Medicine – The Student Life Part 1

EXCEPT it be a lover, no one is more interesting as an object of study than a student. Shakespeare might have made him a fourth in his immortal group. The lunatic with his fixed idea, the poet with his fine frenzy, the lover with his frantic idolatry, and the student aflame with the desire for knowledge are of “imagination all compact.” To an absorbing passion, a whole-souled devotion, must be joined an enduring energy, if the student is to become a devotee of the grey-eyed goddess to whose law his services are bound. Like the quest of the Holy Grail, the quest of Minerva is not for all. For the one, the pure life; for the other, what Milton calls “a strong propensity of nature.” Here again the student often resembles the poet—he is born, not made. While the resultant of two moulding forces, the accidental, external conditions, and the hidden germinal energies, which produce in each one of us national, family, and individual traits, the true student possesses in some measure a divine spark which sets at naught their laws. Like the Snark, he defies definition, but there are three unmistakable signs by which you may recognize the genuine article from a Boojum—an absorbing desire to know the truth, an unswerving steadfastness in its pursuit, and an open, honest heart, free from suspicion, guile, and jealousy.

At the outset do not be worried about this big question —Truth. It is a very simple matter if each one of you starts with the desire to get as much as possible. No human being is constituted to know the truth, the whole truth, and nothing but the truth; and even the best of men must be content with fragments, with partial glimpses, never the full fruition. In this unsatisfied quest the attitude of mind, the desire, the thirst—a thirst that from the soul must rise!—the fervent longing, are the be-all and the end-all. What is the student but a lover courting a fickle mistress who ever eludes his grasp? In this very elusiveness is brought out his second great characteristic —steadfastness of purpose. Unless from the start the limitations incident to our frail human faculties are frankly accepted, nothing but disappointment awaits you. The truth is the best you can get with your best endeavour, the best that the best men accept—with this you must learn to be satisfied, retaining at the same time with due humility an earnest desire for an ever larger portion. Only by keeping the mind plastic and receptive does the student escape perdition. It is not, as Charles Lamb remarks, that some people do not know what to do with truth when it is offered to them, but the tragic fate is to reach, after years of patient search, a condition of mind-blindness in which the truth is not recognized, though it stares you in the face. This can never happen to a man who has followed step by step the growth of a truth, and who knows the painful phases of its evolution. It is one of the great tragedies of life that every truth has to struggle to acceptance against honest but mind-blind students. Harvey knew his con-temporaries well, and for twelve successive years demonstrated the circulation of the blood before daring to publish the facts on which the truth was based.’ Only steadfastness of purpose and humility enable the student to shift his position to meet the new conditions in which new truths are born, or old ones modified beyond recognition. And, thirdly, the honest heart will keep him in touch with his fellow students, and furnish that sense of comradeship with-out which he travels an arid waste alone. I say advisedly an honest heart—the honest head is prone to be cold and stern, given to judgment, not mercy, and not always able to entertain that true charity which, while it thinketh no evil, is anxious to put the best possible interpretation upon the motives of a fellow worker. It will foster, too, an attitude of generous, friendly rivalry untinged by the green peril, jealousy, that is the best preventive of the growth of a bastard scientific spirit, loving seclusion and working in a lock-and-key laboratory, as timorous of light as is a thief.

You have all become brothers in a great society, not. apprentices, since that implies a master, and nothing should be further from the attitude of the teacher than much that is meant in that word, used though it be in another sense, particularly by our French brethren in a most delightful way, signifying a bond of intellectual filiation. A fraternal attitude is not easy to cultivate—the chasm between the chair and the bench is difficult to bridge. Two things have helped to put up a cantilever across the gulf. The successful teacher is no longer on a height, pumping knowledge at high pressure into passive receptacles. The new methods have changed all this. He is no longer Sir Oracle, perhaps unconsciously by his very manner antagonizing minds to whose level he cannot possibly descend, but he is a senior student anxious to help his juniors. When a simple, earnest spirit animates a college, there is no appreciable interval between the teacher and the taught—both are in the same class, the one a little more advanced than the other. So animated, the student feels that he has joined a family whose honour is his honour, whose welfare is his own, and whose interests should be his first consideration.

