medical essays-第73部分

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likely　to　be　useful　than　any　single　talent；　even　were　it　the　power　of　observation；　in　excess。　　For　a　mere　observer　is　liable　to　be　too　fond　of　facts　for　their　own　sake；　so　that；　if　he　told　the　real　truth；　he　would　confess　that　he　takes　more　pleasure　in　a　post…mortem　examination　which　shows　him　what　was　the　matter　with　a　patient；　than　in　a　case　which　insists　on　getting　well　and　leaving　him　in　the　dark　as　to　its　nature。　　Far　more　likely　to　interfere　with　the　sound　practical　balance　of　the　mind　is　that　speculative；　theoretical　tendency　which　has　made　so　many　men　noted　in　their　day；　whose　fame　has　passed　away　with　their　dissolving　theories。　Read　Dr。　Bartlett's　comparison　of　the　famous　Benjamin　Rush　with　his　modest　fellow…townsman　Dr。　William　Currie；　and　see　the　dangers　into　which　a　passion　for　grandiose　generalizations　betrayed　a　man　of　many　admirable　qualities。

I　warn　you　against　all　ambitious　aspirations　outside　of　your　profession。　　Medicine　is　the　most　difficult　of　sciences　and　the　most　laborious　of　arts。　　It　will　task　all　your　powers　of　body　and　mind　if　you　are　faithful　to　it。　　Do　not　dabble　in　the　muddy　sewer　of　politics；　nor　linger　by　the　enchanted　streams　of　literature；　nor　dig　in　far…off　fields　for　the　hidden　waters　of　alien　sciences。　　The　great　practitioners　are　generally　those　who　concentrate　all　their　powers　on　their　business。　　If　there　are　here　and　there　brilliant　exceptions；　it　is　only　in　virtue　of　extraordinary　gifts；　and　industry　to　which　very　few　are　equal。

To　get　business　a　man　mast　really　want　it；　and　do　you　suppose　that　when　you　are　in　the　middle　of　a　heated　caucus；　or　half…way　through　a　delicate　analysis；　or　in　the　spasm　of　an　unfinished　ode；　your　eyes　rolling　in　the　fine　frenzy　of　poetical　composition；　you　want　to　be　called　to　a　teething　infant；　or　an　ancient　person　groaning　under　the　griefs　of　a　lumbago？　　I　think　I　have　known　more　than　one　young　man　whose　doctor's　sign　proclaimed　his　readiness　to　serve　mankind　in　that　capacity；　but　who　hated　the　sound　of　a　patient's　knock；　and　as　he　sat　with　his　book　or　his　microscope；　felt　exactly　as　the　old　party　expressed　himself　in　my　friend　Mr。　Brownell's　poem

　　　　　　　　　　〃All　I　axes　is；　let　me　alone：'

The　community　soon　finds　out　whether　you　are　in　earnest；　and　really　mean　business；　or　whether　you　are　one　of　those　diplomaed　dilettanti　who　like　the　amusement　of　quasi　medical　studies；　but　have　no　idea　of　wasting　their　precious　time　in　putting　their　knowledge　in　practice　for　the　benefit　of　their　suffering　fellow…creatures。

The　public　is　a　very　incompetent　judge　of　your　skill　and　knowledge；　but　it　gives　its　confidence　most　readily　to　those　who　stand　well　with　their　professional　brethren；　whom　they　call　upon　when　they　themselves　or　their　families　are　sick；　whom　they　choose　to　honorable　offices；　whose　writings　and　teachings　they　hold　in　esteem。　　A　man　may　be　much　valued　by　the　profession　and　yet　have　defects　which　prevent　his　becoming　a　favorite　practitioner；　but　no　popularity　can　be　depended　upon　as　permanent　which　is　not　sanctioned　by　the　judgment　of　professional　experts；　and　with　these　you　will　always　stand　on　your　substantial　merits。

