(fM. LA-a^-<^ \&^\s^Li$A*<^«*-^a^ ~^f- -^4- -^. ^. yc ^-..r.V ihV THE TRUE PHYSICIAN. AN ANNIVERSARY DISCOURSE DELIVERED BEFORE THE NEW YORK ACADEMY OF MEDICINE, NOVEMBER 7, 1860. JOHN WATSON, M. D. PRESIDENT OF THE ACADEMY. irno$ PUBLISHED BY ORDER OF THE ACA DEMY. ' NEW YORK: SAMUEL S- «fe WILLIAM WOOD, 889 BROADWAY. 1860. ANNIVERSARY DISCOURSE. Fellows of the Academy of Medicine : Philosophers and men of science are sometimes said to have lived in advance of their epoch. The remark may convey sufficient truth to war- rant its acceptance; and yet it is never to be re- ceived without reserve. So far as his peculiar tal- ents, acquirements, inventions, or discoveries carry him, the philosopher or man of science may be in advance of others ; but he is never so far in advance as to be wholly above the influences of the age in which he lives. Socrates, about to suffer for his exalted faith in a Supreme Being, is consulting his familiar demon ; he offers his libation from the fatal bowl, and with his latest breath orders the sacrifice of a cock to iEsculapius! Bacon, the founder of inductive philosophy, with all his intellectual pene- tration, conforms to the spirit of a venal age, and bar- ters his judicial decisions for a bribe. Luther, while fulminating against the superstitions of the Church, yields to the grosser superstitions of his country- men. Water-imps, and changelings, substituted by the Evil One for the infants which he was believed 4 THE TRUE PHYSICIAN. to have carried off, were, with Luther, no mere fig- ments of the imagination. Thus it is that the spirit of the age,—the extrin- sic influences of time and place,—are continually moulding the opinions, habits, and prejudices, even of the most enlightened. Our spontaniety is little else than the reflex influence of external impressions. " God never made an independent man." We grow up, and increase in knowledge, or yield to ignorance, under the institutions, the example, and usages of those around us. The judgment essen- tial to turn these influences only to good account for the elevation and refinement of our better feel- ings and faculties, is the gift of comparatively few. The mass of men, indeed, may in some respects be said to exercise no judgment at all. They fall in with the habits and opinions of the community in which they live as readily as with their costume; and, having with but little thought adopted these, are with as little reason forward to uphold them. The liberalizing agency of a thorough education, intercourse with men of all classes, frequent commu- nication with those who are opposed to us, and opportunity of studying the character and institu- tions of different nations, may do much to obviate the evils of social, professional, partisan, or personal prejudice, but will not always be sufficient to over- come them. To be thus unduly biased, the members of the medical profession are as liable as other men. We see, in fact, how readily many of them fall in with THE TRUE PHYSICIAN. 5 false pretenders, and with novel doctrines, however crude. Every new discovery, every newly-devel- oped principle in science, has its counterpart in med- ical hypotheses. The whims of influential practi- tioners, the caprices of popular instructors, are received as important truths, and acted upon as such by their admiring disciples. Theorists and speculators are thus continually rising to notoriety, who, with all their assumption, are as little worthy of consid- eration as those charlatans of ancient times, who, as we learn from Hippocrates, were like unskillful pilots, whose ignorant maneuvers, in fair weather and in an open sea, are of little consequence ; but who, when the tempest rages, are unable to direct the vessel's course, or to recognize the quicksand or the shelving rock in time to avert the catastrophe that awaits them. Of such as are unhappily misled by these, it may be said, as was said by Thucydides of his countrymen, the Athenians, while struggling for life against the avenging arms of Syracuse : " When they might have been saved by human means, after visible hopes have failed them, in their distress they betake themselves to such as are invisible—to proph- ecy and oracles, and all such things as bring men to ruin, together with the hopes resting upon them." But our object on the present occasion is not to dwell on the weaker points of human nature, nor on those false pretenders who claim to belong to our own body; but rather to call attention to those characteristics, natural and acquired, which distin- guish the acute medical observer, enabling him, in 6 THE TRUE PnYSICIAX. the study and treatment of disease, to avoid those errors by which the unwary are misled; to walk with steady step where the pace of the less gifted is faltering and insecure ; to discern the light where others grope in darkness; and to discover hope of safety where, to others, all is discouragement or de- spair. * It is our privilege to know that men of this stamp have been, and are still, amongst us ; and that, notwithstanding the many idols before which medi- cine from age to age has offered incense, there have ever existed believers in the true principles of their divine calling—men of thought, of earnest inquiry, of hopeful perseverance—who, like Hippocrates, Aretseus, Guido de Cauliaco, Pare, or Sydenham, without neglecting the sciences of their day, have drawn the first principles of their profession from the study of the human frame in health and disease, and, combining the knowledge thus acquired with such information as could be collected from other sources, have founded their curative indications on reason and experience. With fitting opportunities and careful study, most men may learn to recognize the ordinary forms of disease, and to distinguish these from one another; but the power of detecting diseases in their obscurer shades, at seasons and under circumstances uncom- mon to them, when latent, complicated, perverted, or masked by their concomitants, belongs, as'a spe- cial gift, only to the well-trained practical observer. Skill of this kind, in its highest degree, is never THE TRUE PHYSICIAN. 