medical essays-第44章

按键盘上方向键 ← 或 → 可快速上下翻页，按键盘上的 Enter 键可回到本书目录页，按键盘上方向键 ↑ 可回到本页顶部！
————未阅读完？加入书签已便下次继续阅读！


provision　of　science；　in　distinction　from　practical　skill；　he　may　be　a　useful　and　acceptable　member　of　the　profession　to　which　the　health　of　the　community　is　intrusted。

To　those　who　are　not　to　engage　in　practice；　the　various　pursuits　of　science　hardly　require　to　be　commended。　　Only　they　must　not　be　disappointed　if　they　find　many　subjects　treated　in　our　courses　as　a　medical　class　requires；　rather　than　as　a　scientific　class　would　expect；　that　is；　with　special　limitations　and　constant　reference　to　practical　ends。　　Fortunately　they　are　within　easy　reach　of　the　highest　scientific　instruction。　　The　business　of　a　school　like　this　is　to　make　useful　working　physicians；　and　to　succeed　in　this　it　is　almost　as　important　not　to　overcrowd　the　mind　of　the　pupil　with　merely　curious　knowledge　as　it　is　to　store　it　with　useful　information。

In　this　direction　I　have　written　my　lecture；　not　to　undervalue　any　form　of　scientific　labor　in　its　place；　an　unworthy　thought　from　which　I　hope　I　need　not　defend　myself；but　to　discourage　any　undue　inflation　of　the　scholastic　programme；　which　even　now　asks　more　of　the　student　than　the　teacher　is　able　to　obtain　from　the　great　majority　of　those　who　present　themselves　for　examination。　　I　wish　to　take　a　hint　in　education　from　the　Secretary　of　the　Massachusetts　Board　of　Agriculture；　who　regards　the　cultivation　of　too　much　land　as　a　great　defect　in　our　New　England　farming。　　I　hope　that　our　Medical　Institutions　may　never　lay　themselves　open　to　the　kind　of　accusation　Mr。　Lowe　brings　against　the　English　Universities；　when　he　says　that　their　education　is　made　up　〃of　words　that　few　understand　and　most　will　shortly　forget；　of　arts　that　can　never　be　used；　if　indeed　they　can　even　be　learnt；　of　histories　inapplicable　to　our　times；　of　languages　dead　and　even　mouldy；　of　grammatical　rules　that　never　had　living　use　and　are　only　post　mortem　examinations；　and　of　statements　fagoted　with　utter　disregard　of　their　comparative　value。〃

This　general　thought　will　be　kept　in　view　throughout　my　somewhat　discursive　address；　which　will　begin　with　an　imaginary　clinical　lesson　from　the　lips　of　an　historical　personage；　and　close　with　the　portrait　from　real　life　of　one　who；　both　as　teacher　and　practitioner；　was　long　loved　and　honored　among　us。　　If　I　somewhat　overrun　my　hour；　you　must　pardon　me；　for　I　can　say　with　Pascal　that　I　have　not　had　the　time　to　make　my　lecture　shorter。


In　the　year　1647；　that　good　man　John　Eliot；　commonly　called　the　Apostle　Eliot；　writing　to　Mr。　Thomas　Shepherd；　the　pious　minister　of　Cambridge；　referring　to　the　great　need　of　medical　instruction　for　the　Indians；　used　these　words：

〃I　have　thought　in　my　heart　that　it　were　a　singular　good　work；　if　the　Lord　would　stirre　up　the　hearts　of　some　or　other　of　his　people　in　England　to　give　some　maintenance　toward　some　Schoole　or　Collegiate　exercise　this　way；　wherein　there　should　be　Anatomies　and　other　instructions　that　way；　and　where　there　might　be　some　recompence　given　to　any　that　should　bring　in　any　vegetable　or　other　thing　that　is　vertuous　in　the　way　of　Physick。

〃There　is　another　reason　which　moves　my　thought　and　desires　this　way；　namely　that　our　young　students　in　Physick　may　be　trained　up　better　then　they　yet　bee；　who　have　onely　theoreticall　knowledge；　and　are　forced　to　fall　to　practise　before　ever　they　saw　an　Anatomy　made；　or　duely　trained　up　in　making　experiments；　for　we　never　had　but　one　Anatomy　in　the　countrey；　which　Mr。　Giles　Firman　＇Firmin＇　now　in　England；　did　make　and　read　upon　very　well；　but　no　more　of　that　now。〃

Since　the　time　of　the　Apostle　Eliot　the　Lord　has　stirred　up　the　hearts　of　our　people　to　the　building　of　many　Schools　and　Colleges　where　medicine　is　taught　in　all　its　branches。　　Mr。　Giles　Firmin's　〃Anatomy　〃　may　be　considered　the　first　ancestor　of　a　long　line　of　skeletons　which　have　been　dangling　and　rattling　in　our　lecture…rooms　for　more　than　a　century。

