Some remarks on the education of medical students : particularly with reference to those of King's College, London, in a letter to the Rev. John Lonsdale, B.D., Principal of the College
Todd, Robert Bentley, 1809-1860
'■Ik "7 <g«?c ■ "f SOME REMARKS ON THE EDUCATION OF MEDICAL STUDENTS, PARTICULARLY WITH REFERENCE TO THOSE OF KING’S COLLEGE, LONDON, IN A LETTER TO TOE REV. JOHN LONSDALE, B.D. PRINCIPAL OF THE COLLEGE. BY R. B. TODD, M.D. F.R.S. PROFESSOR OF PHYSIOLOGY IN THE COLLEGE, AND PHYSICIAN TO KING’S COLLEGE HOSPITAL. PRINTED FOR CIRCULATION AMONG THE MEMBERS OF TIIE COUNCIL OF KING’S COLLEGE, AND OTHER FRIENDS TO THE IMPROVEMENT OF MEDICAL EDUCATION. 1842 The writer of the following pages is very anxious that in any allusion which he may have felt it necessary to make to other medical schools in comparison with that of King’s College, it may not be thought that he wishes to disparage the one. or unduly praise the other. lie has, indeed, not hesitated to complain of the system pursued at all ; but with respect to the former, he has felt especially anxious not to represent them other¬ wise than as they are — not unmindful of the injunction, ■ - “ Nothing extenuate, “ Nor set down aught in malice.” It he have been misinformed with respect to any of them, he will be very thankful to any one who will set him right. LONDON : MARC 11 A NT, SINGER, AND SMITH, PRINTERS, INGRAM-COURT. A L E T T E II, ETC. ETC. My dear Sir, In the frequent conversations with which you have favoured me respecting the education of medical students, I have perceived how much you feel the neglected condition of that class of young men, and how desirous you are to render the system pursued at King’s College -truly efficient, and .A.'/. -- '• J • -x worthy of being imitated by other establishments. I hope, therefore, you will not consider that I tres¬ pass too much on your indulgence in addressing you by letter on a subject so interesting and so important. I propose, in the first place, briefly to point out the system now prevailing at the medical schools of London, and some of the evils attendant on it. a 2 4 Secondly, to suggest a plan of education such as, in my judgment, ought to be pursued. Thirdly, to show how far the system now adopted at King’s College does or does not correspond with that model. And lastly, to suggest certain alterations in the medical arrangements of King's College, which, it seems to me, are much needed. There is certainly no class of persons in this country who may be so correctly described as “ sheep without a shepherd 5' as the medical students ; young men who are being prepared for a profession in which a high tone of moral and gentlemanly feeling is so desirable, and who, in the exercise of their profession in after-life, as well as whilst pursuing their studies in order to become qualified for practice, are much exposed to tempta¬ tions peculiarly calculated to try even the most deeply-rooted principles. Medical students are at present entirely deprived of all moral guidance and of all opportunities for religious instruction. The medical schools of the metropolis (that of King’s College alone excepted) are merely lecture- rooms in which certain lectures on divers branches of medical science are given. The students attend these lectures more or less regularly, but there are no means of enforcing regularity of attendance, nor is any care taken to ascertain whether the students are regular in their attendance or not. Many of the students at these schools are per¬ sonally unknown to their lecturers, and it is impos¬ sible that the lecturers can know how the largest proportion of these young men employ their time, or how they conduct themselves when absent from the school. And the method of teaching which is universally adopted at these schools of necessity occasions that distance between teacher and student which is so much to be deprecated. The mode of teaching to which I allude is by lecturing. A lecture of one hour is given daily, or on alternate days, or less frequently, according to the nature and extent of the subject; the lecturer generally remains a few minutes, at the conclusion of the hour devoted to the lecture, to answer any questions the students may propose. Occasionally an examination of the class is held, but as this extends only to those who choose to submit to be G examined, it affords the lecturer only very imperfect means of ascertaining the proficiency of his class. And these examinations, u few and far between,” are the only opportunities the teacher has of per¬ sonal communication with his pupils. At the end of the session the students apply for certificates of having attended the lectures. It very rarely happens that a student is refused his certifi¬ cate, for indeed it is often impossible for a teacher to prove that the pupil has neglected the lectures, and in too many instances he is obliged to trust the assurance of the young men themselves that they have been regular in their attendance. And thus, it is notorious, certificates are often given to students who are not in any degree entitled to them. It is not difficult to suppose, that if so little pro¬ vision be made in these schools to ensure the atten¬ tion of the students to their professional studies, their moral and religious culture should be totally disregarded. And, indeed, I fear it is but too true that in the arrangements of some of them there is much that is calculated to create a taste for low practices, or to foster and promote it where un¬ happily it may have previously existed. 