The hardest conviction to get into the mind of a beginner is that the education upon which he is engaged is not a college course, not a medical course, but a life course, for which the work of a few years under teachers is but a preparation. Whether you will falter and fail in the race or whether you will be faithful to the end depends on the training before the start, and on your staying powers, points upon which I need not enlarge. You can all become good students, a few may become great students, and now and again one of you will be found who does easily and well what others cannot do at all, or very badly, which is John Ferriar’s excellent definition of a genius.

In the hurry and bustle of a business world, which is the life of this continent, it is not easy to train first-class students. Under present conditions it is hard to get the needful seclusion, on which account it is that our educational market is so full of wayside fruit. I have always been much impressed by the advice of St. Chrysostom: “Depart from the highway and transplant thyself in some enclosed ground, for it is hard for a tree which stands by the wayside to keep her fruit till it be ripe.” The dilettante is abroad in the land, the man who is always venturing on tasks for which he is imperfectly equipped, a habit of mind fostered by the multiplicity of subjects of the curriculum; and while many things are studied, few are studied thoroughly. Men will not take time to get to the heart of a matter. After all, concentration is the price the modern student pays for success. Thoroughness is the most difficult habit to acquire, but it is the pearl of great price, worth all the worry and trouble of the search. The dilettante lives an easy, butter-fly life, knowing nothing of the toil and labour with which the treasures of knowledge are dug out of the past, or wrung by patient research in the laboratories. Take, for example, the early history of this country-how easy for the student of the one type to get a smattering, even a fairly full acquaintance with the events of the French and Spanish settlements. Put an original document before him, and it might as well be Arabic. What we need is the other type, the man who knows the records, who, with a broad outlook and drilled in what may be called the embryology of history, has yet a powerful vision for the minutiae of life. It is these kitchen and backstair men who are to be encouraged, the men who know the subject in hand in all possible relation-ships. Concentration has its drawbacks. It is possible to become so absorbed in the problem of the “enclitic Se,” or the structure of the flagella of the Trichomonas, or of the toes of the prehistoric horse, that the student loses the sense of proportion in his work, and even wastes a lifetime in researches which are valueless because not in touch with current knowledge. You remember poor Casaubon, in Middlemarch, whose painful scholarship was lost on this account. The best preventive to this is to get denationalized early. The true student is a citizen of the world, the allegiance of whose soul, at any rate, is too precious to be restricted to a single country. The great minds, the great works transcend all limitations of time, of language, and of race, and the scholar can never feel initiated into the company of the elect until he can approach all of life’s problems from the cosmopolitan standpoint. I care not in what subject he may work, the full knowledge cannot be reached without drawing on supplies from lands other than his own —French, English, German, American, Japanese, Russian, Italian—there must be no discrimination by the loyal student, who should willingly draw from any and every source with an open mind and a stern resolve to render unto all their dues. I care not on what stream of knowledge he may embark, follow up its course, and the rivulets that feed it flow from many lands. If the work is to be effective he must keep in touch with scholars in other countries. How often has it happened that years of precious time have been given to a problem already solved or shown to be insoluble, because of the ignorance of what had been done elsewhere. And it is not only book knowledge and journal knowledge, but a knowledge of men that is needed. The student will, if possible, see the men in other lands. Travel not only widens the vision and gives certainties in place of vague surmises, but the personal contact with foreign workers enables him to appreciate better the failings or successes in his own line of work, perhaps to look with more charitable eyes on the work of some brother whose limitations and opportunities have been more restricted than his own. Or, in contact with a mastermind, he may take fire, and the glow of the enthusiasm may be the inspiration of his life. Concentration must then be associated with large views on the relation of the problem, and a knowledge of its status elsewhere; otherwise it may land him in the slough of a specialism so narrow that it has depth and no breadth, or he may be led to make what he believes to be important discoveries, but which have long been current coin in other lands. It is sad to think that the day of the great polymathic student is at an end; that we may, perhaps, never again see a Scaliger, a Haller, or a Humboldt—men who took the whole field of knowledge for their domain and viewed it as from a pinnacle. And yet a great specializing generalist may arise, who can tell? Some twentieth-century Aristotle may be now tugging at his bottle, as little dreaming as are his parents or his friends of a conquest of the mind, beside which the wonderful victories of the Stagirite will look pale. The value of a really great student to the country is equal to half a dozen grain elevators or a new transcontinental railway. He is a commodity singularly fickle and variable, and not to be grown to order. So far as his advent is concerned there is no telling when or where he may arise. The conditions seem to be present even under the most unlikely externals. Some of the greatest students this country has produced have come from small villages and country places. It is impossible to predict from a study of the environment, which a “strong propensity of nature,” to quote Milton’s phrase again, will easily bend or break.

