medical essays-第67章

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over　the　noise　of　doors　and　footsteps。

Broussais　was　now　sixty…two　years　old。　　The　new　generation　had　outgrown　his　doctrines；　and　the　Professor　for　whose　hour　the　benches　had　filled　themselves　belonged　to　that　new　generation。　　Gabriel　Andral　was　little　more　than　half　the　age　of　Broussais；　in　the　full　prime　and　vigor　of　manhood　at　thirty…seven　years。　　He　was　a　rapid；　fluent；　fervid；　and　imaginative　speaker；　pleasing　in　aspect　and　manner；a　strong　contrast　to　the　harsh；　vituperative　old　man　who　had　just　preceded　him。　　His　Clinique　Medicale　is　still　valuable　as　a　collection　of　cases；　and　his　researches　on　the　blood；　conducted　in　association　with　Gavarret；　contributed　new　and　valuable　facts　to　science。　　But　I　remember　him　chiefly　as　one　of　those　instructors　whose　natural　eloquence　made　it　delightful　to　listen　to　him。　　I　doubt　if　I　or　my　fellow…students　did　full　justice　either　to　him　or　to　the　famous　physician　of　Hotel　Dieu；　Chomel。　　We　had　addicted　ourselves　almost　too　closely　to　the　words　of　another　master；　by　whom　we　were　ready　to　swear　as　against　all　teachers　that　ever　were　or　ever　would　be。

This　object　of　our　reverence；　I　might　almost　say　idolatry；　was　one　whose　name　is　well　known　to　most　of　the　young　men　before　me；　even　to　those　who　may　know　comparatively　little　of　his　works　and　teachings。　Pierre　Charles　Alexandre　Louis；　at　the　age　of　forty…seven；　as　I　recall　him；　was　a　tall；　rather　spare；　dignified　personage；　of　serene　and　grave　aspect；　but　with　a　pleasant　smile　and　kindly　voice　for　the　student　with　whom　he　came　into　personal　relations。　　If　I　summed　up　the　lessons　of　Louis　in　two　expressions；　they　would　be　these；　I　do　not　hold　him　answerable　for　the　words；　but　I　will　condense　them　after　my　own　fashion　in　French；　and　then　give　them　to　you；　expanded　somewhat；　in　English：

　　　　　　　　　　Formez　toujours　des　idees　nettes。　　　　　　　　　　　Fuyez　toujours　les　a　peu　pres。

Always　make　sure　that　you　form　a　distinct　and　clear　idea　of　the　matter　you　are　considering。

Always　avoid　vague　approximations　where　exact　estimates　are　possible；　about　so　many；about　so　much；　instead　of　the　precise　number　and　quantity。

Now；　if　there　is　anything　on　which　the　biological　sciences　have　prided　themselves　in　these　latter　years　it　is　the　substitution　of　quantitative　for　qualitative　formulae。　　The　〃numerical　system；〃　of　which　Louis　was　the　great　advocate；　if　not　the　absolute　originator；　was　an　attempt　to　substitute　series　of　carefully　recorded　facts；　rigidly　counted　and　closely　compared；　for　those　never…ending　records　of　vague；　unverifiable　conclusions　with　which　the　classics　of　the　healing　art　were　overloaded。　　The　history　of　practical　medicine　had　been　like　the　story　of　the　Danaides。　　〃Experience　〃　had　been；　from　time　immemorial；　pouring　its　flowing　treasures　into　buckets　full　of　holes。　　At　the　existing　rate　of　supply　and　leakage　they　would　never　be　filled；　nothing　would　ever　be　settled　in　medicine。　　But　cases　thoroughly　recorded　and　mathematically　analyzed　would　always　be　available　for　future　use；　and　when　accumulated　in　sufficient　number　would　lead　to　results　which　would　be　trustworthy；　and　belong　to　science。

You　young　men　who　are　following　the　hospitals　hardly　know　how　much　you　are　indebted　to　Louis。　　I　say　nothing　of　his　Researches　on　Phthisis　or　his　great　work　on　Typhoid　Fever。　　But　I　consider　his　modest　and　brief　Essay　on　Bleeding　in　some　Inflammatory　Diseases；　based　on　cases　carefully　observed　and　numerically　analyzed；　one　of　the　most　important　written　contributions　to　practical　medicine；　to　the　treatment　of　internal　disease；　of　this　century；　if　not　since　the　days　of　Sydenham。　　The　lancet　was　the　magician's　wand　of　the　dark　ages　of　medicine。　　The　old　physicians　not　only　believed　in　its　general　efficacy　as　a　wonder…worker　in　disease；　but　they　believed　that　each　malady　could　be　successfully　attacked　from　some　special　part　of　the　body；the　strategic　point　which　commanded　the　seat　of　the　morbid　affection。　　On　a　figure　given　in　the　curious　old　work　of　John　de　Ketam；　no　less　than　thirty…eight　separate　places　are　marked　as　the　proper　ones　to　bleed　from；　in　different　diseases。　　Even　Louis；　who　had　not　wholly　given　up　venesection；　used　now　and　then　to　order　that　a　patient　suffering　from　headache　should　be　bled　in　the　foot；　in　preference　to　any　other　part。

