medical essays-第57节
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Again； the complaint is often heard that the native population is not increasing so rapidly as in former generations。 The breeding and nursing period of American women is one of peculiar delicacy and frequent infirmity。 Many of them must require a considerable interval between the reproductive efforts； to repair damages arid regain strength。 This matter is not to be decided by an appeal to unschooled nature。 It is the same question as that of the deformed pelvis；one of degree。 The facts of mal…vitalization are as much to be attended to as those of mal…formation。 If the woman with a twisted pelvis is to be considered an exempt； the woman with a defective organization should be recognized as belonging to the invalid corps。 We shudder to hear what is alleged as to the prevalence of criminal practices； if back of these there can be shown organic incapacity or overtaxing of too limited powers； the facts belong to the province of the practical physician； as well as of the moralist and the legislator； and require his gravest consideration。
Take the important question of bleeding。 Is venesection done with forever？ Six years ago it was said here in an introductory Lecture that it would doubtless come back again sooner or later。 A fortnight ago I found myself in the cars with one of the most sensible and esteemed practitioners in New England。 He took out his wallet and showed me two lancets； which he carried with him； he had never given up their use。 This is a point you will have to consider。
Or； to mention one out of many questionable remedies； shall you give Veratrum Viride in fevers and inflammations？ It makes the pulse slower in these affections。 Then the presumption would naturally be that it does harm。 The caution with reference to it on this ground was long ago recorded in the Lecture above referred to。 See what Dr。 John Hughes Bennett says of it in the recent edition of his work on Medicine。 Nothing but the most careful clinical experience can settle this and such points of treatment。
These are all practical questionsquestions of life and death； and every day will be full of just such questions。 Take the problem of climate。 A patient comes to you with asthma and wants to know where he can breathe； another comes to you with phthisis and wants to know where he can live。 What boy's play is nine tenths of all that is taught in many a pretentious course of lectures； compared with what an accurate and extensive knowledge of the advantages and disadvantages of different residences in these and other complaints would be to a practising physician
I saw the other day a gentleman living in Canada； who had spent seven successive winters in Egypt； with the entire relief of certain obscure thoracic symptoms which troubled him while at home。 I saw； two months ago； another gentleman from Minnesota； an observer and a man of sense； who considered that State as the great sanatorium for all pulmonary complaints。 If half our grown population are or will be more or less tuberculous； the question of colonizing Florida assumes a new aspect。 Even within the borders of our own State； the very interesting researches of Dr。 Bowditch show that there is a great variation in the amount of tuberculous disease in different towns； apparently connected with local conditions。 The hygienic map of a State is quite as valuable as its geological map； and it is the business of every practising physician to know it thoroughly。 They understand this in England； and send a patient with a dry irritating cough to Torquay or Penzance； while they send another with relaxed bronchial membranes to Clifton or Brighton。 Here is another great field for practical study。
So as to the all…important question of diet。 〃Of all the means of cure at our command；〃 says Dr。 Bennett； 〃a regulation of the quantity and quality of the diet is by far the most powerful。〃 Dr。 MacCormac would perhaps except the air we breathe； for he thinks that impure air； especially in sleeping rooms； is the great cause of tubercle。 It is sufficiently proved that the American；the New Englander；the Bostonian； can breed strong and sound children； generation after generation；nay； I have shown by the record of a particular family that vital losses may be retrieved； and a feeble race grow to lusty vigor in this very climate and locality。 Is not the question why our young men and women so often break down； and how they can be kept from breaking down； far more important for physicians to settle than whether there is one cranial vertebra； or whether there are four； or none？
But I have a taste for the homologies； I want to go deeply into the subject of embryology； I want to analyze the protonihilates precipitated from pigeon's milk by the action of the lunar spectrum；… shall I not follow my star；shall I not obey my instinct；shall I not give myself to the lofty pursuits of science for its own sake？
Certainly you may； if you like。 But take down your sign； or never put it up。 That is the way Dr。 Owen and Dr。 Huxley； Dr。 Agassiz and Dr。 Jeffries Wyman； Dr。 Gray and Dr。 Charles T。 Jackson settled the difficulty。 We all admire the achievements of this band of distinguished doctors who do not practise。 But we say of their work and of all pure science； as the French officer said of the charge of the six hundred at Balaclava； 〃C'est magnifique； mais ce n'est pas la guerre；〃it is very splendid； but it is not a practising doctor's business。 His patient has a right to the cream of his life and not merely to the thin milk that is left after 〃science 〃 has skimmed it off。 The best a physician can give is never too good for the patient。
It is often a disadvantage to a young practitioner to be known for any accomplishment outside of his profession。 Haller lost his election as Physician to the Hospital in his native city of Berne； principally on the ground that he was a poet。 In his later years the physician may venture more boldly。 Astruc was sixty…nine years old when he published his 〃Conjectures；〃 the first attempt； we are told； to decide the authorship of the Pentateuch showing anything like a discerning criticism。 Sir Benjamin Brodie was seventy years old before he left his physiological and surgical studies to indulge in psychological speculations。 The period of pupilage will be busy enough in acquiring the knowledge needed； and the season of active practice will leave little leisure for any but professional studies。
Dr。 Graves of Dublin； one of the first clinical teachers of our time； always insisted on his students' beginning at once to visit the hospital。 At the bedside the student must learn to treat disease； and just as certainly as we spin out and multiply our academic prelections we shall work in more and more stuffing； more and more rubbish； more and more irrelevant； useless detail which the student will get rid of just as soon as he leaves us。 Then the next thing will be a new organization； with an examining board of first…rate practical men； who will ask the candidate questions that mean business；who will make him operate if he is to be a surgeon； and try him at the bedside if he is to be a physician；and not puzzle him with scientific conundrums which not more than one of the questioners could answer himself or ever heard of since he graduated。
Or these women who are hammering at the gates on which is written 〃No admittance for the mothers of mankind；〃 will by and by organize an institution； which starting from that skilful kind of nursing which Florence Nightingale taught so well； will work backwards through anodynes； palliatives； curatives； preventives； until with little show of science it imparts most of what is most valuable in those branches of the healing art it professes to teach。 When that time comes； the fitness of women for certain medical duties； which Hecquet advocated in 1708； which Douglas maintained in 1736； which Dr。 John Ware； long the honored Professor of Theory and Practice in this Institution； upheld within our own recollection in the face of his own recorded opinion to the contrary； will very possibly be recognized。
My advice to every teacher less experienced than myself would be； therefore： Do not fret over the details you have to omit； you probably teach altogether too many as it is。 Individuals may learn a thing with once hearing it； but the only way of teaching a whole class is by enormous repetition； representation； and illustration in all possible forms。 Now and then you will have a young man on your benches like the late Waldo Burnett；not very often； if you lecture half a century。 You cannot pretend to lecture chiefly for men like that；a Mississippi raft might as well take an ocean…steamer in tow。 To meet his wants you would have to leave the rest of your class behind and that you must not do。 President Allen of Jefferson College says that his instruction has been successful in proportion as it has been elementary。 It may be a humiliating statement； but it is one which I have found true in my own experience。
To the student I would say； that however plain and simple may be our teaching； he must expect to forget much which he follows intelligently in the lecture…room。 But it is not the same as if he had never learned it。 A m
