medical essays-第50部分

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sort；　did　not　turn　out　better　working　physicians　than　our　more　elaborate　method。　　The　best　practitioner　I　ever　knew　was　mainly　shaped　to　excellence　in　that　way。　　I　can　understand　perfectly　the　regrets　of　my　friend　Dr。　John　Brown　of　Edinburgh；　for　the　good　that　was　lost　with　the　old　apprenticeship　system。　　I　understand　as　well　Dr。　Latham's　fear　〃that　many　men　of　the　best　abilities　and　good　education　will　be　deterred　from　prosecuting　physic　as　a　profession；　in　consequence　of　the　necessity　indiscriminately　laid　upon　all　for　impossible　attainments。〃

I　feel　therefore　impelled　to　say　a　very　few　words　in　defence　of　that　system　of　teaching　adopted　in　our　Colleges；　by　which　we　wish　to　supplement　and　complete　the　instruction　given　by　private　individuals　or　by　what　are　often　called　Summer　Schools。

The　reason　why　we　teach　so　much　that　is　not　practical　and　in　itself　useful；　is　because　we　find　that　the　easiest　way　of　teaching　what　is　practical　and　useful。　　If　we　could　in　any　way　eliminate　all　that　would　help　a　man　to　deal　successfully　with　disease；　and　teach　it　by　itself　so　that　it　should　be　as　tenaciously　rooted　in　the　memory；　as　easily　summoned　when　wanted；　as　fertile　in　suggestion　of　related　facts；　as　satisfactory　to　the　peremptory　demands　of　the　intelligence　as　if　taught　in　its　scientific　connections；　I　think　it　would　be　our　duty　so　to　teach　the　momentous　truths　of　medicine；　and　to　regard　all　useless　additions　as　an　intrusion　on　the　time　which　should　be　otherwise　occupied。

But　we　cannot　successfully　eliminate　and　teach　by　itself　that　which　is　purely　practical。　　The　easiest　and　surest　why　of　acquiring　facts　is　to　learn　them　in　groups；　in　systems；　and　systematized　knowledge　is　science。　　You　can　very　often　carry　two　facts　fastened　together　more　easily　than　one　by　itself；　as　a　housemaid　can　carry　two　pails　of　water　with　a　hoop　more　easily　than　one　without　it。　　You　can　remember　a　man's　face；　made　up　of　many　features；　better　than　you　can　his　nose　or　his　mouth　or　his　eye…brow。　　Scores　of　proverbs　show　you　that　you　can　remember　two　lines　that　rhyme　better　than　one　without　the　jingle。　The　ancients；　who　knew　the　laws　of　memory；　grouped　the　seven　cities　that　contended　for　the　honor　of　being　Homer's　birthplace　in　a　line　thus　given　by　Aulus　Gellius　：

Smurna；　Rodos；　Colophon；　Salamin；　Ios；　Argos；　Athenai。

I　remember；　in　the　earlier　political　days　of　Martin　Van　Buren；　that　Colonel　Stone；　of　the　〃New　York　Commercial；〃　or　one　of　his　correspondents；　said　that　six　towns　of　New　York　would　claim　in　the　same　way　to　have　been　the　birth…place　of　the　〃Little　Magician；〃　as　he　was　then　called；　and　thus　he　gave　their　names；　any　one　of　which　I　should　long　ago　have　forgotten；　but　which　as　a　group　have　stuck　tight　in　my　memory　from　that　day　to　this；

Catskill；　Saugerties；　Redhook；　Kinderhook；　Scaghticoke；　Schodac。

If　the　memory　gains　so　much　by　mere　rhythmical　association；　how　much　more　will　it　gain　when　isolated　facts　are　brought　together　under　laws　and　principles；　when　organs　are　examined　in　their　natural　connections；　when　structure　is　coupled　with　function；　and　healthy　and　diseased　action　are　studied　as　they　pass　one　into　the　other！　Systematic；　or　scientific　study　is　invaluable　as　supplying　a　natural　kind　of　mnemonics；　if　for　nothing　else。　　You　cannot　properly　learn　the　facts　you　want　from　Anatomy　and　Chemistry　in　any　way　so　easily　as　by　taking　them　in　their　regular　order；　with　other　allied　facts；　only　there　must　be　common　sense　exercised　in　leaving　out　a　great　deal　which　belongs　to　each　of　the　two　branches　as　pure　science。　　The　dullest　of　teachers　is　the　one　who　does　not　know　what　to　omit。