The student must be allowed full freedom in his work, undisturbed by the utilitarian spirit of the Philistine, who cries, Cui bono? and distrusts pure science. The present remarkable position in applied science and in industrial trades of all sorts has been made possible by men who did pioneer work in chemistry, in physics, in biology, and in physiology, without a thought in their researches of any practical application. The members of this higher group of productive students are rarely understood by the common spirits, who appreciate as little their unselfish devotion as their unworldly neglect of the practical side of the problems.

Everywhere now the medical student is welcomed as an honoured member of the guild. There was a time, I confess, and it is within the memory of some of us, when, like Falstaff, he was given to “taverns and sack and wine and metheglins, and to drinkings and swearings and starings, pribbles and prabbles”; but all that has changed with the curriculum, and the “Meds” now roar you as gently as the “Theologs.” On account of the peculiar character of the subject-matter of your studies, what I have said upon the general life and mental attitude of the student applies with tenfold force to you. Man, with all his mental and bodily anomalies and diseases—the machine in order, the machine in disorder, and the business yours to put it to rights. Through all the phases of its career this most complicated mechanism of this wonderful world will be the subject of our study and of your care—the naked, new-born infant, the artless child, the lad and the lassie just aware of the tree of knowledge overhead, the strong man in the pride of life, the woman with the benediction of maternity on her brow, and the aged, peaceful in the contemplation of the past. Almost everything has been renewed in the science and in the art of medicine, but all through the long centuries there has been no variableness or shadow of change in the essential features of the life which is our contemplation and our care. The sick love-child of Israel’s sweet singer, the plague-striken hopes of the great Athenian statesman, Elpenor bereft of his beloved Artemidora, and “Tully’s daughter mourned so tenderly,” are not of any age or any race—they are here with us today, with the Hamlets, the Ophelias, and the Lears. Amid an eternal heritage of sorrow and suffering our work is laid, and this eternal note of sadness would be insupportable if the daily tragedies were not relieved by the spectacle of the heroism and devotion displayed by the actors. Nothing will sustain you more potently than the power to recognize in your humdrum routine, as perhaps it may be thought, the true poetry of life—the poetry of the commonplace, of the ordinary man, of the plain, toil-worn woman, with their loves and their joys, their sorrows and their griefs. The comedy, too, of life will be spread before you, and nobody laughs more often than the doctor at the pranks Puck plays upon the Titanias and the Bottoms among his patients. The humorous side is really almost as frequently turned towards him as the tragic. Lift up one hand to heaven and thank your stars if they have given you the proper sense to enable you to appreciate the inconceivably droll situations in which we catch our fellow creatures. Unhappily, this is one of the free gifts of the gods, unevenly distributed, not bestowed on all, or on all in equal portions. In undue measure it is not without risk, and in any case in the doctor it is better appreciated by the eye than expressed on the tongue. Hilarity and good humour, a breezy cheerfulness, a nature “sloping toward the southern side,” as Lowell has it, help enormously both in the study and in the practice of medicine. To many of a sombre and sour disposition it is hard to maintain good spirits amid the trials and tribulations of the day, and yet it is an unpardonable mistake to go about among patients with a long face.

