get rid of these errors, and to establish the proper distinctions between certain and uncertain, between the true and problematical, a judicious sifting and testing must be resorted to, credulity and scepticism being equally avoided. CHAPTER II. SKILL IN MEDICINE. THE uncertainty of medicine is often an excuse for blind experimenting. It ought rather to act as a stimulus to the most careful observation. This uncertainty in medicine exhibits to us in what the real skill in the practice of the medical art consists. It consists in appreciating the actual state of the patient in all respects, and then applying our remedies in such manner as are calculated to do the greatest amount of good. In order to appreciate the true condition of our patient, we must not only find out the seat, nature, and amount of disease, but, as far as we are able, acquaint ourselves with every concomitant circumstance. Disregard in these points frequently leads to error in practice. For example: Many Physicians are disposed to consider the morbid state of the system in almost every case as arising from disease in some particular organ. They, therefore, in examining the symptoms search for this disease, and when they think that they have found it, they refer to this, either directly or indirectly, all the phenomena which the case presents. In their treatment of the case, therefore, they direct the remedial means principally to the local disease. They lose sight of the fact, that often there are several organs simultaneously affected, and that the organ which seems to be most diseased is sometimes found less so than some other organ which exhibited no marked signs of its morbid state. They lose sight too of another important fact, that the disease of an organ is often a mere result of a general bad condition of the system. If, in such a case, the Physician considers the local disease the main thing to be attacked by remedies, and directs his efforts to that point, a great error is committed. Some Physicians, from having directed the attention specially to the investigation of diseases of certain organs, are apt to acquire exclusive and narrow notions of disease, and are always disposed to refer to the favourite organ for the origin of the malady. Undue attachment to certain modes of investigation, to the exclusion of others, is also frequently a source of error. Too extensive a reliance upon what are termed physical evidences of diseases of the chest may be cited as an example. The value of percussion and auscultation as evidence of disease of the lungs and heart is not to be doubted, but if relied upon exclusively they become equally sources of errors. Error must necessarily result in the application of our remedies, if we take too exclusive a view in the investigation of symptoms. A remedy may be applicable to a disease which the Physician finds developed in a given case, but there may be some condition of some organ which may render it wholly inapplicable to that case. The general condition of the patient sometimes fails to be appreciated by the practitioner. He may be pursuing a course which would be admirably adapted to cure the disease in a more vigorous patient; and yet, in the case in hand, it may be ruinous. Though it may cure the disease, it may destroy the patient. A Sometimes fearful issues depend upon the decision of the Physician. For instance, here is a case which has been going on for some time without giving much occasion for anxiety; all at once it assumes a new aspect; a new set of formidable symptoms have come on, requiring an entire change in the treatment. variety of perplexing questions arise in the mind of the Physician. If we attempt to remove these new symptoms, how much reason is there to fear that the attempt will so affect the debilitated patient as to destroy life? Severe as the symptoms are, is there a probability, that if a mild course be pursued, the patient may weather the storm? Will he certainly die if the symptoms are left to go on without any attempt to arrest them? And if so, what measures will probably arrest them with the least amount of risk to the patient's life? Such are some of the momentous questions which press upon the Physician's mind. There is no time for consideration; he must act with promptness and decision. In order to decide such questions, under such circumstances, great comprehensiveness of mind and concentration of thought, a cool and clear judgment, are necessary. A mind of narrow views and loose habits of observation will fail to arrive at a right decision. Some, under such circumstances, will doubt and doubt, till the time in which anything effectual can be done is passed by, and the patient dies without having a single intelligent effort put forth to save him. Others, in the confusion of their ideas, pursue a vacillating course, at one moment inefficient, at another destructive; and no rational and steady plan is adopted. Others, still, without waiting to consider the different questions which have been mentioned, see in the new group of symptoms nothing but a new enemy to be attacked, and plunge at once into the fight; a reckless course is entered upon, which either kills or cures. The judicious Physician, in contrast with all these, is neither bewildered nor precipitate. He takes a rapid glance at all the circumstances of the case, and looks carefully at the important and perplexing questions which start up one after another, and then decides intelligently, coolly, and definitely upon his plan of treatment. He may err, it is true; but if he does, it is not his fault, for he has made use of all possible pre |