more in the future by allowing diagnosis and removal of cerebral pus or hydatid (or perhaps other tumours) in that particular part of the brain and consequent cure of the patient instead of certain death. I shall simply content myself, in conclusion, with emphasising this fact; seeing that the optic tract begins in the occipital lobe and passes right forward to the eye in front, and that there are in its path at least six distinguishable regions which are connected, sometimes very definitely, with visual symptoms-the six regions being (1) the occipital lobe, (2) the posterior limb of the internal capsule, (3) the optic ganglia, including the optic thalami, the corpora quadrigemina and the external geniculate body, (4) the optic tract, (5) the optic chiasm, and (6) the intracranial portion of the optic nerve, the field for investigation of cerebral cases in the light of ophthalmology is very wide and most promising. You will note that I have been able to only rapidly glance at a few examples typical of a very large number of facts, but sufficient, I hope, to enforce the conclusion that a science, such as ophthalmology shews itself to be, which is connected more or less intimately with, and assists in the diagnosis, prognosis, and treatment of so great an array of diseases as various affections of the kidneys, liver, stomach and bowels, heart, circulation, spinal cord and and brain, etc., etc., besides possessing its own immense direct value in sight giving to the blind and sight preserving to those who see, is well worthy to take its place as a special branch of the great tree of medical development; that it successfully carries out the twofold object of specialism, viz., of producing the maximum of science and skill in the study and treatment of local, and of throwing light upon, and assisting in the study and treatment of general diseases, and that it becomes an active and worthy member of the great organic body of medical science, whose motto is the princely Ich dien' (I serve), and whose objective of service is suffering humanity. 6 MEDICAL ETHICS. It is evident from the number and variety of these questions that a large proportion of the members of our profession have but scant acquaintance with the rules which should guide them in their relations to their fellow practitioners, their patients, and the general public. This ignorance is not surprising when we remember that the ethics of medical practice are not taught in our schools of medicine. Nowhere, I believe, except in Paris, and there only by an occasional lecture, is instruction in the subject given to students. No doubt in all schools of medicine the teachers do in a casual and desultory manner impart some information upon the subject, but anything like systematic teaching is unknown. The student completes his course of scientific training and engages in practice insufficiently prepared to deal with the moral problems peculiar to his calling. No wonder that many breaches of the medical code of morals are committed, and this not from wilful disobedience to it, but from ignorance of its terms. Such knowledge as the young practitioner comes ultimately to possess is acquired after many mistakes, and, in some cases, through painful experience, from much of which he might have been saved by a little systematic instruction. It was, I suppose, considerations such as these which moved the Senate of the University of Sydney last year to decide that at least one lecture on the ethics of medical practice should be delivered annually to the senior medical students. That body wisely determined that future medical graduates of the University should not labour under the disadvantages which I have pointed out. It was not thought well to make attendance upon the lecture compulsory, but judging from the number of fourth and fifth-year men who attended, it would appear that the students regarded the arrangement with favour, and as one which, at least in part, supplied what was lacking in their curriculum. An annual lecture on medical ethics, even if it do no more, will serve to draw the attention of the students to the importance of the subject. It may be argued that as medical ethics is but a branch of general ethics, no special code By P. Sydney Jones, M.D. Lond., F.R.CS Eng., is necessary, and that the observance of the Sydney. Golden Rule, "Whatsoever ye would that men should do unto you even so do ye also unto them," would be sufficient. It requires however, not only the good will, but considerable thought and sympathy to place one's self mentally in another man's situation. Moreover, character is so inscrutable, the motives and impulses of action are so hard to discover, that the task is sometimes well nigh impossible of execution. Prejudice and jealousy too, (those deadly foes to our happiness and usefulness), disturb our mental vision and prevent us from seeing clearly the path of duty. Specific rules for guidance in the practice of our art are, therefore, necessary. The best men in the profession have felt this and have drawn up codes, all of which substantially agree. There are some differences of opinion upon the propriety of a few of these rules, but on the whole a code such as that of which Dr. Jukes de Styrap is the author, is accepted as binding by the profession at large. It is not my purpose, even if it were possible in this short article, to discuss the whole code of medical ethics, but I should like to mention a few considerations bearing on our relations to our fellow practitioners which, if we always kept them in mind and acted upon them, would. I think, save us from many mistakes and estrangements. those who may be disposed to follow an improper or unprofessional line of conduct, for in proportion to the frequency with which the practitioner associates himself with his fellow practitioners, will it become difficult for him to violate the rules of professional life. As an old practitioner who has himself experienced the