An Address on Medical Reform: Delivered at the Annual Meeting of the Lancashire and Cheshire Branch on June 30th, 1897
BMJ (Clinical Research Edition)
Lecturer on Medicine, and myself, protested againstthe action of the College of Physicians when our learned colleagues of that body deliberately threw the study of pharmacology out of their scheme of education. By this action they went over to the party of "cram" as opposed to the party of mental training; and a few months later, when the tears of their lament for the heavy burdens of the hapless student were scarcely dry on their cheeks, they dictated to his professors of pathology, a scheme
... r a compulsory course of bacteriology-a course of instruction in a large field of delicate manipulations which no busy practitioner would ever find time to pursue, and which, if I may speak for myself, perhaps not half a dozen of the Fellows who voted are competent themselves to undertake. Sagacity in practice, the art of applying so much of larger theory as may be useful and of combining it readily with current empirical rules, a good memory for symptoms, and a quickness in giving what painters call true values to each symptom of a group are qualities partly innate, partly learned in the wards, partly in the world. But even these great qualities are of less effect if associated, as too often they are, with unverified premisses and random speculations. Another source of fallacy is the vicious circle of illusions which consists on the one hand in believing what we see, and on the other in seeing what we believe. If we believe that a necklace of coral fades with the health of the wearer, we shall see what we look for; if we see a child after taking pseony root get the better of an epilepsy, we may forget that this prescription of Oribasius always contains with the root an active purgative. When we read in the life of Charles Wesley that a plaster of egg and brimstone on brown paper cured his sickness, we may omit to observe that, as Dr. Paris tells us, he also followed the prescription of Fothergill, which was country air, rest, asses' milk, and llorse exercise. Another besetting fallacy lies in what has been called, since the days of Aristotle, equivocal terms. The meaning of words is not precisely defined, and we, as we argue, slip unconsciously out of one meaning into another. That study of language which our public schools so loudly profess, but which, if I may judge by my own students, they carry out so ill, is the best foundation for clear thinking, as it teaches the student to compare words in various contexts and under widely different conceptions and to perceive their concords and discords as they move from one language into another; in a word, to realise the equivocations which lie always like nets about his feet. Mill well pointed out how great a disadvantage it was to the ancient Greeks that they knew but one language; so that for lack of the study of comparative meanings they were often led astray by merely verbal differences. Finally, let me point out one more danger-that is the danger not only of attaching too high and too permanent an estimate to our empirical laws or maxims within their own sphere, and of forgetting how relative and transitory their values are, but also of carrying them beyond our own sphere, and applying to other orders of phenomena rules which, even within their own order, have to be used with caution and reserve. Yet this error is committed daily, even by medical men. Medical men, let us say, formulate a maxim that insanity, speaking generally, is apt to be hereditary; or that phthisis pulmonalis is infectious-both useful maxims, and indicative of much truth, but far enough from scientific laws. Yet with these imperfect and rather rickety instruments some medical men do not hesitate to invade the sphere of jurisprudence, or the sphere of ethics and civil order, and to order people about in courts of law or in contracts of marriage, forgetting that the very difficulty of using general laws on any large scale, even in mcdicine itself, and that the difficulties of particular cases which arise under the incursions of the causes of secondary and tertiary perturbations, and which are embarrassing enough in medicine, are still more embarrassing in the more complex orders of ethics and of society. When we are angrywith a judge because he declines to discuss a prisoner's guilt " from a psychological point of view," as in a recent celebrated trial was the grotesque appeal of a notorious scoundrel, let us remember that the lawyer, too, has his empirical formulas, which no doubt he ought to revise from time to time in the light of enlarging medical and other knowledge, but which meanwhile, like a sagacious doctor, he will prefer to broader principles which neglect the multiform and heterogeneous elements which are woven into the complex web of the lives of men and women.