me to speak on these topics—rather let me confine myself to the one matter on which my experience as a student of medicine, and an examiner of long standing, who has taken a great interest in the subject of medical education, may entitle me to a hearing. I mean

the nature of medical education itself, and the co-operation of the university in its promotion.

What is the object of medical education? It is to enable the practitioner, on the one hand, to prevent disease by his knowledge of hygiene; on the other hand, to divine its nature, and to alleviate or cure it, by his knowledge of pathology, therapeutics, and practical medicine. That is his business in life, and if he has not a thorough and practical knowledge of the conditions of health, of the causes which tend to the establishment of disease, of the meaning of symptoms, and of the uses of medicines and operative appliances, he is incompetent, even if he were the best anatomist, or physiologist, or chemist, that ever took a gold medal or won a prize certificate. This is one great truth respecting medical education. Another is, that all practice in medicine is based upon theory of some sort or other; and therefore, that it is desirable to have such theory in the closest possible accordance with fact. The veriest empiric who gives a drug in one case because he has seen it do good in another of apparently the same sort, acts upon the theory that similarity of superficial symptoms means similarity of lesions; which, by the way, is perhaps as wild an hypothesis as could be invented. To understand the nature of disease we must understand health, and the

understanding of the healthy body means the having a knowledge of its structure and of the way in which its manifold actions are performed, which is what is technically termed human anatomy and human physiology. The physiologist again must needs possess an acquaintance with physics and chemistry, inasmuch as physiology is, to a great extent, applied physics and chemistry. For ordinary purposes a limited amount of such knowledge is all that is needful; but for the pursuit of the higher branches of physiology no knowledge of these branches of science can be too extensive, or too profound. Again, what we call therapeutics, which has to do with the action of drugs and medicines on the living organism, is, strictly speaking, a branch of experimental physiology, and is daily receiving a greater and greater experimental development.

The third great fact which is to be taken into consideration in dealing with medical education, is that the practical necessities of life do not, as a rule, allow aspirants to medical practice to give more than three, or it may be four years to their studies. Let us put it at four years, and then reflect that, in the course of this time, a young man fresh from school has to acquaint himself with medicine, surgery, obstetrics, therapeutics, pathology, hygiene, as well as with the anatomy and the