Divide your attentions equally between books and men. The strength of the student of books is to sit still—two or three hours at a stretch—eating the heart out of a subject with pencil and notebook in hand, determined to master the details and intricacies, focussing all your energies on its difficulties. Get accustomed to test all sorts of book problems and statements for yourself, and take as little as possible on trust. The Hunterian “Do not think, but try” attitude of mind is the important one to cultivate. The question came up one day, when discussing the grooves left on the nails after fever, how long it took for the nail to grow out, from root to edge. A majority of the class had no further interest; a few looked it up in books; two men marked their nails at the root with nitrate of silver, and a few months later had positive knowledge on the subject. They showed the proper spirit. The little points that come up in your reading try to test for yourselves. With one fundamental difficulty many of you will have to contend from the outset—a lack of proper preparation for really hard study. No one can have watched successive groups of young men pass through the special schools without profoundly regretting the haphazard, fragmentary character of their preliminary education. It does seem too bad that we cannot have a student in his eighteenth year sufficiently grounded in the humanities and in the sciences preliminary to medicine—but this is an educational problem upon which only a Milton or a Locke could discourse with profit. With pertinacity you can overcome the preliminary defects and once thoroughly interested, the work in books becomes a pastime. A serious drawback in the student life is the selfconsciousness, bred of too close devotion to books. A man gets shy, “dysopic,” as old Timothy Bright calls it, and shuns the looks of men, and blushes like a girl.

The strength of a student of men is to travel-to study men, their habits, character, mode of life, their behaviour under varied conditions, their vices, virtues, and peculiarities. Begin with a careful observation of your fellow students and of your teachers; then, every patient you see is a lesson in much more than the malady from which he suffers. Mix as much as you possibly can with the outside world, and learn its ways. Cultivated systematically, the student societies, the students’ union, the gymnasium, and the outside social circle will enable you to conquer the diffidence so apt to go with bookishness and which may prove a very serious drawback in after-life. I cannot too strongly impress upon the earnest and attentive men among you the necessity of overcoming this unfortunate failing in your student days. It is not easy for every one to reach a happy medium, and the distinction between a proper self-confidence and “cheek,” particularly in junior students, is not always to be made. The latter is met with chiefly among the student pilgrims who, in travelling down the Delectable Mountains, have gone astray and have passed to the left hand, where lieth the country of Conceit, the country in which you remember the brisk lad Ignorance met Christian.

I wish we could encourage on this continent among our best students the habit of wandering. I do not know that we are quite prepared for it, as there is still great diversity in the curricula, even among the leading schools, but it is undoubtedly a great advantage to study under different teachers, as the mental horizon is widened and the sympathies enlarged. The practice would do much to lessen that narrow “I am of Paul and I am of Apollos” spirit which is hostile to the best interests of the profession.

There is much that I would like to say on the question of work, but I can spare only a few moments for a word or two. Who will venture to settle upon so simple a matter as the best time for work? One will tell us there is no best time; all are equally good; and truly, all times are the same to a man whose soul is absorbed in some great problem. The other day I asked Edward Martin, the well-known story-writer, what time he found best for work. “Not in the evening, and never between meals!” was his answer, which may appeal to some of my hearers. One works best at night; another, in the morning; a majority of the students of the past favour the latter. Erasmus, the great exemplar, says, “Never work at night; it dulls the brain and hurts the health.” One day, going with George Ross through Bedlam, Dr. Savage, at that time the physician in charge, remarked upon two great groups of patients—those who were depressed in the morning and those who were cheerful, and he suggested that the spirits rose and fell with the bodily temperature—those with very low morning temperatures were depressed, and vice versa. This, I believe, expresses a truth which may explain the extraordinary difference in the habits of students in this matter of the time at which the best work can be done. Outside of the asylum there are also the two great types, the student-lark who loves to see the sun rise, who comes to breakfast with a cheerful morning face, never so “fit” as at 6 a.m. We all know the type. What a contrast to the student-owl with his saturnine morning face, thoroughly unhappy, cheated by the wretched breakfast bell of the two best hours of the day for sleep, no appetite, and permeated with an unspeakable hostility to his vis-a-vis, whose morning garrulity and good humour are equally offensive. Only gradually, as the day wears on and his temperature rises, does he become endurable to himself and to others. But see him really awake at 10 p.m. while our blithe lark is in hopeless coma over his books, from which it is hard to rouse him sufficiently to get his boots off for bed, our lean owl-friend, Saturn no longer in the ascendant, with bright eyes and cheery face, is ready for four hours of anything you wish—deep study, or

Heart-affluence in discursive talk, and by 2 a.m. he will undertake to unsphere the spirit of Plato. In neither a virtue, in neither a fault we must recognize these two types of students, differently constituted, owing possibly—though I have but little evidence for the belief-to thermal peculiarities.