medical essays-第64部分

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　the　operating　amphitheatre。　　It　is　the　special　advantage　of　large　cities　that　they　afford　the　opportunity　of　seeing　a　great　deal　of　disease　in　a　short　space　of　time；　and　of　seeing　many　cases　of　the　same　kind　of　disease　brought　together。　　Let　us　not　be　unjust　to　the　claims　of　the　schools　remote　from　the　larger　centres　of　population。　　Who　among　us　has　taught　better　than　Nathan　Smith；　better　than　Elisha　Bartlett？　who　teaches　better　than　some　of　our　living　contemporaries　who　divide　their　time　between　city　and　country　schools？　　I　am　afraid　we　do　not　always　do　justice　to　our　country　brethren；　whose　merits　are　less　conspicuously　exhibited　than　those　of　the　great　city　physicians　and　surgeons；　such　especially　as　have　charge　of　large　hospitals。　　There　are　modest　practitioners　living　in　remote　rural　districts　who　are　gifted　by　nature　with　such　sagacity　and　wisdom；　trained　so　well　in　what　is　most　essential　to　the　practice　of　their　art；　taught　so　thoroughly　by　varied　experience；　forced　to　such　manly　self…reliance　by　their　comparative　isolation；　that；　from　converse　with　them　alone；　from　riding　with　them　on　their　long　rounds　as　they　pass　from　village　to　village；　from　talking　over　cases　with　them；　putting　up　their　prescriptions；　watching　their　expedients；　listening　to　their　cautions；　marking　the　event　of　their　predictions；　hearing　them　tell　of　their　mistakes；　and　now　and　then　glory　a　little　in　the　detection　of　another's　blunder；　a　young　man　would　find　himself　better　fitted　for　his　real　work　than　many　who　have　followed　long　courses　of　lectures　and　passed　a　showy　examination。　　But　the　young　man　is　exceptionally　fortunate　who　enjoys　the　intimacy　of　such　a　teacher。　　And　it　must　be　confessed　that　the　great　hospitals；　infirmaries；　and　dispensaries　of　large　cities；　where　men　of　well…　sifted　reputations　are　in　constant　attendance；　are　the　true　centres　of　medical　education。　　No　students；　I　believe；　are　more　thoroughly　aware　of　this　than　those　who　have　graduated　at　this　institution。　Here；　as　in　all　our　larger　city　schools；　the　greatest　pains　are　taken　to　teach　things　as　well　as　names。　　You　have　entered　into　the　inheritance　of　a　vast　amount　of　transmitted　skill　and　wisdom；　which　you　have　taken；　warm；　as　it　were；　with　the　life　of　your　well…schooled　instructors。　　You　have　not　learned　all　that　art　has　to　teach　you；　but　you　are　safer　practitioners　to…day　than　were　many　of　those　whose　names　we　hardly　mention　without　a　genuflection。　　I　had　rather　be　cared　for　in　a　fever　by　the　best…taught　among　you　than　by　the　renowned　Fernelius　or　the　illustrious　Boerhaave；　could　they　come　back　to　us　from　that　better　world　where　there　are　no　physicians　needed；　and；　if　the　old　adage　can　be　trusted；　not　many　within　call。　　I　had　rather　have　one　of　you　exercise　his　surgical　skill　upon　me　than　find　myself　in　the　hands　of　a　resuscitated　Fabricius　Hildanus；　or　even　of　a　wise　Ambroise　Pare；　revisiting　earth　in　the　light　of　the　nineteenth　century。

You　will　not　accuse　me　of　underrating　your　accomplishments。　　You　know　what　to　do　for　a　child　in　a　fit；　for　an　alderman　in　an　apoplexy；　for　a　girl　that　has　fainted；　for　a　woman　in　hysterics；　for　a　leg　that　is　broken；　for　an　arm　that　is　out　of　joint；　for　fevers　of　every　color；　for　the　sailor's　rheumatism；　and　the　tailor's　cachexy。　　In　fact　you　do　really　know　so　much　at　this　very　hour；　that　nothing　but　the　searching　test　of　time　can　fully　teach　you　the　limitations　of　your　knowledge。

