Advice to medical students

by Henry William Fuller

ADVICE TO MEDICAL STUDENTS,

BEING

THE INTRODUCTORY ADDRESS

DELIVERED AT

ST. GEORGE’S HOSPITAL,

AT THE

OPENING OF THE MEDICAL SESSION,

OCTOBER 1, 1857.

BY

HENRY WILLIAM FULLER, M.D. Cantab., F.R.C.P.,

PHYSICIAN TO THE HOSPITAL, &C. &C.

 

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PUBLISHED BY REQUEST.

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LONDON:
JOHN CHURCHILL. NEW BURLINGTON STREET.

MDCCCLVIII.

INTRODUCTORY ADDRESS.

 

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October 1, 1857.

Gentlemen,—We are this day assembled to inaugurate the opening of another medical session, an event of the deepest interest to us all. To many of us this day is the anniversary of our first introduction within these walls, and it speaks of the time when, like those who are now beginning their professional career, we entered on the trials of a medical life. It recalls the strange perplexity and misgiving we felt when first we mixed with those who were to be our fellow-students at the hospital, and, some at least, our friends in after life: the difficulties we had to encounter, the temptations we had to resist, the need we found for counsel and assistance. And few persons can come to a meeting like the present, and see so many young men about to enter on a race which they themselves have partially run already, without a sense of deep anxiety and heartfelt interest on their account. They cannot fail to remember that, spite of many advantages and much excellent advice, they wasted precious time which ought to have been devoted to the study of their profession or the moral culture of their minds; that they lost many opportunities of improvement, and neglected many seasons of usefulness to their fellow-creatures; and the thought excites a fervent prayer for the success and moral well-being of those who are now, as they were then, about to commence their career amid the turmoil of this great city.

And if this be true in regard to those who, like many here present, have no direct or personal interest in the welfare of our medical students, how much more must it be the case with us to whose charge these young men are committed during this, the most eventful period of their lives. It is hardly too much to say, that on the associations they form, and the tastes and habits of life they acquire, during the three short years they will pass within the precincts of St. George's Hospital, will depend, in great measure, their success in this world, and possibly their eternal happiness in the next. Our responsibilities then are great and onerous, and I trust I shall be excused if I seize this opportunity of addressing myself to those whom I have now the pleasure of welcoming as my younger professional brethren.

Gentlemen, you have already taken one of the most important steps a man can take—you have chosen your profession, and are about to commence those special studies which are to form the groundwork of your future career in life. Time was when I, too, did the same. I selected the same path and passed through the same portal as you are now about to enter, and I am sure you will bear with me, as one who has already trodden the track you have chosen, if I endeavour to point out the difficulties and dangers whereby it is beset, and offer you such advice and encouragement as experience has taught me to be wholesome and necessary.

And first, as to the nature of your adopted calling, and the motives with which it ought to be pursued. If it be true, that a profession which has for its object the saving of human life and the prevention of human suffering; which calls forth the noblest qualities of the mind, enlarges its sympathies, and tends to clear it of prejudice and error; which brings us in direct and intimate relation with our suffering fellow-creatures, and by giving us an insight into human nature under every form and every aspect, enables us to learn wisdom from the dearly bought experience of others,—I say, if such a profession be worthy of your choice, you may be truly thankful for the selection you have made. A life of honorable usefulness lies before you, such as does not fall to the lot of every one. The profession of medicine, if worthily pursued, is a noble and beneficent vocation, softening and humanising those who follow it, leading them to regard with leniency the weaknesses of their fellow-creatures, and prompting them to spare no effort to relieve their mental anguish or assuage their bodily suffering. And, gentlemen, I trust it is with these ends in view that you are entering on your present course. The position you are hereafter to occupy in the world, and the influence you will exercise, for good or for evil, over those with whom you come in contact, will depend in great measure on the view you are now induced to take of your duties and responsibilities. If, fortunately, you are led to follow the dictates of your better nature, and, taking a high view of your profession, determine to follow it steadily and consistently, in the hope that whilst it may one day yield you an honorable subsistence, it may also enable you to cultivate those qualities which serve to distinguish a Christian gentleman, depend upon it you will find your reward in the esteem of your professional brethren, the kind regard of your neighbours and acquaintances, and the affectionate gratitude of those poor sufferers to whose relief you are enabled to minister. Whereas, if, in a narrow, selfish spirit, unmindful of the privilege committed to your charge, you regard it simply as a means of earning your daily bread or accumulating wealth, you will fail to derive from it those elevating influences which sanctify the inner man and stamp the outward character, and, lacking those qualities which command the respect and confidence of your fellow-men, you will probably fail to attain the pecuniary reward at which you aim, and assuredly will want that peace of mind without which riches are valueless.

