During the memorable century which bred and bore the Revolution, the medical profession gave great names to our history. But John Brooks belonged to the State, and Joseph Warren belongs to the country and mankind, and to speak of them would lead me beyond my limited—subject. There would be little pleasure in dwelling on the name of Benjamin Church; and as for the medical politicians, like Elisha Cooke in the early part of the century, or Charles Jarvis, the bald eagle of Boston, in its later years, whether their practice was heroic or not, their patients were, for he is a bold man who trusts one that is making speeches and coaxing voters, to meddle with the internal politics of his corporeal republic.
One great event stands out in the medical history of this eighteenth century; namely, the introduction of the practice of inoculation for small-pox. Six epidemics of this complaint had visited Boston in the course of a hundred years. Prayers had been asked in the churches for more than a hundred sick in a single day, and this many times. About a thousand persons had died in a twelvemonth, we are told, and, as we may infer, chiefly from this cause.
In 1721, this disease, after a respite of nineteen years, again appeared as an epidemic. In that year it was that Cotton Mather, browsing, as was his wont, on all the printed fodder that came within reach of his ever-grinding mandibles, came upon an account of inoculation as practised in Turkey, contained in the "Philosophical Transactions." He spoke of it to several physicians, who paid little heed to his story; for they knew his medical whims, and had probably been bored, as we say now-a-days, many of them, with listening to his "Angel of Bethesda," and satiated with his speculations on the Nishmath Chajim.
The Reverend Mather,—I use a mode of expression he often employed when speaking of his honored brethren,—the Reverend Mather was right this time, and the irreverent doctors who laughed at him were wrong. One only of their number disputes his claim to giving the first impulse to the practice, in Boston. This is what that person says: "The Small-Pox spread in Boston, New England, A.1721, and the Reverend Dr. Cotton Mather, having had the use of these Communications from Dr. William Douglass (that is, the writer of these words); surreptitiously, without the knowledge of his Informer, that he might have the honour of a New fangled notion, sets an Undaunted Operator to work, and in this Country about 290 were inoculated."
All this has not deprived Cotton Mather of the credit of suggesting, and a bold and intelligent physician of the honor of carrying out, the new practice. On the twenty-seventh day of June, 1721, Zabdiel Boylston of Boston inoculated his only son for smallpox,—the first person ever submitted to the operation in the New World. The story of the fierce resistance to the introduction of the practice; of how Boylston was mobbed, and Mather had a hand-grenade thrown in at his window; of how William Douglass, the Scotchman, "always positive, and sometimes accurate," as was neatly said of him, at once depreciated the practice and tried to get the credit of suggesting it, and how Lawrence Dalhonde, the Frenchman, testified to its destructive consequences; of how Edmund Massey, lecturer at St. Albans, preached against sinfully endeavoring to alter the course of nature by presumptuous interposition, which he would leave to the atheist and the scoffer, the heathen and unbeliever, while in the face of his sermon, afterwards reprinted in Boston, many of our New England clergy stood up boldly in defence of the practice,—all this has been told so well and so often that I spare you its details. Set this good hint of Cotton Mather against that letter of his to John Richards, recommending the search after witch-marks, and the application of the water-ordeal, which means throw your grandmother into the water, if she has a mole on her arm;—if she swims, she is a witch and must be hanged; if she sinks, the Lord have mercy on her soul!
Thus did America receive this great discovery, destined to save thousands of lives, via Boston, from the hands of one of our own Massachusetts physicians.
The year 1735 was rendered sadly memorable by the epidemic of the terrible disease known as "throat distemper," and regarded by many as the same as our "diphtheria." Dr. Holyoke thinks the more general use of mercurials in inflammatory complaints dates from the time of their employment in this disease, in which they were thought to have proved specially useful.
