medical essays-第74部分

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bleed　from；　in　different　diseases。　　Even　Louis；　who　had　not　wholly　given　up　venesection；　used　now　and　then　to　order　that　a　patient　suffering　from　headache　should　be　bled　in　the　foot；　in　preference　to　any　other　part。

But　what　Louis　did　was　this：　he　showed　by　a　strict　analysis　of　numerous　cases　that　bleeding　did　not　strangle；jugulate　was　the　word　then　used；acute　diseases；　more　especially　pneumonia。　　This　was　not　a　reform；it　was　a　revolution。　　It　was　followed　up　in　this　country　by　the　remarkable　Discourse　of　Dr。　Jacob　Bigelow　upon　Self…Limited　Diseases；　which　has；　I　believe；　done　more　than　any　other　work　or　essay　in　our　own　language　to　rescue　the　practice　of　medicine　from　the　slavery　to　the　drugging　system　which　was　a　part　of　the　inheritance　of　the　profession。

Yes；　I　say；　as　I　look　back　on　the　long　hours　of　the　many　days　I　spent　in　the　wards　and　in　the　autopsy　room　of　La　Pitie；　where　Louis　was　one　of　the　attending　physicians；yes；　Louis　did　a　great　work　for　practical　medicine。　　Modest　in　the　presence　of　nature；　fearless　in　the　face　of　authority；　unwearying　in　the　pursuit　of　truth；　he　was　a　man　whom　any　student　might　be　happy　and　proud　to　claim　as　his　teacher　and　his　friend；　and　yet；　as　I　look　back　on　the　days　when　I　followed　his　teachings；　I　feel　that　I　gave　myself　up　too　exclusively　to　his　methods　of　thought　and　study。

There　is　one　part　of　their　business　which　certain　medical　practitioners　are　too　apt　to　forget；　namely；　that　what　they　should　most　of　all　try　to　do　is　to　ward　off　disease；　to　alleviate　suffering；　to　preserve　life；　or　at　least　to　prolong　it　if　possible。　　It　is　not　of　the　slightest　interest　to　the　patient　to　know　whether　three　or　three　and　a　quarter　cubic　inches　of　his　lung　are　hepatized。　　His　mind　is　not　occupied　with　thinking　of　the　curious　problems　which　are　to　be　solved　by　his　own　autopsy；whether　this　or　that　strand　of　the　spinal　marrow　is　the　seat　of　this　or　that　form　of　degeneration。　　He　wants　something　to　relieve　his　pain；　to　mitigate　the　anguish　of　dyspnea；　to　bring　back　motion　and　sensibility　to　the　dead　limb；　to　still　the　tortures　of　neuralgia。　　What　is　it　to　him　that　you　can　localize　and　name　by　some　uncouth　term　the　disease　which　you　could　not　prevent　and　which　you　cannot　cure？　　An　old　woman　who　knows　how　to　make　a　poultice　and　how　to　put　it　on；　and　does　it　tuto；　eito；　jucunde；　just　when　and　where　it　is　wanted；　is　better；a　thousand　times　better　in　many　cases；than　a　staring　pathologist；　who　explores　and　thumps　and　doubts　and　guesses；　and　tells　his　patient　be　will　be　better　tomorrow；　and　so　goes　home　to　tumble　his　books　over　and　make　out　a　diagnosis。

