The moral aspects of medical life, consisting of the 'Akesios' of Professor K.F.H. Marx / translated from the German, with biographical notices and illustrative remarks, By James Mackness.

  • Marx, K. F. H. (Karl Friedrich Heinrich), 1796-1877.
Date:
1846
    prosectors and by lecturers—provided with means, and glutted with help—who flies in despair at the difficulties that overwhelm, him to the friendly arms of the grindery may blush, perhaps, to read how Mr. Johnson struggled to obtain an education, unsupported by money, unassisted by friends, unaided by those manuals, plates, and wood- cuts which, professing to facilitate, appear to supersede exertion, and form at once the refuge and the ruin of complaining indolence." If it were even possible to acquire in one year the knowledge which ought to have been acquired in four, it is not possible to acquire with it the vigour and dis- cipline of mind, the habits of attention, analysis, and discrimination, which can alone result from the patient gradual subjugation of difficulties. But to return to our German neighbours. "During the first year, what little time they give to science, is generally devoted to the lectures on natural philosophy, chemistry, botany, mineralogy, zoology, logic, and psychology. These sciences constitute the absolu- torium philosophicum, or the reunion of the preparatory sciences, on which an examination has to be undergone at the Faculty of Philosophy, before the doctor's degree can be obtained. The dean of the Faculty of Medicine is obliged to be present at this examination. The expense of the examination is ten thalers. " The second and third years are, or ought to be, devoted to anatomical studies, to physiology, pathological anatomy, external and internal pathology, legal medicine, toxicology, and the history of medicine. The fourth or last year is employed in the study of midwifery, and of external and internal clinical medicine in the hospitals; it is the period allotted to the practical examination of disease. "During the first three months of their university studies (this respects the clinical studies) tbe pupils only
    follow the visits of the physician or surgeon, listening to his examinations of the patients and to his lectures, they are then called auscultantes. In the second trimestre they become practicantes, that is, they themselves have patients to see and examine. The 'practicans' is obliged to visit his patient every morning, often twice a day; moreover he has to draw up the history of the case intrusted to him, and to submit it to the clinical professor. " To graduate as doctor, at the end of the four years, the student has to produce, first, a certificate from the Faculty of Philosophy, of having passed the tentamen phi- losophicum; the examination in logic, and the accessory sciences to which we have alluded. Secondly, a certificate of having devoted four years to medical studies. The ex- amination for the degree is a mere formality; it consists of a written and an oral trial; The candidate composes a Latin dissertation, or thesis on a subject chosen by him- self, or by the dean, which he supports publicly. Having fulfilled these conditions, he is saluted by the title of " doctor medicines rite promotus." We shall now proceed to look a little at Dr. Marx's observations; he complains that " men, in general, too seldom inquire of themselves, and that youth, in particular between dissipation and varieties of study, scarcely attain to any self-intercourse." In connexion with this com- plaint the following judicious remarks of Dr. Graves, in his introductory lecture at the session 1837-8, may be advantageously taken into consideration. " I think students are very much misled, as to the best mode of becoming good practitioners. This is an age of ambitious acquirement, and professional men seem to be ashamed unless they have the character of universal know- ledge. Everybody studies everything, and the consequence is that few know anything well. We live amidst the din of declamations in favour of general education; and are
    everywhere assailed by the ceaseless competition of those who vend cheap knowledge in the form of penny periodi- cals, lectures innumerable, and hosts of rival encyclopaedias; but ours is not an age of calm unpretending acquirement and secure precise study, without which the effort to be- come good physicians and surgons must prove vain and fruitless. Can anything be more embarrassing than tbe multitudinous array of studies presented to the young student, who comes to London or Dublin with the view of educating himself as a general practitioner ? So many departments of knowledge are spread before him, and so numerous are the exhortations to study each with particu- lar care that he feels at a loss where to begin. The merits, advantages, and necessity of his own branch are insisted on by the respective teachers with all the force of im- pressive eloquence ; and, after running the round of intro- ductory lectures (an