WhatshallIsayofthepersonalhabitsyoumustformifyouwishforsuccess?Temperanceisfirstuponthelist。Intemperanceinaphysicianpartakesoftheguiltofhomicide,forthemuddledbrainmayeasilymakeafatalblunderinaprescriptionandtheunsteadyhandtransfixanarteryinanoperation。Tipplingdoctorshavebeentoocommoninthehistoryofmedicine。Paracelsuswasasot,Radcliffewasmuchtoofondofhisglass,andDr。JamesHurlbutofWethersfield,Connecticut,afamousmaninhistime,usedtodrinkasquarebottleofrumaday,withacorrespondingallowanceofopiumtohelpsteadyhisnerves。Wecommonlyspeakofamanasbeingtheworseforliquor,butIwasaskinganIrishlaboreronedayabouthisdoctor,who,ashesaid,wassomewhatgiventodrink。“Ilikehimbestwhenhe’salittlethatway,“hesaid;“thenIcanspaketohim。“Ipitiedthepoorpatientwhocouldnotventuretoalludetohiscolicorhispleurisyuntilhisphysicianwastipsy。
TherearepersonalhabitsoflessgravitythantheoneIhavementionedwhichitiswelltoguardagainst,or,iftheyareformed,torelinquish。Amanwhomaybecalledatamoment’swarningintothefragrantboudoirofsufferinglovelinessshouldnotunsweetenitsatmospherewithreminiscencesofextinguishedmeerschaums。Heshouldrememberthatthesickaresensitiveandfastidious,thattheylovethesweetodorsandthepuretintsofflowers,andifhispresenceisnotlikethebreathoftherose,ifhishandsarenotliketheleafofthelily,hisvisitmaybeunwelcome,andifhelooksbehindhimhemayseeawindowthrownopenafterhehasleftthesick-chamber。
Iremembertoowelltheolddoctorwhosometimescametohelpmethroughthoseinwardgriefstowhichchildhoodisliable。“Faroffhiscoming“——shallIsay“shone,“andfinishtheMiltonicphrase,orleavetheverbtothehappyconjecturesofmyaudience?Beforehimcameasoul-subduingwhiffofipecacuanha,andafterhimlingeredashudderingconsciousnessofrhubarb。Hehadlivedsomuchamonghismedicamentsthathehadatlastbecomehimselfadrug,andtohavehimpassthroughasick-chamberwasastrongerdosethanaconscientiousdiscipleofHahnemannwouldthinkitsafetoadminister。
NeedIremindyonoftheimportanceofpunctualityinyourengagements,andoftheworryanddistresstopatientsandtheirfriendswhichthewantofitoccasions?Oneofmyoldteachersalwayscarriedtwowatches,tomakequitesureofbeingexact,andnotonlykepthisappointmentswiththeregularityofachronometer,buttookgreatpainstobeathispatient’shouseatthetimewhenhehadreasontobelievehewasexpected,evenifnoexpressappointmentwasmade。Itisagoodrule;ifyoucalltooearly,mylady’shairmaynotbesosmoothascouldbewished,and,ifyoukeepherwaitingtoolong,herhairmaybesmooth,buthertemperotherwise。
Youwillremember,ofcourse,alwaystogettheweather-gageofyourpatient。Imean,toplacehimsothatthelightfallsonhisfaceandnotonyours。Itisakindof,ocularduelthatisabouttotakeplacebetweenyou;youaregoingtolookthroughhisfeaturesintohispulmonaryandhepaticandotherinternalmachinery,andheisgoingtolookintoyoursquiteassharplytoseewhatyouthinkabouthisprobabilitiesfortimeoreternity。
Nomatterhowhardhestaresatyourcountenance,heshouldneverbeabletoreadhisfateinit。Itshouldbecheerfulaslongasthereishope,andsereneinitsgravitywhennothingisleftbutresignation。Thefaceofaphysician,likethatofadiplomatist,shouldbeimpenetrable。Natureisabenevolentoldhypocrite;shecheatsthesickandthedyingwithillusionsbetterthananyanodynes。Iftherearecogentreasonswhyapatientshouldbeundeceived,doitdeliberatelyandadvisedly,butdonotbetrayyourapprehensionsthroughyourtell-talefeatures。
Wehadaphysicianinourcitywhosesmilewascommonlyreckonedasbeingworthfivethousanddollarsayeartohim,inthedays,too,ofmoderateincomes。Youcannotputonsuchasmileasthatanymorethanyoucangetsunshinewithoutsun;therewasatranquilandkindlynatureunderitthatirradiatedthepleasantfaceitmadeonehappiertomeetonhisdailyrounds。Butyoucancultivatethedisposition,anditwillworkitswaythroughtothesurface,nay,more,——youcantrytowearaquietandencouraginglook,anditwillreactonyourdispositionandmakeyoulikewhatyouseemtobe,oratleastbringyounearertoitsownlikeness。
