>£J NATIONAL LIBRARY OF MEDICINE Bethesda, Maryland THE MUTUAL BESPONSIBIILTIES O F PHYSICIANS ADD THE COMMUNITY. BEING AN ADDRESS TO THE GRADUATING CLASS OF THE MEDICAL COLLEGE OP THE UNIVERSITY OF MICHIGAN. DELIVERED March 27th, 1856. BY HENRY P. TAPPAN, D.D., LL.D. CHANCELLOR OP THE UNIVERSITY OP MICHIGAN DETROIT, MICH.: ISSUED PROM THE OIFICE OP PENINSULAR JOURNAL OP MEDICINE. FRIB PRESS PRINT. 1856. At a meeting of the Board of Regents of the University of Michigan, held March 27th, 1856, the following communication was received from the State Medical Association : University of Michigan, ? March 27th, 1856, $ Hon. Board of Regents of the University of Michigan : Gentlemen :—At a meeting of the State Medical Association, the following resolution was passed, viz; Resolved. That the Secretary pro tern, be requested to solicit of the Hon. Board of Regents, in behalf of this Association, the publication of 3000 copies of President Tappan's address to the Graduates of the Medical Department for distribution. Abram Sager, Sec. P. T. Upon motion, the request contained in the above communication was granted, and the number of copies above specified was ordered printed. A. WINCHELL.Sse. Chancellor Tappan: Honored Sir :—The Graduating Class, through their Committee, respectfully solicit, for publication, a copy of the Address delivered to them, at the Sixth Annual Commencement of the Medical Department of the University of Michigan. Respectfully yours, A. O. POTTER. ) ^A- THOMPSON, ( Committee. CHAS. h. SACKRIDER, ) Medical College, March 27,1856. THE MUTUAL RESPONSIBILITIES OF PHYSICIANS AND THE COMMUNITY. Gentlemen:—You have honorably completed the course of study of the College of Medicine in this University, and have received at our hands the diploma of Doctor of Medi- cine. In behalf of the Regents and the Faculty, I congratu- late you on this happy and, to you, important occasion. Years of arduous study have been brought to a successful termination, and you are now about to enter the world, to do your work in one of the most humane, noble, and responsible of the "learned professions." Before parting with you, will you permit one, who although not of the profession deems himself not altogether incapable of judging of its value and importance, to say a few words to you on the mutual responsibilities of physicians and the community at large? As one of the community, I may, properly, speak of their responsibilities; while, from my re- lation to you, I trust I shall trespass upon no propriety in speaking also of yours. In the first place, you are bound to make good the title of your profession—" a learned profession." The title "learned" was, originally, applied to the three professions of Theology, Law and Medicine, because, origin- ally, they composed all the professions which were supposed 4 to require the gifts of learning. In the Middle Ages, when they were fully and distinctively developed, the professors or teachers belonged also, generally, to these professions. In our age they claim, no less, to be learned professions, although sciolists may creep into them; and, certainly, they demand, no less, all the discipline and preparations of learning. And if we were to point out one of them as demanding, beyond the others, the basis of solid learning, as well as the unceasing prosecution of learned studies and investigations, we would point out the profession of Medicine as that one. In its wide reach, it lays almost all science and literature under contribution. Its history can be traced only by an extensive knowledge of languages. Its history and treatises can be written only by those who possess high literary accomplishments. If philosophy, in the strictest meaning of the word, be de- manded by any profession, it is demanded by one so inti- mately connected with both the physical, and the intellectual and moral constitution of man, with anthropology, and with the morbific and remedial agencies of nature. As to the exact sciences, if in any case they be required for the rigid and manly discipline of the mind where they cannot be directly applied in professional pursuits, then the medical student may not wholly discard them; for he, surely, should possess firmness and clearness of mind, and the ability to reason with an unerring logic. In the Inductive Sciences, no one will deny that the phy- sician finds his natural and appropriate field. Consequently the principles and methods of inductive investigation and reasoning should be familiar to him. By the daily duties of his profession, he is led to the nice and accurate observation of phenomena and the exact application of principles He is also invited to original investigations, and enjoys opportu nities of enlarging the boundaries of medical science, by add- ing to the facts upon which it is based. 0 N It is not necessary that I should attempt an enumeration of the sciences which are particularly comprised in the course of medical study. The whole range of natural science be- longs to the student of medicine; and since it belongs to him to deal with the diseases of the mind as well as of the body, and since the states of the one are influenced by the states of the other, psychology is his as well as anatomy and physio- logy. Indeed, Gentlemen, the fully educated physician must be a most scientific and accomplished man. And, in confirma- tion of this, I ask you, if the great lights and authorities of your profession are not recalled by you with pride, as men who have stood among the first in science and literature, and who are claimed by universal humanity, no less, than by you? I will here grant at once that there have been many useful and eminent practitioners of medicine who could lay no claim to a high rank in science and literature. I