James F. Duncan

“ Clinical instruction, in addition to affording an opportunity for the exercise of the several senses in their approximate functions, trains the student to habits of accurate observation. This he does when he watches closely the several changes that occur from one day to another in the patient's condition. Regular attendance is, of course, essential to this; otherwise 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. ”

“ The confidence which the poor feel in the skill of a physician, explaining to a class of students the peculiarities of their ailments, is much greater than in that of one who having no occasion to express his opinions, makes his examination, and directs his treatment in silence. Upon this point I think I am better able to express an opinion than most persons, having been for many years physician to the non-clinical wards in Sir P. Dun's Hospital, before I accepted my present office. ”

“ No men have a greater unwillingness to meddle in the treatment of disease than those who, having practised it honourably in some department of the public service during the greater part of their lives, have retired from the field of labour. Knowing the progressive character of medicine as a practical art, they feel that it should be transferred to the hands of younger men than themselves, more conversant with the existing state of scientific knowledge than they can possibly be. ”

“ This is more likely to occur with oral instruction than with books, because the living man seen and heard is more apt to bulk in the eye and to influence the judgment of the student than the author of a treatise whom he has never met. When a man learns all by reading, all his instructors are placed on the same level, and no one takes undue precedence over the rest.
Clinical instruction differs from both the methods of study just mentioned in this, that it deals with cases of real disease present in the hospital, and subjected to all the details of actual treatment. ”

“ The last method of instruction—"grinding"—is, as you are all aware, a system of catechetical instruction earned on in classes by private tutors, principally with a view of enabling the pupil to pass his examination for his licence to practice. It exercises the attention and memory of the student, and supplies him with much useful information; but as it is conducted at a distance from the sick, it can do nothing directly to exercise his senses and improve his powers of observation. Against this system there exists among many persons a very decided objection. ”

“ Besides, if it is to remain an hospital, where the sick are to come for health, it must be obvious to everyone that the poor, for whose benefit it is intended, have a right to be assured that they will receive within its walls the best and most skilful treatment, otherwise they will naturally prefer admission to some other institution, even though it does not present to them the same religious advantages. ”

“ 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. ”

“ In the first place, if he has never seen any plan of treatment put into practice, how is he to decide between the merits of different, and it may be, opposite plans recommended by different authors? These differences, in many cases, may be satisfactorily explained and reconciled; but to the student, brought into contact with disease for the first time, they must prove hopelessly embarrassing. In the second place, medicine is a progressive science. ”

“ Here we are accustomed not only to tell the students that they will find certain signs and symptoms in the patient, if they will take the trouble of looking for them, but we place the stethoscope ourselves on the spot indicated, and by personal efforts endeavour to make the student realize exactly what he is in search of. It is astonishing how often mistakes will occur when least to be expected; and a pupil will sometimes say he hears a particular sound, and in reality thinks he hears it, when all the while his attention is directed to a different direction. ”

“ My friends, the service you have entered on is like the forlorn hope of a besieging army. It exposes you to greater dangers than fills to the lot of other young men of your own age. You are more liable to sickness—more liable to death. ”

“ Therein are laid down the results of a past experience for the guidance of younger and less experienced men following in their track. As well might the mariner think of starting on a long and dangerous voyage without the appliances of his art, as the medical man enter on the practice of his profession without a knowledge of the views entertained by his predecessors of the treatment of disease. ”

“ As to our pupils, we already count them by scores; and we can point with some degree of pardonable pride, not only to the numbers who have passed the usual Collegiate Examinations to qualify them for practice, but still more to the high places that many of them have taken at the Competitive Examinations, where rival institutions, represented in the persons of their alumni, are brought into collision, and the merits of each, as a school of medicine, put to the only test appreciated by the public. ”

“ Next to a church, there is not a more sacred spot on earth than an hospital. The feelings with which we enter the wards ought to bear some affinity to that holy reverence with which we go up to worship. God is there in an especial manner, accomplishing his own purposes of mercy, and working really but invisibly in the hearts of His people. ”

“ A medical man, above all others, requires to have them all—sight, hearing, touch, taste, and smell—highly developed, and in a condition of perfect health. If he has not, so far as the imperfection extends, he is unfitted for his office; and it ought to be a matter of serious consideration for a young man labouring under any physical defect, whether he ought to think of entering a profession in which the want of any faculty is a serious hindrance to his success. ”

“ When I add to this, that, without being particularly demonstrative in his manner, he was a warm and steady friend, conscientious in the discharge of duty, inflexible in his principles, and animated by a delicate sense of honour in all the relations of life, I think I have said enough to convince all who now hear me, that the loss which we have sustained is no ordinary one, and that the best use we can make of his example is to follow it as closely as we can. ”