7 Certain it is that young men may attend these schools from year to year and may neither hear nor see anything to remind them of the duty they owe their Maker, or of that which is due to their fellow-men, much less to nurture and improve what¬ ever of religious feeling and knowledge they may have acquired before, or to direct them to or en¬ courage them in the use of those means of grace which God has mercifully ordained for the benefit of all his sinful creatures. It is no wonder that under such a system as I have endeavoured to pourtray, I fear too faithfully, the “ medical student ” should be very generally de¬ scribed as one of a class habitually regardless of the common usages and ordinary decorum of re¬ spectable society, decidedly inclined to associate with persons of low habits, and to frequent places of bad repute ; adopting a particular costume, ap¬ parently intended to travesty the leading fashion of the day; prone to sensual indulgences, and indiffe¬ rent to religion and religious observances. I am sensible that this description is a most unjust libel upon a large number of the medical students of London ; that many of them fully deserve a character the very opposite to that which it contains; but I am equally convinced that 8 there are too many to whom the description applies with fidelity, and that that class of persons must con¬ tinue so long as the system remains unaltered. But in truth there is nothing in the pursuit of medicine, either as a study or as a profession, cal¬ culated to lower the tone of the moral feelings, or to uncivilize young men ; on the contrary, there is much to improve the moral man, and to call forth the kindly feelings of the heart. Many of these misguided youths, doubtless, have come to town perfectly free from the vices and follies which now degrade them ; but from having been allowed to be entirely their own masters, they have as a natural consequence fallen under the control and become the dupes of very improper and unprincipled guides, “ blind leaders of the blind.” “ Oh ! felices nimium sua si bona norint! ” It is a fault too common with youth — nay, perhaps, with men at all ages — to be impatient of restraint or control, and either to forget or to close their eyes to the important principle in the consti¬ tution of the moral world, — that man must be subject to the control of his fellow-man ; nay, that every man shall carry within him a conscience, to whose suggestions he cannot help listening, however 9 be may forbear to follow them., And the non-inter¬ ference system of our medical schools has certainly fostered this natural tendency of the mind to throw off the yoke of restraint, and to such a degree that now there is no class of young men so impatient of anything like control, restraint, or discipline as the medical students. But this is not the only evil which results from the absurd system of our medical schools. The in¬ adequacy of the present mode of teaching to meet the wants of the students, gives rise to others of a very serious kind. By it the lecturer is unable to direct the private studies of his pupils, and consequently to carry the greater part of them with him from one part of his subject to another. He does not know (he must, however, take it for granted) that the students comprehend fully the portion of his subject he has just finished, before he breaks new ground. A few follow him throughout his course ; others acquire some slight smattering, and make up somewhat in a second course for what they failed to acquire in a first ; but many break down irretrievably, be¬ come disgusted, and yield to the natural tempta¬ tion of idleness. 10 The consequence of this is, that a large propor¬ tion of the students, having spent two or more winters, with little or no profit, in attendance on the regular lecturer, are driven to have recourse to the assistance of persons called Grinders , with whom they find what I believe ought to be afforded them in the schools, namely, direct teaching ; * but they find it accompanied with this evil, namety, that as a certain space of ground is to be got over by hook or crook within a certain time, so they must submit to be crammed within that time with a series of facts, dogmas, and doctrines prevalent in the schools, without being instructed in the reasoning and argu¬ ments, the practical observations and experiments upon which all medical science is founded. The object of all this cramming is to prepare them to pass a certain examination, after which they are sent forth into the world, licensed to learn their profession by practising upon such of Her Majesty's lieges, as, from necessity or choice, may fall into their hands. It is, I presume, from the slight confidence which * See The Principles of English University Education, by the Master of Trinity College, Cambridge. 