Well! gentlemen, I will assume that, before choosing your profession, you have well considered its duties and responsibilities, and that you are here to-day with firm resolve to follow that good path which alone leads to real success and happiness. Experience, however, tells me that your feelings on this occasion are not of an unmixed, unalloyed character. You have your hopes and aspirations; but you are not without your fears and misgivings. How can it be otherwise? Strangers to London—arrived, perhaps, from a quiet country home—you find yourselves amidst the busy din of this vast metropolis, surrounded by strange faces, jostled by persons who neither know nor care for you, met on all sides by a cold indifference which excites a painful sense of isolation, and oppressed by the feeling that now, for the first time in your lives, you are thrown entirely on your own resources. There are few positions in life more anxious or more trying, and none certainly in which greater need is felt for counsel and assistance. Doubtless, your first impulse will be to relieve the tedium of your loneliness by making the acquaintance of your fellow-students. But let me beg of you not to be over hasty in so doing. At all times and in all societies there are to be found young men both good and bad, idle and industrious; men who are careless, reckless, and extravagant, with little self-respect, little sense of moral responsibility, and with few desires beyond the gratification of self-indulgence; and, on the other hand, men who are cautious, well-behaved, and of strict moral rectitude, whose anxious wish it is to qualify themselves for the practiee of their profession, and to take a high standing as good members of society. I am thankful to say that at St. George's Hospital there is a large proportion of men belonging to this latter class; men whose advice you may safely follow and whose conduct you will do well to emulate; and I doubt not that, amongst your own immediate contemporaries, those who are now for the first time amongst us, there will be found many with like feelings and of like behaviour. Probably they may be of quiet, retiring dispositions, not over anxious to cultivate unknown acquaintances, and less ready, therefore, than others may be, to listen immediately to overtures of companionship. But do not on that account allow yourselves to become the associates of men who are less cautious, only because they have less reason to be particular. Rather let the discretion exercised by those whose conduct marks them as gentlemen in the true sense of the word, prove a warning to you to avoid a too hasty choice of your own companions. In the lecture-room, at the bedside of the suffering patient, and in presence of his corpse in the dead-house of the hospital, you will have ample opportunities of noting the characters of your fellow-students, and need have little difficulty in selecting your friends.

But I will go further in my advice to you respecting this important matter. My warning is directed not only against the idle and the dissolute, if such there should be found among you; but against the good-natured, well-meaning, but thoughtless, whose inexperience leads them to imagine that there can be no harm in a little temporary idleness and self-indulgence, a little time devoted to the so-called pleasures of a London life. Such men are desirous of earning a good character at the hospital, and intend ere long to work steadily and diligently, but they fancy that their movements here will be unwatched, their irregularities unnoticed, and that, for a time at least, they may neglect their duties with impunity. Gentlemen, there can be no mistake more fatal to your success and happiness. Thousands have trodden this dangerous road, and their example has shown, that he whose course is marked at its outset by negligence or irregularity, is gradually led ou to utter idleness and into evil company, and finds himself at the close of his hospital career without the knowledge requisite for the proper exercise of his profession, and without a character calculated to assist him in any effort he may be then induced to make to redeem his mispent hours. For, remember, the tribunal by which you will be judged hereafter will not be composed only of us who are now your teachers at the hospital, but of your friends, your contemporaries, your fellow-students, who will have ample opportunities of marking your conduct, and who, whatever their present feelings, will assuredly form their estimate of your character according to the incidents of your student life. Yes, whilst you fancy yourselves unnoticed, your career will be closely watched by those whose observation you cannot escape; and in future days, when you stand in need of assistance, you will be surprised to find how closely all your acts have been noted, and how greatly the position you are to occupy in the world will depend upon the character you earn for yourselves during the three years you pass at this hospital.

Let me beg of you, then, one and all, to devote yourselves from the very outset to the study of your profession. Begin, as you intend to go on; be regular and constant in your attendance at lectures; be diligent in the dissecting-room, earnest in your private studies, zealous in the pursuit of that practical knowledge which is only to be acquired in the wards of the hospital. Miss nothing; neglect nothing; for that which to-day appears of little moment, will be found ou the morrow to supply a link in your educational chain, and to be necessary to the right understanding of the subject then before you. Consider well the magnitude and exceeding interest of the study you have embraced; its subject is the marvellous fabric of the human body, the mutual relation of its various parts, the perfection of its entire mechanism, the different modes in which that mechanism may become de ranged, and the means which science places at our command to assist in removing impediments to its action. It is a study to engross your whole attention, even if it had no relation to your future career through life. But forming as it does the groundwork of that profession which you have deliberately chosen, you are bound to devote your whole energies to its prosecution. You are bound to do so for the sake of your own reputation and future happiness; for the sake of those friends who have given you your education, and who are still assisting you, and for the sake of those poor suffering fellow-creatures who hereafter will look to you for relief. Above all, you are bound to do so as the servants of an All-wise Providence, who has been pleased to enrol you among the number of those whom He employs as the channels of His mercy and the ministers of His earthly blessings, and who one day will require at your hands an account of the talents committed to your charge.