The　larger　aim　of　scientific　training　is　to　furnish　you　with　principles　to　which　you　will　be　able　to　refer　isolated　facts；　and　so　bring　these　within　the　range　of　recorded　experience。　　See　what　the　〃London　Times〃　said　about　the　three　Germans　who　cracked　open　John　Bull　Chatwood's　strong…box　at　the　Fair　the　other　day；　while　the　three　Englishmen　hammered　away　in　vain　at　Brother　Jonathan　Herring's。　　The　Englishmen　represented　brute　force。　　The　Germans　had　been　trained　to　appreciate　principle。　　The　Englishman　〃knows　his　business　by　rote　and　rule　of　thumb〃science；　which　would　〃teach　him　to　do　in　an　hour　what　has　hitherto　occupied　him　two　hours；〃　〃is　in　a　manner　forbidden　to　him。〃　　To　this　cause　the　〃Times〃　attributes　the　falling　off　of　English　workmen　in　comparison　with　those　of　the　Continent。

Granting　all　this；　we　must　not　expect　too　much　from　〃science〃　as　distinguished　from　common　experience。　　There　are　ten　thousand　experimenters　without　special　apparatus　for　every　one　in　the　laboratory。　　Accident　is　the　great　chemist　and　toxicologist。　　Battle　is　the　great　vivisector。　　Hunger　has　instituted　researches　on　food　such　as　no　Liebig；　no　Academic　Commission　has　ever　recorded。

Medicine；　sometimes　impertinently；　often　ignorantly；　often　carelessly　called　〃allopathy；〃　appropriates　everything　from　every　source　that　can　be　of　the　slightest　use　to　anybody　who　is　ailing　in　any　way；　or　like　to　be　ailing　from　any　cause。　　It　learned　from　a　monk　how　to　use　antimony；　from　a　Jesuit　how　to　cure　agues；　from　a　friar　how　to　cut　for　stone；　from　a　soldier　how　to　treat　gout；　from　a　sailor　how　to　keep　off　scurvy；　from　a　postmaster　how　to　sound　the　Eustachian　tube；　from　a　dairy…maid　how　to　prevent　small…pox；　and　from　an　old　market…　woman　how　to　catch　the　itch…insect。　　It　borrowed　acupuncture　and　the　moxa　from　the　Japanese　heathen；　and　was　taught　the　use　of　lobelia　by　the　American　savage。　　It　stands　ready　to…day　to　accept　anything　from　any　theorist；　from　any　empiric　who　can　make　out　a　good　case　for　his　discovery　or　his　remedy。　　〃Science〃　is　one　of　its　benefactors；　but　only　one；　out　of　many。　　Ask　the　wisest　practising　physician　you　know；　what　branches　of　science　help　him　habitually；　and　what　amount　of　knowledge　relating　to　each　branch　he　requires　for　his　professional　duties。　　He　will　tell　you　that　scientific　training　has　a　value　independent　of　all　the　special　knowledge　acquired。　　He　will　tell　you　that　many　facts　are　explained　by　studying　them　in　the　wider　range　of　related　facts　to　which　they　belong。　　He　will　gratefully　recognize　that　the　anatomist　has　furnished　him　with　indispensable　data；　that　the　physiologist　has　sometimes　put　him　on　the　track　of　new　modes　of　treatment；　that　the　chemist　has　isolated　the　active　principles　of　his　medicines；　has　taught　him　how　to　combine　them；　has　from　time　to　time　offered　him　new　remedial　agencies；　and　so　of　others　of　his　allies。　But　he　will　also　tell　you；　if　I　am　not　mistaken；　that　his　own　branch　of　knowledge　is　so　extensive　and　so　perplexing　that　he　must　accept　most　of　his　facts　ready　made　at　their　hands。　　He　will　own　to　you　that　in　the　struggle　for　life　which　goes　on　day　and　night　in　our　thoughts　as　in　the　outside　world　of　nature；　much　that　he　learned　under　the　name　of　science　has　died　out；　and　that　simple　homely　experience　has　largely　taken　the　place　of　that　scholastic　knowledge　to　which　he　and　perhaps　some　of　his　instructors　once　attached　a　paremount　importance。

