Medicine - Teacher and Student Part 2
( Originally Published 1905 )
To paraphrase the words of Matthew Arnold, the function of the teacher is to teach and to propagate the best that is known and taught in the world. To teach the current knowledge of the subject he professes—sifting, analyzing, assorting, laying down principles. To propagate, i.e., to multiply, facts on which to base principles—experimenting, searching, testing. The best that is known and taught in the world—nothing less can satisfy a teacher worthy of the name, and upon us of the medical faculties lies a bounden duty in this respect, since our Art, coordinate with human suffering, is cosmopolitan.
There are two aspects in which we may view the teacher —as a worker and instructor in science, and as practitioner and professor of the art; and these correspond to the natural division of the faculty into the medical school proper and the hospital.
In this eminently practical country the teacher of science has not yet received full recognition, owing in part to the great expense connected with his work, and in part to carelessness or ignorance in the public as to the real strength of a nation. To equip and maintain separate laboratories in Anatomy, Physiology, Chemistry (physiological and pharmacological), Pathology and Hygiene, and to employ skilled teachers, who shall spend all their time in study and instruction, require a capital not today at the command of any medical school in the land. There are fortunate ones with two or three departments well organized, not one with all. In contrast, Bavaria, a kingdom of the German Empire, with an area less than this State, and a population of five and a half millions, supports in its three University towns flourishing medical schools with extensive laboratories, many of which are presided over by men of world-wide reputation, the steps of whose doors are worn in many cases by students who have crossed the Atlantic; seeking the wisdom of methods and the virtue of inspiration not easily accessible at home. But there were professors in Bavarian medical schools before Marquette and Joliet had launched their canoes on the great stream which the intrepid La Salle had discovered, before Du Lhut met Father Hennepin below the falls of St. Anthony; and justice compels us to acknowledge that while winning an empire from the back-woods the people of this land had more urgent needs than laboratories of research. All has now changed. In this State, for example, the phenomenal growth of which has repeated the growth of the nation, the wilderness has been made to blossom as the rose, and the evidences of wealth and prosperity on every side almost constrain one to break out into the now old song, "Happy is that people that is in such a case."
But in the enormous development of material interests there is danger lest we miss altogether the secret of a nation's life, the true test of which is to be found in its intellectual and moral standards. There is no more potent antidote to the corroding influence of mammon than the presence in a community of a body of men devoted to science, living for investigation and caring nothing for the lust of the eyes and the pride of life. We forget that the measure of the value of a nation to the world is neither the bushel nor the barrel, but mind; and that wheat and pork, though useful and necessary, are but dross in comparison with those intellectual products which alone are imperishable. The kindly fruits of the earth are easily grown; the finer fruits of the mind are of slower development and require prolonged culture.
Each one of the scientific branches to which I have referred has been so specialized that even to teach it takes more time than can be given by a single Professor, while the laboratory classes also demand skilled assistance. The aim of a school should be to have these departments in the charge of men who have, first, enthusiasm, that deep love of a subject, that desire to teach and extend it without which all instruction becomes cold and lifeless; secondly, a full personal knowledge of the branch taught; not a second-hand information derived from books, but the living experience derived from experimental and practical work in the best laboratories. This type of instructor is fortunately not rare in American schools. The well-grounded students who have pursued their studies in England and on the Continent have added depth and breadth to our professional scholar-ship, and their critical faculties have been sharpened to discern what is best in the world of medicine. It is particularly in these branches that we need teachers of wide learning, whose standards of work are the highest known, and whose methods are those of the masters in Israel. Thirdly, men are required who have a sense of obligation, that feeling which impels a teacher to be also a contributor, and to add to the stores from which he so freely draws. And precisely here is the necessity to know the best that is taught in this branch, the world over. The investigator, to be successful, must start abreast of the knowledge of the day, and he differs from the teacher, who, living in the present, expounds only what is current, in that his thoughts must be in the future, and his ways and work in advance of the day in which he lives. Thus, unless a bacteriologist has studied methods thoroughly, and is familiar with the extra-ordinarily complex flora associated with healthy and diseased conditions, and keeps in touch with every laboratory of research at home and abroad, he will in attempting original work, find himself exploring ground already well-known, and will probably burden an already over-laden literature with faulty and crude observations. To avoid mistakes, he must know what is going on in the laboratories of England, France and Germany, as well as in those of his own country, and he must receive and read six or ten journals devoted to the subject. The same need for wide and accurate study holds good in all branches.
