whom the learned doctors of the Jewish law considered a sinner, and, as
such, very unlikely to have been endowed with a divine gift of healing.
They visited the patient repeatedly, and evidently teased him with their
questions about the treatment, and their insinuations about the young
man, until he lost his temper. At last he turned sharply upon them:
“Whether he be a sinner or no, I know not: one thing I know, that,
whereas I was blind, now I see.”
This is the answer that always has been and always will be given by most
persons when they find themselves getting well after doing anything, no
matter what,--recommended by anybody, no matter whom. Lord Bacon, Robert
Boyle, Bishop Berkeley, all put their faith in panaceas which we should
laugh to scorn. They had seen people get well after using them. Are we
any wiser than those great men? Two years ago, in a lecture before the
Massachusetts Historical Society, I mentioned this recipe of Sir Kenelm
Digby for fever and ague: Pare the patient's nails; put the parings in a
little bag, and hang the bag round the neck of a live eel, and place him
in a tub of water. The eel will die, and the patient will recover.
Referring to this prescription in the course of the same lecture, I
said: “You smiled when I related Sir Kenehn 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?” Nobody saw fit to empty his or
her pockets, and my question brought no response. But two months ago
I was in a company of educated persons, college graduates every one of
them, when a gentleman, well known in our community, a man of superior
ability and strong common-sense, on the occasion of some talk arising
about rheumatism, took a couple of very shiny horse-chestnuts from his
breeches-pocket, and laid them on the table, telling us how, having
suffered from the complaint in question, he had, by the advice of a
friend, procured these two horse-chestnuts on a certain time a year or
more ago, and carried them about him ever since; from which very day he
had been entirely free from rheumatism.
This argument, from what looks like cause and effect, whether it be so
or not, is what you will have to meet wherever you go, and you need not
think you can answer it. In the natural course of things some thousands
of persons must be getting well or better of slight attacks of colds,
of rheumatic pains, every week, in this city alone. Hundreds of them do
something or other in the way of remedy, by medical or other advice, or
of their own motion, and the last thing they do gets the credit of the
recovery. Think what a crop of remedies this must furnish, if it were
all harvested!
Experience has taught, or will teach you, that most of the wonderful
stories patients and others tell of sudden and signal cures are like
Owen Glendower's story of the portents that announced his birth. The
earth shook at your nativity, did it? Very likely, and
“So it would have done,
At the same season, if your mother's cat
Had kittened, though yourself had ne'er been born.”
You must listen more meekly than Hotspur did to the babbling Welshman,
for ignorance is a solemn and sacred fact, and, like infancy, which it
resembles, should be respected. Once in a while you will have a patient
of sense, born with the gift of observation, from whom you may learn
something. When you find yourself in the presence of one who is fertile
of medical opinions, and affluent in stories of marvellous cures,--of
a member of Congress whose name figures in certificates to the value of
patent medicines, of a voluble dame who discourses on the miracles she
has wrought or seen wrought with the little jokers of the sugar-of-milk
globule-box, take out your watch and count the pulse; also note the time
of day, and charge the price of a visit for every extra fifteen, or, if
you are not very busy, every twenty minutes. In this way you will turn
what seems a serious dispensation into a double blessing, for this class
of patients loves dearly to talk, and it does them a deal of good, and
you feel as if you had earned your money by the dose you have taken,
quite as honestly as by any dose you may have ordered.
You must take the community just as it is, and make the best of it.
You wish to obtain its confidence; there is a short rule for doing this
which you will find useful,--deserve it. But, to deserve it in full
measure, you must unite many excellences, natural and acquired.
As the basis of all the rest, you must have all those traits of
character which fit you to enter into the most intimate and confidential
relations with the families of which you are the privileged friend and
counsellor. Medical Christianity, if I may use such a term, is of very
early date. By the oath of Hippocrates, the practitioner of ancient
times bound himself to enter his patient's house with the sole purpose
of doing him good, and so to conduct himself as to avoid the very
appearance of evil. Let the physician of to-day begin by coming up to
this standard, and add to it all the more recently discovered virtues
and graces.
A certain amount of natural ability is requisite to make you a good
physician, but by no means that disproportionate development of some
special faculty which goes by the name of genius. A just balance of the
mental powers is a great deal more likely to be useful than any single
talent, even were it the power of observation, in excess. For a mere
observer is liable to be too fond of facts for their own sake, so that,
if he told the real truth, he would confess that he takes more pleasure
in a post-mortem examination which shows him what was the matter with a
patient, than in a case which insists on getting well and leaving him in
the dark as to its nature. Far more likely to interfere with the sound
practical balance of the mind is that speculative, theoretical tendency
which has made so many men noted in their day, whose fame has passed
away with their dissolving theories. Read Dr. Bartlett's comparison of
the famous Benjamin Rush with his modest fellow-townsman Dr. William
Currie, and see the dangers into which a passion for grandiose
generalizations betrayed a man of many admirable qualities.
I warn you against all ambitious aspirations outside of your profession.
Medicine is the most difficult of sciences and the most laborious of
arts. It will task all your powers of body and mind if you are faithful
to it. Do not dabble in the muddy sewer of politics, nor linger by
the enchanted streams of literature, nor dig in far-off fields for the
hidden waters of alien sciences. The great practitioners are generally
those who concentrate all their powers on their business. If there
are here and there brilliant exceptions, it is only in virtue of
extraordinary gifts, and industry to which very few are equal.
To get business a man must really want it; and do you suppose that when
you are in the middle of a heated caucus, or half-way through a delicate
analysis, or in the spasm of an unfinished ode, your eyes rolling in the
fine frenzy of poetical composition, you want to be called to a teething
infant, or an ancient person groaning under the griefs of a lumbago?