11 is to be placed in the present mode of education of medical students and in the ordinary examina¬ tions for licenses, that the heads of the medical departments of the Army, Navy, and Artillery, think it necessary to subject these young men to a second examination before they confirm their ap¬ pointments in their respective services. I cannot but regard the system of cramming or grinding as a necessary consequence of the present method of teaching, and one which must last as long as the direct teaching of the students conti¬ nues to be as much neglected in the schools as at present. And it is not the only evil of this cram¬ ming or grinding that it gives the young men who submit to it a very imperfect knowledge of their profession ; it must likewise be more or less injuri¬ ous to many of them in a moral point of view, for it withdraws them entirely from their legitimate teachers, and obliges them to associate with the idlest, not only of their own fellow-students, but of those belonging to other schools. If, then, this pernicious practice is to be got rid of, it can only be done by a very decided alteration in the method of teaching now adopted at the medical schools. 12 v II. I lav in g thus freely attacked the present system of the medical schools, and exposed its evils, it is only fair that I should be required to propose a plan which will be at once feasible and free from the evils of which I complain in the old system. The problem to be solved is this. To provide a scheme of medical education , i. e. of professional and moral training for young men, of an age ranging between 17 and 22, who are required to be brought up as well informed medical practitioners, honest, conscientious, and religious. And here let me remark, that viewed as a mere matter of policy, the solution of this problem is highly important. For there is no more influential body of men than medical men; — they form a neces¬ sary portion of every community, however small, — they are diffused throughout the country more completely, perhaps, than any other class of profes¬ sional men, — and not only so, but they are sent to our colonies and dependencies — they accompany our ships and our armies — they are attached to our embassies, and often form most valuable and useful appendages to them — they go with our expeditions to explore foreign lands, often in the double capa¬ city of medical men and naturalists — and they 13 sometimes attend our missionaries. I believe that, next to the clergy, the members of the medical pro¬ fession possess the most extensive influence, whether for good or for evil ; indeed in many instances the influence of the medical man is superior to that of the clergyman ; and the former has often access to families from whom the latter is entirely excluded. Surely the early training of so large, so influen¬ tial a body of men is scarcely less important than that of the clergy themselves. So our ancestors thought ; for they made provision for the education of the members of the medical profession at the Universities. In those days, however, the principal medical business was in the hands of physicians, by whom the barber-surgeons were employed to perform the various manual operations. In later times, the surgeons and the apothecaries have in¬ creased so much in numbers as to form the largest proportion of the profession, and those most exten¬ sively employed among the middle and lowest classes of society ; and consequently the largest proportion .of the students who are being brought up for the medical profession in our medical schools are intended to be surgeons or surgeon-apotheca¬ ries, and it is for them more especially, although 14 not exclusively, that we need an approved system of education. But to return from this digression. In the scheme I am to propose, provision must be made, 1. For the moral and religious culture of the O students, and for training them in habits of regu¬ larity and industry. 2. For their full medical instruction ; and those arrangements which will effectually attain the first object, will, I have no doubt, contribute materially to the attainment of the second. I do not see why those principles of education which have been for so long a time carried into effect at our Universities, with such beneficial results to the clergy and gentry of this country, should not be applied to medical students. Their age does not exceed the average age of the under¬ graduates at Oxford and Cambridge ; and, although they may now be very impatient of control or discipline, when enforced in a partial way at one school, while the students of others are not in¬ terfered with, there can be little doubt that they would readily enough fall in with any system that might be generally adopted, and enforced by the medical corporations. 