Thoroughly equipped laboratories, in charge of men, thoroughly equipped as teachers and investigators, is the most pressing want to-day in the medical schools of this country.
The teacher as a professor and practitioner of his art is more favoured than his brother, of whom I have been speaking; he is more common, too, and less interesting; though in the eyes of "the fool multitude who choose by show" more important. And from the standpoint of medicine as an art for the prevention and cure of disease, the man who translates the hieroglyphics of science into the plain language of healing is certainly the more useful. He is more favoured inasmuch as the laboratory in which he works, the hospital, is a necessity in every centre of population. The same obligation rests on him to know and to teach the best that is known and taught in the world—on the surgeon the obligation to know thoroughly the scientific principles on which his art is based, to be a master in the technique of his handicraft, ever studying, modifying, improving;—on the physician, the obligation to study the natural history of diseases and the means for their prevention, to know the true value of regimen, diet and drugs in their treatment, ever testing, devising, thinking; and upon both, to teach to their students habits of reliance, and to be to them examples of gentleness, forbearance and courtesy in dealing with their suffering brethren.
I would fain dwell upon many other points in the relation of the hospital to the medical school—on the necessity of ample, full and prolonged clinical instruction, and on the importance of bringing the student and the patient into close contact, not through the cloudy knowledge of the amphitheatre, but by means of the accurate, critical know-ledge of the wards; on the propriety of encouraging the younger men as instructors and helpers in ward work; and on the duty of hospital physicians and surgeons to con-tribute to the advance of their art—but I pass on with an allusion to a very delicate matter in college faculties.
From one who, like themselves, has passed la crise de quarante ans, the seniors present will pardon a few plain remarks upon the disadvantages to a school of having too many men of mature, not to say riper, years. Insensibly, in the fifth and sixth decades, there begins to creep over most of us a change, noted physically among other ways in the silvering of the hair and that lessening of elasticity, which impels a man to open rather than to vault a five-barred gate. It comes to all sooner or later; to some it is only too painfully evident, to others it comes unconsciously, with no pace perceived. And with most of us this physical change has its mental equivalent, not necessarily accompanied by loss of the powers of application or of judgment; on the contrary, often the mind grows clearer and the memory more retentive, but the change is seen in a weakened receptivity and in an inability to adapt oneself to an altered intellectual environment. It is this loss of mental elasticity which makes men over forty so slow to receive new truths. Harvey complained in his day that few men above this critical age seemed able to accept the doctrine of the circulation of the blood, and in our own time it is interesting to note how the theory of the bacterial origin of certain diseases has had, as other truths, to grow to acceptance with the generation in which it was announced. The only safeguard in the teacher against this lamentable condition is to live in, and with the third decade, in company with the younger, more receptive and progressive minds.
There is no sadder picture than the Professor who has outgrown his usefulness, and, the only one unconscious of the fact, insists, with a praiseworthy zeal, upon the performance of duties for which the circumstances of the time have rendered him unfit. When a man nor wax nor honey can bring home, he should, in the interests of an institution, be dissolved from the hive to give more labourers room; though it is not every teacher who will echo the sentiment---
Let me not live...
As we travel farther from the East, our salvation lies in keeping our faces toward the rising sun, and in letting the fates drag us, like Cacus his oxen, backward into the cave of oblivion.