450 ON A CASE OF EXCISION OF THE KNEE-JOINT 



you might all have done for \^ourselves. Any one of j^ou might, as a dresser, 

 clip away a piece of granulations and see that the proceeding was painless, 

 or any of you might equally easily make a pattern of a granulating sore and 

 prove to himself its shrinking tendency. You might perhaps have opportunities 

 for performing skin-grafting ; and might, for aught I know, draw for yourselves 

 the inferences to be deduced from it. 



But, on the other hand, you might very likely fail to do some or all of these 

 things even in the entire course of your studentship ; and if you do not learn 

 these matters when students, you may perhaps never learn them at all. Some 

 of you may become in course of time * pure physicians', and in that case you 

 will have no opportunity of studying the healing of sores ; and yet it is a subject 

 which concerns the physician as well as the surgeon. If the intestines become 

 ulcerated in typhoid fever, the sores must heal by granulation and cicatrization 

 in a manner precisely similar to that which occurs in an ulcer of the leg. But 

 the physician has no opportunity of witnessing this healing process during 

 life ; and when he sees its effects on post mortem examination, they are probably 

 marred by the results of decomposition. And so with a multitude of other 

 things, which it is easy for me to prove to you by demonstration here, but which 

 the physician can only learn by inference. For medical diseases differ from 

 surgical diseases not so much in their nature as in their situation ; and the 

 same great principles of pathology, and to a large extent of practice also, must 

 guide alike the physician and the surgeon. 



Now, these great principles may often be illustrated by extremely simple 

 facts, such as those which you have witnessed in that ulcer. But such simple 

 and rudimentary, or, so to speak, homely, truths are not only much more easily 

 demonstrated in the theatre than in the ward, but would very likely never be 

 taught in the ward at all. In ward visits the surgeon passes from bed to bed, 

 and points out the most striking features of interest in the various cases ; but 

 matters of everyday experience, though concerned with the most fundamental 

 principles of our art, are not likely to receive attention except from some one 

 who is appointed to discharge the duty of impressing upon his class by way of 

 demonstration, not only points of unusual interest, but the most commonplace 

 facts, which, though less attractive, are, in truth, more important to the student. 



Thus our clinical course resembles in so far a systematic one that it is our 

 duty, as the material at our disposal permits, to illustrate all departments of 

 general surgery ah initio every session. And meeting you so frequently as I do 

 — twice a week — with an attendance on your part as regular as is given to a 

 systematic course, I am encouraged to keep my eyes open throughout the session 

 for the materials requisite for such illustrations. 



