Medicine - The Student Life Part 3
( Originally Published 1905 )
The student-specialist has to walk warily, as with two advantages there are two great dangers against which he has constantly to be on guard. In the bewildering complexity of modern medicine it is a relief to limit the work of a life to a comparatively narrow field which can be thoroughly tilled. To many men there is a feeling of great satisfaction in the mastery of a small department, particularly one in which technical skill is required. How much we have benefited from this concentration of effort in dermatology, laryngology, ophthalmology, and in gynecology! Then, as a rule, the specialist is a free man, with leisure or, at any rate, with some leisure; not the slave of the public, with the incessant demands upon him of the general practitioner. He may live a more rational life, and has time to cultivate his mind, and he is able to devote himself to public interests and to the welfare of his professional brethren, on whose suffrages he so largely depends. How much we are indebted in the larger cities to the disinterested labours of this favoured class the records of our libraries and medical societies bear witness. The dangers do not come to the strong man in a speciality, but to the weak brother who seeks in it an easier field in which specious garrulity and mechanical dexterity may take the place of solid knowledge. All goes well when the man is larger than his speciality and controls it, but when the speciality runs away with the man there is disaster, and a topsy-turvy condition which, in every branch, has done incalculable injury. Next to the danger from small men is the serious risk of the loss of perspective in prolonged and concentrated effort in a narrow field. Against this there is but one safeguard—the cultivation of the sciences upon which the speciality is based. The student-specialist may have a wide vision—no student wider—if he gets away from the mechanical side of the art, and keeps in touch with the physiology and pathology upon which his art depends. More than any other of us, he needs the lessons of the laboratory, and wide contact with men in other departments may serve to correct the inevitable tendency to a narrow and perverted vision, in which the life of the ant-hill is mistaken for the world at large.
Of the student-teacher every faculty affords examples in varying degrees. It goes without saying that no man can teach successfully who is not at the same time a student. Routine, killing routine, saps the vitality of many who start with high aims, and who, for years, strive with all their energies against the degeneration which it is so prone to entail. In the smaller schools isolation the absence of congenial spirits working at the same subject, favours stag-nation, and after a few years the fires of early enthusiasm no longer glow in the perfunctory lectures. In many teachers the ever-increasing demands of practice leave less and less time for study, and a first-class man may lose touch with his subject through no fault of his own, but through an entanglement in outside affairs which he deeply regrets yet cannot control. To his five natural senses the student-teacher must add two more—the sense of responsibility and the sense of proportion. Most of us start with a highly developed sense of the importance of the work, and with a desire to live up to the responsibilities entrusted to us. Punctuality, the class first, always and at all times; the best that a man has in him, nothing less; the best the profession has on the subject, nothing less; fresh energies and enthusiasm in dealing with dry details; animated, unselfish devotion to all alike; tender consideration for his assistants-these are some of the fruits of a keen sense of responsibility in a good teacher. The sense of proportion is not so easy to acquire, and much depends on the training and on the natural disposition. There are men who never possess it; to others it seems to come naturally. In the most careful ones it needs constant cultivation—nothing over-much should be the motto of every teacher. In my early days I came under the influence of an ideal student-teacher, the late Palmer Howard, of Montreal. If you ask what manner of man he was, read Matthew Arnold's noble tribute to his father in his well-known poem, Rugby Chapel. When young, Dr. Howard had chosen a path—"path to a clear-purposed goal," and he pursued it with unswerving devotion. With him the study and the teaching of medicine were an absorbing passion, the ardour of which neither the incessant and ever-increasing demands upon his time nor the growing years could quench. When I first, as a senior student, came into intimate contact with him in the summer of 1871, the problem of tuberculosis was under discussion, stirred up by the epoch-making work of Villemin and the radical views of Niemeyer. Every lung lesion at the Montreal General Hospital had to be shown to him, and I got my first-hand introduction to Laennec, to Graves, and to Stokes, and became familiar with their works. No matter what the hour, and it usually was after 10 p.m., I was welcome with my bag, and if Wilks and Moxon, Virchow, or Rokitanski gave us no help, there were the Transactions of the Pathological Society and the big Dictionnaire of Dechambre. An ideal teacher because a student, ever alert to the new problems, an indomitable energy enabled him in the midst of an exacting practice to maintain an ardent enthusiasm, still to keep bright the fires which he had lighted in his youth. Since those days I have seen many teachers, and I have had many colleagues, but I have never known one in whom was more happily combined a stern sense of duty with the mental freshness of youth.
But as I speak, from out the memory of the past there rises before me a shadowy group, a long line of students whom I have taught and loved, and who have died prematurely—mentally, morally, or bodily. To the successful we are willing and anxious to bring the tribute of praise, but none so poor to give recognition to the failures. From one cause or another, perhaps because when not absorbed in the present, my thoughts are chiefly in the past, I have cherished the memory of many young men whom I have loved and lost. Io victis: let us sometimes sing of the vapquished. Let us sometimes think of those who have fallen in the battle of life, who have striven and failed, who have failed even without the strife. How many have I lost from the student band by mental death, and from so many causes-some stillborn from college, others dead within the first year of infantile marasmus, while mental rickets, teething, tabes, and fits have carried off many of the most promising minds! Due to improper feeding within the first five fateful years, scurvy and rickets head the mental mortality bills of students. To the teacher-nurse it is a sore disappointment to find at the end of ten years so few minds with the full stature, of which the early days gave promise. Still, so widespread is mental death that we scarcely comment upon it in our friends. The real tragedy is the moral death which, in different forms, overtakes so many good fellows who fall away from the pure, honour-able, and righteous service of Minerva into the idolatry of Bacchus, of Venus, or of Circe. Against the background of the past these tragedies stand out, lurid and dark, and as the names and faces of my old boys recur (some of them my special pride), I shudder to think of the blighted hopes and wrecked lives, and I force my memory back to those happy days when they were as you are now, joyous and free from care, and I think of them on the benches, in the laboratories, and in the wards—and there I leave them. Less painful to dwell upon, though associated with a more poignant grief, is the fate of those whom physical death has snatched away in the bud or blossom of the student life. These are among the tender memories of the teacher's life, of which he does not often care to speak, feeling with Longfellow that the surest pledge of their remembrance is "the silent homage of thoughts unspoken." As I look back it seems now as if the best of us had died, that the brightest and the keenest had been taken and the more commonplace among us had been spared. An old mother, a devoted sister, a loving brother, in some cases a broken-hearted wife, still pay the tribute of tears for the untimely ending of their high hopes, and in loving remembrance I would mingle mine with theirs. What a loss to our profession have been the deaths of such true disciples as Zimmerman, of Toronto; of Jack Cline and of R. L. MacDonnell, of Montreal; of Fred Packard and of Kirkbride, of Philadelphia; of Livingood, of Lazear, of Oppenheimer, and of Oechsner, in Baltimore—cut off with their leaves still in the green, to the inconsolable grief of their friends!
To each one of you the practice of medicine will be very much as you make it—to one a worry, a care, a perpetual annoyance; to another, a daily joy and a life of as much happiness and usefulness as can well fall to the lot of man. In the student spirit you can best fulfil the high mission of our noble calling—in his humility, conscious of weakness, while seeking strength; in his confidence, knowing the power, while recognizing the limitations of his art; in his pride in the glorious heritage from which the greatest gifts to man have been derived; and in his sure and certain hope that the future holds for us richer blessings than the past.