No. 2703.

JUNE 19, 1875.

ABSTRACTOF AN

Introductory LectureDelivered by

P. W. LATHAM, M.D., F.R.C.P.,DOWNING PROFESSOR OF MEDICINE, CAMBRIDGE; PHYSICIAN TO

ADDENBROOKE’S HOSPITAL.

(Concluded from p. 816.)

IF then, gentlemen, medicine as a science and as a prac-tical art is advancing with such rapid strides at the presenttime, are you prepared to master it, and to take your partin it and to aid its progress ? Has your preliminary train-ing been such that you can now study advantageously thenature and properties of remedies here, and then go withme to the hospital and watch their effects in the treatmentof disease ? Are you prepared to investigate carefully thephenomena of disease, to learn how to recognise its presence,and to trace its cause and relations; and to bring to yourassistance all the aids which modern science has affordedus ? The study of morbid phenomena and how to deal withthem is the work upon which you are now embarking, andit will require all your energies and time and perseverance.Perhaps you will ask, What scientific culture ought we topossess for this ? P I will briefly endeavour to discuss thepoint. You are all well acquainted with the schedules ofsubjects which, in their prescribed order, are to be studiedbefore you present yourselves for your various examinations;and, in my opinion, wisely and well have these subjects andtheir order of study been suggested, and I would stronglyadvise you to adhere to what has been drawn up for your.guidance. But what I would warn you against is, being ledaway by enthusiasm for any special branch of science tcdevote an undue amount of your time to that branch, neg-lecting your other studies, and so failing to acquire a com-petent and sound knowledge of all the subjects with whichit is necessary that you should be acquainted. The dazzlingexperiments in chemistry, or the wonderful revelations ofphysiology, cannot fail to produce their effect on any sensi-tive mind, and to entrance it; and not a few who havecommenced the study of one or other of these sciences pre-paratory to the study of medicine have found so much tocharm and interest them, they have been so willing tolinger over their experiments and investigations, that medi-cine has been forsaken; they have, perhaps, become enthu-siastic and illustrious workers in these departments, butthey have never realised that an equal, I think a greater,interest is to be found in those studies which were beyond,and for which their own were merely the foundations. But

independently of the attractiveness which practical che-

mistry and practical physiology have for the mind, there isanother danger to which students are at the present dayparticularly exposed; and that is, the overweening import-ance which is attached to their own subjects by someteachers of these special branches. Now you must have agood acquaintance with human anatomy, as far as observa-tion will give it you, and a sound knowledge of chemistryand physiology, gained by practical work. Mark what Isay, a "sound knowledge"; not an intimate acquaintancewith these subjects-that would require more time than isat your disposal even for fitting yourselves for the practiceof your profession. Not many years ago, even within thepresent century, the 11 physician might have been able tocomprehend all that then constituted the allied sciences ofmedicine; but that can never again be possible." *’ No onecan hope, even as the sciences now stand, and much less asthey shall further advance, to obtain a foremost knowledgeof them and of medicine at the same time." The studentof medicine, then, may well stand appalled when he hearsthe demands which the teacher of physiology would makeupon him, and when he hears of the importance and primarynecessity which exists for his becoming a physiologist beforehe is a physician. But, gentlemen, be comforted; the hypo-

thesis is false. " The clinical physician knows that thephenomena of disease are not explained by the phenomenaof healthy texture nor by the action of healthy organs."*You must have a sound knowledge of the groundwork ofphysiology to begin with; but all the minuter portions, alloriginal investigations and experiments, had (unless you haveunlimited time at your command) better be postponed untilyou have acquired a certain knowledge and familiarity withthe other branches of professional study. H If all medicalstudents had fifteen or twenty years at their disposal, andcould dedicate them all to professional education, we mightpardon a little innocent declamation in displaying the richand varied field of knowledge about to be disclosed to them;but even then sober truth would compel us to confess thatthe field so pompously displayed far exceeded in extentwhat the best minds could hope to compass, even in fifteenor twenty years. When, however, we recollect what spaceof time the majority of men so addressed really can give totheir education, the whole affair becomes inexpressibly ludi-crous."t Let us consider for a moment what preliminarytraining is necessary in anyone who aspires to become aphysiologist. By a physiologist I do not mean one whosimply has had his hand trained to perform various mecha-nical operations and his eye taught to observe certain phe-nomena, but one who, in addition, has a mind trained todraw the logical inferences from the phenomena observed.Now I do not say that a man cannot do this latter withouta mathematical training, but no other training is so wellcalculated to "discipline the reasoning faculty, to give thehabit of concentrated thought, and to place in the student’shand a weapon indispensable for the thorough mastery ofthe physical sciences"; and for this reason I regret that inthe Cambridge Natural Sciences Tripos more mathematicalknowledge is not required of the candidates. Again, theprogress of physiology has always been influenced by dis-coveries in physics; but English physicists and physiologistsare very wide apart, and this is one reason, perhaps, whyphysiology in England seems to be so much indebted toworkers in Germany, where the natural sciences are basedupon the solid and only permanent foundation of mathe-matical research. You cannot, then, with the time at pre-sent at your disposal, be physiologists before you are phy-sicians, and you must be content with a limited knowledgeto begin with; improve that knowledge afterwards as youhave opportunity; and in the mean time refer your physio-logical difficulties to the physiologists for solution.The cry, too, for original research, which has become so

