Peaks of Clinical Medicine

JUST over one hundred years ago Robert Graves, in an address to medical students, wrote these words: "Be assured of this, that however accurate be your knowledge of anatomy, however skilful you may be in chemical theories and manipulations, however extensively you may have mastered botany, however well you are acquainted with the nature and properties of drugs-be assured, I say, that you have acquired all this knowledge in vain, unless you have diligently studied symptoms at the bedside of the patient." It is with this study of clinical or bedside medicine which I wish to deal this morning. I think we will gain a better appreciation of its importance if we look at it from a distance, for true perspective is seen only at a distance. When otne watches the recedinig coast line from the deck of a ship, the view, at first blurredl and confused, becomes clearer, the little hills drop out of sight andi the peaks come up against the sky. I will ask you to look, with me, at the peaks of clinical medicine as they stand out against the sky of history, and in doing so we cannot fail to realise that, in many cases, the peaks of clinical study were also the peaks of medical knowledge, and that the influence of those who kept to the bedside has been one of the greatest factors in the growth of modern medicine. The history of medicine is as old as the history of man-and man is very old. Civilization, as we know it, is a mere fringe on the history of the human race. For countless thousands of years man has lived, sickened, and died in a wrorld very different from ours. As Osler puts it: "What upstarts of yesterday are the Pharaohs, in comparison with the men who followed the Glacial periods." In this dlim distant age the art of medicine must have had its place, and there can be no doubt that it arose from the primitive instinct of sympathy and the desire of man to help his fellows. How did primitive man attempt to equip himself for this task? Probably by generations of, what we would now call, clinical observations. That fever often followed wounds, that chills might cause pain in the side, difficulty in breathing and even death, that movement increased pain in an injured limb, and many other similar causes and …