Page:Introductory lecture delivered in the Adelaide Hospital, Dublin, at the commencement of the clinical course, October 31, 1864 (IA b21916433).pdf/17

17 he may miss the opportunity of noticing some of the most important phenomena that present themselves; above all, he will fail to trace the connexion that subsists between the treatment employed and the results to which it leads. Recently we discovered the friction sound of pericarditis newly developed in a boy convalescent from scarlatina. The students in attendance—some of our most intelligent and expert pupils—all satisfied themselves of the accuracy of the observation. Prompt and active treatment was employed, and the next day every trace of the affection had disappeared. The gentlemen who were present when the morbid sound was discovered, and who saw the success of the remedies employed, required no argument to convince them of what their own senses had witnessed; but the others who attended on the next day after the removal of the physical condition, had to take the statement entirely on trust.

It may be thought, after what has been said, that clinical teaching alone is sufficient of itself to educate medical pupils for the practical part of their profession, and to fit them for entering upon the duties of their office. But this is obviously a mistake. It only reaches to a small portion of the catalogue of ills that flesh is heir to. It is evident that students only meet with instances of those forms of disease that happen to be admitted to hospital during the period of their attendance. Of the rest they can know nothing, except as they become acquainted with them in some other way. Some diseases are never to be seen within the walls of an hospital. Others appear there occasionally, at uncertain and distant intervals. Variations in the intensity of epidemic influences account for many of these irregularities; others can be traced to no definite cause. This, then, is the defect of this method of instruction—a defect incapable of being got rid of, and requiring to be supplemented by one or other of the modes already specified. There is also another defect inherent in the system, and traceable to the same cause—namely, that the teaching must be more or less of a desultory character. Depending, as it does, upon the particular instances of disease present in the hospital at any given time, it cannot be taken up in