Of　some　of　these　you　will　permit　me　to　remind　you。　　You　will　never　have　outgrown　the　possibility　of　new　acquisitions；　for　Nature　is　endless　in　her　variety。　　But　even　the　knowledge　which　you　may　be　said　to　possess　will　be　a　different　thing　after　long　habit　has　made　it　a　part　of　your　existence。　　The　tactus　eruditus　extends　to　the　mind　as　well　as　to　the　finger…ends。　　Experience　means　the　knowledge　gained　by　habitual　trial；　and　an　expert　is　one　who　has　been　in　the　habit　of　trying。　　This　is　the　kind　of　knowledge　that　made　Ulysses　wise　in　the　ways　of　men。　　Many　cities　had　he　seen；　and　known　the　minds　of　those　who　dwelt　in　them。　　This　knowledge　it　was　that　Chaucer's　Shipman　brought　home　with　him　from　the　sea　a

　　　　　〃In　many　a　tempest　had　his　berd　be　shake。〃

This　is　the　knowledge　we　place　most　confidence　in；　in　the　practical　affairs　of　life。

Our　training　has　two　stages。　　The　first　stage　deals　with　our　intelligence；　which　takes　the　idea　of　what　is　to　be　done　with　the　most　charming　ease　and　readiness。　　Let　it　be　a　game　of　billiards；　for　instance；　which　the　marker　is　going　to　teach　us。　　We　have　nothing　to　do　but　to　make　this　ball　glance　from　that　ball　and　hit　that　other　ball；　and　to　knock　that　ball　with　this　ball　into　a　certain　caecal　sacculus　or　diverticulum　which　our　professional　friend　calls　a　pocket。　　Nothing　can　be　clearer；　it　is　as　easy　as　〃playing　upon　this　pipe；〃　for　which　Hamlet　gives　Guildenstern　such　lucid　directions。　But　this　intelligent　Me；　who　steps　forward　as　the　senior　partner　in　our　dual　personality；　turns　out　to　be　a　terrible　bungler。　　He　misses　those　glancing　hits　which　the　hard…featured　young　professional　person　calls　〃carroms；〃　and　insists　on　pocketing　his　own　ball　instead　of　the　other　one。

It　is　the　unintelligent　Me；　stupid　as　an　idiot；　that　has　to　try　a　thing　a　thousand　times　before　he　can　do　it；　and　then　never　knows　how　he　does　it；　that　at　last　does　it　well。　　We　have　to　educate　ourselves　through　the　pretentious　claims　of　intellect；　into　the　humble　accuracy　of　instinct；　and　we　end　at　last　by　acquiring　the　dexterity；　the　perfection；　the　certainty；　which　those　masters　of　arts；　the　bee　and　the　spider；　inherit　from　Nature。

Book…knowledge；　lecture…knowledge；　examination…knowledge；　are　all　in　the　brain。　　But　work…knowledge　is　not　only　in　the　brain；　it　is　in　the　senses；　in　the　muscles；　in　the　ganglia　of　the　sympathetic　nerves；　all　over　the　man；　as　one　may　say；　as　instinct　seems　diffused　through　every　part　of　those　lower　animals　that　have　no　such　distinct　organ　as　a　brain。　　See　a　skilful　surgeon　handle　a　broken　limb；　see　a　wise　old　physician　smile　away　a　case　that　looks　to　a　novice　as　if　the　sexton　would　soon　be　sent　for；　mark　what　a　large　experience　has　done　for　those　who　were　fitted　to　profit　by　it；　and　you　will　feel　convinced　that；　much　as　you　know；　something　is　still　left　for　you　to　learn。

May　I　venture　to　contrast　youth　and　experience　in　medical　practice；　something　in　the　way　the　man　painted　the　lion；　that　is；　the　lion　under？

