Chapter 9
You can divide mankind in the same way, I said. Two words, each of two letters, will serve to distinguish two classes of human beings who constitute the principal divisions of mankind. Can any of you tell what those two words are?
“Give me five letters,” cried Number Seven, “and I can solve your problem! F-o-o-l-s,--those five letters will give you the first and largest half. For the other fraction”--
Oh, but, said I, I restrict you absolutely to two letters. If you are going to take five, you may as well take twenty or a hundred.
After a few attempts, the company gave it up. The nearest approach to the correct answer was Number Five's guess of Oh and Ah: Oh signifying eternal striving after an ideal, which belongs to one kind of nature; and Ah the satisfaction of the other kind of nature, which rests at ease in what it has attained.
Good! I said to Number Five, but not the answer I am after. The great division between human beings is into the Ifs and the Ases.
“Is the last word to be spelt with one or two s's?” asked the young Doctor.
The company laughed feebly at this question. I answered it soberly. With one s. There are more foolish people among the Ifs than there are among the Ases.
The company looked puzzled, and asked for an explanation.
This is the meaning of those two words as I interpret them: If it were,--if it might be,--if it could be,--if it had been. One portion of mankind go through life always regretting, always whining, always imagining. These are the people whose backbones remain cartilaginous all their lives long, as do those of certain other vertebrate animals,--the sturgeons, for instance. A good many poets must be classed with this group of vertebrates.
As it is,--this is the way in which the other class of people look at the conditions in which they find themselves. They may be optimists or pessimists, they are very largely optimists,--but, taking things just as they find them, they adjust the facts to their wishes if they can; and if they cannot, then they adjust themselves to the facts. I venture to say that if one should count the Ifs and the Ases in the conversation of his acquaintances, he would find the more able and important persons among them--statesmen, generals, men of business--among the Ases, and the majority of the conspicuous failures among the Ifs. I don't know but this would be as good a test as that of Gideon,--lapping the water or taking it up in the hand. I have a poetical friend whose conversation is starred as thick with ifs as a boiled ham is with cloves. But another friend of mine, a business man, whom I trust in making my investments, would not let me meddle with a certain stock which I fancied, because, as he said, “there are too many ifs in it. As it looks now, I would n't touch it.”
I noticed, the other evening, that some private conversation was going on between the Counsellor and the two Annexes. There was a mischievous look about the little group, and I thought they were hatching some plot among them. I did not hear what the English Annex said, but the American girl's voice was sharper, and I overheard what sounded to me like, “It is time to stir up that young Doctor.” The Counsellor looked very knowing, and said that he would find a chance before long. I was rather amused to see how readily he entered into the project of the young people. The fact is, the Counsellor is young for his time of life; for he already betrays some signs of the change referred to in that once familiar street song, which my friend, the great American surgeon, inquired for at the music-shops under the title, as he got it from the Italian minstrel,
“Silva tredi mondi goo.”
I saw, soon after this, that the Counsellor was watching his chance to “stir up the young Doctor.”
It does not follow, because our young Doctor's bald spot is slower in coming than he could have wished, that he has not had time to form many sound conclusions in the calling to which he has devoted himself Vesalius, the father of modern descriptive anatomy, published his great work on that subject before he was thirty. Bichat, the great anatomist and physiologist, who died near the beginning of this century, published his treatise, which made a revolution in anatomy and pathology, at about the same age; dying soon after he had reached the age of thirty. So, possibly the Counsellor may find that he has “stirred up” a young man who, can take care of his own head, in case of aggressive movements in its direction.
“Well, Doctor,” the Counsellor began, “how are stocks in the measles market about these times? Any corner in bronchitis? Any syndicate in the vaccination business?” All this playfully.
“I can't say how it is with other people's patients; most of my families are doing very well without my help, at this time.”
“Do tell me, Doctor, how many families you own. I have heard it said that some of our fellow-citizens have two distinct families, but you speak as if you had a dozen.”
“I have, but not so large a number as I should like. I could take care of fifteen or twenty more without: having to work too hard.”
“Why, Doctor, you are as bad as a Mormon. What do you mean by calling certain families yours?”
“Don't you speak about my client? Don't your clients call you their lawyer? Does n't your baker, does n't your butcher, speak of the families he supplies as his families?”
“To be sure, yes, of course they do; but I had a notion that a man had as many doctors as he had organs to be doctored.”
“Well, there is some truth in that; but did you think the old-fashioned family doctor was extinct, a fossil like the megatherium?”
“Why, yes, after the recent experience of a friend of mine, I did begin to think that there would soon be no such personage left as that same old-fashioned family doctor. Shall I tell you what that experience was?”