Gentlemen, you have no time to lose. You have much to do during the next three years which cannot be done at any other period of your lives. You have not only to acquire a knowledge of a profession which, in a scientific point of view, has deeper and wider foundations than almost any other; but even now, whilst your natures are plastic and your characters are being moulded, you must learn to regulate your feelings and behaviour, to discipline your mind, and to train yourselves strictly in the path of moral rectitude. You must cultivate habits of order, method, and punctuality, so as to be able to economise your time; you must acquire the habit of directing your whole attention to the subject before you, so as to analyse and reason on it correctly; you must learn to be exact in observation and scrupulously accurate in your record of facts; to discriminate between the important and the unimportant, and so to arrange and classify your knowledge as to have it always available in practice. But, beyond all this, if you would succeed in your career, and occupy an honorable position in the world, you must learn to cherish self-respect and honesty of purpose,—feelings inconsistent with mean or dishonorable actions; you must evince integrity of conduct, generosity of character, and kindliness of feeling towards your professional brethren; you must acquire a habit of self-restraint which shall enable you to bear with the waywardness of your patients, and a gentleness of manner and cheerfulness of disposition which shall render you a welcome visitor to them; you must learn to sympathise with them in their afflictions, to counsel them in their distress, and in every way so to regulate your conduct as to make yourselves their friends, as well as their advisers. These are habits which take root in youth and grow with the man; and if you do not implant them in early life, and cultivate them assiduously, you will find, when it is too late, that you have neglected to lay one of the surest and best foundations of professional success.

Truly may it be said at the present moment, that your fortunes are placed in your own hands, and that you may make or mar them as you please. There is no walk of life in which persevering industry and good moral conduct meet with a surer and more lasting reward, or in which a life of idleness and misconduct more certainly leads to misery and ruin. Men will not willingly entrust you with their lives if they consider you careless or incompetent; neither will they admit you into the privacy of their families if they believe you to be sensual or profligate. As you sow, so will you reap. In order that there may be a good harvest, the land must be manured and carefully prepared, the seed must be sown in due season, the weeds which spring up must be rooted out, and the soil must be diligently cultivated throughout. Each act of husbandry must be performed in its appointed season, and on each much time and labour must be bestowed. So is it also n regard to you. You cannot neglect your duties now, and regain your lost time by labour hereafter. Now is the season for preparing your land and sowing the seed, which, if carefully tended, will hereafter bear an abundant crop; this is your time for steady labour, your only opportunity of laying a secure foundation for the future. At present you have health and vigour to prosecute your studies, you have hopes to realise, good intentions to carry out, elasticity of spirit to urge you forwards, and your minds are undistracted by cares and unbiassed by preconceived or erroneous notions. But this state of things will not continue long. Before many years have passed you will have entered on the active business of life, and will find yourselves engaged in a struggle for your daily bread. There will be little time for study then. Each day will bring with it its own labour, its own peculiar cares and anxieties, and with your time occupied by multifarious engagements, and your minds harassed by responsibilities and anxieties, you will find little opportunity for regular study, and will feel unequal to close and continued mental application. If you neglect your present season of improvement, you will then discover how great and irreparable a loss you have sustained. You will be constantly in want of that very knowledge which ought to have been acquired at the outset of your career, and which can hardly be attained without beginning your education anew; and, dispirited by a sense of your own incompetence, and nettled by the success of your more diligent fellow-students, you will be assailed by never-ceasing, but useless regrets.

Do not imagine, that the warning I am giving you is prompted by any special misgiving as to your future conduct. Judging by my own observation of medical students—and my experience is drawn chiefly from St. George's Hospital—I believe them, on the whole, to be as moral, well-conducted, and diligent, as any class of men of their age and position. But I am addressing you as youug men to whom an insight into the practical issue of any course of conduct is always valuable; I am addressing you as friends and fellow-students, for whose welfare and future happiness I cannot but entertain a deep feeling of anxiety; I am addressing you as your teacher—as one who is desirous of seeing you take a proper position in the world as useful and respectable members of an honorable profession, and who feels that he is in some measure answerable for your so doing. Bear with me, then, if I seem to have said more than is absolutely necessary, and believe me when I add, that if you firmly resolve to follow my advice and act up to your resolutions, you will one day thank me for having endeavoured, however prosily, to impress these truths on your minds.