At some time in the course of this century medical practice had settled down on four remedies as its chief reliance. I must repeat an incident which I have related in another of these Essays. When Dr. Holyoke, nearly seventy years ago, received young Mr. James Jackson as his student, he showed him the formidable array of bottles, jars, and drawers around his office, and then named the four remedies referred to as being of more importance than all the rest put together. These were "Mercury, Antimony, Opium, and Peruvian Bark." I doubt if either of them remembered that, nearly seventy years before, in 1730, Dr. William Douglass, the disputatious Scotchman, mentioned those same four remedies, in the dedication of his quarrelsome essay on inoculation, as the most important ones in the hands of the physicians of his time.
In the "Proceedings" of this Society for the year 1863 is a very pleasant paper by the late Dr. Ephraim Eliot, giving an account of the leading physicians of Boston during the last quarter of the last century. The names of Lloyd, Gardiner, Welsh, Rand, Bulfinch, Danforth, John Warren, Jeffries, are all famous in local history, and are commemorated in our medical biographies. One of them, at least, appears to have been more widely known, not only as one of the first aerial voyagers, but as an explorer in the almost equally hazardous realm of medical theory. Dr. John Jeffries, the first of that name, is considered by Broussais as a leader of medical opinion in America, and so referred to in his famous "Examen des Doctrines Medicales."
Two great movements took place in this eighteenth century, the effect of which has been chiefly felt in our own time; namely, the establishment of the Massachusetts Medical Society, and the founding of the Medical School of Harvard University.
The third century of our medical history began with the introduction of the second great medical discovery of modern times,—of all time up to that date, I may say,—once more via Boston, if we count the University village as its suburb, and once more by one of our Massachusetts physicians. In the month of July, 1800, Dr. Benjamin Waterhouse of Cambridge submitted four of his own children to the new process of vaccination,—the first persons vaccinated, as Dr. Zabdiel Boylston's son had been the first person inoculated in the New World.
A little before the first half of this century was completed, in the autumn of 1846, the great discovery went forth from the Massachusetts General Hospital, which repaid the debt of America to the science of the Old World, and gave immortality to the place of its origin in the memory and the heart of mankind. The production of temporary insensibility at will—tuto, cito, jucunde, safely, quickly, pleasantly—is one of those triumphs over the infirmities of our mortal condition which change the aspect of life ever afterwards. Rhetoric can add nothing to its glory; gratitude, and the pride permitted to human weakness, that our Bethlehem should have been chosen as the birthplace of this new embodiment of the divine mercy, are all we can yet find room for.
The present century has seen the establishment of all those great charitable institutions for the cure of diseases of the body and of the mind, which our State and our city have a right to consider as among the chief ornaments of their civilization.
The last century had very little to show, in our State, in the way of medical literature. The worthies who took care of our grandfathers and great-grandfathers, like the Revolutionary heroes, fought (with disease) and bled (their patients) and died (in spite of their own remedies); but their names, once familiar, are heard only at rare intervals. Honored in their day, not unremembered by a few solitary students of the past, their memories are going sweetly to sleep in the arms of the patient old dry-nurse, whose "blackdrop" is the never-failing anodyne of the restless generations of men. Except the lively controversy on inoculation, and floating papers in journals, we have not much of value for that long period, in the shape of medical records.
But while the trouble with the last century is to find authors to mention, the trouble of this would be to name all that we find. Of these, a very few claim unquestioned preeminence.
Nathan Smith, born in Rehoboth, Mass., a graduate of the Medical School of our University, did a great work for the advancement of medicine and surgery in New England, by his labors as teacher and author, greater, it is claimed by some, than was ever done by any other man. The two Warrens, of our time, each left a large and permanent record of a most extended surgical practice. James Jackson not only educated a whole generation by his lessons of wisdom, but bequeathed some of the most valuable results of his experience to those who came after him, in a series of letters singularly pleasant and kindly as well as instructive. John Ware, keen and cautious, earnest and deliberate, wrote the two remarkable essays which have identified his name, for all time, with two important diseases, on which he has shed new light by his original observations.
