medical essays-第73部分

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nt　habitat；　but　I　never　saw　him　do　more　than　look　as　if　he　wanted　to　cut　a　good　dollop　out　of　a　patient　he　was　examining。　　The　short；　square；　substantial　man　with　iron…gray　hair；　ruddy　face；　and　white　apron　is　Baron　Larrey；　Napoleon's　favorite　surgeon；　the　most　honest　man　he　ever　saw；it　is　reputed　that　he　called　him。　　To　go　round　the　Hotel　des　Invalides　with　Larrey　was　to　live　over　the　campaigns　of　Napoleon；　to　look　on　the　sun　of　Austerlitz；　to　hear　the　cannons　of　Marengo；　to　struggle　through　the　icy　waters　of　the　Beresina；　to　shiver　in　the　snows　of　the　Russian　retreat；　and　to　gaze　through　the　battle　smoke　upon　the　last　charge　of　the　red　lancers　on　the　redder　field　of　Waterloo。　　Larrey　was　still　strong　and　sturdy　as　I　saw　him；　and　few　portraits　remain　printed　in　livelier　colors　on　the　tablet　of　my　memory。

Leave　the　little　group　of　students　which　gathers　about　Larrey　beneath　the　gilded　dome　of　the　Invalides　and　follow　me　to　the　Hotel　Dieu；　where　rules　and　reigns　the　master…surgeon　of　his　day；　at　least　so　far　as　Paris　and　France　are　concerned；the　illustrious　Baron　Dupuytren。　No　man　disputed　his　reign；　some　envied　his　supremacy。　　Lisfranc　shrugged　his　shoulders　as　he　spoke　of　〃ce　grand　homme　de　1'autre　cots　de　la　riviere；〃　that　great　man　on　the　other　side　of　the　river；　but　the　great　man　he　remained；　until　he　bowed　before　the　mandate　which　none　may　disobey。　　〃Three　times；〃　said　Bouillaud；　〃did　the　apoplectic　thunderbolt　fall　on　that　robust　brain；〃it　yielded　at　last　as　the　old　bald　cliff　that　is　riven　and　crashes　down　into　the　valley。　　I　saw　him　before　the　first　thunderbolt　had　descended：　a　square；　solid　man；　with　a　high　and　full…domed　head；　oracular　in　his　utterances；　indifferent　to　those　around　him；　sometimes；　it　was　said；　very　rough　with　them。　　He　spoke　in　low；　even　tones；　with　quiet　fluency；　and　was　listened　to　with　that　hush　of　rapt　attention　which　I　have　hardly　seen　in　any　circle　of　listeners　unless　when　such　men　as　ex…President　John　Quincy　Adams　or　Daniel　Webster　were　the　speakers。　　I　do　not　think　that　Dupuytren　has　left　a　record　which　explains　his　influence；　but　in　point　of　fact　he　dominated　those　around　him　in　a　remarkable　manner。　You　must　have　all　witnessed　something　of　the　same　kind。　　The　personal　presence　of　some　men　carries　command　with　it；　and　their　accents　silence　the　crowd　around　them；　when　the　same　words　from　other　lips　might　fall　comparatively　unheeded。

As　for　Lisfranc；　I　can　say　little　more　of　him　than　that　he　was　a　great　drawer　of　blood　and　hewer　of　members。　　I　remember　his　ordering　a　wholesale　bleeding　of　his　patients；　right　and　left；　whatever　might　be　the　matter　with　them；　one　morning　when　a　phlebotomizing　fit　was　on　him。　　I　recollect　his　regretting　the　splendid　guardsmen　of　the　old　Empire；for　what？　　because　they　had　such　magnificent　thighs　to　amputate。　　I　got　along　about　as　far　as　that　with　him；　when　I　ceased　to　be　a　follower　of　M。　Lisfranc。

