medical essays-第71节
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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 a
〃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 th
