Chapter 32

But while many of the sciences have so changed that the teachers of the past would hardly know them, it has not been so with the branch I teach, or, rather, with that division of it which is chiefly taught in this amphitheatre. General anatomy, or histology, on the other hand, is almost all new; it has grown up, mainly, since I began my medical studies. I never saw a compound microscope during my years of study in Paris. Individuals had begun to use the instrument, but I never heard it alluded to by either Professors or students. In descriptive anatomy I have found little to unlearn, and not a great deal that was both new and important to learn. Trifling additions are made from year to year, not to be despised and not to be overvalued. Some of the older anatomical works are still admirable, some of the newer ones very much the contrary. I have had recent anatomical plates brought me for inspection, and I have actually button-holed the book-agent, a being commonly as hard to get rid of as the tar-baby in the negro legend, that I might put him to shame with the imperial illustrations of the bones and muscles in the great folio of Albinus, published in 1747, and the unapproached figures of the lymphatic system of Mascagni, now within a very few years of a century old, and still copied, or, rather, pretended to be copied, in the most recent works on anatomy.

I am afraid that it is a good plan to get rid of old Professors, and I am thankful to hear that there is a movement for making provision for those who are left in need when they lose their offices and their salaries. I remember one of our ancient Cambridge Doctors once asked me to get into his rickety chaise, and said to me, half humorously, half sadly, that he was like an old horse,--they had taken off his saddle and turned him out to pasture. I fear the grass was pretty short where that old servant of the public found himself grazing. If I myself needed an apology for holding my office so long, I should find it in the fact that human anatomy is much the same study that it was in the days of Vesalius and Fallopius, and that the greater part of my teaching was of such a nature that it could never become antiquated.

Let me begin with my first experience as a medical student. I had come from the lessons of Judge Story and Mr. Ashmun in the Law School at Cambridge. I had been busy, more or less, with the pages of Blackstone and Chitty, and other text-books of the first year of legal study. More or less, I say, but I am afraid it was less rather than more. For during that year I first tasted the intoxicating pleasure of authorship. A college periodical, conducted by friends of mine, still undergraduates, tempted me into print, and there is no form of lead-poisoning which more rapidly and thoroughly pervades the blood and bones and marrow than that which reaches the young author through mental contact with type-metal. Qui a bu, boira,--he who has once been a drinker will drink again, says the French proverb. So the man or woman who has tasted type is sure to return to his old indulgence sooner or later. In that fatal year I had my first attack of authors' lead-poisoning, and I have never got quite rid of it from that day to this. But for that I might have applied myself more diligently to my legal studies, and carried a green bag in place of a stethoscope and a thermometer up to the present day.

What determined me to give up Law and apply myself to Medicine I can hardly say, but I had from the first looked upon that year's study as an experiment. At any rate, I made the change, and soon found myself introduced to new scenes and new companionships.

I can scarcely credit my memory when I recall the first impressions produced upon me by sights afterwards become so familiar that they could no more disturb a pulse-beat than the commonest of every-day experiences. The skeleton, hung aloft like a gibbeted criminal, looked grimly at me as I entered the room devoted to the students of the school I had joined, just as the fleshless figure of Time, with the hour-glass and scythe, used to glare upon me in my childhood from the “New England Primer.” The white faces in the beds at the Hospital found their reflection in my own cheeks, which lost their color as I looked upon them. All this had to pass away in a little time; I had chosen my profession, and must meet its painful and repulsive aspects until they lost their power over my sensibilities.

The private medical school which I had joined was one established by Dr. James Jackson, Dr. Walter Channing, Dr. John Ware, Dr. Winslow Lewis, and Dr. George W. Otis. Of the first three gentlemen I have either spoken elsewhere or may find occasion to speak hereafter. The two younger members of this association of teachers were both graduates of our University, one of the year 1819, the other of 1818.