Yourpatienthasnomorerighttoallthetruthyouknowthanhehastoallthemedicineinyoursaddlebags,ifyoucarrythatkindofcartridge-boxfortheammunitionthatslaysdisease。Heshouldgetonlyjustsomuchasisgoodforhim。Ihaveseenaphysicianexaminingapatient’scheststopallatonce,ashebroughtoutaparticularsoundwithataponthecollarbone,intheattitudeofapointerwhohasjustcomeonthescentorsightofawoodcock。YouremembertheSpartanboy,who,withunmovedcountenance,hidthefoxthatwastearinghisvitalsbeneathhismantle。Whathecoulddoinhisownsufferingyoumustlearntodoforothersonwhosevitalorgansdiseasehasfasteneditsdevouringteeth。Itisaterriblethingtotakeawayhope,evenearthlyhope,fromafellow-creature。
Beverycarefulwhatnamesyouletfallbeforeyourpatient。HeknowswhatitmeanswhenyoutellhimhehastuberclesorBright’sdisease,and,ifhehearsthewordcarcinoma,hewillcertainlylookitoutinamedicaldictionary,ifhedoesnotinterpretitsdreadsignificanceontheinstant。Tellhimhehasasthmaticsymptoms,oratendencytothegoutydiathesis,andhewillatoncethinkofalltheasthmaticandgoutyoldpatriarchshehaseverheardof,andbecomforted。Youneednotbesocautiousinspeakingofthehealthofrichandremoterelatives,ifheisinthelineofsuccession。
Someshrewdolddoctorshaveafewphrasesalwaysonhandforpatientsthatwillinsistonknowingthepathologyoftheircomplaintswithouttheslightestcapacityofunderstandingthescientificexplanation。Ihaveknowntheterm“spinalirritation“
servewellonsuchoccasions,butIthinknothingonthewholehascoveredsomuchground,andmeantsolittle,andgivensuchprofoundsatisfactiontoallparties,asthemagnificentphrase“congestionoftheportalsystem。“
Oncemore,letmerecommendyou,asfaraspossible,tokeepyourdoubtstoyourself,andgivethepatientthebenefitofyourdecision。Firmness,gentlefirmness,isabsolutelynecessaryinthisandcertainotherrelations。Mr。RareywithCruiser,RichardwithLadyAnn,Pinelwithhiscrazypeople,showwhatsteadynervescandowiththemostintractableofanimals,themostirresistibleofdespots,andthemostunmanageableofinvalids。
Ifyoucannotacquireandkeeptheconfidenceofyourpatient,itistimeforyoutogiveplacetosomeotherpractitionerwhocan。Ifyouarewiseanddiligent,youcanestablishrelationswiththebestofthemwhichtheywillfinditveryhardtobreak。But,iftheywishtoemployanotherperson,who,astheythink,knowsmorethanyoudo,donottakeitasapersonalwrong。Apatientbelievesanothermancansavehislife,canrestorehimtohealth,which,ashethinks,youhavenottheskilltodo。Nomatterwhetherthepatientisrightorwrong,itisagreatimpertinencetothinkyouhaveanypropertyinhim。Yourestimateofyourownabilityisnotthequestion,itiswhatthepatientthinksofit。Allyourwisdomistohimlikethelady’svirtueinRaleigh’ssong:
“Ifsheseemnotchastetome,WhatcareIhowchasteshebe?“
WhatIcallagoodpatientisonewho,havingfoundagoodphysician,stickstohimtillhedies。ButtherearemanyverygoodpeoplewhoarenotwhatIcallgoodpatients。Iwasoncerequestedtocallonaladysufferingfromnervousandothersymptoms。Itcameoutinthepreliminaryconversationalskirmish,halfmedical,halfsocial,thatIwasthetwenty-sixthmemberofthefacultyintowhosearms,professionallyspeaking,shehadsuccessivelythrownherself。Notbeingabelieverinsucharapidrotationofscientificcrops,I
gentlydepositedtheburden,commendingittothecareofnumbertwenty-seven,and,him,whoeverhemightbe,tothecareofHeaven。
Iftherehappenedtobeamongmyaudienceanypersonwhowishedtoknowonwhatprinciplesthepatientshouldchoosehisphysician,I
shouldgivehimthesefewpreceptstothinkover:
Chooseamanwhoispersonallyagreeable,foradailyvisitfromanintelligent,amiable,pleasant,sympatheticpersonwillcostyounomorethanonefromaslovenoraboor,andhispresencewilldomoreforyouthananyprescriptiontheotherwillorder。
Lethimbeamanofrecognizedgoodsenseinothermatters,andthechanceisthathewillbesensibleasapractitioner。
Lethimbeamanwhostandswellwithhisprofessionalbrethren,whomtheyapproveashonest,able,courteous。
Lethimbeonewhosepatientsarewillingtodieinhishands,notonewhomtheygotofortrifles,andleaveassoonastheyareindanger,andwhocansay,therefore,thatheneverlosesapatient。
Donotleavetheranksofwhatiscalledtheregularprofession,unlessyouwishtogofartherandfareworse,foryoumaybeassuredthatitsmembersrecognizenoprinciplewhichhinderstheiracceptinganyremedialagentprovedtobeuseful,nomatterfromwhatquarteritcomes。Thedifficultyisthatthestragglers,organizedunderfantasticnamesinpretentiousassociations,orlurkinginsolitarydensbehinddoorsleftajar,makenorealcontributionstotheartofhealing。Whentheybringforwardaremedialagentlikechloral,likethebromideofpotassium,likeether,usedasananesthetic,theywillfindnodifficultyinprocuringitsrecognition。
