Medicine - Books and Men
( Originally Published 1905 )
THOSE of us from other cities who bring congratulations this evening can hardly escape the tinglings of envy when we see this noble treasure house; but in my own case the bitter waters of jealousy which rise in my soul are at once diverted by two strong sensations. In the first place I have a feeling of lively gratitude towards this library. In 1876 as a youngster interested in certain clinical subjects to which I could find no reference in our library at McGill, I came to Boston, and I here found what I wanted, and I found moreover a cordial welcome and many friends. It was a small matter I had in hand but I wished to make it as complete as possible, and I have always felt that this library helped me to a good start. It has been such a pleasure in recurring visits to the library to find Dr Brigham in charge, with the same kindly interest in visitors that he showed a quarter of a century ago. But the feeling which absorbs all others is one of deep satisfaction that our friend, Dr. Chadwick, has at last seen fulfilled the desire of his eyes. To few is given the tenacity of will which enables a man to pursue a cherished purpose through a quarter of a century—" Ohne Hast, aber ohne Rast" ('tis his favourite quotation); to fewer still is the fruition granted. Too often the reaper is not the sower. Too often the fate of those who labour at some object for the public good is to see their work pass into other hands, and to have others get the credit for enterprises which they have initiated and made possible. It has not been so with our friend, and it intensifies a thousandfold the pleasure of this occasion to feel the fitness, in every way, of the felicitations which have been offered to him.
It is hard for me to speak of the value of libraries in terms which would not seem exaggerated. Books have been my delight these thirty years, and from them I have received incalculable benefits. To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all. Only a maker of books can appreciate the labours of others at their true value. Those of us who have brought forth fat volumes should offer hecatombs at these shrines of Minerva Medica. What exsuccous, attenuated offspring they would have been but for the pabulum furnished through the placental circulation of a library. How often can it be said of us with truth, "Das beste was er ist verdankt er Andern!"
For the teacher and the worker a great library such as this is indispensable. They must know the world's best work and know it at once. They mint and make current coin the ore so widely scattered in journals, transactions and monographs. The splendid collections which now exist in five or six of our cities and the unique opportunities of the Surgeon-General's Library have done much to give to American medicine a thoroughly eclectic character.
But when one considers the unending making of books, who does not sigh for the happy days of that thrice happy Sir William Browne' whose pocket library sufficed for his life's needs, drawing from a Greek testament his divinity, from the aphorisms of Hippocrates his medicine, and from an Elzevir Horace his good sense and vivacity. There should be in connection with every library a corps of instructors in the art of reading, who would, as a labour of love, teach the young idea how to read. An old writer says that there are four sorts of readers: "Sponges which attract all without distinguishing; Howre-glasses which receive and powre out as fast; Bagges which only retain the dregges of the spices and let the wine escape, and Sives which retaine the best onely." A man wastes a great many years before he reaches the "sive" stage.
For the general practitioner a well-used library is one of the few correctives of the premature senility which is so apt to overtake him. Self-centred, self-taught, he leads a solitary life, and unless his every-day experience is con-trolled by careful reading or by the attrition of a medical society it soon ceases to be of the slightest value and becomes a mere accretion of isolated facts, without correlation. It is astonishing with how little reading a doctor can practise medicine, but it is not astonishing how badly he may do it. Not three months ago a physician living within an hour's ride of the Surgeon-General's Library brought to me his little girl, aged twelve. The diagnosis of infantile myxoedema required only a half glance. In placid contentment he had been practising twenty years in "Sleepy Hollow" and not even when his own flesh and blood was touched did he rouse from an apathy deep as Rip Van Winkle's sleep. In reply to questions: No, he had never seen anything in the journals about the thyroid gland; he had seen no pictures of cretinism or myxoedema; in fact his mind was a blank on the whole subject. He had not been a reader, he said, but he was a practical man with very little time. I could not help thinking of John Bunyan's remarks on the elements of success in the practice of medicine. "Physicians," he says, "get neither name nor fame by the pricking of wheals or the picking out thistles, or by laying of plaisters to the scratch of a pin; every old woman can do this. But if they would have a name and a fame, if they will have it quickly, they must do some great and desperate cures. Let them fetch one to life that was dead, let them recover one to his wits that was mad, let them make one that was born blind to see, or let them give ripe wits to a fool—these are notable cures, and he that can do thus, if he doth thus first, he shall have the name and fame he deserves; he may lie abed till noon." Had my doctor friend been a reader he might have done a great and notable cure and even have given ripe wits to a fool! It is in utilizing the fresh knowledge of the journals that the young physician may attain quickly to the name and fame he desires.