Dr. Lewis was a great favorite with students. He was a man of very lively temperament, fond of old books and young people, open-hearted, free-spoken, an enthusiast in teaching, and especially at home in that apartment of the temple of science where nature is seen in undress, the anthropotomic laboratory, known to common speech as the dissecting-room. He had that quality which is the special gift of the man born for a teacher,--the power of exciting an interest in that which he taught. While he was present the apartment I speak of was the sunniest of studios in spite of its mortuary spectacles. Of the students I met there I best remember James Jackson, Junior, full of zeal and playful as a boy, a young man whose early death was a calamity to the profession of which he promised to be a chief ornament; the late Reverend J. S. C. Greene, who, as the prefix to his name signifies, afterwards changed his profession, but one of whose dissections I remember looking upon with admiration; and my friend Mr. Charles Amory, as we call him, Dr. Charles Amory, as he is entitled to be called, then, as now and always, a favorite with all about him. He had come to us from the schools of Germany, and brought with him recollections of the teachings of Blumenbach and the elder Langenbeck, father of him whose portrait hangs in our Museum. Dr. Lewis was our companion as well as our teacher. A good demonstrator is,--I will not say as important as a good Professor in the teaching of Anatomy, because I am not sure that he is not more important. He comes into direct personal relations with the students,--he is one of them, in fact, as the Professor cannot be from the nature of his duties. The Professor's chair is an insulating stool, so to speak; his age, his knowledge, real or supposed, his official station, are like the glass legs which support the electrician's piece of furniture, and cut it off from the common currents of the floor upon which it stands. Dr. Lewis enjoyed teaching and made his students enjoy being taught. He delighted in those anatomical conundrums to answer which keeps the student's eyes open and his wits awake. He was happy as he dexterously performed the tour de maitre of the old barber-surgeons, or applied the spica bandage and taught his scholars to do it, so neatly and symmetrically that the aesthetic missionary from the older centre of civilization would bend over it in blissful contemplation, as if it were a sunflower. Dr. Lewis had many other tastes, and was a favorite, not only with students, but in a wide circle, professional, antiquarian, masonic, and social.

Dr. Otis was less widely known, but was a fluent and agreeable lecturer, and esteemed as a good surgeon.

I must content myself with this glimpse at myself and a few of my fellow-students in Boston. After attending two courses of Lectures in the school of the University, I went to Europe to continue my studies.

You may like to hear something of the famous Professors of Paris in the days when I was a student in the Ecole de Medicine, and following the great Hospital teachers.

I can hardly believe my own memory when I recall the old practitioners and Professors who were still going round the hospitals when I mingled with the train of students that attended the morning visits. See that bent old man who is groping his way through the wards of La Charity. That is the famous Baron Boyer, author of the great work on surgery in nine volumes, a writer whose clearness of style commends his treatise to general admiration, and makes it a kind of classic. He slashes away at a terrible rate, they say, when he gets hold of the subject of fistula in its most frequent habitat,--but I never saw him do more than look as if he wanted to cut a good dollop out of a patient he was examining. The short, square, substantial man with iron-gray hair, ruddy face, and white apron is Baron Larrey, Napoleon's favorite surgeon, the most honest man he ever saw,--it is reputed that he called him. To go round the Hotel des Invalides with Larrey was to live over the campaigns of Napoleon, to look on the sun of Austerlitz, to hear the cannons of Marengo, to struggle through the icy waters of the Beresina, to shiver in the snows of the Russian retreat, and to gaze through the battle smoke upon the last charge of the red lancers on the redder field of Waterloo. Larrey was still strong and sturdy as I saw him, and few portraits remain printed in livelier colors on the tablet of my memory.

Leave the little group of students which gathers about Larrey beneath the gilded dome of the Invalides and follow me to the Hotel Dieu, where rules and reigns the master-surgeon of his day, at least so far as Paris and France are concerned,--the illustrious Baron Dupuytren. No man disputed his reign, some envied his supremacy. Lisfranc shrugged his shoulders as he spoke of “ce grand homme de l'autre cote de la riviere,” that great man on the other side of the river, but the great man he remained, until he bowed before the mandate which none may disobey. “Three times,” said Bouillaud, “did the apoplectic thunderbolt fall on that robust brain,”--it yielded at last as the old bald cliff that is riven and crashes down into the valley. I saw him before the first thunderbolt had descended: a square, solid man, with a high and full-domed head, oracular in his utterances, indifferent to those around him, sometimes, it was said, very rough with them. He spoke in low, even tones, with quiet fluency, and was listened to with that hush of rapt attention which I have hardly seen in any circle of listeners unless when such men as ex-President John Quincy Adams or Daniel Webster were the speakers. I do not think that Dupuytren has left a record which explains his influence, but in point of fact he dominated those around him in a remarkable manner. You must have all witnessed something of the same kind. The personal presence of some men carries command with it, and their accents silence the crowd around them, when the same words from other lips might fall comparatively unheeded.

As for Lisfranc, I can say little more of him than that he was a great drawer of blood and hewer of members. I remember his ordering a wholesale bleeding of his patients, right and left, whatever might be the matter with them, one morning when a phlebotomizing fit was on him. I recollect his regretting the splendid guardsmen of the old Empire,--for what? because they had such magnificent thighs to amputate. I got along about as far as that with him, when I ceased to be a follower of M. Lisfranc.

