"I should be thoroughly acquainted with the real Practice & this is a thing very different from what can be learned in a College; thus for instance we are taught by our Professors that if a sick person breaths with great difficulty, one thing must be done; if his respiration is yet more laborious, another. But how shall we judge of the nice degrees of laborious breathing unless from a dayly & familiar acquaintance with, & study of, the appearances and looks of Patients &c. Most young Physicians neglect this essential point of their art in their education & very often acquire it when they come to Practice at the expense of their patients' safety."