medical essays-第53节
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instruction in various important specialties； whatever might be gained； a good deal would certainly be lost in our case by the exchange。
The most essential part of a student's instruction is obtained； as I believe； not in the lecture…room； but at the bedside。 Nothing seen there is lost； the rhythms of disease are learned by frequent repetition； its unforeseen occurrences stamp themselves indelibly in the memory。 Before the student is aware of what he has acquired； he has learned the aspects and course and probable issue of the diseases he has seen with his teacher； and the proper mode of dealing with them； so far as his master knows it。 On the other hand； our ex cathedra prelections have a strong tendency to run into details which； however interesting they may be to ourselves and a few of our more curious listeners； have nothing in them which will ever be of use to the student as a practitioner。 It is a perfectly fair question whether I and some other American Professors do not teach quite enough that is useless already。 Is it not well to remind the student from time to time that a physician's business is to avert disease； to heal the sick； to prolong life； and to diminish suffering？ Is it not true that the young man of average ability will find it as much as he can do to fit himself for these simple duties？ Is it not best to begin； at any rate； by making sure of such knowledge as he will require in his daily walk； by no means discouraging him from any study for which his genius fits him when he once feels that he has become master of his chosen art。
I know that many branches of science are of the greatest value as feeders of our medical reservoirs。 But the practising physician's office is to draw the healing waters； and while he gives his time to this labor he can hardly be expected to explore all the sources that spread themselves over the wide domain of science。 The traveller who would not drink of the Nile until he had tracked it to its parent lakes； would be like to die of thirst； and the medical practitioner who would not use the results of many laborers in other departments without sharing their special toils； would find life far too short and art immeasurably too long。
We owe much to Chemistry； one of the most captivating as well as important of studies； but the medical man must as a general rule content himself with a clear view of its principles and a limited acquaintance with its facts； such especially as are pertinent to his pursuits。 I am in little danger of underrating Anatomy or Physiology； but as each of these branches splits up into specialties； any one of which may take up a scientific life…time； I would have them taught with a certain judgment and reserve； so that they shall not crowd the more immediately practical branches。 So of all the other ancillary and auxiliary kinds of knowledge； I would have them strictly subordinated to that particular kind of knowledge for which the community looks to its medical advisers。
A medical school is not a scientific school； except just so far as medicine itself is a science。 On the natural history side； medicine is a science； on the curative side； chiefly an art。 This is implied in Hufeland's aphorism： 〃The physician must generalize the disease and individualize the patient。〃
The coordinated and classified results of empirical observation； in distinction from scientific experiment； have furnished almost all we know about food； the medicine of health； and medicine； the food of sickness。 We eat the root of the Solanum tuberosum and throw away its fruit； we eat the fruit of the Solanum Lycopersicum and throw away its root。 Nothing but vulgar experience has taught us to reject the potato ball and cook the tomato。 So of most of our remedies。 The subchloride of mercury； calomel； is the great British specific； the protochloride of mercury； corrosive sublimate； kills like arsenic； but no chemist could have told us it would be so。
》From observations like these we can obtain certain principles from which we can argue deductively to facts of a like nature； but the process is limited； and we are suspicious of all reasoning in that direction applied to the processes of healthy and diseased life。 We are continually appealing to special facts。 We are willing to give Liebig's artificial milk when we cannot do better； but we watch the child anxiously whose wet…nurse is a chemist's pipkin。 A pair of substantial mammary glands has the advantage over the two hemispheres of the most learned Professor's brain； in the art of compounding a nutritious fluid for infants。
The bedside is always the true centre of medical teaching。 Certain branches must be taught in the lecture…room； and will necessarily involve a good deal that is not directly useful to the future practitioner。 But the over ambitious and active student must not be led away by the seduction of knowledge for its own sake from his principal pursuit。 The humble beginner； who is alarmed at the vast fields of knowledge opened to him； may be encouraged by the assurance that with a very slender provision of science； in distinction from practical skill； he may be a useful and acceptable member of the profession to which the health of the community is intrusted。
To those who are not to engage in practice； the various pursuits of science hardly require to be commended。 Only they must not be disappointed if they find many subjects treated in our courses as a medical class requires； rather than as a scientific class would expect； that is； with special limitations and constant reference to practical ends。 Fortunately they are within easy reach of the highest scientific instruction。 The business of a school like this is to make useful working physicians； and to succeed in this it is almost as important not to overcrowd the mind of the pupil with merely curious knowledge as it is to store it with useful information。
In this direction I have written my lecture； not to undervalue any form of scientific labor in its place； an unworthy thought from which I hope I need not defend myself；but to discourage any undue inflation of the scholastic programme； which even now asks more of the student than the teacher is able to obtain from the great majority of those who present themselves for examination。 I wish to take a hint in education from the Secretary of the Massachusetts Board of Agriculture； who regards the cultivation of too much land as a great defect in our New England farming。 I hope that our Medical Institutions may never lay themselves open to the kind of accusation Mr。 Lowe brings against the English Universities； when he says that their education is made up 〃of words that few understand and most will shortly forget； of arts that can never be used； if indeed they can even be learnt； of histories inapplicable to our times； of languages dead and even mouldy； of grammatical rules that never had living use and are only post mortem examinations； and of statements fagoted with utter disregard of their comparative value。〃
This general thought will be kept in view throughout my somewhat discursive address； which will begin with an imaginary clinical lesson from the lips of an historical personage； and close with the portrait from real life of one who； both as teacher and practitioner； was long loved and honored among us。 If I somewhat overrun my hour； you must pardon me； for I can say with Pascal that I have not had the time to make my lecture shorter。
In the year 1647； that good man John Eliot； commonly called the Apostle Eliot； writing to Mr。 Thomas Shepherd； the pious minister of Cambridge； referring to the great need of medical instruction for the Indians； used these words：
〃I have thought in my heart that it were a singular good work； if the Lord would stirre up the hearts of some or other of his people in England to give some maintenance toward some Schoole or Collegiate exercise this way； wherein there should be Anatomies and other instructions that way； and where there might be some recompence given to any that should bring in any vegetable or other thing that is vertuous in the way of Physick。
〃There is another reason which moves my thought and desires this way； namely that our young students in Physick may be trained up better then they yet bee； who have onely theoreticall knowledge； and are forced to fall to practise before ever they saw an Anatomy made； or duely trained up in making experiments； for we never had but one Anatomy in the countrey； which Mr。 Giles Firman ＇Firmin＇ now in England； did make and read upon very well； but no more of that now。〃
Since the time of the Apostle Eliot the Lord has stirred up the hearts of our people to the building of many Schools and Colleges where medicine is taught in all its branches。 Mr。 Giles Firmin's 〃Anatomy 〃 may be considered the first ancestor of a long line of skeletons which have been dangling and rattling in our lecture…rooms for more than a century。
Teaching in New England in 1647 was a grave but simple matter。 A single person； combining in many cases； as in that of Mr。 Giles Firmin； the offices of physician and preacher； taught what he knew to a few disciples whom he gathered about him。 Of the making of that 〃Anatomy〃 on whic