advantages of frequent meetings with his medical brethren, I would urge upon my younger colleagues the wisdom of "not forsaking the assembling of themselves together." The second consideration has reference to the course which we should adopt when asked for an opinion on a case as set forth by a layman, or when obliged to listen to the disparaging remarks of a patient upon the conduct of his case by his previous medical attendant. This is a position in which we are frequently placed, and it is one which calls for the utmost tact and caution. Seldom indeed are the facts correctly reported; something material is omitted or something is added which gives the case a false complexion, and as this is not always done in a manifestly malevolent spirit, but simply from thoughtlessness or from the want of ap The first of these relates to the course which we should adopt when we think we have reason to be aggrieved by the action of a fellow practitioner, or when from any cause a misunder-preciation of the exact meaning of words, or it standing has arisen between us. We are too apt to conclude that our colleague has been actuated by unworthy motives, instead of which we should believe, until the contrary has been proved, that there has been some mistake which is capable of explanation. We should follow the great Physician's advice:-" If thy brother shall trespass against thee, go and tell him his fault between thee and him alone." We should say nothing to others, but call upon or write to the practitioner and, if possible, dispassionately discuss all the circumstances. A satisfactory explanation will often be forthcoming, and even as I have experienced in my own practice, a lasting friendship will sometimes be formed. Should, however, this course of action fail to remove the grievance, the proper plan is to submit the matter in dispute to the arbitration of some such body as the Council of the British Medical Association, or of one of its Branches, or failing it, to the arbitration of three medical practitioners of repute, one to be nominated by each disputant and the third by the selected two. In this connection I would point out the beneficial influence of frequent meetings of members of the profession in scientific or social gatherings. Nothing is more conducive to harmony and good understanding between practitioners than such meetings. Indeed, they do more than remove misunderstandings and rub off asperities, they constitute a check upon may be from the desire to heighten a story, we are the more likely to be led into unwary speech. Of course, the best plan is to avoid expressing any opinion at all, though this is not always satisfactory, for silence is often taken for assent to the views expressed. We should at any rate exercise the utmost reticence, and certainly we should never act upon such a statement without the most complete corroborative testimony of its truth, and on no account should we allow it to influence our behaviour towards our fellow practitioner until such evidence is forthcoming. The third consideration applies to our attitude when consulted at our own rooms by another man's patient. There is some difference of opinion on this matter. Should we in every case on learning the fact decline to prescribe and propose a consultation with the doctor, or may we regard our consulting room as neutral ground on which we are at liberty to give advice to anyone coming to us without regard to the medical man who has been attending him? The Conseil-General des Societies d'Arrondisement of Paris has recently declared emphatically in favour of the latter course. To my mind, however, the proper course in this as in so many other instances, is the middle one. We must all admit the right of the patient to have as many opinions on his case as he pleases, and we should remember that a large proportion of the sick are unable to bear the extra cost of a consultation of medical men; also that there is some truth in the patient's contention that in seeing a consultant alone he is more likely to obtain an unbiassed opinion, for we are all more or less influenced by the views of others. On the other hand, to adopt in all cases the course recommended by the Paris council would, I think, be wrong, and would tend to prevent that mutual and respectful co-operation which is so desirable on the part of the consultant and the general practitioner. With the experience gained by a quarter of a century of consulting work, I think the course which I have always adopted and which on the whole has worked satisfactorily, is the right one. I do not regard it as obligatory upon me in every case to ask the patient if he is under the care of a medical man. If he is, the fact usually comes out in the course of the interview. Then, if the case is not of a serious nature, and does not need constant attention, I have no hesitation in treating it without reference to the usual medical adviser. If, on the other hand, it is a grave one, and requires the watchful care of a medical man, I recommend the patient to return to his family doctor, and I write a note to that gentleman informing him that I have seen the patient, and giving him my views of the case. I have no reason to think that this course has ever been resented, or given offence, and on many occasions I have been thanked by the practitioner for adopting it. We all admit that it is the prime duty of every member of a learned profession such as that of medicine to promote its honour and dignity; to raise its status and extend its influence and usefulness. We shall best do this by ourselves maintaining a high standard of moral excellence, by a careful observance of the ethical code, by a courteous bearing towards all men, and by diligence in the cultivation of our science. It is only when we are true to ourselves, true to our fellow practitioners, and to the public, that we shall secure that respectful consideration which is our due. How fully the Greek sage and father