will grant, also, that in the present state of medical education in our country, and, indeed, of education in general, we cannot meet the wants of the community if we rigidly require of all medi- cal students to pursue this lofty and thorough course. Some men have great native tact, and grow rapidly by experience in what may be called the a/rt of medicine. And then the science of medicine is so old a science, and has accumulated such a mass of experience and of reliable authorities that the faithful study of books, a proper attendance upon the lectures of able men—the elite of the profession, and an apprentice- ship served under a skillful practitioner, do serve to initiate into the most necessary parts of the science and into the practice of the art. All this, as a matter of common sense and obvious expediency, I grant at once But then, I ask you, has not this science ready prepared to your hand, have not these reliable rules of art, these facilities and possibilities of becoming useful and safe physicians, been the result of profound science, of rigid and philosophic in- vestigation, and of the most varied learning somewhere f Was 6 it not necessary that there should be physicians possessing all that I have described as belonging to the profession, in order that the humblest practitioner might be accredited as measurably proficient in the art? aS'ay, as medicine is acknowledged to be a progressive science, is it not required that there should ever be men who square up to the highest standards of medical attainment? But where were the lights and authorities of your profession found, and how were they developed? Where shall they still be found, and how shall they still be developed ? Were they not found where the highest forms of education existed, and were they not developed by a laborious and long continued discipline in science and literature? Have not the great medical scholars of Europe, educated at European Universities with all the completeness which pertains to these institutions, laid the foundations of medical science? In the absence of original investigations, is not he, now, regarded as learned in the science, who has only mastered the books which these great men have written ? And is not he regarded as the wisest physician who abides by their principles, and walks in the light of their theories ? It is true of medical science as well as of all other sciences, that there is no royal road to it.' Great thinkers, deep and laborious investigators, mighty scholars, must do the work. Other men may enter into their labors, and avail themselves of their discoveries: but what would other men have done, had not these appeared as the guiding stars? And the places where these men appeared, at first, are the places where we still find them: and the same discipline which developed them, at first, is that which now perpetuates them. But, it may be said, that even at those celebrated institu- tions of learning all the students do not become eminent men- and that, indeed, it is not necessary that all should become Buch. Nevertheless, it would be no evil did all become emi nent men. Wide-spread perfection will lead neither to sick ness nor death, and will produce no disastrous convulsions. It were well if we all tried to be as perfect as possible. But there are two advantages belonging to these massive systems of education which must be obvious to a very little reflection: First, they afford the best and the only sure opportunities for the appearance of true scholars and great lights, in suffi- cient numbers to meet the wants of the world. These may spring up, and do occasionally spring up, as they sprang up, at first, before institutions of learning existed, without the advantages of early and exact training. But when these do appear under such circumstances, are they not always eager to find books, and to enter institutions of learning, although at a late period; and do they not honestly regret the inauspi- cious conditions under which they started upon their career? And if there be geniuses that by their own native strength can overleap the discipline of the schools, and, like Minerva, burst into the light full armed from the head of Jove, they are too few and far between to supply the demands of man- kind. We want abundance of machine shops, and that too of the best kind, or all our manufactures and our commerce by sea and land will soon come to a pause. We cannot trust here to solitary native ingenuity. It is just the same with educa- tion: we must have institutions amply furnished with the means of education, or we shall not have as many scholars and eminent men as we need. We say, therefore, give us the great and perfect institutions of learning, that all who please may try to become great scholars and great men. The world has never yet been over- run by them. Secondly, where the great and perfect institutions exist, all degrees of scholarship will be more perfect, inasmuch as the scale will be adjusted on higher principles and concep- tions of scholarship. 