Clinical medicine

“ In the latter, clinical medicine or medical practise seeks to lay hold of the acquisitions of experimental science and to utilize them in the interpretation of symptoms. The clinical or hospital laboratory approaches medical problems from the professional side and is thus an extension of medical practise into a territory where science and practise meet and shade into one another. Here the future physician should receive most careful training when he begins to direct his studies toward some branch of medicine. ”

“ Much of what is taught to-day in pathology belongs to clinical medicine and surgery, for it is largely special and diagnostic in character. The pathologist is now the servant of the physician and surgeon in completing and rectifying their diagnoses. The pathologist of the future will deal with more general phenomena derived from experimental and comparative data, just as the physiologist has moved onward, or backward if you please, into general and comparative physiology. ”

“ The advances in general medical science and practice have also necessitated great elaboration of the resources for the study and treatment of the physical condition of the patients. Instruments of precision, laboratories, x-ray departments, dental and surgical operating rooms, massage and hydrotherapy departments, facilities for eye, throat, nose, and ear examinations and treatment, and all the other means of determining disease processes and applying proper treatment have been supplied and the methods and standards of modern clinical medicine and surgery are utilized. ”

“ 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. ”

“ The physician is, alas! too often powerless to contend against the ills that are raging around us. But, really, we can not expect physiology to cure incurable diseases and make men immortal; its mission is to discover the truth, and it is for the physician to apply the lessons of the new truth to the treatment of diseases. Who can say seriously that modern medicine, enlightened by the great physiological discoveries of this and former centuries, is not superior to the medicine of the middle ages? The circulation of the blood was discovered by vivisection. ”

“ At a period when pathological research is lending its aid in investigating the appearances of disease in every part of the body, and many nice distinctions in diagnosis are aimed at, which are better calculated for nosological than practical purposes, it seems to me not a little extraordinary, that so few have cultivated that most important branch of medicine, the study of the diseases of children. ”

“ A patient suffering from a disease belonging to the last class remains well as long as he continues the use of medicine, but relapses as soon as the treatment is stopped, just as a tottering house collapses on the removal of the props. The physician is advised to refrain from treating a disease which is quite incurable.* [2] The other two classes of diseases should be treated with all possible care and skill. In order to acquire success in his profession, the physician is expected to know both the theoretical and the practical sides of the science of medicine. ”

“ It involves a continuance of the mischievous ideal of medical practice of the past, a conception still held by a large portion of the public to its own detriment, that a hasty inquiry, a perfunctory examination, and a bottle of medicine, represent the best that scientific medicine can offer a patient. ”

“ How weak appears the reasoning of many great physicians, when we examine it, not in their works, but on the dead body. Medicine was for a long time excluded from the circle of the exact sciences; it will have a right to be associated with them, at least in the diagnostics of diseases, when we shall every where unite to accurate observation, an examination of the changes our organs undergo. ”

“ Many practitioners, indeed, hold every thing that is in the least theoretical, in great contempt. They 3alledge, that a physician possesses all the knowledge requisite in medicine, who is acquainted with particular remedies which will infallibly cure particular diseases. Could such remedies be discovered, their reasoning would indeed hold good; and medicine, which, of all arts, is in reality the most difficult, would be the easiest. ”

“ It is a common proverb, that one extreme often follows another. It is sometimes so in medicine. As soon as physicians had let go the absurd idea that diseases were the work of demons, had given up their useless mysticisms, and begun to look upon disease as the effect of natural causes—when Anatomy, Physiology and Pathology had helped to explain morbid phenomena, and rational means had come to be employed, practitioners commenced a course of active treatment and went to work with all their might to cure all diseases by positive medication. ”

“ This universal and acknowledged rule is Pathology, the science which unfolds and exhibits the nature and character of disease, and "dictates the maxims of rational practice." It is the foundation and only base of rational medicine, which proceeds on the assumption that the nature and character of disease is fully known and appreciated. This knowledge is not only rational, but indispensable, in order to understand and apply the principles which ought to govern in the medication and cure of disease. ”

“ While the practice of medicine is so vast and extensive a field, that it has been found necessary to subdivide it amongst physicians, surgeons, accoucheurs, apothecaries, oculists, aurists, dentists, men for the gout and men for the gravel, one for the belly and another for the brain, these reformers seem to regard medical knowledge and medical practice as in a nutshell,—as already perfect and complete. ”

“ Undoubtedly one of the most important steps which medicine has made in its development, is the recognition of the difference between disease itself and those symptoms which may be caused as the result of such disease. We shall find that in most, if not in all, of the older writers on medicine, the treatment of the physician was directed towards the alleviation of those prominent symptoms, which, then not so much looked upon as symptoms, were only recognized as the main cause of the attack. ”

“ Dr FRANK, an eminent author and practitioner.
"Our actual information or knowledge of disease does not increase in proportion to our experimental practice. Every dose of medicine given is a blind experiment upon the vitality of the patient." ”

“ These are the words of one of our wisest physicians, deliberately written in the full maturity of a life devoted to original research and its practical application to medicine. His experience led him to the recognition of this great truth: that the supreme aim of the medical profession must become more and more the advancement of sanitation. In any comprehensive view of medical art as a science the cure of disease is rationally secondary to its prevention. ”

