medical essays-第74部分

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Some　shrewd　old　doctors　have　a　few　phrases　always　on　hand　for　patients　that　will　insist　on　knowing　the　pathology　of　their　complaints　without　the　slightest　capacity　of　understanding　the　scientific　explanation。　　I　have　known　the　term　〃spinal　irritation　〃　serve　well　on　such　occasions；　but　I　think　nothing　on　the　whole　has　covered　so　much　ground；　and　meant　so　little；　and　given　such　profound　satisfaction　to　all　parties；　as　the　magnificent　phrase　〃congestion　of　the　portal　system。〃

Once　more；　let　me　recommend　you；　as　far　as　possible；　to　keep　your　doubts　to　yourself；　and　give　the　patient　the　benefit　of　your　decision。　　Firmness；　gentle　firmness；　is　absolutely　necessary　in　this　and　certain　other　relations。　　Mr。　Rarey　with　Cruiser；　Richard　with　Lady　Ann；　Pinel　with　his　crazy　people；　show　what　steady　nerves　can　do　with　the　most　intractable　of　animals；　the　most　irresistible　of　despots；　and　the　most　unmanageable　of　invalids。

If　you　cannot　acquire　and　keep　the　confidence　of　your　patient；　it　is　time　for　you　to　give　place　to　some　other　practitioner　who　can。　　If　you　are　wise　and　diligent；　you　can　establish　relations　with　the　best　of　them　which　they　will　find　it　very　hard　to　break。　　But；　if　they　wish　to　employ　another　person；　who；　as　they　think；　knows　more　than　you　do；　do　not　take　it　as　a　personal　wrong。　　A　patient　believes　another　man　can　save　his　life；　can　restore　him　to　health；　which；　as　he　thinks；　you　have　not　the　skill　to　do。　　No　matter　whether　the　patient　is　right　or　wrong；　it　is　a　great　impertinence　to　think　you　have　any　property　in　him。　　Your　estimate　of　your　own　ability　is　not　the　question；　it　is　what　the　patient　thinks　of　it。　　All　your　wisdom　is　to　him　like　the　lady's　virtue　in　Raleigh's　song：

　　　　〃If　she　seem　not　chaste　to　me；　　　　　　What　care　I　how　chaste　she　be？〃

What　I　call　a　good　patient　is　one　who；　having　found　a　good　physician；　sticks　to　him　till　he　dies。　　But　there　are　many　very　good　people　who　are　not　what　I　call　good　patients。　　I　was　once　requested　to　call　on　a　lady　suffering　from　nervous　and　other　symptoms。　　It　came　out　in　the　preliminary　conversational　skirmish；　half　medical；　half　social；　that　I　was　the　twenty…sixth　member　of　the　faculty　into　whose　arms；　professionally　speaking；　she　had　successively　thrown　herself。　　Not　being　a　believer　in　such　a　rapid　rotation　of　scientific　crops；　I　gently　deposited　the　burden；　commending　it　to　the　care　of　number　twenty…seven；　and；　him；　whoever　he　might　be；　to　the　care　of　Heaven。

If　there　happened　to　be　among　my　audience　any　person　who　wished　to　know　on　what　principles　the　patient　should　choose　his　physician；　I　should　give　him　these　few　precepts　to　think　over：

Choose　a　man　who　is　personally　agreeable；　for　a　daily　visit　from　an　intelligent；　amiable；　pleasant；　sympathetic　person　will　cost　you　no　more　than　one　from　a　sloven　or　a　boor；　and　his　presence　will　do　more　for　you　than　any　prescription　the　other　will　order。

Let　him　be　a　man　of　recognized　good　sense　in　other　matters；　and　the　chance　is　that　he　will　be　sensible　as　a　practitioner。

Let　him　be　a　man　who　stands　well　with　his　professional　brethren；　whom　they　approve　as　honest；　able；　courteous。

Let　him　be　one　whose　patients　are　willing　to　die　in　his　hands；　not　one　whom　they　go　to　for　trifles；　and　leave　as　soon　as　they　are　in　danger；　and　who　can　say；　therefore；　that　he　never　loses　a　patient。

Do　not　leave　the　ranks　of　what　is　called　the　regular　profession；　unless　you　wish　to　go　farther　and　fare　worse；　for　you　may　be　assured　that　its　members　recognize　no　principle　which　hinders　their　accepting　any　remedial　agent　proved　to　be　useful；　no　matter　from　what　quarter　it　comes。　　The　difficulty　is　that　the　stragglers；　organized　under　fantastic　names　in　pretentious　associations；　or　lurking　in　solitary　dens　behind　doors　left　ajar；　make　no　real　contributions　to　the　art　of　healing。　　When　they　bring　forward　a　remedial　agent　like　chloral；　like　the　bromide　of　potassium；　like　ether；　used　as　an　anesthetic；　they　will　find　no　difficulty　in　procuring　its　recognition。

Some　of　you　will　probably　be　more　or　less　troubled　by　the　pretensions　of　that　parody　of　mediaeval　theology　which　finds　its　dogma　of　hereditary　depravity　in　the　doctrine　of　psora；　its　miracle　of　transubstantiation　in　the　mystery　of　its　triturations　and　dilutions；　its　church　in　the　people　who　have　mistaken　their　century；　and　its　priests　in　those　who　have　mistaken　their　calling。　　You　can　do　little　with　persons　who　are　disposed　to　accept　these　curious　medical　superstitions。　　The　saturation…point　of　individual　minds　with　reference　to　evidence；　and　especially　medical　evidence；　differs；　and　must　always　continue　to　differ；　very　widely。　　There　are　those　whose　minds　are　satisfied　with　the　decillionth　dilution　of　a　scientific　proof。　　No　wonder　they　believe　in　the　efficacy　of　a　similar　attenuation　of　bryony　or　pulsatilla。　　You　have　no　fulcrum　you　can　rest　upon　to　lift　an　error　out　of　such　minds　as　these；　often　highly　endowed　with　knowledge　and　talent；　sometimes　with　genius；　but　commonly　richer　in　the　imaginative　than　the　observing　and　reasoning　faculties。

