medical essays-第47章

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These　are　all　practical　questionsquestions　of　life　and　death；　and　every　day　will　be　full　of　just　such　questions。　　Take　the　problem　of　climate。　　A　patient　comes　to　you　with　asthma　and　wants　to　know　where　he　can　breathe；　another　comes　to　you　with　phthisis　and　wants　to　know　where　he　can　live。　　What　boy's　play　is　nine　tenths　of　all　that　is　taught　in　many　a　pretentious　course　of　lectures；　compared　with　what　an　accurate　and　extensive　knowledge　of　the　advantages　and　disadvantages　of　different　residences　in　these　and　other　complaints　would　be　to　a　practising　physician

I　saw　the　other　day　a　gentleman　living　in　Canada；　who　had　spent　seven　successive　winters　in　Egypt；　with　the　entire　relief　of　certain　obscure　thoracic　symptoms　which　troubled　him　while　at　home。　　I　saw；　two　months　ago；　another　gentleman　from　Minnesota；　an　observer　and　a　man　of　sense；　who　considered　that　State　as　the　great　sanatorium　for　all　pulmonary　complaints。　　If　half　our　grown　population　are　or　will　be　more　or　less　tuberculous；　the　question　of　colonizing　Florida　assumes　a　new　aspect。　　Even　within　the　borders　of　our　own　State；　the　very　interesting　researches　of　Dr。　Bowditch　show　that　there　is　a　great　variation　in　the　amount　of　tuberculous　disease　in　different　towns；　apparently　connected　with　local　conditions。　　The　hygienic　map　of　a　State　is　quite　as　valuable　as　its　geological　map；　and　it　is　the　business　of　every　practising　physician　to　know　it　thoroughly。　　They　understand　this　in　England；　and　send　a　patient　with　a　dry　irritating　cough　to　Torquay　or　Penzance；　while　they　send　another　with　relaxed　bronchial　membranes　to　Clifton　or　Brighton。　　Here　is　another　great　field　for　practical　study。

So　as　to　the　all…important　question　of　diet。　　〃Of　all　the　means　of　cure　at　our　command；〃　says　Dr。　Bennett；　〃a　regulation　of　the　quantity　and　quality　of　the　diet　is　by　far　the　most　powerful。〃　　Dr。　MacCormac　would　perhaps　except　the　air　we　breathe；　for　he　thinks　that　impure　air；　especially　in　sleeping　rooms；　is　the　great　cause　of　tubercle。　It　is　sufficiently　proved　that　the　American；the　New　Englander；the　Bostonian；　can　breed　strong　and　sound　children；　generation　after　generation；nay；　I　have　shown　by　the　record　of　a　particular　family　that　vital　losses　may　be　retrieved；　and　a　feeble　race　grow　to　lusty　vigor　in　this　very　climate　and　locality。　　Is　not　the　question　why　our　young　men　and　women　so　often　break　down；　and　how　they　can　be　kept　from　breaking　down；　far　more　important　for　physicians　to　settle　than　whether　there　is　one　cranial　vertebra；　or　whether　there　are　four；　or　none？

But　I　have　a　taste　for　the　homologies；　I　want　to　go　deeply　into　the　subject　of　embryology；　I　want　to　analyze　the　protonihilates　precipitated　from　pigeon's　milk　by　the　action　of　the　lunar　spectrum；…　shall　I　not　follow　my　star；shall　I　not　obey　my　instinct；shall　I　not　give　myself　to　the　lofty　pursuits　of　science　for　its　own　sake？

Certainly　you　may；　if　you　like。　　But　take　down　your　sign；　or　never　put　it　up。　　That　is　the　way　Dr。　Owen　and　Dr。　Huxley；　Dr。　Agassiz　and　Dr。　Jeffries　Wyman；　Dr。　Gray　and　Dr。　Charles　T。　Jackson　settled　the　difficulty。　　We　all　admire　the　achievements　of　this　band　of　distinguished　doctors　who　do　not　practise。　　But　we　say　of　their　work　and　of　all　pure　science；　as　the　French　officer　said　of　the　charge　of　the　six　hundred　at　Balaclava；　〃C'est　magnifique；　mais　ce　n'est　pas　la　guerre；〃it　is　very　splendid；　but　it　is　not　a　practising　doctor's　business。　　His　patient　has　a　right　to　the　cream　of　his　life　and　not　merely　to　the　thin　milk　that　is　left　after　〃science　〃　has　skimmed　it　off。　　The　best　a　physician　can　give　is　never　too　good　for　the　patient。