There is yet one point to which I would allude before we cross the threshold of your future career. You are collected here from all parts of England, you are strangers to each other, and hitherto have not had any opportunity of testing, by competition, your respective talents and acquirements. Some of you will soon perceive that you have knowledge and ability above the average of your fellow-students; whilst others, whose early education has been neglected, will feel themselves unable to cope in the first instance with their more highly gifted or better grounded competitors. But let not these inequalities under which you will begin your race prevent you from exerting yourselves to the utmost. After a very short time, if you steadily persevere, the differences between you will be less than you now imagine. The mental faculties admit of development to a degree of which, perhaps, you have little conception; and you will soon discover that moderate ability, backed by well-directed mental discipline and steady industry, will place any one of you in a position to compete with the most talented of your neighbours. Barely, indeed, in a profession like ours, does innate talent determine the difference between man and man. Where so much depends on personal observation, and the adaptation of our knowledge to special circumstances, the acquirements which are most essential to success are a practical familiarity with the different phases of disease, and a well-grounded confidence in the administration of remedies—acquirements which the greatest talent will not command without steady, persevering industry, and which any man of moderate ability may possess, if, with a determined will, he devote himself to their attainment.

I trust I shall not be understood as estimating lightly the natural gifts with which it has pleased God to bless us. They are precious talents committed to our charge, and if rightly used, may be made to forward our success in this world and our happiness in the world to come. But he who is possessed of many talents may neglect his opportunities, and fall below the level of him who, though possessed of only one, yet turns that one to the best account. Be not dismayed, then, if now at the outset of your career you find yourselves deficient in some of those qualities which would most assist you in your race through life. Bather let the discovery urge you to fresh and more earnest exertions. You cannot at present form a just estimate of your powers, neither can you judge to what extent they may be developed. Many have gone before you, who, with little talent and against every disadvantage, have won their way to affluence and respect, and he who devotes himself in earnest to his work, and with an honest upright heart walks manfully along the path he has chosen, will seldom, if ever, fail in obtaining a reasonable amount of professional success. Eminence and high distinction he possibly may not attain, for amid the competition of the present day something more is needed than industry and good conduct to raise a man to the first rank in his profession. He must have a clear, vigorous, and well-trained intellect; he must possess physical powers of no common order, powers which shall enable him to endure a vast amount of anxiety and fatigue without producing exhaustion of his energies; and even then he will need a happy combination of circumstances to place him in positions favorable to the display of his talents and acquirements. The same holds good of other professions as well as our own; the highly gifted and more fortunate must rise to the top: but there are few professions—I believe there is hardly one—in which a man who resolves to do his duty, and to improve the talents wherewith he is blessed, can reckon with so much certainty on attaining an honorable position in society, and wealth sufficient to maintain him there. Assuredly there is none which will give him more opportunities of benefiting his fellow-creatures, or which in the retrospect will afford him greater satisfaction.

It is not my intention, on the present occasion, to offer you any advice as to the mode of studying the various subjects which form the groundwork of medical knowledge. This must be left to your respective teachers, who, in their several classes, will tell you what to do, and how to do it. But I think I may venture on some general remarks which may prove of use to you at the present time. You will find that your course is extremely varied. It embraces the study of anatomy, or the intimate structure of the human body, with its endless array of bones, muscles, and ligaments, its glands, nerves, and blood-vessels; of physiology, or the functions of that body and its various parts, the independence of their action and their mutual relation—the most complex and mysterious of medical investigations; of pathology, or the derangements which the bodily functions undergo, and the structural changes which may be produced by disease; of botany, which is deeply interesting and important; of chemistry, the handmaid of modern discovery, the most rapidly progressive of all sciences; of Materia Medica, or the natural history of those remedial agents which are profusely scattered through the realms of nature; and last, but not least in a practical point of view, the application of these various branches of knowledge to the alleviation of human suffering, the prevention and cure of disease, and the elucidation of legal investigations. Now the first impression usually produced by this formidable list of subjects, each one of which is a fitting study for a life, is that of helpless bewilderment; the mind is aghast at the vastness of the prospect which lies before it. But you must not permit yourselves to yield to this feeling. You must be sadly faint-hearted and utterly unfit for the journey of life if you allow yourselves to be daunted by the extent or roughness of the ground you have to traverse. There are few paths, however lengthy and rugged, and few difficulties, however great, which may not be surmounted by patient toil and firmness of purpose. What the poet has said of agriculture applies to every walk through life:

"Pater ipse colendi
Haud facilem esse viam voluit."