But　in　those　days；　I；　like　most　of　my　fellow　students；　was　thinking　much　more　of　〃science〃　than　of　practical　medicine；　and　I　believe　if　we　had　not　clung　so　closely　to　the　skirts　of　Louis　and　had　followed　some　of　the　courses　of　men　like　Trousseau；therapeutists；　who　gave　special　attention　to　curative　methods；　and　not　chiefly　to　diagnosis；　it　would　have　been　better　for　me　and　others。　　One　thing；　at　any　rate；　we　did　learn　in　the　wards　of　Louis。　　We　learned　that　a　very　large　proportion　of　diseases　get　well　of　themselves；　without　any　special　medication；the　great　fact　formulated；　enforced；　and　popularized　by　Dr。　Jacob　Bigelow　in　the　Discourse　referred　to。　　We　unlearned　the　habit　of　drugging　for　its　own　sake。　　This　detestable　practice；　which　I　was　almost　proscribed　for　condemning　somewhat　too　epigrammatically　a　little　more　than　twenty　years　ago；　came　to　us；　I　suspect；　in　a　considerable　measure　from　the　English　〃general　practitioners；〃　a　sort　of　prescribing　apothecaries。　　You　remember　how；　when　the　city　was　besieged；　each　artisan　who　was　called　upon　in　council　to　suggest　the　best　means　of　defence　recommended　the　articles　he　dealt　in：　the　carpenter；　wood；　the　blacksmith；　iron；　the　mason；　brick；　until　it　came　to　be　a　puzzle　to　know　which　to　adopt。　Then　the　shoemaker　said；　〃Hang　your　walls　with　new　boots；〃　　and　gave　good　reasons　why　these　should　be　the　best　of　all　possible　defences。　　Now　the　〃general　practitioner〃　　charged；　as　I　understand；　for　his　medicine；　and　in　that　way　got　paid　for　his　visit。　　Wherever　this　is　the　practice；　medicine　is　sure　to　become　a　trade；　and　the　people　learn　to　expect　drugging；　and　to　consider　it　necessary；　because　drugs　are　so　universally　given　to　the　patients　of　the　man　who　gets　his　living　by　them。

It　was　something　to　have　unlearned　the　pernicious　habit　of　constantly　giving　poisons　to　a　patient；　as　if　they　were　good　in　themselves；　of　drawing　off　the　blood　which　he　would　want　in　his　struggle　with　disease；　of　making　him　sore　and　wretched　with　needless　blisters；　of　turning　his　stomach　with　unnecessary　nauseous　draught　and　mixtures；　only　because　he　was　sick　and　something　must　be　done。　　But　there　were　positive　as　well　as　negative　facts　to　be　learned；　and　some　of　us；　I　fear；　came　home　rich　in　the　negatives　of　the　expectant　practice；　poor　in　the　resources　which　many　a　plain　country　practitioner　had　ready　in　abundance　for　the　relief　and　the　cure　of　disease。　　No　one　instructor　can　be　expected　to　do　all　for　a　student　which　he　requires。　　Louis　taught　us　who　followed　him　the　love　of　truth；　the　habit　of　passionless　listening　to　the　teachings　of　nature；　the　most　careful　and　searching　methods　of　observation；　and　the　sure　means　of　getting　at　the　results　to　be　obtained　from　them　in　the　constant　employment　of　accurate　tabulation。　　He　was　not　a　showy；　or　eloquent；　or；　I　should　say；　a　very　generally　popular　man；　though　the　favorite；　almost　the　idol；　of　many　students；　especially　Genevese　and　Bostonians。　　But　he　was　a　man　of　lofty　and　admirable　scientific　character；　and　his　work　will　endure　in　its　influences　long　after　his　name　is　lost　sight　of　save　to　the　faded　eyes　of　the　student　of　medical　literature。

Many　other　names　of　men　more　or　less　famous　in　their　day；　and　who　were　teaching　while　I　was　in　Paris；　come　up　before　me。　　They　are　but　empty　sounds　for　the　most　part　in　the　ears　of　persons　of　not　more　than　middle　age。　　Who　of　you　knows　anything　of　Richerand；　author　of　a　very　popular　work　on　Physiology；　commonly　put　into　the　student's　hands　when　I　first　began　to　ask　for　medical　text…books？　　I　heard　him　lecture　once；　and　have　had　his　image　with　me　ever　since　as　that　of　an　old；　worn…out　man；a　venerable　but　dilapidated　relic　of　an　effete　antiquity。　　To　verify　this　impression　I　have　just　looked　out　the　dates　of　his　birth　and　death；　and　find　that　he　was　eighteen　years　younger　than　the　speaker　who　is　now　addressing　you。　　There　is　a　terrible　parallax　between　the　period　before　thirty　and　that　after　threescore　and　ten；　as　two　men　of　those　ages　look；　one　with　naked　eyes；　one　through　his　spectacles；　at　the　man　of　fifty　and　thereabout。　Magendie；　I　doubt　not　you　have　all　heard　of。　　I　attended　but　one　of　his　lectures。　　I　question　if　one　here；　unless　some　contemporary　of　my　own　has　strayed　into　the　amphitheatre；knows　anything　about　Marjolin。　　I　remember　two　things　about　his　lectures　on　surgery；　the　deep　tones　of　his　voice　as　he　referred　to　his　oracle；the　earlier　writer；　Jean　Louis　Petit；and　his　formidable　snuffbox。　　What　he　taught　me　lies　far　down；　I　doubt　not；　among　the　roots　of　my　knowledge；　but　it　does　not　flower　out　in　any　noticeable　blossoms；　or　offer　me　any　very　obvious　fruits。　　Where　now　is　the　fame　of　Bouillaud；　Professor　and　Deputy；　the　Sangrado　of　his　time？　　Where　is　the　renown　of　Piorry；　percussionist　and　poet；　expert　alike　in　the　resonances　of　the　thoracic　cavity　and　those　of　the　rhyming　vocabulary？　I　think　life　has　not　yet　done　with　the　vivacious　Ricord；　whom　I　remember　calling　the　Voltaire　of　pelvic　literature；a　sceptic　as　to　the　morality　of　the　race　in　general；　who　would　have　submitted　Diana　to　treatment　with　his　mineral　specifics；　and　ordered　a　course　of　blue　pills　for　the　vestal　virgins。