It　is　often　a　disadvantage　to　a　young　practitioner　to　be　known　for　any　accomplishment　outside　of　his　profession。　　Haller　lost　his　election　as　Physician　to　the　Hospital　in　his　native　city　of　Berne；　principally　on　the　ground　that　he　was　a　poet。　　In　his　later　years　the　physician　may　venture　more　boldly。　　Astruc　was　sixty…nine　years　old　when　he　published　his　〃Conjectures；〃　the　first　attempt；　we　are　told；　to　decide　the　authorship　of　the　Pentateuch　showing　anything　like　a　discerning　criticism。　　Sir　Benjamin　Brodie　was　seventy　years　old　before　he　left　his　physiological　and　surgical　studies　to　indulge　in　psychological　speculations。　　The　period　of　pupilage　will　be　busy　enough　in　acquiring　the　knowledge　needed；　and　the　season　of　active　practice　will　leave　little　leisure　for　any　but　professional　studies。

Dr。　Graves　of　Dublin；　one　of　the　first　clinical　teachers　of　our　time；　always　insisted　on　his　students'　beginning　at　once　to　visit　the　hospital。　　At　the　bedside　the　student　must　learn　to　treat　disease；　and　just　as　certainly　as　we　spin　out　and　multiply　our　academic　prelections　we　shall　work　in　more　and　more　stuffing；　more　and　more　rubbish；　more　and　more　irrelevant；　useless　detail　which　the　student　will　get　rid　of　just　as　soon　as　he　leaves　us。　　Then　the　next　thing　will　be　a　new　organization；　with　an　examining　board　of　first…rate　practical　men；　who　will　ask　the　candidate　questions　that　mean　business；who　will　make　him　operate　if　he　is　to　be　a　surgeon；　and　try　him　at　the　bedside　if　he　is　to　be　a　physician；and　not　puzzle　him　with　scientific　conundrums　which　not　more　than　one　of　the　questioners　could　answer　himself　or　ever　heard　of　since　he　graduated。

Or　these　women　who　are　hammering　at　the　gates　on　which　is　written　〃No　admittance　for　the　mothers　of　mankind；〃　will　by　and　by　organize　an　institution；　which　starting　from　that　skilful　kind　of　nursing　which　Florence　Nightingale　taught　so　well；　will　work　backwards　through　anodynes；　palliatives；　curatives；　preventives；　until　with　little　show　of　science　it　imparts　most　of　what　is　most　valuable　in　those　branches　of　the　healing　art　it　professes　to　teach。　　When　that　time　comes；　the　fitness　of　women　for　certain　medical　duties；　which　Hecquet　advocated　in　1708；　which　Douglas　maintained　in　1736；　which　Dr。　John　Ware；　long　the　honored　Professor　of　Theory　and　Practice　in　this　Institution；　upheld　within　our　own　recollection　in　the　face　of　his　own　recorded　opinion　to　the　contrary；　will　very　possibly　be　recognized。

My　advice　to　every　teacher　less　experienced　than　myself　would　be；　therefore：　Do　not　fret　over　the　details　you　have　to　omit；　you　probably　teach　altogether　too　many　as　it　is。　　Individuals　may　learn　a　thing　with　once　hearing　it；　but　the　only　way　of　teaching　a　whole　class　is　by　enormous　repetition；　representation；　and　illustration　in　all　possible　forms。　　Now　and　then　you　will　have　a　young　man　on　your　benches　like　the　late　Waldo　Burnett；not　very　often；　if　you　lecture　half　a　century。　　You　cannot　pretend　to　lecture　chiefly　for　men　like　that；a　Mississippi　raft　might　as　well　take　an　ocean…steamer　in　tow。　To　meet　his　wants　you　would　have　to　leave　the　rest　of　your　class　behind　and　that　you　must　not　do。　　President　Allen　of　Jefferson　College　says　that　his　instruction　has　been　successful　in　proportion　as　it　has　been　elementary。　　It　may　be　a　humiliating　statement；　but　it　is　one　which　I　have　found　true　in　my　own　experience。

