The Complete PG Works of Oliver Wendell Holmes, Sr.

O >> Oliver Wendell Holmes, Sr. (The Physician and Poet not the Jurist) >> The Complete PG Works of Oliver Wendell Holmes, Sr.


I am not disposed to deny the occasional injurious effect of the
materializing influences to which the physician is subjected. A spiritual
guild is absolutely necessary to keep him, to keep us all, from becoming
the "fingering slaves" that Wordsworth treats with such shrivelling
scorn. But it is well that the two callings have been separated, and it
is fitting that they remain apart. In settling the affairs of the late
concern, I am afraid our good friends remain a little in our debt. We
lent them our physician Michael Servetus in fair condition, and they
returned him so damaged by fire as to be quite useless for our purposes.
Their Reverend Samuel Willard wrote us a not over-wise report of a case
of hysteria; and our Jean Astruc gave them (if we may trust Dr. Smith's
Dictionary of the Bible) the first discerning criticism on the authorship
of the Pentateuch. Our John Locke enlightened them with his letters
concerning toleration; and their Cotton Mather obscured our twilight with
his "Nishmath Chajim."

Yet we must remember that the name of Basil Valentine, the monk, is
associated with whatever good and harm we can ascribe to antimony; and
that the most remarkable of our specifics long bore the name of "Jesuit's
Bark," from an old legend connected with its introduction. "Frere
Jacques," who taught the lithotomists of Paris, owes his ecclesiastical
title to courtesy, as he did not belong to a religious order.

Medical science, and especially the study of mental disease, is destined,
I believe, to react to much greater advantage on the theology of the
future than theology has acted on medicine in the past. The liberal
spirit very generally prevailing in both professions, and the good
understanding between their most enlightened members, promise well for
the future of both in a community which holds every point of human
belief, every institution in human hands, and every word written in a
human dialect, open to free discussion today, to-morrow, and to the end
of time. Whether the world at large will ever be cured of trusting to
specifics as a substitute for observing the laws of health, and to
mechanical or intellectual formula as a substitute for character, may
admit of question. Quackery and idolatry are all but immortal.

We can find most of the old beliefs alive amongst us to-day, only having
changed their dresses and the social spheres in which they thrive. We
think the quarrels of Galenists and chemists belong to the past,
forgetting that Thomsonism has its numerous apostles in our community;
that it is common to see remedies vaunted as purely vegetable, and that
the prejudice against "mineral poisons," especially mercury, is as strong
in many quarters now as it was at the beginning of the seventeenth
century. Names are only air, and blow away with a change of wind; but
beliefs are rooted in human wants and weakness, and die hard. The oaks
of Dodona are prostrate, and the shrine of Delphi is desolate; but the
Pythoness and the Sibyl may be consulted in Lowell Street for a very
moderate compensation. Nostradamus and Lilly seem impossible in our time;
but we have seen the advertisements of an astrologer in our Boston papers
year after year, which seems to imply that he found believers and
patrons. You smiled when I related Sir Kenelm Digby's prescription with
the live eel in it; but if each of you were to empty his or her pockets,
would there not roll out, from more than one of them, a horse-chestnut,
carried about as a cure for rheumatism? The brazen head of Roger Bacon
is mute; but is not "Planchette" uttering her responses in a hundred
houses of this city? We think of palmistry or chiromancy as belonging to
the days of Albertus Magnus, or, if existing in our time, as given over
to the gypsies; but a very distinguished person has recently shown me the
line of life, and the line of fortune, on the palm of his hand, with a
seeming confidence in the sanguine predictions of his career which had
been drawn from them. What shall we say of the plausible and
well-dressed charlatans of our own time, who trade in false pretences,
like Nicholas Knapp of old, but without any fear of being fined or
whipped; or of the many follies and inanities, imposing on the credulous
part of the community, each of them gaping with eager, open mouth for a
gratuitous advertisement by the mention of its foolish name in any
respectable connection?

I turn from this less pleasing aspect of the common intelligence which
renders such follies possible, to close the honorable record of the
medical profession in this, our ancient Commonwealth.