8 Ln the medical profession, as indeed in every other pro- fession, there will be, in general, two classes of men: First, the original thinkers and investigators—the men who advance the science and the art. These, comparatively, are the few, but the indispensable. Secondly, those who learn the established principles of the science, and become proficients in the art according to estab- lished rules. Now, it is plain that these, forming the great body of professional working men, ought to be most thorough- ly grounded in the principles, and to be disciplined to the highest possible skill in practical medicine. But where can this be so fully accomplished as in the most highly endowed and fm-nished institutions ? The institutions which afford to genius and talent the best opportunities for developing them- selves, must afford also the best advantages to every other grade of mental capacity. Nay, if we assume that the mass of mind, although good enough, is of what is usually called the ordinary stamp, then we ought to multiply the more our educational appliances: genius may overcome disadvantages, but men, in general, will turn out according to the circum- stances under which they are educated. One of the most remarkable and important features of a thorough and properly regulated system of education is that it saves both time and expense to the student. It saves time, because it begins in time, is adjusted to the capacity and wants of the mind, is logically arranged in respect to the order of subjects, and by conducting to a thor- ough mastery of each subject in proper succession, removes the necessity of retracing one's steps. Besides, it affords such a discipline in the art of study, and leads to such ample pre- paration at the beginning, that amid all the engagements of active life the habits and pursuits of the scholar are easily preserved, and a constant increase of knowledge is made without painful exertion, and without temptations to indo- lence. The foundations of thorough scholarship early laid make the scholar for life. ' 9 It saves expense, because it saves time, both in the pre- paratory education, and in the studies of after life. It will be found that in those countries where the best Universities exist, all the subordinate schools also exist in great perfection; and that hence the whole course of education is both more perfect and earlier completed, so that professional life is entered upon sooner than with us. With us, much time is lost to many for the want of early advantages, or in futile experiments under a variable and imperfect system. Suppose that there existed in our country a general system of public education, so that every boy until fourteen years of age would, by the natural operation of that system, be taught in the best manner possible; and that then, if so led by his tastes, or by the election of his parents, he could enter upon a higher discipline provided in the proper institutions, and pursue it up to a preparation for professional studies; and that after this, he could find institutions for scientific and literary, and for professional study, furnished with every means of the noblest education: Or, suppose that at eight or nine years of age he could be placed in an institution com- plete in every respect as a disciplinary institution, and there be educated without interruption up to the point of commen- cing professional or the higher scientific studies—see you not how many years which, now, many of us are compelled to look back upon as wasted, would be saved to us, and how much more methodical and finished our education would be? Instead of striving to gain this preparatory education by private efforts with great irregularity, or trying experiments at various schools established on various plans, and none, perhaps, organized according to just philosophical principles, what a noble system that would be which would save to the youth of our country some of the best years of human life, and enable those who enter upon professional study, to bring with them a rich and manly discipline! The establishment of such a system in our country is not beyond the bounds of possibility, for such a system does exist 2 10 in 6ome countries, and in those where we find those great lights and authorities we have spoken of, above. Xow, when I say you are bound to make good the title of your profession—"a learned profession"—I mean two things: First, that as educated men, you are bound to take the live- liest interest in the great cause of education in the communi- ties where you may-be called to reside, and to lend your in- fluence and exertions to build up such a system as we need. The difficulties which you may have encountered, teach you to sympathize with those who shall come after you; while your position, and the nature of your pursuits as professional men. naturally attract the expectations of the community, that you will lead the way in whatever tends to human im- provement. Besides, the dignity and vital interests of your profession, as well as of the other learned professions, are consulted in the general interests of education. Education is the basis of your worth, your success, your greatness. Secondly, I mean that during your professional life, you are never to cease to be students and men of science. The progress you have already made in science, of course, is not uniform. Some have made more; some less. You en- tered upon your medical studies with various degrees of pre- paration, and this has exerted an influence upon the sum total of your attainments. The course of study you have pursued in the Medical College, has initiated you into rich and important sciences, whether considered in relation to your particular profession, or in relation to the whole scope of human knowledge. Whatever, therefore, may be the sum total of your attainments, you have attached yourselves to the class, you have taken upon yourselves the name and responsibilities of scientific men. But scientific men may never remit observation and thought. Their duty to them- selves is to labor continually to increase in knowledge- their duty to science to labor to enlarge its boundaries. If your attainments up to this point are equal to your years, then 11 yon possess a vantage ground which instead of excusing you from the toils of the student, imposes upon you the obliga- gation while it cheers you with the promise of accomplish- ing the more. If you are conscious of many deficiences, then the true spirit of manhood will impel you, patiently and laboriously, to supply them. Your field is the world; in yourselves you have the working power; be faithful to your opportunities, and you cannot fail of a satisfactory re- sult. In addition to the general interests of science, you owe it to your profession to lead a studious life, and to approve yourselves men of thought and observation. The great distinction between the Empiric and the true Physician lies just here: The Empiric is not a man of science; or, if he has made acquisitions in science, in respect to his profession he forsakes a genuine scientific me'.hod. He experiments loosely and vainly; he runs after boastful, but unsupported theories; be becomes a man of mysteri.