The　young　man　knows　the　rules；　but　the　old　man　knows…the　exceptions。　The　young　man　knows　his　patient；　but　the　old　man　knows　also　his　patient's　family；　dead　and　alive；　up　and　down　for　generations。　　He　can　tell　beforehand　what　diseases　their　unborn　children　will　be　subject　to；　what　they　will　die　of　if　they　live　long　enough；　and　whether　they　had　better　live　at　all；　or　remain　unrealized　possibilities；　as　belonging　to　a　stock　not　worth　being　perpetuated。　The　young　man　feels　uneasy　if　he　is　not　continually　doing　something　to　stir　up　his　patient's　internal　arrangements。　　The　old　man　takes　things　more　quietly；　and　is　much　more　willing　to　let　well　enough　alone：　All　these　superiorities；　if　such　they　are；'you　must　wait　for　time　to　bring　you。　　In　the　meanwhile　（if　we　will　let　the　lion　be　uppermost　for　a　moment）；　the　young　man's　senses　are　quicker　than　those　of　his　older　rival。　　His　education　in　all　the　accessory　branches　is　more　recent；　and　therefore　nearer　the　existing　condition　of　knowledge。　　He　finds　it　easier　than　his　seniors　to　accept　the　improvements　which　every　year　is　bringing　forward。　　New　ideas　build　their　nests　in　young　men's　brains。　　〃Revolutions　are　not　made　by　men　in　spectacles；〃　as　I　once　heard　it　remarked；　and　the　first　whispers　of　a　new　truth　are　not　caught　by　those　who　begin　to　feel　the　need　of　an　ear…trumpet。　　Granting　all　these　advantages　to　the　young　man；　he　ought；　nevertheless；　to　go　on　improving；　on　the　whole；　as　a　medical　practitioner；　with　every　year；　until　he　has　ripened　into　a　well…　mellowed　maturity。　　But；　to　improve；　he　must　be　good　for　something　at　the　start。　　If　you　ship　a　poor　cask　of　wine　to　India　and　back；　if　you　keep　it　a　half　a　century；　it　only　grows　thinner　and　sharper。

You　are　soon　to　enter　into　relations　with　the　public；　to　expend　your　skill　and　knowledge　for　its　benefit；　and　find　your　support　in　the　rewards　of　your　labor。　　What　kind　of　a　constituency　is　this　which　is　to　look　to　you　as　its　authorized　champions　in　the　struggle　of　life　against　its　numerous　enemies？

In　the　first　place；　the　persons　who　seek　the　aid　of　the　physician　are　very　honest　and　sincere　in　their　wish　to　get　rid　of　their　complaints；　and；　generally　speaking；　to　live　as　long　as　they　can。　　However　attractively　the　future　is　painted　to　them；　they　are　attached　to　the　planet　with　which　they　are　already　acquainted。　　They　are　addicted　to　the　daily　use　of　this　empirical　and　unchemical　mixture　which　we　call　air；　and　would　hold　on　to　it　as　a　tippler　does　to　his　alcoholic　drinks。　　There　is　nothing　men　will　not　do；　there　is　nothing　they　have　not　done；　to　recover　their　health　and　save　their　lives。　　They　have　submitted　to　be　half…drowned　in　water；　and　half…choked　with　gases；　to　be　buried　up　to　their　chins　in　earth；　to　be　seared　with　hot　irons　like　galley…slaves；　to　be　crimped　with　knives；　like　cod…fish；　to　have　needles　thrust　into　their　flesh；　and　bonfires　kindled　on　their　skin；　to　swallow　all　sorts　of　abominations；　and　to　pay　for　all　this；　as　if　to　be　singed　and　scalded　were　a　costly　privilege；　as　if　blisters　were　a　blessing；　and　leeches　were　a　luxury。　　What　more　can　be　asked　to　prove　their　honesty　and　sincerity？

This　same　community　is　very　intelligent　with　respect　to　a　great　many　subjects…commerce；　mechanics；　manufactures；　politics。　　But　with　regard　to　medicine　it　is　hopelessly　ignorant　and　never　finds　it　out。　I　do　not　know　that　it　is　any　worse　in　this　country　than　in　Great　Britain；　where　Mr。　Huxley　speaks　very　freely　of　〃the　utter　ignorance　of　the　simplest　laws　of　their　own　animal　life；　which　prevails　among　even　the　most　highly　educated　persons。〃　　And　Cullen　said　before　him　〃Neither　the　acutest　genius　nor　the　soundest　judgment　will　avail　in　judging　of　a　particular　science；　in　regard　to　which　they　have　not　been　exercised。　　I　have　been　obliged　to　please　my　patients　sometimes　with　reasons；　and　I　have　found　that　any　will　pass；　even　wit