Letters on the study and practice of medicine and surgery, and on topics connected with the medical profession : addressed to students and young practitioners of medicine, to parents and guardians, and the public in general

Front matter

LETTERS

ON THE

STUDY AND PRACTICE

Dedication

IN MEMORY OF THE LATE

MR JOHN WALLACE OF GLASGOW, SURGEON, R.N.

When I began to write the following Letters, I determined, if they should ever be given to the world, to dedicate them to him whose name appears above. It was at his instigation that I first entered on the study of Medicine ; it was from him that I received many excellent lessons regarding it ; and it was with him I hoped to have practised it in after-life. But ere these Letters were brought to a close, we were separated forever. He died at an early age, when he was gradually rising in his profession, and in the esteem of men. I can, therefore, only put his name on record as one departed, but as one by me never to be forgotten. Being my brother, it becomes me not to speak here of his goodness, or of his talent. It is enough to state, that they were known and appreciated in the iv

LETTER I. Page

On the necessity of attending to the Disposition before fixing the Profession 1

LETTER IL

The Importance of the Medical Profession — Requisites for its Practice, &c . . 12

LETTER in.

On the age at which the Study of Medicine should be entered upon, and on the question. Whether a Medical Man should be generally learned 26

LETTER IV.

The Course of Study 45

LETTER V.

The Course of Study continued 60

LETTER VL

Advice to the Student 78

LETTER VIL

Books necessary for the Student 1 05

LETTER Vin.

Advice to the Young Physician or Surgeon 122 vi

CONTENTS.

Page.

LETTER IX.

Advice to the Young Physician or Surgeon continued . .144

LETTER X.

On Amateur-Physicians, &c 170

LETTER XL

On the impropriety of interfering with the Practice of Medical Men, &c. . 181

LETTER XIL On the Exhumation and Dissection of the Dead . . . .197

Preface

It is undoubtedly of essential service to a person about to begin the study of any branch of science, to have his subject fully explained to him by one who understands it, and to have the best methods by which he can arrive at his knowledge clearly pointed out to him. He thus knows beforehand what he has to do, and, having a direction for each step in his progress, he is at no time left in uncertainty ; he has merely to give application, and follow the path which is marked out for him. This is essentially necessary in all things, from the boy who is beginning his earliest lessons, to the matured man who is seeking to become acquainted with the most intricate parts of learning. There must be something to guide them, whether it be a book or a friend, through the difficulties of their tasks, or their progress will not only be slow, but it will also be imperfect. It is im-

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PREFACE.

possible to get to the knowledge of a science, except by the one proper path. We may become acquainted with parts of it, or we may even get an imperfect knowledge of the whole, by merely taking our own judgment as our guide, as we proceed to meddle with its intricacies ; but we save a great deal of time, and we accumulate infinitely more knowledge, if we at once seek the advice of persons wiser than ourselves, and submit to be led by them so long as we stand in need of teaching. In Medicine, this is especially necessary, because Medicine is a complicated science, requiring great judgment, and great attention on the part of the pupil. It is a science made up of so many branches, (each branch, indeed, forming a science of itself,) requiring so much order in its study, and so much skill in its cultivators, that it is out of the question to think of acquiring it without having reference to some instructor. Its parts are so numerous, and its path so extensive, that we can never hope to find the way in it ourselves ; and so much depends upon keeping in the right path — upon meddling with each part at

PREFACE.

ix the proper time, and devoting to it the due portion of labour — that we must of necessity have a guide to direct us, if we would learn it perfectly.

And yet, there are a great many who enter upon this very nice and intricate piece of learnino; without instructors, and without almost any preparation for it whatever. Young men come in from the country, every season, to study Medicine at our Universities, who have not only little natural talent, but even that talent which they have has not at all been prepared for the work they are to engage in. They have been told, perhaps, by some practitioner in their neighbourhood, what classes they ought to attend, and what books they ought to procure, but they have received no regular code of instructions for their guidance, and they must rely upon their own judgment for all that they may do in the winter. Or, perhaps, when they arrive in town, they seek amongst the other students for instruction, many of whom are no better informed than themselves ; and thus they are led astray in the beginning, and continue to

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PREFACE.

be led astray to the very end of the session. It is only when they get farther knowledge in the business, or perhaps when they happen to compare notes with students better informed, that they find out how much they have been deceived. I have known many fall into this error ; and he who is so unfortunate as to be led into a mistake of this kind, will regret it forever, when he comes to be sensible of the time and opportunities which have so unprofitably gone by.

