medical essays-第66部分

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th　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；　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