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mind of the patient into the state least apt to give right information. In the adoption of particular methods to obviate this, every one having discretion should exercise his own choice. A man of sound understanding, and who holds good faith with himself, may discover (and it is fit he should seek to do so) in what points his faculties are oftenest at fault; and this ascertained, he is in case to determine how the correction may best be made.
Rightly used, and not allowed to become too technical, a certain rule pursued in questioning the sick will strengthen, by disciplining, the powers of observation. Nor is there much danger lest this should cramp that higher and rarer quality (derived either from long experience, or from quick natural perception) which enables some men to comprehend at the first glance, to seize by a sort of intuition, all that is most needful to be noted in the diseases before them. These instances are not so frequent as to form a rule; nor can the faculty, though an eminent one in itself, ever preclude the necessity of further research. The persons thus gifted, moreover, cannot really be fettered by methods; and will use them only so far as they are actually conducive to good.
It is a frequent error in young practitioners to allow themselves to be betrayed into hasty diagnosis or prognosis of disease, either by their own nervousness, or by the importunity of the patient and those around him. The fault is serious;-not merely as a source of embarrassment, but often by impairing integrity in practice, from the desire to redeem a wrong opinion thus given. It concerns greatly the reputation and usefulness of the profession that every caution should be exercised on this point. Forbearance in words, till the judgment is well decided, is therefore in some sort a duty, as well as an act of prudence. And it further behoves the physician to acquire as much mastery and readiness as possible in the
observation of those symptoms which distinguish a disease or foretell its probable event; — another phrase, it may be, for medical experience; yet with the advantage of being more explicit as to a very important part of practice.* If mistakes in judgment be still made (and this will occur to every one), though their avowal is not always needful or desirable, yet I believe the character of the profession, as well as of the practitioner, to be best sustained by truth; -- spoken as a man of sense and integrity will speak it. This is a point of medical morality to be impressed upon all who are still young in their professional career.
Not only in the examination of symptoms, but also in describing them, it were much to be wished that something like a determinate method could be devised, admitting of being carried into general use. Such method, if attained, would render practice itself more exact, and the record of cases more intelligible and useful to others; besides facilitating greatly the study of those general relations of disease and remedial means, upon which the progress of medicine, as a science, mainly depends.†
There is reason for affirming that neither diagnosis nor prognosis (particularly the latter) have attained all the exactness of which they are capable, even on our present knowledge. It is worthy of note how much more the ancient physicians deal in the prognostics of disease, and the mutual relation of symptoms, than do those of our own time. Perhaps the very progress of physical knowledge, and of methods of experimental research, are concerned in this change. When physiological science scarcely existed, these particular signs had a more especial value in the interpretation of the course and results of disease. It might be curious, and not useless, to collect all the poppηrika and кpices of Hippocrates, in comparison with the results of modern observation on the same points. A vast number would be found affirmed by him of which we have no present note; some wholly groundless, but many others true and of useful application.
+ Dr. Todd, of Brighton, published some years ago a short treatise containing some excellent suggestions on this subject.
In the treatment of disease, it is not a bad rule to look first to the external remedies befitting each case, before determining those for internal use. This also may seem a trifling suggestion. Yet such technical arrangement, if involving no practical error, is generally useful, and especially to the young practitioner; who is often painfully harassed, not only by the responsibility of instant judgment, but by the number of objects and methods present to him for consideration. Nor is it the technical aid alone which is of value here. It is well that every practitioner should keep in mind the expediency of attaining all that is possible by external remedies; discreet preference, strongly sanctioned by modern research, and in no wise incompatible with the bold and sufficient use of internal means when called for by the more urgent necessities of practice.
The physician who leaves the bed-room of his patient, especially in cases of fever or acute disorder, without attending to more than the prescription of medicine and diet, has very imperfectly fulfilled his office. He is bound further to look to temperature and ventilation; the fit state of the patient's bed; his posture; the needful changes of clothing; the proper use of water for cleanliness or coolness; and the maintenance of quiet. These things, contributing alike to the comfort of the patient and to the chances of recovery from disease, are often, it must be allowed, passed over or too hastily dealt with, in the hurry of practice; -an omission the more important, as many of them are expressly the subjects of popular prejudice and mischievous error, and as it frequently happens that the patient himself is wholly unable to explain what is thus needful to his situation.
The ability and good faith of the practitioner are equally put to test in these less ostentatious parts of his science, as in those to which common opinion assigns a higher value. And
it is a further reason for the use of certain regulated methods in these details, that nothing may be omitted, where so much is to be considered and done; and this under circumstances the least favourable to collectedness of thought, or exactness and sufficiency of direction.*
The medical scholar will recollect the various precepts of Hippocrates as to the methods fitting to be observed in a sick room, as well as his more admirable maxims touching the moral demeanour of the physician in his professional life.
If it should seem that the remarks of this chapter (a small part of so wide a subject) are either too familiar or made too much ex cathedrâ, I must plead my conviction from experience of their importance; and my hope that they may be useful to some, who need guidance in details in the earlier and more difficult stages of practice.
ON GOUT, AND THE USE OF COLCHICUM.
ARETEUS has said of gout Αιτιην δε ατρεκεα μεν ισασι μουνοι Θεοί, εοικυίαν δε ανθρωποι- and even now, with the lapse of nearly eighteen centuries between, it would be difficult to state our knowledge of the intimate nature of this disease in very different terms. The greater part of that which is either ascertained, or strongly to be presumed, may, I think, be comprized under the following general heads: —
1. That there is some part of bodily organization disposing to gout, because it is an hereditary disorder.
2. That there is a materies morbi, whatever its nature, capable of accumulation in the system,― of change of place within the body, and of removal from it.
3. That though identity be not hitherto proved, there is a presumable relation between the lithic acid, or its compounds, and the matter of gout; and a connexion through this with other forms of the calculous diathesis.
4. That the accumulation of this matter of the disease may be presumed to be in the blood; and its retrocession or change of place, when occurring, to be effected through the same medium.
5. That an attack of gout, so called, consists in, or tends to produce, the removal of this matter from the circulation; either by deposits in the parts affected; by the excretions; or in some other less obvious way, through the train of actions forming the paroxysm of the disorder.
6. That there is intimate relation between the condition of