Teaching　in　New　England　in　1647　was　a　grave　but　simple　matter。　　A　single　person；　combining　in　many　cases；　as　in　that　of　Mr。　Giles　Firmin；　the　offices　of　physician　and　preacher；　taught　what　he　knew　to　a　few　disciples　whom　he　gathered　about　him。　　Of　the　making　of　that　〃Anatomy〃　on　which　my　first　predecessor　in　the　branch　I　teach〃　did　read　very　well〃　we　can　know　nothing。　　The　body　of　some　poor　wretch　who　had　swung　upon　the　gallows；　was　probably　conveyed　by　night　to　some　lonely　dwelling　at　the　outskirts　of　the　village；　and　there　by　the　light　of　flaring　torches　hastily　dissected　by　hands　that　trembled　over　the　unwonted　task。　　And　ever　and　anon　the　master　turned　to　his　book；　as　he　laid　bare　the　mysteries　of　the　hidden　organs；　to　his　precious　Vesalius；　it　might　be；　or　his　figures　repeated　in　the　multifarious　volume　of　Ambroise　Pare；　to　the　Aldine　octavo　in　which　Fallopius　recorded　his　fresh　observations；　or　that　giant　folio　of　Spigelius　just　issued　from　the　press　of　Amsterdam；　in　which　lovely　ladies　display　their　viscera　with　a　coquettish　grace　implying　that　it　is　rather　a　pleasure　than　otherwise　to　show　the　lace…like　omentum；　and　hold　up　their　appendices　epiploicae　as　if　they　were　saying　〃these　are　our　jewels。〃

His　teaching　of　medicine　was　no　doubt　chiefly　clinical；　and　received　with　the　same　kind　of　faith　as　that　which　accepted　his　words　from　the　pulpit。　　His　notions　of　disease　were　based　on　what　he　had　observed；　seen　always　in　the　light　of　the　traditional　doctrines　in　which　he　was　bred。　　His　discourse　savored　of　the　weighty　doctrines　of　Hippocrates；　diluted　by　the　subtle　speculations　of　Galen；　reinforced　by　the　curious　comments　of　the　Arabian　schoolmen　as　they　were　conveyed　in　the　mellifluous　language　of　Fernelius；　blended；　it　may　be；　with　something　of　the　lofty　mysticism　of　Van　Helmont；　and　perhaps　stealing　a　flavor　of　that　earlier　form　of　Homoeopathy　which　had　lately　come　to　light　in　Sir　Kenelm　Digby's　〃Discourse　concerning　the　Cure　of　Wounds　by　the　Sympathetic　Powder。〃

His　Pathology　was　mythology。　　A　malformed　foetus；　as　the　readers　of　Winthrop's　Journal　may　remember；　was　enough　to　scare　the　colonists　from　their　propriety；　and　suggest　the　gravest　fears　of　portended　disaster。　　The　student　of　the　seventeenth　century　opened　his　Licetus　and　saw　figures　of　a　lion　with　the　head　of　a　woman；　and　a　man　with　the　head　of　an　elephant。　　He　had　offered　to　his　gaze；　as　born　of　a　human　mother；　the　effigy　of　a　winged　cherub；　a　pterocephalous　specimen；　which　our　Professor　of　Pathological　Anatomy　would　hardly　know　whether　to　treat　with　the　reverence　due　to　its　celestial　aspect；　or　to　imprison　in　one　of　his　immortalizing　jars　of　alcohol。

His　pharmacopoeia　consisted　mainly　of　simples；　such　as　the　venerable　〃Herball〃　of　Gerard　describes　and　figures　in　abounding　affluence。　St。　John's　wort　and　Clown's　All…heal；　with　Spurge　and　Fennel；　Saffron　and　Parsley；　Elder　and　Snake…root；　with　opium　in　some　form；　and　roasted　rhubarb　and　the　Four　Great　Cold　Seeds；　and　the　two　Resins；　of　which　it　used　to　be　said　that　whatever　the　Tacamahaca　has　not　cured；　the　Caranna　will；　with　the　more　familiar　Scammony　and　Jalap　and　Black　Hellebore；　made　up　a　good　part　of　his　probable　list　of　remedies。　　He　would　have　ordered　Iron　now　and　then；　and　possibly　an　occasional　dose　of　Antimony。　　He　would　perhaps　have　had　a　rheumatic　patient　wrapped　in　the　skin　of　a　wolf　or　a　wild　cat；　and　in　case　of　a　malignant　fever　with　〃purples〃　or　petechiae；　or　of　an　obstinate　king's　evil；　he　might　have　prescribed　a　certain　black　powder；　which　had　been　made　by　calcining　toads　in　an　earthen　pot；　a　choice　remedy；　taken　internally；　or　applied　to　any　outward　grief。

