478 ON THE CAUSATION OF 



But, leaving these personal considerations, let us turn to the subject that 

 lies before us. Clinical surgery is, strictly speaking, surgery at the bed-side ; 

 surgery illustrated by cases in hospital, as distinguished from surgery taught 

 systematically in the class-room. The importance of clinical or bedside study 

 cannot be overestimated. It is the very keystone, without which all the 

 rest of the educational structure, being merely preparatory, would be absolutely 

 useless. It is to surgery or medicine what dissection is to anatomy. It confers 

 a familiar acquaintance with the nature of disease, and an instinctive know- 

 ledge of the appropriate treatment, without which, a man, however accom- 

 plished otherwise, would be utterly unfit to practise the profession. But how, 

 it may be asked, can a course of lectures be delivered upon this principle ? 

 Can it be possible to take a class of the size of my present audience from bed 

 to bed in a ward, and profitably teach them there ? To do this would 

 certainly be impossible. Remarks made at the bed-side are doubtless highly 

 valuable to those who hear them and who see their subject ; but it is only a few 

 at a time who can be thus taught. Hence clinical lectures commonly degenerate 

 into the reading of details of cases, with remarks upon them, which, for the great 

 majority of those who hear them, lack the genuine element of clinical interest. 



This difficulty was happily overcome by Mr. Syme. Though it was 

 impossible to take a large class to the bed-side of the patient, it was easy in 

 most instances to bring the patient before the class, collected in the operating 

 theatre, where they could all see the salient features of the case, and hear not 

 only the remarks of the teacher, but the patient's own account of his symp- 

 toms, and witness the treatment then and there put in practice ; or, if it was 

 thought desirable to defer the operation to another day, they were prepared 

 to watch its various steps with intelligence and profit, after having heard the 

 principles of the procedure fully discussed. Such a course of instruction is 

 truly clinical, and, if rightly conducted, possesses a vividness of interest and 

 permanence of impression peculiar to itself. Having witnessed its advantages 

 when in Edinburgh, I have followed this system in Glasgow, and shall continue 

 to pursue it here. But invaluable as such lectures may be made, you must 

 not suppose that attendance upon them will do all that is needful for you in 

 the way of clinical study. You must not only see diseases and watch their 

 treatment by others, but handle them and be personally concerned in their 

 management. Facilities for this are presented by the hospital offices of dresser, 

 clerk, and house surgeon, and no man should consider himself justified in 

 assuming the serious responsibilities of practice without having availed him- 

 self largely of such opportunities, either in our infirmary or in some other 

 similar institution. 



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