7 the result of education merely. It is no simple acquisition of the class-room. It is never reached through the abstract study of logic or philosophy. But, whilst it implies careful preparation, and a fair amount of practical training, it implies, beyond these, something proper to the individual: a mind imbued with the love of truth, and with zeal'in its pursuit; a judgment quick, accurate, and discrimin- ating ; habits of investigation, of intense reflection, of looking beyond appearances to things as they are ; disposition and ability to win and secure confi- dence ; powers of combination, of comparison, and analysis; insight into ruling motives; a knowledge of the world, and especially of the habits, circum- stances, language, and expressions of the sick; and, added to all these, a ready perception of the ever- varying phases of disease, their import and tend- ency, as well as of the agencies, immediate or remote, that modify or induce them. The full enjoyment of these several qualifications is, perhaps, never within the reach of a single indi- vidual. Perfection is to be conceived by us, rather than to be seen. The beau-ideal of the human form embodied in the Apollo Belvidere, or in the Venus de Medici, is the combined transcript of excellencies from many quarters. And in our contemplation of medical acumen we must treat of this, too, as an abstraction, the traits of which are to be collected and set together from numerous individual sources. The skillful investigator of disease must, in the first place, have received a competent education. Now, the training most proper for the practi- 8 THE TRUE PHYSICIAN". tioner of medicine has long been an unsettled ques- tion. The solution of this question, however, as bear- ing on the subject before us, is of little moment. It could supply at best only an index to the lowest point of acceptable preparation. The training for the higher duties of the profession commences at this point—at the close of preparatory study—and is effected, if ever, only after years of watchful ob- servation. The art of medicine is still progressive; its limits of to-day may to-morrow need extension. The sciences subservient to it are still upon the in- crease. Whole sections of these, within the past few years,have been for the first time opened and explored. With continual growth in the medical sciences, the requirements of the schools, whatever be their pres- ent limitation, must sooner or later undergo revision. Such has hitherto always been the case. But, pass- ing from these requirements to the question at large, whatever system of education be adopted, it should be sufficiently ample and prolonged to familiarize the student with every branch of knowledge essen- tial to the exercise of his art, and to give him equal rank with men of liberal education in other walks of life. High attainments in medical literature, though not so essential as a thorough knowledge of first principles, supply, nevertheless, important guards against error. By a judicious plan of reading, the aspirant to the profession extends his views beyond his own school, beyond his time and country; traces the rise and progress of opinions ; sees the growth of THE TRUE PHYSICIAN. 9 truth, the delusive and ever-varying tendency of hypotheses; and, aware of what has been effected by his predecessors, is the better able to appreciate the labors of his contemporaries, and, in his own due time, to increase the general stock of knowledge by contributions of his own. His reading is not pursued with the pointless aim of the litterateur, nor with the mole-eyed vision of the antiquary. He has a practical object in it, and prosecutes it with most effect in connection with some given topic on which he looks to written authority, as well as to nature herself, for full and definite knowledge. In his choice of books, he is confined to no age or nation ; and yet, husbanding his time and means, he has little regard for dubious 7 O t authorities, for the mere retailers of other men's viewTs; preferring the ablest originals—the works of those who have thought and observed for them- selves—who have by their own labor extended the boundaries of science, or bequeathed to posterity from earlier ages the ablest expositions of the medi- cine and associated sciences of their times. But, whatever be his professional acquirements, the stu- dent desirous of high rank in his calling can never afford to overlook those accomplishments wrhich fit him for his position as a gentleman and man of prin- ciple, which are his best introduction to easy and familiar intercourse