-*— a medicine man', he dreams of arcana which have never been discovered; and even seeks suggestions from familiar spirits. The true physician is really a physician—what the name indicates, a student and interpreter of nature. He will neither yield to theories, merely, because they are old, nor arbitrarily discard them, because they are new; but he will examine all with philosophical discrimination. He will ac- cept theories only as sustained by facts; and he will employ them as guides to farther investigations. With him, the simplicity of nature is grander than all mysteries. To him, the talk of nature with open face is more reliable than mut- terings from behind the veiled Isis. He is an inductive philosopher in spirit and in practice. He does not profess to know all the sources of disease, or to penetrate all its forms; but he avails himself of all the facts which have been col- lected, and seeks to collect more. He does not profess to have discovered specifics for all diseases; and is as far from 12 a panacea, as mechanicians are from perpetual motion. He simply aims to aid nature under the light of her known laws; and, instead of making rash experiments which must kill or cure, is content to sooth and meliorate where he sees no prob- able means of cure: To prolong the life that remains is better to him than to run the risk of extinguishing all life. The true physician is modest and cautious in proportion to his knowledge: The Empiric is bold and boastful in proportion to his ignorance; like the feathered bipeds from which he has gained an epithet, he quacks the louder as he has the less sense to convey. The very difficulties which necessarily attend the science of medicine—the fact that the nature, causes and cure of disease have never been perfectly known, and probably never can be, or that nature herself, perhaps, has not provided for absolute and universal health, nor contains absolute and universal remedies, give the Empiric all his advantages. He dares to assume what the wisest men have never yet found reason to believe; he dares to attempt what scientific observation and the widest experience have found no fact to support. The mystery of nature, he meets with an antagon- istic mystery which has no basis but his affirmation. He assumes to control the unknown by a power which he does not make known. Thus he addresses himself, at once, to the fears, the anxieties, the sufferings, the longings for relief, the despair of ordinary help, the superstition, the indefinite dreaming about mysterious potencies-to all the weakest and yet most excitable elements of human nature. The unreasoning sufferers failing to receive relief from the regular physician, because their cases may admit of no relief begin to doubt his skill: or, they grow impatient, because the treatment prescribed appears slow and doubtful in its opera- tion. Themy8t,ryinwhiciltneEmpiric ^ ^ or his sophistical reasonings respecting subtle powers in na ture, attended with confident promises of a speedy cirre and sneers at the impotency of the profession-form the vTry c0n 13 trast which is calculated to arrest attention and inspire hope. It is apparent caution, timidity and doubt contrasted with freedom, boldness and confidence. It is a contrast of what appear like inert and common place simples with mysterious and mighty potencies. The mystery and power of disease are met by the mystery and power of the remedy. Now, if the regular practitioner be a man who has only grasped the common-place rules of practice, and has neither original tact and insight, nor a familiar knowledge of the history of medical science and of the principles and methods of inductive reasoning, he can maintain but a feeble conflict with the bold and unscrupulous Empiric. But, if he be a man of true science, of various information, and one who can readily and familiarly expound and illustrate the valid me- thods of investigation and reasoning, he can call the Empiric to a stern account before the bar of public opinion, and must, in the end, expose his sophistry and chicanery. Good sense, sound learning and correct reasoning are the only weapons by which errors can be subdued; and no pro- fession needs them more than the medical. Deeply interested to become learned and skillful physicians yourselves, you cannot but feel, also, the liveliest interest in the schools which are designed to rear up learned and skillful physicians. There is no subject which has higher claims upon the medical profession in our country than the condition of our medical schools, together with the means by which they may be carried to the highest degree of perfection. That many of our schools have developed a limited and feeble discipline is a just subject of complaint on the part of the most eminent men in the profession. Students have been admitted to the study of medicine with a crude and inade- quate preparation; the course of medical study has been limited as to time, if not as to subjects, in a way that has rendered sound and mature scholarship impracticable; and a competition for