But　what　Louis　did　was　this：　he　showed　by　a　strict　analysis　of　numerous　cases　that　bleeding　did　not　strangle；jugulate　was　the　word　then　used；acute　diseases；　more　especially　pneumonia。　　This　was　not　a　reform；it　was　a　revolution。　　It　was　followed　up　in　this　country　by　the　remarkable　Discourse　of　Dr。　Jacob　Bigelow　upon　Self…Limited　Diseases；　which　has；　I　believe；　done　more　than　any　other　work　or　essay　in　our　own　language　to　rescue　the　practice　of　medicine　from　the　slavery　to　the　drugging　system　which　was　a　part　of　the　inheritance　of　the　profession。

Yes；　I　say；　as　I　look　back　on　the　long　hours　of　the　many　days　I　spent　in　the　wards　and　in　the　autopsy　room　of　La　Pitie；　where　Louis　was　one　of　the　attending　physicians；yes；　Louis　did　a　great　work　for　practical　medicine。　　Modest　in　the　presence　of　nature；　fearless　in　the　face　of　authority；　unwearying　in　the　pursuit　of　truth；　he　was　a　man　whom　any　student　might　be　happy　and　proud　to　claim　as　his　teacher　and　his　friend；　and　yet；　as　I　look　back　on　the　days　when　I　followed　his　teachings；　I　feel　that　I　gave　myself　up　too　exclusively　to　his　methods　of　thought　and　study。

There　is　one　part　of　their　business　which　certain　medical　practitioners　are　too　apt　to　forget；　namely；　that　what　they　should　most　of　all　try　to　do　is　to　ward　off　disease；　to　alleviate　suffering；　to　preserve　life；　or　at　least　to　prolong　it　if　possible。　　It　is　not　of　the　slightest　interest　to　the　patient　to　know　whether　three　or　three　and　a　quarter　cubic　inches　of　his　lung　are　hepatized。　　His　mind　is　not　occupied　with　thinking　of　the　curious　problems　which　are　to　be　solved　by　his　own　autopsy；whether　this　or　that　strand　of　the　spinal　marrow　is　the　seat　of　this　or　that　form　of　degeneration。　　He　wants　something　to　relieve　his　pain；　to　mitigate　the　anguish　of　dyspnea；　to　bring　back　motion　and　sensibility　to　the　dead　limb；　to　still　the　tortures　of　neuralgia。　　What　is　it　to　him　that　you　can　localize　and　name　by　some　uncouth　term　the　disease　which　you　could　not　prevent　and　which　you　cannot　cure？　　An　old　woman　who　knows　how　to　make　a　poultice　and　how　to　put　it　on；　and　does　it　tuto；　eito；　jucunde；　just　when　and　where　it　is　wanted；　is　better；a　thousand　times　better　in　many　cases；than　a　staring　pathologist；　who　explores　and　thumps　and　doubts　and　guesses；　and　tells　his　patient　be　will　be　better　tomorrow；　and　so　goes　home　to　tumble　his　books　over　and　make　out　a　diagnosis。

