Introductory Address on the Need for a Liberal Education in Medicine
Authors: T. C. Allbutt
Journal: BMJ (1889)

ness.If you learn thoroughly to know even one case-diagnosis, prognosis, and treatment, and all about it-in a humane as well as a scientific spirit, you may rest assured that you have got something which will remain with you all your life.If you learn otherwise than thoroughly to know after a fashion a great many cases, you have also goc something that may remain with you as a life-long possession, but that something is simply a bad habit of working; while in the other case it is a good habit, and, over and above this, a valuable addition to your positive knowledge.I can remember now single cases seen by me forty years ago, and some of them are so printed in the memory that they have all the vividness as well as the value to me as though they were of yes- terday, Now I am going to say to you what may seem to be, but is not, a reflection upon particular teachers or pupils.There is a way of perking and pluming one's self upon a diagnosis, as who should say: "See how rapidly and surely I can do it.A single glance at the expression, a moment with the stethoscope, a word or two of conversation, and the thing is done, and the whole case is before my mind."This, according to my experience, is a very fatal bad habit both for the teacher and the taught.No doubt rapidity of diagnosis comes with experience, and is not without a certain value; but,in teaching,the first and the last lesson is always, or ought to be, thoroughness; and thoroughness, in the sense in which I am using the word now, is not consistent with aiming at these lightning flashes of intuition.A true diagnosis risks nothing; it aims at being exact, not at all at being wonderful or rapid.Therefore it is never a thing to make a show of, or to boast one's self about; and he that does it in that boastful spirit is, in the very act of doing so, setting a bad example and teaching a bad habit.What shall we say then of those out-patient rooms where twenty, thirty, or forty cases are disposed of in an hour, not only as to diagnosis but also as to treatment?What again of those immensely busy practices, where the mere multitude of the cases, or the distance to be traversed, make it well-nigh impossible ever to comjplete a diagnosis.Can these be considered as fit fields for gathering sound clinical instruction, or for maturing the crude experience of young aspirants whose chief desire is, according to the programme I mentioned a little while ago, to have personally seen and treated almost every common form of disease?I do not stop, as you will observe, to argue out these questions, for I have no time to do so; but I state, without the slightest hesitation, my own sincere conviction, that for sound clinical teaching and for the formation of correct ways of observing, and thinking about and treating disease-such habits in short, as will be serviceable for a lifetime-the first and absolute rule is thoroughness; there must be no hurry.An hour, or even more, spent over one case (always supposing that the state of the patient admits of this) is out of all calculation more valuable than five minutes each over twelve cases, or even ten minutes each over six cases.And there- fore I say again that the maxim which should guide our superiors in laying down the law of practical instruction is non multa sed multum; not a great multitude of cases just seen, or very super- ficially observed: but a smaller or much more moderate number, the deliberate and careful observation and management of which in detail may form, as Tennyson sings, thA stepping-stones on which to rise to the higher levels of a more rare, or a more diffl- cult, or a more advanced experience.Gentlemen, I have done.I had a good deal more that I should have liked to say to you, but the lapse of time warns me that there will be some of you, at least, waiting anxiously for the end of my sermon.It now only remains for me, as an outsider, to wish you all possible success, and all possible happiness and effi- ciency, in the studies of this medical school during the present session.I have endeavoured to indicate to you only the broad lines on which such success and such efficiency are to be sought.It is for you, so far as lies in you, to make the application.FRANCE AND ITS BEVERAGEs.-Theconsumption of coffee in France during 1888 amounted to 66,969,246 kilogrammes, being 1,752 grammes for each inhabitant.The conrumption of tea was only 516,834 kilogrammes, or 13 grammes per head.In the same year, the production of alcohol amounted to 2,162,000 hectolitres, which gives a consumption of nearly 4 litres per head.Taking individual towns, the consumption at Rouen averaged more than 16 litres, at Havre 15k, at Amiens 11, at Brest between 10 and 11, at Paris 6i, and at Lyons a little ove 5 for each inhabitant.From this it would appear that, roughly speaking, the South of France is three times-as temperate as the North.