Someofyouwillprobablybemoreorlesstroubledbythepretensionsofthatparodyofmediaevaltheologywhichfindsitsdogmaofhereditarydepravityinthedoctrineofpsora,itsmiracleoftransubstantiationinthemysteryofitstriturationsanddilutions,itschurchinthepeoplewhohavemistakentheircentury,anditspriestsinthosewhohavemistakentheircalling。Youcandolittlewithpersonswhoaredisposedtoacceptthesecuriousmedicalsuperstitions。Thesaturation-pointofindividualmindswithreferencetoevidence,andespeciallymedicalevidence,differs,andmustalwayscontinuetodiffer,verywidely。Therearethosewhosemindsaresatisfiedwiththedecillionthdilutionofascientificproof。Nowondertheybelieveintheefficacyofasimilarattenuationofbryonyorpulsatilla。Youhavenofulcrumyoucanrestupontoliftanerroroutofsuchmindsasthese,oftenhighlyendowedwithknowledgeandtalent,sometimeswithgenius,butcommonlyricherintheimaginativethantheobservingandreasoningfaculties。
Letmereturnoncemoretotheyounggraduate。Yourrelationstoyourprofessionalbrethrenmaybeasourceoflifelonghappinessandgrowthinknowledgeandcharacter,ortheymaymakeyouwretchedandendbyleavingyouisolatedfromthosewhoshouldbeyourfriendsandcounsellors。Thelifeofaphysicianbecomesignoblewhenhesuffershimselftofeedonpettyjealousiesandsourshistemperinperpetualquarrels。Youwillbeliabletomeetanuncomfortablemanhereandthereintheprofession,——onewhoissofondofbeinginhotwaterthatitisawonderallthealbumeninhisbodyisnotcoagulated。
Therearecommonbarratorsamongdoctorsasthereareamonglawyers,——stirrersupofstrifeunderonepretextandanother,butinrealitybecausetheylikeit。Theyaretheirownworstenemies,anddothemselvesamischiefeachtimetheyassailtheirneighbors。InmystudentdaysIrememberagooddealofthisDonnybrook-Fairstyleofquarrelling,moreespeciallyinParis,wheresomeofthenotedsurgeonswerealwaysatloggerheads,andinoneofourlivelyWesterncities。SoonafterIhadsetupanoffice,Ihadatriflingexperiencewhichmayservetopointamoralinthisdirection。Ihadplacedalampbehindtheglassintheentrytoindicatetothepasser-bywhererelieffromallcurableinfirmitieswastobesoughtandfound。Itsbrilliancyattractedtheattentionofadeviousyouth,whodashedhisfistthroughtheglassandupsetmymodestluminary。Allhegotbyhisvivaciousassaultwasthatheleftportionsofintegumentfromhisknucklesupontheglass,hadalamehand,wasveryeasilyidentified,andhadtopaytheglazier’sbill。
Themoralisthat,ifthebrilliancyofanother’sreputationexcitesyourbelligerentinstincts,itisnotworthyourwhiletostrikeatit,withoutcalculatingwhichofyouislikelytosuffermost,ifyoudo。
Youmaybeassuredthatwhenanill-conditionedneighborisalwayscomplainingofabadtasteinhismouthandanevilatmosphereabouthim,thereissomethingwrongabouthisownsecretions。Insuchcasesthereisanalterativeregimenofremarkableefficacy:itisastarvation-dietoflettingalone。Thegreatmajorityoftheprofessionarepeacefullyinclined。Theirpursuitsareeminentlyhumanizing,andtheylookwithdisgustonthepersonalitieswhichintrudethemselvesintotheplaciddomainofanartwhoseprovinceitistohealandnottowound。
Theintercourseofteacherandstudentinalargeschoolisnecessarilylimited,butitshouldbe,and,sofarasmyexperiencegoes,itis,eminentlycordialandkindly。Youwillleavewithregret,andholdintenderremembrance,thosewhohavetakenyoubythehandatyourentranceonyourchosenpath,andledyoupatientlyandfaithfully,untilthegreatgatesatitsendhaveswungupontheirhinges,andtheworldliesopenbeforeyou。ThatvenerableoathtowhichIhavebeforereferredboundthestudenttoregardhisinstructorinthelightofaparent,totreathischildrenlikebrothers,tosuccorhiminhisdayofneed。ItrustthespiritoftheoathofHippocratesisnotdeadintheheartsofthestudentsofto-day。Theywillrememberwithgratitudeeveryearnesteffort,everyencouragingword,whichhashelpedthemintheirdifficultandlaboriouscareerofstudy。Thenamestheyreadontheirdiplomaswillrecallfacesthatarelikefamily-portraitsintheirmemory,andtheechoofvoicestheyhavelistenedtosolongwilllingerintheirmemoriesfarintothestilleveningoftheirlives。
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