There is a third class of men in the profession to whom books are dearer than to teachers or practitioners—a small, a silent band, but in reality the leaven of the whole lump. The profane call them bibliomaniacs, and in truth they are at times irresponsible and do not always know the difference between meum and tuum. In the presence of Dr. Billings or of Dr. Chadwick I dare not further characterize them. Loving books partly for their contents, partly for the sake of the authors, they not alone keep alive the sentiment of historical continuity in the profession, but they are the men who make possible such gatherings as the one we are enjoying this evening. We need more men of their class, particularly in this country, where every one carries in his pocket the tape-measure of utility. Along two lines their work is valuable. By the historical method alone can many problems in medicine be approached profitably. For example, the student who dates his knowledge of tuberculosis from Koch may have a very correct, but he has a very incomplete, appreciation of the subject. Within a quarter of a century our libraries will have certain alcoves devoted to the historical consideration of the great diseases, which will give to the student that mental perspective which is so valuable an equipment in life. The past is a good nurse, as Lowell remarks, particularly for the weanlings of the fold.
'Tis man's worst deed
But in a more excellent way these laudatores temporis acti render a royal service. For each one of us today, as in Plato's time, there is a higher as well as a lower education. The very marrow and fatness of books may not suffice to save a man from becoming a poor, mean-spirited devil, without a spark of fine professional feeling, and without a thought above the sordid issues of the day. The men I speak of keep alive in us an interest in the great men of the past and not alone in their works, which they cherish, but in their lives, which they emulate. They would remind us continually that in the records of no other profession is there to be found so large a number of men who have combined intellectual pre-eminence with nobility of character. This higher education so much needed today is not given in the school, is not to be bought in the market place, but it has to be wrought out in each one of us for himself; it is the silent influence of character on character and in no way more potent than in the contemplation of the lives of the great and good of "the past, in no way more than in "the touch divine of noble natures gone."
I should like to see in each library a select company of the Immortals set apart for special adoration. Each country might have its representatives in a sort of alcove of Fame, in which the great medical classics were gathered. Not necessarily books, more often the epoch-making contributions to be found in ephemeral journals. It is too early, perhaps, to make a selection of American medical classics, but it might be worth while to gather suffrages in regard to the contributions which ought to be placed upon our Roll of Honour. A few years ago I made out a list of those I thought the most worthy which I carried down to 1850, and it has a certain interest for us this evening. The native modesty of the Boston physician is well known, but in certain circles there has been associated with it a curious psychical phenomenon, a conviction of the utter worthlessness of the status praesens in New England, as compared with conditions existing elsewhere. There is a variety today of, the Back Bay Brahmin who delights in cherishing the belief that medically things are everywhere better than in Boston, and who is always ready to predict "an Asiatic removal of candlesticks," to borrow a phrase from Cotton Mather. Strange indeed would it have been had not such a plastic profession as ours felt the influences which moulded New England into the intellectual centre of the New World. In reality, nowhere in the country has the profession been adorned more plentifully with men of culture and of character—not voluminous writers or exploiters of the products of other men's brains—and they manage to get a full share on the Roll of Fame which I have suggested. To 1850, I have counted some twenty contributions of the first rank, contributions which for one reason or another deserve to be called American medical classics. New England takes ten. But in medicine the men she has given to the other parts of the country have been better than books. Men like Nathan R. Smith, Austin Flint, Willard Parker, Alonzo Clark, Elisha Bartlett, John C. Dalton, and others carried away from their New England homes a love of truth, a love of learning and above all a proper estimate of the personal character of the physician.
Dr. Johnson shrewdly remarked that ambition was usually proportionate to capacity, which is as true of a profession as it is of a man. What we have seen tonight reflects credit not less on your ambition than on your capacity. A library after all is a great catalyser, accelerating the nutrition and rate of progress in a profession, and I am sure you will find yourselves the better for the sacrifice you have made in securing this home for your books, this workshop for your members.