Medical Essays, 1842-1882 Part 25

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 pa.s.sed 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 pa.s.sion 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 pract.i.tioners 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 mast really want it; and do you suppose that when you are in the middle of a heated caucus, or half-way through a delicate a.n.a.lysis, 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 amus.e.m.e.nt 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 pract.i.tioner, 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 gla.s.s, 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 pa.s.s 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 suns.h.i.+ne 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 att.i.tude of a pointer who has just come on the scent or sight of a woodc.o.c.k. 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 pract.i.tioner 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 pract.i.tioner.

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 a.s.sured 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 a.s.sociations, 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 pota.s.sium, 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 superst.i.tions. 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 ign.o.ble 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 alb.u.men 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 a.s.sail 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 gla.s.s in the entry to indicate to the pa.s.ser-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 gla.s.s and upset my modest luminary. All he got by his vivacious a.s.sault was that he left portions of integument from his knuckles upon the gla.s.s, 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 a.s.sured 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 grat.i.tude 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 friends.h.i.+p, or to bid the bitter tears of sorrow flow afresh. Yet I cannot help remembering what a void the death of such a pract.i.tioner as your late instructor must leave in the wide circle of those who leaned upon his counsel and a.s.sistance 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 s.h.i.+eld to protect others. The student is called from his bench, the professor from his chair, the pract.i.tioner 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.

But if there is so much left for age, how beautiful, how inspiring is the hope of youth! I see among those whom I count as listeners one by whose side I have sat as a fellow-teacher, and by whose instructions I have felt myself not too old to profit. As we borrowed him from your city, I must take this opportunity of telling you that his zeal, intelligence, and admirable faculty as an instructor were heartily and universally recognized among us. We return him, as we trust, uninjured, to the fellow-citizens who have the privilege of claiming him as their own.

And now, gentlemen of the graduating cla.s.s, nothing remains but for me to bid you, in the name of those for whom I am commissioned and privileged to speak, farewell as students, and welcome as pract.i.tioners.

I p.r.o.nounce the two benedictions in the same breath, as the late king's demise and the new king's accession are proclaimed by the same voice at the same moment. You would hardly excuse me if I stooped to any meaner dialect than the cla.s.sical and familiar language of your prescriptions, the same in which your t.i.tle to the name of physician is, if, like our own inst.i.tution, you follow the ancient usage, engraved upon your diplomas.

Valete, JUVENES, artis medicae studiosi; valete, discipuli, valete, filii!

Salvete, VIRI, artis medicae magister; Salvete amici; salvete fratres!

MEDICAL LIBRARIES.

[Dedicatory Address at the opening of the Medical Library in Boston, December 3, 1878.]

It is my appointed task, my honorable privilege, this evening, to speak of what has been done by others. No one can bring his tribute of words into the presence of great deeds, or try with them to embellish the memory of any inspiring achievement, without feeling and leaving with others a sense of their insufficiency. So felt Alexander when he compared even his adored Homer with the hero the poet had sung. So felt Webster when he contrasted the phrases of rhetoric with the eloquence of patriotism and of self-devotion. So felt Lincoln when on the field of Gettysburg he spoke those immortal words which Pericles could not have bettered, which Aristotle could not have criticised. So felt he who wrote the epitaph of the builder of the dome which looks down on the crosses and weatherc.o.c.ks that glitter over London.

We are not met upon a battle-field, except so far as every laborious achievement means a victory over opposition, indifference, selfishness, faintheartedness, and that great property of mind as well as matter,--inertia. We are not met in a cathedral, except so far as every building whose walls are lined with the products of useful and enn.o.bling thought is a temple of the Almighty, whose inspiration has given us understanding. But we have gathered within walls which bear testimony to the self-sacrificing, persevering efforts of a few young men, to whom we owe the origin and development of all that excites our admiration in this completed enterprise; and I might consider my task as finished if I contented myself with borrowing the last word of the architect's epitaph and only saying, Look around you!

The reports of the librarian have told or will tell you, in some detail, what has been accomplished since the 21st of December, 1874, when six gentlemen met at the house of Dr. Henry Ingersoll Bowditch to discuss different projects for a medical library. In less than four years from that time, by the liberality of a.s.sociations and of individuals, this collection of nearly ten thousand volumes, of five thousand pamphlets, and of one hundred and twenty-five journals, regularly received,--all worthily sheltered beneath this lofty roof,--has come into being under our eyes. It has sprung up, as it were; in the night like a mushroom; it stands before us in full daylight as l.u.s.ty as an oak, and promising to grow and flourish in the perennial freshness of an evergreen.

