232 



SCIENTIFIC NE\VS. 



[Dec. 1st, 18S7. 



Abridgment of Address by Sir James Paget, Bart., 

 F.R.S., Delivered at the Owen's College, Man- 

 chester, AT the Opening of the Medical Session, 

 1887-88. 



I WISH to speak on the utility of scientific work in the prac- 

 tice of medicine and surgery ; not in the sense of 

 using, for the purposes of practice, all the medical scientific 

 knowledge that has been acquired, but in that of using, after 

 a scientific manner, all the opportunities which practice 

 affords for the acquirement ot more knowledge. In our call- 

 ing careful practice and scientific study should be insepar- 

 able ; they always may be so ; and I want to urge that 

 every one of you should be, to the full measure of his ability, 

 a scientific student both now and all his life long. I have 

 seen enough to make me sure, that they who, whether they 

 know it or not, do their work after a scientific manner are 

 the best practitioners, and contribute most to the general 

 increase of knowledge. Although, therefore, as I have said, 

 my chief object may be to urge the use of science for gain- 

 ing fresh knowledge by the study of what may be observed 

 in practice, yet I would have it always understood that who- 

 ever will thus work will be all the more useful to his 

 patients, whatever kind of practice he may be engaged 

 in. 



I shall not attempt to define " science " or " scientific." 

 Like many of the most useful words in our language, they 

 do not admit of any exact brief definition. What I mean 

 by them may appear as I go on. Many of you are beginning, 

 others have lately passed through, what are especially 

 called your scientific studies, or the scientific part of your 

 curriculum. I could wish that they were not so called, for it 

 seems to imply that the studies following them are not 

 scientific ; and to some minds it implies that the studies 

 which are called scientific are not useful — both of which are 

 serious errors. For, to any of you who so choose, clinical 

 study, whether in your pupilage or in your practice, whether 

 in hospitals or in private, may be made as scientific, in any 

 fair meaning of the word, as either chemistry or physiology ; 

 and to those of you who so choose, the studies of the first 

 two years of the curriculum may be made very useful in 

 after life. 



Now, the first, and certainly in student life the only, safe 

 means for becoming scientific in our profession is the train- 

 ing of the mind in the power and habit of accurately obser- 

 ving facts. Medicine and surgery are eminently a science 

 of observation ; deductions from facts are always unsafe ; 

 I believe that they have done far more harm than good ; 

 and, for the most part, when sufficient facts have been col- 

 lected and arranged, the general conclusions that may 

 justly be drawn from them are nearly manifest. The main 

 thing for progress and for self-employment is accurate ob- 

 servation. Some seem to think it easy to observe ac- 

 curately — they cannot doubt, as they say, the evidence of 

 their senses. There are few greater fallacies. In scientific 

 studies the evidence of the senses needs as much cross- 

 examination as any evidence given in a criminal trial. Self 

 cross-examination it may be, but it must be steady and 

 severe. For by accurate observation we must mean not 

 the mere exercise of the senses, not the mere seeing or 

 hearing or touching of a thing, with some levity of think- 

 ing about it — we must not mean even the keenest use of 

 the eye cultivated in microscopic work, or of the ear hear- 

 ing sounds that to the uneducated sense would be inaudible, 

 or the use of the finger with the most refined detective 

 touch. All these higher powers of the senses you must 

 acquire by careful study and practice, and you must learn 

 to exercise them with all the attention with which a strong 

 will can direct and watch them ; but even all this, difficult 

 as it is, is only a part ot scientific observation. This must 



include, besides, an habitual constant watchfulness — the 

 taking notice of all the conditions in which objects or events 

 are found — their concurrence, their sequences, their seem- 

 ing mutual relations, all their variations. To do this, and 

 to do it again and again, and with constant care, whether it 

 be in things occurring naturally or in experiments — to do 

 this accurately and always is really very difficult. A few 

 seem to have the power naturally — there are some born 

 naturalists, some born physicists ; you have had some 

 here — but in nearly all men, and, you may safely believe, 

 in yourselves, the power to observe accurately needs care- 

 ful self-training, self suspicion, and self-discipline. 



If accurate observation were easy, how could we explain 

 the oversights and the errors of which the evidences 

 abound in the whole history of medicine, and which, I 

 think, every one could find in a retrospect of his own woik ? 

 Look at the history of discoveries. As a general rule, 

 every discovery of things that can be observed tells of pre- 

 vious oversight or want of observation. Some discoveries, 

 indeed, have followed quickly on the invention of im- 

 proved means of observation, or on the advancement ot 

 knowledge clearing away some previous obscurities. 

 These, it may fairly be said, could not have been made 

 much sooner; but of far more it may certainly be said that 

 the discoveries in each generation are evidences of the over- 

 sights, the defective or erroneous observations, of men of 

 previous times — even of the best ot them. Take some 

 leading instances. All the facts which enabled Jenner to 

 discover vaccination were within the range of his pre- 

 decessors; they saw and heard of them, but they did not 

 observe them ; they all overlooked them, except the one 

 farmer who vaccinated his children, but could not persuade 

 others to follow his example. All the sounds on which 

 Laennec established his system of auscultation were within 

 the hearing of previous generations and of his elder con- 

 temporaries ; many had heard them, but they did not 

 listen as he did, and they did not observe the conditions in 

 which the different sounds occurred — how each coincided 

 with some diseased process or change of structure in the 

 heart or lungs. All the facts by which Hunter was guided 

 to his operation lor aneurysm might have been obvious to 

 other surgeons of his own and lately previous times. They 

 did see them ; they did not carefully observe them. I need 

 not multiply examples. Look at any discovery of this or 

 last year, and think whether it might not have been made 

 in the previous year or some years ago ; and when you find 

 that it might have been and was not, though men of ex- 

 cellent ability were within reach of it, then j'ou may feel 

 that accurate and complete observation is a really difficult 

 thing, and that for the fulfilment of your duty, whether to 

 science or to your patients, you must cultivate the power of 

 searching and observing with all your might. 



Not a year passes but someone describes a disease of 

 which we had no previous record — a novelty. And the 

 first case is thought unique, strange, and, by some, not 

 much worth thinking of; but soon similar cases are found 

 here and there, and the new disease ssems hardly rare. I 

 will not say that no new diseases ever appear. I have 

 long maintained that they do ; but they do not come among 

 us on a sudden, and we may be certain, whenever a case of 

 a new disease is observed, it is not the first that has 

 occurred or the only one existing ; similar cases have been 

 overlooked — they have been within sight and have not been 

 observed. And without doubt there are similar examples 

 of oversight among us still. 



I wish that the arguments for this were only in the over- 

 sights, the mere defects of observation. Unhappily the 

 errors illustrated in all the history of medicine, and in 

 much that is still in progress, are very numerous too. 