But believe me, the path which you are about to tread is not beset by any obstacles which may not be overcome by steady industry and application. It has its own, its special difficulties, but so has every walk through life, and he who would be useful, happy, and contented, must meet them in a proper spirit, and make the exertion which is necessary to overcome them. Amongst the earliest you will have to encounter is the multiplicity of new and isolated facts which will be brought before you in your different lectures; you will find yourselves unable to arrange and classify them, or to trace out their practical application; and until you do so, you will have no little difficulty in fixing them in the storehouse of your memory. But this is not peculiar to the study of medicine. It is a difficulty which meets every one who enters for the first time on a wide field of research, and it is one which at this hospital may be readily overcome. Whenever you are in doubt or perplexity, inquire of your elder fellow-students, consult your teachers, refer to your text-books, and turn again and again to Nature's pages. Like travellers in a strange country, question every person you meet respecting the road along which you are journeying, and glean from them as much information as possible; but do not rely upon such precarious sources of knowledge. Regard attentively everything that comes before you; note every landmark, every object, however small and trifling it may appear; mark well their position and mutual relations, and endeavour day by day to recall what you have seen, and retrace in your mind each step you have taken. So, by degrees, the face of the country will become familiar to you; each object which has met your view, each fact you have acquired, will serve as the basis of further research, until at length the road which at first seemed dark, dreary, and perplexing, will prove bright, interesting, and agreeable.

I cannot too strongly impress upon you the necessity of observing and thinking for yourselves; you are, as I have said, like travellers in a strange country, and you are bound to act accordingly. Begin by a careful study of your charts — those books and lectures which are furnished for your guidance and instruction, and endeavour thus to make yourselves acquainted with the facts collected by the patient investigation of your predecessors. But when you have thus obtained a knowledge of your position, and gleaned some insight into the course to be pursued, you must turn to Nature and consult her landmarks. Your further progress will depend entirely on your so doing. You will soon begin to find that books are poor interpreters of Nature's works; that disease is not so simple and straightforward an affair as authors would lead you to suppose, but varies infinitely in type, and presents a multitude of different phases according to age, sex, constitution, and the like; you will learn that no precise line of treatment can be laid down which shall be applicable to these several varieties; that every case must be made the subject of special thought and special study; and that, although what you have learned from books and lectures may assist you in arriving at a correct decision, yet that your treatment must be directed by general principles deduced from personal observation of disease and of the effect of remedies. Yes, gentlemen, the most valuable knowledge we possess is that which we have acquired by long-continued observation and experience. It cannot to any great extent be communicated to others, either orally or by writing, and the utmost that can be said of books and lectures is that they are faithful outlines simplified and adapted for your instruction, and intended to be filled up by your personal observation. The sources whence you must derive the knowledge which will enable you to fill them up, are the dissecting-room, the wards, and the dead-house of the hospital. Let me beg of you then to go to those sources, and make the utmost use of your opportunities. Be patient in your inquiries, take nothing for granted, slur nothing over, make out everything for yourselves, and test the knowledge you have derived from others by an appeal to the result of your personal observation. How can you be good surgeons if you are not anatomists, familiar with the structure of the body you will have to operate on, practically acquainted by oft-repeated dissections, with the relative position of its several parts, and skilled by long-continued use of the scalpel to employ it cautiously and dexterously? How can you be physicians if you do not examine the functions of the living body, and note how they are affected by emotions of the mind, and by other moral and physical influences; if you do not learn to mark the early inroads of disease, and watch its onward progress; to ascertain the effects of different remedies under varying conditions of human suffering, and to estimate correctly, by personal observation, the extent of the power which the body possesses of repairing functional or structural lesions? And yet further, how can you be either physicians or surgeons, how can you venture on the responsibility of practitioners charged with the safety of your patients' lives, if you neglect to bring your imperfect knowledge to the test of actual inspection in the dead-house, and thus learn to trace from their beginning to their end the different injuries you may be called upon to remedy, or the various diseases you may have to combat. It is only by lessons thus acquired, and frequently repeated, that you can obtain that practical insight into disease which will give you confidence in the sick-room, and serve as a guide to you in seasons of anxiety: it is thus, and thus alone, that you can lay the foundation of that knowledge which in any case of doubt or difficulty will render you of real use to your suffering fellow-creatures.

