not think that the breach of the seventh commandment can be shown to
have been of advantage to 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 other--who was no less a man than
John Hunter--to 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 and 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 questions--questions 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 psychological
speculations. The period of pupilage will be busy enough in acquiring
the knowledge needed, and the season of active practice will leave
little leisure for any but professional studies.
Dr. Graves of Dublin, one of the first clinical teachers of our
time, always insisted on his students' beginning at once to visit the
hospital. At the bedside the student must learn to treat disease, and
just as certainly as we spin out and multiply our academic prelections
we shall work in more and more stuffing, more and more rubbish, more and
more irrelevant, useless detail which the student will get rid of just
as soon as he leaves us. Then the next thing will be a new organization,
with an examining board of first-rate practical men, who will ask the
candidate questions that mean business,--who will make him operate if
he is to be a surgeon, and try him at the bedside if he is to be a
physician,--and not puzzle him with scientific conundrums which not more
than one of the questioners could answer himself or ever heard of since
he graduated.
Or these women who are hammering at the gates on which is written “No
admittance for the mothers of mankind,” will by and by organize an
institution, which starting from that skilful kind of nursing which
Florence Nightingale taught so well, will work backwards through
anodynes, palliatives, curatives, preventives, until with little show
of science it imparts most of what is most valuable in those branches of
the healing art it professes to teach. When that time comes, the fitness
of women for certain medical duties, which Hecquet advocated in 1708,
which Douglas maintained in 1736, which Dr. John Ware, long the honored
Professor of Theory and Practice in this Institution, upheld within
our own recollection in the face of his own recorded opinion to the
contrary, will very possibly be recognized.
My advice to every teacher less experienced than myself would be,
therefore: Do not fret over the details you have to omit; you probably
teach altogether too many as it is. Individuals may learn a thing
with once hearing it, but the only way of teaching a whole class is by
enormous repetition, representation, and illustration in all possible
forms. Now and then you will have a young man on your benches like the
late Waldo Burnett,--not very often, if you lecture half a century. You
cannot pretend to lecture chiefly for men like that,--a Mississippi raft
might as well take an ocean-steamer in tow. To meet his wants you would
have to leave the rest of your class behind and that you must not do.
President Allen of Jefferson College says that his instruction has
been successful in proportion as it has been elementary. It may be a
humiliating statement, but it is one which I have found true in my own
experience.
To the student I would say, that however plain and simple may be our
teaching, he must expect to forget much which he follows intelligently
in the lecture-room. But it is not the same as if he had never learned
it. A man must get a thing before he can forget it. There is a great
world of ideas we cannot voluntarily recall,--they are outside the
limits of the will. But they sway our conscious thought as the unseen
planets influence the movements of those within the sphere of vision. No
man knows how much he knows,--how many ideas he has,--any more than
he knows how many blood-globules roll in his veins. Sometimes accident
brings back here and there one, but the mind is full of irrevocable
remembrances and unthinkable thoughts, which take a part in all
its judgments as indestructible forces. Some of you must feel your
scientific deficiencies painfully after your best efforts. But every one
can acquire what is most essential. A man of very moderate ability may
be a good physician, if he devotes himself faithfully to the work. More
than this, a positively dull man, in the ordinary acceptation of the
term, sometimes makes a safer practitioner than one who has, we will
say, five per cent. more brains than his average neighbor, but who
thinks it is fifty per cent. more. Skulls belonging to this last variety
of the human race are more common, I may remark, than specimens like the
Neanderthal cranium, a cast of which you will find on the table in the
Museum.
Whether the average talent be high or low, the Colleges of the land must
make the best commodity they can out of such material as the country and
the cities furnish them. The community must have Doctors as it must
have bread. It uses up its Doctors just as it wears out its shoes, and
requires new ones. All the bread need not be French rolls, all the shoes
need not be patent leather ones; but the bread must be something that
can be eaten, and the shoes must be something that can be worn. Life
must somehow find food for the two forces that rub everything to
pieces, or burn it to ashes,--friction and oxygen. Doctors are oxydable
products, and the schools must keep furnishing new ones as the old
ones turn into oxyds; some of first-rate quality that burn with a great
light, some of a lower grade of brilliancy, some honestly, unmistakably,
by the grace of God, of moderate gifts, or in simpler phrase, dull.
The public will give every honest and reasonably competent worker in
the healing art a hearty welcome. It is on the whole very loyal to the
Medical Profession. Three successive years have borne witness to the
feeling with which this Institution, representing it in its educational
aspect, is regarded by those who are themselves most honored and
esteemed. The great Master of Natural Science bade the last year's class
farewell in our behalf, in those accents which delight every audience.
The Head of our ancient University honored us in the same way in the
preceding season. And how can we forget that other occasion when the
Chief Magistrate of the Commonwealth, that noble citizen whom we have
just lost, large-souled, sweet-natured, always ready for every kind
office, came among us at our bidding, and talked to us of our duties in
words as full of wisdom as his heart was of goodness?
You have not much to fear, I think, from the fancy practitioners. The
vulgar quackeries drop off, atrophied, one after another. Homoeopathy
has long been encysted, and is carried on the body medical as quietly as
an old wen. Every year gives you a more reasoning and reasonable people
to deal with. See how it is in Literature. The dynasty of British
dogmatists, after lasting a hundred years and more, is on its last legs.
Thomas Carlyle, third in the line of descent, finds an audience very
different from those which listened to the silver speech of Samuel
Taylor Coleridge and the sonorous phrases of Samuel Johnson. We
read him, we smile at his clotted English, his “swarmery” and other
picturesque expressions, but we lay down his tirade as we do one of Dr.