I must do violence to the modesty of the living by referring to the many important contributions to medical science by Dr. Jacob Bigelow, and especially to his discourse on "Self-limited Diseases," an address which can be read in a single hour, but the influence of which will be felt for a century.
Nor would the profession forgive me if I forgot to mention the admirable museum of pathological anatomy, created almost entirely by the hands of Dr. John Barnard Swett Jackson, and illustrated by his own printed descriptive catalogue, justly spoken of by a distinguished professor in the University of Pennsylvania as the most important contribution which had ever been made in this country to the branch to which it relates.
When we look at the literature of mental disease, as seen in hospital reports and special treatises, we can mention the names of Wyman, Woodward, Brigham, Bell, and Ray, all either natives of Massachusetts or placed at the head of her institutions for the treatment of the insane.
We have a right to claim also one who is known all over the civilized world as a philanthropist, to us as a townsman and a graduate of our own Medical School, Dr. Samuel Gridley Howe, the guide and benefactor of a great multitude who were born to a world of inward or of outward darkness.
I cannot pass over in silence the part taken by our own physicians in those sanitary movements which are assuming every year greater importance. Two diseases especially have attracted attention, above all others, with reference to their causes and prevention; cholera, the "black death" of the nineteenth century, and consumption, the white plague of the North, both of which have been faithfully studied and reported on by physicians of our own State and city. The cultivation of medical and surgical specialties, which is fast becoming prevalent, is beginning to show its effects in the literature of the profession, which is every year growing richer in original observations and investigations.
To these benefactors who have labored for us in their peaceful vocation, we must add the noble army of surgeons, who went with the soldiers who fought the battles of their country, sharing many of their dangers, not rarely falling victims to fatigue, disease, or the deadly volleys to which they often exposed themselves in the discharge of their duties.
The pleasant biographies of the venerable Dr. Thacher, and the worthy and kind-hearted gleaner, Dr. Stephen W. Williams, who came after him, are filled with the names of men who served their generation well, and rest from their labors, followed by the blessing of those for whom they endured the toils and fatigues inseparable from their calling. The hardworking, intelligent country physician more especially deserves the gratitude of his own generation, for he rarely leaves any permanent record in the literature of his profession. Books are hard to obtain; hospitals, which are always centres of intelligence, are remote; thoroughly educated and superior men are separated by wide intervals; and long rides, though favorable to reflection, take up much of the time which might otherwise be given to the labors of the study. So it is that men of ability and vast experience, like the late Dr. Twitchell, for instance, make a great and deserved reputation, become the oracles of large districts, and yet leave nothing, or next to nothing, by which their names shall be preserved from blank oblivion.
One or two other facts deserve mention, as showing the readiness of our medical community to receive and adopt any important idea or discovery. The new science of Histology, as it is now called, was first brought fully before the profession of this country by the translation of Bichat's great work, "Anatomie Generale," by the late Dr. George Hayward.
The first work printed in this country on Auscultation,—that wonderful art of discovering disease, which, as it were, puts a window in the breast, through which the vital organs can be seen, to all intents and purposes, was the manual published anonymously by "A Member of the Massachusetts Medical Society."
We are now in some slight measure prepared to weigh the record of the medical profession in Massachusetts, and pass our judgment upon it. But in-order to do justice to the first generation of practitioners, we must compare what we know of their treatment of disease with the state of the art in England, and the superstitions which they saw all around them in other departments of knowledge or belief.
English medical literature must have been at a pretty low ebb when Sydenham recommended Don Quixote to Sir Richard Blackmore for professional reading. The College Pharmacopoeia was loaded with the most absurd compound mixtures, one of the most complex of which (the same which the Reverend Mr. Harward, "Lecturer at the Royal Chappel in Boston," tried to simplify), was not dropped until the year 1801. Sir Kenelm Digby was playing his fantastic tricks with the Sympathetic powder, and teaching Governor Winthrop, the second, how to cure fever and ague, which some may like to know. "Pare the patient's nails; put the parings in a little bag, and hang the bag round the neck of a live eel, and put him in a tub of water. The eel will die, and the patient will recover."
