medical essays-第52节
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he germ of innumerable beneficent future medical reforms。
I cannot help believing that medical curative treatment will by and by resolve itself in great measure into modifications of the food； swallowed and breathed； and of the natural stimuli； and that less will be expected from specifics and noxious disturbing agents； either alien or assimilable。 The noted mineral…waters containing iron； sulphur； carbonic acid； supply nutritious or stimulating materials to the body as much as phosphate of lime and ammoniacal compounds do to the cereal plants。 The effects of a milk and vegetable diet； of gluten bread in diabetes； of cod…liver oil in phthisis； even of such audacious innovations as the water…cure and the grape…cure； are only hints of what will be accomplished when we have learned to discover what organic elements are deficient or in excess in a case of chronic disease； and the best way of correcting the abnormal condition； just as an agriculturist ascertains the wants of his crops and modifies the composition of his soil。 In acute febrile diseases we have long ago discovered that far above all drug…medication is the use of mild liquid diet in the period of excitement； and of stimulant and nutritious food in that of exhaustion。 Hippocrates himself was as particular about his barley…ptisan as any Florence Nightingale of our time could be。
The generation to which you； who are just entering the profession； belong； will make a vast stride forward； as I believe； in the direction of treatment by natural rather than violent agencies。 What is it that makes the reputation of Sydenham； as the chief of English physicians？ His prescriptions consisted principally of simples。 An aperient or an opiate； a 〃cardiac〃 or a tonic； may be commonly found in the midst of a somewhat fantastic miscellany of garden herbs。 It was not by his pharmaceutic prescriptions that he gained his great name。 It was by daring to order fresh air for small…pox patients； and riding on horseback for consumptives； in place of the smothering system； and the noxious and often loathsome rubbish of the established schools。 Of course Sydenham was much abused by his contemporaries； as he frequently takes occasion to remind his reader。 〃I must needs conclude；〃 he says； 〃either that I am void of merit； or that the candid and ingenuous part of mankind； who are formed with so excellent a temper of mind as to be no strangers to gratitude； make a very small part of the whole。〃 If in the fearless pursuit of truth you should find the world as ungracious in the nineteenth century as he found it in the seventeenth； you may learn a lesson of self… reliance from another utterance of the same illustrious physician： 〃'T is none of my business to inquire what other persons think； but to establish my own observations； in order to which； I ask no favor of the reader but to peruse my writings with temper。〃
The physician has learned a great deal from the surgeon； who is naturally in advance of him； because he has a better opportunity of seeing the effects of his remedies。 Let me shorten one of Ambroise Pare's stories for you。 There had been a great victory at the pass of Susa； and they were riding into the city。 The wounded cried out as the horses trampled them under their hoofs； which caused good Ambroise great pity； and made him wish himself back in Paris。 Going into a stable he saw four dead soldiers； and three desperately wounded； placed with their backs against the wall。 An old campaigner came up。 〃Can these fellows get well？〃 he said。 〃No！〃 answered the surgeon。 Thereupon； the old soldier walked up to them and cut all their throats； sweetly； and without wrath （doulcement et sans cholere）。 Ambroise told him he was a bad man to do such a thing。 〃I hope to God；〃 he said； 〃somebody will do as much for me if I ever get into such a scrape〃 （accoustre de telle facon）。 〃I was not much salted in those days〃 （bien doux de sel）； says Ambroise； 〃and little acquainted with the treatment of wounds。〃 However； as he tells us； he proceeded to apply boiling oil of Sambuc （elder） after the approved fashion of the time；with what torture to the patient may be guessed。 At last his precious oil gave out； and he used instead an insignificant mixture of his own contrivance。 He could not sleep that night for fear his patients who had not been scalded with the boiling oil would be poisoned by the gunpowder conveyed into their wounds by the balls。 To his surprise； he found them much better than the others the next morning； and resolved never again to burn his patients with hot oil for gun…shot wounds。