If there is one point more than another connected with my own professional education upon which I look back with unfeigned thankfulness, it is that during a long course of years I was led to spend many hours daily in the wards of this hospital. There is no school like Nature's, no storehouse upon which you can draw with so much certainty of obtaining what you seek. Only let your search be zealous and persevering, and I venture to say it will not fail to be successful. Go to the bedside with a note-book in your hand, preserve a record of the cases which come before you, illustrate them if you are able by sketches and drawings, and in the evening arrange them methodically, study their details, compare them with one another, and discuss them with your fellow-students. Whilst so doing many things .will occur to you which had previously escaped your notice; you will be led to view symptoms in a different light, or to trace some unobserved connection between them; and if you steadily follow out this system of note-taking, you will be surprised to find, when you leave this scene of your labours, how well acquainted you will have become with disease, and how large a store of facts you will have accumulated—facts, moreover, of a practical nature, which will serve as references in after years, and prove most valuable guides to you through life. At first possibly your study may appear to be productive of very little result, for some time must necessarily elapse before you can acquire familiarity with disease, or form a correct judgment as to the administration of remedies. But this is not a ground for slackening your exertions. The seed takes time to swell and sprout, the fruit to grow and ripen, but the various stages of growth are accomplished nevertheless, each in its appointed season; and when at length the harvest time arrives, the crop is found to be closely proportioned to the skill and labour bestowed on its cultivation. So also will it be in regard to the attention you are now induced to give to the clinical investigation of disease. This is your time for tilling the land and sowing the seed; and although day by day, as you work in the wards, you may fail to perceive that you derive any advantage from it, you will find in future years that the seed you now sow will bring forth vigorous and healthy plants, and return you an abundant harvest. Have confidence in what I tell you then, and persevere unto the end: your time cannot be more profitably employed, or your energies turned to a more practical account.

It is with this feeling, that we have this year determined to establish a distinct department of clinical instruction, and to offer several valuable prizes^[1] to those who show themselves most proficient in that practical knowledge which can be acquired only at the bedside of the patient. To further our views, the Governors of the hospital have made it incumbent upon all who shall now or hereafter enter as pupils of the hospital, to follow out a properly regulated course of study in the wards. It is no longer optional as to whether you shall hold clinical clerkships and dresserships; the signature of your schedules for hospital practice is made contingent on your doing so, and directors have been appointed to regulate the time at which you shall hold these several offices. The adoption of this rule is a token of the depth and reality of our conviction respecting the importance of this branch of your studies, and an acknowledgment of our responsibility in the matter; whilst the prizes form a material guarantee of our intention to offer you every encouragement in our power. How could we have asked the Governors to sanction these regulations, and with what face could we have offered prizes for clinical knowledge, if we had not resolved to do our utmost to impart the instruction which is necessary to the attainment of that knowledge? Gentlemen, we have not taken this step without grave and anxious consideration. We are aware that it must impose upon us a vast amount of additional labour; but we have felt it our bounden duty, regardless of our own convenience, to take every step to promote your welfare, and to prepare you for the practical duties of your profession. We trust you will meet us in a proper spirit, and reward us by your industry and attention. We hope that those of you to whom these new regulations do not apply—for of course they cannot be made retrospective—will enrol yourselves on our clinical directors' lists, and show yourselves anxious to benefit by the move we have made on your behalf. If you do so, you will find at the end of your career that you have acquired a practical acquaintance with disease which you would have sought in vain by any other means, and you will feel pleasure in the reflection that, whilst fulfilling your duties to yourselves, you have not neglected the responsibility which attaches to you in relation to your younger fellow-students, of setting an example of steady industry, and of striving after the attainment of practical knowledge.

I do not wish it to be understood that attendance in the wards of the hospital is to take the place of other prescribed means of instruction. On the contrary, it is essential for you to obtain a competent knowledge of all the various branches of medical science which are embraced in our curriculum; and he who acquires the largest amount of this knowledge will lay the surest foundation of future success. But a man may be a minute anatomist, a profound physiologist, an expert chemist, and nevertheless be an indifferent medical practitioner. No one can be fit to practise his profession who has not studied carefully by the bedside of the sick, and thus learned by constant observation and experience to trace symptoms back to their source and to interpret them correctly. Nothing can compensate for a neglect of this; and if you do not cultivate, carefully and diligently, the wide field of observation which is here provided for you, you will ever have occasion to repent your negligence.

