Robert Gordon Latham

“ Too much of the spirit of exaggeration is abroad—of that sort of exaggeration which makes men see in the requisites for their own profession the requisites for half-a-dozen others—of that sort of exaggeration which made Vitruvius, himself an architect, prove elaborately that before a man could take a trowel in his hand he must have a knowledge of all the sciences, and a habit of all the virtues. Undoubtedly it would elevate medicine for every member in the profession to know much more than is required of him—yet this is no reason for our requiring much more than we do. ”

“ I am quite satisfied that as far as the merits or demerits of an education contribute to the position of a profession, we may take ours as we find it, and yet hold our own. Nevertheless, lest the position given to medicine by its pre-eminent prominence, in conjunction with the church and bar, as one of the so-called learned professions, should encourage the idea that a multiplicity of accomplishments should be the character of a full and perfect medical practitioner, one or two important realities in respect to our position should be indicated. ”

“ 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 ”

“ Proud to be useful—scorning to be more—must be the motto of him whose integrity should be on a level with his skill, who should win a double confidence, and who, if he do his duty well, is as sure of his proper influence in society, and on society—and that influence a noble one—as if he were the member of a profession ensured to respectability by all the favours that influence can extort, and all the prerogatives that time can accumulate. ”

“ What they profess is never very formidable and what they require is generally less than what is professed. But the time that is sufficient for this modicum (or minimum) of professional learning is not the time sufficient for the formation of a practitioner of that degree of excellence which the competition of an open profession, like that of medicine, requires as the guarantee of success. An examining board has but one point to look to—it must see that you can practise with safety to the public. ”

“ We are at a disadvantage as compared with both the church and the bar. We have nothing to set against such great political prizes as chancellorships and archbishoprics. We are at this disadvantage; and, in a country like England, it is a great one: so that what we gain by the connection, in the eyes of the public, is more than what we give; and the connection is itself artificial, and, as such, dissoluble. It is best to look the truth in the face—we must stand or fall by our own utility. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ If you could contrive the cure of disease without a knowledge of morbid processes, it would be a waste of time to trouble yourself with pathology; or if you could bottom the phenomena of diseased action without a knowledge of the actions of health, physiology would be but a noble science for philosophers; or if you could build up a system of physiology, determining the functions of organs, and the susceptibilities of tissues, independent of the anatomy of those organs and those tissues, scalpels would be as irrelevant to you as telescopes ”

“ 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. ”

“ 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. ”

“ No single subject thus taught is the direct and primary object of your learning. The art of healing is so. You learn other things that you may understand this; and in hospitals at least you learn them with that view exclusively. If you wish to be a physiologist, chemist, or botanist, irrespectively of the medical application of the sciences of physiology, chemistry, and botany, there are better schools than the Middlesex Hospital, or, indeed, than any hospital whatever. ”

“ 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. ”

“ 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. ”

“ You have no odd months, or weeks, or days, or even hours, to play with. It is a sufficient space for you to lay in that knowledge of your profession which the experience and opinion of your examining boards have thought proper to require. I believe the amount thus required, to be, like the time granted for the acquisition of it, a fair amount. But it is not a high one, and it is not right that it should be so. Standards of fitness that are set up for the measure of a body of students so numerous as those in medicine, rarely err on the side of severity. They favour mediocrity ”

“ 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. ”

“ It never ensures, or professes to ensure, that you shall practise with success to yourself, or even that you shall practise at all. In the eyes of an Examiner, as in those of a Commissioner of Lunacy, there are but two sorts of individuals; those that can be let loose upon the public, and those that cannot. In the eyes of the public there is every degree of excellence, and every variety of comparative merit or demerit. ”

“ You call to you all those that are oppressed; but you may aggravate the misery that you should comfort and relieve. You bear with you the outward and visible signs, if not of the high wisdom that heals, at least of the sagacious care that alleviates. ”

“ It is the current parodox of your practical men, i. e. of men who can be taught by practice alone. Clear your heads of this nonsense. It will make you egotists, and it will make you empirics: it will make you men of one idea: it will make you, even when you fancy it would do you just the contrary, the wildest of speculators. ”

“ I should be at liberty to say, in language more plain and complimentary, and more cogent than persuasive, that you must be up to your work when you begin it. If you stumble at the threshold, you have broken down for after-life. A blunder at the commencement is failure for the time to come. ”

“ 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 ”

“ Its chemistry, which I would willingly see more mixed with physics, carries you to the threshold of the exact sciences. Its botany is pre-eminently disciplinal to the faculty of classification; indeed, for the natural-history sciences altogether, a medical education is almost necessary. Clear ideas in physiology are got at only through an exercised power of abstraction and generalization. The phenomena of insanity can be appreciated only when the general phenomena of healthy mental function are understood, and when the normal actions of the mind are logically analyzed. ”

“ And now we may ask, whether, when a medical education has been gone through, you have collected from it, over and above your professional sufficiency, any secondary advantages of that kind which are attributed to education itself taken in the abstract? ”

“ What you are taught in the schools is taught to you, not because it is worth knowing—for Latin, and Greek, and Mathematics, are worth knowing—but because, before patients can be cured, they are necessary to be learned. ”

“ Not at present, indeed, but within a few brief years it will be so. Short as is human life, the period for the learning of your profession is but a fraction of the time that must be spent in the practice of it. ”

“ As compared with that of the church and bar, our hold upon the public is by a thread—but it is the thread of life. Such are the responsibilities, the opportunities, and the prospects, of those who are now about to prepare themselves for their future career. We who teach have our responsibilities also ”

“ 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. ”

“ If it do so, it is worse than a simple speculative error,—it is a mischievous delusion: it engenders a pernicious procrastination, justifies supineness, and creates an excuse for the neglect of opportunities: it wastes time, which is bad, and encourages self-deception, which is worse.
A difference between old practitioners and beginners there always will be: but it should consist not so much in the quality of their work as in the ease with which it is done. It should he the gain of the practitioner, not the loss of the patient. ”

“ 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. ”