“ Pupils are taught a certain number of answers to appropriate questions, which they afterwards repeat with little more intelligence than a parrot. The "cruxes" of crusty examiners are carefully registered, to meet their peculiar views; while comparatively little care is taken to give the student a true insight into the real nature of disease. But all these objections spring from the abuses which have crept into the system. In its proper place, where rightly used, it is a most valuable auxiliary to other modes of study. ”

“ Other hospitals in this city [2] have made ample provision for the bodily ailments of the inmates, supplying them freely with the most skilful medical and surgical treatment, while they have left the higher interests of their spiritual nature unattended to. They do not, indeed, prevent benevolent efforts for their welfare being made by other persons willing to undertake the task; but these, originating beyond the limits of the hospital arrangements, are necessarily subjected to regulations which restrict their freedom of action, and interfere with their efficiency. ”

“ So far as legitimate medicine has yet triumphed over the boasted presumptions of irregular practitioners, the victory has been due to the increasing intelligence of the community. The credulity of the multitude springs from their ignorance—remove this, and the field in which quackery flourishes, as weeds do in a neglected farm, will cease to yield its accustomed harvest. ”

“ Nothing but true religion can make you so. But this, whatever opinion you may have hitherto formed regarding it, will not only enable you to look forward to the last great conflict without apprehension, but will greatly enhance your happiness during life. It will make yon more devoted to your profession, will inspire you with fresh motives for its cultivation, supply you with encouragement under difficulties, and will recompense you in the end with a better reward than you can possibly have without it. ”

“ Mayne to say that his abilities, great as they were, were not of that pre-eminent kind occasionally met with, which seem to grasp by a sort of ready intuition at the results of learning without the labour of acquiring them; whatever he learned, he learned in the ordinary way, with all the toil and self-denial and perseverance that other men have to use in doing so. It is this that makes him so peculiarly a model for young men to study. Had his success in life been due to his great talents mainly, it could have furnished no encouragement to others not similarly endowed. ”

“ Not to mention emergencies that are liable to happen in remote quarters of the globe, how often do occasions arise at home of sudden and severe illness, when no skilled assistance is within reach, when the bystanders, in their anxiety to do something that may be useful, unfortunately fall into the mistake of doing the very opposite of what they ought to have done; so that when the expected aid arrives, he finds the patient actually injured by their well-meant but injudicious interference? ”

“ The time has not yet arrived in the history of the world when, either as a part of general education, or as an avenue to social rank and distinction, men will think it worth their while to spend time in hospital attendance. ”

“ Do we think enough, as we pass from bed to bed, that we are ourselves partakers of the same mortality, and that in due time we shall be called to take our places in the sick room, and on the bed of death? ”

“ If practical medicine is to maintain its proper place among the kindred professions, it can only be done by the body at large possessing: some claim to the title of a learned and an educated class; and a man who has no taste for reading, and no personal acquaintance with books, especially those bearing on his own department of general science, can scarcely be looked upon as having any pretension to be regarded in this light. ”

“ Studying any subject in its analogies and contrasts tends materially to enlarge the mind of the student. It prevents misapprehensions, suggests useful hints, and prepares the way for enlightened and skilful practice. ”

“ As to the other objection I cannot help thinking, that if the principle were once admitted that the public were to be left to themselves to supply, without solicitation, the requisite funds to support the charity, the resources at the disposal of the committee would get smaller and smaller, until they dwindled down to nothing. The great advantage of charity sermons in support of such an institution as this is, not so much the amount of money they bring in, as their keeping the existence of the necessities of the hospital prominently before the public. ”

“ Systematic courses of lectures, as given in connexion with schools of anatomy, have this advantage over text-books, that being given vivâ voce, the teacher is able to introduce into his lectures every new discovery as it comes out, and so to keep his pupils up to the standard of medical knowledge existing at the time. They are also usually illustrated by morbid preparations and drawings, which are rarely accessible to the mere reader of books. But they labour under the same defects as books, of not bringing the student into direct intercourse with the sick. ”

“ The great Father of the human family takes his erring children aside, each one separately, that he may talk to them in private, chiding them for their faults, and administering correction. With what subdued feelings, with what bated breath, ought the other members of the household to stand by, and pause till the chastisement is over, and the offender restored to favour. ”

“ Then, again, he was remarkably humble; he never gave you the idea of a man who thought of himself more highly than he ought to think; he was ever ready to recognise merit wherever discovered, and he was always more anxious to give to others the meed of praise for any professional discoveries to which they were entitled than to secure his own. ”

“ But the great objection is, that books, however well adapted to explain the theory of medicine, are of little practical use in making us acquainted with disease as it occurs in nature. The ordinary symptoms of any morbid state, as described in books, are rarely if ever met with in any individual. ”

“ It would be easy to point to other names in the catalogue of eminent men, alas! too numerous, recently removed from the profession in this city, more distinguished for brilliancy of genius, for originality of conception, for fertility of resource ”