fashionable, has not a good influence upon the student.Original research unquestionably is to be encouraged to thegreatest extent in those whose training has fitted them forit. But all men are not and cannot be educated for dis-coverers. These stand alone; they become what they arebeyond, and often in spite of, their education. You cannotmake an Adams, a Stokes, or a Helmholtz out of ordinaryhuman brains, or look for the same results to occur to allindividuals trained in precisely the same way as they were.11 This would be the same thing as to take measure of allmankind by the proportions of a giant, and make the singlewonder of a hundred years the common expectation of everyday." There are nevertheless some people who, with aplausibility and an iteration not perhaps commendable, doinduce a certain class of persons, generally uneducated, tobelieve that all students in Cambridge ought to be dis-coverers. Even in a scientific periodical I saw, not longsince, the hope expressed that early research may be therule at Cambridge instead of the exception. How can aman be fitted for original research unless his mind has beendisciplined, unless he has been trained to habits of patientobservation, and unless he is acquainted with what hasbeen done by others ? And how much patient continuouswork does all this require ! Place little stress on the acquisi-tion of facts and theories which have been already estab-lished ; tell the student of science "it is little matter whatthis or that authority has said, or what the words in whichhe has spoken-Nature is to be the authority"; " that theessence of the scientific spirit is that it is free, and thattrue scientific inquiry refuses blindly to submit to authority";that in the science examinations here less attention shouldbe given to what a man knows of a subject than to his so-called original investigations in it-or, in other words, in acompetition for honours in science the competitors are to

* Sir William Gull. t Dr. P. M. Latham.

850

show, not that they know what other people know, but thatthey know something in it which nobody else knows tellthis to the student, and would it encourage him in that con-tinuous study and practice which are necessary to enablehim, both in his own observations and in judging the state-ments of others, to distinguish accurately the phenomenaobserved from the interpretation given to them ? P Wouldhe not rather start off on his voyage of discovery an unin-structed and uneducated sailor, without guide or compass ?He might possibly discover some unknown region, but thereis a greater probability of his suffering shipwreck. The re-sult is that among certain so-called purely natural sciencemen we see little deference shown to the opinions, and littleregard of the work, of others-little of that humility whichcharacterises the distinguished workers in other branchesof science, but a bold and arrogant confidence in their ownopinions and a contemptuous disdain of the opinions ofothers. This may be modified in the course of years, when,humiliated by their fallacies being exposed by better trainedworkers, they feel, though perhaps they don’t confess,. thatless original research and more careful and extended ac-quisition of facts already established would have been betterfor their peace of mind, their usefulness, and their reputa-tion.But this cry for originality affects others besides the

young student. According to a recent able leader in TheTimes, " rich men are apt to take up study for amusementwithout adequate discipline or acquaintance with the workof others, and to produce in consequence a good deal ofamateur or duplicate work of no great value." And a fur-ther result is, that 11 we get in this country a great deal ofpopular exposition of fashionable subjects and a considerablequantity of incompetent and paradoxical discoveries."Be satisfied, then, gentlemen, for the present, to neglect

