Part 18 (1/2)
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 pract.i.tioner 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 cla.s.sified 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 Lycopersic.u.m 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 a.r.s.enic, 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 pract.i.tioner. But the over ambitious and active student must not be led away by the seduction of knowledge for its own sake from his princ.i.p.al pursuit. The humble beginner, who is alarmed at the vast fields of knowledge opened to him, may be encouraged by the a.s.surance 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 cla.s.s requires, rather than as a scientific cla.s.s 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 Ma.s.sachusetts 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 Inst.i.tutions 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 f.a.goted 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 pract.i.tioner, 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 which my first predecessor in the branch I teach ”did read very well”
we can know nothing. The body of some poor wretch who had swung upon the gallows, was probably conveyed by night to some lonely dwelling at the outskirts of the village, and there by the light of flaring torches hastily dissected by hands that trembled over the unwonted task.
And ever and anon the master turned to his book, as he laid bare the mysteries of the hidden organs; to his precious Vesalius, it might be, or his figures repeated in the multifarious volume of Ambroise Pare; to the Aldine octavo in which Fallopius recorded his fresh observations; or that giant folio of Spigelius just issued from the press of Amsterdam, in which lovely ladies display their viscera with a coquettish grace implying that it is rather a pleasure than otherwise to show the lace-like omentum, and hold up their appendices epiploicae as if they were saying ”these are our jewels.”
His teaching of medicine was no doubt chiefly clinical, and received with the same kind of faith as that which accepted his words from the pulpit. His notions of disease were based on what he had observed, seen always in the light of the traditional doctrines in which he was bred.
His discourse savored of the weighty doctrines of Hippocrates, diluted by the subtle speculations of Galen, reinforced by the curious comments of the Arabian schoolmen as they were conveyed in the mellifluous language of Fernelius, blended, it may be, with something of the lofty mysticism of Van Helmont, and perhaps stealing a flavor of that earlier form of h.o.m.oeopathy which had lately come to light in Sir Kenelm Digby's ”Discourse concerning the Cure of Wounds by the Sympathetic Powder.”
His Pathology was mythology. A malformed foetus, as the readers of Winthrop's Journal may remember, was enough to scare the colonists from their propriety, and suggest the gravest fears of portended disaster.
The student of the seventeenth century opened his Licetus and saw figures of a lion with the head of a woman, and a man with the head of an elephant. He had offered to his gaze, as born of a human mother, the effigy of a winged cherub, a pterocephalous specimen, which our Professor of Pathological Anatomy would hardly know whether to treat with the reverence due to its celestial aspect, or to imprison in one of his immortalizing jars of alcohol.
His pharmacopoeia consisted mainly of simples, such as the venerable ”Herball” of Gerard describes and figures in abounding affluence. St.
John's wort and Clown's All-heal, with Spurge and Fennel, Saffron and Parsley, Elder and Snake-root, with opium in some form, and roasted rhubarb and the Four Great Cold Seeds, and the two Resins, of which it used to be said that whatever the Tacamahaca has not cured, the Caranna will, with the more familiar Scammony and Jalap and Black h.e.l.lebore, made up a good part of his probable list of remedies. He would have ordered Iron now and then, and possibly an occasional dose of Antimony.
He would perhaps have had a rheumatic patient wrapped in the skin of a wolf or a wild cat, and in case of a malignant fever with ”purples” or petechiae, or of an obstinate king's evil, he might have prescribed a certain black powder, which had been made by calcining toads in an earthen pot; a choice remedy, taken internally, or applied to any outward grief.
Except for the toad-powder and the peremptory drastics, one might have borne up against this herb doctoring as well as against some more modern styles of medication. Barbeyrac and his scholar Sydenham had not yet cleansed the Pharmacopoeia of its perilous stuff, but there is no doubt that the more sensible physicians of that day knew well enough that a good honest herb-tea which amused the patient and his nurses was all that was required to carry him through all common disorders.
The student soon learned the physiognomy of disease by going about with his master; fevers, pleurisies, asthmas, dropsies, fluxes, small-pox, sore-throats, measles, consumptions. He saw what was done for them. He put up the medicines, gathered the herbs, and so learned something of materia medico and botany. He learned these few things easily and well, for he could give his whole attention to them. Chirurgery was a separate specialty. Women in child-birth were cared for by midwives. There was no chemistry deserving the name to require his study. He did not learn a great deal, perhaps, but what he did learn was his business, namely, how to take care of sick people.
Let me give you a picture of the old=fas.h.i.+oned way of instruction, by carrying you with me in imagination in the company of worthy Master Giles Firmin as he makes his round of visits among the good folk of Ipswich, followed by his one student, who shall answer to the scriptural name of Luke. It will not be for entertainment chiefly, but to ill.u.s.trate the one mode of teaching which can never be superseded, and which, I venture to say, is more important than all the rest put together. The student is a green hand, as you will perceive.
In the first dwelling they come to, a stout fellow is bellowing with colic.
”He will die, Master, of a surety, methinks,” says the timid youth in a whisper.