Medical skill

“ Whatever skill we may boast in investigating the nature of a disease, or in understanding the structure of the body, yet without a knowledge of the instruments which are to be used, and of their properties and action upon the body, whereby they produce a change from sickness to health, other knowledge avails little in the cure of diseases.
The Theory of Physic, more commonly termed Medical Institutions, comprehends under it, the important doctrines of Physiology and Pathology. ”

“ Diseases are often stubborn or incurable, and effectually baffle the most skilful practitioner. In most cases, however, diseases are under the control of medical skill; and the high satisfaction which a benevolent physician feels, in relieving the sufferings of his fellow-creatures, may serve as a recompense for the many adverse circumstances which attend the profession. ”

“ Finally, it must be remembered that we cannot expect to find many favourable notices of medical practice in an age and country in which medical skill was at a very low ebb. ‘Medicorum optimus dignus est Gehenna,’ said the Rabbis of the later Judaism.95 In nothing has human knowledge made more astonishing strides than in medical and in surgical discovery ”

“ Now to set before you the distinction between all these things, and give you a perfectly exact view of them, so that you may in brief comprehend the medical art, is quite impossible, even for one in the highest degree qualified by care and skill: but actual experience and practice are requisite to form a medical system and a medical man. ”

“ 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. ”

“ He made the study of medicine and surgery his avocation, and by his life exemplified its highest ideals in culture and ethics. To the furtherance of post-graduate instruction he enthusiastically devoted his skill, his knowledge and his scholarly attainments. ”

“ It should the rather stimulate to the most careful and searching observation of all the doubtful points of the case in hand, so that whatever of experimenting may be necessary, shall be as rational and intelligent as possible. This leads me to remark, that the views, which we have taken of the uncertainty of medicine, show us in what real skill in the practice of the medical art consists. It consists in appreciating the actual state of the patient in all respects, and then applying such remedies, and in such quantities and forms as will do the greatest probable amount of good. ”

“ The physician, therefore, in fulfilling his high vocation, should not only have a full knowledge of mental philosophy, but he should aim to acquire a practical skill in applying its principles to all the ever varying phases, which the mind presents in its connection with disease. The possession of this skill is one of the most valuable endowments of the medical art. ”

“ Object of this chapter to show how the community can judge of them correctly. Education of physicians—evidences of it. Medical education practically despised by a large portion of the public. Standing of medical man among his brethren criterion of merit. Difficulty in getting their unbiased opinions. Certain mental qualities essential to skill in the practice of medicine. How the common observer can detect and measure these qualities. Observe them as exhibited in regard to subjects which he understands in common with the physician. Illustration from surgery. ”

“ 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. ”

“ Its practitioners brought with them much of the knowledge and many of the errors of the Old World; they have always been in communication with its wisdom and its folly; it is not without interest to see how far the new conditions in which they found themselves have been favorable or unfavorable to the growth of sound medical knowledge and practice.
The state of medicine is an index of the civilization of an age and country,—one of the best, perhaps, by which it can be judged. Surgery invokes the aid of all the mechanical arts. ”

“ Yet we regard clinical medicine as illustrating art, and didactic medicine as representing science. What figure, think you, would the hospital professor make who should come before you with a patient, and be unable to determine with what disease the person was suffering, the organs affected by it, the nature of their functional disturbance, why some functions rather than others were disordered, how these various elements affect the issue of the attack, what that issue will probably be, and finally, what means should be taken to render it favorable? ”

“ But a man may be a minute anatomist, a profound physiologist, an expert chemist, and nevertheless be an indifferent medical practitioner. No one can be fit to practise his profession who has not studied carefully by the bedside of the sick, and thus learned by constant observation and experience to trace symptoms back to their source and to interpret them correctly. ”

“ Medical Science is one whole, of which all the branches I have enumerated are the several parts. They may be considered as the links of a chain that have a mutual connection with one another. Anatomy, Materia Medica, Botany, Chymistry, and the Institutions, are only the ladder by which we are to mount up to practice. A general knowledge, at least, in each one of them, is useful to both Physician and Surgeon; particularly to the former, who in proportion as he is more intimately acquainted with them all, will become more skillful in the healing science. ”

“ We conclude by impressing upon our brethren who are studying medicine in the light of reason and science, the urgency of the duty [251] that devolves upon them of so using the element of physic in medical practice as to make more and more apparent the great gulf that is fixed between their practice and the rival quackeries of the day. Let them use medicine so that the most undiscerning patient will perceive that it is only one of many means to an end, auxiliary only to great provisions in the body itself, and for the most part acting, not mysteriously, like quinine, but sensibly or chemically. ”

“ 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. ”

“ There is another profession, to the members of which, I think, a certain preliminary knowledge of physical science might be quite as valuable as to the medical man. The practitioner of medicine sets before himself the noble object of taking care of man's bodily welfare ”