with the world, and especially with those most able to appreciate him properly, whose friendship and esteem should be most worthy of his choice. In the second place, the habits of close study 10 THE TRUE PHYSICIAN. contracted during pupilage are afterwards to be continued. They are as essential to success in the field of original inquiry as in the preparatory exer- cises of the Pala?stra. We rely on them for light in examining the suggestions and performances of our compeers, as well as for guarding against error in our own investigations. Exalted attainments are within the reach only of those who have at heart the advancement of knowledge, and whose zeal is active, watchful, and undeviating. It is not always necessary to success, as the secluded practitioner is too apt to believe, that the close observer should enjoy unlimited advantages. The Pathological Researches of Abercrombie were not the product of hospital experience. With the desire to enrich the profession by the careful and well-digested record of facts, he found the means of effecting his object where others have too often overlooked them—in the walks of private practice. Scarpa, who did so much for surgery, lived in a small town. Allowing no opportunity of investiga- tion to escape him, he contributed much to elevate his art, and has thereby secured a name not soon to be forgotten. It does not appear that Sydenham ever officiated as an hospital physician. Galen, though for a time a resident of Rome, owed his rep- utation to the studies of his earlier years in Asia Minor. Hippocrates was never long the inhabitant of a great city, but spent most of his life on the small islands and among the rural districts of Greece. Amid the rush of business, with important facts con- tinually crowding each other before our eyes, there THE TRUE PHYSICIAN. 11 is no leisure for minute investigation. It is by the close and careful study of single cases, rather than by the illimitable opportunities of hospital experi- ence, that the judgment is ripened and the art of medicine improved. But whatever be the aptitude, zeal, or opportu- nities of the medical inquirer, his course, to be successful, must be persistently aided by artificial means. Among these, the first and most essential is the case-book, for the full and faithful registry of his own experience. Nulla dies sine linea. The habit of recording facts as they occur is the strongest incentive to their close and accurate examination. By disregarding this habit, and trust- ing for direction to the inspirations of the moment, the practitioner at length finds his powers of observ- ation blunted. The very accumulation of facts, half studied, may in time render his judgment wavering and confused, so that, when called upon for an exact and orderly exposition of his knowledge on any point, he may be unable to give this, or to render a sufficient reason for his opinions. Isolated observa- tions, which at the moment appear trifling, may, if properly recorded, lead to important generalizations. The summing up of such led Harvey to discover and demonstrate the circulation of the blood, and Jen- ner to detect the prophylactic powers of kine-pock. The truths most worthy of notice are such as bear directly upon our own pursuits. But the intellect is sometimes sharpened by the study of others of a kindred nature. Jenner might have treated as idle 12 THE TRUE PHYSICIAN. tales the statements received from the dairymen of Gloucestershire, had his talents as an observer not been previously quickened by experimental researches in natural history, or had he not at the time been actively engaged in studying the habits of the cuckoo. But, as a general role, multiplicity of pursuits is unfavorable to high attainments in any calling. The domain of the sciences accessory to medicine is, at present, more than sufficient for thorough mastery by any single student; and the practitioner who is satisfied with nothing short of deep research in whatever he attempts will hardly undertake the whole of them. The time has come for the division of labor. We must hereafter take some portion of our knowledge upon trust, and concentrate our force upon those studies to which our talents, inclinations, interests, or opportunities direct us. " Let your zeal and industry," says Sir Astley Cooper, " be un- bounded. Be an excellent anatomist, and under- stand well the duties and practice of your profes- sion." But to this he adds, " Bend the force of your mind to some useful object; and be not multifarious or vacillating in your pursuits " In the study of disease, nature is usually the ex- perimenter, and the physician the interpreter of her action. But there are truths to be ascertained only by active interference with her secret processes, and by taking the business of discovery or demonstra- tion into our own hands. The first, or passive mode of inquiry, demands patience and assiduity in the THE TRUE PHYSICIAN. 