But　in　those　days；　I；　like　most　of　my　fellow　students；　was　thinking　much　more　of　〃science〃　than　of　practical　medicine；　and　I　believe　if　we　had　not　clung　so　closely　to　the　skirts　of　Louis　and　had　followed　some　of　the　courses　of　men　like　Trousseau；therapeutists；　who　gave　special　attention　to　curative　methods；　and　not　chiefly　to　diagnosis；　it　would　have　been　better　for　me　and　others。　　One　thing；　at　any　rate；　we　did　learn　in　the　wards　of　Louis。　　We　learned　that　a　very　large　proportion　of　diseases　get　well　of　themselves；　without　any　special　medication；the　great　fact　formulated；　enforced；　and　popularized　by　Dr。　Jacob　Bigelow　in　the　Discourse　referred　to。　　We　unlearned　the　habit　of　drugging　for　its　own　sake。　　This　detestable　practice；　which　I　was　almost　proscribed　for　condemning　somewhat　too　epigrammatically　a　little　more　than　twenty　years　ago；　came　to　us；　I　suspect；　in　a　considerable　measure　from　the　English　〃general　practitioners；〃　a　sort　of　prescribing　apothecaries。　　You　remember　how；　when　the　city　was　besieged；　each　artisan　who　was　called　upon　in　council　to　suggest　the　best　means　of　defence　recommended　the　articles　he　dealt　in：　the　carpenter；　wood；　the　blacksmith；　iron；　the　mason；　brick；　until　it　came　to　be　a　puzzle　to　know　which　to　adopt。　Then　the　shoemaker　said；　〃Hang　your　walls　with　new　boots；〃　　and　gave　good　reasons　why　these　should　be　the　best　of　all　possible　defences。　　Now　the　〃general　practitioner〃　　charged；　as　I　understand；　for　his　medicine；　and　in　that　way　got　paid　for　his　visit。　　Wherever　this　is　the　practice；　medicine　is　sure　to　become　a　trade；　and　the　people　learn　to　expect　drugging；　and　to　consider　it　necessary；　because　drugs　are　so　universally　given　to　the　patients　of　the　man　who　gets　his　living　by　them。

It　was　something　to　have　unlearned　the　pernicious　habit　of　constantly　giving　poisons　to　a　patient；　as　if　they　were　good　in　themselves；　of　drawing　off　the　blood　which　he　would　want　in　his　struggle　with　disease；　of　making　him　sore　and　wretched　with　needless　blisters；　of　turning　his　stomach　with　unnecessary　nauseous　draught　and　mixtures；　only　because　he　was　sick　and　something　must　be　done。　　But　there　were　positive　as　well　as　negative　facts　to　be　learned；　and　some　of　us；　I　fear；　came　home　rich　in　the　negatives　of　the　expectant　practice；　poor　in　the　resources　which　many　a　plain　country　practitioner　had　ready　in　abundance　for　the　relief　and　the　cure　of　disease。　　No　one　instructor　can　be　expected　to　do　all　for　a　student　which　he　requires。　　Louis　taught　us　who　followed　him　the　love　of　truth；　the　habit　of　passionless　listening　to　the　teachings　of　nature；　the　most　careful　and　searching　methods　of　observation；　and　the　sure　means　of　getting　at　the　results　to　be　obtained　from　them　in　the　constant　employment　of　accurate　tabulation。　　He　was　not　a　showy；　or　eloquent；　or；　I　should　say；　a　very　generally　popular　man；　though　the　favorite；　almost　the　idol；　of　many　students；　especially　Genevese　and　Bostonians。　　But　he　was　a　man　of　lofty　and　admirable　scientific　character；　and　his　work　will　endure　in　its　influences　long　after　his　name　is　lost　sight　of　save　to　the　faded　eyes　of　the　student　of　medical　literature。

Many　other　names　of　men　more　or　less　famous　in　their　day；　and　who　were　teaching　while　I　was　in　Paris；　come　up　before　me。　　They　are　but　empty　sounds　for　the　most　part　in　the　ears　of　persons　of　not　more　than　middle　age。　　Who　of　you　knows　anything　of　Richerand；　author　of　a　very　popular　work　on　Physiology；　commonly　put　into　the　student's　hands　when　I　first　began　to　ask　for　medical　text…books？　　I　heard　him　lecture　once；　and　have　had　his　image　with　me　ever　since　as　that　of　an　old；　worn…out　man；a　venerable　but　dilapidated　relic　of　an　effete　antiquity。　　To　verify　this　impression　I　have　just　looked　out　the　dates　of　his　birth　and　death；　and　find　that　he　was　eighteen　years　younger　than　the　speaker　who　is　now　addressing　you。　　There　is　a　terrible　parallax　between　the　period　before　thirty　and　that　after　threescore　and　ten；　as　two　men　of　those　ages　look；　one　with　naked　eyes；　one　through　his　spectacles；　at　the　man　of　fifty　and　thereabout。　Magendie；　I　doubt　not　you　have　all　heard　of。　　I　attended　but　one　of　his　lectures。　　I　question　if　one　here；　unless　some　contemporary　of　my　own　has　strayed　into　the　amphitheatre；knows　anything　about　Marjolin。　　I　remember　two　things　about　his　lectures　on　surgery；　the　deep　tones　of　his　voice　as　he　referred　to　his　oracle；the　earlier　writer；　Jean　Louis　Petit；and　his　formidable　snuffbox。　　What　he　taught　me　lies　far　down；　I　doubt　not；　among　the　roots　of　my　knowledge；　but　it　does　not　flower　out　in　any　noticeable　blossoms；　or　offer　me　any　very