We have seen it in the first century divided among clergymen,
magistrates, and regular practitioners; yet, on the whole, for the time,
and under the circumstances, respectable, except where it invoked
supernatural agencies to account for natural phenomena.

In the second century it simplified its practice, educated many
intelligent practitioners, and began the work of organizing for concerted
action, and for medical teaching.

In this, our own century, it has built hospitals, perfected and
multiplied its associations and educational institutions, enlarged and
created museums, and challenged a place in the world of science by its
literature.

In reviewing the whole course of its history we read a long list of
honored names, and a precious record written in private memories, in
public charities, in permanent contributions to medical science, in
generous sacrifices for the country. We can point to our capital as the
port of entry for the New World of the great medical discoveries of two
successive centuries, and we can claim for it the triumph over the most
dreaded foe that assails the human body,--a triumph which the annals of
the race can hardly match in three thousand years of medical history.




THE YOUNG PRACTITIONER

[A Valedictory Address delivered to the Graduating Class of the Bellevue
Hospital College, March 2, 1871.]

The occasion which calls us together reminds us not a little of that
other ceremony which unites a man and woman for life. The banns have
already been pronounced which have wedded our young friends to the
profession of their choice. It remains only to address to them some
friendly words of cheering counsel, and to bestow upon them the parting
benediction.

This is not the time for rhetorical display or ambitious eloquence. We
must forget ourselves, and think only of them. To us it is an occasion;
to them it is an epoch. The spectators at the wedding look curiously at
the bride and bridegroom; at the bridal veil, the orange-flower garland,
the giving and receiving of the ring; they listen for the tremulous "I
will," and wonder what are the mysterious syllables the clergyman
whispers in the ear of the married maiden. But to the newly-wedded pair
what meaning in those words, "for better, for worse," "in sickness and in
health," "till death us do part!" To the father, to the mother, who know
too well how often the deadly nightshade is interwoven with the wreath of
orange-blossoms, how empty the pageant, how momentous the reality!

You will not wonder that I address myself chiefly to those who are just
leaving academic life for the sterner struggle and the larger tasks of
matured and instructed manhood. The hour belongs to them; if others find
patience to listen, they will kindly remember that, after all, they are
but as the spectators at the wedding, and that the priest is thinking
less of them than of their friends who are kneeling at the altar.

I speak more directly to you, then, gentlemen of the graduating class.
The days of your education, as pupils of trained instructors, are over.
Your first harvest is all garnered. Henceforth you are to be sowers as
well as reapers, and your field is the world. How does your knowledge
stand to-day? What have you gained as a permanent possession? What must
you expect to forget? What remains for you yet to learn? These are
questions which it may interest you to consider.

There is another question which must force itself on the thoughts of many
among you: "How am I to obtain patients and to keep their confidence?"
You have chosen a laborious calling, and made many sacrifices to fit
yourselves for its successful pursuit. You wish to be employed that you
may be useful, and that you may receive the reward of your industry. I
would take advantage of these most receptive moments to give you some
hints which may help you to realize your hopes and expectations. Such is
the outline of the familiar talk I shall offer you.

Your acquaintance with some of the accessory branches is probably greater
now than it will be in a year from now,--much greater than it will by ten
years from now. The progress of knowledge, it may be feared, or hoped,
will have outrun the text-books in which you studied these branches.
Chemistry, for instance, is very apt to spoil on one's hands. "Nous
avons change tout cela" might serve as the standing motto of many of our
manuals. Science is a great traveller, and wears her shoes out pretty
fast, as might be expected.

You are now fresh from the lecture-room and the laboratory. You can pass
an examination in anatomy, physiology, chemistry, materia medica, which
the men in large practice all around you would find a more potent
sudorific than any in the Pharmacopceia. These masters of the art of
healing were once as ready with their answers as you are now, but they
have got rid of a great deal of the less immediately practical part of
their acquisitions, and you must undergo the same depleting process.
Hard work will train it off, as sharp exercise trains off the fat of a
prize-fighter.