Ricord　was　born　at　the　beginning　of　the　century；　and　Piorry　some　years　earlier。　　Cruveilhier；　who　died　in　1874；　is　still　remembered　by　his　great　work　on　pathological　anatomy；　his　work　on　descriptive　anatomy　has　some　things　which　I　look　in　vain　for　elsewhere。　　But　where　is　Civiale；where　are　Orfila；　Gendrin；　Rostan；　Biett；　Alibert；　jolly　old　Baron　Alibert；　whom　I　remember　so　well　in　his　broad…　brimmed　hat；　worn　a　little　jauntily　on　one　side；　calling　out　to　the　students　in　the　court…yard　of　the　Hospital　St。　　Louis；　〃Enfans　de　la　methode　naturelle；　etes…vous　tous　ici？〃　〃Children　of　the　natural　method　＇his　own　method　of　classification　of　skin　diseases；＇　are　you　all　here？　　〃All　here；　then；　perhaps；　all　where；　now？

My　show　of　ghosts　is　over。　　It　is　always　the　same　story　that　old　men　tell　to　younger　ones；　some　few　of　whom　will　in　their　turn　repeat　the　tale；　only　with　altered　names；　to　their　children's　children。

　　　　　Like　phantoms　painted　on　the　magic　slide；　　　　　　Forth　from　the　darkness　of　the　past　we　glide；　　　　　　As　living　shadows　for　a　moment　seen　　　　　　In　airy　pageant　on　the　eternal　screen；　　　　　　Traced　by　a　ray　from　one　unchanging　flame；　　　　　　Then　seek　the　dust　and　stillness　whence　we　came。

Dr。　Benjamin　Waterhouse；　whom　I　well　remember；　came　back　from　Leyden；　where　he　had　written　his　Latin　graduating　thesis；　talking　of　the　learned　Gaubius　and　the　late　illustrious　Boerhaave　and　other　dead　Dutchmen；　of　whom　you　know　as　much；　most　of　you；　as　you　do　of　Noah's　apothecary　and　the　family　physician　of　Methuselah；　whose　prescriptions　seem　to　have　been　lost　to　posterity。　　Dr。　Lloyd　came　back　to　Boston　full　of　the　teachings　of　Cheselden　and　Sharpe；　William　Hunter；　Smellie；　and　Warner；　Dr。　James　Jackson　loved　to　tell　of　Mr。　Cline　and　to　talk　of　Mr。　John　Hunter；　Dr。　Reynolds　would　give　you　his　recollections　of　Sir　Astley　Cooper　and　Mr。　Abernethy；　I　have　named　the　famous　Frenchmen　of　my　student　days；　Leyden；　Edinburgh；　London；　Paris；　were　each　in　turn　the　Mecca　of　medical　students；　just　as　at　the　present　day　Vienna　and　Berlin　are　the　centres　where　our　young　men　crowd　for　instruction。　　These　also　must　sooner　or　later　yield　their　precedence　and　pass　the　torch　they　hold　to　other　hands。　　Where　shall　it　next　flame　at　the　head　of　the　long　procession？　　Shall　it　find　its　old　place　on　the　shores　of　the　Gulf　of　Salerno；　or　shall　it　mingle　its　rays　with　the　northern　aurora　up　among　the　fiords　of　Norway；or　shall　it　be　borne　across　the　Atlantic　and　reach　the　banks　of　the　Charles；　where　Agassiz　and　Wyman