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CHAPTER XXVIII.
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THE HOSPITAL SYSTEM.
"——Non h?c sine numine Divum
Eveniunt."
?neid, lib. ii, 1. 777.

If we would view any human institution dispassionately, we must distinguish the vices1 of System from the faults of those who administer it.

Trite2 as this remark may be, the caution it involves is just that which is too frequently overlooked or unobserved. By a careful attention to the distinction it implies, we may develop the elements of rational reform, as contrasted with Utopian schemes; which, whatever of abstract truth they may contain, are frequently useless, simply because they are impracticable. We cannot effect any material change in human nature by any summary legislation, nor prevent the obtrusive3 necessities of daily life from bringing down the soaring aspirations4 of mind, to the humble5 level of the practicabilities of matter. Whoever, therefore, expects that any body of men, invested with irresponsible power, will hesitate to exercise it so as to procure6, as they believe, the maximum of advantage to themselves,—might just as hopefully quarrel with the negro on account of his complexion7. Do what you may, Man is Man "for a' that;" but whilst it is necessary to remember this, it is by no means so, to do it in a spirit of unkindness or hostility8, nor in any sense opposed to brotherly love; but, on the contrary, in a tone of mind which, alike mild and uncompromising, desires to promote universal harmony and good feeling, by removing the285 temptations which experience has shown to be influential9 in disturbing such relations.

Neither should we quarrel with a man who endeavours to do the best he can for his family and friends. Should he, even in this pursuit, compromise his duty to the public, it is very possible that the objects which he had in view may have been in themselves praiseworthy, and therefore, instead of exasperating10 our blame, may readily extenuate11 faults which it may be impossible to excuse.

The truth is, that the interests of the public and of individuals are seldom, if ever, incompatible12; the occasions on which they appear to be so are not unfrequent; those in which they really clash are extremely rare.

Wherever circumstances occur in which the temptation of a present fruition is found habitually13 to lead men to courses which, however apparently14 promotive of their own interests, are really detrimental15 to those of the public,—it becomes very necessary that the public should impose safeguards against such an injurious exercise of power.

The hospitals of London, as we formerly16 observed, are, in the main, very fine institutions. They are many of them very wealthy, which generally means powerful also.

The Governors, as they are termed, consist of certain noblemen and gentlemen; the latter being, for the most part, drawn17 from the more wealthy sections of the mercantile and trading classes.

The knowledge possessed18 by these gentlemen of the requisitions of a large public hospital, must (special instances excepted) be very measured; and be, in the main, derived19 from the medical officers with whom they are associated.

It thus happens that the administration of the hospital is in great part confided20—as, with some restrictions21, it ought to be—to the medical officers. The interests of these gentlemen, it may be assumed, would be best promoted by carrying out in the most efficient manner the benevolent22 objects of the institution: and we believe, looked at fairly and comprehensively, this would be really the case. The duties of a large hospital, however—if they are to286 be performed conscientiously—require much time, not a little labour, and some health to boot. Now all these, in a crowded community, are very costly23 articles; and which must, in justice—and, what is material, in fact too—be fairly remunerated. The public never really pay so dearly, as when they appear to get labour for nothing.

Here we come to the first defect in the "Hospital System."

It might be supposed that, with ample means, the Governors of Hospitals, by adopting such previous tests as were in their power, would have secured the most efficient officers, by paying them remunerative24 salaries; and, having retained them as long as their services were deemed efficient, or the duration of them justified25, that they would have released them from the necessity of further exertion26 by a retiring pension. No such thing. The Hospital gives nothing: actually, there is a small nominal27 retaining fee, as it were, of about £60 to £100 a year, and the medical officer is left to obtain his remuneration for time, trouble, and health, by such private practice as his reputation or the prestige of being attached to an hospital may afford; from fees from pupils, or such other means as the position he occupies may place within his power.

He very naturally sets to work to do the best he can; and from this first budding, we very soon arrive at the full blossom of the System; one effect of which is, that, in hospitals, which have so large a care of public health—institutions which, whether correctly or incorrectly, give so much of the tone to the medical opinions of the day, which exert, either directly or indirectly28, an influence on the claims of hundreds to public confidence—that in these hospitals there is not one single surgeoncy that is fairly and bona fide open to scientific competition.

Let us now examine a little into the machinery29 by which these results are brought out.

The experience afforded by the hospitals necessarily supplies abundant means for instructing students in surgery. They are accordingly admitted on paying certain fees to the surgeon; and this at once supplies a large revenue. This revenue is of course regulated by the number of pupils; and as there are in London287 many hospitals, so it follows that there is an active competition. Thus, some time before the season commences, the advertisements of the medical schools occupy a considerable space in the public journals, and circulars are also liberally distributed.

Well, the points here, as in all other cases, are the advantages offered, and the price paid—the maximum and minimum respectively. Here we arrive at the elements of numerous evils.

Students are not always—and before they try, hardly ever—judges of a school. The general reputation of a man (as he is never subjected to open competition) is no test whatever of his comparative power in teaching students; but they are accustomed to ascribe great importance to operations; and, c?teris paribus, they incline to prefer that hospital where the greatest number are supposed to be performed.

This arises from various causes; in some of which the public play no unimportant part. The student has perhaps seen, in the country, a good deal of medical and surgical30 practice; but very few operations. His stay in London is comparatively short, averaging, perhaps, not more than the better part of two years. Unnecessary length of time is generally inconvenient31, always expensive, and the student is naturally anxious to see most of that which he will have least opportunity of observing elsewhere. Moreover, he knows that when he returns to the country he may save twenty limbs, before he obtains the same amount of reputation that he may possibly get by one amputation—the ignorance of the public, here, not appreciating results which very probably involved the exercise of the highest talent, whilst they are ready to confer a very profitable distinction on that which does not necessarily involve any talent at all.

We have no wish whatever, and certainly there is no necessity, for straining any point in reference to this very serious matter; but these two facts are indisputable—that the surgeons obtain their remuneration from the hospitals by the fees they obtain from the pupils; and, c?teris paribus, the pupils will flock the thickest where they expect to see most operations.