13 collection of facts; accuracy, fullness, and discrim- ination in recording them; powers of combination, of selection, and analysis, in contrasting, weighing, and generalizing them. But in the second, or active method, to the exercise of these several faculties must be joined tac5 and ingenuity in projecting new researches, and practical dexterity in their execu- tion. The latter method, though often indispensa- ble, is not always the most reliable ; and its results, if possible, should always be confirmed by collate- ral evidence obtained from other sources. The two methods must be occasionally combined; and the ability to combine them successfully is among the higher characteristics of the accomplished investi- gator. In the study of hidden truth by either method, but particularly by the last, even though unsuccess- ful in the main object of inquiry at the time, we occasionally fall, as if by accident, upon discoveries of importance, or on facts which may afterwards be turned to useful account. The ancient alchymists were often in the pursuit of phantoms. But if they labored in vain to discover the elixir of life, the phi- losopher's stone, or the means of transmuting the baser metals into gold, yet, in the midst of their dis- appointments, they brought to light much of what constitutes the ehemistry and pharmacy of the pres- ent day, and no few of the industrial arts that spring from these. " I love to be puzzled," said John Hun- ter, " for then I am sure to learn something valua- ble." 14 THE TRUE PHYSICIAN. In the history of society there are periods dur- ing which men and nations rise to new and unusual efforts in literature, science, and the arts. Such were the brilliant epochs of Pericles, at Athens; of Ptolemy Philadelphus, at Alexandria; and of Augus- tus, in ancient Rome. Such, too, the era of Haroun al Raschid, among the Arabians; and, in more recent ages, such were the epochs of the Emperor Frede- rick II., in Southern Italy; of the Medici, at Flor- ence ; of Elizabeth, in England; of Louis XIV., in France; and others of modern times; not to speak of that long-continued term of universal progress which, commencing with the first organization of sci- entific associations, in the early part of the seven- teenth century, has extended to the present day. These periodical movements have sometimes been ascribed to the encouragement of princes; sometimes to the force of example among able men ; sometimes to protracted national prosperity; some- times to coexisting political organizations; but, what- ever other agencies may be shown to have led to them, we can trace in the whole of them one great, controlling power—the power of associated effort. To this power medicine is under no less obligation than are most other departments of human knowl- edge. The transactions of the numerous philosoph- ical and medical societies of Europe and our own country, the voluminous publications of learned bod- ies in the form of miscellanies and collections of original essays, and, more recently, our countless journals and magazines, need here hardly be referred THE TRUE PHYSICIAN. 1 to in support of this remark. Here, then, union is strength. This truth the observing physician is not only disposed to remember, but is also forward to act upon,—looking to organized association and fre- quent intercourse with his compeers for information and encouragement, as well as for quickening his judgment and sagacity as an observer. But in placing himself so as to be beneficially influenced by associated effort, the man of acumen works with no eye to petty honors and distinctions, aware that if measured by his own intrinsic merits he is esteemed as much in harness as in epaulets; that in scientific as well as in other associations mere forms and ceremonies too often usurp the place of weightier matter, and that it is usually the man of prudent, common-place ideas that rules and regu- lates. The medical practitioner, as already remarked, is as much exposed to misguiding influences as other members of the community. Unless well trained by education and experience, his liability to be mis- led is perhaps greater than that of most other men, from the circumstance that the practical questions with which he has to deal are complex and difficult, and from the fact that the doctrines in which he has been educated are occasionally subject to modifica- tion in accordance with new advances in science. The easy, obtuse practitioner, expecting disease always to present itself in the same aspect, will often find himself at fault in judging of the appearances, circumstances, or expressions of the sick; in yield- 16 THE TRUE PHYSICIAN. ing to the opinion of third parties directly or indi- rectly interested in the welfare of the sick; or in interchanging views with his associates; not to speak of the innumerable obscurities, perplexities, and un- foreseen modifications of diseased action. Upon each of these influences, as special topics, it might be a profitable exercise to expatiate. But there are, to the American practitioner, popular influences, which only the well-trained, conscientious, and acute observer is able to obviate, and which, in this con- nection, should not be overlooked. As in literature and the fine arts, so also in med- icine, every enlightened nation has its own peculiar- ities. Local organizations differ, conventional habits and opinions vary, with varying forms of govern- ment. The style of education, and the social rank of medical men, are not the same in all countries. Their modes of promotion to posts of honor, the number and nature of these, are not everywhere alike. The tendency to practical inquiry or abstract speculation, the character and freedom of their dis- cussions, even their artistic skill in writing for the press, partake