The　name　of　Velpeau　must　have　reached　many　of　you；　for　he　died　in　1867；　and　his　many　works　made　his　name　widely　known。　　Coming　to　Paris　in　wooden　shoes；　starving；　almost；　at　first；　he　raised　himself　to　great　eminence　as　a　surgeon　and　as　an　author；　and　at　last　obtained　the　Professorship　to　which　his　talents　and　learning　entitled　him。　His　example　may　be　an　encouragement　to　some　of　my　younger　hearers　who　are　born；　not　with　the　silver　spoon　in　their　mouths；　but　with　the　two…tined　iron　fork　in　their　hands。　　It　is　a　poor　thing　to　take　up　their　milk　porridge　with　in　their　young　days；　but　in　after　years　it　will　often　transfix　the　solid　dumplings　that　roll　out　of　the　silver　spoon。　　So　Velpeau　found　it。　　He　had　not　what　is　called　genius；　he　was　far　from　prepossessing　in　aspect；　looking　as　if　he　might　have　wielded　the　sledge…hammer　（as　I　think　he　had　done　in　early　life）　rather　than　the　lancet；　but　he　had　industry；　determination；　intelligence；　character；　and　he　made　his　way　to　distinction　and　prosperity；　as　some　of　you　sitting　on　these　benches　and　wondering　anxiously　what　is　to　become　of　you　in　the　struggle　for　life　will　have　done　before　the　twentieth　century　has　got　halfway　through　its　first　quarter。　　A　good　sound　head　over　a　pair　of　wooden　shoes　is　a　great　deal　better　than　a　wooden　head　belonging　to　an　owner　who　cases　his　feet　in　calf…skin；　but　a　good　brain　is　not　enough　without　a　stout　heart　to　fill　the　four　great　conduits　which　carry　at　once　fuel　and　fire　to　that　mightiest　of　engines。

How　many　of　you　who　are　before　me　are　familiarly　acquainted　with　the　name　of　Broussais；　or　even　with　that　of　Andral？　　Both　were　lecturing　at　the　Ecole　de　Medicine；　and　I　often　heard　them。　　Broussais　was　in　those　days　like　an　old　volcano；　which　has　pretty　nearly　used　up　its　fire　and　brimstone；　but　is　still　boiling　and　bubbling　in　its　interior；　and　now　and　then　sends　up　a　spirt　of　lava　and　a　volley　of　pebbles。　　His　theories　of　gastro…enteritis；　of　irritation　and　inflammation　as　the　cause　of　disease；　and　the　practice　which　sprang　from　them；　ran　over　the　fields　of　medicine　for　a　time　like　flame　over　the　grass　of　the　prairies。　　The　way　in　which　that　knotty…featured；　savage　old　man　would　bring　out　the　word　irritationwith　rattling　and　rolling　reduplication　of　the　resonant　letter　rmight　have　taught　a　lesson　in　articulation　to　Salvini。　　But　Broussais's　theory　was　languishing　and　well…nigh　become　obsolete；　and　this；　no　doubt；　added　vehemence　to　his　defence　of　his　cherished　dogmas。

Old　theories；　and　old　men　who　cling　to　them；　must　take　themselves　out　of　the　way　as　the　new　generation　with　its　fresh　thoughts　and　altered　habits　of　mind　comes　forward　to　take　the　place　of　that　which　is　dying　out。　This　was　a　truth　which　the　fiery　old　theorist　found　it　very　hard　to　learn；　and　harder　to　bear；　as　it　was　forced　upon　him。　　For　the　hour　of　his　lecture　was　succeeded　by　that　of　a　younger　and　far　more　popular　professor。　　As　his　lecture　drew　towards　its　close；　the　benches；　thinly　sprinkled　with　students；　began　to　fill　up；　the　doors　creaked　open　and　banged　back　oftener　and　oftener；　until　at　last　the　sound　grew　almost　continuous；　and　the　voice　of　the　lecturer　became　a　leonine　growl　as　he　strove　in　vain　to　be　heard　over　the　noise　of　doors　and　footsteps。

Broussais　was　now　sixty…two　years　old。　　The　new　generation　had　outgrown　his　doctrines；　and　the　Professor　for　whose　hour　the　benches　had　filled　themselves　belonged　to　that　new　generation。　　Gabriel　Andral　was　little　more　than　half　the　age　of　Broussais；　in　the　full　prime　and　vigor　of　manhood　at　thirty…seven　years。　　He　was　a　rapid；　fluent；　fervid；　and　imaginative　speaker；　pleasing　in　aspect　and　manner；a　strong　contrast　to　the　harsh；　vituperative　old　man　who　had　just　preceded　him。　　His　Clinique　Medicale　is　still　valuable　as　a　collection　of　cases；　and　his　researches　on　the　blood；　conducted　in　association　with　Gavarret；　contributed　new　and　valuable　facts　to　science。　　But　I　remember　him　chiefly　as　one　of　those　instructors　whose　natural　eloquence　made　it　delightful　to　listen　to　him。　　I　doubt　if　I　or　my　fellow…students　did　full　justice　either　to　him　or　to　the　famous　physician　of　Hotel　Dieu；　Chomel。　　We　had　addicted　ourselves　almost　too　closely　to　the　words　of　another　master；　by　whom　we　were　ready　to　swear　as　against　all　teachers　that　ever　were　or　ever　would　be。