What　shall　I　say　of　the　personal　habits　you　must　form　if　you　wish　for　success？　　Temperance　is　first　upon　the　list。　　Intemperance　in　a　physician　partakes　of　the　guilt　of　homicide；　for　the　muddled　brain　may　easily　make　a　fatal　blunder　in　a　prescription　and　the　unsteady　hand　transfix　an　artery　in　an　operation。　　Tippling　doctors　have　been　too　common　in　the　history　of　medicine。　　Paracelsus　was　a　sot；　Radcliffe　was　much　too　fond　of　his　glass；　and　Dr。　James　Hurlbut　of　Wethersfield；　Connecticut；　a　famous　man　in　his　time；　used　to　drink　a　square　bottle　of　rum　a　day；　with　a　corresponding　allowance　of　opium　to　help　steady　his　nerves。　　We　commonly　speak　of　a　man　as　being　the　worse　for　liquor；　but　I　was　asking　an　Irish　laborer　one　day　about　his　doctor；　who；　as　he　said；　was　somewhat　given　to　drink。　　〃I　like　him　best　when　he's　a　little　that　way；〃　he　said；　〃then　I　can　spake　to　him。〃　　I　pitied　the　poor　patient　who　could　not　venture　to　allude　to　his　colic　or　his　pleurisy　until　his　physician　was　tipsy。

There　are　personal　habits　of　less　gravity　than　the　one　I　have　mentioned　which　it　is　well　to　guard　against；　or；　if　they　are　formed；　to　relinquish。　　A　man　who　may　be　called　at　a　moment's　warning　into　the　fragrant　boudoir　of　suffering　loveliness　should　not　unsweeten　its　atmosphere　with　reminiscences　of　extinguished　meerschaums。　　He　should　remember　that　the　sick　are　sensitive　and　fastidious；　that　they　love　the　sweet　odors　and　the　pure　tints　of　flowers；　and　if　his　presence　is　not　like　the　breath　of　the　rose；　if　his　hands　are　not　like　the　leaf　of　the　lily；　his　visit　may　be　unwelcome；　and　if　he　looks　behind　him　he　may　see　a　window　thrown　open　after　he　has　left　the　sick…chamber。　I　remember　too　well　the　old　doctor　who　sometimes　came　to　help　me　through　those　inward　griefs　to　which　childhood　is　liable。　　〃Far　off　his　coming　〃shall　I　say　〃shone；〃　and　finish　the　Miltonic　phrase；　or　leave　the　verb　to　the　happy　conjectures　of　my　audience？　　Before　him　came　a　soul…subduing　whiff　of　ipecacuanha；　and　after　him　lingered　a　shuddering　consciousness　of　rhubarb。　　He　had　lived　so　much　among　his　medicaments　that　he　had　at　last　become　himself　a　drug；　and　to　have　him　pass　through　a　sick…chamber　was　a　stronger　dose　than　a　conscientious　disciple　of　Hahnemann　would　think　it　safe　to　administer。

Need　I　remind　yon　of　the　importance　of　punctuality　in　your　engagements；　and　of　the　worry　and　distress　to　patients　and　their　friends　which　the　want　of　it　occasions？　　One　of　my　old　teachers　always　carried　two　watches；　to　make　quite　sure　of　being　exact；　and　not　only　kept　his　appointments　with　the　regularity　of　a　chronometer；　but　took　great　pains　to　be　at　his　patient's　house　at　the　time　when　he　had　reason　to　believe　he　was　expected；　even　if　no　express　appointment　was　made。　　It　is　a　good　rule；　if　you　call　too　early；　my　lady's　hair　may　not　be　so　smooth　as　could　be　wished；　and；　if　you　keep　her　waiting　too　long；　her　hair　may　be　smooth；　but　her　temper　otherwise。

