Page:Introductory lecture, delivered at the Middlesex Hospital, Oct. 1, 1847 (IA b31880472).pdf/6

 must have used both your senses and your understanding; must have seen, touched, and handled with the one, and must have understood and reflected with the other.

I am talking of these things as they exist in disciplined intellects, and in retentive memories; and, perhaps, it may be objected that I am talking of things that form the exception rather than the rule; that I am measuring the power of common men by those of extraordinary instances. I weigh my words, when I deliberately assert, that such, although partially the case, is not so altogether; and that it is far less the case than is commonly imagined. In most of those instances where we lose the advantage of prior experience, by omitting the application of our knowledge of a previous similar case, the fault is less in the laxity of memory than in the original incompleteness of the observation. Observe closely, and ponder well, and the memory may take care of itself. Like a well-applied nick-name, a well-made observation will stick to you—whether you look after it or neglect it. The best way to learn to swim is to try to sink, and it is so because floatation, like memory, is natural if you set about it rightly. Let those who distrust their remembrance once observe closely, and then forget if they can.

There are good reasons for cultivating this habit at all times, but there are especial reasons why those who are on the threshold of their profession should more particularly cultivate it. Not because you have much to learn—we have all that—nor yet because you have the privilege of great opportunities—we have all that also—must you watch, and reflect, and arrange, and remember. Your time of life gives you an advantage. The age of the generality of you is an age when fresh facts are best seized; and best seized because they are fresh. Whether you are prepared to understand their whole import, as you may do at some future period, is doubtful. It is certain that the effect of their novelty is to impress them more cogently on your recollection.

And this is practice—practice in the good sense of the term, and in a sense which induces me to guard against the misconstruction of a previous application of it. A few sentences back I used the phrases practical men, adding that those so called were men who could be taught by practice only. I confess that this mode of expression was disparaging: for the purpose to which it was applied it was meant to be so. It is a term you must be on your guard against. Practice is so good a thing of itself that its name and appellation are applied to many bad things. Slovenliness is practice, if it suits the purpose of any one to call it so; contempt for reading is practice; and bleeding on all occasions when you omit to

purge is practice;—and bad practice too. Be on your guard against this: but do not be on your guard against another sort of practice: the practice of men who first observe, and then reflect, and then generalise, and then reduce to a habit their results. This is the true light for you to follow, and in this sense practice is not only a safe guide but the safe guide. It is experience, or, if you choose a more philosophic term, induction. Theoretical men can be taught by this, and the wisest theorists are taught by it. When I said that practical men were taught by practice only, I never implied that they were the only men that practice could teach. Experience makes fools wise; but fools are not the only persons who can profit by experience.

See and hear—the senses must administer to the understanding. Eye, and ear, and finger—exercise these that they may bring in learning.

See and hear—the senses must administer to their own improvement. Eye, and ear, and finger—exercise these, that they may better themselves as instruments. The knowledge is much, but the discipline is more. The knowledge is the fruit that is stored, but the discipline is the tree that yields. The one is the care that keeps, the other the cultivation that supplies.

The habit of accurate observation is by no means so difficult as is darkly signified by logicians, nor yet so easy as is vainly fancied by empirics. It is the duty of those who teach you to indicate the medium.

The tenor of some of my observations runs a risk of misrepresentation. It has been limited. It has spoken of cases, as if there was nothing in the whole range of medical study but cases; and of observation, as if the faculties of a medical man were to take a monomaniac form, and to run upon observation only; of hospitals, as if they consisted of beds and patients alone; and of clinical medicine and of clinical surgery, as if there was no such a paramount subject as physiology, and no such important subsidiary studies as chemistry and botany. It is all hospital and no school—all wards and no museum—all sickness and no health. This has been the line that I have run on; and I feel that it may be imputed to me that I have run on it too long and too exclusively. Whether I undervalue the acquisition of those branches of knowledge which are collateral and subordinate to medicine, rather than the elements of medicine itself—which are the approaches to the temple rather than the innermost shrine—will be seen in the sequel. At present I only vindicate the prominence which has been given to clinical observation, by insisting upon the subordinate character of everything that is taught away from the bed, and beyond the