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قراءة كتاب Opuscula Essays chiefly Philological and Ethnographical
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Opuscula Essays chiefly Philological and Ethnographical
should be the gain of the practitioner, not the loss of the patient.
Now, if I did those whom I have the honour to address the injustice of supposing that the moral reasons for disciplinal preparation, during the course of study now about to be entered into, were thrown away upon their minds and consciences, I should be at liberty to make short work of this part of my argument, and to dispose of much of it in a most brief and summary manner. I should be at liberty to say, in language more plain and complimentary, and more cogent than persuasive, that you must be up to your work when you begin it. If you stumble at the threshold, you have broken down for after-life. A blunder at the commencement is failure for the time to come. Furthermore; mala praxis is a misdemeanor in the eyes of the law, for which you may first be mulcted by a jury, and afterwards be gibbeted by the press. This fact, which there is no denying, ought to be conclusive against the preposterous doctrine which I have exposed: conclusive, however, as it is, it is one which I have not chosen to put prominent. Let a better feeling stand instead of it. Honesty is the best policy; but he is not honest who acts upon that policy only.
All this may be true; yet it may be said that the responsibility is prospective. "'Sufficient for the day is the evil thereof.' We'll think about this when we have got through the Halls and Colleges. You must give us better reasons for sacrificing our inclinations to our duty than those of a paulo-post-futurum responsibility." Be it so: you have still a duty, urgent and absolute—not prospective, but immediate—not in the distance, with contingent patients, but close at hand, with the realities of friend and family—not abroad with the public, but at home with your private circle of parents, relatives, and guardians. By them you are entrusted here with the special, definite, unequivocal, undoubted object—an object which no ingenuity can refine away, and no subtlety can demur to—of instruction, discipline, preparation. You not only come up here to learn, but you are sent up to do so: and anxious wishes and reasonable hopes accompany you. You are commissioned to avail yourself of a time which experience has shewn to be sufficient, and of opportunities which are considered necessary: and there is no excuse for neglect.
Great as are the opportunities, they are not numerous enough to be wasted; and limited as is the time in the eyes of those who only know it in its misapplication, it is the period that a considerable amount of experience has sanctioned as a fair and average time for fair and average abilities, and for fair and average industry:—not a minimum period made for iron assiduity on the one hand, or for fiery talent on the other, but a period adapted to the common capacities of the common mass of mankind—a common-sense time,—a time too long or too short only for the extremes of intellect—too short for the slowness of confirmed dulness, too long for the rapid progress of extraordinary and rarely-occurring genius.
Of this time you are bound to make the most. It is your interest to do so for your own sakes; it is your duty to do so for the sake of your friends.
You come to the hospital to learn—you come to the hospital to learn in the strictest sense of the word. You come to learn medicine, as you would go—if instead of physic your profession were the law—to the chambers of a special pleader, a common lawyer, or an equity draughtsman. In this strict sense does your presence here imply study—study exclusive, and study without any loss of time, and without any division of attention. You do not come here as a clergyman goes to the University; but as artists go to Rome—not to keep terms, but to do work.
I must here guard against the misinterpretation of an expression used a few sentences back. I wish to let nothing drop that may encourage the germs of an undue presumption. I expressed an opinion—which I meant to be a decided one—that the time allowed for your medical studies was full, fair, and sufficient,—so much so that if it prove insufficient the fault must lie in the neglect of it. Sufficient, however, as it is, it gives no opportunity for any superfluous leisure. It must not be presumed on. You have no odd months, or weeks, or days, or even hours, to play with. It is a sufficient space for you to lay in that knowledge of your profession which the experience and opinion of your examining boards have thought proper to require. I believe the amount thus required, to be, like the time granted for the acquisition of it, a fair amount. But it is not a high one, and it is not right that it should be so. Standards of fitness that are set up for the measure of a body of students so numerous as those in medicine, rarely err on the side of severity. They favour mediocrity; and they ought to favour it. It is safe: and that is all they have a right to look to. What they profess is never very formidable; and what they require is generally less than what is professed. But the time that is sufficient for this modicum (or minimum) of professional learning is not the time sufficient for the formation of a practitioner of that degree of excellence which the competition of an open profession, like that of medicine, requires as the guarantee of success. An examining board has but one point to look to—it must see that you can practise with safety to the public. It never ensures, or professes to ensure, that you shall practise with success to yourself, or even that you shall practise at all. In the eyes of an Examiner, as in those of a commissioner of lunacy, there are but two sorts of individuals; those that can be let loose upon the public, and those that cannot. In the eyes of the public there is every degree of excellence, and every variety of comparative merit or demerit.
Now as to the way of attaining these higher degrees of merit, and the rewards, moral or material, which they ensure—which follow them as truly as satisfaction follows right actions, and as penalties follow wrong ones. The opportunity we have spoken of. It consists in the whole range of means and appliances by which we here, and others elsewhere, avail ourselves of those diseases that humanity has suffered, and is suffering, for the sake of alleviating the misery that they seem to ensure for the future. Disease with us is not only an object of direct and immediate relief to the patient who endures it, but it is an indirect means of relief to sufferers yet untouched. Out of evil comes good. We make the sick helpful to the sound; the dead available to the living. Out of pestilence comes healing, and out of the corruption of death the laws and rule of life. Suffering we have, and teaching we have, and neither must be lost upon you. It is too late to find that these objects, and objects like them, are repugnant and revolting. These things should have been thought of before. Your choice is now taken, and it must be held to. The discovery that learning is unpleasant is the discovery of a mistake in the choice of your profession; and the sooner you remedy such a mistake the better—the better for yourselves, the better for your friends, the better for the public, and the better for the profession itself.
Steady work, with fair opportunities—this is what makes practitioners. The one without the other is insufficient. There is an expenditure of exertion where your industry outruns your materials, and there is a loss of useful facts when occasions for observation are neglected.
See all you can, and hear all you can. It is not likely that cases will multiply themselves for your special observations, and it is neither the policy nor the practice of those who are commissioned with your instruction to open their mouths at random.
See all you can.