Page:Essentials of the Art of Medicine Stille.djvu/19

Rh have spoken one hundred languages. Yet of the structure of them he was entirely ignorant, and he was unable to teach them. Still more striking, and yet more common, are the instances of musical prodigies, and of poets, "who lisped in numbers" almost from infancy; of mechanicians also who even in childhood showed a genius for invention which afterward made them famous.

In like manner there are physicians by instinct as well as by education; just as there are many persons whom the most assiduous training can never make great linguists, musicians, artists, or scientists, so are there not a few whom all the learning, and science of the schools and all the bedside training of the hopitalshospitals [sic], indeed, all the experience of a lifetime can never transform into skilful, wise, and prudent physicians. It has been well said that "the men called great who have risen to distinction are not men of brains but of aptitude." Among physicians nature has granted them the gift of insight by which to discern the essential elements of individual diseases, as well as those which they have in common with other diseases, and to weigh their value in special cases; and also the co-ordinate talent for selecting the fittest medicines and duly adjusting their doses, combinations, and times and modes of administration. An old Scotch doctor is said to have remarked of one of his young competitors in practice: "He's one of the kind they turn out in plenty nowadays: all theory and no grit." And by "grit" he meant those minute particulars I have just enumerated, and upon which the efficacy of medicines so largely depends. It should never be forgotten that the patient has no direct concern with the learning and science of his physician, and is incapable of estimating their value. They are of interest to him in so far only as they are reinforced by the physician's tact in seizing the essential elements of his patient's disease, and his dexterity in adapting his remedies, not so much to the nominal affection, as to the actual, living, suffering, endangered patient before him. After all that science and experience can teach him, he may still lack the essential faculty which is the power to see, and know, and judge the condition of his patient, not only in its entirety, but in every individual element.

This power, or tact, is a peculiar faculty. It resembles instinct, for it reaches a definite object without a consciousness of the intervening steps. On the other hand, it is allied to the imagination, for it leaps from premises to conclusions in disregard of those steps if, indeed, it is conscious of them. To an exceptional few the relations of the two ends of the chain are revealed in a flash, as it were, of that divine fire