To whom does our profession owe this already large collection of books, exceeded in numbers only by four or five of the most extensive medical libraries in the country, and lodged in a building so well adapted to its present needs? We will not point out individually all those younger members of the profession who have accomplished what their fathers and elder brethren had attempted and partially achieved. We need not write their names on these walls, after the fas.h.i.+on of those civic dignitaries who immortalize themselves on tablets of marble and gates of iron. But their contemporaries know them well, and their descendants will not forget them,--the men who first met together, the men who have given their time and their money, the faithful workers, worthy a.s.sociates of the strenuous agitator who gave no sleep to his eyes, no slumber to his eyelids, until he had gained his ends; the untiring, imperturbable, tenacious, irrepressible, all-subduing agitator who neither rested nor let others rest until the success of the project was a.s.sured. If, against his injunctions, I name Dr. James Read Chadwick, it is only my revenge for his having kept me awake so often and so long while he was urging on the undertaking in which he has been preeminently active and triumphantly successful.

We must not forget the various medical libraries which preceded this: that of an earlier period, when Boston contained about seventy regular pract.i.tioners, the collection afterwards transferred to the Boston Athenaeum; the two collections belonging to the University; the Treadwell Library at the Ma.s.sachusetts General Hospital; the collections of the two societies, that for Medical Improvement and that for Medical Observation; and more especially the ten thousand volumes relating to medicine belonging to our n.o.ble public city library,--too many blossoms on the tree of knowledge, perhaps, for the best fruit to ripen. But the Ma.s.sachusetts Medical Society now numbers nearly four hundred members in the city of Boston. The time had arrived for a new and larger movement.

There was needed a place to which every respectable member of the medical profession could obtain easy access; where, under one roof, all might find the special information they were seeking; where the latest medical intelligence should be spread out daily as the s.h.i.+pping news is posted on the bulletins of the exchange; where men engaged in a common pursuit could meet, surrounded by the mute oracles of science and art; where the whole atmosphere should be as full of professional knowledge as the apothecary's shop is of the odor of his medicaments. This was what the old men longed for,--the prophets and kings of the profession, who

"Desired it long, But died without the sight."

This is what the young men and those who worked under their guidance undertook to give us. And now such a library, such a reading-room, such an exchange, such an intellectual and social meeting place, we be hold a fact, plain before us. The medical profession of our city, and, let us add, of all those neighboring places which it can reach with its iron arms, is united as never before by the commune vinculum, the common bond of a large, enduring, enn.o.bling, unselfish interest. It breathes a new air of awakened intelligence. It marches abreast of the other learned professions, which have long had their extensive and valuable centralized libraries; abreast of them, but not promising to be content with that position. What glorifies a town like a cathedral? What dignifies a province like a university? What illuminates a country like its scholars.h.i.+p, and what is the nest that hatches scholars but a library?

The physician, some may say, is a practical man and has little use for all this book-learning. Every student has heard Sydenham's reply to Sir Richard Blackmore's question as to what books he should read,--meaning medical books. "Read Don Quixote," was his famous answer. But Sydenham himself made medical books and may be presumed to have thought those at least worth reading. Descartes was asked where was his library, and in reply held up the dissected body of an animal. But Descartes made books, great books, and a great many of them. A physician of common sense without erudition is better than a learned one without common sense, but the thorough master of his profession must have learning added to his natural gifts.

It is not necessary to maintain the direct practical utility of all kinds of learning. Our shelves contain many books which only a certain cla.s.s of medical scholars will be likely to consult. There is a dead medical literature, and there is a live one. The dead is not all ancient, the live is not all modern. There is none, modern or ancient, which, if it has no living value for the student, will not teach him something by its autopsy. But it is with the live literature of his profession that the medical pract.i.tioner is first of all concerned.

Now there has come a great change in our time over the form in which living thought presents itself. The first printed books,--the incunabula,--were inclosed in boards of solid oak, with brazen clasps and corners; the boards by and by were replaced by pasteboard covered with calf or sheepskin; then cloth came in and took the place of leather; then the pasteboard was covered with paper instead of cloth; and at this day the quarterly, the monthly, the weekly periodical in its flimsy unsupported dress of paper, and the daily journal, naked as it came from the womb of the press, hold the larger part of the fresh reading we live upon. We must have the latest thought in its latest expression; the page must be newly turned like the morning bannock; the pamphlet must be newly opened like the ante-prandial oyster.