medical essays-第82章
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likely to be useful than any single talent； even were it the power of observation； in excess。 For a mere observer is liable to be too fond of facts for their own sake； so that； if he told the real truth； he would confess that he takes more pleasure in a post…mortem examination which shows him what was the matter with a patient； than in a case which insists on getting well and leaving him in the dark as to its nature。 Far more likely to interfere with the sound practical balance of the mind is that speculative； theoretical tendency which has made so many men noted in their day； whose fame has passed away with their dissolving theories。 Read Dr。 Bartlett's comparison of the famous Benjamin Rush with his modest fellow…townsman Dr。 William Currie； and see the dangers into which a passion for grandiose generalizations betrayed a man of many admirable qualities。
I warn you against all ambitious aspirations outside of your profession。 Medicine is the most difficult of sciences and the most laborious of arts。 It will task all your powers of body and mind if you are faithful to it。 Do not dabble in the muddy sewer of politics； nor linger by the enchanted streams of literature； nor dig in far…off fields for the hidden waters of alien sciences。 The great practitioners are generally those who concentrate all their powers on their business。 If there are here and there brilliant exceptions； it is only in virtue of extraordinary gifts； and industry to which very few are equal。
To get business a man mast really want it； and do you suppose that when you are in the middle of a heated caucus； or half…way through a delicate analysis； or in the spasm of an unfinished ode； your eyes rolling in the fine frenzy of poetical composition； you want to be called to a teething infant； or an ancient person groaning under the griefs of a lumbago？ I think I have known more than one young man whose doctor's sign proclaimed his readiness to serve mankind in that capacity； but who hated the sound of a patient's knock； and as he sat with his book or his microscope； felt exactly as the old party expressed himself in my friend Mr。 Brownell's poem
〃All I axes is； let me alone：'
The community soon finds out whether you are in earnest； and really mean business； or whether you are one of those diplomaed dilettanti who like the amusement of quasi medical studies； but have no idea of wasting their precious time in putting their knowledge in practice for the benefit of their suffering fellow…creatures。
The public is a very incompetent judge of your skill and knowledge； but it gives its confidence most readily to those who stand well with their professional brethren； whom they call upon when they themselves or their families are sick； whom they choose to honorable offices； whose writings and teachings they hold in esteem。 A man may be much valued by the profession and yet have defects which prevent his becoming a favorite practitioner； but no popularity can be depended upon as permanent which is not sanctioned by the judgment of professional experts； and with these you will always stand on your substantial merits。
What shall I say of the personal habits you must form if you wish for success？ Temperance is first upon the list。 Intemperance in a physician partakes of the guilt of homicide； for the muddled brain may easily make a fatal blunder in a prescription and the unsteady hand transfix an artery in an operation。 Tippling doctors have been too common in the history of medicine。 Paracelsus was a sot； Radcliffe was much too fond of his glass； and Dr。 James Hurlbut of Wethersfield； Connecticut； a famous man in his time； used to drink a square bottle of rum a day； with a corresponding allowance of opium to help steady his nerves。 We commonly speak of a man as being the worse for liquor； but I was asking an Irish laborer one day about his doctor； who； as he said； was somewhat given to drink。 〃I like him best when he's a little that way；〃 he said； 〃then I can spake to him。〃 I pitied the poor patient who could not venture to allude to his colic or his pleurisy until his physician was tipsy。
There are personal habits of less gravity than the one I have mentioned which it is well to guard against； or； if they are formed； to relinquish。 A man who may be called at a moment's warning into the fragrant boudoir of suffering loveliness should not unsweeten its atmosphere with reminiscences of extinguished meerschaums。 He should remember that the sick are sensitive and fastidious； that they love the sweet odors and the pure tints of flowers； and if his presence is not like the breath of the rose； if his hands are not like the leaf of the lily； his visit may be unwelcome； and if he looks behind him he may see a window thrown open after he has left the sick…chamber。 I remember too well the old doctor who sometimes came to help me through those inward griefs to which childhood is liable。 〃Far off his coming 〃shall I say 〃shone；〃 and finish the Miltonic phrase； or leave the verb to the happy conjectures of my audience？ Before him came a soul…subduing whiff of ipecacuanha； and after him lingered a shuddering consciousness of rhubarb。 He had lived so much among his medicaments that he had at last become himself a drug； and to have him pass through a sick…chamber was a stronger dose than a conscientious disciple of Hahnemann would think it safe to administer。
Need I remind yon of the importance of punctuality in your engagements； and of the worry and distress to patients and their friends which the want of it occasions？ One of my old teachers always carried two watches； to make quite sure of being exact； and not only kept his appointments with the regularity of a chronometer； but took great pains to be at his patient's house at the time when he had reason to believe he was expected； even if no express appointment was made。 It is a good rule； if you call too early； my lady's hair may not be so smooth as could be wished； and； if you keep her waiting too long； her hair may be smooth； but her temper otherwise。
You will remember； of course； always to get the weather…gage of your patient。 I mean； to place him so that the light falls on his face and not on yours。 It is a kind of； ocular duel that is about to take place between you； you are going to look through his features into his pulmonary and hepatic and other internal machinery； and he is going to look into yours quite as sharply to see what you think about his probabilities for time or eternity。
No matter how hard he stares at your countenance； he should never be able to read his fate in it。 It should be cheerful as long as there is hope； and serene in its gravity when nothing is left but resignation。 The face of a physician； like that of a diplomatist； should be impenetrable。 Nature is a benevolent old hypocrite； she cheats the sick and the dying with illusions better than any anodynes。 If there are cogent reasons why a patient should be undeceived； do it deliberately and advisedly； but do not betray your apprehensions through your tell…tale features。
We had a physician in our city whose smile was commonly reckoned as being worth five thousand dollars a year to him； in the days； too； of moderate incomes。 You cannot put on such a smile as that any more than you can get sunshine without sun； there was a tranquil and kindly nature under it that irradiated the pleasant face it made one happier to meet on his daily rounds。 But you can cultivate the disposition； and it will work its way through to the surface； nay； more；you can try to wear a quiet and encouraging look； and it will react on your disposition and make you like what you seem to be； or at least bring you nearer to its own likeness。
Your patient has no more right to all the truth you know than he has to all the medicine in your saddlebags； if you carry that kind of cartridge…box for the ammunition that slays disease。 He should get only just so much as is good for him。 I have seen a physician examining a patient's chest stop all at once； as he brought out a particular sound with a tap on the collarbone； in the attitude of a pointer who has just come on the scent or sight of a woodcock。 You remember the Spartan boy； who