of medicine, Hippocrates. | realized the sacredness of our obligations is manifest in the oath which bears his name, and as some of my younger readers may not be familiar with it, I will conclude these remarks by quoting Dr. Adams' translation of it. "I swear by Apollo and Esculapius and Health and all Heal and all the gods and goddesses that according to my ability and judgment I will keep this oath and this stipulation-to reckon him who taught me this art equally dear to me as my parents; to share my substance with him and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture and every other mode of instruction I will impart a knowledge of the art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which according to my ability and judgment I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievious. I will give no deadly medicine to anyone if asked, nor suggest any such counsel, and in like manner I will not give to a woman a pessary to procure abortion-with purity and with holiness I will pass my life and practise my art. I will not cut persons labouring under the stone, but will leave this to be done by men who are practitioners of this work. whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption, and further, from the seduction of females or males, freemen or slaves. Whatever, in connection with my professional practice, or not in connection with it, I see or hear in the life of men, which ought not to be spoken of abroad, I will not divulge as reckoning that all should be kept secret. While I continue to keep this oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men in all times! But should I trespass and violate this oath, may the reverse be my lot." THE MEDICAL CURRICULUM. Into By J. T. Wilson, M.B., C.M., Edin.; Challis Professor of Anatomy, University of Sydney. To any who have attentively watched the development of the medical sciences and of medical teaching during the past twenty-five years, it must have become evident that if we have not already attained, we are at any rate fast approaching, a limit of mere expansion of the subject-matter of ordinary medical training. The burden upon the student of the multifarious subjects of both practical and scientific importance, of which he is now expected to have a sound working knowledge, is steadily increasing. It is, indeed, already so great as to constitute a positive hindrance to the natural and healthy development of a spirit of intelligent and disinterested inquiry, and of genuine interest in the subjects themselves. A comprehensive and rational grasp of what may be called human biology, both normal and pathological, is well-nigh out of his power. The unity of the whole is crowded out by the detail. He is unable to see the wood for the trees. Let it be borne in mind that this is true not only perhaps even not so much of the scientific subjects of the curriculum, but of the practical and professional ones. The tendency to the spl tting-off of subordinate divisions of the traditional branches, for the purposes of a more adequate instruction, and the tendency to raise such sub-departments to independent or quasi-independent rank, have disturbed the equilibrium of the later years of the curriculum, and have been productive of results, both as regards study and examination, which were not contemplated, and are by no means wholly desirable. The tendency indicated has itself been quite natural and its aim thoroughly laudable, but the ideal inspiring it has been akin to that which enabled the scholar some centuries ago proudly to exclaim: "I have taken all knowledge for my province." And just as, with the growth of human knowledge and attainment, such an ideal became impossible of realisation to the scholar of even the seventeenth or eighteenth centuries, so it has become impossible of attainment within the narrower circle of medical science at the begin. ning of the twentieth. And until this is thoroughly realised, the difficult problems of modern medical education cannot be satisfactorily solved. Within the limits of a brief article it is, of course, impossible to enter into any criticism in detail of the principles and methods of the medical studies and examinations which are embodied in the curricula and regulations for medical education now ruling in most of our medical schools. In a recent address on "Medical Education,” "" # the writer ventured to express his views in regard to certain features of these. The general nature of the criticism there offered is embodied in the conviction that the uniform, rigid and inelastic character of our present curricula is a practical evil of no little magnitude, and that the efficiency of our system of education is menaced by the continued multiplication of the branches of medical science and practice, with all of which every student is expected to make himself equally familiar. Another element of evil which follows inevitably • Intercolonial Medical Journal of Australia, 20th Sept,, 1901. in the train of our presently recognised method of training, is the ever-increasing bondage to the examination system, which often proves a most efficient device for crushing the soul out of the individual work of the student. In an editorial comment upon the address above referred to, the editor of the Medical Press and Circular, 20th November, November, 1901, well remarks:"The student's life is one continuous struggle with examinations. He has come almost of necessity to look upon each course solely as a preparation for an examination. He becomes an adept in discerning the points which are likely to have the greatest examination value. The lecturer whose discourses are considered to most nearly suit the examination which is to follow is most carefully listened to; the professor whose lectures are calculated to enable the student to justly appreciate the great principles of the healing art, or to dip below the surface of the subject, rather than to help him to pass the examination, finds his discourses neglected. These teachers become, perhaps unwittingly, the greatest friends of the 'coach.'" Though the latter objection may apply with less force in places in which only one medical school is in existence-even there it is not destitute of applicability-the general principle, as applied to the character of the work of the student, holds with undiminished strength. An undue crowding of subjects, more especially in the later years of the medical curiculum, will probably be admitted by the majority of those who are familiar with our schemes and systems of medical education, and it cannot be denied that, with the more complete organisation of the various sub-departments, both of scientific and of practical hospital work, we are promised, or threatened with, still further additions to the teaching resources of our medical schools, and thus a further expansion of the area with which the medical student is supposed to make himself familiar. to be our attitude to this progressive expansion, which in itself is undoubtedly both a valuable result and a potent means of educational development? What is An obvious expedient for the solution of the difficulty, would, of course, be the addition of another year to the already lengthy curriculum. But this would mean an additional educational burden which it may be doubted whether the community is able to sustain under present circumstances. And it may also well be doubted whether a mere extension of time affords the best means of enabling the student to cope consultation of medical men; also that there is some truth in the patient's contention that in seeing a consultant alone he is more likely to I obtain an unbiassed opinion, for we are all more or less influenced by the views of others. On the other hand, to adopt in all cases the course recommended by the Paris council would, I think, be wrong, and would tend to prevent that mutual and respectful co-operation which is so desirable on the part of the consultant and the general practitioner. With the experience gained by a quarter of a century of consulting work, I think the course which I have always adopted and which on the whole has worked satisfactorily, is the right one. I do not regard it as obligatory upon me in every case to ask the patient if he is under the care of a medical man. If he is, the fact usually comes out in the course of the interview. Then, if the case is not of a serious nature, and does not need constant attention, I have no hesitation in treating it without reference to the usual medical adviser. If, on the other hand, it is a grave one, and requires the watchful care of a medical man, I recommend the patient to return to his family doctor, and I write a note to that gentleman informing him that I have seen the patient, and giving him my views of the case. I have no reason to think that this course has ever been resented, or given offence, and on many occasions I have been thanked by the practitioner for adopting it. We all admit that it is the prime duty of every member of a learned profession such as that of medicine to promote its honour and dignity; to raise its status and extend its influence and usefulness. We shall best do this by ourselves maintaining a high standard of moral excellence, by a careful observance of the ethical code, by a courteous bearing towards all men, and by diligence in the cultivation of our science. It is only when we are true to ourselves, true to our fellow practitioners, and to the public, that we shall secure that respectful consideration which is our due. How fully the Greek sage and father of medicine, Hippocrates. realized the sacredness of our obligations is manifest in the oath which bears his name, and some of my younger readers may not be familiar with it, I will conclude these remarks by quoting Dr. Adams' translation of it. as "I swear by Apollo and Esculapius and Health and all Heal and all the gods and goddesses that according to my ability and judgment I will keep this oath and this stipulation-to reckon him who taught me this art equally dear to me as my parents; to share my substance with him and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture and every other mode of instruction I will impart a knowledge of the art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which according to my ability and judgment I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to anyone if asked, nor suggest any such counsel, and in like manner I will not give to a woman a pessary to procure abortion-with purity and with holiness I will pass my life and practise my art. I will not cut persons labouring under the stone, but will leave this to be done by men who are practitioners of this work. whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption, and further, from the seduction of females or males, freemen or slaves. Whatever, in connection with my professional practice, or not in connection with it, I see or hear in the life of men, which ought not to be spoken of abroad, I will not divulge as reckoning that all should be kept secret. While I continue to keep this oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men in all times! But should I trespass and violate this oath, may the reverse be my lot." THE MEDICAL CURRICULUM. Into By J. T. Wilson, M.B., C.M., Edin.; Challis Professor of Anatomy, University of Sydney. To any who have attentively watched the development of the medical sciences and of medical teaching during the past twenty-five years, it must have become evident that if we have not already attained, we are at any rate fast approaching, a limit of mere expansion of the subject-matter of ordinary medical training. The burden upon the student of the multifarious subjects of both practical and scientific importance, of which he is now expected to have a sound working knowledge, is steadily increasing. It is, indeed, already so great as to constitute a positive hindrance to the natural and |