In those parts of learning, where the pupil is immediately under the eye and direction of the master, it is scarcely necessary that he should have any assistance except the teacher's ; indeed, in some cases it might be positively injurious for another to interfere. When it is so managed, that the scholar comes in actual contact with the preceptor at every lesson — when he can enter into familiar discourse with him at every time he meets him, and seek his assistance whenever he finds himself in difficulty — then there is no need for either a friend or a book to instruct ; he has merely to walk by the master's advice. But as it is

PREFACE.

xi the case, in studying Medicine, that the student never, perhaps, exchanges a word with the teacher from the beginning of the course to the end of it — from the time he purchases his ticket of attendance till he goes to get his attendance certified — I say there is great need for his having some other guide than the teacher to help him on in his studies. I am far from saying that teachers of Medicine will not give the necessary advice to the pupils when it is asked of them. I know many who are glad to do this. But it is not the custom to ask it of them, unless there be some little acquaintanceship between the parties ; and even then, from the fear of giving trouble, we sometimes keep from asking what we are really anxious to know. It is necessary, therefore, that the student should have a book of instructions to render him in some measure independent of every one. In case he should have no friend to direct him, he should then have a book as a directory, which will at any rate give him an idea of the path he should walk in. And what I here say does not alone apply to medicine. In many other sciences

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the learners stand much in need of some good books of reference. •

After a good deal of reflection upon these matters, I formed the resolution of putting a few thoughts together on Medical Education. I resolved upon the thing when I was myself at College, but many things, until lately, prevented me from carrying my plan into execution. In the following Letters I have entered pretty extensively into the subject. I have given the student ample directions regarding the classes he ought to attend — the order of his studies — the books he ought to procure — the attention due to each subject, &c. ; and I have followed this up by advice to him as a young physician or surgeon, when he has entered on the practice of his profession, and has the lives and health of society in his hands. Previous, however, to directing my attention to the student, I have addressed some advice to the parent and guardian on the disposition and talents which a surgeon ought to possess — the age at which the study of Medicine should be begun — the learning which the medical student should have be-

PREFACE.

XU sides his medical learning, &c. And, after having got done with the student and surgeon, I then give some hints to the public in general on the study of Medicine as a part of a liberal education — on the conduct of the public towards medical men in the practice of their profession — and on the opinions which prevail in society regarding the exhumation and dissection of the dead. It will be easy, without any farther instruction, for each party concerned to pick out what particularly relates to them ; but it will do no harm to mention, that the three first Letters are intended for the parent and guardian ; the four following these for the student ; the next two for the young physician or surgeon ; and the last three for the public in general. However, I trust even the whole book may be perused with some little advantage by all or either of the parties. The student and young surgeon may not be the worse for readino" it all ; and though to the others some parts of It may not be very interesting, yet if they take any interest in medical science, they may perhaps find time to glance at the whole.

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PREFACE.

At the same time, I am perfectly sensible of the many imperfections which exist in the work. I am satisfied that the majority of medical men would have executed the task better than I have done ; but I have at any rate made an attempt at something useful, and if it should serve the purpose till a better work appears, I shall have accomplished what I had in view. Perhaps some one more capable will produce from these imperfect hints a more useful book ; and if this happens, though the present volume should then be altogether forgotten, it will have had its use. He who projects is sometimes deserving of as much praise as he who actually carries into execution ; for without the hint from the humble originator, the subject might have remained unthought of, and its execution, of course, could not have happened.

These letters were written in 1826, while I was attached to H. M. ship Ocean, at that time lying in the Tagus. The writing of them beguiled some hours, which otherwise miffht have been tedious ; and whatever their fate may be, I shall not regret the time spent

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PREFACE.

XV in composing them. I have even profited by them myself ; and if others also find something in them useful, I am amply rewarded for my trouble.

J. W.

Glasgow, 25tli September 1828.

LETTER I.

