On some Points of Interest to the General Practitioner

J. Ramsay
1888 BMJ (Clinical Research Edition)  
scend to form a precipitate without showing any tendency to again permeate the fluid. Iood.-In his remarks on the subject of food Dr. Woodman expressed his opinion that man is an omnivorous animal, and should not be either a vegetarian or an excessive meat-eater. Moderation in eating and drinng should be observed. Schoots.-In Exeter the co-operation of school teachers has been secured in dealing with infectious diseases. Affected scholars are watched for and excluded from attendance, as well as
more » ... children from infected houses. Notification fDisease.-This Dr. Woodman considers should be compulsory, but the duty should devolve on the householder alone, and not on the medical attendant, although of course the latter should be obliged to inform the householder of the nature of the malady. The objections to the alternative system were briefly referred to. Medical Officers of Health.-Dr. Woodman admits that the appointment of these offlicers is at present in a very unsatisfactory position. In his opinion, the appointment should be for life (except for neglect of duty or infrmity), and while much might be said in favour of medical men not in practice being appointed for large consolidated districts if the appointments were now being first made, it would be unjust to dismiss at once and without compensation a number of medical officers of health who have been for some years giving their services, for the most part for very inadequate salaries, and who have taken much time and trouble to qualify themselves for their duties, often to the damage of their private practice. President of the Bramhel. AFTrF thanking the members of the Branclh for having elected him President in succession to so distinguished a man as Mr. Wheellhouse, Dr. Ramsay alluded to the special fitness of York as a place of meeting for a scientific society. iniasmuch as it was in that city and in the very building (the Museum of the Yorkshire Philosophical Society) in which he was addressing them, that the first meeting of the British Association was held. That association, he pointed out, had originated with some members of the Yorkshire Philosophical Society, and upon the model of that association, the British Mledical Association itself was at the outset framed. Their special function as a Branch was to localise the spirit and work of the parent Association, and to bring the power and influence of the whole organisation to bear on the particular area which they represente. The British Medical Association, by the labours of its various Committees, its ably conducted JOURNAL, and its scientific gatherings, was an enormous power for good to the public, not less than to the profession. As the good of each individual member was important for the general effectiveness of the Association, it might be said with truth that it was before all an educational body. Medical men were learning and unlearning all throuigh their professional lives, and they should be incessantly striving after an ideal perfection as -' general practitioners of medicine and surgery." He disliked the term "ggeneral practitioner " as clumsy, and not expressive of any deflnite legal qualification, and he should be glad to substitute some one word which would adequately convey its meaning. It was a reproach to the language of Shakespeare that it could only furnish a periphrasis to describe a practitioner of the whole art of healing. In England, the collegiate title "surgeon" was employed for the purpose, whereas in Scotland, where a university degree had long been the aim of most who sought to undertake the same line of work, the assumption of the title of "doctor" was common. Considering that the general practitioner was more largely engaged in medical than in surgical work, the latter usage was more logical than the former. It resulted that the profession was made up of surgeons who practised physic, and physicians who practised surgery. Hippocrates, who was known to history as a physician, and who was for his time an ideal general practitioner, showed that in his day " surgery: was included in the total covered by the term "physic," and it was inferred that he was himself an operative surgeon, though the general drift of his writings and observations showed that he did not regard himself as anything but a physician. "1 Physic," in its wider sense, meant 4n6ozs, that was to say, "' N ature." The physician was a student of Nature all round. In this country, the study of natural phenomena in general had been accorded the name of" physics," but all this study and inquiry had been undertaken by the physicians of old, with the object of relieving and curin disease, and in the sense here given to the word "1 physic," medicine and surgery were one. In the practice of physic, however, the surgeon was not always a necessarv figure, his operations used to be classed among the opprobria medzin&. Outside the sphere of iis handicraft, the surgeon wvas hound by medical methods, and in the matter of physical diagnosis, he was under great obligations to the physician. In his introdulction Hippocrates had said: "It is the business of the physician to know in the first place things similar and things dissimilar; those connected with things most important, most easily known, and in anywise known; which are to be seen, touiched, and heard; which are to be perceived in the sight, in the touch, and the hearing, and the nose, and the tongue, and the understanding; wlhich are to be known by all the means whereby we know other things." The Father of Medicine had also said: "The things relating to surgery are the patient, the operator, the assistants, the instruments, the light, where and how, how many things and how, where the body and the instruments, the time, the manner, the place." These two passages gave the scope of the general practitioner of ancient Greece, in whose hands the work of the profession chiefly wa. Even then, however, there were surgical specialists, as was proved by the Hippocratic oath, whereby the candidate bound himself to leave cutting for stone to those who practised that art. Avenzoar, the Arabian, had even charactised lithotomy as an operation " which no respectable physician would witness, far less perform." Nowadays there was a fairly defined boundary between the plhysician and the surgeon. That this division was tending to be overstepped by the surgeon, who had achieved wonderfutl success in regions formerly held sacred from the knife, was a fact which every true physician recognised with the keenest satisfaction. To the physician would still be left the function of detecting the cause of the mischief aiid indicating the mechanical procedure necessary for its relief. Sir William Stokes, in speaking of the indebtedness of surgery to medicine, had exemplified this by a reference to the work of Dr. Ferrier, of whicih, as he said, "brain surgery has to a large extent been the outcome." Though there was a certain fitness in the term " doctor," as used by the public to designate any and every member of the profession, those who had acquired the title from a university might hesitate to follow this custom. It was to that prefix, however, that the whole profession owed a good deal of its social status. For centuries, while surgery was working in a lower sphere, medicine had kept its place as one of the faculties in all universities. The medical profession was justly called a "learned" one, and an excellent case could be made out for calling it the learned one. Medicine and surgery were no doubt sciences, but the successful application of these sciences in practice constituted an art of no little difficulty. This art, was greatly advanced by personal intercourse among those who cultivated it, and it was in this sense more especially that the Association was pre-eminently an educational institution. The history of medicine should find a place in the curriculum because it clearly taught the important truth that there was a medical art no less than a medica science. To the successful cultivation of that art a study of human nature was essential; and it would be most advantageous to us to note the difficulties and the errors as well as the achievements of our professional ancestors. A survey of the past would show us that success in the practice of medicine was something dependent on individual prowess, apart altogether from the perfection of scientific apparatus and modes of inquiry. The very perfection of modern methods tended to the elevation of the whole profession to a uniformity of excellence which made it relatively more difficult for anyone to attain eminence nowadays than used to be the case. If the clinical records of cases of the same disease were taken from the practices of our predecessors so as to illustrate the treatment of any particular ailment by the leading physicians of each period, it could not fail to be highly instructive. It would be found that the reputation of these leading men was due more to their success in treatment than to their peculiarities of doctrine. This was illustrated by the contrast between the theory of such men as Cullen, Sydenham, and Cardan, and their actual practice. The medical practitioner should strive to acquire as much
doi:10.1136/bmj.2.1439.174 fatcat:r6jxh3orsfg73f7hffbhutx6mq