Wiseman, the great surgeon, was discoursing eloquently on the efficacy of the royal touch in scrofula. The founder of the Ashmolean Museum at Oxford, consorting with alchemists and astrologers, was treasuring the manuscripts of the late pious Dr. Richard Napier, in which certain letters (Rx Ris) were understood to mean Responsum Raphaelis,—the answer of the angel Raphael to the good man's medical questions. The illustrious Robert Boyle was making his collection of choice and safe remedies, including the sole of an old shoe, the thigh bone of a hanged man, and things far worse than these, as articles of his materia medica. Dr. Stafford, whose paper of directions to his "friend, Mr. Wintrop," I cited, was probably a man of standing in London; yet toad-powder was his sovereign remedy.
See what was the state of belief in other matters among the most intelligent persons of the colonies, magistrates and clergymen. Jonathan Brewster, son of the church-elder, writes the wildest letters to John Winthrop about alchemy,—"mad for making gold as the Lynn rock-borers are for finding it."
Remember the theology and the diabology of the time. Mr. Cotton's Theocracy was a royal government, with the King of kings as its nominal head, but with an upper chamber of saints, and a tremendous opposition in the lower house; the leader of which may have been equalled, but cannot have been surpassed by any of our earth-born politicians. The demons were prowling round the houses every night, as the foxes were sneaking about the hen-roosts. The men of Gloucester fired whole flasks of gunpowder at devils disguised as Indians and Frenchmen.
How deeply the notion of miraculous interference with the course of nature was rooted, is shown by the tenacity of the superstition about earthquakes. We can hardly believe that our Professor Winthrop, father of the old judge and the "squire," whom many of us Cambridge people remember so well, had to defend himself against the learned and excellent Dr. Prince, of the Old South Church, for discussing their phenomena as if they belonged to the province of natural science:
Not for the sake of degrading the aspect of the noble men who founded our State, do I refer to their idle beliefs and painful delusions, but to show against what influences the common sense of the medical profession had to assert itself.
Think, then, of the blazing stars, that shook their horrid hair in the sky; the phantom ship, that brought its message direct from the other world; the story of the mouse and the snake at Watertown; of the mice and the prayer-book; of the snake in church; of the calf with two heads; and of the cabbage in the perfect form of a cutlash,—all which innocent occurrences were accepted or feared as alarming portents.
We can smile at these: but we cannot smile at the account of unhappy Mary Dyer's malformed offspring; or of Mrs. Hutchinson's domestic misfortune of similar character, in the story of which the physician, Dr. John Clark of Rhode Island, alone appears to advantage; or as we read the Rev. Samuel Willard's fifteen alarming pages about an unfortunate young woman suffering with hysteria. Or go a little deeper into tragedy, and see poor Dorothy Talby, mad as Ophelia, first admonished, then whipped; at last, taking her own little daughter's life; put on trial, and standing mute, threatened to be pressed to death, confessing, sentenced, praying to be beheaded; and none the less pitilessly swung from the fatal ladder.
The cooper's crazy wife—crazy in the belief that she has committed the unpardonable sin—tries to drown her child, to save it from misery; and the poor lunatic, who would be tenderly cared for to-day in a quiet asylum, is judged to be acting under the instigation of Satan himself. Yet, after all, what can we say, who put Bunyan's "Pilgrim's Progress," full of nightmare dreams of horror, into all our children's hands; a story in which the awful image of the man in the cage might well turn the nursery where it is read into a madhouse?