Yet, pause a moment before you infer that your teachers must have been in
fault when they furnished you with mental stores not directly convertible
to practical purposes, and likely in a few years to lose their place in
your memory. All systematic knowledge involves much that is not
practical, yet it is the only kind of knowledge which satisfies the mind,
and systematic study proves, in the long-run, the easiest way of
acquiring and retaining facts which are practical. There are many things
which we can afford to forget, which yet it was well to learn. Your
mental condition is not the same as if you had never known what you now
try in vain to recall. There is a perpetual metempsychosis of thought,
and the knowledge of to-day finds a soil in the forgotten facts of
yesterday. You cannot see anything in the new season of the guano you
placed last year about the roots of your climbing plants, but it is
blushing and breathing fragrance in your trellised roses; it has scaled
your porch in the bee-haunted honey-suckle; it has found its way where
the ivy is green; it is gone where the woodbine expands its luxuriant
foliage.

Your diploma seems very broad to-day with your list of accomplishments,
but it begins to shrink from this hour like the Peau de Chagrin of
Balzac's story. Do not worry about it, for all the while there will be
making out for you an ampler and fairer parchment, signed by old Father
Time himself as President of that great University in which experience is
the one perpetual and all-sufficient professor.

Your present plethora of acquirements will soon cure itself. Knowledge
that is not wanted dies out like the eyes of the fishes of the Mammoth
Cave. When you come to handle life and death as your daily business,
your memory will of itself bid good-by to such inmates as the well-known
foramina of the sphenoid bone and the familiar oxides of
methyl-ethylamyl-phenyl-ammonium. Be thankful that you have once known
them, and remember that even the learned ignorance of a nomenclature is
something to have mastered, and may furnish pegs to hang facts upon which
would otherwise have strewed the floor of memory in loose disorder.

But your education has, after all, been very largely practical. You have
studied medicine and surgery, not chiefly in books, but at the bedside
and in the operating amphitheatre. It is the special advantage of large
cities that they afford the opportunity of seeing a great deal of disease
in a short space of time, and of seeing many cases of the same kind of
disease brought together. Let us not be unjust to the claims of the
schools remote from the larger centres of population. Who among us has
taught better than Nathan Smith, better than Elisha Bartlett? who teaches
better than some of our living contemporaries who divide their time
between city and country schools? I am afraid we do not always do
justice to our country brethren, whose merits are less conspicuously
exhibited than those of the great city physicians and surgeons, such
especially as have charge of large hospitals. There are modest
practitioners living in remote rural districts who are gifted by nature
with such sagacity and wisdom, trained so well in what is most essential
to the practice of their art, taught so thoroughly by varied experience,
forced to such manly self-reliance by their comparative isolation, that,
from converse with them alone, from riding with them on their long rounds
as they pass from village to village, from talking over cases with them,
putting up their prescriptions, watching their expedients, listening to
their cautions, marking the event of their predictions, hearing them tell
of their mistakes, and now and then glory a little in the detection of
another's blunder, a young man would find himself better fitted for his
real work than many who have followed long courses of lectures and passed
a showy examination. But the young man is exceptionally fortunate who
enjoys the intimacy of such a teacher. And it must be confessed that the
great hospitals, infirmaries, and dispensaries of large cities, where men
of well-sifted reputations are in constant attendance, are the true
centres of medical education. No students, I believe, are more
thoroughly aware of this than those who have graduated at this
institution. Here, as in all our larger city schools, the greatest pains
are taken to teach things as well as names. You have entered into the
inheritance of a vast amount of transmitted skill and wisdom, which you
have taken, warm, as it were, with the life of your well-schooled
instructors. You have not learned all that art has to teach you, but you
are safer practitioners to-day than were many of those whose names we
hardly mention without a genuflection. I had rather be cared for in a
fever by the best-taught among you than by the renowned Fernelius or the
illustrious Boerhaave, could they come back to us from that better world
where there are no physicians needed, and, if the old adage can be
trusted, not many within call. I had rather have one of you exercise his
surgical skill upon me than find myself in the hands of a resuscitated
Fabricius Hildanus, or even of a wise Ambroise Pare, revisiting earth in
the light of the nineteenth century.