The young Doctor said he should be mightily pleased to hear it. He was going to be one of those old-fogy practitioners himself.
“I don't know,” the Counsellor said, “whether my friend got all the professional terms of his story correctly, nor whether I have got them from him without making any mistakes; but if I do make blunders in some of the queer names, you can correct me. This is my friend's story:
“My family doctor,” he said, “was a very sensible man, educated at a school where they professed to teach all the specialties, but not confining himself to any one branch of medical practice. Surgical practice he did not profess to meddle with, and there were some classes of patients whom he was willing to leave to the female physician. But throughout the range of diseases not requiring exceptionally skilled manual interference, his education had authorized him to consider himself, and he did consider himself, qualified to undertake the treatment of all ordinary cases--It so happened that my young wife was one of those uneasy persons who are never long contented with their habitual comforts and blessings, but always trying to find something a little better, something newer, at any rate. I was getting to be near fifty years old, and it happened to me, as it not rarely does to people at about that time of life, that my hair began to fall out. I spoke of it to my doctor, who smiled, said it was a part of the process of reversed evolution, but might be retarded a little, and gave me a prescription. I did not find any great effect from it, and my wife would have me go to a noted dermatologist. The distinguished specialist examined my denuded scalp with great care. He looked at it through a strong magnifier. He examined the bulb of a fallen hair in a powerful microscope. He deliberated for a while, and then said, 'This is a case of alopecia. It may perhaps be partially remedied. I will give you a prescription.' Which he did, and told me to call again in a fortnight. At the end of three months I had called six times, and each time got a new recipe, and detected no difference in the course of my 'alopecia.' After I had got through my treatment, I showed my recipes to my family physician; and we found that three of them were the same he had used, familiar, old-fashioned remedies, and the others were taken from a list of new and little-tried prescriptions mentioned in one of the last medical journals, which was lying on the old doctor's table. I might as well have got no better under his charge, and should have got off much cheaper.
“The next trouble I had was a little redness of the eyes, for which my doctor gave me a wash; but my wife would have it that I must see an oculist. So I made four visits to an oculist, and at the last visit the redness was nearly gone,--as it ought to have been by that time. The specialist called my complaint conjunctivitis, but that did not make it feel any better nor get well any quicker. If I had had a cataract or any grave disease of the eye, requiring a nice operation on that delicate organ, of course I should have properly sought the aid of an expert, whose eye, hand, and judgment were trained to that special business; but in this case I don't doubt that my family doctor would have done just as well as the expert. However, I had to obey orders, and my wife would have it that I should entrust my precious person only to the most skilful specialist in each department of medical practice.
“In the course of the year I experienced a variety of slight indispositions. For these I was auriscoped by an aurist, laryngoscoped by a laryngologist, ausculted by a stethoscopist, and so on, until a complete inventory of my organs was made out, and I found that if I believed all these searching inquirers professed to have detected in my unfortunate person, I could repeat with too literal truth the words of the General Confession, 'And there is no health in us.' I never heard so many hard names in all my life. I proved to be the subject of a long catalogue of diseases, and what maladies I was not manifestly guilty of I was at least suspected of harboring. I was handed along all the way from alopecia, which used to be called baldness, to zoster, which used to be known as shingles. I was the patient of more than a dozen specialists. Very pleasant persons, many of them, but what a fuss they made about my trifling incommodities! 'Please look at that photograph. See if there is a minute elevation under one eye.'
“'On which side?' I asked him, for I could not be sure there was anything different on one side from what I saw on the other.
“'Under the left eye. I called it a pimple; the specialist called it acne. Now look at this photograph. It was taken after my acne had been three months under treatment. It shows a little more distinctly than in the first photograph, does n't it?'
“'I think it does,' I answered. 'It does n't seem to me that you gained a great deal by leaving your customary adviser for the specialist.'
“'Well,' my friend continued, 'following my wife's urgent counsel, I kept on, as I told you, for a whole year with my specialists, going from head to foot, and tapering off with a chiropodist. I got a deal of amusement out of their contrivances and experiments. Some of them lighted up my internal surfaces with electrical or other illuminating apparatus. Thermometers, dynamometers, exploring-tubes, little mirrors that went half-way down to my stomach, tuning-forks, ophthalmoscopes, percussion-hammers, single and double stethoscopes, speculums, sphygmometers,--such a battery of detective instruments I had never imagined. All useful, I don't doubt; but at the end of the year I began to question whether I should n't have done about as well to stick to my long tried practitioner. When the bills for 'professional services' came in, and the new carpet had to be given up, and the old bonnet trimmed over again, and the sealskin sack remained a vision, we both agreed, my wife and I, that we would try to get along without consulting specialists, except in such cases as our family physician considered to be beyond his skill.'”