The miserable delusion of witchcraft illustrates, in a still more impressive way, the false ideas which governed the supposed relation of men with the spiritual world. I have no doubt many physicians shared in these superstitions. Mr. Upham says they—that is, some of them—were in the habit of attributing their want of success to the fact, that an "evil hand" was on their patient. The temptation was strong, no doubt, when magistrates and ministers and all that followed their lead were contented with such an explanation. But how was it in Salem, according to Mr. Upham's own statement? Dr. John Swinnerton was, he says, for many years the principal physician of Salem. And he says, also, "The Swinnerton family were all along opposed to Mr. Parris, and kept remarkably clear from the witchcraft delusion." Dr. John Swinnerton—the same, by the way, whose memory is illuminated by a ray from the genius of Hawthorne—died the very year before the great witchcraft explosion took place. But who can doubt that it was from him that the family had learned to despise and to resist the base superstition; or that Bridget Bishop, whose house he rented, as Mr. Upham tells me, the first person hanged in the time of the delusion, would have found an efficient protector in her tenant, had he been living, to head the opposition of his family to the misguided clergymen and magistrates?
I cannot doubt that our early physicians brought with them many Old-World medical superstitions, and I have no question that they were more or less involved in the prevailing errors of the community in which they lived. But, on the whole, their record is a clean one, so far as we can get at it; and where it is questionable we must remember that there must have been many little-educated persons among them; and that all must have felt, to some extent, the influence of those sincere and devoted but unsafe men, the physic-practising clergymen, who often used spiritual means as a substitute for temporal ones, who looked upon a hysteric patient as possessed by the devil, and treated a fractured skull by prayers and plasters, following the advice of a ruling elder in opposition to the "unanimous opinion of seven surgeons."
To what results the union of the two professions was liable to lead, may be seen by the example of a learned and famous person, who has left on record the product of his labors in the double capacity of clergyman and physician.
I have had the privilege of examining a manuscript of Cotton Mather's relating to medicine, by the kindness of the librarian of the American Antiquarian Society, to which society it belongs. A brief notice of this curious document may prove not uninteresting.
It is entitled "The Angel of Bethesda: an Essay upon the Common Maladies of Mankind, offering, first, the sentiments of Piety," etc., etc., and "a collection of plain but potent and Approved REMEDIES for the Maladies." There are sixty-six "Capsula's," as he calls them, or chapters, in his table of contents; of which, five—from the fifteenth to the nineteenth, inclusive—are missing. This is a most unfortunate loss, as the eighteenth capsula treated of agues, and we could have learned from it something of their degree of frequency in this part of New England. There is no date to the manuscript; which, however, refers to a case observed Nov. 14, 1724.
The divine takes precedence of the physician in this extraordinary production. He begins by preaching a sermon at his unfortunate patient. Having thrown him into a cold sweat by his spiritual sudorific, he attacks him with his material remedies, which are often quite as unpalatable. The simple and cleanly practice of Sydenham, with whose works he was acquainted, seems to have been thrown away upon him. Everything he could find mentioned in the seventy or eighty authors he cites, all that the old women of both sexes had ever told him of, gets into his text, or squeezes itself into his margin.
Evolving disease out of sin, he hates it, one would say, as he hates its cause, and would drive it out of the body with all noisome appliances. "Sickness is in Fact Flagellum Dei pro peccatis mundi." So saying, he encourages the young mother whose babe is wasting away upon her breast with these reflections:
"Think; oh the grievous Effects of Sin! This wretched Infant has not arrived unto years of sense enough, to sin after the similitude of the transgression committed by Adam. Nevertheless the Transgression of Adam, who had all mankind Foederally, yea, Naturally, in him, has involved this Infant in the guilt of it. And the poison of the old serpent, which infected Adam when he fell into his Transgression, by hearkening to the Tempter, has corrupted all mankind, and is a seed unto such diseases as this Infant is now laboring under. Lord, what are we, and what are our children, but a Generation of Vipers?"
Many of his remedies are at least harmless, but his pedantry and utter want of judgment betray themselves everywhere. He piles his prescriptions one upon another, without the least discrimination. He is run away with by all sorts of fancies and superstitions. He prescribes euphrasia, eye-bright, for disease of the eyes; appealing confidently to the strange old doctrine of signatures, which inferred its use from the resemblance of its flower to the organ of vision. For the scattering of wens, the efficacy of a Dead Hand has been out of measure wonderful. But when he once comes to the odious class of remedies, he revels in them like a scarabeus. This allusion will bring us quite near enough to the inconceivable abominations with which he proposed to outrage the sinful stomachs of the unhappy confederates and accomplices of Adam.
