materializing influences to which the physician is subjected. A
spiritual guild is absolutely necessary to keep him, to keep us all,
from becoming the “fingering slaves” that Wordsworth treats with such
shrivelling scorn. But it is well that the two callings have been
separated, and it is fitting that they remain apart. In settling the
affairs of the late concern, I am afraid our good friends remain a
little in our debt. We lent them our physician Michael Servetus in
fair condition, and they returned him so damaged by fire as to be quite
useless for our purposes. Their Reverend Samuel Willard wrote us a not
over-wise report of a case of hysteria; and our Jean Astruc gave
them (if we may trust Dr. Smith's Dictionary of the Bible) the first
discerning criticism on the authorship of the Pentateuch. Our John
Locke enlightened them with his letters concerning toleration; and their
Cotton Mather obscured our twilight with his “Nishmath Chajim.”
Yet we must remember that the name of Basil Valentine, the monk, is
associated with whatever good and harm we can ascribe to antimony;
and that the most remarkable of our specifics long bore the name of
“Jesuit's Bark,” from an old legend connected with its introduction.
“Frere Jacques,” who taught the lithotomists of Paris, owes his
ecclesiastical title to courtesy, as he did not belong to a religious
order.
Medical science, and especially the study of mental disease, is
destined, I believe, to react to much greater advantage on the theology
of the future than theology has acted on medicine in the past. The
liberal spirit very generally prevailing in both professions, and the
good understanding between their most enlightened members, promise well
for the future of both in a community which holds every point of human
belief, every institution in human hands, and every word written in a
human dialect, open to free discussion today, to-morrow, and to the end
of time. Whether the world at large will ever be cured of trusting
to specifics as a substitute for observing the laws of health, and to
mechanical or intellectual formula as a substitute for character, may
admit of question. Quackery and idolatry are all but immortal.
We can find most of the old beliefs alive amongst us to-day, only having
changed their dresses and the social spheres in which they thrive.
We think the quarrels of Galenists and chemists belong to the past,
forgetting that Thomsonism has its numerous apostles in our community;
that it is common to see remedies vaunted as purely vegetable, and
that the prejudice against “mineral poisons,” especially mercury, is
as strong in many quarters now as it was at the beginning of the
seventeenth century. Names are only air, and blow away with a change of
wind; but beliefs are rooted in human wants and weakness, and die hard.
The oaks of Dodona are prostrate, and the shrine of Delphi is desolate;
but the Pythoness and the Sibyl may be consulted in Lowell Street for a
very moderate compensation. Nostradamus and Lilly seem impossible in our
time; but we have seen the advertisements of an astrologer in our Boston
papers year after year, which seems to imply that he found believers and
patrons. You smiled when I related Sir Kenelm Digby's prescription with
the live eel in it; but if each of you were to empty his or her pockets,
would there not roll out, from more than one of them, a horse-chestnut,
carried about as a cure for rheumatism? The brazen head of Roger Bacon
is mute; but is not “Planchette” uttering her responses in a hundred
houses of this city? We think of palmistry or chiromancy as belonging to
the days of Albertus Magnus, or, if existing in our time, as given over
to the gypsies; but a very distinguished person has recently shown me
the line of life, and the line of fortune, on the palm of his hand, with
a seeming confidence in the sanguine predictions of his career which
had been drawn from them. What shall we say of the plausible and
well-dressed charlatans of our own time, who trade in false pretences,
like Nicholas Knapp of old, but without any fear of being fined or
whipped; or of the many follies and inanities, imposing on the credulous
part of the community, each of them gaping with eager, open mouth for
a gratuitous advertisement by the mention of its foolish name in any
respectable connection?
I turn from this less pleasing aspect of the common intelligence which
renders such follies possible, to close the honorable record of the
medical profession in this, our ancient Commonwealth.
