for the first time.

[Sidenote: Is the faculty of observing on the decline?]

Yet it appears that scarcely any improvement in the faculty of observing
is being made. Vast has been the increase of knowledge in pathology--
that science which teaches us the final change produced by disease on
the human frame--scarce any in the art of observing the signs of the
change while in progress. Or, rather, is it not to be feared that
observation, as an essential part of medicine, has been declining?

Which of us has not heard fifty times, from one or another, a nurse, or
a friend of the sick, aye, and a medical friend too, the following
remark:--"So A is worse, or B is dead. I saw him the day before; I
thought him so much better; there certainly was no appearance from which
one could have expected so sudden (?) a change." I have never heard any
one say, though one would think it the more natural thing, "There _must_
have been _some_ appearance, which I should have seen if I had but
looked; let me try and remember what there was, that I may observe
another time." No, this is not what people say. They boldly assert that
there was nothing to observe, not that their observation was at fault.

Let people who have to observe sickness and death look back and try to
register in their observation the appearances which have preceded
relapse, attack, or death, and not assert that there were none, or that
there were not the _right_ ones.[5]

[Sidenote: Observation of general conditions.]

A want of the habit of observing conditions and an inveterate habit of
taking averages are each of them often equally misleading.

Men whose profession like that of medical men leads them to observe
only, or chiefly, palpable and permanent organic changes are often just
as wrong in their opinion of the result as those who do not observe at
all. For instance, there is a broken leg; the surgeon has only to look
at it once to know; it will not be different if he sees it in the
morning to what it would have been had he seen it in the evening. And in
whatever conditions the patient is, or is likely to be, there will still
be the broken leg, until it is set. The same with many organic diseases.
An experienced physician has but to feel the pulse once, and he knows
that there is aneurism which will kill some time or other.

But with the great majority of cases, there is nothing of the kind; and
the power of forming any correct opinion as to the result must