from the lessons of Judge Story and Mr. Ashmun in the Law School at
Cambridge. I had been busy, more or less, with the pages of Blackstone
and Chitty, and other text-books of the first year of legal study. More
or less, I say, but I am afraid it was less rather than more. For during
that year I first tasted the intoxicating pleasure of authorship. A
college periodical, conducted by friends of mine, still undergraduates,
tempted me into print, and there is no form of lead-poisoning which more
rapidly and thoroughly pervades the blood and bones and marrow than that
which reaches the young author through mental contact with type-metal.
Qui a bu, boira,--he who has once been a drinker will drink again, says
the French proverb. So the man or woman who has tasted type is sure to
return to his old indulgence sooner or later. In that fatal year I had
my first attack of authors' lead-poisoning, and I have never got quite
rid of it from that day to this. But for that I might have applied
myself more diligently to my legal studies, and carried a green bag in
place of a stethoscope and a thermometer up to the present day.
What determined me to give up Law and apply myself to Medicine I can
hardly say, but I had from the first looked upon that year's study as
an experiment. At any rate, I made the change, and soon found myself
introduced to new scenes and new companionships.
I can scarcely credit my memory when I recall the first impressions
produced upon me by sights afterwards become so familiar that they
could no more disturb a pulse-beat than the commonest of every-day
experiences. The skeleton, hung aloft like a gibbeted criminal, looked
grimly at me as I entered the room devoted to the students of the school
I had joined, just as the fleshless figure of Time, with the hour-glass
and scythe, used to glare upon me in my childhood from the “New England
Primer.” The white faces in the beds at the Hospital found their
reflection in my own cheeks, which lost their color as I looked upon
them. All this had to pass away in a little time; I had chosen my
profession, and must meet its painful and repulsive aspects until they
lost their power over my sensibilities.
The private medical school which I had joined was one established by Dr.
James Jackson, Dr. Walter Channing, Dr. John Ware, Dr. Winslow Lewis,
and Dr. George W. Otis. Of the first three gentlemen I have either
spoken elsewhere or may find occasion to speak hereafter. The two
younger members of this association of teachers were both graduates of
our University, one of the year 1819, the other of 1818.
Dr. Lewis was a great favorite with students. He was a man of very
lively temperament, fond of old books and young people, open-hearted,
free-spoken, an enthusiast in teaching, and especially at home in that
apartment of the temple of science where nature is seen in undress, the
anthropotomic laboratory, known to common speech as the dissecting-room.
He had that quality which is the special gift of the man born for a
teacher,--the power of exciting an interest in that which he taught.
While he was present the apartment I speak of was the sunniest of
studios in spite of its mortuary spectacles. Of the students I met there
I best remember James Jackson, Junior, full of zeal and playful as a
boy, a young man whose early death was a calamity to the profession of
which he promised to be a chief ornament; the late Reverend J. S. C.
Greene, who, as the prefix to his name signifies, afterwards changed his
profession, but one of whose dissections I remember looking upon with
admiration; and my friend Mr. Charles Amory, as we call him, Dr. Charles
Amory, as he is entitled to be called, then, as now and always, a
favorite with all about him. He had come to us from the schools
of Germany, and brought with him recollections of the teachings of
Blumenbach and the elder Langenbeck, father of him whose portrait hangs
in our Museum. Dr. Lewis was our companion as well as our teacher. A
good demonstrator is,--I will not say as important as a good Professor
in the teaching of Anatomy, because I am not sure that he is not
more important. He comes into direct personal relations with the
students,--he is one of them, in fact, as the Professor cannot be from
the nature of his duties. The Professor's chair is an insulating stool,
so to speak; his age, his knowledge, real or supposed, his official
station, are like the glass legs which support the electrician's piece
of furniture, and cut it off from the common currents of the floor upon
which it stands. Dr. Lewis enjoyed teaching and made his students enjoy
being taught. He delighted in those anatomical conundrums to answer
which keeps the student's eyes open and his wits awake. He was happy as
he dexterously performed the tour de maitre of the old barber-surgeons,
or applied the spica bandage and taught his scholars to do it, so neatly
and symmetrically that the aesthetic missionary from the older centre of
civilization would bend over it in blissful contemplation, as if it were
a sunflower. Dr. Lewis had many other tastes, and was a favorite, not
only with students, but in a wide circle, professional, antiquarian,
masonic, and social.
Dr. Otis was less widely known, but was a fluent and agreeable lecturer,
and esteemed as a good surgeon.
I must content myself with this glimpse at myself and a few of my
fellow-students in Boston. After attending two courses of Lectures in
the school of the University, I went to Europe to continue my studies.
You may like to hear something of the famous Professors of Paris in the
days when I was a student in the Ecole de Medicine, and following the
great Hospital teachers.
I can hardly believe my own memory when I recall the old practitioners
and Professors who were still going round the hospitals when I mingled
with the train of students that attended the morning visits. See that
bent old man who is groping his way through the wards of La Charity.
That is the famous Baron Boyer, author of the great work on surgery in
nine volumes, a writer whose clearness of style commends his treatise to
general admiration, and makes it a kind of classic. He slashes away at a
terrible rate, they say, when he gets hold of the subject of fistula in
its most frequent 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 l'autre cote 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
irritation--with rattling and rolling reduplication of the resonant
letter r--might 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
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 he 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.