This was the beginning； as nearly as we can fix it； of that reform which has introduced plain water…dressings in the place of the farrago of external applications which had been a source of profit to apothecaries and disgrace to art from； and before； the time when Pliny complained of them。 A young surgeon who was at Sudley Church； laboring among the wounded of Bull Run； tells me they had nothing but water for dressing； and he （being also doux de sel） was astonished to see how well the wounds did under that simple treatment。
Let me here mention a fact or two which may be of use to some of you who mean to enter the public service。 You will； as it seems； have gun…shot wounds almost exclusively to deal with。 Three different surgeons； the one just mentioned and two who saw the wounded of Big Bethel； assured me that they found no sabre…cuts or bayonet wounds。 It is the rifle…bullet from a safe distance which pierces the breasts of our soldiers； and not the gallant charge of broad platoons and sweeping squadrons； such as we have been in the habit of considering the chosen mode of warfare of ancient and modern chivalry。 ＇Sir Charles James Napier had the same experience in Virginia in 1813。 〃Potomac。 We have nasty sort of fighting here； amongst creeks and bushes； and lose men without show。〃 〃Yankee never shows himself； he keeps in the thickest wood； fires and runs off。〃 These five thousand in the open field might be attacked； but behind works it would be throwing away lives。〃 He calls it 〃an inglorious warfare；〃 says one of the leaders is 〃a little deficient in gumption；〃but still my opinion is； that if we tuck up our sleeves and lay our ears back we might thrash them； that is； if we caught them out of their trees； so as to slap at them with the bayonet。〃 Life； etc。 vol。 i。 p。 218 et seq。＇
Another fact parallels the story of the old campaigner； and may teach some of you caution in selecting your assistants。 A chaplain told it to two of our officers personally known to myself。 He overheard the examination of a man who wished to drive one of the 〃avalanche〃 wagons； as they call them。 The man was asked if he knew how to deal with wounded men。 〃Oh yes；〃 he answered； 〃if they're hit here；〃 pointing to the abdomen； 〃knock 'em on the head；they can't get well。〃
In art and outside of it you will meet the same barbarisms that Ambroise Pare met with；for men differ less from century to century than we are apt to suppose； you will encounter the same opposition； if you attack any prevailing opinion； that Sydenham complained of。 So far as possible； let not such experiences breed in you a contempt for those who are the subjects of folly or prejudice； or foster any love of dispute for its own sake。 Should you become authors； express your opinions freely； defend them rarely。 It is not often that an opinion is worth expressing； which cannot take care of itself。 Opposition is the best mordant to fix the color of your thought in the general belief。
It is time to bring these crowded remarks to a close。 The day has been when at the beginning of a course of Lectures I should have thought it fitting to exhort you to diligence and entire devotion to your tasks as students。 It is not so now。 The young man who has not heard the clarion…voices of honor and of duty now sounding throughout the land； will heed no word of mine。 In the camp or the city； in the field or the hospital； under sheltering roof； or half…protecting canvas； or open sky； shedding our own blood or stanching that of our wounded defenders； students or teachers； whatever our calling and our ability； we belong； not to ourselves； but to our imperilled country； whose danger is our calamity； whose ruin would be our enslavement； whose rescue shall be our earthly salvation！
SCHOLASTIC AND BEDSIDE TEACHING。
An Introductory Lecture delivered before the Medical Class of Harvard University； November 6； 1867。
The idea is entertained by some of our most sincere professional brethren； that to lengthen and multiply our Winter Lectures will be of necessity to advance the cause of medical education。 It is a fair subject for consideration whether they do not overrate the relative importance of that particular mode of instruction which forms the larger part of these courses。
As this School could only lengthen its lecture term at the expense of its 〃Summer Session；〃 in which more direct； personal； and familiar teaching takes the place of our academic discourses； and in which more time can be given to hospitals； infirmaries； and practical instruction in various important specialties； whatever might be gained； a good deal would certainly
