Page:Introductory lecture, delivered at the Middlesex Hospital, Oct. 1, 1847 (IA b31880472).pdf/5

 higher degrees of merit, and the rewards, moral or material, which they ensure; which follow them as truly as satisfaction follows right actions, and as penalties follow wrong ones. The opportunity we have spoken of. It consists in the whole range of means and appliances by which we here, and others elsewhere, avail ourselves of those diseases that humanity has suffered, and is suffering, for the sake of alleviating the misery that they seem to ensure for the future. Disease with us is not only an object of direct and immediate relief to the patient who endures it, but it is an indirect means of relief to sufferers yet untouched. Out of evil comes good. We make the sick helpful to the sound; the dead available to the living. Out of pestilence comes healing, and out of the corruption of death the laws and rule of life. Suffering we have, and teaching we have, and neither must be lost upon you. It is too late to find that these objects, and objects like them, are repugnant and revolting. These things should have been thought of before. Your choice is now taken, and it must be held to. The discovery that learning is unpleasant is the discovery of a mistake in the choice of your profession; and the sooner you remedy such a mistake the better—the better for yourselves, the better for your friends, the better for the public, and the better for the profession itself.

Steady work, with fair opportunities—this is what makes practitioners. The one without the other is insufficient. There is an expenditure of exertion where your industry outruns your materials, and there is a loss of useful facts when occasions for observation are neglected.

See all you can, and hear all you can. It is not likely that cases will multiply themselves for your special observations, and it is neither the policy nor the practice of those who are commissioned with your instruction to open their mouths at random.

See all you can. If the case be a common one, you get so much familiarity with a phenomenon that it will be continually presenting itself. If a rare one, you have seen what you may seldom see again. There is every reason for taking the practice of the hospital exactly as you find it. It represents the diseases of the largest class of mankind—the poor; and, although in some of the details there may be a difference, upon the whole the forms of disease that are the commonest in hospitals are the commonest in the world at large; and vice versa. Hence, what you see here is the rule rather than the exception for what you will see hereafter. The diseases are not only essentially the same, but the proportion which they bear to one another is nearly so, I mention this, because there is often a tendency to run after rare cases to the neglect of common ones; whilst, on the other hand, remarkable and instructive forms of disease are overlooked, simply because they are thought the curiosities rather than the elements of practice. You may carry your neglect of common cases, on the strength of their being common, too far. You may know all about catalepsy and hydrophobia, and nothing about itch or measles. You may find that, of the two parties concerned, the patient and yourself, it is the former that knows the most about his complaint. You may live to have your diagnosis corrected by the porter, your prognosis criticised by the nurse. On the other hand, by missing single instances of rare disease, you may miss the opportunity of being able to refer to your memory rather than to your library.

I have given you reasons against being afraid of over-observation, and against the pernicious habit of neglecting the case because it is common, and that because it is rare—a common excuse for neglecting all diseases, and a popular reason for doing so. Medicus sum, nihil in re medicâ a me alienum puto, &c. Some minds, indeed, are so constituted that they can make much, very much, out of single cases, out of solitary specimens of diseases. The power of minute analysis is the characteristic of this sort of observation. It is just possible so to seize upon the true conditions of a disease, as to satisfy yourself, once for all, of its real permanent attribute—of its essence, if I may so express myself. And this being seen, you may, for certain purposes, have seen enough; seen it at one glance; seen it at a single view as well as others see it at a hundred. I say that certain minds are thus constituted; but they are rarely the minds of many men in a single generation, and never the minds of beginners. Before this power is attained your observation must be disciplined into the accuracy and the rapidity of an instinct; and to this power of observation—attainable only by long practice, and after long practice—a high power of reflection must be superadded.

No such power must be presumed on. If the student delude himself, the disease will undeceive him. The best practitioners, in the long run, are those whose memory is stored with the greatest number of individual cases—individual cases well observed, and decently classified. It is currently stated that the peculiar power of the late Sir Astley Cooper was a power of memory of this sort, and I presume that no better instance of its value need be adduced. Now the memory for cases implies the existence of cases to remember; and before you arrange them in the storehouse of your thoughts you must have seen and considered;