more or less of the national spirit. Every point in these and other national characteris- tics has its influence upon the judgment. Peculiari- ties thus engendered are not always recognized by those moving only in the atmosphere of their own nationality and who never breathe the air of other places; but to the stranger, or returning traveler, they are perceptible enough. " Be sure you 're right at first, then go ahead," THE TRUE PHYSICIAN. IT is an apothegm bequeathed to us by a man worthy of remembrance, as much for his practical common sense as for his deeds of daring among our western pioneers. The latter part of this injunction is now an accepted Americanism, as common to the habits as to the language of our people ; but the clause with which it is coupled is too apt to be forgotten. It is hardly of domestic origin. It points to habitual forethought; to times anterior to the rapid march of modern innovation, and not to those whose cus- tom is to act first, and think afterwards.1 In the epidemic of 1832, a practitioner of this city, more given to action than reflection, was sum- moned to a gentleman supposed to be suffering from cholera, and in a few moments had his patient vig- orously rubbed from head to foot with a compound of camphor, red pepper, and mercurial ointment. An associate physician, happening to come in, nat- urally inquired what led to the belief that the case was one of cholera. " I confess," was the reply, "that the symptoms are not yet very apparent; but you know it is well to have an anchor ahead." Truly, in most emergencies it is well to have an anchor ahead; but there should be serious reason for resorting to one so weighty as this. The well-known words of Jefferson, "free and equal," have been the theme of many commentators, for approval on the one hand or ridicule on the other. There may have been a time when their influence was trifling; but such is not the case at present. They have long since ceased to apply here 2 18 THE TRUE PHYSICIAN. simply to political freedom and equality. They are now the enunciation of a sentiment common to our people of every rank and station. This, as it affects our own profession, is most conspicuous in our neo- phytes, and humbler aspirants after notoriety; but it is also occasionally seen in other quarters. Cullen, we are told, was on one occasion repri- manded for publishing, and was obliged to retract, certain statements in his work on the Materia Med- ica which had not the sanction of the Faculty at Edinburgh. The time has never come—it probably never will come—for any medical writer here to de- sist, at the dictation of any school or association, from giving to the world opinions the most crude, or state- ments the most unworthy of reliance. This, perhaps, is right. The conflict of errors is their best cure. But the privilege of doing wrong does not imply the expediency of wrong-doing. When the University of Upsal, at the instiga- tion of Professor Rosen, silenced Linnaeus and pro- hibited him from lecturing on botany, simply for the reason that he was yet an undergraduate, the indignant naturalist drew his sword upon his enemy. For, though young, he was already conscious of his own abilities, and felt that he had been injured by a man inferior to himself. In America, the man of talent has nothing to apprehend from such indigni- ties. But every aspirant to the professorial chair is not a Linnaeus, even in America; and it is no strange 7 O thing for our professors to become familiar with the department of education assigned to them only after receiving official sanction to take charge of it. THE TRUE PHYSICIAN. 19 In connection with this disposition to rest satis- fied with superficial attainments, and in some meas- ure the result of it, is a tendency on the part of many of our people to frequent change of occupa- tion ; and of others to undertake more than they can accomplish. Here every country village can supply its man, " Who, in the course of one revolving moon, Is statesman, chemist, fiddler, and buffoon." I might pursue this topic. But with these seri- ous drawbacks it is proper to remark that we are not without our advantages; that in connection with the profession at home we can point to hon- ored names and deserving institutions; that if our schools are not all equal to the best-appointed schools in Europe, the fault is not so much in their style of education as in the low requirements for their degrees ; and that such of our youth as are de- sirous of thorough professional training can find at home the amplest opportunities. In no other nation are books and periodicals, medical as well as others, so cheap and accessible as among ourselves. In no other is the habit of read- ing so general. In no other are the rewards of hon- orable enterprise so open to men of moderate means; and in no other is the energy of the individual so frequently or so variously displayed, or certainly rewarded. Hence it is, that if the profession, as a body, here, have not yet secured the front rank in aggressive science, many among them have thus dis- tinguished themselves, and others are in rapid pro- 20 THE TRUE PHYSICIAN. gress towards these. Hence, too, it is, that though our medical luminaries may not be so numerous as in the Old World, the great mass of men here engaged in the active duties of the profession are better read, and better