The Counsellor's story of his friend's experiences seemed to please the young Doctor very much. It “stirred him up,” but in an agreeable way; for, as he said, he meant to devote himself to family practice, and not to adopt any limited class of cases as a specialty. I liked his views so well that I should have been ready to adopt them as my own, if they had been challenged.
The young Doctor discourses.
“I am very glad,” he said, “that we have a number of practitioners among us who confine themselves to the care of single organs and their functions. I want to be able to consult an oculist who has done nothing but attend to eyes long enough to know all that is known about their diseases and their treatment,--skilful enough to be trusted with the manipulation of that delicate and most precious organ. I want an aurist who knows all about the ear and what can be done for its disorders. The maladies of the larynx are very ticklish things to handle, and nobody should be trusted to go behind the epiglottis who has not the tactus eruditus. And so of certain other particular classes of complaints. A great city must have a limited number of experts, each a final authority, to be appealed to in cases where the family physician finds himself in doubt. There are operations which no surgeon should be willing to undertake unless he has paid a particular, if not an exclusive, attention to the cases demanding such operations. All this I willingly grant.
“But it must not be supposed that we can return to the methods of the old Egyptians--who, if my memory serves me correctly, had a special physician for every part of the body--without falling into certain errors and incurring certain liabilities.
“The specialist is much like other people engaged in lucrative business. He is apt to magnify his calling, to make much of any symptom which will bring a patient within range of his battery of remedies. I found a case in one of our medical journals, a couple of years ago, which illustrates what I mean. Dr. __________ of Philadelphia, had a female patient with a crooked nose,--deviated septum, if our young scholars like that better. She was suffering from what the doctor called reflex headache. She had been to an oculist, who found that the trouble was in her eyes. She went from him to a gynecologist, who considered her headache as owing to causes for which his specialty had the remedies. How many more specialists would have appropriated her, if she had gone the rounds of them all, I dare not guess; but you remember the old story of the siege, in which each artisan proposed means of defence which he himself was ready to furnish. Then a shoemaker said, 'Hang your walls with new boots.'
“Human nature is the same with medical specialists as it was with ancient cordwainers, and it is too possible that a hungry practitioner may be warped by his interest in fastening on a patient who, as he persuades himself, comes under his medical jurisdiction. The specialist has but one fang with which to seize and bold his prey, but that fang is a fearfully long and sharp canine. Being confined to a narrow field of observation and practice, he is apt to give much of his time to curious study, which may be magnifique, but is not exactly la guerre against the patient's malady. He divides and subdivides, and gets many varieties of diseases, in most respects similar. These he equips with new names, and thus we have those terrific nomenclatures which are enough to frighten the medical student, to say nothing of the sufferers staggering under this long catalogue of local infirmities. The 'old-fogy' doctor, who knows the family tendencies of his patient, who 'understands his constitution,' will often treat him better than the famous specialist, who sees him for the first time, and has to guess at many things 'the old doctor' knows from his previous experience with the same patient and the family to which he belongs.
“It is a great luxury to practise as a specialist in almost any class of diseases. The special practitioner has his own hours, hardly needs a night-bell, can have his residence out of the town in which he exercises his calling, in short, lives like a gentleman; while the hard-worked general practitioner submits to a servitude more exacting than that of the man who is employed in his stable or in his kitchen. That is the kind of life I have made up my mind to.”
The teaspoons tinkled all round the table. This was the usual sign of approbation, instead of the clapping of hands.
The young Doctor paused, and looked round among The Teacups. “I beg your pardon,” he said, “for taking up so much of your time with medicine. It is a subject that a good many persons, especially ladies, take an interest in and have a curiosity about, but I have no right to turn this tea-table into a lecture platform.”
“We should like to hear you talk longer about it,” said the English Annex. “One of us has thought of devoting herself to the practice of medicine. Would you lecture to us; if you were a professor in one of the great medical schools?”
“Lecture to students of your sex? Why not, I should like to know? I don't think it is the calling for which the average woman is especially adapted, but my teacher got a part of his medical education from a lady, Madame Lachapelle; and I don't see why, if one can learn from a woman, he may not teach a woman, if he knows enough.”
“We all like a little medical talk now and then,” said Number Five, “and we are much obliged to you for your discourse. You are specialist enough to take care of a sprained ankle, I suppose, are you not?”
“I hope I should be equal to that emergency,” answered the young Doctor; “but I trust you are not suffering from any such accident?”
