Medicine - The Master-Word in Medicine Part 2
( Originally Published 1905 )
Of the value of an introductory lecture I am not altogether certain. I do not remember to have derived any enduring benefit from the many that I have been called upon to hear, or from the not a few that I have inflicted in my day. On the whole, I am in favour of abolishing the old custom, but as this is a very special occasion, with special addresses, I consider myself most happy to have been selected for this part of the programme. To the audience at large I fear that what I have to say will appear trite and commonplace, but bear with me, since, indeed, to most of you how good soever the word, the season is long past in which it could be spoken to your edification. As I glance from face to face the most striking single peculiarity is the extraordinary diversity that exists among you. Alike in that you are men and white, you are unlike in your features, very unlike in your minds and in your mental training, and your teachers will mourn the singular inequalities in your capacities. And so it is sad to think will be your careers; for one success, for another failure; one will tread the primrose path to the great bonfire, another the straight and narrow way to renown; some of the best of you will be striken early on the road, and will join that noble band of youthful martyrs who loved not their lives to the death; others, perhaps the most brilliant among you, like my old friend and comrade, Dick Zimmerman (how he would have rejoiced to see this day!), the Fates will overtake and whirl to destruction just as success seems assured. When the iniquity of oblivion has blindly scattered her poppy over us, some of you will be the trusted counsellors of this community, and the heads of the departments of this Faculty; while for the large majority of you, let us hope, is reserved the happiest and most useful lot given to man—to become vigorous, whole-souled, intelligent, general practitioners.
It seems a bounden duty on such an occasion to be honest and frank, so I propose to tell you the secret of life as I have seen the game played, and as I have tried to play it myself. You remember in one of the Jungle Stories that when Mowgli wished to be avenged on the villagers he could only get the help of Hathi and his sons by sending them the master-word. This I propose to give you in the hope, yes, in the full assurance, that some of you at least will lay hold upon it to your profit. Though a little one, the master-word looms large in meaning. It is the open sesame to every portal, the great equalizer in the world, the true philosopher's stone, which transmutes all the base metal of humanity into gold. The stupid man among you it will make bright, the bright man brilliant, and the brilliant student steady. With the magic word in your heart all things are possible, and without it all study is vanity and vexation. The miracles of life are with it; the blind see by touch, the deaf hear with eyes, the dumb speak with fingers. To the youth it brings hope, to the middle-aged confidence, to the aged repose. True balm of hurt minds, in its presence the heart of the sorrowful is lightened and consoled. It is directly responsible for all advances in medicine during the past twenty-five centuries. Laying hold upon it Hippo-crates made observation and science the warp and woof of our art. Galen so read its meaning that fifteen centuries , stopped thinking, and slept until awakened by the De Fabrica of Vesalius, which is the very incarnation of the master-word. With its inspiration Harvey gave an impulse to a larger circulation than he wot of, an impulse which we feel today. Hunter sounded all its heights and, depths, and stands out in our history as one of the great exemplars of its virtue. With it Virchow smote the rock, and the waters of progress gushed out; while in the hands of Pasteur it proved a very talisman to open to us a new heaven in medicine and a new earth in surgery. Not only has it been the touchstone of progress, but it is the measure of success in every-day life. Not a man before you but is beholden to it for his position here, while he who addresses you has that honour directly in consequence of having had it graven on his heart when he was as you are to-day. And the master-word is Work, a little one, as I have said, but fraught with momentous sequences if you can but write it on the tablets of your hearts, and bind it upon your fore-heads. But there is a serious difficulty in getting you to understand the paramount importance of the work-habit as part of your organization. You are not far from the Tom Sawyer stage with its philosophy "that work consists of whatever a body is obliged to do, and that play consists of whatever a body is not obliged to do. "
A great many hard things may be said of the work-habit: For most of us it means a hard battle; the few take to it naturally; the many prefer idleness and never learn to love labour. Listen to this: "Look at one of your industrious fellows for a moment, I beseech you," says Robert Louis Stevenson. "He sows hurry and reaps indigestion; he puts a vast deal of activity out to interest, and receives a large measure of nervous derangement in return. Either he absents himself entirely from all fellowship, and lives a recluse in a garret, with carpet slippers and a leaden inkpot, or he comes among people swiftly and bitterly, in a con-traction of his whole nervous system, to discharge some temper before he returns to work. I do not care how much or how well he works, this fellow is an evil feature in other people's lives. " These are the sentiments of an over-worked, dejected man; let me quote the motto of his saner moments: "To travel hopefully is better than to arrive, and the true success is in labour." If you wish to learn of the miseries of scholars in order to avoid them, read Part I, Section 9., Member 3, Subsection XV, of that immortal work, the Anatomy of Melancholy; but I am here to warn you against these evils, and to entreat you to form good habits in your student days.