I think I have known more than one young man whose doctor's sign
proclaimed his readiness to serve mankind in that capacity, but who
hated the sound of a patient's knock, and as he sat with 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 you 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 patients are willing to die in his hands, not one
whom they go to for trifles, and leave as soon as they are in danger,
and who can say, therefore, that he never loses a patient.
Do not leave the ranks of what is called the regular profession, unless
you wish to go farther and fare worse, for you may be assured that
its members recognize no principle which hinders their accepting any
remedial agent proved to be useful, no matter from what quarter it
comes. The difficulty is that the stragglers, organized under fantastic
names in pretentious associations, or lurking in solitary dens behind
doors left ajar, make no real contributions to the art of healing. When
they bring forward a remedial agent like chloral, like the bromide
of potassium, like ether, used as an anesthetic, they will find no
difficulty in procuring its recognition.
Some of you will probably be more or less troubled by the pretensions
of that parody of mediaeval theology which finds its dogma of hereditary
depravity in the doctrine of psora, its miracle of transubstantiation in
the mystery of its triturations and dilutions, its church in the people
who have mistaken their century, and its priests in those who have
mistaken their calling. You can do little with persons who are disposed
to accept these curious medical superstitions. The saturation-point
of individual minds with reference to evidence, and especially medical
evidence, differs, and must always continue to differ, very widely.
There are those whose minds are satisfied with the decillionth dilution
of a scientific proof. No wonder they believe in the efficacy of a
similar attenuation of bryony or pulsatilla. You have no fulcrum you
can rest upon to lift an error out of such minds as these, often highly
endowed with knowledge and talent, sometimes with genius, but commonly
richer in the imaginative than the observing and reasoning faculties.
Let me return once more to the young graduate. Your relations to your
professional brethren may be a source of lifelong happiness and growth
in knowledge and character, or they may make you wretched and end
by leaving you isolated from those who should be your friends and
counsellors. The life of a physician becomes ignoble when he suffers
himself to feed on petty jealousies and sours his temper in perpetual
quarrels. You will be liable to meet an uncomfortable man here and there
in the profession,--one who is so fond of being in hot water that it is
a wonder all the albumen in his body is not coagulated. There are common
barrators among doctors as there are among lawyers,--stirrers up of
strife under one pretext and another, but in reality because they like
it. They are their own worst enemies, and do themselves a mischief each
time they assail their neighbors. In my student days I remember a good
deal of this Donnybrook-Fair style of quarrelling, more especially in
Paris, where some of the noted surgeons were always at loggerheads, and
in one of our lively Western cities. Soon after I had set up an office,
I had a trifling experience which may serve to point a moral in this
direction. I had placed a lamp behind the glass in the entry to indicate
to the passer-by where relief from all curable infirmities was to be
sought and found. Its brilliancy attracted the attention of a devious
youth, who dashed his fist through the glass and upset my modest
luminary. All he got by his vivacious assault was that he left portions
of integument from his knuckles upon the glass, had a lame hand, was
very easily identified, and had to pay the glazier's bill. The moral is
that, if the brilliancy of another's reputation excites your belligerent
instincts, it is not worth your while to strike at it, without
calculating which of you is likely to suffer most, if you do.
You may be assured that when an ill-conditioned neighbor is always
complaining of a bad taste in his mouth and an evil atmosphere about
him, there is something wrong about his own secretions. In such
cases there is an alterative regimen of remarkable efficacy: it is a
starvation-diet of letting alone. The great majority of the profession
are peacefully inclined. Their pursuits are eminently humanizing, and
they look with disgust on the personalities which intrude themselves
into the placid domain of an art whose province it is to heal and not to
wound.
The intercourse of teacher and student in a large school is necessarily
limited, but it should be, and, so far as my experience goes, it is,
eminently cordial and kindly. You will leave with regret, and hold
in tender remembrance, those who have taken you by the hand at your
entrance on your chosen path, and led you patiently and faithfully,
until the great gates at its end have swung upon their hinges, and the
world lies open before you. That venerable oath to which I have before
referred bound the student to regard his instructor in the light of a
parent, to treat his children like brothers, to succor him in his day of
need. I trust the spirit of the oath of Hippocrates is not dead in the
hearts of the students of to-day. They will remember with gratitude
every earnest effort, every encouraging word, which has helped them in
their difficult and laborious career of study. The names they read on
their diplomas will recall faces that are like family-portraits in their
memory, and the echo of voices they have listened to so long will linger
in their memories far into the still evening of their lives.
One voice will be heard no more which has been familiar to many among
you. It is not for me, a stranger to these scenes, to speak his eulogy.
I have no right to sadden this hour by dwelling on the deep regrets
of friendship, or to bid the bitter tears of sorrow flow afresh. Yet I
cannot help remembering what a void the death of such a practitioner as
your late instructor must leave in the wide circle of those who leaned
upon his counsel and assistance in their hour of need, in a community
where he was so widely known and esteemed, in a school where he bore so
important a part. There is no exemption from the common doom for him
who holds the shield to protect others. The student is called from his
bench, the professor from his chair, the practitioner in his busiest
period hears a knock more peremptory than any patient's midnight
summons, and goes on that unreturning visit which admits of no excuse,
and suffers no delay. The call of such a man away from us is the
bereavement of a great family. Nor can we help regretting the loss
for him of a bright and cheerful earthly future; for the old age of a
physician is one of the happiest periods of his life. He is loved and
cherished for what he has been, and even in the decline of his faculties
there are occasions when his experience is still appealed to, and his
trembling hands are looked to with renewing hope and trust, as being yet
able to stay the arm of the destroyer.