15 A principal part of my scheme, then, would be to .place all medical schools on the footing of collegiate establishments. Each medical college should have in connection with it the means of accommodating a certain number of resident students ; and those who do not reside should leave their addresses, so that they might from time to time be visited by the authorities of the college. The internal arrangement of these colleges should correspond, as nearly as the difference of circum¬ stances would permit, to those of an Oxford or Cambridge college. A Chaplain should be attached to them, who should give lectures on divinity and morals ; and the discipline of the college should be regulated by him in conjunction with one of the medical professors or lecturers, who, from being obliged to mix on ordinary occasions with all the students, non-resident as well as resident, and from the knowledge which he could thereby obtain of their general habits, would be in a better posi¬ tion than the Chaplain to act as Dean. And the college would be incomplete without a dining-hall, where all the resident students should be required to dine a certain number of days in the week, and where the non-residents should find 1 G it to their advantage and comfort to dine ; the Chaplain, Dean, or other person in authority, being present to keep order. But I should not expect that these arrangements would be productive of good to the fullest extent unless they were accompanied with such alterations in regard to the mode of medical instruction as would obviate the evils to which I have before alluded, by the introduction of more direct teaching through more frequent examinations of the students, and by affording them within the college all the assistance they can require, that they need not have to seek it elsewhere. It is obvious how much greater facilities would thus be gained of preserv¬ ing discipline and noting the attendance of the students at lectures. If the medical corporations could be brought to interfere, they might do much to render this plan truly efficient. For instance, instead of requiring certificates of attendance on certain courses of lectures, as they now do, they might oblige each young man to go through a course of education at one of these colleges during a certain period ; and the test of his having duly pursued bis studies would be afforded by his having 17 passed, at stated intervals during that period, say at the end of each year, certain examinations before the lecturers of his college. Each student, then, upon presenting himself at the College of Surgeons for instance, to be examined for his diploma, should produce a testimonial from the principal or dean of his college, stating that Mr. - had pursued his studies at - Medical College, and had conducted himself to the satis¬ faction of the Principal and Professors. This would be a sufficient guarantee to the Exami¬ ners at the College of Surgeons that due time had been spent in the acquisition of professional know¬ ledge, and would be infinitely more satisfactory than the present plan of producing a bundle of certificates, signed by a variety of lecturers, not one of which, in too many instances, is a boyia Jide attestation of what the parties who have affixed their signatures believe to be true.'* * It would tend much to improve medical Education if the Corporate Bodies would make it a rule to recognize only those schools which give real and full advantages to their students, and then require simply that a student should have spent a certain time in studying at one of these schools. It would have the further good effect, of doing away with the cumbrous machinery B 18 I shall not take up your time, my dear Sir, by placing the plan which I now suggest in contrast with the mischievous system of the medical schools at present. No one who has enjoyed the blessing of an University education, or who has ever heard by report what it is, can fail to admit that my scheme would greatly elevate the character of the medical student, and raise the tone of medical education. In short, what I want is to obtain for the great mass of our medical students the inestimable benefits, moral, religious, and profes¬ sional, of an education conducted, as nearly as pos¬ sible, on the same principles as that at our Univer- / sities ; and this, I believe, would be accomplished by adopting the measures I have now proposed. III. 1 have to ask, does a King's College medical education come up to this standard ? I shall at once admit that it does not , nor is it likely to do so, unless some material alterations are adopted by the Council. It is defective in the following points : — 1. The accommodation for resident students they now employ to enforce obedience to their mandates, which only serves to fetter the teachers and annoy the students. suffices for only a very few; not above ten or a dozen. 2. No cognizance is taken of those who reside out of college. Many, it is true, live in the houses of the professors or in other private families ; but those, who are not so fortunate, are not sufficiently looked after by the college authorities. 3. The internal discipline of the medical de¬ partment is very defective ; so that a student may absent himself for a considerable time, and yet receive no check for such negligence. 4. I do not think the arrangements in the dining-hall are quite what they should be. It seems highly desirable that some senior person should always preside at the high table. 