Except　for　the　toad…powder　and　the　peremptory　drastics；　one　might　have　borne　up　against　this　herb　doctoring　as　well　as　against　some　more　modern　styles　of　medication。　　Barbeyrac　and　his　scholar　Sydenham　had　not　yet　cleansed　the　Pharmacopoeia　of　its　perilous　stuff；　but　there　is　no　doubt　that　the　more　sensible　physicians　of　that　day　knew　well　enough　that　a　good　honest　herb…tea　which　amused　the　patient　and　his　nurses　was　all　that　was　required　to　carry　him　through　all　common　disorders。

The　student　soon　learned　the　physiognomy　of　disease　by　going　about　with　his　master；　fevers；　pleurisies；　asthmas；　dropsies；　fluxes；　small…pox；　sore…throats；　measles；　consumptions。　　He　saw　what　was　done　for　them。　　He　put　up　the　medicines；　gathered　the　herbs；　and　so　learned　something　of　materia　medico　and　botany。　　He　learned　these　few　things　easily　and　well；　for　he　could　give　his　whole　attention　to　them。　　Chirurgery　was　a　separate　specialty。　　Women　in　child…birth　were　cared　for　by　midwives。　　There　was　no　chemistry　deserving　the　name　to　require　his　study。　　He　did　not　learn　a　great　deal；　perhaps；　but　what　he　did　learn　was　his　business；　namely；　how　to　take　care　of　sick　people。

Let　me　give　you　a　picture　of　the　old=fashioned　way　of　instruction；　by　carrying　you　with　me　in　imagination　in　the　company　of　worthy　Master　Giles　Firmin　as　he　makes　his　round　of　visits　among　the　good　folk　of　Ipswich；　followed　by　his　one　student；　who　shall　answer　to　the　scriptural　name　of　Luke。　　It　will　not　be　for　entertainment　chiefly；　but　to　illustrate　the　one　mode　of　teaching　which　can　never　be　superseded；　and　which；　I　venture　to　say；　is　more　important　than　all　the　rest　put　together。　　The　student　is　a　green　hand；　as　you　will　perceive。

In　the　first　dwelling　they　come　to；　a　stout　fellow　is　bellowing　with　colic。

〃He　will　die；　Master；　of　a　surety；　methinks；〃　says　the　timid　youth　in　a　whisper。

〃Nay；　Luke；〃　the　Master　answers；　〃't　is　but　a　dry　belly…ache。　　Didst　thou　not　mark　that　he　stayed　his　roaring　when　I　did　press　hard　over　the　lesser　bowels？　　Note　that　he　hath　not　the　pulse　of　them　with　fevers；　and　by　what　Dorcas　telleth　me　there　hath　been　no　long　shutting　up　of　the　vice　naturales。　　We　will　steep　certain　comforting　herbs　which　I　will　shew　thee；　and　put　them　in　a　bag　and　lay　them　on　his　belly。　　Likewise　he　shall　have　my　cordial　julep　with　a　portion　of　this　confection　which　we　do　call　Theriaca　Andromachi；　which　hath　juice　of　poppy　in　it；　and　is　a　great　stayer　of　anguish。　　This　fellow　is　at　his　prayers　to…day；　but　I　warrant　thee　he　shall　be　swearing　with　the　best　of　them　to…morrow。〃

They　jog　along　the　bridle…path　on　their　horses　until　they　come　to　another　lowly　dwelling。　　They　sit　a　while　with　a　delicate　looking　girl　in　whom　the　ingenuous　youth　naturally　takes　a　special　interest。　The　good　physician　talks　cheerfully　with　her；　asks　her　a　few　questions。　　Then　to　her　mother：　〃Good…wife；　Margaret　hath　somewhat　profited；　as　she　telleth；　by　the　goat's　milk　she　hath　taken　night　and　morning。　　Do　thou　pluck　a　maniplethat　is　an　handfulof　the　plant　called　Maidenhair；　and　make　a　syrup　therewith　as　I　have　shewed　thee。　Let　her　take　a　cup　full　of　the　same；　fasting；　before　she　sleepeth；　also　before　she　riseth　from　her　bed。〃　　And　so　they　leave　the　house。

〃What　thinkest　thou；　Luke；　of　the　maid　we　have　been　visiting？〃　　〃She　seemeth　not　much　ailing；　Master；　according　to　my　poor　judgment。　　For　she　did　say　she　was　better。　　And　she　had　a　red　cheek　and　a　bright　eye；　and　she　spake　of　being　soon　able　to　walk　unto　the　meeting；　and　did　seem　greatly　hopeful；　but　spare　of　flesh；　methought；　and　her　voice　something　hoarse；　as　of　one　that　hath　a　defluxion；　with　some　small　coughing　from　a　cold；　as　she　did　say。　　Speak　I　not　truly；　Master；　that　she　will　be　well　speedily？〃

〃Yea；　Luke；　I　d