You will not accuse me of underrating your accomplishments. You know
what to do for a child in a fit, for an alderman in an apoplexy, for a
girl that has fainted, for a woman in hysterics, for a leg that is
broken, for an arm that is out of joint, for fevers of every color, for
the sailor's rheumatism, and the tailor's cachexy. In fact you do really
know so much at this very hour, that nothing but the searching test of
time can fully teach you the limitations of your knowledge.

Of some of these you will permit me to remind you. You will never have
outgrown the possibility of new acquisitions, for Nature is endless in
her variety. But even the knowledge which you may be said to possess
will be a different thing after long habit has made it a part of your
existence. The tactus eruditus extends to the mind as well as to the
finger-ends. Experience means the knowledge gained by habitual trial,
and an expert is one who has been in the habit of trying. This is the
kind of knowledge that made Ulysses wise in the ways of men. Many cities
had he seen, and known the minds of those who dwelt in them. This
knowledge it was that Chaucer's Shipman brought home with him from the
sea--

"In many a tempest had his berd be shake."

This is the knowledge we place most confidence in, in the practical
affairs of life.

Our training has two stages. The first stage deals with our
intelligence, which takes the idea of what is to be done with the most
charming ease and readiness. Let it be a game of billiards, for
instance, which the marker is going to teach us. We have nothing to do
but to make this ball glance from that ball and hit that other ball, and
to knock that ball with this ball into a certain caecal sacculus or
diverticulum which our professional friend calls a pocket. Nothing can
be clearer; it is as easy as "playing upon this pipe," for which Hamlet
gives Guildenstern such lucid directions. But this intelligent Me, who
steps forward as the senior partner in our dual personality, turns out to
be a terrible bungler. He misses those glancing hits which the
hard-featured young professional person calls "carroms," and insists on
pocketing his own ball instead of the other one.

It is the unintelligent Me, stupid as an idiot, that has to try a thing a
thousand times before he can do it, and then never knows how he does it,
that at last does it well. We have to educate ourselves through the
pretentious claims of intellect, into the humble accuracy of instinct,
and we end at last by acquiring the dexterity, the perfection, the
certainty, which those masters of arts, the bee and the spider, inherit
from Nature.

Book-knowledge, lecture-knowledge, examination-knowledge, are all in the
brain. But work-knowledge is not only in the brain, it is in the senses,
in the muscles, in the ganglia of the sympathetic nerves,--all over the
man, as one may say, as instinct seems diffused through every part of
those lower animals that have no such distinct organ as a brain. See a
skilful surgeon handle a broken limb; see a wise old physician smile away
a case that looks to a novice as if the sexton would soon be sent for;
mark what a large experience has done for those who were fitted to profit
by it, and you will feel convinced that, much as you know, something is
still left for you to learn.

May I venture to contrast youth and experience in medical practice,
something in the way the man painted the lion, that is, the lion under?

The young man knows the rules, but the old man knows-the exceptions. The
young man knows his patient, but the old man knows also his patient's
family, dead and alive, up and down for generations. He can tell
beforehand what diseases their unborn children will be subject to, what
they will die of if they live long enough, and whether they had better
live at all, or remain unrealized possibilities, as belonging to a stock
not worth being perpetuated. The young man feels uneasy if he is not
continually doing something to stir up his patient's internal
arrangements. The old man takes things more quietly, and is much more
willing to let well enough alone: All these superiorities, if such they
are,'you must wait for time to bring you. In the meanwhile (if we will
let the lion be uppermost for a moment), the young man's senses are
quicker than those of his older rival. His education in all the
accessory branches is more recent, and therefore nearer the existing
condition of knowledge. He finds it easier than his seniors to accept
the improvements which every year is bringing forward. New ideas build
their nests in young men's brains. "Revolutions are not made by men in
spectacles," as I once heard it remarked, and the first whispers of a new
truth are not caught by those who begin to feel the need of an
ear-trumpet. Granting all these advantages to the young man, he ought,
nevertheless, to go on improving, on the whole, as a medical
practitioner, with every year, until he has ripened into a well-mellowed
maturity. But, to improve, he must be good for something at the start.
If you ship a poor cask of wine to India and back, if you keep it a half
a century, it only grows thinner and sharper.