It is well that the treatise was never printed, yet there are passages in it worth preserving. He speaks of some remedies which have since become more universally known:
"Among the plants of our soyl, Sir William Temple singles out Five [Six] as being of the greatest virtue and most friendly to health: and his favorite plants, Sage, Rue, Saffron, Alehoof, Garlick, and Elder."
"But these Five [Six] plants may admitt of some competitors. The
QUINQUINA—How celebrated: Immoderately, Hyperbolically celebrated!"
Of Ipecacuanha, he says,—"This is now in its reign; the most fashionable vomit."
"I am not sorry that antimonial emetics begin to be disused."
He quotes "Mr. Lock" as recommending red poppy-water and abstinence from flesh as often useful in children's diseases.
One of his "Capsula's" is devoted to the animalcular origin of diseases, at the end of which he says, speaking of remedies for this supposed source of our distempers:
"Mercury we know thee: But we are afraid thou wilt kill us too, if we employ thee to kill them that kill us.
"And yett, for the cleansing of the small Blood Vessels, and making way for the free circulation of the Blood and Lymph—there is nothing like Mercurial Deobstruents."
From this we learn that mercury was already in common use, and the subject of the same popular prejudice as in our own time.
His poetical turn shows itself here and there:
"O Nightingale, with a Thorn at thy Breast; Under the trouble of a Cough, what can be more proper than such thoughts as these?"…
If there is pathos in this, there is bathos in his apostrophe to the millipede, beginning "Poor sowbug!" and eulogizing the healing virtues of that odious little beast; of which he tells us to take "half a pound, putt 'em alive into a quart or two of wine," with saffron and other drugs, and take two ounces twice a day.
The "Capsula" entitled "Nishmath Chajim" was printed in 1722, at New London, and is in the possession of our own Society. He means, by these words, something like the Archxus of Van Helmont, of which he discourses in a style wonderfully resembling that of Mr. Jenkinson in the "Vicar of Wakefield." "Many of the Ancients thought there was much of a Real History in the Parable, and their Opinion was that there is, DIAPHORA KATA TAS MORPHAS, A Distinction (and so a Resemblance) of men as to their Shapes after Death." And so on, with Ireaeus, Tertullian, Thespesius, and "the TA TONE PSEUCONE CROMATA," in the place of "Sanconiathon, Manetho, Berosus," and "Anarchon ara kai ateleutaion to pan."
One other passage deserves notice, as it relates to the single medical suggestion which does honor to Cotton Mather's memory. It does not appear that he availed himself of the information which he says, he obtained from his slave, for such I suppose he was.
In his appendix to "Variolae Triumphatae," he says,—
"There has been a wonderful practice lately used in several parts of the world, which indeed is not yet become common in our nation.
"I was first informed of it by a Garamantee servant of my own, long before I knew that any Europeans or Asiaticks had the least acquaintance with it, and some years before I was enriched with the communications of the learned Foreigners, whose accounts I found agreeing with what I received of my servant, when he shewed me the Scar of the Wound made for the operation; and said, That no person ever died of the smallpox, in their countrey, that had the courage to use it.
"I have since met with a considerable Number of these Africans, who all agree in one story; That in their countrey grandy-many dy of the small-pox: But now they learn this way: people take juice of smallpox and cutty-skin and put in a Drop; then by'nd by a little sicky, sicky: then very few little things like small-pox; and nobody dy of it; and nobody have small-pox any more. Thus, in Africa, where the poor creatures dy of the smallpox like Rotten Sheep, a merciful God has taught them an Infallible preservative. 'T is a common practice, and is attended with a constant success."