ON THE NECESSITY OF ATTENDING TO THE DISPOSI- TION BEFORE FIXING THE PROFESSION.

Lisbon^ April, 1826.

" I have seen a book written by Juan Huartes, a Spanish physician, entitled ' Examen de Ingenios,' wherein he lays it down as one of his first positions, that nothing but nature can qualify a man for learning; and that without a proper temperament for the particular art or science which he studies, his utmost pains and application, assisted by the ablest masters, will be to no purpose." Spedaior.

All the prudent agree, that in the choice of a wife, the individual should be allowed to judge for himself, and that nothing should be done contrary to inclination. That man is not likely to be blessed in his choice, who will allow, at the season when he thinks on marrying, relatives or friends to have any undue influence over him. That man, indeed, hardly deserves to be happy, who would make his marriage a matter of interest or convenience, and give his hand where his heart is not, merely because he thinks the connection is to be in some way beneficial to

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him. — How could he be happy ? How could it be expected that the parties thus brought together would have any thing like true conjugal felicity ? Was it to be supposed, that two united, not so much by their own desires as by the desires of others, would be well suited to each other ? Can the heart which gives itself away only for gain, ever be supposed to amalgamate with the one which gives itself away only for love? Can there be affection after union, if it does not exist before ? Never. Two individuals thus united may preserve, it is true, even through life, all the outward forms of decency ; but to them can never come that warmer and more devoted attachment which is characteristic of the pair who have been drawn together by natural affection only. They jog on together on the road of life, just because they are obliged to do so — just because they are tacked together, and the tacking is of such a nature that, when once made, it cannot easily be undone — but they travel with uncongenial feelings ; their path is heartless ; and it would have been better for both had they never known each other.

So, in the choice of a profession, should the will be left altogether without restraint ;

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or, if violence be done here, exactly as in the other case, unhappy consequences will ensue. The individual,because it is the profession he has been wedded to, may follow it ; but he never will have the proper success or comfort in it : because he is bound to it, as the man is bound to his wife — because he has learned it, and learned no other — he may stick to it, but he sticks to it in some degree with a grudge, and he never can prosecute it with the ardour that another does who is devoted to it. Others not possessing half the ability that he does, get on far more successfully, and go far a-head of him in his line — and why ? — ^Just because he cannot bring his ability to apply here — he has not been fitted for this profession — this is not the occupation congenial with his feelings — this is not the ground upon which he is to be stimulated to effort— therefore he cannot compete in the cause. They may surpass him who will, for here he is not ambitious to try his strength. Like the ill-assorted pair, he may keep to his profession through life, but, like them also, he will keep to it without any strong attachment. He may plod in it; because he must plod, but there will be an apathy in his plodding ; and, as the man and

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wife would have been better separate, so would he have been better had this not been his occupation.

Surely, then, it should be a point with those who have the allotting of youth to professions, to leave them in a great measure, if not indeed altogether, to themselves. There ought to be a sounding of the disposition — a trial of the inclination — in the first place — in order to see how the feelings run. This should be done before any particular advice is given ; and then when it is ascertained how the bent of the mind is, unless the feelings are evidently leading somewhere astray, the individual should be indulged, and allowed to fix, by his own wish, his line of life. This it is especially necessary to attend to, as regards the three learned professions. In Divinity, Law, and Physic, I hold that there is an imperative necessity on us to watch and see that they who are admitted into them, come with the proper capacity, and be qualified for what they are to undertake. For these are professions, all of them, in which much talent, and many peculiar requisites, are necessary, and he that does not possess this talent and these peculiar requisites, is incapable of practising them as he ought. They have to be prosecuted with

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such assiduity and research^ that it is not all who are fitted for the necessary labour, and they involve interests of so high an order that it is our duty to be assured that only those who are fitted be allowed to engage in them. But, further, I have to observe, that Medicine, of all the three^ is most deserving of our attention. For, in as much as we value our life more than our property, we will scrutinize our physician more narrowly than our lawyer. And, although it be admitted that the care of the soul is ever to take place of the care of the body, still, it is known that we can change our divine, if we find him not so capable, or so careful of us, as he ought to be ; but ere we can change our physician — ere we can make trial of another cure in that way, we may be out of the reach of all physicians— out of the reach of all help. So, upon these accounts, it is incumbent on us, while we carefully watch over all, especially to watch over Physic.

