medical essays-第72节
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t 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