The next thing that we would submit, is that the prestige in favour of operations is both directly and indirectly opposed to the288 progress of scientific surgery. Almost all operations, commonly so termed, are examples of defective32 science. To practical common sense, therefore, it would appear a very infelicitous33 mode of obtaining the maximum of a man's genius in aid of the diminution34 of operations, to open to him a prospect35 of enriching himself by the multiplication36 of them. We desire to consider the subject with reference to its scientific bearings only, and would avoid entirely37, were that possible, any appeal merely to the feelings. Such impulses, however right, are apt to be paroxysmal and uncertain, unless supported by the intellect. But, on such a subject, the feelings must necessarily become more or less interested. Wherever a system takes a wrong direction, a great many minor38 evils insensibly grow out of it.

The erection of a theatre for the purpose of operating, though founded on a feasible pretext39, is a very questionable40 measure; and, unless of clear advantage to the profession or the public, is surely not without some character of repulsion. As regards art and science, it is certain that not more than twenty or thirty can be near enough in the theatre to see anything that can be really instructive in the performance of operations. In the absence of actual advantage, therefore, an exhibition of this kind is more calculated to give publicity41 to the surgeon operating, than it is to raise the tone or chasten the feelings of men about to enter a profession which almost daily establishes requisitions for our highest faculties42. Operations without opportunities of real instruction, are merely unprofitable expenditure43 of valuable time. That which is viewed as a sort of exhibition to-day, may be with difficulty regarded in the light of a serious duty to-morrow. Were the object to tax the sensibility of a student, and blind him to any higher association with pain and suffering than that afforded by custom and chloroform, and to substitute for a dignified44 self-possession and sympathy with suffering, which each kept the other in due control, an indifference45 to everything save adroitness46 of manipulation and mechanical display,—no machinery could be better calculated to effect such objects; but science and humanity require very different qualifications, and experience has shown that they are neither incompatible nor beyond our power.

289

The humanity and science that beholds47, in operative surgery, the lowest of our employments, and which would thence be impelled48 to seek, and as experience has taught us to seek successfully, to diminish the number of such exhibitions, and to lessen49 the suffering of those which are still retained, is perfectly50 compatible with coolness and skill in the performance of them.

When we speak of lessening51 pain, we must not be understood as alluding52 to chloroform, or agencies of that kind. We have, on the contrary, the greatest distrust of their utility; we do not hesitate to admit the propriety53 of their use in certain cases; but we are satisfied that, as at present employed, a very few years will make a great change. Many a so-called incurable54 case has been shown to be curable by the hesitation55 of the patient to submit to an operation. We have published some ourselves, wherein we joined in recommending the measure which the patient declined. Many deaths that we do know have already occurred from the use of chloroform; and a significant remark was made by a man who had considerable reputation in this way. He said: "Chloroform is a good thing for operating surgeons."

To return from this digression. The most distinguished56 surgeons ever known in this country have shown us how to combine, in the highest degree, dexterity57 and skill, with science and humanity; together with a just estimate of the low position occupied by operations in the scale of our important studies. I may allude58 to two more particularly, Cheselden and John Hunter; the former, the most expert and successful operator of his day, in the European sense of the word, has left us a satisfactory declaration on this subject. Cheselden acknowledges that he seldom slept much the night previous to the day on which he had any important operation; but that, once engaged in operating, he was always firm, and his hand never trembled. John Hunter was not only a good operator himself, but he deduced from observation one of the greatest improvements in operative surgery. His discovery had all the elements of improvement that are possible in this branch of the profession.

290

An operation which had been founded upon erroneous views of the nature and relations of the parts affected—which had been always tedious and painful in performance—which, whether successful or not, entailed59 much subsequent suffering, which in its results was highly dangerous, and which was very commonly followed by the loss of the limb or life,—was replaced by one founded on more correct views of the disease, easy and simple in its execution, occupying not more than a very few minutes, and which, so far as regards the purpose for which it was instituted, and to which it should be restricted, is almost invariably successful. If it be performed under circumstances implying conditions contrary to those on which Mr. Hunter's operation was founded, very different results have no doubt taken place; but, when properly applied60, his operation for aneurism is no doubt one of the greatest improvements in operative surgery.

John Hunter treats of operations in terms which show how low he rated that part of our duties. He speaks of them as humiliating examples of the imperfection of our science, and figures to himself an operator under the repulsive61 symbol of an armed savage62. "No surgeon," said he, "should approach the victim of his operation without a sacred dread63 and reluctance64, and should be superior to that popular éclat generally attending painful operations, often only because they are so, or because they are expensive to the patient"—p. 210. Abernethy, whose keen observation saw the difficult web which various sophistries65, to use no harsher term, had thrown around the subject, was very characteristic in the manner in which he dashed it aside, and pointed66 to the salient source of error.

"Never perform an operation," he would say, "on another person, which, under similar circumstances, you would not have performed on yourself."

The truth is, that operations, to be performed properly, must be properly studied. They must be frequently performed on the dead, and afterwards carefully examined. There is a wide difference between neglecting a necessary study and making that the test of science which is the most emphatic67 proof of its imperfection. We have ourselves had no lack of experience in this291 branch of the profession, and have included not a few operations which are too commonly delivered over to men who are said to devote themselves to special objects. The result of our experience satisfies us in entertaining the views which the most distinguished men have held on this subject; whilst we are persuaded that few things have contributed more to impede68 the progress of science than the abuse of operations.

To return to the surgical appointments of the hospital.

The positions which had at first been left without any remuneration, become, by the machinery described, very lucrative69; directly, by the fees paid by the pupils; and indirectly, in some cases, by keeping the surgeon constantly before the public. Any prestige, therefore, in obtaining these appointments, is of great value; but, if that do not really involve professional excellence70, it is as plain as possible that the public may be very badly served, and an evil generated equally opposed to the interests of science and humanity. It is obvious that the only legitimate71 grounds of eligibility72 are moral and professional superiority, as determined73 by the test adopted at public schools and universities—namely, public competition. Now, what are the tests employed? Without meaning to insinuate74 that moral or professional eligibility is wholly disregarded—no system in these days will support that—still the eligibility depends on a qualification which few would beforehand have imagined. It is certainly something better than Mr. Macaulay's joke in relation to the proposed franchise75 to the Militia—namely, that the elector should be five feet two—but something not much more elevated; namely, that a bounty76 should have been paid to one of the hospital surgeons in the shape of an apprentice77 fee; thus making the holding one of the most responsible offices in the profession—a condition, which absolutely ignores relative eligibility of skill, steadiness, assiduity, and humanity; and which recognizes them only in such shape that the possession of office is practically made to depend on a point absolutely extrinsic78 to any one important requisition recognized by the public or the profession.

We need not insist on the tendency of this system to the protection of idleness and incapacity, or the injustice79 inseparable292 from it to the young gentlemen whose interests it is supposed to guard. One necessary consequence is obvious—namely, that the hospitals, instead of having to select from the general body of pupils, or from the more industrious80 or talented of them, is obliged to choose from a very small minority.

It is, in fact, just as if scholarships and fellowships at public schools and universities were conferred without any reference to the proofs which the candidates might have given of their talents or industry; but were distributed to those who had given a certain fee to a particular professor. Would any man in his senses doubt as to the influence of such a plan on the interests of classical literature or mathematical science? It seems to us impossible that men should really differ on that point, or hesitate to admit that, mutatis mutandis, whatever the science might be, so far as the cultivation81 of it could be influenced by system, the result must be alike prejudicial in all cases. We are, however, far from arriving at the end of the System by this general statement.

The public and the government, uninformed or unmindful of this "system," wish to consult authorities on professional matters. They not unnaturally82 look to those who hold public appointments, because these afford the prestige of extensive opportunity, which is supposed to imply, and under a fair system would ensure, skill and experience. Men are apt to look at a man's position, without stopping to inquire how it was obtained; and although position may cut both ways, and in particular instances "throw a cruel sunshine" over incapacity, still amongst gentlemen extreme cases are not to be expected; the rule is much more likely to be a respectable and protected mediocrity, which is just that tone which has rarely done anything to enlarge the boundaries of any kind of knowledge.

It happens, however, from the "system," and the position thus given to those who are supposed to profit by it, that the interests of the poor, and, in a considerable degree, those of the rich also, are, in a very large sense, confided to their care.

It thus follows that positions, in themselves highly desirable, and which enable men to exert considerable influence on the progress293 of a science, on the sound condition of which the physical comforts, and in no small degree the moral condition, of mankind depend, are occupied by men who have undergone none of those tests which public competition alone affords, and which the summi honores of almost every other profession either directly or indirectly imply.

So far for one mode in which the interests of the public are compromised; but there are many other channels. The government, ignoring the evils of this system, have placed the regulation of the surgical branch of the profession in the hands of a body of men whom, when we examine, we find to be no other than the apprentices83 we had recognized at the hospital, grown into the full bloom of a legislative84 body—whence again are chosen Presidents, Vice-Presidents, Examiners, &c., of the Royal College of Surgeons of London!

If, fatigued85 with this machinery, we walk to the Royal Medical and Chirurgical Society—a chartered body for the especial cultivation of science—we meet, as its name would imply, a number of our honoured brothers, the physicians; but here we find that, whether we observe Presidents or any other Officers, the influence exerted by the apprentice system continues; and that, in almost everything surgical, the best possible individual is an apprentice who has attained86 his first position without any public competition. Can any one be surprised that the published transactions of this society are not of a higher character. We hope and believe that the point of the wedge is already inserted, which will, at no distant period, rend87 asunder88 this system, which we shall not trust ourselves by attempting to characterize farther. But there are points in connection with the interests of science and of Abernethy which require yet to be noticed.

We need scarcely observe that it would be very desirable that the interests of science should be entrusted89 to those who had shown most assiduity or talent in the cultivation of them; that if operative surgery be really, as a whole, a series of facts exemplifying the defects of a science—that whilst every pains should be taken that what is necessary should be done thoroughly90 well—all294 factitious inducement to multiply their number should be avoided, and especially any which tended to increase emolument91 commensurately with their multiplication.

That as operations (with some few exceptions) merely minister to effects, their real bearings on disease can only be estimated by knowing the ultimate result; and that, in order to this effect, returns of all operations should be kept, with full accounts of the cases; the addresses of the patients should also be taken, and such means as were obvious and practicable employed to obtain the ultimate result of the case.

Another point which should be attended to in hospitals, is an accurate notation92 and return of all cases whatever; so that we might obtain from statistical93 records whatever light they might be capable of affording in aid of the prosecution94 of a definite science. In this return, a full history, and all the phenomena95 of the case, which are known to have an influence on the Body, should be accurately96 noted97, and in tabular forms convenient for reference.

The defects of the hospitals in this respect are too well known to require comment; and we think the profession indebted to Dr. Webster for the exertions98 he has made to draw attention to this subject. In no respect are the hospitals more defective than as regards the division of labour75. To supply the requisitions of a yet dawning science, there is too much confided to one surgeon; for, at present, the practical administration and the scientific investigation99 should be confided to the same hand. If more be entrusted to one man than can be performed without great labour, and the greater labour be voluntary, we shall have little chance of obtaining that full and accurate notation of facts which all cases furnish more or less the means of obtaining, and without which the evolution of the maximum of human ability is absolutely impossible. It seems to us also an imperative100 duty to avail ourselves of the experience afforded by the history of other sciences, in the cultivation of our own.

295

All sciences have been in as bad a condition as medicine and surgery, or worse. All sciences have progressed immediately that they were investigated on a rational plan—a plan, which, simply stated, is little more than the bringing together all the facts that can be perceived to bear any relation to the inquiry101, and reasoning on them according to well-established and necessary conditions. If this be the case, and this plan have never been applied to the investigation of medical science, we know not how those who are placed in positions which supply the necessary means can be excused; or how we can halt in condemning102 the system under which such a flagitious neglect of the claims of science and mankind is exemplified. It is true, when we arrive at the acmé of our convictions of the effects of such a system, our reflections remind us that such things are "permitted," and that ultimately they will work for good; that Man is not destined103 to interfere104 with the ultimate plan and designs of Providence105, however he may be allowed to place his intellect under the direction of a responsible volition106, and to discover the path to the temple of truth, only after having fruitlessly threaded the mazes107 of error.


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1 vices 01aad211a45c120dcd263c6f3d60ce79     
缺陷( vice的名词复数 ); 恶习; 不道德行为; 台钳
参考例句:
  • In spite of his vices, he was loved by all. 尽管他有缺点,还是受到大家的爱戴。
  • He vituperated from the pulpit the vices of the court. 他在教堂的讲坛上责骂宫廷的罪恶。
2 trite Jplyt     
adj.陈腐的
参考例句:
  • The movie is teeming with obvious and trite ideas.这部电影充斥着平铺直叙的陈腐观点。
  • Yesterday,in the restaurant,Lorraine had seemed trite,blurred,worn away.昨天在饭店里,洛兰显得庸俗、堕落、衰老了。
3 obtrusive b0uy5     
adj.显眼的;冒失的
参考例句:
  • These heaters are less obtrusive and are easy to store away in the summer.这些加热器没那么碍眼,夏天收起来也很方便。
  • The factory is an obtrusive eyesore.这工厂很刺眼。
4 aspirations a60ebedc36cdd304870aeab399069f9e     
强烈的愿望( aspiration的名词复数 ); 志向; 发送气音; 发 h 音
参考例句:
  • I didn't realize you had political aspirations. 我没有意识到你有政治上的抱负。
  • The new treaty embodies the aspirations of most nonaligned countries. 新条约体现了大多数不结盟国家的愿望。
5 humble ddjzU     
adj.谦卑的,恭顺的;地位低下的;v.降低,贬低
参考例句:
  • In my humble opinion,he will win the election.依我拙见,他将在选举中获胜。
  • Defeat and failure make people humble.挫折与失败会使人谦卑。
6 procure A1GzN     
vt.获得,取得,促成;vi.拉皮条
参考例句:
  • Can you procure some specimens for me?你能替我弄到一些标本吗?
  • I'll try my best to procure you that original French novel.我将尽全力给你搞到那本原版法国小说。
7 complexion IOsz4     
n.肤色;情况,局面;气质,性格
参考例句:
  • Red does not suit with her complexion.红色与她的肤色不协调。
  • Her resignation puts a different complexion on things.她一辞职局面就全变了。
8 hostility hdyzQ     
n.敌对,敌意;抵制[pl.]交战,战争
参考例句:
  • There is open hostility between the two leaders.两位领导人表现出公开的敌意。
  • His hostility to your plan is well known.他对你的计划所持的敌意是众所周知的。
9 influential l7oxK     
adj.有影响的,有权势的
参考例句:
  • He always tries to get in with the most influential people.他总是试图巴结最有影响的人物。
  • He is a very influential man in the government.他在政府中是个很有影响的人物。
10 exasperating 06604aa7af9dfc9c7046206f7e102cf0     
adj. 激怒的 动词exasperate的现在分词形式
参考例句:
  • Our team's failure is very exasperating. 我们队失败了,真是气死人。
  • It is really exasperating that he has not turned up when the train is about to leave. 火车快开了, 他还不来,实在急人。
11 extenuate Qzfyq     
v.减轻,使人原谅
参考例句:
  • Nothing can extenuate his crime.他的罪责无法减轻。
  • Because of extenuating circumstances,the court acquitted him of the crime.因考虑到情有可原,法庭判他无罪。
12 incompatible y8oxu     
adj.不相容的,不协调的,不相配的
参考例句:
  • His plan is incompatible with my intent.他的计划与我的意图不相符。
  • Speed and safety are not necessarily incompatible.速度和安全未必不相容。
13 habitually 4rKzgk     
ad.习惯地,通常地
参考例句:
  • The pain of the disease caused him habitually to furrow his brow. 病痛使他习惯性地紧皱眉头。
  • Habitually obedient to John, I came up to his chair. 我已经习惯于服从约翰,我来到他的椅子跟前。
14 apparently tMmyQ     
adv.显然地;表面上,似乎
参考例句:
  • An apparently blind alley leads suddenly into an open space.山穷水尽,豁然开朗。
  • He was apparently much surprised at the news.他对那个消息显然感到十分惊异。
15 detrimental 1l2zx     
adj.损害的,造成伤害的
参考例句:
  • We know that heat treatment is detrimental to milk.我们知道加热对牛奶是不利的。
  • He wouldn't accept that smoking was detrimental to health.他不相信吸烟有害健康。
16 formerly ni3x9     
adv.从前,以前
参考例句:
  • We now enjoy these comforts of which formerly we had only heard.我们现在享受到了过去只是听说过的那些舒适条件。
  • This boat was formerly used on the rivers of China.这船从前航行在中国内河里。
17 drawn MuXzIi     
v.拖,拉,拔出;adj.憔悴的,紧张的
参考例句:
  • All the characters in the story are drawn from life.故事中的所有人物都取材于生活。
  • Her gaze was drawn irresistibly to the scene outside.她的目光禁不住被外面的风景所吸引。
18 possessed xuyyQ     
adj.疯狂的;拥有的,占有的
参考例句:
  • He flew out of the room like a man possessed.他像着了魔似地猛然冲出房门。
  • He behaved like someone possessed.他行为举止像是魔怔了。
19 derived 6cddb7353e699051a384686b6b3ff1e2     
vi.起源;由来;衍生;导出v.得到( derive的过去式和过去分词 );(从…中)得到获得;源于;(从…中)提取
参考例句:
  • Many English words are derived from Latin and Greek. 英语很多词源出于拉丁文和希腊文。 来自《简明英汉词典》
  • He derived his enthusiasm for literature from his father. 他对文学的爱好是受他父亲的影响。 来自《简明英汉词典》
20 confided 724f3f12e93e38bec4dda1e47c06c3b1     
v.吐露(秘密,心事等)( confide的过去式和过去分词 );(向某人)吐露(隐私、秘密等)
参考例句:
  • She confided all her secrets to her best friend. 她向她最要好的朋友倾吐了自己所有的秘密。
  • He confided to me that he had spent five years in prison. 他私下向我透露,他蹲过五年监狱。 来自《简明英汉词典》
21 restrictions 81e12dac658cfd4c590486dd6f7523cf     
约束( restriction的名词复数 ); 管制; 制约因素; 带限制性的条件(或规则)
参考例句:
  • I found the restrictions irksome. 我对那些限制感到很烦。
  • a snaggle of restrictions 杂乱无章的种种限制
22 benevolent Wtfzx     
adj.仁慈的,乐善好施的
参考例句:
  • His benevolent nature prevented him from refusing any beggar who accosted him.他乐善好施的本性使他不会拒绝走上前向他行乞的任何一个乞丐。
  • He was a benevolent old man and he wouldn't hurt a fly.他是一个仁慈的老人,连只苍蝇都不愿伤害。
23 costly 7zXxh     
adj.昂贵的,价值高的,豪华的
参考例句:
  • It must be very costly to keep up a house like this.维修这么一幢房子一定很昂贵。
  • This dictionary is very useful,only it is a bit costly.这本词典很有用,左不过贵了些。
24 remunerative uBJzl     
adj.有报酬的
参考例句:
  • He is prepared to make a living by accepting any remunerative chore.为了生计,他准备接受任何有酬报的杂活。
  • A doctor advised her to seek remunerative employment.一个医生建议她去找有酬劳的工作。
25 justified 7pSzrk     
a.正当的,有理的
参考例句:
  • She felt fully justified in asking for her money back. 她认为有充分的理由要求退款。
  • The prisoner has certainly justified his claims by his actions. 那个囚犯确实已用自己的行动表明他的要求是正当的。
26 exertion F7Fyi     
n.尽力,努力
参考例句:
  • We were sweating profusely from the exertion of moving the furniture.我们搬动家具大费气力,累得大汗淋漓。
  • She was hot and breathless from the exertion of cycling uphill.由于用力骑车爬坡,她浑身发热。
27 nominal Y0Tyt     
adj.名义上的;(金额、租金)微不足道的
参考例句:
  • The king was only the nominal head of the state. 国王只是这个国家名义上的元首。
  • The charge of the box lunch was nominal.午餐盒饭收费很少。
28 indirectly a8UxR     
adv.间接地,不直接了当地
参考例句:
  • I heard the news indirectly.这消息我是间接听来的。
  • They were approached indirectly through an intermediary.通过一位中间人,他们进行了间接接触。
29 machinery CAdxb     
n.(总称)机械,机器;机构
参考例句:
  • Has the machinery been put up ready for the broadcast?广播器材安装完毕了吗?
  • Machinery ought to be well maintained all the time.机器应该随时注意维护。
30 surgical 0hXzV3     
adj.外科的,外科医生的,手术上的
参考例句:
  • He performs the surgical operations at the Red Cross Hospital.他在红十字会医院做外科手术。
  • All surgical instruments must be sterilised before use.所有的外科手术器械在使用之前,必须消毒。
31 inconvenient m4hy5     
adj.不方便的,令人感到麻烦的
参考例句:
  • You have come at a very inconvenient time.你来得最不适时。
  • Will it be inconvenient for him to attend that meeting?他参加那次会议会不方便吗?
32 defective qnLzZ     
adj.有毛病的,有问题的,有瑕疵的
参考例句:
  • The firm had received bad publicity over a defective product. 该公司因为一件次品而受到媒体攻击。
  • If the goods prove defective, the customer has the right to compensation. 如果货品证明有缺陷, 顾客有权索赔。
33 infelicitous M7kx0     
adj.不适当的
参考例句:
  • There are several infelicitous remarks in this article.文中有一些不贴切的措辞。
  • The infelicitous typesetting was due to illegible copy.错误的排版是由于难以辨认的拷贝造成的。
34 diminution 2l9zc     
n.减少;变小
参考例句:
  • They hope for a small diminution in taxes.他们希望捐税能稍有减少。
  • He experienced no diminution of his physical strength.他并未感觉体力衰落。
35 prospect P01zn     
n.前景,前途;景色,视野
参考例句:
  • This state of things holds out a cheerful prospect.事态呈现出可喜的前景。
  • The prospect became more evident.前景变得更加明朗了。
36 multiplication i15yH     
n.增加,增多,倍增;增殖,繁殖;乘法
参考例句:
  • Our teacher used to drum our multiplication tables into us.我们老师过去老是让我们反覆背诵乘法表。
  • The multiplication of numbers has made our club building too small.会员的增加使得我们的俱乐部拥挤不堪。
37 entirely entirely     
ad.全部地,完整地;完全地,彻底地
参考例句:
  • The fire was entirely caused by their neglect of duty. 那场火灾完全是由于他们失职而引起的。
  • His life was entirely given up to the educational work. 他的一生统统献给了教育工作。
38 minor e7fzR     
adj.较小(少)的,较次要的;n.辅修学科;vi.辅修
参考例句:
  • The young actor was given a minor part in the new play.年轻的男演员在这出新戏里被分派担任一个小角色。
  • I gave him a minor share of my wealth.我把小部分财产给了他。
39 pretext 1Qsxi     
n.借口,托词
参考例句:
  • He used his headache as a pretext for not going to school.他借口头疼而不去上学。
  • He didn't attend that meeting under the pretext of sickness.他以生病为借口,没参加那个会议。
40 questionable oScxK     
adj.可疑的,有问题的
参考例句:
  • There are still a few questionable points in the case.这个案件还有几个疑点。
  • Your argument is based on a set of questionable assumptions.你的论证建立在一套有问题的假设上。
41 publicity ASmxx     
n.众所周知,闻名;宣传,广告
参考例句:
  • The singer star's marriage got a lot of publicity.这位歌星的婚事引起了公众的关注。
  • He dismissed the event as just a publicity gimmick.他不理会这件事,只当它是一种宣传手法。
42 faculties 066198190456ba4e2b0a2bda2034dfc5     
n.能力( faculty的名词复数 );全体教职员;技巧;院
参考例句:
  • Although he's ninety, his mental faculties remain unimpaired. 他虽年届九旬,但头脑仍然清晰。
  • All your faculties have come into play in your work. 在你的工作中,你的全部才能已起到了作用。 来自《简明英汉词典》
43 expenditure XPbzM     
n.(时间、劳力、金钱等)支出;使用,消耗
参考例句:
  • The entry of all expenditure is necessary.有必要把一切开支入账。
  • The monthly expenditure of our family is four hundred dollars altogether.我们一家的开销每月共计四百元。
44 dignified NuZzfb     
a.可敬的,高贵的
参考例句:
  • Throughout his trial he maintained a dignified silence. 在整个审讯过程中,他始终沉默以保持尊严。
  • He always strikes such a dignified pose before his girlfriend. 他总是在女友面前摆出这种庄严的姿态。
45 indifference k8DxO     
n.不感兴趣,不关心,冷淡,不在乎
参考例句:
  • I was disappointed by his indifference more than somewhat.他的漠不关心使我很失望。
  • He feigned indifference to criticism of his work.他假装毫不在意别人批评他的作品。
46 adroitness 3a57832c80698c93c847783e9122732b     
参考例句:
  • He showed similar adroitness and persistence in strategic arm control. 在战略武器方面,他显示出了同样的机敏和执著。 来自辞典例句
  • He turned his large car with some adroitness and drove away. 他熟练地把他那辆大车子调了个头,开走了。 来自辞典例句
47 beholds f506ef99b71fdc543862c35b5d46fd71     
v.看,注视( behold的第三人称单数 );瞧;看呀;(叙述中用于引出某人意外的出现)哎哟
参考例句:
  • He who beholds the gods against their will, shall atone for it by a heavy penalty. 谁违背神的意志看见了神,就要受到重罚以赎罪。 来自辞典例句
  • All mankind has gazed on it; Man beholds it from afar. 25?所行的,万人都看见;世人都从远处观看。 来自互联网
48 impelled 8b9a928e37b947d87712c1a46c607ee7     
v.推动、推进或敦促某人做某事( impel的过去式和过去分词 )
参考例句:
  • He felt impelled to investigate further. 他觉得有必要作进一步调查。
  • I feel impelled to express grave doubts about the project. 我觉得不得不对这项计划深表怀疑。 来自《简明英汉词典》
49 lessen 01gx4     
vt.减少,减轻;缩小
参考例句:
  • Regular exercise can help to lessen the pain.经常运动有助于减轻痛感。
  • They've made great effort to lessen the noise of planes.他们尽力减小飞机的噪音。
50 perfectly 8Mzxb     
adv.完美地,无可非议地,彻底地
参考例句:
  • The witnesses were each perfectly certain of what they said.证人们个个对自己所说的话十分肯定。
  • Everything that we're doing is all perfectly above board.我们做的每件事情都是光明正大的。
51 lessening 7da1cd48564f42a12c5309c3711a7945     
减轻,减少,变小
参考例句:
  • So however much he earned, she spent it, her demands growing and lessening with his income. 祥子挣多少,她花多少,她的要求随着他的钱涨落。 来自汉英文学 - 骆驼祥子
  • The talks have resulted in a lessening of suspicion. 谈话消减了彼此的怀疑。
52 alluding ac37fbbc50fb32efa49891d205aa5a0a     
提及,暗指( allude的现在分词 )
参考例句:
  • He didn't mention your name but I was sure he was alluding to you. 他没提你的名字,但是我确信他是暗指你的。
  • But in fact I was alluding to my physical deficiencies. 可我实在是为自己的容貌寒心。
53 propriety oRjx4     
n.正当行为;正当;适当
参考例句:
  • We hesitated at the propriety of the method.我们对这种办法是否适用拿不定主意。
  • The sensitive matter was handled with great propriety.这件机密的事处理得极为适当。
54 incurable incurable     
adj.不能医治的,不能矫正的,无救的;n.不治的病人,无救的人
参考例句:
  • All three babies were born with an incurable heart condition.三个婴儿都有不可治瘉的先天性心脏病。
  • He has an incurable and widespread nepotism.他们有不可救药的,到处蔓延的裙带主义。
55 hesitation tdsz5     
n.犹豫,踌躇
参考例句:
  • After a long hesitation, he told the truth at last.踌躇了半天,他终于直说了。
  • There was a certain hesitation in her manner.她的态度有些犹豫不决。
56 distinguished wu9z3v     
adj.卓越的,杰出的,著名的
参考例句:
  • Elephants are distinguished from other animals by their long noses.大象以其长长的鼻子显示出与其他动物的不同。
  • A banquet was given in honor of the distinguished guests.宴会是为了向贵宾们致敬而举行的。
57 dexterity hlXzs     
n.(手的)灵巧,灵活
参考例句:
  • You need manual dexterity to be good at video games.玩好电子游戏手要灵巧。
  • I'm your inferior in manual dexterity.论手巧,我不如你。
58 allude vfdyW     
v.提及,暗指
参考例句:
  • Many passages in Scripture allude to this concept.圣经中有许多经文间接地提到这样的概念。
  • She also alluded to her rival's past marital troubles.她还影射了对手过去的婚姻问题。
59 entailed 4e76d9f28d5145255733a8119f722f77     
使…成为必要( entail的过去式和过去分词 ); 需要; 限定继承; 使必需
参考例句:
  • The castle and the land are entailed on the eldest son. 城堡和土地限定由长子继承。
  • The house and estate are entailed on the eldest daughter. 这所房子和地产限定由长女继承。
60 applied Tz2zXA     
adj.应用的;v.应用,适用
参考例句:
  • She plans to take a course in applied linguistics.她打算学习应用语言学课程。
  • This cream is best applied to the face at night.这种乳霜最好晚上擦脸用。
61 repulsive RsNyx     
adj.排斥的,使人反感的
参考例句:
  • She found the idea deeply repulsive.她发现这个想法很恶心。
  • The repulsive force within the nucleus is enormous.核子内部的斥力是巨大的。
62 savage ECxzR     
adj.野蛮的;凶恶的,残暴的;n.未开化的人
参考例句:
  • The poor man received a savage beating from the thugs.那可怜的人遭到暴徒的痛打。
  • He has a savage temper.他脾气粗暴。
63 dread Ekpz8     
vt.担忧,忧虑;惧怕,不敢;n.担忧,畏惧
参考例句:
  • We all dread to think what will happen if the company closes.我们都不敢去想一旦公司关门我们该怎么办。
  • Her heart was relieved of its blankest dread.她极度恐惧的心理消除了。
64 reluctance 8VRx8     
n.厌恶,讨厌,勉强,不情愿
参考例句:
  • The police released Andrew with reluctance.警方勉强把安德鲁放走了。
  • He showed the greatest reluctance to make a reply.他表示很不愿意答复。
65 sophistries f5da383d4c8e87609b099a040d0193f1     
n.诡辩术( sophistry的名词复数 );(一次)诡辩
参考例句:
  • They refuted the "sophistries of the economists". 他们驳斥了“经济学家们似是而非的观点”。 来自柯林斯例句
66 pointed Il8zB4     
adj.尖的,直截了当的
参考例句:
  • He gave me a very sharp pointed pencil.他给我一支削得非常尖的铅笔。
  • She wished to show Mrs.John Dashwood by this pointed invitation to her brother.她想通过对达茨伍德夫人提出直截了当的邀请向她的哥哥表示出来。
67 emphatic 0P1zA     
adj.强调的,着重的;无可置疑的,明显的
参考例句:
  • Their reply was too emphatic for anyone to doubt them.他们的回答很坚决,不容有任何人怀疑。
  • He was emphatic about the importance of being punctual.他强调严守时间的重要性。
68 impede FcozA     
v.妨碍,阻碍,阻止
参考例句:
  • One shouldn't impede other's progress.一个人不应该妨碍他人进步。
  • The muddy roads impede our journey.我们的旅游被泥泞的道路阻挠了。
69 lucrative dADxp     
adj.赚钱的,可获利的
参考例句:
  • He decided to turn his hobby into a lucrative sideline.他决定把自己的爱好变成赚钱的副业。
  • It was not a lucrative profession.那是一个没有多少油水的职业。
70 excellence ZnhxM     
n.优秀,杰出,(pl.)优点,美德
参考例句:
  • His art has reached a high degree of excellence.他的艺术已达到炉火纯青的地步。
  • My performance is far below excellence.我的表演离优秀还差得远呢。
71 legitimate L9ZzJ     
adj.合法的,合理的,合乎逻辑的;v.使合法
参考例句:
  • Sickness is a legitimate reason for asking for leave.生病是请假的一个正当的理由。
  • That's a perfectly legitimate fear.怀有这种恐惧完全在情理之中。
72 eligibility xqXxL     
n.合格,资格
参考例句:
  • What are the eligibility requirements? 病人被选参加试验的要求是什么? 来自英汉非文学 - 生命科学 - 回顾与展望
  • Eligibility for HINARI access is based on gross national income (GNI). 进入HINARI获取计划是依据国民总收入来评定的。
73 determined duszmP     
adj.坚定的;有决心的
参考例句:
  • I have determined on going to Tibet after graduation.我已决定毕业后去西藏。
  • He determined to view the rooms behind the office.他决定查看一下办公室后面的房间。
74 insinuate hbBzH     
vt.含沙射影地说,暗示
参考例句:
  • He tried to insinuate himself into the boss's favor.他设法巧妙地渐渐取得老板的欢心。
  • It seems to me you insinuate things about her.我觉得你讲起她来,总有些弦外之音。
75 franchise BQnzu     
n.特许,特权,专营权,特许权
参考例句:
  • Catering in the schools is run on a franchise basis.学校餐饮服务以特许权经营。
  • The United States granted the franchise to women in 1920.美国于1920年给妇女以参政权。
76 bounty EtQzZ     
n.慷慨的赠予物,奖金;慷慨,大方;施与
参考例句:
  • He is famous for his bounty to the poor.他因对穷人慷慨相助而出名。
  • We received a bounty from the government.我们收到政府给予的一笔补助金。
77 apprentice 0vFzq     
n.学徒,徒弟
参考例句:
  • My son is an apprentice in a furniture maker's workshop.我的儿子在一家家具厂做学徒。
  • The apprentice is not yet out of his time.这徒工还没有出徒。
78 extrinsic ulJyo     
adj.外部的;不紧要的
参考例句:
  • Nowadays there are more extrinsic pressures to get married.现在来自外部的结婚压力多了。
  • The question is extrinsic to our discussion.这个问题和我们的讨论无关。
79 injustice O45yL     
n.非正义,不公正,不公平,侵犯(别人的)权利
参考例句:
  • They complained of injustice in the way they had been treated.他们抱怨受到不公平的对待。
  • All his life he has been struggling against injustice.他一生都在与不公正现象作斗争。
80 industrious a7Axr     
adj.勤劳的,刻苦的,奋发的
参考例句:
  • If the tiller is industrious,the farmland is productive.人勤地不懒。
  • She was an industrious and willing worker.她是个勤劳肯干的员工。
81 cultivation cnfzl     
n.耕作,培养,栽培(法),养成
参考例句:
  • The cultivation in good taste is our main objective.培养高雅情趣是我们的主要目标。
  • The land is not fertile enough to repay cultivation.这块土地不够肥沃,不值得耕种。
82 unnaturally 3ftzAP     
adv.违反习俗地;不自然地;勉强地;不近人情地
参考例句:
  • Her voice sounded unnaturally loud. 她的嗓音很响亮,但是有点反常。 来自《简明英汉词典》
  • Her eyes were unnaturally bright. 她的眼睛亮得不自然。 来自《简明英汉词典》
83 apprentices e0646768af2b65d716a2024e19b5f15e     
学徒,徒弟( apprentice的名词复数 )
参考例句:
  • They were mere apprentices to piracy. 他们干海盗仅仅是嫩角儿。
  • He has two good apprentices working with him. 他身边有两个好徒弟。
84 legislative K9hzG     
n.立法机构,立法权;adj.立法的,有立法权的
参考例句:
  • Congress is the legislative branch of the U.S. government.国会是美国政府的立法部门。
  • Today's hearing was just the first step in the legislative process.今天的听证会只是展开立法程序的第一步。
85 fatigued fatigued     
adj. 疲乏的
参考例句:
  • The exercises fatigued her. 操练使她感到很疲乏。
  • The President smiled, with fatigued tolerance for a minor person's naivety. 总统笑了笑,疲惫地表现出对一个下级人员的天真想法的宽容。
86 attained 1f2c1bee274e81555decf78fe9b16b2f     
(通常经过努力)实现( attain的过去式和过去分词 ); 达到; 获得; 达到(某年龄、水平、状况)
参考例句:
  • She has attained the degree of Master of Arts. 她已获得文学硕士学位。
  • Lu Hsun attained a high position in the republic of letters. 鲁迅在文坛上获得崇高的地位。
87 rend 3Blzj     
vt.把…撕开,割裂;把…揪下来,强行夺取
参考例句:
  • Her scrams would rend the heart of any man.她的喊叫声会撕碎任何人的心。
  • Will they rend the child from his mother?他们会不会把这个孩子从他的母亲身边夺走呢?
88 asunder GVkzU     
adj.分离的,化为碎片
参考例句:
  • The curtains had been drawn asunder.窗帘被拉向两边。
  • Your conscience,conviction,integrity,and loyalties were torn asunder.你的良心、信念、正直和忠诚都被扯得粉碎了。
89 entrusted be9f0db83b06252a0a462773113f94fa     
v.委托,托付( entrust的过去式和过去分词 )
参考例句:
  • He entrusted the task to his nephew. 他把这任务托付给了他的侄儿。
  • She was entrusted with the direction of the project. 她受委托负责这项计划。 来自《简明英汉词典》
90 thoroughly sgmz0J     
adv.完全地,彻底地,十足地
参考例句:
  • The soil must be thoroughly turned over before planting.一定要先把土地深翻一遍再下种。
  • The soldiers have been thoroughly instructed in the care of their weapons.士兵们都系统地接受过保护武器的训练。
91 emolument opFxm     
n.报酬,薪水
参考例句:
  • The emolument of this profession is not satisfactory.此行业的报酬不令人满意。
  • Emolument management occupies a significant part in HR.薪酬管理在人力资源管理活动中占据重要的地位。
92 notation lv1yi     
n.记号法,表示法,注释;[计算机]记法
参考例句:
  • Music has a special system of notation.音乐有一套特殊的标记法。
  • We shall find it convenient to adopt the following notation.采用下面的记号是方便的。
93 statistical bu3wa     
adj.统计的,统计学的
参考例句:
  • He showed the price fluctuations in a statistical table.他用统计表显示价格的波动。
  • They're making detailed statistical analysis.他们正在做具体的统计分析。
94 prosecution uBWyL     
n.起诉,告发,检举,执行,经营
参考例句:
  • The Smiths brought a prosecution against the organizers.史密斯家对组织者们提出起诉。
  • He attempts to rebut the assertion made by the prosecution witness.他试图反驳原告方证人所作的断言。
95 phenomena 8N9xp     
n.现象
参考例句:
  • Ade couldn't relate the phenomena with any theory he knew.艾德无法用他所知道的任何理论来解释这种现象。
  • The object of these experiments was to find the connection,if any,between the two phenomena.这些实验的目的就是探索这两种现象之间的联系,如果存在着任何联系的话。
96 accurately oJHyf     
adv.准确地,精确地
参考例句:
  • It is hard to hit the ball accurately.准确地击中球很难。
  • Now scientists can forecast the weather accurately.现在科学家们能准确地预报天气。
97 noted 5n4zXc     
adj.著名的,知名的
参考例句:
  • The local hotel is noted for its good table.当地的那家酒店以餐食精美而著称。
  • Jim is noted for arriving late for work.吉姆上班迟到出了名。
98 exertions 2d5ee45020125fc19527a78af5191726     
n.努力( exertion的名词复数 );费力;(能力、权力等的)运用;行使
参考例句:
  • As long as they lived, exertions would not be necessary to her. 只要他们活着,是不需要她吃苦的。 来自辞典例句
  • She failed to unlock the safe in spite of all her exertions. 她虽然费尽力气,仍未能将那保险箱的锁打开。 来自辞典例句
99 investigation MRKzq     
n.调查,调查研究
参考例句:
  • In an investigation,a new fact became known, which told against him.在调查中新发现了一件对他不利的事实。
  • He drew the conclusion by building on his own investigation.他根据自己的调查研究作出结论。
100 imperative BcdzC     
n.命令,需要;规则;祈使语气;adj.强制的;紧急的
参考例句:
  • He always speaks in an imperative tone of voice.他老是用命令的口吻讲话。
  • The events of the past few days make it imperative for her to act.过去这几天发生的事迫使她不得不立即行动。
101 inquiry nbgzF     
n.打听,询问,调查,查问
参考例句:
  • Many parents have been pressing for an inquiry into the problem.许多家长迫切要求调查这个问题。
  • The field of inquiry has narrowed down to five persons.调查的范围已经缩小到只剩5个人了。
102 condemning 3c571b073a8d53beeff1e31a57d104c0     
v.(通常因道义上的原因而)谴责( condemn的现在分词 );宣判;宣布…不能使用;迫使…陷于不幸的境地
参考例句:
  • The government issued a statement condemning the killings. 政府发表声明谴责这些凶杀事件。
  • I concur with the speaker in condemning what has been done. 我同意发言者对所做的事加以谴责。 来自《现代英汉综合大词典》
103 destined Dunznz     
adj.命中注定的;(for)以…为目的地的
参考例句:
  • It was destined that they would marry.他们结婚是缘分。
  • The shipment is destined for America.这批货物将运往美国。
104 interfere b5lx0     
v.(in)干涉,干预;(with)妨碍,打扰
参考例句:
  • If we interfere, it may do more harm than good.如果我们干预的话,可能弊多利少。
  • When others interfere in the affair,it always makes troubles. 别人一卷入这一事件,棘手的事情就来了。
105 providence 8tdyh     
n.深谋远虑,天道,天意;远见;节约;上帝
参考例句:
  • It is tempting Providence to go in that old boat.乘那艘旧船前往是冒大险。
  • To act as you have done is to fly in the face of Providence.照你的所作所为那样去行事,是违背上帝的意志的。
106 volition cLkzS     
n.意志;决意
参考例句:
  • We like to think that everything we do and everything we think is a product of our volition.我们常常认为我们所做和所想的一切都出自自己的意愿。
  • Makin said Mr Coombes had gone to the police of his own volition.梅金说库姆斯先生是主动去投案的。
107 mazes 01f00574323c5f5c055dbab44afc33b9     
迷宫( maze的名词复数 ); 纷繁复杂的规则; 复杂难懂的细节; 迷宫图
参考例句:
  • The mazes of the dance were ecstatic. 跳舞那种错综曲折,叫人快乐得如登九天。
  • For two hours did this singlehearted and simpleminded girl toil through the mazes of the forest. 这位心地单纯的傻姑娘在林间曲径中艰难地走了两个来小时。


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