medical essays-第53部分

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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