students has been created among different schools which has often made a diploma appear like a pur- 14 chase by money rather than like a testimony of medical pro- ficiency and capability. The Medical College of this University claims to be one of the schools which are laboring to correct these evils. It pos- sesses peculiar advantages for effecting reforms and elevating the standard of medical education. Endowed by the General Government, this University is tempted, in none of its de- partments, for the sake of fees, to lower the standard of edu- cation and sell its diplomas to meet its necessities. Indeed, to establish a medical school here, with the ordinary require- ments, would be to abuse and waste our endowment. If we are to have a school like the schools of our country, in general, let it be supported as they are supported; and we will appr<> priate our funds to the higher object of providing for thorough education in the department of science and arts. But if our view be to establish a school on that solid basis, with those ample preparations, with those thorough courses of study conducted by eminent and devoted professors, which have made the great medical schools of Europe such an honor to the nations to which they belong, and such a benefit to man- kind, then we feel assured that we are making one of the most necessary and worthy appropriations of our endowment and one which claims the approbation of the State We look to the students who go forth from us to aid us in our endeavours. We have not yet reached the point at whi h we aim Why should not the medical school of the UnTvI Betake its stand beside those venerable institutions wheTe the great men of the profession have been nurtured? with such models before us, will it not be for the honor of the pi fession and for the honor of our count™ f„ . P come up to them} The .d^^^T^ ^ isthebeginningofreform. Have we not all ? T^ thi. I May we not hope that weTve l!d !! ' *"?"** You may have done well, GentleTen ^tn TbT ^^ ties afforded in our country, you ^IT"^^ can you not conceive of a divine which you n w, w*h 15 had been yours—which, begun earlier, would have given a more rich and varied training, and which would have brought you to this point, more learned, more cultivated, more accom- plished in all that belongs to the id«al of a physician ? What you may have lost through circumstances beyond , your control, will you not combine your efforts to create for those who shall come after you ? Do you not owe it to your profession; do you not owe it to the community to make it one of the cardinal duties of your after life to give your thoughts and influence to this important interest of medical education, both that our country may be supplied abundantly with eminent practitioners, and that we too may raise up great lights and authorities in medical science? I have been led farther on this branch of my subject than I anticipated; and yet, compared with the magnitude of the topic, I have said but little: I have only made some sugges- tions, and there I must leave it. The other responsibilities which rest upon you, are various and of a serious and interesting character. I would that some aged, wise and gracious physician, of fifty years' study and practice, stood before you to talk to you about these responsibilities. What would he say to you? Me thinks he would say to you, first of all: Kemember that your profession is eminently a benevolent one, and that you are bound to be true to its character. You must, indeed, claim a remuneration for your services. Every man must find his living by his profession, or he cannot do service to the world. Every man doing service to the world, is both entitled to his living, and to rewards proportionate to the value of his services. All this is plain enough. What we mean is that, when a profession in its very nature is bene- volent, so that every duty of it well performed aims directly at the benefit of another, he who exercises it, should himself be permeated by its governing spirit, and realise in his own consciousness that he is appointed to relieve human suffering and to diffuse blessings on every side. The Empiric is ready 16 to sacrifice his patient to his gains. His sole aim is to get money. He trades in pretension, deception, and lies. The true physician, while he finds a scientific interest in his pro- fession, feels his heart warmed to the sufferings of his fellow men, and goes about to alleviate and to heal. It is a remarkable fact that the most benevolent being who ever appeared in our world, introduced himself to mankind as a good physician, and healed the sick while he preached the gospel to the poor. The good physician, while seeking patients among those who can pay him, as his own necessities demand, will not refuse the applications of the poor. To the extent of his ability, he will relieve suffering wherever it meets him. In this, too, he will, soon or late, meet with his reward; for, the prayers and blessings of the poor will be like the rain and sunshine of heaven upon him. Avoid the reputation of ex- action and oppression, as you would avoid your worst enemy. You are appointed to the walks of mercy: be true to your vocation, and human hearts and God's providence will be true to you. In the second place, this old and good physician, whom I have imagined to be addressing you, would, me thinks, say to you: Cultivate the spirit, the honor and the manners of gentlemen. Who does not love that good old word, gmOmum? Who does not reverence what it conveys? It is no monopoly of femriy, wealth, or station: it is simply a cultivated, refined and proper hnmamty. It „ not a plant growing, only, nnder the shadow of monarchies and in the gardens of ari Lracv Crr^dflowrnat™ ■**-* <££% xopes to its