What has come down to us of the first century of medical practice, in the hands of Winthrop and Oliver, is comparatively simple and reasonable. I suspect that the conditions of rude, stern life, in which the colonists found themselves in the wilderness, took the nonsense out of them, as the exigencies of a campaign did out of our physicians and surgeons in the late war. Good food and enough of it, pure air and water, cleanliness, good attendance, an anaesthetic, an opiate, a stimulant, quinine, and two or three common drugs, proved to be the marrow of medical treatment; and the fopperies of the pharmacopoeia went the way of embroidered shirts and white kid gloves and malacca joints, in their time of need. "Good wine is the best cordiall for her," said Governor John Winthrop, Junior, to Samuel Symonds, speaking of that gentleman's wife,—just as Sydenham, instead of physic, once ordered a roast chicken and a pint of canary for his patient in male hysterics.
But the profession of medicine never could reach its full development until it became entirely separated from that of divinity. The spiritual guide, the consoler in affliction, the confessor who is admitted into the secrets of our souls, has his own noble sphere of duties; but the healer of men must confine himself solely to the revelations of God in nature, as he sees their miracles with his own eyes. No doctrine of prayer or special providence is to be his excuse for not looking straight at secondary causes, and acting, exactly so far as experience justifies him, as if he were himself the divine agent which antiquity fabled him to be. While pious men were praying—humbly, sincerely, rightly, according to their knowledge—over the endless succession of little children dying of spasms in the great Dublin Hospital, a sagacious physician knocked some holes in the walls of the ward, let God's blessed air in on the little creatures, and so had already saved in that single hospital, as it was soberly calculated thirty years ago, more than sixteen thousand lives of these infant heirs of immortality. [Collins's Midwifery, p. 312. Published by order of the Massachusetts Medical Society. Boston, 1841.]
Let it be, if you will, that the wise inspiration of the physician was granted in virtue of the clergyman's supplications. Still, the habit of dealing with things seen generates another kind of knowledge, and another way of thought, from that of dealing with things unseen; which knowledge and way of thought are special means granted by Providence, and to be thankfully accepted.
The mediaeval ecclesiastics expressed a great truth in that saying, so often quoted, as carrying a reproach with it: "Ubi tres medici, duo athei,"—"Where there are three physicians, there are two atheists."
It was true then, it is true to-day, that the physician very commonly, if not very generally, denies and repudiates the deity of ecclesiastical commerce. The Being whom Ambroise Pare meant when he spoke those memorable words, which you may read over the professor's chair in the French School of Medicine, "Te le pensay, et Dieu le guarit," "I dressed his wound, and God healed it,"—is a different being from the God that scholastic theologians have projected from their consciousness, or shaped even from the sacred pages which have proved so plastic in their hands. He is a God who never leaves himself without witness, who repenteth him of the evil, who never allows a disease or an injury, compatible with the enjoyment of life, to take its course without establishing an effort, limited by certain fixed conditions, it is true, but an effort, always, to restore the broken body or the shattered mind. In the perpetual presence of this great Healing Agent, who stays the bleeding of wounds, who knits the fractured bone, who expels the splinter by a gentle natural process, who walls in the inflammation that might involve the vital organs, who draws a cordon to separate the dead part from the living, who sends his three natural anaesthetics to the over-tasked frame in due order, according to its need,—sleep, fainting, death; in this perpetual presence, it is doubtless hard for the physician to realize the theological fact of a vast and permanent sphere of the universe, where no organ finds itself in its natural medium, where no wound heals kindly, where the executive has abrogated the pardoning power, and mercy forgets its errand; where the omnipotent is unfelt save in malignant agencies, and the omnipresent is unseen and unrepresented; hard to accept the God of Dante's "Inferno," and of Bunyan's caged lunatic. If this is atheism, call three, instead of two of the trio, atheists, and it will probably come nearer the truth.
I am not disposed to deny the occasional injurious effect of the 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 by 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.
A blind man was said to have been restored to sight by a young person 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 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 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: