Commission attacked the entire problem from the standpoint that ‘university teaching can be given only by men who are actively and systematically engaged in the advancement of knowledge in the subject they teach'; and it decided that, from this point of view, the clinical teaching of the London medical schools is not of university grade. It held that in a university 'the standard of the teachers in these [i.e. the clinical] subjects ought not to be different from that of university professors in other subjects, and it is therefore necessary to appoint and pay professors of the various branches of clinical medicine and surgery who will devote the greater part of their time to teaching and research.' This recommendation is frankly intended to introduce the German university conception into English medical education. But the Commission appreciates fully the value of clinical clerking and does not intend either to surrender or curtail it. All the evidence we have received points to the necessity of continuing the distinctly English method of clinical teaching. Under the German system this kind of instruction is not provided for, but this defect has no essential connection with the merits of that system, and could be corrected without interfering with the organization or spirit of the clinic. There is no inherent difficulty in combining the two systems of teaching.'1

In conclusion, a word may be added in reference to American conditions. Of medical education in America, it is difficult to speak in general terms, for it lacks the homogeneity characteristic of other countries. Whatever the respective merits or defects, medical ed

1 This valuable report is of general educational interest. It has been published as a Blue Book entitled Final Report of the Commissioners on University Education in London, and can be had for two shillings through any bookdealer from T. Fisher Unwin, London W.C.—THE AUTHOR.

ucation in Germany, France, or England is at any rate always the same sort of thing. This is not true of the United States, where medical education includes something of what is best and all of what is worst to be found among civilized nations. In respect to the really essential and characteristic excellences above pointed out, the American medical school is on the whole inferior to both German and English types: it has in general not yet attained the homogeneous university constitution characteristic of the German medical faculty; it too frequently lacks the clinical opportunity characteristic of the English hospital school. Exceptions are indeed beginning to be more frequent on both counts: something approaching university homogeneity may be occasionally affirmed; the clinical clerkship is becoming more frequent under more and more favorable conditions. The one point of real superiority in American conditions is, however, their greater plasticity. The Germans can hardly be imagined as deliberately and resolutely altering their scheme to meet criticism; the English will but slowly come to love and value university ideals in medical teaching. In America, however, a few well-managed schools have already contrived to unite what is best in German with what is best in English medical education. They have taken from Germany the productive ideal; they have taken from England the clinical clerkship. And convincing proof of their compatibility is already at hand.

Despite a heterogeneous and generally unsatisfactory situation, progress in other directions, indicative of the capacity for growth, can also be recorded. A very rapid reduction in the number of schools- a process that must, however, be carried much further shows that general conditions tend to respond to intelligent and well

-

informed criticism. Interesting efforts are making in a few of the good schools to devise more efficient teaching methods and to correlate more effectively laboratory and clinical work. These efforts are bound to tell in developing a more intelligent medical pedagogy. Moreover, the question has been raised as to what sort of preliminary education most naturally leads to the study of medicine, and an interesting and helpful experience is being well utilized to economize time and effort in the medical school.

Perhaps the most interesting innovation, however, undertakes to deal with the problem of the clinical teacher. In Germany, the clinical professor has long been of precisely the same type as the laboratory professor, a man devoted to teaching and research. Latterly, however, professional prosperity in large centres has tended to make him too worldly a figure, both education and research suffering in consequence. In England, the hospital consultant has rarely been anything else; and his educational and scientific importance have accordingly been limited. America, like England, has employed practicing physicians and surgeons as professors of medicine and surgery, with results generally unsatisfactory both to science and to education.

Three university schools of medicine the Johns Hopkins at Baltimore, Washington University at St. Louis, and Yale have now undertaken to reorganize the main clinical departments on the full-time or university basis. It is proposed that the incumbents of the posts in question and their necessary assistants- laboratory and clinical become salaried members of the university staff,-like the teachers of anatomy and physiology; that they devote themselves wholly to the service of the hospital, education, and research; and that they withdraw altogether

from paid private practice. In order that their experience may be in no wise restricted, it is stipulated that absolutely no limitation is to be placed upon them: they remain entirely free to see any case that interests them, be the patient a pauper or a millionaire. The well-to-do and the wealthy cease, however, to be able to command the academic clinician's time and attention. He may and will see them, not because he is to be paid, but because it is worth while in the service of science, education, and humanity. Fees paid for such service are to go, not to the university clinician personally, but to the fund which supports the new system. It is gratifying and perhaps not surprising to find that academic posts on this basis have been already accepted by men in the prime of life at immense pecuniary sacrifices. The reasons are not far to seek: the scientific prosecution of medicine and surgery in America as in England - has been backward for the lack, first, of adequate facilities; secondly, of conditions favorable to single-minded devotion. Latterly, the facilities have been provided in a few places; but the men have been distracted by the routine and the entanglements inseparably connected with practice. Meanwhile, the clinical branches make a powerful appeal from both scientific and humanitarian sides; and the full-time scheme just outlined represents an endeavor to pitch their cultivation on a high plane. The schools which are undertaking to introduce the full-time principle in clinical teaching are university departments which have appropriated from Germany the productive ideal, and from England the clinical clerkship. They work therefore under the most favorable conditions, and ought to train a generation of physicians who are at once skillful practitioners, competent investigators, and devoted humanitarians.

I

THERE was no more significant incident in the crowded drama of the days that preceded the war than the strange scene, described by Sir W. E. Goschen, which took place at the final interview that the British Ambassador at Berlin had with Herr von Bethmann-Hollweg. No one who knows the German Chancellor would regard him as nervous and excitable. He gives the impression of an amiable man, and, what is even more rare among German statesmen, of a plain and candid man. Apart from Herr Posadowsky, I do not recall any public man of first position in Germany who seemed so free from the almost universal suggestion of secrecy that pervades the diplomatic tone of the country, or whose word one would so readily accept at its face value. That he should have so frankly revealed his mind about the action of England is not surprising, but that he should have revealed it with such an undisciplined burst of anger and astonishment is as remarkable as it is unusual. It was due in part no doubt to the failure of his attempts to preserve the peace; for that he was opposed to the war party then, as he had always been, is accepted as unquestionable by the best-informed opinion in England. But its extravagance was due to the gravity of the discovery. It was due to fear.

Germany had no doubt that, if she were opposed by Russia and France alone, her task and that of Austria would be assured of swift and easy ac

complishment, and events have largely justified the calculation. But the intervention of England gravely altered the task.

It was not that Germany feared the armies of England. For them she had little respect, and her miscalculation on this point was to cost her dear: for it was the professional army of England, the best trained and the most experienced in Europe, that very largely broke the first shock of the German invasion and changed the current of the

war.

But while Germany held the British army in little esteem, she had no illusions about the British navy. She knew that at sea her inferiority was almost as indisputable as her superiority on land, and that in the event of a swift decision not being attained, her exclusion from the sea and her consequent isolation from the world would seriously prejudice her chances. The intervention of England in fact made the certainty much less certain, and the completeness of the victory much less assured.

The restraint upon her powers of offense which the British naval superiority involved had occupied the mind of Germany for twenty years. Naval supremacy had never come within the scope of Bismarck's ambitions. His purpose was to dominate the Continent, not the extra-European world, and for this purpose he relied upon the sword. He recognized the advantage which the French navy gave to the French in 1870, especially in connection with the sup

ply of horses from England, but that advantage he dismissed with a phrase: 'I will deal with the French navy at Paris.' To the end he remained indifferent to naval aspirations.

But the Kaiser's dream of 'a German world-empire and a Hohenzollern world-ruler' led him naturally to cultivate naval ambitions. The command of the sea was the key to the achievement of his object, and in 1898 at Stettin he made the momentous declaration that 'Our future lies upon the water.' In that declaration and its implications is the seed of the antagonism between England and Germany. Up to that time the German navy had been of negligible proportions, but thenceforth its extension became the dominant new fact in the life of Germany, and with the Naval Law of 1900 there emerged definitely the challenge to Great Britain's command of the seas. The new departure was conceived and carried out with characteristic method and thoroughness, and in Admiral von Tirpitz the Kaiser found an extremely capable instrument for his great ad

venture.

Von Tirpitz is not an original or imaginative mind, but he has the German industry and thoroughness. He did not initiate ideas; he followed a little slavishly, but with extraordinary efficiency, in the tradition of the country which he had set out, not merely to rival but to surpass. There is no contribution of great original quality that can be ascribed to him, and on the three capital developments of the past fifteen years -the invention of the all-big-gun ship, the submarine, and the development of the big gun - he was slow to respond. But though his conservative and uninspired temper was suspicious of new ideas and too imitative for an enterprising policy, his industry and mechanical capacity, coupled with the enthusiastic support of the Kaiser and ultimately of

the country, enabled him to make his challenge a reality. Behind all the external movements of the intervening years, it was the growth of the German navy which was the ultimate consideration in the relations of the two countries.

II

For five years, however, the new cloud which was appearing in the sky of England evoked no action. The naval supremacy of the country had been so long an established fact in the national thought that it seemed almost a part of the eternal order of things. There had been, it is true, a naval sensation some twenty-five years ago, when the late Mr. W. T. Stead in the Pall Mall Gazette had temporarily shaken the country out of its sense of comfortable security. But the fear then was of France, and it was some time before the historic antagonism could be switched, in the public mind, into a new channel. But in 1905 the reply to the developing aims of Germany came in a sensational form with the emergence of the most remarkable man that the British navy has produced since Nelson.

It has been well said that Admiral Fisher is not so much a man as a natural element. He accommodates himself to no known type of character, and cuts with a sublime unconsciousness and indifference across all the conventions of men. He is like a bomb-shell in a parlor. It is fifty years since, as a lad, he was nominated for the navy by the last of Nelson's captains, and in the intervening years he had sailed every sea and filled every position open to him in the navy. And wherever he had been and whatever post he had occupied, 'Jacky' Fisher had been the centre of a new and energizing life. There was about him a freshness of mind and an audacity of temperament that made him irresistible. You might hate him

or distrust him, but you could not despise or ignore him. He brought with him everywhere a fearless directness of vision that made him the unceasing challenger of things as they were. Nothing was sacred to him except the memory of Nelson, whom he quoted as freely as he quoted the Bible, with which he garnished his tumultuous talk almost as abundantly as a revivalist preacher. 'What I object to in you,' said King Edward — who had a great affection for the breezy sailor- on one occasion, 'is that you are so violent.' 'Yes, sir,' came the reply, 'but the Kingdom of Heaven suffereth violence and the violent man takes it by storm.' I do not know whether this habit of scriptural quotation or his notorious love of sermons can be assumed to predicate exceptional piety. Certainly piety is not suggested by that sardonic, half-humorous, half-ruthless manner, and it must be admitted that his quotations have usually a bearing on the business of war. The comminatory Psalms make more appeal to him than the Book of Revelation.

It was Lord Ripon who first brought 'Radical Jack' into administrative prominence by making him Director of Naval Ordnance. He had already won reputation in the navy as a revolutionary thinker, a rebel against social traditions and accepted maxims. He had had no social backing himself, and he saw in the influences of society upon the navy the greatest danger to its efficiency, and he cared for nothing except efficiency. 'Buggins's turn,' he would say, 'is the curse of the navy. Buggins is first cousin of the Duke of Blankshire and brother-in-law of the Archbishop of Timbuctoo, and therefore he must have his turn though everybody knows he is a fool.' And with his love of paradox he would declare that Favoritism is the secret of success'

young man who has the rope round his neck,' of the man on the lower deck if he has the genius for the job.

Naturally all the Bugginses of the Navy were scared by the apparition of this tornado of a man. They saw all the comfortable tranquillity of the service threatened if he were allowed his head. They naturally believed that the ruts into which they had fallen were sacred. They were the ruts of the past. They had been made by the fathers of the British navy, and any interference with them was hardly distinguishable from blasphemy. Moreover, they were comfortable ruts. They saved one the trouble of thought and the inconvenience of change. It was true that the whole material of the navy had undergone a revolution, but that did not involve any revolution in thought or method. The navy had grown and did not need a surgical operation.

But though the hostility to Admiral Fisher was backed by formidable influences it failed to check his career. Once it seemed that he was beaten. He had become Second Sea Lord, but failing to get his way, he executed a retreat which his opponents hopefully regarded as equivalent to extinction. He assumed the sinecure at Portsmouth, and to his great joy, ran his own flag up on Nelson's old flagship. But so far from having finished he had not yet really begun. His full triumph came when in 1904 Lord Selborne urged him to return to the Admiralty as First Sea Lord. He laid down fourteen essentials as the conditions of his return, and when it was agreed that they should be adopted one at a time, his reply was, 'No, all at once. If I've got to kick people's shins, I want to kick them all together. I want them all to be too busy rubbing their own shins to turn on me when I'm occupied with other things.'

His return to Whitehall, master at last of the situation, was the signal for