full luxuriance and perfection Ti^ t ^ the leadpr nf fV,Q a Flection. Thomas Jefferson, ssriSisrj'ra reman- ^^ Benjamin Rush,the paWairf Zl ' "V f^^ a gentleman. American physicians, waa 17 The human soul is a worthy thing: it is all that makes us men. That human soul imbued with knowledge and the principles of truth, wisdom and goodness, and refined by genial culture, becomes the soul of a gentleman. The con- dition of the soul, within, gives its expressions, without, in the attitudes and movements of the person, in the looks of the countenance, in the forms of speech, in the very tones of the voice, and in the habits of daily life. A gentleman can- not be made by dress, by pretension, by assumed airs of con- sequence and gentility, by the affectation of refinement, or by attempting to conceal, under freedom and ease of manner, the vulgarity and rudeness which reign within. Perfection of manner demands perfection of grace; and yet grace of manner may be gained, by associating with the world, with- out any grace and goodness of heart. And, although, awk- wardness is never desirable, a man awkward through natural timidity may, nevertheless, be a true gentleman. He may be awkward, but he will never be uncourteous, coarse and rude. One who is called to mingle with all varieties of people, like the physician, will open human hearts, inspire confidence, scatter sunshine, and win his way, by being simply a gentle- man. And then the honor of a gentleman—what a glorious thing is the honor of a gentleman! You may pile upon a man any amount of learning and cultivation; you may give him the highest talents, the greatest professional skill; you may even clothe him with a religious profession; and yet, if he have not the honor of a gentleman, he is not to be trusted. No profession demands more of this fine quality than that of a physician; for, no man is admitted into such intimate and confidental relations. He dwells among our Lcvres, and is like one of them. He comes to us when caution is dis- armed by affliction. He enters our domestic sanctities. The sources of disease are often domestic and mental troubles; and we may be compelled to make known to him what we 3 18 would conceal from our nearest friend, and to allow him to converse with our secret consciousness. We receive him as we would receive an angel of God, that he may do us good. If we can only feel assured that he has the honor of a gentle- man, we feel assured that we are safe. The honor of a gentle- man is the truest seal of manhood; and he that has it will sooner die than betray a trust, take advantage of confidence, or do any mean or unworthy act. The man who has it, has it as the very life, element and inspiration of his being: he is morally incapable of a dishonorable act. This fine quality hath in it much of native disposition, and often appears like a gift; and yet, like all qualities of human nature, may be cultivated and perfected. The physician should assure him- self of it. The community will soon come to know whether he has it or not. Cunning and dishonesty do, sometimes, prove successful in trade, but honor is the only safe capital for a physician. Such, I believe, would be the language of any worthy and experienced member of your profession. But when we speak of this unimpeachable honor, do we not imply that keen moral sense which would seem naturally to develope itself into all that is pure in morals, and sincere and holy in religion? Are we not therefore to expect of a physician that he shall be the friend of morality and religion, and lend all his influence in supporting them ? Happy is he who can unite with that professional skill which relieves dis- ease, with those gentlemanly manners which breed attraction, with that unsullied honor which wins confidence, the spirit of a sincere and devout christian! The physician dwells with those who are hovering on the borders of eternity. He is ever among the sick and the dying, and the lamentations of the bereaved are continually falling upon his ear He keeps "watch o'er man's mortality." Firmness, coolness and cheerfulness he must have, for these qualities are necessary to a proper discharge of his duties, and exert over the sick a recuperative power. But should he not, also, have the religi- 19 ous tenderness and sympathy which would lead him to point the eye of the dying to the cross of Christ, and to show the afflicted the living waters of consolation ? In fine, gentlemen, the responsibilities of a physician per- tain to science, truth, honor, goodness, morality and religion. It remains for us to offer some remarks upon the responsi- bilities of the community in relation to the medical profession. This profession has appeared under three forms: the Ma- gical, the Empirical, and the Philosophic and Kational. The mystery attending the nature and causes of disease, in rude and superstitious ages, or among a rude and supersti- tious people, has led to the belief that disease is attributable to supernatural and demoniacal agencies exerting themselves either directly, or through human ministers, such as wisards and witches. Hence, arose supernatural modes of treatment, by charms and spells; and the physician was the mighty magician who could control the malignant powers. Number- less are the legends and stories of witchcraft and magic that might be recited to illustrate the weakness and folly of man- kind. This weakness and folly do not seem even yet to have wholly subsided, since spirits, in our day, if they do not in- flict diseases, do at least rap out recipes. The Empirical form has several phases. There is, first, the simple herb-doctcrmg of the multitude. This has the merit of being, generally, innocent, and may often prove beneficial, since accident, sometimes, leads the rudest men to important discoveries. The abuse lies in prescribing what may have been beneficial in one or more cases as a panacea, and in making a merit of ignorance, because the ignorant stumbled upon a good thing. There is, secondly, the mixture of herbs with magical in- cantations, such as we see in the case of the medicine men of our aborigines. Indian doctors were once in great repute, and, perhaps, may yet be found perambulating certain parts of our country. It is questionable whether all Indian Doctors are Indians; but the association of the title in the minds of 20 the vulgar with mysterious knowledge, has led many Empirics to adopt it The search after the Elixir of Life is a phase of Empiricism long since exploded. But we have many approximations to this in elixirs and pills which profess to be infallible cures for all diseases. The nature of these compounds, is, of course, concealed for the benefit of the inventors. They are thus, too, rendered more popular: they have the charm of mystery; and in the unknown, the imagination is left free to dream of mighty potencies. Wonderful cures are proclaimed by means of the press; and, sometimes, theories of disease and an ex- planation of the mode of the operation of the medicine are appended. It is common, also to warn the public against Empirical counterfeits, very like the thief who escapes by crying thief. The success of these impositions is shown by palaces erected in our great cities, and by estates created upon our great rivers. Thus the most ignorant and reckless Empiricism prevails by the sophistry of reiterated assertion and by the boldness of its lies. If thousands are physicked out of life, the Empiric lives on in splendor, gains conse- quence by his wealth, and even takes his place in the halls of legislation. It is not necessary, however, to conceal the nature of a medicine in order to constitute an Empiricism. The Em- piricism may consist in the theories of disease, and of cure propounded. All theories are Empirical which do not obey the laws of induction: and as men generally are not sufficient- ly acquainted with these laws, they are prone to conclude that theories are probable, because they are ingenious, and that facts are relevant, because they are plausibly affirmed to be so. There is a sophistical as well as a mystical Empiri- cism. The first covertly violates induction: the second de- fies it. Opposed to all these errors, is the philosophic and rational science of medicine. This is true, simply, because it obeys the laws of induction. It has a common basis with other \ 21 Bciences which are received to be true. How far induction has succeeded in establishing a science of medicine, is a question by itself. The science of medicine, so called, is really a complication of sciences, some of which are firmly estab- lished. The particular points of difficulty are the theory and practice of medicine, Pathology and Therapeutics. But these, as far as established, are established only by the true inductive method. They can be legitimate only as based upon scientific observation and experiment; and when they call in other sciences, the principles of these sciences may not be violated. Now, to whom shall we look for a reliable medical science? Shall we look to him who deals in charms and spells ? Shall we look to the rude Empiricism of the unlearned ? Shall we look to the Indian root doctor ? Shall we look to those who, without any claims to be scientific, compound elixirs, pills and panaceas—men who unacquainted with anatomy, phy- siology, chemistry and botany—ignorant alike of nature and of man—mix drugs at random, and have no merit but that of exciting the imagination of the unthinking by the mystery under which they conceal their shallowness, or their atrocity ? Shall we look to subtle theorists who, although not without learning, have forsaken the only safe methods of investiga- tion, and are led astray by imaginary facts, and dream of potencies yet undiscovered, and voiceless intangible serial agencies? Or, shall we look to those old established schools where learned men and true philosophers have ever been found? At these schools there is neither sciolism nor mysticism. Here, scholarship is thorough, and fact is not outrun by spe- culation. Here, medical science has been advanced in com- pany with the other sciences, and by the same methods, and, often, by the same men. If genius, learning, philosophical conception, legitimate investigation, and the utmost diligence with all the aids that have hitherto been collected in our world, can meet with any success in any region of enquiry, 22 then we must go to these schools to find the results. If the medical schools of London, Edinburgh, Paris, Berlin, Munich and Vienna cannot give us a medical science, then we have none. If their discipline cannot make reliable physicians, then our world is destitute of them. But the medical schools of our country have been estab- lished on the same basis with these eminent foreign schools, so far as the science, the method, and the aim are concerned. We differ from them, only, in falling short of them in the degree of our development. They are our models, and we shall perfect our schools only by squaring up to them. And we may, therefore, say that if a proper medical education is to be found in our country, it must be looked for in our me- dical schools; and if we do not make reliable physicians, here, we do not make them at all. Do any find fault with our schools? Then let them aid us to perfect them. Try not to pull them down. There is nothing to put in their place. Improve them as much as you please; lend every effort to bring them up to the ripest development. You cannot change the science, the method, the aim, without annihilating them, and