Cumming's interpretations of prophecy, which tells us that the world is
coming to an end next week or next month, if the weather permits,--not
otherwise,--feeling very sure that the weather will be unfavorable.
It is the same common-sense public you will appeal to. The less
pretension you make, the better they will like you in the long run. I
hope we shall make everything as plain and as simple to you as we can.
I would never use a long word, even, where a short one would answer
the purpose. I know there are professors in this country who “ligate”
arteries. Other surgeons only tie them, and it stops the bleeding just
as well. It is the familiarity and simplicity of bedside instruction
which makes it so pleasant as well as so profitable. A good clinical
teacher is himself a Medical School. We need not wonder that our young
men are beginning to announce themselves not only as graduates of this
or that College, but also as pupils of some one distinguished master.
I wish to close this Lecture, if you will allow me a few moments longer,
with a brief sketch of an instructor and practitioner whose character
was as nearly a model one in both capacities as I can find anywhere
recorded.
Dr. JAMES JACKSON, Professor of the Theory and Practice of Medicine
in this University from 1812 to 1846, and whose name has been since
retained on our rolls as Professor Emeritus, died on the 27th of August
last, in the ninetieth year of his age. He studied his profession, as
I have already mentioned, with Dr. Holyoke of Salem, one of the few
physicians who have borne witness to their knowledge of the laws of life
by living to complete their hundredth year. I think the student took
his Old Master, as he always loved to call him, as his model; each was
worthy of the other, and both were bright examples to all who come after
them.
I remember that in the sermon preached by Dr. Grazer after Dr. Holyoke's
death, one of the points most insisted upon as characteristic of that
wise and good old man was the perfect balance of all his faculties. The
same harmonious adjustment of powers, the same symmetrical arrangement
of life, the same complete fulfilment of every day's duties, without
haste and without needless delay, which characterized the master,
equally distinguished the scholar. A glance at the life of our own Old
Master, if I can do any justice at all to his excellences, will give
you something to carry away from this hour's meeting not unworthy to be
remembered.
From December, 1797, to October, 1799, he remained with Dr. Holyoke as a
student, a period which he has spoken of as a most interesting and
most gratifying part of his life. After this he passed eight months
in London, and on his return, in October, 1800, he began business in
Boston.
He had followed Mr. Cline, as I have mentioned, and was competent to
practise Surgery. But he found Dr. John Collins Warren had already
occupied the ground which at that day hardly called for more than
one leading practitioner, and wisely chose the Medical branch of the
profession. He had only himself to rely upon, but he had confidence in
his prospects, conscious, doubtless, of his own powers, knowing his
own industry and determination, and being of an eminently cheerful and
hopeful disposition. No better proof of his spirit can be given
than that, just a year from the time when he began to practise as a
physician, he took that eventful step which in such a man implies that
he sees his way clear to a position; he married a lady blessed with many
gifts, but not bringing him a fortune to paralyze his industry.
He had not miscalculated his chances in life. He very soon rose into a
good practice, and began the founding of that reputation which grew with
his years, until he stood by general consent at the head of his chosen
branch of the profession, to say the least, in this city and in all this
region of country. His skill and wisdom were the last tribunal to which
the sick and suffering could appeal. The community trusted and loved
him, the profession recognized him as the noblest type of the physician.
The young men whom he had taught wandered through foreign hospitals;
where they learned many things that were valuable, and many that were
curious; but as they grew older and began to think more of their ability
to help the sick than their power of talking about phenomena, they began
to look back to the teaching of Dr. Jackson, as he, after his London
experience, looked back to that of Dr. Holyoke. And so it came to be at
last that the bare mention of his name in any of our medical assemblies
would call forth such a tribute of affectionate regard as is only
yielded to age when it brings with it the record of a life spent in well
doing.
No accident ever carries a man to eminence such as his in the medical
profession. He who looks for it must want it earnestly and work for it
vigorously; Nature must have qualified him in many ways, and education
must have equipped him with various knowledge, or his reputation will
evaporate before it reaches the noon-day blaze of fame. How did Dr.
Jackson gain the position which all conceded to him? In the answer to
this question some among you may find a key that shall unlock the gate
opening on that fair field of the future of which all dream but which
not all will ever reach.
First of all, he truly loved his profession. He had no intellectual
ambitions outside of it, literary, scientific or political. To him it
was occupation enough to apply at the bedside the best of all that he
knew for the good of his patient; to protect the community against the
inroads of pestilence; to teach the young all that he himself had been
taught, with all that his own experience had added; to leave on record
some of the most important results of his long observation.
With his patients he was so perfect at all points that it is hard to
overpraise him. I have seen many noted British and French and American
practitioners, but I never saw the man so altogether admirable at the
bedside of the sick as Dr. James Jackson. His smile was itself a remedy
better than the potable gold and the dissolved pearls that comforted the
praecordia of mediaeval monarchs. Did a patient, alarmed without cause,
need encouragement, it carried the sunshine of hope into his heart and
put all his whims to flight, as David's harp cleared the haunted chamber
of the sullen king. Had the hour come, not for encouragement, but for
sympathy, his face, his voice, his manner all showed it, because his
heart felt it. So gentle was he, so thoughtful, so calm, so absorbed
in the case before him, not to turn round and look for a tribute to his
sagacity, not to bolster himself in a favorite theory, but to find out
all he could, and to weigh gravely and cautiously all that he found,
that to follow him in his morning visit was not only to take a lesson in
the healing art, it was learning how to learn, how to move, how to look,
how to feel, if that can be learned. To visit with Dr. Jackson was a
medical education.