posted on every question of importance to ourselves than the body of professional men of any other nation. And this remark applies to the practi- tioner in the rural districts and retired hamlets of the United States as well as to those of our larger cities. Again, without reference to our medical litera- ture, of which, on the whole, we have no reason to be ashamed ; or to the numerous and valuable acces- sions wThich have been made to practical medicine and surgery, we have our voluntary associations for mutual improvement, and for the collection and publication of important facts and discoveries ; our county and State organizations for supervising the general interests of the profession ; and, above all, our National Medical Association, which, in its an- nual migrations, is uniting us all into one body, awakening public spirit, and inciting to concerted and energetic action the members of the profession in every section of our country. Let us hope for its continued influence and growing usefulness. " Had I, as formerly, for the same ailment, been under the care of my old medical adviser at Nor- wich," said an intelligent English lady to me on one occasion, " I would by this time have had at my dis- posal a closetful of empty bottles." The remark was probably correct. The apothe- cary in England is the ordinary family attendant. His rank is an humble one. Until recently, he THE TRUE PHYSICIAN. 21 could charge only for his medicine; and, to secure a fair return for his services, he felt justified in pre- scribing as much medicine as decency and the usages of the people would endure. Hence the English system of over-dosing, a system now happily on the decline, and one until recently much in vogue among ourselves; for in this, as in many other points, we have been ever ready to copy from our professional brethren of the parent nation ; who, overlooking some few of their peculiarities, are, after all, among our best and safest models. A gentleman on a visit to London, from one of the provincial towns of England, was taken sud- denly ill at night, and his daughter, in her alarm, set out, with a servant-maid, for the nearest physi- cian. She called upon a practitioner of great celeb- rity, a Fellow of the Royal College of Physicians. The distance was not great, but the equipage was an accompaniment of the visit, and to be thus pro- vided was an affair of two hours. On arriving, he found the sick man in need of venesection. Here again arose a new difficulty. The abstraction of blood, under prescription, is the work of the sur- geon or of the apothecary ; and this young lady was a second time obliged to traverse the city in which she was a stranger, and that, too, after mid- night, in order to have the services rendered to her father, which the ph}Tsician, if an American, would have been ready and willing to perform without delay. When professional subdivisions reach to such a pass as to discommode the sick, they have proved 22 THE TRUE PHYSICIAN. their own absurdity, and ought to be laid aside. Whoever would practice medicine properly must yield to it all his faculties and ignore none of its offices. The safety of the patient may depend upon the prompt and skillful use of the lancet, or of in- strumental appliances humbler than this. The age of medical priestcraft has gone by. The canons of the Church may, as formerly, denounce the shed- ding of blood even for the preservation of life ; but the laws of nature and the regulations of the medi- cal profession in this country never will. Nor will the educated physician here ever lose caste by act- ing, when action in a professional way is needed, as a working man. We acknowledge no professional aristocracy, or only that of intellect. The physician here, as elsewhere, may occasionally be better read or better educated than the surgeon or obstetrician ; but it will not do for him to shut himself up in the crust of his own dignity on that account, or with the hierophant of the ancient mysteries, to exclaim, against his humbler associates, as pure as himself, " Procul* 0 procul, este profani!" It was a remark of Lord Nelson, that his hatred of Frenchmen was so great that he could never learn their language. Until recently this national antipathy was not confined to Nelson, nor to men of his own cast or nation. With us, in matters of sci- ence, at least, it has never existed. In the course of conversation with Sir Astley Cooper, in the Autumn of 1835, that distinguished teacher, then at the zenith of his reputation, inquired THE TRUE PHYSICIAN. 23 of me whose course of instruction I proposed to follow at Paris. In reply, I gave him to understand that some portion of my attention would be given to the clinique of M. Louis. " I have never heard of M. Louis," said Sir Astley ; " I know M. Roux and M. Lisfranc ; but I have never so much as heard of M. Louis." And no wonder; for with all Sir Astley's reputation as a surgeon, he was a surgeon after the English pattern,—having little to do with the physi- cian* proper, and still less with strictly medical liter- ature. In our own country, where fortunately the profession has never, as in England, been subdivided by the influence of close corporations into arbitrary sections, there was at that time probably not a re- spectable practitioner—I might add, not an advanced student—to whom the name of M.Louis, the