You are soon to enter into relations with the public, to expend your
skill and knowledge for its benefit, and find your support in the rewards
of your labor. What kind of a constituency is this which is to look to
you as its authorized champions in the struggle of life against its
numerous enemies?

In the first place, the persons who seek the aid of the physician are
very honest and sincere in their wish to get rid of their complaints,
and, generally speaking, to live as long as they can. However
attractively the future is painted to them, they are attached to the
planet with which they are already acquainted. They are addicted to the
daily use of this empirical and unchemical mixture which we call air; and
would hold on to it as a tippler does to his alcoholic drinks. There is
nothing men will not do, there is nothing they have not done, to recover
their health and save their lives. They have submitted to be
half-drowned in water, and half-choked with gases, to be buried up to
their chins in earth, to be seared with hot irons like galley-slaves, to
be crimped with knives, like cod-fish, to have needles thrust into their
flesh, and bonfires kindled on their skin, to swallow all sorts of
abominations, and to pay for all this, as if to be singed and scalded
were a costly privilege, as if blisters were a blessing, and leeches were
a luxury. What more can be asked to prove their honesty and sincerity?

This same community is very intelligent with respect to a great many
subjects-commerce, mechanics, manufactures, politics. But with regard to
medicine it is hopelessly ignorant and never finds it out. I do not know
that it is any worse in this country than in Great Britain, where Mr.
Huxley speaks very freely of "the utter ignorance of the simplest laws of
their own animal life, which prevails among even the most highly educated
persons." And Cullen said before him "Neither the acutest genius nor the
soundest judgment will avail in judging of a particular science, in
regard to which they have not been exercised. I have been obliged to
please my patients sometimes with reasons, and I have found that any will
pass, even with able divines and acute lawyers; the same will pass with
the husbands as with the wives." If the community could only be made
aware of its own utter ignorance, and incompetence to form opinions on
medical subjects, difficult enough to those who give their lives to the
study of them, the practitioner would have an easier task. But it will
form opinions of its own, it cannot help it, and we cannot blame it, even
though we know how slight and deceptive are their foundations.

This is the way it happens: Every grown-up person has either been ill
himself or had a friend suffer from illness, from which he has recovered.
Every sick person has done something or other by somebody's advice, or of
his own accord, a little before getting better. There is an irresistible
tendency to associate the thing done, and the improvement which followed
it, as cause and effect. This is the great source of fallacy in medical
practice. But the physician has some chance of correcting his hasty
inference. He thinks his prescription cured a single case of a
particular complaint; he tries it in twenty similar cases without effect,
and sets down the first as probably nothing more than a coincidence. The
unprofessional experimenter or observer has no large experience to
correct his hasty generalization. He wants to believe that the means he
employed effected his cure. He feels grateful to the person who advised
it, he loves to praise the pill or potion which helped him, and he has a
kind of monumental pride in himself as a living testimony to its
efficacy. So it is that you will find the community in which you live,
be it in town or country, full of brands plucked from the burning, as
they believe, by some agency which, with your better training, you feel
reasonably confident had nothing to do with it. Their disease went out
of itself, and the stream from the medical fire-annihilator had never
even touched it.

You cannot and need not expect to disturb the public in the possession of
its medical superstitions. A man's ignorance is as much his private
property, and as precious in his own eyes, as his family Bible. You have
only to open your own Bible at the ninth chapter of St. John's Gospel,
and you will find that the logic of a restored patient was very simple
then, as it is now, and very hard to deal with. My clerical friends will
forgive me for poaching on their sacred territory, in return for an
occasional raid upon the medical domain of which they have now and then
been accused.

A blind man was said to have been restored to sight by a young person
whom the learned doctors of the Jewish law considered a sinner, and, as
such, very unlikely to have been endowed with a divine gift of healing.
They visited the patient repeatedly, and evidently teased him with their
questions about the treatment, and their insinuations about the young
man, until he lost his temper. At last he turned sharply upon them:
"Whether he be a sinner or no, I know not: one thing I know, that,
whereas I was blind, now I see."