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I must be allowed to repeat, that what it contains are not formal treatises on the several subjects discussed; but simply selections, from my notes and experience, of those general views or practical suggestions, which I am led to regard as deserving more notice than they have hitherto commonly received. It will be thought by some that I am too sceptical as to the extent and exactness of the attainments already made in medical science. I can only reply to this, that I have in every instance sought to define what I believe to be the truth; satisfied that by the abandonment of all wrong pretensions, the true interests of the profession are best consulted, and the fairest foundation laid for repairing all present deficiencies of our knowledge. I have, at the same time, generally endeavoured to suggest, as far as my judgment would allow, those methods of reasoning or research which seemed to me most conducive to this important object.
I have only to add further, that the reception of this work will encourage me still to persevere in noting down the various reflections which occur to me in practice; and that, if on revision of them at some future period, they should appear worthy of this, I may perhaps venture to make public another volume, on the same principle of selection as that I have adopted in the present.
Lower Brook Street, July 30. 1840.
TO THE FIRST EDITION.
THE title of this volume is chosen as being that which most nearly expresses its contents. Though appearing now as detached papers, they are founded chiefly upon notes made in the course of twenty years of medical practice in London. During nearly the whole of this time, I have been accustomed to preserve notices, not merely of particular cases, but also of such general reflections as were suggested to me by actual observation. At the expiration of the period named, I have thought it well to look back upon these various memoranda; to give something of more definite form to those which seemed worth preserving; and to compare the whole, as well with my own present impressions, as with the actual state of knowledge on the several subjects in question. This volume is the result of a revision and selection so made. But as its form, though sanctioned by
precedents of high value, is not altogether common, it may be right to add a few words more, in explanation of the motive and manner of publication.
It seemed to me, looking at them as impartially as I was able to do, that there were, among these papers so revised, a certain number which might be likely to contribute in some degree to medical knowledge, or to the exactness of our views in practice. I have had regard to these objects only, as justifying publication; and as a principle of selection out of the materials before me. In making this selection, I have put aside a great deal as relating to subjects of inferior importance; still more, from finding that many of my notes related to facts or opinions no longer new. What I have retained includes much that will be familiar to all who have carried observation and study into their medical life. But this was inevitable, without wholly omitting many subjects of great interest; and it would have been presumptuous to offer a work composed, as this has been, from materials acquired in the course of active practice, as one of original research.
Every physician has, in his progress, some particular occasions or facilities capable of being converted to good. The opportunities of private practice, from which almost exclusively my own observations are drawn, do not furnish the same striking conclusions as those of hospitals; nor the large classes of facts, which form the statistics of medicine, and are so fruitful of results. Yet such is
the scope of the subject, that a prolonged experience, with due regard to the nature and sufficiency of the evidence, may from this more limited source derive much to aid other methods of research, and to enlarge the general amount of medical knowledge.
What I would fain hope may be found in this volume is, a just view of some of the relations of diseases, as well to each other as to the healthy functions of the body; the correction of some doubtful or erroneous views in practice; -suggestions which may be useful as regards particular classes of remedies; and reflections on certain points of physiology, in which, without any pretension to experimental inquiry, it appeared to me that something might be gained by arranging the facts and inferences in a new form. On topics of the latter class I have sought especially to associate pathology with physiology, the morbid with the natural and healthy states of the body; believing this principle of modern inquiry to be above all others fertile in sound conclusions, and far from being yet worked out to its full extent. If I might venture on giving any distinctive character to the volume, it would be that of aiming throughout at this object.
In one instance only have I indulged in any mere speculation; and this only interrogatively, as to an old hypothesis, regarded in its relation to modern science, and to the history of a remarkable disease. Many other points I have put as questions; finding them as such in my notes; and thinking it well,
whenever it could be done, thus to mark the objects most open to inquiry. I have further taken the privilege (which experience may perhaps be allowed to sanction) of commenting on certain usages and details of practice, in which the character and usefulness of the profession, and through them, the welfare of the public, are materially concerned.
On each subject treated of, I have brought together my notes in the manner best suited for perspicuity; adding whatever seemed necessary to give greater completeness to the reasoning, or to connect it with the inquiries of others on the same topics.* In effect of this, much of the volume has been wholly written anew. I had at one time proposed the insertion of a greater number of the cases upon which its materials were founded; but I abandoned the intention, from a wish not to increase the size of the work, which this must largely have done. And for the same reason I have abridged into the form of notes many topics on which I had originally written at greater length.
As respects the arrangement of the subjects, it will be found a very desultory one; such as naturally arose out of the miscellaneous materials employed. In a few instances only have I thought it worth while
* On the latter point great deficiencies are inevitable. In these days of various research, actively pursued in so many countries, it would require more reading than is compatible with actual practice to collect together all that has been done on these subjects; nor would a single volume suffice for the mere references needful to such a work.