5. The mode of instruction in the College being the same as that adopted everywhere, is equally open to the objections which I have already stated : more frequent compulsory examinations are greatly needed. I have no reason to think that the number of our students who have recourse to the Grinder is materially less than at other places. In what respects, then, you will ask, does King’s College claim to differ from other schools of medi¬ cine? I must candidly confess my regret that the 20 \ difference is not so striking and obvious as to render it unnecessary to reply to this question. It may, however, be stated that the students of King’s College enjoy the following not unimportant advantages. The facilities afforded to the diligent students for cultivating knowledge purely professional are of the very highest kind. They are not inferior to those of any school in London, and certainly far excel those of the majority. The museums, laboratories, and libraries to which the students have access, are on such a scale that they cannot easily be rivalled ; and now we can add an excellent practical school in the Hospital, the internal arrangements of which are in every way suitable to the instruction of the students, consistently with the comforts of the patients. A student at King’s College may avail himself of the classes in other departments of knowledge besides medical, ancient or modern' languages, natural sciences, &c. Our students have constantly before them the example of religious observances — the daily service in our chapel, the two services on Sunday. And abundant opportunity and encouragement 21 are held out to them to avail themselves of instruc¬ tion in religion and morals. The Principal’s and Chaplain’s lectures are open to them, and exhibi¬ tions and prizes are specially awarded to proficients in Theology and Ethics. The medical scholarships lately founded in the College are specially intended for those who have evinced a competent theological knowledge.* The prizes founded by Dr. Warneford (which are very valuable) and by the late Mr. Leathes are exclusively devoted to the encourage¬ ment of scriptural and theological learning among the medical students. The medical student of King’s College has there¬ fore no excuse, if he neglect his religious duties. He has continually before him the warning of example, and he has open to him ample means of instruction in the Principal’s and Chaplain’s lectures. Defective, then, although I admit our system at King’s College to be, I cannot but regard it as greatly superior to that of other places, and highly * In order to be admitted as candidates for the scholarship, the students are required to pass an examination in a certain portion of Scripture and in Butler’s Analogy. deserving of their imitation. Indeed the only at¬ tempt that has ever been made to introduce some improvement into the practical part of medical education, has originated with the founders of King’s College. And it is evident that they must have felt the need of some change of this kind, from the following passage of the prospectus put forth by them at the opening of the College. It is there said — “ They believe, likewise, that every one who has the welfare of society at heart, and who has considered the most effectual means of pro¬ moting it, will feel an especial interest in this part of their undertaking, under the conviction that the duties which devolve upon the medical profession are such as to render the religious and moral cha¬ racter of its members not less important, than their practical and scientific attainments.” And that such interference was necessary seemed still more obvious from the fact, that some of^the leading members of the medical profession not only sub¬ scribed largely to the College, but also consented, and have continued, to act as members of the Council. Eleven years have elapsed since the opening of the Medical Department of the College ; and what are the fruits^ of the system of medical education pursued in it ? I have no means of getting at the statistical details respecting the pupils of King’s College or of other places ; and, if the information to be derived from these were within my reach, I do not know that one could obtain a very satisfactory reply to the question proposed in the last paragraph. The advocacy of the system rests, not on the fact of our having had fewer bad characters among our students — or upon our having reclaimed a certain number — or upon our students having done better in life than others — but upon whether the system is right in principle — whether it is such a provision as ought to exist in a Christian country for the education of a highly important portion of the community. And if these points can be determined affirmatively, we may cast our bread upon the waters, in the full assurance that we shall find it after many days. But, without going to particular cases, I think it may be stated very positively that the establishment of the Medical Department at King’s College has led to very advantageous results. If it had done no more than to call public attention to the subject of medical education, I believe its founders would 24 lmve much reason to congratulate themselves on its institution. I believe that King’s College Medical School has had a very favourable influence on other Institutions for medical education ; and it must continue to exercise that influence, and the more completely, as our system