E NTERTAIN and show respect for your seniors in practice. There is probably no type of medical man more unworthy than young Dr. Knowitall, who overestimates himself and underestimates his seniors, and shows a corresponding contempt for opinions based on simple reasoning, and regards everything except the latest procedures as entirely obsolete. "He doesn't believe in this that I do," or "He believes this that I don't," or "They don't know this that I know" : Old opinions! Old opinions! Rags and tatters! Get ye gone! Fresh from college, and ours being a progressive science, he may excel the elders with the microscope, and other scientific aids and technical tests; but long experience has been to them a teacher, and they have a clinical acquaintance with disease which gives them almost intuitive perception as to the choice of remedies, that makes them good medical logicians and safer therapeutists, because there are peculiarities which belong to almost every disease about which but little or nothing can be learned from the books; and knowledge and skill derived from observation and experience with them far outweigh mere college-learning and book-knowledge, or specific formulas, learned by rote and applied by routine; and are more like part of one's very self than that gotten from any other source, because they are fixed indelibly on both the senses and reason, to be brought forth again when needed. Remember, too, that although young physicians may have recourse to scientific "extras," fine-drawn distinctions, and modern instrumental aids to diagnosis, and the very latest in treatment, much oftener than do the older men, yet in relying on these too much and on rational subjective symptoms and on the unaided eye too little, they are apt to forget the fact that the value of experience is universally conceded and that the best part of every man's knowledge is that which he has acquired for himself by clear and accurate observation of phenomena, and that the art of curing disease owes more to sound judgment and common-sense bedside observation and experience than to anything else. True, the elders are more apt to disregard the nicer pathological diagnosis, which defines the technical variety of the disease—whether, for instance, a pneumonia is catarrhal, croupous, or interstitial-and to be more attentive to the therapeutical diagnosis which deals chiefly with what the treatment should be; but weighing the quantity and degree of the malady, the influence of age, season, rate of progress, physiognomy, complications, secondary affections, compensatory changes, and other clinical phenomena with a nicety that the junior with all his scientific aids can never acquire from text-books or in the lecture-room; then, with almost intuitive wisdom determining the best remedies for the mental and physical condition of the patient before him—antidoting, reducing, evacuating, quieting, stimulating, or feeding as foresight and experience have taught him: Past mistakes teach future wisdom. Besides, the reputation of every physician is threefold: one portion earned by himself, another acquired from the general respectability and good repute of the profession, and a third from public confidence in it; the last two have done much to give our profession honorable standing, and to smooth the way for the younger men, and those who have done this are certainly entitled to both courtesy and respect. On the other hand, the older physicians, having had their turn, and remembering the rough, difficult, thorny, and discouraging trials; the painful responsibilities, exhausting toils, and heart-rending doubts; the anxieties, the galling rebuffs, and ill treatments; the blunders, the sufferings, and the dearly bought lessons of their own beginning, having been through the mill, and knowing what a treadmill it is, should help and encourage their younger brothers, instead of attempting to: Crush young genius just bursting from the shell, and take them by the hand and all work side by side, with friendly feelings, for, no matter how many aspirants appear, there is always enough work left for the older physician who has done his duty in the community; yea! the world is wide enough, and there are sickness and misery enough in it to give every worthy hand and head and heart something to do. Life is a school for all. When you have been in practice long enough to cultivate observation and to acquire aptitude in the management of the sick and to impress your patients with the fact that you have good common-sense in everything and uncommonly good sense in medicine; have accurate judgment, and evolve practical wisdom out of your own brain; and that you know all the duties of the physician to the sick, and, in addition, are especially conversant with the mental, moral, and physical idiosyncrasies of your different patients, such impressions will be of great advantage to you and will make professional attendance much easier on those who believe: He knows the water best who has waded through it. You will occasionally be employed in cases because you attended them in childhood or have attended other members of the family in similar affections, and are supposed to know their blood, and to understand the peculiarities and defects of the family constitution-their temperament, their idiosyncrasies, and their hereditary tendencies-and to possess sovereign remedies for their relief. You will find that the belief that you understand this and that person's constitution from scalp to toe, from outer surface to inner core, and know exactly what they require inside and outside is a powerful advantage-one that will give you prestige and a favorable chance to show your skill, and to increase their confidence. Experience and skill are what the public especially seek in a physician; they are often vitally important, and everybody knows it. You should carefully try to show that you possess both. Of course, we all have aftersight, but far-seeing foresight and ability to comprehend correctly all the changes that have taken place between your visits are what are needed. These are neither described in text-books nor furnished by lectures, but are sure to come from practical, dear-bought experience, and will develop and improve your judgment in every way, and enable you each year to see more fully into the very essence of different diseases, and to foresee their events with increased clearness. Every day is a little life, and a whole life but varying days repeated; and if you compel yourself to work faithfully and train your faculty of observation, every year will make you a better physician, and by the time you have labored and observed for ten or twelve years: Learning something every day, you will possess a large stock of wisdom, and be clinically familiar with the symptoms and events of all the common afflictions that confront us, and will then know far better than at first how to wave the Esculapian wand; and how to avoid former errors and mistakes; and also more easily and more exactly to shape your diagnosis, prognosis, and treatment in your various medical and surgical cases. In addition to the immense advantage the older physicians have over the younger ones, from greater ability to discern the nature and to foresee the probable degree and duration of grave and critical cases, and to give, concerning them, more discreet, definite, and true opinions from the beginning; experience enables them to recognize cases that are doubtful or likely to prove slow and tedious, and to show more accurate judgment, and to give wiser cautions and more practical precepts, and thereby to relieve themselves of many anxieties and risks of blame-advantages that naturally enhance their reputation, and enable them to reap the full value of their skill, and give them a steadier manner and greater confidence in themselves, and enable them to treat serious and tedious cases with steadiness, and to retain confidence more fully and much longer than younger physicians. This is the chief reason why those sharpened by long practice are less harassed in difficult cases by meddling officiousness from outsiders than younger ones, and less often either dismissed or forced to call in a consultant, and why the practice of medicine becomes relatively easier every year. You will find that after you have practiced twelve or fifteen years; after many of the finely spun precepts and descriptions of disease, all beautifully divided like the counties on a colored map, and other nice distinctions gotten from the professors at college, have taken wings; after you have forgotten much of your theoretical text-book knowledge—which was probably greater at graduation than it will ever be again-your experience, observation, and absorption will then give you a stock of practical facts that will be invaluable to you, and will often serve you in cases in which book-learning cannot; indeed, it is impossible to obtain from books alone sufficient knowledge of disease to make you a good |