medical essays-第63章
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they belong。 He will gratefully recognize that the anatomist has furnished him with indispensable data； that the physiologist has sometimes put him on the track of new modes of treatment； that the chemist has isolated the active principles of his medicines； has taught him how to combine them； has from time to time offered him new remedial agencies； and so of others of his allies。 But he will also tell you； if I am not mistaken； that his own branch of knowledge is so extensive and so perplexing that he must accept most of his facts ready made at their hands。 He will own to you that in the struggle for life which goes on day and night in our thoughts as in the outside world of nature； much that he learned under the name of science has died out； and that simple homely experience has largely taken the place of that scholastic knowledge to which he and perhaps some of his instructors once attached a paremount importance。
This； then； is my view of scientific training as conducted in courses such as you are entering on。 Up to a certain point I believe in set Lectures as excellent adjuncts to what is far more important； practical instruction at the bedside； in the operating room； and under the eye of the Demonstrator。 But I am so far from wishing these courses extended； that I think some of themsuppose I say my ownwould almost bear curtailing。 Do you want me to describe more branches of the sciatic and crural nerves？ I can take Fischer's plates； and lecturing on that scale fill up my whole course and not finish the nerves alone。 We must stop somewhere； and for my own part I think the scholastic exercises of our colleges have already claimed their full share of the student's time without our seeking to extend them。
I trust I have vindicated the apparent inconsequence of teaching young students a good deal that seems at first sight profitless； but which helps them to learn and retain what is profitable。 But this is an inquisitive age； and if we insist on piling up beyond a certain height knowledge which is in itself mere trash and lumber to a man whose life is to be one long fight with death and disease； there will be some sharp questions asked by and by； and our quick…witted people will perhaps find they can get along as well without the professor's cap as without the bishop's mitre and the monarch's crown。
I myself have nothing to do with clinical teaching。 Yet I do not hesitate to say it is more essential than all the rest put together； so far as the ordinary practice of medicine is concerned； and this is by far the most important thing to be learned； because it deals with so many more lives than any other branch of the profession。 So of personal instruction； such as we give and others give in the interval of lectures； much of it at the bedside； some of it in the laboratory； some in the microscope…room； some in the recitation…room； I think it has many advantages of its own over the winter course； and I do not wish to see it shortened for the sake of prolonging what seems to me long enough already。
If I am jealous of the tendency to expand the time given to the acquisition of curious knowledge； at the expense of the plain old… fashioned bedside teachings； I only share the feeling which Sydenham expressed two hundred years ago； using an image I have already borrowed。 〃He would be no honest and successful pilot who was to apply himself with less industry to avoid rocks and sands and bring his vessel safely home； than to search into the causes of the ebbing and flowing of the sea； which； though very well for a philosopher； is foreign to him whose business it is to secure the ship。 So neither will a physician； whose province it is to cure diseases； be able to do so； though he be a person of great genius； who bestows less time on the hidden and intricate method of nature； and adapting his means thereto； than on curious and subtle speculation。〃
〃Medicine is my wife and Science is my mistress；〃 said Dr。 Rush。 I do not think that the breach of the seventh commandment can be shown to have been of advantage to the legitimate owner of his affections。 Read what Dr。 Elisha Bartlett says of him as a practitioner； or ask one of our own honored ex…professors； who studied under him； whether Dr。 Rush had ever learned the meaning of that saying of Lord Bacon； that man is the minister and interpreter of Nature； or whether he did not speak habitually of Nature as an intruder in the sick room； from which his art was to expel her as an incompetent and a meddler。
All a man's powers are not too much for such a profession as Medicine。 〃He is a learned man；〃 said old Parson Emmons of Franklin； 〃who understands one subject； and he is a very learned man who understands two subjects。〃 Schonbein says he has been studying oxygen for thirty years。 Mitscherlich said it took fourteen years to establish a new fact in chemistry。 Aubrey says of Harvey； the discoverer of the circulation； that 〃though all his profession would allow him to be an excellent anatomist； I have never heard of any who admired his therapeutic way。〃 My learned and excellent friend before referred to； Dr。 Brown of Edinburgh； from whose very lively and sensible Essay； 〃Locke and Sydenham；〃 I have borrowed several of my citations； contrasts Sir Charles Bell； the discoverer； the man of science； with Dr。 Abercrombie； the master in the diagnosis and treatment of disease。 It is through one of the rarest of combinations that we have in our Faculty a teacher on whom the scientific mantle of Bell has fallen； and who yet stands preeminent in the practical treatment of the class of diseases which his inventive and ardent experimental genius has illustrated。 M。 Brown… Sequard's example is as； eloquent as his teaching in proof of the advantages of well directed scientific investigation。 But those who emulate his success at once as a discoverer and a practitioner must be content like him to limit their field of practice。 The highest genius cannot afford in our time to forget the ancient precept； Divide et impera。
〃I suppose I must go and earn this guinea；〃 said a medical man who was sent for while he was dissecting an animal。 I should not have cared to be his patient。 His dissection would do me no good； and his thoughts would be too much upon it。 I want a whole man for my doctor； not a half one。 I would have sent for a humbler practitioner； who would have given himself entirely to me； and told the otherwho was no less a man than John Hunterto go on and finish the dissection of his tiger。
Sydenham's 〃Read Don Quixote〃 should be addressed not to the student； but to the Professor of today。 Aimed at him it means； 〃Do not be too learned。
Do not think you are going to lecture to picked young men who are training themselves to be scientific discoverers。 They are of fair average capacity； and they are going to be working doctors。
These young men are to have some very serious vital facts to deal with。 I will mention a few of them。
Every other resident adult you meet in these streets is or will be more or less tuberculous。 This is not an extravagant estimate； as very nearly one third of the deaths of adults in Boston last year were from phthisis。 If the relative number is less in our other northern cities； it is probably in a great measure because they are more unhealthy； that is； they have as much； or nearly as much； consumption； but they have more fevers or other fatal diseases。
These heavy…eyed men with the alcoholized brains； these pallid youths with the nicotized optic ganglia and thinking…marrows brown as their own meerschaums； of whom you meet too many；will ask all your wisdom to deal with their poisoned nerves and their enfeebled wills。
Nearly seventeen hundred children under five years of age died last year in this city。 A poor human article； no doubt； in many cases； still； worth an attempt to save them； especially when we remember the effect of Dr。 Clarke's suggestion at the Dublin Hospital； by which some twenty…five or thirty thousand children's lives have probably been saved in a single city。
Again； the complaint is often heard that the native population is not increasing so rapidly as in former generations。 The breeding and nursing period of Ame