becomes more perfect. A College, patronized and upheld as King’s College is by the leading Clergy and Laity, cannot fail to obtain the full confidence of the Medical Corporations, if only the provision it makes for the moral and intellectual improvement of its students be ample and complete. IV. And now, my dear Sir, let me submit to you those alterations which seem much called for to increase the efficiency of our system. And I can do this with the more confidence, as I know, from the various conversations I have had with you, that many of the propositions I shall make are likely to meet your approbation. In the first place, I beg to urge most strenuously the provision of additional accommodation for resi¬ dent students. We ought to have the means* of receiving fifty students. The charge for the rooms should be moderate, and the convenience and comfort of the students should be consulted as much 25 as possible in the arrangements, in order to hold out to them every inducement to prefer residing in them, to private lodgings. - I cannot but believe that if due diligence were used by the College Officers, the means might be found in the neighbourhood of making the necessary addition to the College for this purpose. The rooms should be under the superintendence of a resident Tutor, (query, the Chaplain to the Hospital ?) who should dine as frequently as possible in Hall. It would be his duty to see that order and decorum were observed, to report to the Principal on the infringement of any rule, and, as far as pos¬ sible, to make himself acquainted with the habits of the students in residence. The arrangements of the dining-hall should be such that the young men should find there a dinner as cheap as and more comfortable than at the ordinary taverns ; and it would be desirable to encourage the non-resident students to dine in the College. The question has been mooted how far the young men should be compelled to dine. I think it ought to be stated to the students on coming into rooms, that they will be expected to dine at least four days in the week ; and if their convenience and comfort are duly consulted in the dinner arrangements, there will be no need for any compulsory regulations. Frequent, if not daily, attendance at chapel ought certainly to be enforced, and all the arrangements for lectures, &c. should be so adapted, as to leave the students without excuse as to the non-fulfilment of this duty. And, I would add, that care should also be taken that the medical lectures should be at such times as would not debar the students from availing them- selves of the theological lectures open to them. With regard to the general discipline, there has been much difficulty felt by the Professors in deter¬ mining upon the extent to which surveillance should be exercised, and the mode of carrying it into effect. For some years it was the practice to have the attendance of the students at the lectures marked. A porter stood at the door of the theatre, and, as each student entered, put a mark before his name. This plan did not work well ; there were suspicions, at times, that the porter had his favourites, or did not disdain a bribe ; and it was thought an indignity to gentlemen to subject them to the superintendence of a porter. The 27 students felt that they were driven into lecture, and the lecturer was often doomed to address his dis¬ course to very unwilling hearers ; and the plan was denounced in the weekly press as “ the lecture- room spy system.” It was a very general opinion that to persist in this plan would be injurious to the College. The Professors, however, did not abandon it without much consideration, nor without having first re¬ quested the interference of the ruling powers at the College of Surgeons and Society of Apothecaries. These bodies having declined to interfere, and other unpleasant circumstances having occurred which need not be particularized, it was determined to abandon the plan. And I should be very reluctant to revive it, I believe the best discipline is that which will lead, not drive ; or, at least, that, the restraint of which is least felt. In the classical department, the nature of the lectures favours the marking ; the young men cannot be examined unless their names be called. In these classes, then, marking is a matter of course. I have already stated how desirable it would be to have frequent compulsory examinations ; and I would now add my belief that they would not only contribute greatly to the instruction of the students, 28 but would remove all difficulty as regards discipline. In no class should the examinations be held less frequently than once in the week, and in most they should be held twice. All students should be obliged to attend these examinations. The more elementary parts of each course might be treated of exclusively at the examinations, and thus time would be gained. This arrangement would ensure, to a great ex¬ tent, attendance on the lectures ; it would save the necessity of deputing a porter to mark the students, which I do think objectionable ; it would bring the Professor into closer personal communication with his pupils ; it would be the means of saving many men from the necessity of having recourse