There is yet one point to which I must refer before passing on to other topics. I mean your conduct and personal behaviour in the dissecting-room and in the dead-house and wards of the hospital. Few persons can enter a dissecting-room for the first time without a sense of reverential awe, inspired by their being in presence of the dead; and none can fail to have their feelings harrowed by the scenes which are being enacted there. But habit becomes a second nature, and after a time they learn to handle the lifeless corpse, they separate it limb from limb, particle from particle; they search out its structure, analyse its composition, and examine even by the microscope the fibres of whieh it is composed. Thus, by degrees, they acquire a familiarity with the aspect of death, which is apt to engender a feeling of indifference. men, do not allow yourselves to fall into this common, but grievous error. Do not forget the honour due to human dust, nor fail to bear in mind that the dead body which you are permitted to dissect and examine so carefully, is indeed that body which shall one day rise again and put on immortality. Let your conduct, whether in the dead-house or the dissecting-room, be quiet, thoughtful, and becoming. Strive to the utmost to obtain a thorough knowledge of the subject you are studying; but do so in an earnest, inquiring spirit, abstaining from careless and unseemly jesting. So will you mark your own sense of the almost sacred nature of the work you are engaged upon, and you will establish a character for right feeling, which will have a salutary influence on your fellow-students, and prove of use to you through life.

And if it be necessary to observe propriety of conduct towards the dead, how careful should you be in your behaviour to the living—your poor, sick, suffering fellow-creatures, at whose bedside you are permitted to watch the ravages of disease, and to contemplate the approach of death. Remember that your presence in the wards is only tolerated in order that you may learn to minister to the relief of those who in future days may need assistance, and that you are bound to exercise the greatest care, lest, by any harshness of manner, unkindness of remark, or roughness of conduct, you aggravate the distress of those poor sufferers who are now to form the subjects of your observation. Indeed, this is so obvious, that I am almost ashamed of calling your attention to it; but I would urge you to be not only gentle and decorous in your intercourse with them, but scrupulously kind and considerate towards them. By no class of persons is unkindness felt more keenly; by none is sympathy appreciated more thoroughly, or remembered more gratefully. But whether rich or whether poor, your patients, and those you are brought in contact with professionally, are all equally entitled to look for considerate treatment at your hands, and he must have an ill-regulated mind, and must be strangely shortsighted in regard to his own interest, who fails to appreciate and act up to this principle. Let your maxim be, whether now or hereafter, to "do unto others as you would they should do unto you;" and you will have your reward in the gratitude of the sick, the esteem of your fellow-men, and the tacit approval of your own conscience.

I come now to a point on which your success in life may possibly turn. I refer to the employment of your leisure hours. Nothing will more surely conduce to establish differences between you in after years than the use you make of your leisure moments. If you have ever noted the daily course of a good or a successful man, you must have observed how carefully he economises his time. Regularity is a marked feature, not only of his studies, but of his exercise, his recreations, and hours of repose. Though convinced that it is his duty to devote himself to his labours, he feels that he is entrusted with the preservation of his health, the most precious of earthly blessings; and that if he were to do aught to cause that to fail, he would check or mar the successful prosecution of his studies. Therefore he so divides his time as to enable him to get through the largest amount of work with the least possible injury to his physical and moral energies. Prudence, gentlemen, if no higher consideration, should lead you to adopt a similar course. If you would preserve your youthful vigour, and run successfully the course which is before you, you must neither overtax your physical or mental powers, nor neglect to take reasonable care of your health. Social intercourse, active exercise, bodily rest, and mental repose, are, each in its turn, as essential to your well-being, as they are to your personal comfort; and you must endeavour so to eke out your time as to give to each its fair share, without interfering with the hours that ought to be devoted to work.

Further, it is of the highest importance that you should find some useful recreation for the mind. I do not wish to imply that you are never to spend an hour in rational conversation, or relax your mind by occasional indulgence in innocent amusements; but there must be many intervals in the day which ought not to be filled up by mere desultory occupations. These may be turned to most useful account, or they may prove most dangerous and fatal to your success. "An idle brain is the devil's workshop;" and if you fail to provide some worthy and rational pursuit on which to occupy these leisure moments, you will find to your cost, not only that you will lose much valuable time, but that you will fall into idle, careless habits, and will surely expose yourselves to the inroads of vice.

To medical men there need be no difficulty in selecting subjects for mental recreation. The mind is almost as much refreshed by being directed to fresh objects as it is by entire idleness; and there are so many useful and' deeply interesting studies bearing more or less directly on your own profession, and so many branches of knowledge with which you must be acquainted if you would qualify yourselves to mix with educated men and take a proper standing in society, that the question is not so much, "How shall I occupy my time?" as "How shall I find time to cultivate that knowledge, and attain those acquirements, which will be necessary for me in my position as a gentleman?" I know not how to offer you specific advice respecting this important matter, and fortunately I think it is not needed; for all general knowledge expands the mind, clears it of prejudice, and qualifies it for application to any particular subject; and where the field is so wide, and the labour required so vast and diversified, each labourer must select that style of work which he finds most congenial to his taste and best suited to his powers. But whether you study literature, or busy yourselves with physical or moral science, I would urge you to select as the companions of your leisure the standard works on the subject you engage in. Books are so numerous in the present day, and the time at your disposal is so short, that you are bound to devote yourselves entirely to works which bear the impress of genius and sterling worth. Even when you have recourse to the lighter productions of the day, you should still act upon the same principle. For whatever is trashy enervates the mind; whatever is immoral debases it; whatever is good and wholesome strengthens, expands, and elevates it. Believe me, your character may be known by your books almost as certainly as by your companions; and it should be your endeavour so to select both the one and the other, as to prove yourselves worthy citizens of the republic of letters, and fitting associates of well-educated, intelligent Christian gentlemen.