At the outset appreciate clearly the aims and objects each one of you should have in view—a knowledge of disease and its cure, and a knowledge of yourself. The one, special education, will make you a practitioner of medicine; the other, an inner education, may make you a truly good man, four square and without a flaw. The one is extrinsic and is largely accomplished by teacher and tutor, by text and by tongue; the other is intrinsic and is the mental salvation to be wrought out by each one for himself. The first may be had without the second; any one of you may become an active practitioner, without ever having had sense enough to realize that through life you have been a fool; or you may have the second without the first, and, without knowing much of the art, you may have the endowments of head and heart that make the little you do possess go very far in the community. With what I hope to infect you is a desire to have a due proportion of each.
So far as your professional education is concerned, what I shall say may make for each one of you an easy path easier. The multiplicity of the subjects to be studied is a difficulty, and it is hard for teacher and student to get a due sense of proportion in the work. We are in a transition stage in our methods of teaching, and have not everywhere got away from the idea of the examination as the "be-all and end-all;" so that the student has constantly before his eyes the magical letters of the degree he seeks. And this is well, perhaps, if you will remember that having, in the old phrase, commenced Bachelor of Medicine, you have only reached a point from which you can begin a life-long process of education.
So many and varied are the aspects presented by this theme that I can only lay stress upon a few of the more essential. The very first step towards success in any occupation is to become interested in it. Locke put this in a very happy way when he said, give a pupil "a relish of knowledge" and you put life into his work. And there is nothing more certain than that you cannot study well if you are not interested in your profession. Your presence here is a warrant that in some way you have become attracted to the study of medicine, but the speculative possibilities so warmly cherished at the outset are apt to cool when in contact with the stern realities of the class-room. Most of you have already experienced the all-absorbing attraction of the scientific branches, and nowadays the practical method of presentation has given a zest which was usually lacking in the old theoretical teaching. The life has be-come more serious in consequence, and medical students have put away many of the childish tricks with which we used to keep up their bad name. Compare the picture of the "sawbones" of 1842, as given in the recent biography of Sir Henry Acland, with the representatives to-day, and it is evident a great revolution has been effected, and very largely by the salutary influences of improved methods of education. It is possible now to fill out a day with practical work, varied enough to prevent monotony, and so arranged that the knowledge is picked out by the student himself, and not thrust into him, willy-nilly, at the point of the tongue. He exercises his wits and is no longer a passive Strasbourg goose, tied up and stuffed to repletion.
How can you take the greatest possible advantage of your capacities with the least possible strain? By cultivating system. I say cultivating advisedly, since some of you will find the acquisition of systematic habits very hard. There are minds congenitally systematic; others have a life-long fight against an inherited tendency to diffuseness and carelessness in work. A few brilliant fellows try to dispense with it altogether, but they are a burden to their brethren and a sore trial to their intimates. I have heard it remarked that order is the badge of an ordinary mind. So it may be, but as practitioners of medicine we have to be thankful to get into that useful class. Let me entreat those of you who are here for the first time to lay to heart what I say on this matter. Forget all else, but take away this counsel of a man who has had to fight a hard battle, and not always a successful one, for the little order he has had in his life; take away with you a profound conviction of the value of system in your work. I appeal to the fresh-men especially, because you today make a beginning, and your future career depends very much upon the habits you will form during this session. To follow the routine of the classes is easy enough, but to take routine into every part of your daily life is a hard task. Some of you will start out joyfully as did Christian and Hopeful, and for many days will journey safely towards the Delectable Mountains, dreaming of them and not thinking of disaster until you find yourselves in the strong captivity of Doubt and under the grinding tyranny of Despair. You have been over-confident. Begin again and more cautiously. No student escapes wholly from these perils and trials; be not disheartened, expect them. Let each hour of the day have its allotted duty, and cultivate that power of concentration which grows with its exercise, so that the attention neither flags nor wavers, but settles with a bull-dog tenacity on the subject before you. Constant repetition makes a good habit fit easily in your mind, and by the end of the session you may have gained that most precious of all knowledge the power to work. Do not underestimate the difficulty you will have in wringing from your reluctant selves the stern determination to exact the uttermost minute on your schedule. Do not get too interested in one study at the expense of another, but so map out your day that due allowance is given to each. Only in this way can the average student get the best that he can out of his capacities. And it is worth all the pains and trouble he can possibly take for the ultimate gain—if he can reach his doctorate with system so ingrained that it has become an integral part of his being. The artistic sense of perfection in work is another much-to-be-desired quality to be cultivated. No matter how trifling the matter on hand, do it with a feeling that it demands the best that is in you, and when done look it over with a critical eye, not sparing a strict judgment of yourself. This it is that makes anatomy a student's touch-stone. Take the man who does his "part" to perfection, who has got out all there is in it, who labours over the tags of connective tissue and who demonstrates Meckel's ganglion in his part—this is the fellow in after years who is apt in emergencies, who saves a leg badly smashed in a railway accident, or fights out to the finish, never knowing when he is beaten, in a case of typhoid fever.