This　object　of　our　reverence；　I　might　almost　say　idolatry；　was　one　whose　name　is　well　known　to　most　of　the　young　men　before　me；　even　to　those　who　may　know　comparatively　little　of　his　works　and　teachings。　Pierre　Charles　Alexandre　Louis；　at　the　age　of　forty…seven；　as　I　recall　him；　was　a　tall；　rather　spare；　dignified　personage；　of　serene　and　grave　aspect；　but　with　a　pleasant　smile　and　kindly　voice　for　the　student　with　whom　he　came　into　personal　relations。　　If　I　summed　up　the　lessons　of　Louis　in　two　expressions；　they　would　be　these；　I　do　not　hold　him　answerable　for　the　words；　but　I　will　condense　them　after　my　own　fashion　in　French；　and　then　give　them　to　you；　expanded　somewhat；　in　English：

　　　　　　　　　　Formez　toujours　des　idees　nettes。　　　　　　　　　　　Fuyez　toujours　les　a　peu　pres。

Always　make　sure　that　you　form　a　distinct　and　clear　idea　of　the　matter　you　are　considering。

Always　avoid　vague　approximations　where　exact　estimates　are　possible；　about　so　many；about　so　much；　instead　of　the　precise　number　and　quantity。

Now；　if　there　is　anything　on　which　the　biological　sciences　have　prided　themselves　in　these　latter　years　it　is　the　substitution　of　quantitative　for　qualitative　formulae。　　The　〃numerical　system；〃　of　which　Louis　was　the　great　advocate；　if　not　the　absolute　originator；　was　an　attempt　to　substitute　series　of　carefully　recorded　facts；　rigidly　counted　and　closely　compared；　for　those　never…ending　records　of　vague；　unverifiable　conclusions　with　which　the　classics　of　the　healing　art　were　overloaded。　　The　history　of　practical　medicine　had　been　like　the　story　of　the　Danaides。　　〃Experience　〃　had　been；　from　time　immemorial；　pouring　its　flowing　treasures　into　buckets　full　of　holes。　　At　the　existing　rate　of　supply　and　leakage　they　would　never　be　filled；　nothing　would　ever　be　settled　in　medicine。　　But　cases　thoroughly　recorded　and　mathematically　analyzed　would　always　be　available　for　future　use；　and　when　accumulated　in　sufficient　number　would　lead　to　results　which　would　be　trustworthy；　and　belong　to　science。

You　young　men　who　are　following　the　hospitals　hardly　know　how　much　you　are　indebted　to　Louis。　　I　say　nothing　of　his　Researches　on　Phthisis　or　his　great　work　on　Typhoid　Fever。　　But　I　consider　his　modest　and　brief　Essay　on　Bleeding　in　some　Inflammatory　Diseases；　based　on　cases　carefully　observed　and　numerically　analyzed；　one　of　the　most　important　written　contributions　to　practical　medicine；　to　the　treatment　of　internal　disease；　of　this　century；　if　not　since　the　days　of　Sydenham。　　The　lancet　was　the　magician's　wand　of　the　dark　ages　of　medicine。　　The　old　physicians　not　only　believed　in　its　general　efficacy　as　a　wonder…worker　in　disease；　but　they　believed　that　each　malady　could　be　successfully　attacked　from　some　special　part　of　the　body；the　strategic　point　which　commanded　the　seat　of　the　morbid　affection。　　On　a　figure　given　in　the　curious　old　work　of　John　de　Ketam；　no　less　than　thirty…eight　separate　places　are　marked　as　the　proper　ones　to　bleed　from；　in　different　diseases。　　Even　Louis；　who　had　not　wholly　given　up　venesection；　used　now　an