You　will　remember；　of　course；　always　to　get　the　weather…gage　of　your　patient。　　I　mean；　to　place　him　so　that　the　light　falls　on　his　face　and　not　on　yours。　　It　is　a　kind　of；　ocular　duel　that　is　about　to　take　place　between　you；　you　are　going　to　look　through　his　features　into　his　pulmonary　and　hepatic　and　other　internal　machinery；　and　he　is　going　to　look　into　yours　quite　as　sharply　to　see　what　you　think　about　his　probabilities　for　time　or　eternity。

No　matter　how　hard　he　stares　at　your　countenance；　he　should　never　be　able　to　read　his　fate　in　it。　　It　should　be　cheerful　as　long　as　there　is　hope；　and　serene　in　its　gravity　when　nothing　is　left　but　resignation。　　The　face　of　a　physician；　like　that　of　a　diplomatist；　should　be　impenetrable。　　Nature　is　a　benevolent　old　hypocrite；　she　cheats　the　sick　and　the　dying　with　illusions　better　than　any　anodynes。　　If　there　are　cogent　reasons　why　a　patient　should　be　undeceived；　do　it　deliberately　and　advisedly；　but　do　not　betray　your　apprehensions　through　your　tell…tale　features。

We　had　a　physician　in　our　city　whose　smile　was　commonly　reckoned　as　being　worth　five　thousand　dollars　a　year　to　him；　in　the　days；　too；　of　moderate　incomes。　　You　cannot　put　on　such　a　smile　as　that　any　more　than　you　can　get　sunshine　without　sun；　there　was　a　tranquil　and　kindly　nature　under　it　that　irradiated　the　pleasant　face　it　made　one　happier　to　meet　on　his　daily　rounds。　　But　you　can　cultivate　the　disposition；　and　it　will　work　its　way　through　to　the　surface；　nay；　more；you　can　try　to　wear　a　quiet　and　encouraging　look；　and　it　will　react　on　your　disposition　and　make　you　like　what　you　seem　to　be；　or　at　least　bring　you　nearer　to　its　own　likeness。

Your　patient　has　no　more　right　to　all　the　truth　you　know　than　he　has　to　all　the　medicine　in　your　saddlebags；　if　you　carry　that　kind　of　cartridge…box　for　the　ammunition　that　slays　disease。　　He　should　get　only　just　so　much　as　is　good　for　him。　　I　have　seen　a　physician　examining　a　patient's　chest　stop　all　at　once；　as　he　brought　out　a　particular　sound　with　a　tap　on　the　collarbone；　in　the　attitude　of　a　pointer　who　has　just　come　on　the　scent　or　sight　of　a　woodcock。　　You　remember　the　Spartan　boy；　who；　with　unmoved　countenance；　hid　the　fox　that　was　tearing　his　vitals　beneath　his　mantle。　　What　he　could　do　in　his　own　suffering　you　must　learn　to　do　for　others　on　whose　vital　organs　disease　has　fastened　its　devouring　teeth。　　It　is　a　terrible　thing　to　take　away　hope；　even　earthly　hope；　from　a　fellow…creature。　Be　very　careful　what　names　you　let　fall　before　your　patient。　　He　knows　what　it　means　when　you　tell　him　he　has　tubercles　or　Bright's　disease；　and；　if　he　hears　the　word　carcinoma；　he　will　certainly　look　it　out　in　a　medical　dictionary；　if　he　does　not　interpret　its　dread　significance　on　the　instant。　　Tell　him　he　has　asthmatic　symptoms；　or　a　tendency　to　the　gouty　diathesis；　and　he　will　at　once　think　of　all　the　asthmatic　and　gouty　old　patriarchs　he　has　ever　heard　of；　and　be　comforted。　　You　need　not　be　so　cautious　in　speaking　of　the　health　of　rich　and　remote　relatives；　if　he　is　in　the　line　of　succession。

Some　shrewd　old　doctors　have　a　few　phrases　always　on　hand　for　patients　that　will　insist　on　knowing　the　path