medical essays-第83章
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a pointer who has just come on the scent or sight of a woodcock。 You remember the Spartan boy； who； with unmoved countenance； hid the fox that was tearing his vitals beneath his mantle。 What he could do in his own suffering you must learn to do for others on whose vital organs disease has fastened its devouring teeth。 It is a terrible thing to take away hope； even earthly hope； from a fellow…creature。 Be very careful what names you let fall before your patient。 He knows what it means when you tell him he has tubercles or Bright's disease； and； if he hears the word carcinoma； he will certainly look it out in a medical dictionary； if he does not interpret its dread significance on the instant。 Tell him he has asthmatic symptoms； or a tendency to the gouty diathesis； and he will at once think of all the asthmatic and gouty old patriarchs he has ever heard of； and be comforted。 You need not be so cautious in speaking of the health of rich and remote relatives； if he is in the line of succession。
Some shrewd old doctors have a few phrases always on hand for patients that will insist on knowing the pathology of their complaints without the slightest capacity of understanding the scientific explanation。 I have known the term 〃spinal irritation 〃 serve well on such occasions； but I think nothing on the whole has covered so much ground； and meant so little； and given such profound satisfaction to all parties； as the magnificent phrase 〃congestion of the portal system。〃
Once more； let me recommend you； as far as possible； to keep your doubts to yourself； and give the patient the benefit of your decision。 Firmness； gentle firmness； is absolutely necessary in this and certain other relations。 Mr。 Rarey with Cruiser； Richard with Lady Ann； Pinel with his crazy people； show what steady nerves can do with the most intractable of animals； the most irresistible of despots； and the most unmanageable of invalids。
If you cannot acquire and keep the confidence of your patient； it is time for you to give place to some other practitioner who can。 If you are wise and diligent； you can establish relations with the best of them which they will find it very hard to break。 But； if they wish to employ another person； who； as they think； knows more than you do； do not take it as a personal wrong。 A patient believes another man can save his life； can restore him to health； which； as he thinks； you have not the skill to do。 No matter whether the patient is right or wrong； it is a great impertinence to think you have any property in him。 Your estimate of your own ability is not the question； it is what the patient thinks of it。 All your wisdom is to him like the lady's virtue in Raleigh's song：
〃If she seem not chaste to me； What care I how chaste she be？〃
What I call a good patient is one who； having found a good physician； sticks to him till he dies。 But there are many very good people who are not what I call good patients。 I was once requested to call on a lady suffering from nervous and other symptoms。 It came out in the preliminary conversational skirmish； half medical； half social； that I was the twenty…sixth member of the faculty into whose arms； professionally speaking； she had successively thrown herself。 Not being a believer in such a rapid rotation of scientific crops； I gently deposited the burden； commending it to the care of number twenty…seven； and； him； whoever he might be； to the care of Heaven。
If there happened to be among my audience any person who wished to know on what principles the patient should choose his physician； I should give him these few precepts to think over：
Choose a man who is personally agreeable； for a daily visit from an intelligent； amiable； pleasant； sympathetic person will cost you no more than one from a sloven or a boor； and his presence will do more for you than any prescription the other will order。
Let him be a man of recognized good sense in other matters； and the chance is that he will be sensible as a practitioner。
Let him be a man who stands well with his professional brethren； whom they approve as honest； able； courteous。
Let him be one whose patients are willing to die in his hands； not one whom they go to for trifles； and leave as soon as they are in danger； and who can say； therefore； that he never loses a patient。
Do not leave the ranks of what is called the regular profession； unless you wish to go farther and fare worse； for you may be assured that its members recognize no principle which hinders their accepting any remedial agent proved to be useful； no matter from what quarter it comes。 The difficulty is that the stragglers； organized under fantastic names in pretentious associations； or lurking in solitary dens behind doors left ajar； make no real contributions to the art of healing。 When they bring forward a remedial agent like chloral； like the bromide of potassium； like ether； used as an anesthetic； they will find no difficulty in procuring its recognition。
Some of you will probably be more or less troubled by the pretensions of that parody of mediaeval theology which finds its dogma of hereditary depravity in the doctrine of psora； its miracle of transubstantiation in the mystery of its triturations and dilutions； its church in the people who have mistaken their century； and its priests in those who have mistaken their calling。 You can do little with persons who are disposed to accept these curious medical superstitions。 The saturation…point of individual minds with reference to evidence； and especially medical evidence； differs； and must always continue to differ； very widely。 There are those whose minds are satisfied with the decillionth dilution of a scientific proof。 No wonder they believe in the efficacy of a similar attenuation of bryony or pulsatilla。 You have no fulcrum you can rest upon to lift an error out of such minds as these； often highly endowed with knowledge and talent； sometimes with genius； but commonly richer in the imaginative than the observing and reasoning faculties。
Let me return once more to the young graduate。 Your relations to your professional brethren may be a source of lifelong happiness and growth in knowledge and character； or they may make you wretched and end by leaving you isolated from those who should be your friends and counsellors。 The life of a physician becomes ignoble when he suffers himself to feed on petty jealousies and sours his temper in perpetual quarrels。 You will be liable to meet an uncomfortable man here and there in the profession；one who is so fond of being in hot water that it is a wonder all the albumen in his body is not coagulated。 There are common barrators among doctors as there are among lawyers； stirrers up of strife under one pretext and another； but in reality because they like it。 They are their own worst enemies； and do themselves a mischief each time they assail their neighbors。 In my student days I remember a good deal of this Donnybrook…Fair style of quarrelling； more especially in Paris； where some of the noted surgeons were always at loggerheads； and in one of our lively Western cities。 Soon after I had set up an office； I had a trifling experience which may serve to point a moral in this direction。 I had placed a lamp behind the glass in the entry to indicate to the passer…by where relief from all curable infirmities was to be sought and found。 Its brilliancy attracted the attention of a devious youth； who dashed his fist through the glass and upset my modest luminary。 All he got by his vivacious assault was that he left portions of integument from his knuckles upon the glass； had a lame hand； was very easily identified； and had to pay the glazier's bill。 The moral is that； if the brilliancy of another's reputation excites your belligerent instincts； it is not worth your while to strike at it； without calculating which of you is likely to suffer most； if you do。
You may be assured that when an ill…conditioned neighbor is always complaining of a bad taste in his mouth and an evil atmosphere about him； there is something wrong about his own secretions。 In such cases there is an alterative regimen of remarkable efficacy： it is a starvation…diet of