The name of Velpeau must have reached many of you, for he died in 1867, and his many works made his name widely known. Coming to Paris in wooden shoes, starving, almost, at first, he raised himself to great eminence as a surgeon and as an author, and at last obtained the Professorship to which his talents and learning entitled him. His example may be an encouragement to some of my younger hearers who are born, not with the silver spoon in their mouths, but with the two-tined iron fork in their hands. It is a poor thing to take up their milk porridge with in their young days, but in after years it will often transfix the solid dumplings that roll out of the silver spoon. So Velpeau found it. He had not what is called genius, he was far from prepossessing in aspect, looking as if he might have wielded the sledge-hammer (as I think he had done in early life) rather than the lancet, but he had industry, determination, intelligence, character, and he made his way to distinction and prosperity, as some of you sitting on these benches and wondering anxiously what is to become of you in the struggle for life will have done before the twentieth century has got halfway through its first quarter. A good sound head over a pair of wooden shoes is a great deal better than a wooden head belonging to an owner who cases his feet in calf-skin, but a good brain is not enough without a stout heart to fill the four great conduits which carry at once fuel and fire to that mightiest of engines.

How many of you who are before me are familiarly acquainted with the name of Broussais, or even with that of Andral? Both were lecturing at the Ecole de Medicine, and I often heard them. Broussais was in those days like an old volcano, which has pretty nearly used up its fire and brimstone, but is still boiling and bubbling in its interior, and now and then sends up a spirt of lava and a volley of pebbles. His theories of gastro-enteritis, of irritation and inflammation as the cause of disease, and the practice which sprang from them, ran over the fields of medicine for a time like flame over the grass of the prairies. The way in which that knotty-featured, savage old man would bring out the word irritation--with rattling and rolling reduplication of the resonant letter r--might have taught a lesson in articulation to Salvini. But Broussais's theory was languishing and well-nigh become obsolete, and this, no doubt, added vehemence to his defence of his cherished dogmas.

Old theories, and old men who cling to them, must take themselves out of the way as the new generation with its fresh thoughts and altered habits of mind comes forward to take the place of that which is dying out. This was a truth which the fiery old theorist found it very hard to learn, and harder to bear, as it was forced upon him. For the hour of his lecture was succeeded by that of a younger and far more popular professor. As his lecture drew towards its close, the benches, thinly sprinkled with students, began to fill up; the doors creaked open and banged back oftener and oftener, until at last the sound grew almost continuous, and the voice of the lecturer became a leonine growl as he strove in vain to be heard over the noise of doors and footsteps.

Broussais was now sixty-two years old. The new generation had outgrown his doctrines, and the Professor for whose hour the benches had filled themselves belonged to that new generation. Gabriel Andral was little more than half the age of Broussais, in the full prime and vigor of manhood at thirty-seven years. He was a rapid, fluent, fervid, and imaginative speaker, pleasing in aspect and manner,--a strong contrast to the harsh, vituperative old man who had just preceded him. His Clinique Medicale is still valuable as a collection of cases, and his researches on the blood, conducted in association with Gavarret, contributed new and valuable facts to science. But I remember him chiefly as one of those instructors whose natural eloquence made it delightful to listen to him. I doubt if I or my fellow-students did full justice either to him or to the famous physician of Hotel Dieu, Chomel. We had addicted ourselves almost too closely to the words of another master, by whom we were ready to swear as against all teachers that ever were or ever would be.

This object of our reverence, I might almost say idolatry, was one whose name is well known to most of the young men before me, even to those who may know comparatively little of his works and teachings. Pierre Charles Alexandre Louis, at the age of forty-seven, as I recall him, was a tall, rather spare, dignified personage, of serene and grave aspect, but with a pleasant smile and kindly voice for the student with whom he came into personal relations. If I summed up the lessons of Louis in two expressions, they would be these; I do not hold him answerable for the words, but I will condense them after my own fashion in French, and then give them to you, expanded somewhat, in English:

Formez toujours des idees nettes. Fuyez toujours les a peu pres.

Always make sure that you form a distinct and clear idea of the matter you are considering.

Always avoid vague approximations where exact estimates are possible; about so many,--about so much, instead of the precise number and quantity.

