The Duties of Medical Men. - The Interdependence of Diseases showing the Importance of Periodical Examinations.

Gentlemen, we are all members of a practical profession. We have taken upon ourselves high and responsible duties, all culminating in action. So long as we choose to assume these duties in a profession as yet so far from perfection, we are not justified in spending our time in scientific investigations or speculations, unless they have for their end some practical application for the good of humanity. It is the hope of attaining such an end which has led me on in the design and labour of these Lectures.

I proceed at once to lay it before you.

In the beginning of the first Lecture I asserted that we are justified in practising the profession of medicine only in proportion as we believe in the articles of the following creed: -

1. That man may be the instrument through whom invasion and progress of premature destructive changes in the human organism may be prevented or arrested.

2. That man may be the instrument through whom the damaged organism may be more efficiently repaired.

3. That man may be the instrument through whom the sufferings of the human being may be alleviated.

In what sense the organism is capable of accomplishing these ends without the instrumentality of man, I have shown you (in the previous lectures) by numerous arguments and examples. I have also shown you the various modes by which it becomes deprived of this capability. The conclusion at which I now arrive is this, that man may be the instrument through whom the capability of accomplishing these ends may be preserved and restored to the organism.

The manner in which man is to exercise this instrumentality is the next point for our consideration. But I think we have almost reduced it to a necessary conclusion. For as we have plainly seen that the organism is competent to take care of itself, provided that it possesses a normal Vital force, and is surrounded by normal conditions of life; and as we have also seen that the great causes of defect in the force are the vestiges of disease and abnormal conditions of life; and as we have also learnt that the diseases, from which the vestiges result, are invited by defects of the force; and that, when thus invited and received into the organism, they are capable of being disposed of without leaving vestiges behind, if the Vital force is free from excessive defect; that thus these vestiges are due to defective force; and as we have learnt that the earliest invasion of defects in the force - upon which all the long and intricate succession of ills depend as a germ - as we have learnt, I say, that this state of germination exists at a period anterior to the manifestation of disease in its ordinary characters, and that it is to be found in the garb of slight impairments of the general health, the indications of which are more and more evasive and occult, the earlier the stage of germination; and, finally, as we have learnt that it is in this occult and evasive stage of germination that the defect is most easily and most efficiently to be remedied; I think you will agree with me in the practical conclusion at which I have arrived.

This conclusion is - that the manner in which man is to exercise his instrumentality for the prevention of disease, the prevention of the vestiges of disease, and the prevention of fatality in disease, is to search out these earliest evasive periods of defect in the physiological state, and to adopt measures for their remedy. (See p. 206, "Abnormal Physiological States")

This appears to me to be the highest, the most ennobled duty of the physician, calling for the most abstruse knowledge of the science of life, the deepest experience in disease, the keenest exercise of the perceptive faculties, the calmest, most far-sighted reasoning and the wisest judgment - a duty as much above the management of acute disease as to rule an empire is above fighting a pitched battle.

Now, I am perfectly convinced, from my own observation and experience in practice, that patients never think of consulting their doctors till these conditions of impaired general health have advanced far enough to have been developed into some form of disease: that thousands and thousands of persons, believing themselves to be in health, are nevertheless undergoing these early, occult, and evasive stages of defect in the physiological state; and that such persons may be considered to be in health, not only by themselves, but by any one accustomed to associate with them.

The only means by which to reach this evil and to obtain the good, would be for persons to submit themselves and their children to systematic periodical examinations.

Such examinations ought to include an inquiry into the family history, to learn the hereditary constitution; into the personal history, to learn all the previous diseases that have been passed through, and the habits and vicissitudes of life; into all the conditions of life surrounding the individual; into the condition of the organs and functions of the body; into the state of the secretions and fluids of the body by analyses and microscopical examinations; and so forth.

The examination should be reported in writing; and, after due consideration, such advice should be given as a careful judgment may dictate, for the future conduct, pursuits, and habits of the patient, with a view to correcting any defects or tendency to defects in the organism. Advice should also be given as to the means of removing any vestiges of disease that have been detected, or, if they are not removable, advice as to the best way of overcoming their influence or of averting their increase. To this must be added precautions to be adopted in certain contingencies which, according to the judgment of the case, appear probable.

If such a plan as I have here proposed were to he faithfully and conscientiously carried out by the present and rising generation of well-educated, studious, medical men, immense benefit would be conferred upon the public. The next question is, then, what would be the effect upon the profession in a pecuniary and in an ethical sense. With regard to the pecuniary question, it is only necessary to observe that, of course, I do not expect that any man in good practice, whose time is profitably employed, could conduct such an examination and give such advice for the usual consultation-fee. A special fee would be necessary to enable him to give the necessary time and consideration to every case.