initiatory penance duly performed by all beginners), he returns in the evening to his home puzzled and dispirited. He finds that it will be necessary for him to become an excellent botanist, an able and scientific chemist, and a profound anatomist; that he must have some knowledge of zoology, be well versed in comparative anatomy, know how to detect poisons with accuracy, and study the legislative enactments which bear on questions of medical jurisprudence. Physiology, materia medica, therapeutics, nosology, morbid anatomy, the principles and practice of surgery, medicine, and midwifery, claim all and each his especial attention; nay, many teachers insist upon the necessity of becoming master of several languages,—Greek, Latin, French, and German; while others assure him that he never can prosecute scientific medicine with success, unless he studies physics as well as physic ; some there are even who encourage him to culti- vate mineralogy and geology, as if, forsooth, a knowledge of these sciences could teach the laws that regulate dis-
    eased action, or the indications which should govern the exhibition of remedies." It is a fact not sufficiently considered, that education is of two kinds. There is the education of the mind, that training and culture of the mental faculties, of the judgment, the reasoning powers, the taste and appreciation of those subjects which shall afterwards be presented to it, which fits the mind for the purposes to which it is destined; and there is that special education of the mind thus fitted, for that particular employment in which it is henceforth to be engaged. The former of these departments of education is by far the most important, and it is precisely that in which, in the opinions of able judges, amongst whom we may evi- dently rank Professor Marx, our present systems of medical education are most deficient. In proof of its importance, we shall cite a judge no less competent than the late Dr. Arnold, who, in a lecture on the Divisions and Mutual Rela- tions of Knowledge, observes, " The human mind may fitly be called that great and universal machine, by which we operate upon all things. We all know the fame which was so deservedly obtained by the late Mr. James Watt, for his great improvements in the steam-engine. The value of the steam-engine consists not only in the magnitude of its powers, but in the generality of their application. It is useful not for one purpose only, but for hundreds. How different are the callings of the cotton manufacturer, the brewer, and the packet-master, or coach proprietor! yet steam serves the purposes of them all. Now if the steam- engine be so general an instrument, the human mind is yet more so. Nothing absolutely can be done without it and who can set bounds to what may be done with it ? In improving then this universal engine, we are conferring a service on mankind, something the same in kind with the improvement of the steam-engine, but in degree and extent of usefulness beyond all comparison greater." If this be
    important with regard to mind in general, how much more so with regard to minds which are to be exercised upon a profession like medicine. "No profession," says Dr. Latham, " requires a sounder preliminary education than ours, and in none ought education to be more studiously directed to promote the activity and development of the mental powers." If this first part of education, the educa- tion of the mind, be duly conducted, and successfully effected, the student may be trusted to acquire for himself much which without this must be forced upon him by ex- ternal necessity, and at last but superficially acquired. If the steam-engine, to use Arnold's expressive simile, be fitly constructed and thoroughly efficient, we have but to set it to work, and it will work cheerfully, untiringly, and cor- rectly ; but if its parts be imperfect and unscientifically arranged, urge it as you may, you will obtain but bungling performances. It is then, we repeat, the mind which should be the first object of attention in the education of youth, not the mere acquisition of knowledge, but the cultivation of that instrument by which knowledge is acquired, and by which also that knowledge is alone capable of being rightly wielded. "II ne s'agit pas," says Montesquieu, " autant de faire lire que de faire penser,". and it follows that wherever there is an excessive pressure of study and reading, so as to absorb all the time, exhaust the mind, and prevent the free exercise of thought, making what we read our own, the true business of education is impeded. In after life we may much more easily acquire the knowledge— the facts—than we can acquire the habit of truly appre- ciating them. Professor Marx, in some succeeding paragraphs, touches on the continual effort needed to enable the practitioner to keep up the progress of medical knowledge, and here we may cite a passage to the same effect from Dr. Simon. " If the masters of the science," says he, "have imposed on