Now, if there is anything on which the biological sciences have prided themselves in these latter years it is the substitution of quantitative for qualitative formulae. The “numerical system,” of which Louis was the great advocate, if not the absolute originator, was an attempt to substitute series of carefully recorded facts, rigidly counted and closely compared, for those never-ending records of vague, unverifiable conclusions with which the classics of the healing art were overloaded. The history of practical medicine had been like the story of the Danaides. “Experience” had been, from time immemorial, pouring its flowing treasures into buckets full of holes. At the existing rate of supply and leakage they would never be filled; nothing would ever be settled in medicine. But cases thoroughly recorded and mathematically analyzed would always be available for future use, and when accumulated in sufficient number would lead to results which would be trustworthy, and belong to science.

You young men who are following the hospitals hardly know how much you are indebted to Louis. I say nothing of his Researches on Phthisis or his great work on Typhoid Fever. But I consider his modest and brief Essay on Bleeding in some Inflammatory Diseases, based on cases carefully observed and numerically analyzed, one of the most important written contributions to practical medicine, to the treatment of internal disease, of this century, if not since the days of Sydenham. The lancet was the magician's wand of the dark ages of medicine. The old physicians not only believed in its general efficacy as a wonder-worker in disease, but they believed that each malady could be successfully attacked from some special part of the body,--the strategic point which commanded the seat of the morbid affection. On a figure given in the curious old work of John de Ketam, no less than thirty-eight separate places are marked as the proper ones to bleed from, in different diseases. Even Louis, who had not wholly given up venesection, used now and then to order that a patient suffering from headache should be bled in the foot, in preference to any other part.

But what Louis did was this: he showed by a strict analysis of numerous cases that bleeding did not strangle,--jugulate was the word then used,--acute diseases, more especially pneumonia. This was not a reform,--it was a revolution. It was followed up in this country by the remarkable Discourse of Dr. Jacob Bigelow upon Self-Limited Diseases, which has, I believe, done more than any other work or essay in our own language to rescue the practice of medicine from the slavery to the drugging system which was a part of the inheritance of the profession.

Yes, I say, as I look back on the long hours of the many days I spent in the wards and in the autopsy room of La Pitie, where Louis was one of the attending physicians,--yes, Louis did a great work for practical medicine. Modest in the presence of nature, fearless in the face of authority, unwearying in the pursuit of truth, he was a man whom any student might be happy and proud to claim as his teacher and his friend, and yet, as I look back on the days when I followed his teachings, I feel that I gave myself up too exclusively to his methods of thought and study.

There is one part of their business which certain medical practitioners are too apt to forget; namely, that what they should most of all try to do is to ward off disease, to alleviate suffering, to preserve life, or at least to prolong it if possible. It is not of the slightest interest to the patient to know whether three or three and a quarter cubic inches of his lung are hepatized. His mind is not occupied with thinking of the curious problems which are to be solved by his own autopsy,--whether this or that strand of the spinal marrow is the seat of this or that form of degeneration. He wants something to relieve his pain, to mitigate the anguish of dyspnea, to bring back motion and sensibility to the dead limb, to still the tortures of neuralgia. What is it to him that you can localize and name by some uncouth term the disease which you could not prevent and which you cannot cure? An old woman who knows how to make a poultice and how to put it on, and does it tuto, eito, jucunde, just when and where it is wanted, is better,--a thousand times better in many cases,--than a staring pathologist, who explores and thumps and doubts and guesses, and tells his patient he will be better tomorrow, and so goes home to tumble his books over and make out a diagnosis.

But in those days, I, like most of my fellow students, was thinking much more of “science” than of practical medicine, and I believe if we had not clung so closely to the skirts of Louis and had followed some of the courses of men like Trousseau,--therapeutists, who gave special attention to curative methods, and not chiefly to diagnosis,--it would have been better for me and others. One thing, at any rate, we did learn in the wards of Louis. We learned that a very large proportion of diseases get well of themselves, without any special medication,--the great fact formulated, enforced, and popularized by Dr. Jacob Bigelow in the Discourse referred to. We unlearned the habit of drugging for its own sake. This detestable practice, which I was almost proscribed for condemning somewhat too epigrammatically a little more than twenty years ago, came to us, I suspect, in a considerable measure from the English “general practitioners,” a sort of prescribing apothecaries. You remember how, when the city was besieged, each artisan who was called upon in council to suggest the best means of defence recommended the articles he dealt in: the carpenter, wood; the blacksmith, iron; the mason, brick; until it came to be a puzzle to know which to adopt. Then the shoemaker said, “Hang your walls with new boots,” and gave good reasons why these should be the best of all possible defences. Now the “general practitioner” charged, as I understand, for his medicine, and in that way got paid for his visit. Wherever this is the practice, medicine is sure to become a trade, and the people learn to expect drugging, and to consider it necessary, because drugs are so universally given to the patients of the man who gets his living by them.