We have seen it in the first century divided among clergymen,
magistrates, and regular practitioners; yet, on the whole, for the
time, and under the circumstances, respectable, except where it invoked
supernatural agencies to account for natural phenomena.
In the second century it simplified its practice, educated many
intelligent practitioners, and began the work of organizing for
concerted action, and for medical teaching.
In this, our own century, it has built hospitals, perfected and
multiplied its associations and educational institutions, enlarged and
created museums, and challenged a place in the world of science by its
literature.
In reviewing the whole course of its history we read a long list of
honored names, and a precious record written in private memories, in
public charities, in permanent contributions to medical science, in
generous sacrifices for the country. We can point to our capital as the
port of entry for the New World of the great medical discoveries of two
successive centuries, and we can claim for it the triumph over the most
dreaded foe that assails the human body,--a triumph which the annals of
the race can hardly match in three thousand years of medical history.
THE YOUNG PRACTITIONER
[A Valedictory Address delivered to the Graduating Class of the
Bellevue Hospital College, March 2, 1871.]
The occasion which calls us together reminds us not a little of that
other ceremony which unites a man and woman for life. The banns have
already been pronounced which have wedded our young friends to the
profession of their choice. It remains only to address to them some
friendly words of cheering counsel, and to bestow upon them the parting
benediction.
This is not the time for rhetorical display or ambitious eloquence. We
must forget ourselves, and think only of them. To us it is an occasion;
to them it is an epoch. The spectators at the wedding look curiously at
the bride and bridegroom; at the bridal veil, the orange-flower garland,
the giving and receiving of the ring; they listen for the tremulous
“I will,” and wonder what are the mysterious syllables the clergyman
whispers in the ear of the married maiden. But to the newly-wedded pair
what meaning in those words, “for better, for worse,” “in sickness and
in health,” “till death us do part!” To the father, to the mother, who
know too well how often the deadly nightshade is interwoven with the
wreath of orange-blossoms, how empty the pageant, how momentous the
reality!
You will not wonder that I address myself chiefly to those who are just
leaving academic life for the sterner struggle and the larger tasks of
matured and instructed manhood. The hour belongs to them; if others find
patience to listen, they will kindly remember that, after all, they are
but as the spectators at the wedding, and that the priest is thinking
less of them than of their friends who are kneeling at the altar.
I speak more directly to you, then, gentlemen of the graduating class.
The days of your education, as pupils of trained instructors, are over.
Your first harvest is all garnered. Henceforth you are to be sowers as
well as reapers, and your field is the world. How does your knowledge
stand to-day? What have you gained as a permanent possession? What
must you expect to forget? What remains for you yet to learn? These are
questions which it may interest you to consider.
There is another question which must force itself on the thoughts
of many among you: “How am I to obtain patients and to keep their
confidence?” You have chosen a laborious calling, and made many
sacrifices to fit yourselves for its successful pursuit. You wish to be
employed that you may be useful, and that you may receive the reward of
your industry. I would take advantage of these most receptive moments
to give you some hints which may help you to realize your hopes and
expectations. Such is the outline of the familiar talk I shall offer
you.
Your acquaintance with some of the accessory branches is probably
greater now than it will be in a year from now,--much greater than it
will be ten years from now. The progress of knowledge, it may be feared,
or hoped, will have outrun the text-books in which you studied these
branches. Chemistry, for instance, is very apt to spoil on one's hands.
“Nous avons change tout cela” might serve as the standing motto of many
of our manuals. Science is a great traveller, and wears her shoes out
pretty fast, as might be expected.
You are now fresh from the lecture-room and the laboratory. You can pass
an examination in anatomy, physiology, chemistry, materia medica,
which the men in large practice all around you would find a more potent
sudorific than any in the Pharmacopceia. These masters of the art of
healing were once as ready with their answers as you are now, but they
have got rid of a great deal of the less immediately practical part of
their acquisitions, and you must undergo the same depleting process.