the allurements of original research whilst you fit yourselvesfor the prosecution of it at no very distant date. Be aatis-fied to learn what discoveries have been already made, whichare acknowledged and accepted as true, and which have abearing on the profession the practice of which it will beyour duty to adorn. In your professional work you willfind abundant opportunity for original research in its highestand noblest forms-the relief of pain and suffering, the re-pair of injuries, the controlling of disease, and the preven-tion of death. Every case of suffering has its own pecu-liarities, and your most cultivated discernment and yourhighest skill will often be necessary to determine its natureand peculiarity and to apply the remedy. And these arethe great experiments which,. as students, you have now towatch and learn, and which very soon you will have your-selves to perform. Qualify yourselves, then, to understandand utilise all the discoveries which able workers in thedifferent branches of science may make. The next bestthing to making a discovery is to utilise it, and very oftenit is not until this has been done that the grandeur or im-portance of the discovery is recognised. Prepare yourselvesto be practical physicians-not meaning by that title one"who practises the errors of his predecessors," but onewho neglects no opportunity of increasing his own know-ledge, who is open to receive and to utilise knowledgefrom every quarter-an observer of nature and carefulwatcher of natural processes and operations in all theirvarying, forms, and one who gives his time and steady,patient, continuous attention to the work. Do this and youcannot fail to acquire an interest in your profession; andthen, when the interest and learning and skill have beenacquired, recollect that they are gifts which have been en-trusted to you, and which you are bound to use 11 as a richstorehouse for the glory of the Creator and the relief ofman’s estate."

SALISBURY MEDICAL SOCIETY.-The annual meetingof this Society was held at the White Hart Hotel, Salis.bury, on the 2nd inst. There were twenty members pre-sent, and after the election of officers for the ensuing yea]and an interesting discussion on puerperal fever, which wasadjourned, they partook of a cold luncheon. The followingis the. list of officers :-President: J. Manning, LaverstockPresident-Elect: Dr. Pike, Weyhill. Vice-President : DrFox, Broughton. Committee of Management: MessrsBennett, Darke, and Straton. Treasurer: Mr. G. WiltonSecretary: Mr. Biggs, Salisbury.

A LectureON

HYDATID DISEASE.Delivered at the Middlesex Hospital Medical College,

BY T. SPENCER’ COBBOLD, M.D., F.R.S.,LECTURER ON PARASITIC DISEASES.

OF all the various forms of parasitic disease that comeunder the notice of the physician and surgeon, none isindividually of more importance than the singular affectioncommonly designated 11 hydatids." If, on the one hand, itcannot be said that separate treatises have been written on,this subject, it may with equal truth be affirmed that novolume, dealing with the principles and practice either ofmedicine or surgery, can be regarded as complete if it failto treat of hydatid disease. In short, the subject has aliterature of its own ; yet, nearly all that has been writtenconcerning it is to be found in the pages of innumerablejournals and professional works. In this connexion alsoseveral treatises on helminthology play no inconspicuouspart.In my <<Introduction to the Study of the Internal Para-

sites," published eleven years since, I gave a careful r&eacute;sum&eacute;

of the subject as it then stood, more particularly in relationto the development and mode of origination of the disease.Since that time few of our writers on hydatids have touchedupon the sanitary and endemic bearings of the subject; anotable exception, however, occurring in the case of Dr.Murchison, F.R.S., who, in the early part of his well-knownessay " On Hydatid Tumours of the Liver," makes referenceto the researches of Davaine, Eschricht, Hjaltelin, andothers, in reference to this part of the question. Amongstother contributions, those by Macgillivray, Cleghorn,Robertson, and Begbie, and especially those of Dr. Hearn,*are particularly noteworthy.Whatever motives may have operated to prevent certain

authors from making themselves acquainted with the morerecent results of entozoal research, I am confident that nota few physicians, surgeons, and general practitioners havepersuaded themselves that no purely scientific experiencesin respect of hydatide are of the slightest practical value.Such a false conclusion can only proceed from want of ac-curate knowledge, for, if the question of sanitation is to beallowed to play ita legitimate part in medical education, anacquaintance with what may be called the scientific aspectsof echinococcus disease will be found to be of the veryhighest practical value. However much good the surgeon,

may accomplish by the use of the scalpel and trocar, theprofession at large is not so lacking in the best principles ofhumanity as not, above all things, to desire to check the

prevalence of this or any other equally fatal disorder.The medical profession, on purely philanthropic grounds,

,

has of late years been straining every nerve to diminishl the number of preventable diseases by insisting on the

observance of certain well-known sanitary rules; thereforeI I am only acting in perfect harmony with this collective

effort when I undertake to call your attention to the pre-L valence of this disease, partly in the hope of inducing per-.

sons in authority to adopt measures for preventing its pro-gress. Let me add, as an incentive to patient researches ofthis kind, that, notwithstanding the numerous cures re-

sulting from surgical interference, there will always remain’

a considerable proportion of cases that are utterly beyondthe reach of professional skill. In some of these cases the

incurables- are destined to endure torture of a prolonged andmost distressing kind., If, at the outset, I mention a few of the principal points’ to which I desire to direct your attention, you will the.

better appreciate the great extent of the subject before us.’

In the present series of lectures I can only dwell on one or: two points of great interest ; nevertheless, it is my hope

* Kystes Hydatiques du Poumon, &e.