with them annihilating all medical education. Do any find fault with the Doctors of Medicine we send forth ? Then let them insist upon a higher education, or more thorough discipline, a longer term of study. Let them claim that our Doctors of Medicine shall be as accomplished as those who are reared in the great European schools. Let them create a public opinion that shall stimulate, aid, and foster us, by demanding of our candidates the amplest pre- paration. But, let them not abet the magicians, the spirit- rappers, the ignorant or unprincipled Empirics, the wild and loose theorists of all kinds. We, at least, are on the right track. We are trying to do some good in a legitimate way. If our Eagles do not fly near enough to the sun, do you find any thing more like the birds of Jove among the quackmg brood in the marshes below % • 23 Here, then, we see at once the responsibilities of the com- munity in respect to our medical schools and the legitimately educated physicians. Every man is at liberty, and we must concede to him the right to try all sorts of physicians, and to take all kinds of medicine. Some have claimed that a man has the right to com- mit suicide: at least, it is certain he will neither be hanged, nor imprisoned, if he do. But, in a world like ours, where mysticism and Empiricism have reigned so long, and still prevail to such a fearful extent, is it not incumbent upon all prudent and philanthropic men, upon all good citizens, to pause and reflect upon the folly and the consequences of turning away from systems and from men connected with true scientific methods and aims, to patronise the remorseless charlatan, and the ignorant or visionary Empiric ? It cannot be our duty or our interest to favor the last. It would be more wise and consistent to renounce doctors altogether, and " throw physic to the dogs." If we will have doctors, if we will take medicine, let us go where the probabilities clearly predominate; let us repose confidence in the men who have some title to show for it. Buy not the bottles and the boxes whose labels vauntingly promise results, but dare not explain their contents. Be, at least, as prudent in buying medicines, as you are in buying flour and meat, where you first assure yourselves of the qua- lity. Be, at least, as prudent in choosing a physician, as you are in choosing a tailor and a shoemaker, where you first satisfy yourselves that he is a proper workman, and no bung- ler. What is the madness which impels us to run such fear- ful risks of health and life? And when you have chosen a physician thoughtfully and judiciously, and know that he has talent, tact, education, ex- perience, kindness, truth, honor and morality, treat him accordingly. Kepose confidence in him. Submit to his skill and discretion in your sickness. Do not call him in, merely, to hear your own views of your case, and to share the respon- 21 sibility of your own Empiricism. Let him be fully, truly and wholly your physician. If results do not come as rapid- ly as you desire, do not dismiss him to try new experiments. His judgment must be better than your own. You may die in his hands, it is true. But what grounds have you for be- lieving that you will better your case by calling in another man, or by resorting to an Empirical practice? We must all die at last; and the very change you make to elude your fate, may be an act of imprudence which seals and hastens it. It is your right to ask for consultation; but respect the judgment and wishes of your physician in the selection. Treat honorably your good and tried physician. Recollect his interests are your interests. And when health returns, be grateful to him. Grudge him not his equitable fees, and delay not their payment. The man who has been instrumental in saving your life, in re- storing to you the blessed sensations of health, has done more for you than if he had given you an estate. What will not a man give in exchange for his life ? The relation between the physician and his patient is one of the most confidential, generous, tender and interesting of all human relations. A friend, a father, an angel of mercy, a superior protecting nature—he is to his patient. A suffer- ing, helpless, trustful child the patient is to him. It is a re- lation in which the noblest and purest sympathies, and the most benevolent and hallowed duties are called into existence and exercise. A good physician and a good patient present something so true and faithful, so tender and trustful, that we are tempted to believe that one of the moral ends of sick- ness is to constitute a relation in which some of the highest and most beautiful forms of character can be nurtured. Gentlemen: in taking upon yourselves the duties and responsibilities of one of the worthiest professions, may you be enabled fully to estimate these duties and 'responsibilities. May you imbibe the spirit and copy the example of the great and good men who in all ages have made the name of phy- \ 25 sician a title of honor, and the symbol of all those virtues which heal the evils of mankind. In the exercise of your merciful vocation, may you follow in the steps of that greatest of all physicians, "who went about doing good," and counted it " more blessed to give than to receive." May it be your lot to find good patients, the gratitude of whose hearts shall reward you most of all, although other rewards be not stinted. May you live the lights of your profession, and the friends and furtherers of all public good. And, finally, when you, in your turn, shall need a physi- cian, and find none to heal you, may you submit to die, -----" Sustained and soothed By an unfaltering trust----- Like one who wraps the drapery of his couch About him, and lies down to pleasant dreams." b Do K^- .VSj,