Hard work will train it off, as sharp exercise trains off the fat of a
prize-fighter.
Yet, pause a moment before you infer that your teachers must have
been in fault when they furnished you with mental stores not directly
convertible to practical purposes, and likely in a few years to lose
their place in your memory. All systematic knowledge involves much that
is not practical, yet it is the only kind of knowledge which satisfies
the mind, and systematic study proves, in the long-run, the easiest way
of acquiring and retaining facts which are practical. There are many
things which we can afford to forget, which yet it was well to learn.
Your mental condition is not the same as if you had never known what
you now try in vain to recall. There is a perpetual metempsychosis of
thought, and the knowledge of to-day finds a soil in the forgotten facts
of yesterday. You cannot see anything in the new season of the guano
you placed last year about the roots of your climbing plants, but it is
blushing and breathing fragrance in your trellised roses; it has scaled
your porch in the bee-haunted honey-suckle; it has found its way where
the ivy is green; it is gone where the woodbine expands its luxuriant
foliage.
Your diploma seems very broad to-day with your list of accomplishments,
but it begins to shrink from this hour like the Peau de Chagrin of
Balzac's story. Do not worry about it, for all the while there will be
making out for you an ampler and fairer parchment, signed by old Father
Time himself as President of that great University in which experience
is the one perpetual and all-sufficient professor.
Your present plethora of acquirements will soon cure itself. Knowledge
that is not wanted dies out like the eyes of the fishes of the Mammoth
Cave. When you come to handle life and death as your daily business,
your memory will of itself bid good-by to such inmates as the
well-known foramina of the sphenoid bone and the familiar oxides of
methyl-ethylamyl-phenyl-ammonium. Be thankful that you have once known
them, and remember that even the learned ignorance of a nomenclature
is something to have mastered, and may furnish pegs to hang facts
upon which would otherwise have strewed the floor of memory in loose
disorder.
But your education has, after all, been very largely practical. You have
studied medicine and surgery, not chiefly in books, but at the bedside
and in 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--
“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 with able divines and acute lawyers; the same
will pass with the husbands as with the wives.” If the community could
only be made aware of its own utter ignorance, and incompetence to form
opinions on medical subjects, difficult enough to those who give their
lives to the study of them, the practitioner would have an easier task.
But it will form opinions of its own, it cannot help it, and we cannot
blame it, even though we know how slight and deceptive are their
foundations.
This is the way it happens: Every grown-up person has either been
ill himself or had a friend suffer from illness, from which he has
recovered. Every sick person has done something or other by somebody's
advice, or of his own accord, a little before getting better. There
is an irresistible tendency to associate the thing done, and the
improvement which followed it, as cause and effect. This is the great
source of fallacy in medical practice. But the physician has some chance
of correcting his hasty inference. He thinks his prescription cured a
single case of a particular complaint; he tries it in twenty similar
cases without effect, and sets down the first as probably nothing more
than a coincidence. The unprofessional experimenter or observer has
no large experience to correct his hasty generalization. He wants to
believe that the means he employed effected his cure. He feels grateful
to the person who advised it, he loves to praise the pill or potion
which helped him, and he has a kind of monumental pride in himself as
a living testimony to its efficacy. So it is that you will find the
community in which you live, be it in town or country, full of brands
plucked from the burning, as they believe, by some agency which, with
your better training, you feel reasonably confident had nothing to
do with it. Their disease went out of itself, and the stream from the
medical fire-annihilator had never even touched it.
You cannot and need not expect to disturb the public in the possession
of its medical superstitions. A man's ignorance is as much his private
property, and as precious in his own eyes, as his family Bible. You have
only to open your own Bible at the ninth chapter of St. John's Gospel,
and you will find that the logic of a restored patient was very simple
then, as it is now, and very hard to deal with. My clerical friends
will forgive me for poaching on their sacred territory, in return for an
occasional raid upon the medical domain of which they have now and then
been accused.