to the Grinder. To carry out this system as completely as possi¬ ble, I should further propose that one of the Pro¬ fessors should act as Dean. I have long been of opinion that such an officer is greatly needed in the medical department to give an uniformity to our proceedings, to preserve order, and to ensure regu¬ larity. i I shall, probably, best explain the advantages to be derived from such an officer by enumerating the duties which I would assign to him. 1. All the arrangements of the medical depart- ment should be under the Dean’s direction : it would be his duty to see that they did not clash with those of the other departments, but especially that the hours of medical lectures and Hospital attendance should be such as would not prevent the medical \ students from attending chapel or the divinity lectures. 2. It very frequently happens that parents seek advice for their sons as to the course to be pursued by them. It would devolve on the Dean to reply to all such inquiries, and to advise the students on first coming to the College and at other times, with respect to their studies or other matters. 3. He should, from time to time, go into the various lecture rooms and observe the deportment of the students during lecture. 4. He should obtain monthly reports from each Professor relative to the attendance of the students, and these reports he should lay before the Principal. 5. He should know the residence of every stu¬ dent, and endeavour to make himself acquainted with their habits. 6. He should be permanent Chairman of the Medical Committee, and thus have the chief super¬ intendence of the general business of the medical department. 30 7. He should also ascertain the manner in which the students attend the Hospital Practice. 8. All matters relative to the medical department, upon which the Principal might require information, should be referred to him. 9. He should occasionally dine in Hall. It will be evident that, if the duties be efficiently done, the office of Dean would be no sinecure. It ■ would be unreasonable to expect, and impolitic to re¬ quire, that any one should undertake so responsible an office without remuneration. For this, I think, provision might be made from a small addition to the fees paid by each student. And as the office would be one of labour, and at the same time not likely to be very popular, I think it ought to be held by the Professors in turn — each Professor re¬ maining in office for two years. I think the arrangements I have proposed would tend greatly to give effect to the system of disci¬ pline, and in a way as little disagreeable to the students as any mode of surveillance can be. They would greatly enhance the Collegiate character of the Institution, and offer to parents the best security that, in sending their sons to London, they will not be allowed to waste their time and money in idleness and dissipation. 31 But it may fairly be asked,- — Is King’s College, which is without endowment, and is, therefore, en¬ tirely dependent on popular favour for its support, strong enough to introduce so great an innovation -into the system of medical education, and to be the only school where discipline is enforced ? Although I could not take upon myself to answer this question positively in the affirmative, yet I do not hesitate to express my belief that, if we did make the attempt, we should deserve, and no doubt receive, a more cordial support than we have hitherto received from the many good and influen- tial people who take an interest in the improve¬ ment of medical education. And, therefore, I would fain hope that the step might be taken not merely with impunity but with benefit ; and it would be an additional source of satisfaction to those who advocated this alteration, to find, as I doubt not they would, ere many years elapse, other institutions following the good example shewn them by King’s College. Already I perceive that the propriety of applying the collegiate system to medical education has been discussed in the medical journals and elsewhere, and there seems a strong opinion growing in its favour. Sir Benjamin Brodie, one of our Council, lias been addressed by Mr. North, the Chaplain of St. George’s Hospital, on the subject. Mr. North has not taken notice of what has been already done at King’s College, nor does he seem to have been aware that I had proposed the plan which he advocates in some letters published in the British Magazine for 1837. This, however, is of no mo¬ ment : it is sufficiently encouraging to the friends of King’s College to know that their example has not been without its fruits ; and no doubt they will not be content to let their good work stop short of completion, nor transfer to others the honour and merit of completing what they have so well begun. It will be, however, for the Council to consider whether the changes which I have ventured to sug¬ gest can, with propriety and safety, be carried into effect. I am sure that my colleagues will readily acquiesce in any arrangements which you and they may think desirable for carrying out the great design of the Founders of the College. I am, My dear Sir, Your faithful Servant, R. B. TODD. P.4 r li a men t- Street, April 15, 1842. 