Let　me　return　once　more　to　the　young　graduate。　　Your　relations　to　your　professional　brethren　may　be　a　source　of　lifelong　happiness　and　growth　in　knowledge　and　character；　or　they　may　make　you　wretched　and　end　by　leaving　you　isolated　from　those　who　should　be　your　friends　and　counsellors。　　The　life　of　a　physician　becomes　ignoble　when　he　suffers　himself　to　feed　on　petty　jealousies　and　sours　his　temper　in　perpetual　quarrels。　　You　will　be　liable　to　meet　an　uncomfortable　man　here　and　there　in　the　profession；one　who　is　so　fond　of　being　in　hot　water　that　it　is　a　wonder　all　the　albumen　in　his　body　is　not　coagulated。　There　are　common　barrators　among　doctors　as　there　are　among　lawyers；　stirrers　up　of　strife　under　one　pretext　and　another；　but　in　reality　because　they　like　it。　　They　are　their　own　worst　enemies；　and　do　themselves　a　mischief　each　time　they　assail　their　neighbors。　　In　my　student　days　I　remember　a　good　deal　of　this　Donnybrook…Fair　style　of　quarrelling；　more　especially　in　Paris；　where　some　of　the　noted　surgeons　were　always　at　loggerheads；　and　in　one　of　our　lively　Western　cities。　　Soon　after　I　had　set　up　an　office；　I　had　a　trifling　experience　which　may　serve　to　point　a　moral　in　this　direction。　　I　had　placed　a　lamp　behind　the　glass　in　the　entry　to　indicate　to　the　passer…by　where　relief　from　all　curable　infirmities　was　to　be　sought　and　found。　　Its　brilliancy　attracted　the　attention　of　a　devious　youth；　who　dashed　his　fist　through　the　glass　and　upset　my　modest　luminary。　　All　he　got　by　his　vivacious　assault　was　that　he　left　portions　of　integument　from　his　knuckles　upon　the　glass；　had　a　lame　hand；　was　very　easily　identified；　and　had　to　pay　the　glazier's　bill。　The　moral　is　that；　if　the　brilliancy　of　another's　reputation　excites　your　belligerent　instincts；　it　is　not　worth　your　while　to　strike　at　it；　without　calculating　which　of　you　is　likely　to　suffer　most；　if　you　do。

You　may　be　assured　that　when　an　ill…conditioned　neighbor　is　always　complaining　of　a　bad　taste　in　his　mouth　and　an　evil　atmosphere　about　him；　there　is　something　wrong　about　his　own　secretions。　　In　such　cases　there　is　an　alterative　regimen　of　remarkable　efficacy：　it　is　a　starvation…diet　of　letting　alone。　　The　great　majority　of　the　profession　are　peacefully　inclined。　　Their　pursuits　are　eminently　humanizing；　and　they　look　with　disgust　on　the　personalities　which　intrude　themselves　into　the　placid　domain　of　an　art　whose　province　it　is　to　heal　and　not　to　wound。

The　intercourse　of　teacher　and　student　in　a　large　school　is　necessarily　limited；　but　it　should　be；　and；　so　far　as　my　experience　goes；　it　is；　eminently　cordial　and　kindly。　　You　will　leave　with　regret；　and　hold　in　tender　remembrance；　those　who　have　taken　you　by　the　hand　at　your　entrance　on　your　chosen　path；　and　led　you　patiently　and　faithfully；　until　the　great　gates　at　its　end　have　swung　upon　their　hinges；　and　the　world　lies　open　before　you。　　That　venerable　oath　to　which　I　have　before　referred　bound　the　student　to　regard　his　instructor　in　the　light　of　a　parent；　to　treat　his　children　like　brothers；　to　succor　him　in　his　day　of　need。　　I　trust　the　spirit　of　the　oath　of　Hippocrates　is　not　dead　in　the　hearts　of　the　students　of　to…day。　　They　will　remember　with　gratitude　every　earnest　effort；　every　encouraging　word；　which　has　helped　them　in　their　difficult　and　laborious　career　of　study。　　The　names　they　read　on　their　diplomas　will　recall　faces　that　are　like　family…portraits　in　their　memory；　and　the　echo　of　voices　they　have　listened　to　so　long　will　linger　in　their　memories　far　into　the　still　evening　of　their　lives。

One　voice　will　be　heard　no　more　which　has　been　familiar　to　many　among　you。　　It　is　not　for　me；　a　stranger　to　these　scenes；　to　speak　his　eulogy。　　I　have　no　right　to　sadden　this　hour　by　dwelling　on　the　deep　regrets　of　friendship；　or　to　bid　the　bitter　tears　of　sorrow　flow　afresh。　　Yet　I　cannot　help　remembering　what　a　void　the　death　of　such　a　practitioner　as　your　late　instructor　must　leave　in　the　wide　circle　of　those　who　leaned　upon　his　counsel　and　assistance　in　their　hour　of　need；　in　a　community　where　he　was　so　widely　known　and　esteemed；　in　a　school　where　he　bore　so　important　a　part。　　There　is　no　exemption　from　the　common　doom　for　him