There seems, indeed, of late years, a kind of mania to have got amongst families, to have their sons, right or wrong, brought into the learned professions. Almost every family now must have at least one son a surgeon, and, perhaps, a second a lawyer, and, it may be.

a third a clergyman ; or, very often, two are found in one family of the same profession — nay, I have even known three, the one following the other. Even the poor man now who has scarcely enough to maintain his fa^ mily in a moderate way, must, at any rate, by some means or other, send one of his sons to college, and make a professional man of him. Instead of putting him to some occupation, for which he is better calculated, and where, from the first, he would be bringing in to his father's assistance a return for his labour, the father scrapes together all the means in his power, and stints himself and all the other members of his house, to procure for this son a college education. Instead of putting him to a respectable trade, by which he would secure to him a moderate livelihood for life, he sends him to learn branches of knowledge for which, probably, he has neither taste nor talent. And what is the consequence ? Why, when he has finished his curriculum of education, he goes back to his father's house but half learned, there to remain unemployed, and to be himself, along with the rest of his family, perhaps through life in difficulty. And thus it is that many a respectable family has been kept in poverty for evef, without any actual good accruing from it. And thus it is that our colleges are so continually kept crowded with people who are unequal to their tasks — with people who ought not to be there. In short, it is thus that our pulpits have become filled with preachers who, though they may be pious, get but few listeners, and our courts with lawyers who, though they may be honest, get but few clients, and our towns and villages with surgeons who, though they may be in many respects excellent men, get hardly a patient.

But let me not be misunderstood ; 1 ant not objecting at all to the number that are admitted into the learned professions. I would not keep any one out who has the necessary talent, and an inclination to get in. And as far am I from discountenancing the meritorious efforts of the poor man who is anxious to give his son a good education, and get him set prominently forth in society. For I know that it is by competition that talent is elicited ; and I know that it has not seldom been the sons of poor men who have gone farthest in learning, and who have most distinguished themselves even in the most

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difficult of sciences. But what I wish to impress is, that we should discriminate in the matter — that we should just make those medical men who are fitted to be medical men — those lawyers who are fitted to be lawyers — those clergymen who are fitted to be clergymen— and those who are fitted for none of these things, to be something else. This is all I stand up for. And when I argue thus, I am not only arguing for the good of the profession, but for the good of all. Because when persons are put to do what they never were intended for, they, of course, tannot be expected to do it well, and error and evil must ensue. However much it may be our wish or our interest to put a child to a particular calling, yet if it be evident to us that he will never succeed well in that particular calling, surely it is a pity to force him to it. And however much I may admire the noble ambition of the father who would put himself to distress, and think not of it, in order that he might get his son to some exalted station, I must not refrain from telling him, that while he is doing himself an injury, he is doing his son no good — ^that while he is impoverishing himself, he is not enriching

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his son, unless it has been proven that the son is equal to the office he is aspiring to.

It often happens that we can see, from a very early period, in the age of a boy, that the mind is turned to some particular profession. We can see that there is a leaning to some particular thing; and when we look at the habits and powers of the boy, we find that this is just the thing for which he is best fitted. In such cases there can be no difficulty— there can be no hesitation in fixing the occupation. All that the parent now has to do, is gradually to prepare and lead on his child, by talking to him occasionally of the profession for which he is intended, and giving him all the information he can concerning it. By alluding, every now and then, to the labours which by and bye he is to enter upon, he prepares him in some measure for them ; by making him familiar with some of the secrets of his business beforehand, he is not so likely afterwards to be taken by surprise. But it also fi-equently happens that an individual shows no particular attachment to any profession, even when he has arrived at the age of maturity, and then it is not just such an easy matter to decide properly. Of

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course, the first thing to be done is, to reflect on the genius and the peculiarities of mind which the individual possesses. His habits should be looked into. His passions, and propensities, and powers both of body and mind should be examined. And when we have fixed on the occupation which we think will suit him, then the nature of it should be as fully as possible set before him, in order that he may still have it in his power to draw oflP, if he thinks the task will be more than he is able for. He should have the hardships which he will have to encounter stated to him ; the sacrifices, as well as the gains — the disagreeable parts, as well as the agreeable ones, should be brought fully forward ; and now when he is told of all these, if he chooses to go on with it, let him go ; he knows what the labour is, and as he has accepted it willingly, we, of course, expect that he will perform it to the utmost of his ability. But never should the parent make his will the guide, or use undue persuasion in the matter. A dutiful child will, no doubt, obey the wishes of his parent, even to the sacrifice of his feelings ; but the chance is, that both parent and son will discover, when too late.

