Chapter I: Uncertainty of Medicine, 25

Importance of the subject. Definiteness of results in chemistry.
Only a distant and humble approach to this possible in medicine.
Illustration from chemistry. CAUSES OF THE UNCERTAINTY OF MEDICINE.
1. Sympathy between different organs; 2. Symptoms produced at a
distance from the seat of disease. Disease extended by sympathy.
Transposition of disease from one organ to another. 2. Influence of
unseen or secret causes. Nature of many causes of disease unknown.
Combination of many agencies in producing disease, some of them
having acted a long time. Cases rendered complex by treatment
before physician is applied to. 3. Natural changes in the system
arising from the curative power of nature, and from the principle of
self-limitation in diseases. Illustrations of the operation of the
_vis medicatrix naturæ_—vomiting to remove offending matters from
the stomach—suppuration and discharge of a swelling. Tendency of
diseases to come to a conclusion—more definite and regular in some
complaints than in others. Mistakes from confounding the effects of
remedies with the changes produced by these two tendencies. 4. Mental
influences. Connection of mind with body modifying disease. Effects
produced through the mind often attributed to physical causes and
remedies. Case of the dyspeptic. 5. Individual peculiarities.

CHAPTER II.

SKILL IN MEDICINE, 50

Show in what medical skill consists, in view of the uncertainty of
medicine—_appreciating the condition of the patient in all respects,
and applying remedies in the best manner to relieve this condition_.
Errors impairing skill. Taking limited views of disease. Directing
attention too much to particular organs. Undue attachment to certain
modes of investigation. Difficulties in the way of deciding what
it is best to do. Course of different physicians in view of these
difficulties. Accurate proportioning of means and ends. Value of
experience. Illustration of some of these points in the case of a
sick traveller assisted by his friend in going through a mountain
pass.