“ Among the various avocations of men, that of the physician deserves to be placed in the foremost rank. The profession is founded in the multiplicity of diseases to which humanity is liable, and in the medical qualities of certain substances, which have been found to supply a remedy. ”

“ How can you be physicians if you do not examine the functions of the living body, and note how they are affected by emotions of the mind, and by other moral and physical influences; if you do not learn to mark the early inroads of disease, and watch its onward progress; to ascertain the effects of different remedies under varying conditions of human suffering, and to estimate correctly, by personal observation, the extent of the power which the body possesses of repairing functional or structural lesions? ”

“ In every department of human history the impression that we are the only ones whose work is significant has been receiving a sad jolt in recent years, and perhaps in no branch of science is this so true as in medicine. We are coming to realize how much the physicians and surgeons of long distant times accomplished, and, above all, we are learning to appreciate that they approached problems in medicine at many periods of medical history in the best scientific temper of the modern time. ”

“ A thorough knowledge of anatomy, a complete acquaintance with the physiological effect of every drug or remedy, a no less complete acquaintance with pathology, and a virility of character sufficient to elevate the mind above the crude ideas of past generations, whether sanctioned by usage or made sacred by great names, must in future, he contends, be characteristics of the successful medical practitioner. A determined opponent of everything irrational or unintelligent in medicine, Dr. ”

“ 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. ”

“ That is his business in life, and if he has not a thorough and practical knowledge of the conditions of health, of the causes which tend to the establishment of disease, of the meaning of symptoms, and of the uses of medicines and operative appliances, he is incompetent, even if he were the best anatomist, or physiologist, or chemist, that ever took a gold medal or won a prize certificate. This is one great truth respecting medical education. Another is, that all practice in medicine is based upon theory of some sort or other ”

“ Few persons have contributed more abundantly to the establishment of the true principles of surgery and medical science in those cases which require that minute criticism of the symptoms of disease, upon the proper knowledge and study of which the perfection of medical art must mainly depend. ”

“ Hence the most profoundly ignorant of medicine, are often the oldest members of the profession, and those who have had the most extensive practice. A medical education, founded on a knowledge of anatomy, is, therefore, not only indispensable to prevent the most fatal errors, but to enable a person to obtain advantage from those sources of improvement which extensive practice may open to him. ”

“ The facts of hygiene and therapeutic measures are widely scattered through medical literature, and extend over hundreds of years of time. Many volumes have been written on diseases of the eye, the heart, liver, and stomach, brain and other organs, to understand which requires special technical education. ”

“ Medicine was the foster-mother of chemistry, because it has to do with the preparation of drugs and the detection of poisons; of botany, because it enabled the physician to recognize medicinal herbs; of comparative anatomy and physiology, because the man who studied human anatomy and physiology for purely medical purposes was led to extend his studies to the rest of the animal world. ”

“ You can pass an examination in anatomy, physiology, chemistry, materia medica, which the men in large practice all around you would find a more potent sudorific than any in the Pharmacopceia. These masters of the art of healing were once as ready with their answers as you are now, but they have got rid of a great deal of the less immediately practical part of their acquisitions, and you must undergo the same depleting process. Hard work will train it off, as sharp exercise trains off the fat of a prize-fighter. ”

“ Some years ago I ventured to show in an introductory Lecture how very small a proportion of the anatomical facts taught in a regular course, as delivered by myself and others, had any practical bearing whatever on the treatment of disease. How can I, how can any medical teacher justify himself in teaching anything that is not like to be of practical use to a class of young men who are to hold in their hands the balance in which life and death, ease and anguish, happiness and wretchedness are to be daily weighed? ”

“ And the importance of understanding the true conditions of health and disease—of knowing how to acquire and preserve that healthy habit of body which the most tedious and costly medical treatment so often fails to restore when once lost, should secure a place in general education for the principal maxims of hygiene, and some of those even of practical medicine. For those who aim at high intellectual cultivation, the study of physiology has still greater recommendations, and is, in the present state of advancement of the higher studies, a real necessity. ”

“ In securing such a result there will be needed medical practitioners who are imbued with the ideals of preventive medicine in its widest sense. Let me, in this connection quote the following extract from a recent official report of my own:
There is needed a reconstruction of the training of each medical student, which will make preventive medicine in its widest sense an integral part of his training, and will insure that before he begins practice he has definite instruction in the application of the whole of his knowledge to preventive purposes. ”

“ Physicians are only now beginning to realize that, in all phases of preventive medicine, their strongest, most necessary, and, indeed, essential ally, is the public, and the needed stimulus to a better medical per [Pg 42] formance is an intelligent knowledge on the part of the people as to what should be done. ”