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that they have seriously erred — the one in commanding, and the other in giving his consent.

Note. — I am not yet phrenologist enough to determine whether the science of phrenology is to be at all a help to us in this matter. The advocates for the science say it will ; but I am not sure that all they assert is correct, being a little sceptical as to the correctness and perfectability of their system. Time, however, which makes us better acquainted with all things, will show its truth or fallacy.

LETTER 11.

THE IMPORTANCE OF THE MEDICAL PROFESSION- REQUISITES FOR ITS PRACTICE, &c.

Lisbon, April, 1826.

" Though now we must appear bloody and cruel.

As, by our hands, and this our present act.

You see we do ; yet see you but our hands.

And this, the bleeding business they have done —

Our hearts you see not — they are pitiful." Shakspeare.

For the successful prosecution of any profession, talent is required. It will hold good, I believe, that in all trades, the man of genius, if he has the same diligence, will get a-head of the man who has no genius. For there is no art so simple as to be alike plain to all, nor so fully explored as not to leave yet very considerable room for the exercise of ingenuity in those who have it. The person with the superior mind, will be the person with the superior knowledge, even in the commonest of occupations. That is undoubted. But it is well known, that there are certain occupations which do not require very much talent — that there are certain things for which almost every one is eligible — certain trades, which do not at all require any great exercise of mind, but where common sense and common diligence are enough — and where, when the lessons are once learned, the learner may be said to be master of his trade ; and though he may not stand in the first rank of those of his profession — though he may not be capable of showing in it all the ingenuity which others may show — still, he is quite qualified as to all its essential parts, and is just as able to carry it on as the mass of his brethren. — While it is as well known, that there are certain other occupations, in which a gj^eat deal of talent is required — in which the learner, if he be not in possession of a certain degree of acuteness, and a certain superiority of understanding, will never make any advances towards the point he is aiming at, and he never will be able to emerge from amongst the lowest and the most insignificant of his profession. For, in the prosecution of these occupations, it is solely the mind which has to be tried, and without the necessary talent, nothing, at least nothing of any consequence, can be done. — For the first class of occupations, men of or-

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dinary minds will do. But for the last class, they must be men of superior minds.

Now, at the head of these last occupations, I place Medicine ; next to it I put Law ; and following that, Divinity; and that I am right in ranging them thus, I hope I can satisfactorily show.

Divinity, without any disparagement to it, appears to me to be in some degree like the first class of occupations. That is, there are merelv lessons to be learned — there is a course of study to go through-^and he that can bring with him just enough of talent and assiduity to learn these lessons, and finish this course of study, has learned his profession— his work is, as it were, done. It is true that the lessons to be learned are not rightly to be learned by every one, but that a certain strength and superiority of intellect properly to compass them is required, which gives to the student of Divinity, as well as to the student of Law or Medicine, an opportunity for the display of talent. And it is true, that even when the course of study has been gone through, the clergyman has still a mighty field to labour in, and if he possess an acute and original muid, he may distinguish himself as much, or more, by what he does after mounting the pulpit, as by what he did before. But it is also true, that he who has just that ability which enables him s,ufficiently to understand, and properly to expound, the doctrines of the gospel, is qualified to become a preacher. If he add piety and fervour to this, he may do all the good which the best of clergymen have done ; it is not required of him, unless he feels himself fitted for the task, to engage in any very deep or difficult exercise. But with the professor of Law it is very different. He has not only a long course of study to go through, and a great many lessons also to learn, and a great many difficulties to overcome, but it is when he has finished what is called his course of study, that he may have to encounter his greatest difficulties, and that his judgment, and the exercise of his mind, may come most severely to be tried.