“No,” said Number Five, “but there is no telling what may happen. I might slip, and get a sprain or break a sinew, or something, and I should like to know that there is a practitioner at hand to take care of my injury. I think I would risk myself in your bands, although you are not a specialist. Would you venture to take charge of the case?”
“Ah, my dear lady,” he answered gallantly, “the risk would be in the other direction. I am afraid it would be safer for your doctor if he were an older man than I am.”
This is the first clearly, indisputably sentimental outbreak which has happened in conversation at our table. I tremble to think what will come of it; for we have several inflammable elements in our circle, and a spark like this is liable to light on any one or two of them.
I was not sorry that this medical episode came in to vary the usual course of talk at our table. I like to have one--of an intelligent company, who knows anything thoroughly, hold the floor for a time, and discourse upon the subject which chiefly engages his daily thoughts and furnishes his habitual occupation. It is a privilege to meet such a person now and then, and let him have his full swing. But because there are “professionals” to whom we are willing to listen as oracles, I do not want to see everybody who is not a “professional” silenced or snubbed, if he ventures into any field of knowledge which he has not made especially his own. I like to read Montaigne's remarks about doctors, though he never took a medical degree. I can even enjoy the truth in the sharp satire of Voltaire on the medical profession. I frequently prefer the remarks I hear from the pew after the sermon to those I have just been hearing from the pulpit. There are a great many things which I never expect to comprehend, but which I desire very much to apprehend. Suppose that our circle of Teacups were made up of specialists,--experts in various departments. I should be very willing that each one should have his innings at the proper time, when the company were ready for him. But the time is coming when everybody will know something about every thing. How can one have the illustrated magazines, the “Popular Science Monthly,” the Psychological journals, the theological periodicals, books on all subjects, forced on his attention, in their own persons, so to speak, or in the reviews which analyze and pass judgment upon them, without getting some ideas which belong to many provinces of human intelligence? The air we breathe is made up of four elements, at least: oxygen, nitrogen, carbonic acid gas, and knowledge. There is something quite delightful to witness in the absorption and devotion of a genuine specialist. There is a certain sublimity in that picture of the dying scholar in Browning's “A Grammarian's Funeral:”--
“So with the throttling hands of death at strife, Ground he at grammar; Still, through the rattle, parts of speech were rife; While he could stammer He settled Hoti's business--let it be-- Properly based Oun Gave us the doctrine of the enclitic De, Dead from the waist down.”
A genuine enthusiasm, which will never be satisfied until it has pumped the well dry at the bottom of which truth is lying, always excites our interest, if not our admiration.
One of the pleasantest of our American writers, whom we all remember as Ik Marvel, and greet in his more recent appearance as Donald Grant Mitchell, speaks of the awkwardness which he feels in offering to the public a “panoramic view of British writers in these days of specialists,--when students devote half a lifetime to the analysis of the works of a single author, and to the proper study of a single period.”
He need not have feared that his connected sketches of “English Lands, Letters and Kings” would be any less welcome because they do not pretend to fill up all the details or cover all the incidents they hint in vivid outline. How many of us ever read or ever will read Drayton's “Poly-Olbion?” Twenty thousand long Alexandrines are filled with admirable descriptions of scenery, natural productions, and historical events, but how many of us in these days have time to read and inwardly digest twenty thousand Alexandrine verses? I fear that the specialist is apt to hold his intelligent reader or hearer too cheap. So far as I have observed in medical specialties, what he knows in addition to the knowledge of the well-taught general practitioner is very largely curious rather than important. Having exhausted all that is practical, the specialist is naturally tempted to amuse himself with the natural history of the organ or function he deals with; to feel as a writing-master does when he sets a copy,--not content to shape the letters properly, but he must add flourishes and fancy figures, to let off his spare energy.
I am beginning to be frightened. When I began these papers, my idea was a very simple and innocent one. Here was a mixed company, of various conditions, as I have already told my readers, who came together regularly, and before they were aware of it formed something like a club or association. As I was the patriarch among them, they gave me the name some of you may need to be reminded of; for as these reports are published at intervals, you may not remember the fact that I am what The Teacups have seen fit to call The Dictator.
Now, what did I expect when I began these papers, and what is it that has begun to frighten me?
I expected to report grave conversations and light colloquial passages of arms among the members of the circle. I expected to hear, perhaps to read, a paper now and then. I expected to have, from time to time, a poem from some one of The Teacups, for I felt sure there must be among them one or more poets,--Teacups of the finer and rarer translucent kind of porcelain, to speak metaphorically.
Out of these conversations and written contributions I thought I might make up a readable series of papers; a not wholly unwelcome string of recollections, anticipations, suggestions, too often perhaps repetitions, that would be to the twilight what my earlier series had been to the morning.