Learn to love the freedom of the student life, only too quickly to pass away; the absence of the coarser cares of after days, the joy in comradeship, the delight in new work, the happiness in knowing that you are making progress. Once only can you enjoy these pleasures. The seclusion of the student life is not always good for a man, particularly for those of you who will afterwards engage in general practice, since you will miss that facility of intercourse upon which often the doctor's success depends. On the other hand sequestration is essential for those of you with high ambitions proportionate to your capacity. It was for such that St. Chrysostom gave his famous counsel, "Depart from the highways and transplant thyself into some en-closed ground, for it is hard for a tree that stands by the wayside to keep its fruit till it be ripe."
Has work no dangers connected with it? What of this bogie of overwork of which we hear so much? There are dangers, but they may readily be avoided with a little care. I can only mention two, one physical, one mental. The very best students are often not the strongest. Ill-health, the bridle of Theages, as Plato called it in the case of one of his friends whose mind had thriven at the expense of his body, may have been the diverting influence towards books or the profession. Among the good men who have studied with me there stands out in my remembrance many a young Lycidas, "dead ere his prime," sacrificed to carelessness in habits of living and neglect of ordinary sanitary laws. Medical students are much exposed to infection of all sorts, to combat which the body must be kept in first-class condition. Grosseteste, the great Bishop of Lincoln, remarked that there were three things necessary for temporal salvation—food, sleep and a cheerful disposition. Add to these suitable exercise and you have the means by which good health may be maintained. Not that health is to be a matter of perpetual solicitation, but habits which favour the corpus sanum foster the mens sana, in which the joy of living and the joy of working are blended in one harmony. Let me read you a quotation from old Burton, the great authority on morbi eruditorum. There are "many reasons why students dote more often than others. The first is their negligence; other men look to their tools, a painter will wash his pencils, a smith will look to his hammer, anvil, forge; a husbandman will mend his plough-irons, and grind his hatchet, if it be dull; a falconer or huntsman will have an especial care of his hawks, hounds, horses, dogs, etc.; a musician will string and unstring his lute, etc.; only scholars neglect that instrument, their brain and spirits (I mean) which they daily use." I
Much study is not only believed to be a weariness of the flesh, but also an active cause of ill-health of mind, in all grades and phases. I deny that work, legitimate work, has anything to do with this. It is that foul fiend Worry who is responsible for a large majority of the cases. The more carefully one looks into the causes of nervous break-down in students, the less important is work per se as a factor. There are a few cases of genuine overwork, but they are not common. Of the causes of worry in the student life there are three of prime importance to which I may briefly refer.
An anticipatory attitude of mind, a perpetual forecasting, disturbs the even tenor of his way and leads to disaster. Years ago a sentence in one of Carlyle's essays made a lasting impression on me: "Our duty is not to see what lies dimly at a distance, but to do what lies clearly at hand." I have long maintained that the best motto for a student is, "Take no thought for the morrow." Let the day's work suffice; live for it, regardless of what the future has in store, believing that to-morrow should take thought for the things of itself. There is no such safeguard against the morbid apprehensions about the future, the dread of examinations and the doubt of the ultimate success. Nor is there any risk that such an attitude may breed carelessness. On the contrary, the absorption in the duty of the hour is in itself the best guarantee of ultimate success. "He that observeth the wind shall not sow, and he that regardeth the clouds shall not reap," which means you cannot work profitably with your mind set upon the future.
Another potent cause of worry is an idolatry by which many of you will be sore let and hindered. The mistress of your studies should be the heavenly Aphrodite, the mother-less daughter of Uranus. Give her your whole heart, and she will be your protectress and friend. A jealous creature, brooking no second, if she finds you trifling and coquetting with her rival, the younger, earthly Aphrodite, daughter of Zeus and Dione, she will whistle you off and let you down the wind to be a prey, perhaps to the examiners, certainly to the worm regret. In plainer language, put your affections in cold storage for a few years, and you will take them out ripened, perhaps a bit mellow, but certainly less subject to those frequent changes which perplex so many young men. Only a grand passion, an all-absorbing devotion to the elder goddess can save the man with a congenital tendency to philandering, the flighty Lydgate who sports with Celia and Dorothea, and upon whom the judgment ultimately falls in a basil-plant of a wife like Rosamond.
And thirdly, one and all of you will have to face the or-deal of every student in this generation who sooner or later tries to mix the waters of science with the oil of faith. You can have a great deal of both if you only keep them separate. The worry comes from the attempt at mixture. As general practitioners you will need all the faith you can carry, and while it may not always be of the conventional pattern, when expressed in your lives rather than on your lips, the variety is not a bad one from the standpoint of St. James; and may help to counteract the common scandal alluded to in the celebrated diary of that gossipy old pastor-doctor, the Rev. John Ward: "One told the Bishop of Gloucester that he imagined physicians of all other men the most competent judges of all other affairs of religion—and his reason was because they were wholly unconcerned with it."