“ Modern medicine, on the other hand, declares that disease must be studied in the living person of the patient. And the same disease may require different treatment, if the condition of the patient is different. ”

“ As I devoted myself with all possible zeal to the work in hand it was not long before I realized thoroughly that the best way of increasing one’s knowledge of medicine is to begin applying, in actual practice, such principles as one may already have acquired; and thus I became convinced that the physician [421] who earnestly studies, with his own eyes,—and not through the medium of books,—the natural phenomena of the different diseases, must necessarily excel in the art of discovering what, in any given case, are the true indications as to the remedial measures that should be employed. ”

“ Thirty years of active practice had made him familiar with disease in its varied forms, and had led him to reject as useless that which was merely speculative in medicine, while it enabled him to speak with authority of all that was valuable in our science. Thoroughly familiar with medical literature, he had also studied disease in the great book of nature, at the bedside in private practice, and in the wards of hospitals. ”

“ Well grounded in the observation of disease in its different forms and modes of behavior, and also familiarized with the ordinary methods of treatment, these physicians needed to be shown a new route along which they might advance to greater heights of knowledge, and they also needed to be stimulated to further endeavor. ”

“ The modern reader will probably be surprised at the comprehensiveness of the work, which, besides general diseases, includes considerable portions of physiology, physiognomy, ophthalmology, laryngology, otology, gynecology, neurology, dermatology, embryology, obstetrics, dietetics, urinary and venereal diseases, therapeutics, toxicology, operative surgery, cosmetics and even the hygiene of travel and the prevention of sea-sickness. ”

“ To this end must be added the one thing needful, personal fitness, sagacity in recognizing the peculiarities of individual cases, and in adapting the treatment of them, hygienic, dietetic, and medicinal, to the special requirements of each. In a word, the physician must never forget that he has a patient as well as a disease to treat. ”

“ A hearty emetic effected a cure; and the first child of Jerry and Mary Wilson was distinctly marked on the left shoulder with a bunch of grapes.
HOW TO CURE FITS. Not none of the least difficult problems, in the practice of medicine, is the distinguishing between cases of real disease, and those that are feigned. It is a great stumbling block in the path of young practitioners, and even the old members of the fraternity find a few chips of it in their way occasionally. ”

“ The biological healing system, based on the laws of nature and the acknowledgment of the fact that no two cases of disease are exactly alike, requires much broader knowledge and much deeper insight on the part of the physician than did the old-school of medicine with its search for symptoms of special diseases and its occult prescriptions. ”

“ The latter is a large medical dictionary, containing, in a brief form, not only explanations from all departments of medicine, but also their manifold applications. In connection with every disease is given an explanation of its cause, its symptoms, and the method of its cure, along with even the ordinary prescriptions. This was for me a real treasure. I studied the book thoroughly, and believed myself to be master of the science of medicine, and a complete physician. ”

“ Of course I refer to surgery, and to the discovery of the causes and improvement in the treatment of contagious and epidemic diseases. The general practice has shared in this scientific advance, but it is limited and always will be limited within experimental bounds, by the infinite variations in individual constitutions, and the almost incalculable element of the interference of mental with physical conditions. When we get an exact science of man, we may expect an exact science of medicine. ”

“ The practice of medicine is every year becoming [pg 293] more successful. New and improved methods of treating disease are being discovered and developed, and the conscientious physician will avail himself of all the means, by a knowledge of which he may benefit his fellow-men. ”

“ The author still advises that a physician be consulted, if it be possible, not only on account of the danger of taking a wrong medicine or too much of a proper one, but because few people are really competent to make a proper diagnosis. ”

“ DISEASE HAS CERTAIN UNMISTAKABLE SIGNS,
or symptoms, and, by reason of this fact, we have been enabled to originate and perfect a system of determining with the greatest accuracy the nature of chronic diseases without seeing and personally examining our patients. In recognizing diseases without a personal examination of the patient, we claim to possess no miraculous powers. We obtain our knowledge of the patient's disease by the practical application of well-established principles of modern science to the practice of medicine. ”

“ ADVANTAGES OF SPECIALTIES.
By thorough organization and a perfect system of subdividing the practice of medicine and surgery in this institution, every invalid consulting us is treated by a specialist—one who devotes his undivided attention to the particular class of diseases to which his or her case belongs. The advantage of this arrangement must be obvious. Medical science offers a vast field for investigation, and no physician can, within the limit of a single life-time, achieve the highest degree of success in the treatment of every malady incident to humanity. ”

“ We must always keep in mind that the effect of medicine is in the greatest degree relative to the particular disease for which it is administered, and to the force of such disease. The doses of active medicines are to be diminished as symptoms abate. ”

“ So in natural science and in art the mind must, first of all, distinctly apprehend the thing that is to be studied, and after that its relation to associated things. So in medicine the only safe clue to an accurate conception of disease is through a minute study of all its forms and relations and the modifications they undergo through internal and external influences, and, next to those the variations imposed upon them by hygienic and therapeutic measures, i. e., by treatment. ”