This；　then；　is　my　view　of　scientific　training　as　conducted　in　courses　such　as　you　are　entering　on。　　Up　to　a　certain　point　I　believe　in　set　Lectures　as　excellent　adjuncts　to　what　is　far　more　important；　practical　instruction　at　the　bedside；　in　the　operating　room；　and　under　the　eye　of　the　Demonstrator。　　But　I　am　so　far　from　wishing　these　courses　extended；　that　I　think　some　of　themsuppose　I　say　my　ownwould　almost　bear　curtailing。　　Do　you　want　me　to　describe　more　branches　of　the　sciatic　and　crural　nerves？　　I　can　take　Fischer's　plates；　and　lecturing　on　that　scale　fill　up　my　whole　course　and　not　finish　the　nerves　alone。　　We　must　stop　somewhere；　and　for　my　own　part　I　think　the　scholastic　exercises　of　our　colleges　have　already　claimed　their　full　share　of　the　student's　time　without　our　seeking　to　extend　them。

I　trust　I　have　vindicated　the　apparent　inconsequence　of　teaching　young　students　a　good　deal　that　seems　at　first　sight　profitless；　but　which　helps　them　to　learn　and　retain　what　is　profitable。　　But　this　is　an　inquisitive　age；　and　if　we　insist　on　piling　up　beyond　a　certain　height　knowledge　which　is　in　itself　mere　trash　and　lumber　to　a　man　whose　life　is　to　be　one　long　fight　with　death　and　disease；　there　will　be　some　sharp　questions　asked　by　and　by；　and　our　quick…witted　people　will　perhaps　find　they　can　get　along　as　well　without　the　professor's　cap　as　without　the　bishop's　mitre　and　the　monarch's　crown。

I　myself　have　nothing　to　do　with　clinical　teaching。　　Yet　I　do　not　hesitate　to　say　it　is　more　essential　than　all　the　rest　put　together；　so　far　as　the　ordinary　practice　of　medicine　is　concerned；　and　this　is　by　far　the　most　important　thing　to　be　learned；　because　it　deals　with　so　many　more　lives　than　any　other　branch　of　the　profession。　　So　of　personal　instruction；　such　as　we　give　and　others　give　in　the　interval　of　lectures；　much　of　it　at　the　bedside；　some　of　it　in　the　laboratory；　some　in　the　microscope…room；　some　in　the　recitation…room；　I　think　it　has　many　advantages　of　its　own　over　the　winter　course；　and　I　do　not　wish　to　see　it　shortened　for　the　sake　of　prolonging　what　seems　to　me　long　enough　already。

If　I　am　jealous　of　the　tendency　to　expand　the　time　given　to　the　acquisition　of　curious　knowledge；　at　the　expense　of　the　plain　old…　fashioned　bedside　teachings；　I　only　share　the　feeling　which　Sydenham　expressed　two　hundred　years　ago；　using　an　image　I　have　already　borrowed。　　〃He　would　be　no　honest　and　successful　pilot　who　was　to　apply　himself　with　less　industry　to　avoid　rocks　and　sands　and　bring　his　vessel　safely　home；　than　to　search　into　the　causes　of　the　ebbing　and　flowing　of　the　sea；　which；　though　very　well　for　a　philosopher；　is　foreign　to　him　whose　business　it　is　to　secure　the　ship。　　So　neither　will　a　physician；　whose　province　it　is　to　cure　diseases；　be　able　to　do　so；　though　he　be　a　person　of　great　genius；　who　bestows　less　time　on　the　hidden　and　intricate　method　of　nature；　and　adapting　his　means　thereto；　than　on　curious　and　subtle　speculation。〃

〃Medicine　is　my　wife　and　Science　is　my　mistress；〃　said　Dr。　Rush。　　I　do　not　think　that　the　breach　of　the　seventh　commandment　can　be　shown　to　have　been　of　advantage　to　the　legitimate　owner　of　his　affections。　Read　what　Dr。　Elisha　Bartlett　says　of　him　as　a　practitioner；