One word of caution may, perhaps, be added relative to the pursuits you engage in for the purpose of recreation. Always keep them subservient to the one object you have in view. It is not prudent to devote yourselves too exclusively even to anatomy, physiology, or chemistry, for, as already stated, a man may be sadly wanting as a practitioner who is nevertheless a minute anatomist, a profound physiologist, and an expert chemist. And it would be still more unreasonable to occupy any large portion of your time by aiming at proficiency in other subjects which do not bear so directly on your profession. Your time for study is necessarily so short, that if you wish for success you must turn neither to the right nor to the left, but walk steadily along the path you have chosen. Many persons of great ability and unwearied assiduity have wasted their talents and made shipwreck of their professional reputation by adopting an opposite course and grasping at too much, and it behoves you to be extremely careful not to fall into the same fatal error. Follow your favorite research in your leisure hours; but do not let it lead you to neglect the one pursuit which you have selected as the business of your life.

And when you quit this scene of your early labours to assume the responsibility of medical practitioners, take heed lest you allow the anxieties of life to lead you astray from the path you have chosen. Call to mind the good advice you have received within these walls, and act on it steadily and consistently. Remember that your success depends greatly upon your character, and not merely on attaining a particular grade in the profession. The public care little for medical titles, or for those artificial distinctions which, for the more convenient subdivision of labour, we have established amongst ourselves; they look for men who will prove useful to them in time of need—men in whom they can place confidence, whom they may admit without fear into the bosom of their families, whose feelings and behaviour are those of gentlemen, who are skilled to relieve their bodily sufferings, and to whom they may open the secrets of their hearts and turn for sympathy and advice in seasons of affliction. Show yourselves possessed of these qualifications, devoted to your profession, and willing to make the sacrifices it entails, and you are certain of success, whether you be physicians, surgeons, or general practitioners. Without these qualities your career will be uncertain, and will be marked by constant vexation and disappointment. Your dearest friends will be unable to assist you, and the public will not give you their confidence.

In conclusion, gentlemen, let me once more beg you to be earnest and zealous in your studies. Tread in the footsteps of those great men whose names adorn the bead-roll of our profession, and emulate their virtues, their industry, and attainments. If you cannot rival their glorious achievements, at least let it be obvious that you are doing your very best, that you are conscious of your privileges, and mindful of your responsibilities. There is much here around you to cheer you on. The very ground you tread is hallowed by the memory of men who have earned a glorious, undying reputation. It was here, at St. George's Hospital, that Jenner studied; it was here that Cheselden operated for stone; here, too, the indefatigable Baillie worked, and Hunter won his way to fame. Nor are these the only men whose names deserve to be chronicled for your encouragement—Heberden, Young, and Wollaston; Pemberton, Hope, Chambers, and Mansfield Clarke — these and a host of others who now are numbered with the illustrious dead, passed their early days within these walls, and many of them were medical officers of the hospital. Even now there remains amongst us one who has earned a deservedly world-wide reputation, a man to whom we are largely indebted, and to whom we would all do honour. Yes, gentlemen, with Brodie for a living exemplar, and with the memory of those great and good men who have preceded him to stimulate you in the pursuit of knowledge, you have no excuse for apathy or indolence. Go forward, then, manfully, in the path which they have trodden; follow their footsteps honestly, earnestly, hopefully; strive to the utmost to become skilful practitioners and to do justice to your patients, whether rich or poor; but, above all, be true to yourselves, and let it be your chief endeavour to deserve the good opinion of mankind, as men of feeling, integrity, and honour. So towards the close of your earthly career, you will be able to look back with honest pride upon the course you have been permitted to run, and will feel gratified by the reflection that, as far as in you lay, you have been useful in your generation and have done your duty to God and man.

1. "In order to encourage the study of clinical medicine and surgery in the wards of the Hospital, four prizes of twenty guineas each, will be offered for competition during the ensuing year, in addion to those already established for the same purpose ."—Extract from the prospectus of the St. George's Hospital Medical School, for 1857–8.