medical essays-第51部分

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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　American　women　is　one　of　peculiar　delicacy　and　frequent　infirmity。　　Many　of　them　must　require　a　considerable　interval　between　the　reproductive　efforts；　to　repair　damages　arid　regain　strength。　　This　matter　is　not　to　be　decided　by　an　appeal　to　unschooled　nature。　　It　is　the　same　question　as　that　of　the　deformed　pelvis；one　of　degree。　　The　facts　of　mal…vitalization　are　as　much　to　be　attended　to　as　those　of　mal…formation。　　If　the　woman　with　a　twisted　pelvis　is　to　be　considered　an　exempt；　the　woman　with　a　defective　organization　should　be　recognized　as　belonging　to　the　invalid　corps。　　We　shudder　to　hear　what　is　alleged　as　to　the　prevalence　of　criminal　practices；　if　back　of　these　there　can　be　shown　organic　incapacity　or　overtaxing　of　too　limited　powers；　the　facts　belong　to　the　province　of　the　practical　physician；　as　well　as　of　the　moralist　and　the　legislator；　and　require　his　gravest　consideration。

Take　the　important　question　of　bleeding。　　Is　venesection　done　with　forever？　　Six　years　ago　it　was　said　here　in　an　introductory　Lecture　that　it　would　doubtless　come　back　again　sooner　or　later。　　A　fortnight　ago　I　found　myself　in　the　cars　with　one　of　the　most　sensible　and　esteemed　practitioners　in　New　England。　　He　took　out　his　wallet　and　showed　me　two　lancets；　which　he　carried　with　him；　he　had　never　given　up　their　use。　　This　is　a　point　you　will　have　to　consider。

Or；　to　mention　one　out　of　many　questionable　remedies；　shall　you　give　Veratrum　Viride　in　fevers　and　inflammations？　　It　makes　the　pulse　slower　in　these　affections。　　Then　the　presumption　would　naturally　be　that　it　does　harm。　　The　caution　with　reference　to　it　on　this　ground　was　long　ago　recorded　in　the　Lecture　above　referred　to。　　See　what　Dr。　John　Hughes　Bennett　says　of　it　in　the　recent　edition　of　his　work　on　Medicine。　　Nothing　but　the　most　careful　clinical　experience　can　settle　this　and　such　points　of　treatment。

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　psychol