To　the　student　I　would　say；　that　however　plain　and　simple　may　be　our　teaching；　he　must　expect　to　forget　much　which　he　follows　intelligently　in　the　lecture…room。　　But　it　is　not　the　same　as　if　he　had　never　learned　it。　　A　man　must　get　a　thing　before　he　can　forget　it。　　There　is　a　great　world　of　ideas　we　cannot　voluntarily　recall；　they　are　outside　the　limits　of　the　will。　　But　they　sway　our　conscious　thought　as　the　unseen　planets　influence　the　movements　of　those　within　the　sphere　of　vision。　　No　man　knows　how　much　he　knows；how　many　ideas　he　has；any　more　than　he　knows　how　many　blood…globules　roll　in　his　veins。　　Sometimes　accident　brings　back　here　and　there　one；　but　the　mind　is　full　of　irrevocable　remembrances　and　unthinkable　thoughts；　which　take　a　part　in　all　its　judgments　as　indestructible　forces。　　Some　of　you　must　feel　your　scientific　deficiencies　painfully　after　your　best　efforts。　　But　every　one　can　acquire　what　is　most　essential。　　A　man　of　very　moderate　ability　may　be　a　good　physician；　if　he　devotes　himself　faithfully　to　the　work。　　More　than　this；　a　positively　dull　man；　in　the　ordinary　acceptation　of　the　term；　sometimes　makes　a　safer　practitioner　than　one　who　has；　we　will　say；　five　per　cent。　more　brains　than　his　average　neighbor；　but　who　thinks　it　is　fifty　per　cent。　more。　　Skulls　belonging　to　this　last　variety　of　the　human　race　are　more　common；　I　may　remark；　than　specimens　like　the　Neanderthal　cranium；　a　cast　of　which　you　will　find　on　the　table　in　the　Museum。

Whether　the　average　talent　be　high　or　low；　the　Colleges　of　the　land　must　make　the　best　commodity　they　can　out　of　such　material　as　the　country　and　the　cities　furnish　them。　　The　community　must　have　Doctors　as　it　must　have　bread。　　It　uses　up　its　Doctors　just　as　it　wears　out　its　shoes；　and　requires　new　ones。　　All　the　bread　need　not　be　French　rolls；　all　the　shoes　need　not　be　patent　leather　ones；　but　the　bread　must　be　something　that　can　be　eaten；　and　the　shoes　must　be　something　that　can　be　worn。　　Life　must　somehow　find　food　for　the　two　forces　that　rub　everything　to　pieces；　or　burn　it　to　ashes；friction　and　oxygen。　　Doctors　are　oxydable　products；　and　the　schools　must　keep　furnishing　new　ones　as　the　old　ones　turn　into　oxyds；　some　of　first…　rate　quality　that　burn　with　a　great　light；　some　of　a　lower　grade　of　brilliancy；　some　honestly；　unmistakably；　by　the　grace　of　God；　of　moderate　gifts；　or　in　simpler　phrase；　dull。

The　public　will　give　every　honest　and　reasonably　competent　worker　in　the　healing　art　a　hearty　welcome。　　It　is　on　the　whole　very　loyal　to　the　Medical　Profession。　　Three　successive　years　have　borne　witness　to　the　feeling　with　which　this　Institution；　representing　it　in　its　educational　aspect；　is　regarded　by　those　who　are　themselves　most　honored　and　esteemed。　　The　great　Master　of　Natural　Science　bade　the　last　year's　class　farewell　in　our　behalf；　in　those　accents　which　delight　every　audience。　　The　Head　of　our　ancient　University　honored　us　in　the　same　way　in　the　preceding　season。　　And　how　can　we　forget　that　other　occasion　when　the　Chief　Magistrate　of　the　Commonwealth；　that　noble　citizen　whom　we　have　just　lost；　large…souled；　sweet…　natured；　always　ready　for　every　kind　office；　came　among　us　at　our　bidding；　and　talked　to　us　of　our　duties　in　words　as　full　of　wisdom　as　his　heart　was　of　goodness？

You　have　not　much　to　fear；　I　think；　from　the　fancy　practitioners。　The　vulgar　quackeries　drop　off；　atrophied；　one　after　another。　Homoeopathy　has　long　been　encysted；　and　is　carried　on　the　body　medical　as　quietly　as　an　old　wen。　　Every　year　gives　you　a　more　reasoning　and　reasonable　people　to　deal　with。　　See　how　it　is　in　Literature。　　The　dynasty　of　British　dogmatists；　after　lasting　a　hundred　years　and　more；　is　on　its　last　legs。　　Thomas　Carlyle；　third　in　the　line　of　descent；　finds　an　audience　very　different　from　those　which　listened　to　the　silver　speech　of　Samuel　Taylor　Coleridge　and　the　sonorous　phrases　of　Samuel　Johnson。　　We　read　him；　we　smile　at　his　clotted　English；　his　〃swarmery〃　and　other　picturesque　expressions；　but　we　lay　down　his　tirade　as　we　do　one　of　Dr。　Cumming's　interpretations　of　prophecy；　which　tells　us　that　the　world　is　coming　to　an　end　next　week　or　next　month；　if　the　weather　permits；not　otherwise；feeling　very　sure　that　the　weather　will　be　unfavorable。

It　is　the　same　common…sense