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SCIENCE. 



[N. S. Vol. XVIII. No. 446. 



in the country and still continue to reside 

 there is a long one. Not long ago I had 

 an interview with a physician who resides 

 in a little village in the mountains of 

 North Carolina, and who had gone forty 

 miles to a mountaineer's cabin a few nights 

 before to trephine an incised wound of the 

 skull successfully by the light of a coal-oil 

 lamp, and to remove a knife blade which 

 had been broken off in the wound and 

 which was giving rise to serious and 

 rapidly fatal brain symptoms if relief 

 had not been afforded. He made the diag- 

 nosis and performed the operation which 

 snatched the patient from certain death, 

 from his knowledge of cerebral localiza- 

 tion. Similar instances of modern knowl- 

 edge of medicine among country practi- 

 tioners are frequent. As a matter of fact, 

 the half-educated physician is much more 

 apt to settle in the crowded city than in 

 the country, and the descent into quackery 

 and charlatanism is more easily made there. 

 A good education, I do not say a college 

 degree of necessity, preliminary to the 

 study of medicine is after all the surest 

 safeguard against a misapplication of the 

 knowledge which the physician has ac- 

 quired. 



In the study of medicine we find a com- 

 bination of technical and theoretical knowl- 

 edge rarely required by any other profes- 

 sion. The amount of actual knowledge 

 which the student must acquire by an act 

 of memory is truly appalling. I heard 

 not long since of an elderly physician who 

 apologized for his failure to keep pace 

 with the progress of pathology and bac- 

 teriology, by reason of his age, but added 

 with pride that he once knew the names 

 of all the bones of the human body. I 

 think every physician may reasonably feel 

 a similar and lasting pride in his feats of 

 memory as a student. The student must 

 know the names, relations and functions 

 of the bones, the arteries, the nerves, the 



viscera, the nerves of special senses, the 

 brain and spinal cord, and in fact every- 

 thing about every organ of the human 

 body. He must also know materia medica, 

 pharmacology, chemistry, physiological 

 chemistry, physiology, pathology, bacteri- 

 ology, hygiene, clinical microscopy and the 

 laws of health and disease. In addition to 

 these branches he must know disease itself 

 in its various manifestations, and learn how 

 to recognize it and how to treat it. In med- 

 ical study he must cultivate his memory, 

 his powers of observation and his ability 

 to reason from obscure phenomena. He 

 must cultivate his hand to do and his eye 

 to see. While there is still, especially in 

 seeking the causes of disease, much blind 

 groping, medical diagnosis as a whole is 

 no longer an iridescent dream but a grow- 

 ing certainty. Take, as examples of this, 

 malarial fever, tuberculosis, typhoid fever 

 and diphtheria. No one now needs to be 

 long uncertain as to the presence of these 

 diseases, or, if he is, his uncertainty is due 

 to his own lack of training and medical 

 knowledge. And yet I would not be un- 

 derstood as asserting that all the problems 

 of health and disease are equally free from 

 uncertainty. There are difficulties in- 

 herent in the factors of the problem which 

 often lead to doubt and uncertainty in the 

 mind of the best trained physician. We 

 can not shut our eyes to the fact that dis- 

 ease is not an entity, an organized enemy 

 of health which attacks the body in a uni- 

 form manner, and is to be cast out as a 

 burglar or a midnight intruder is thrust 

 out of your bed-chamber. It is rather the 

 personal reaction of the body of each in- 

 dividual in its own way and in accordance 

 with its own constitution against the mor- 

 bific agency. The portal by which the 

 same disease enters different individuals 

 may vary widely, the extent of the reaction 

 may vary as widely, and the virulence of 

 the original poison may also vary to an 