founder of the numeric mode of medical research, was not perfectly familiar. If our institutions, then, are not exacting, they are of spontaneous growth, inartificial, and every- where free from those invidious distinctions which, in many parts of Europe, split the profession into casts, each with its prescriptive rights, its restric- tions, prerogatives, and exclusiveness ; each in hos- tile array against the other; and the members of all more or less one-sided and out of their easy and nat- ural development as individuals. Turning in the next place from those traits of character which are adventitious and the result of external influences, to such as are inherent, we mav observe that some minds are so constituted as to be capable of only limited, some of only partial, devel- 24 THE TRUE PHYSICIAN. opment; whilst others are so finely tempered, and with their several faculties so happily blended, as to be susceptible of indeterminate improvement and of the highest finish. In our own profession, among the former are those hardy innovators and bold prescribe rs who command the public eye : men prompt, proud, posi- tive, self-sufficient, and dictatorial; w^ho never hesi- tate, are never embarrassed, and by their admirers are believed never to err; men, again, of restless disposition, who, untrammeled by reason or experi- ence, are carried away with their own fantastic imaginations, or run wild in fabricating new systems of their owrn ; men, however, by the close observer of human nature, easily measured, and whom the educated physician would be the last to call upon for counsel or assistance ; quietly consigning them to the gaping throng, " Who praise and who admire they know not what, And know not whom, but as one leads the other." The shades of character proper to the other class, and favorable to high attainments, are numer- ous and variable, but not always easily detected. They are never obtrusive; they are often so blended in the intellectual symmetry of their possessor as hardly to be recognized by himself. Among them are energy, circumspection, tenacity of purpose, in- sight into human affairs, a delicate perception of propriety, a quick and just appreciation of circum- stances and appearances, a zealous, hopeful disposi- tion, the power of winning and securing confidence, of yielding with grace to the force of exigencies, or THE TRUE PHYSICIAN. 25 of controlling without offending the susceptibilities of others ; a strong and abiding love of truth ; that charitable temperament which beareth much and thinketh no evil; an imagination active, yet subject to reason and reflection;—traits which lie at the foundation of character, and which, in the acute medical observer, underlie and give strength to the later attainments of education and experience. Perhaps the clearest perception of the traits essential to accuracy in the study of disease is to be derived from the contemplation of the life and labors of those who have done most, or who at least have done something, for the advancement of med- ical knowledge. Among these, our profession has to boast of many illustrious examples. John Hunter, whose labors still live in British surgery and pathology, had not the advantages of early education, and had but little training in the literature or philosophy of his times. His stud- ies, like those of his still more illustrious coun- tryman, Shakspeare, were in the book of nature ; and in his own section of this great book his skill of interpretation elicited principles not soon to be forgotten. Unyielding perseverance in experimental investigation was his ruling trait. This trait, by force of his example, was impressed upon many of his pupils, and, through them, on their descendants of the present day. Sir Astley Cooper, like his illustrious master, though well trained in the princi- ples of his art, was little addicted to the study of books. But with a hopeful temperament, an un- bounded love of his profession, great self-reliance, a 26 THE TRUE PHYSICIAN. high moral tone, and an ample field of observation, his skill in the recognition of disease became so acute as to enable him to seize at once upon the essential features of a case ; and, after making up his own opinion upon it, he had rarely afterwards reason to relinquish his first convictions. So also Ambrose Pare, who commenced his professional career in the humble rank of a barber-surgeon, was led, while yet a youth, by natural aptitude rather than by education, to expose errors and defects in the surgery of his epoch, and to introduce import- ant innovations. Witness his simple treatment of gun-shot wounds, the ligature for arresting hemor- rhage in amputations, and other kindred improve- ments, which rendered the name of Pare a watch- word of the armies in which he served and secured to him for ever the enviable title of " Father of French Surgery." In connection with the present topic, and as illustrative of circumspection and forbearance of opinion under difficulties in the study of disease, there is perhaps no more appropriate name among the departed than that of Dupuytren. His cool- ness of temper, says his eloquent biographer, never forsook him. In his lectures, in his operations, nothing was left to chance. Every contingency was preconsidered, and the proper means taken to meet it. Did an unusual instance of disease occur to him, or one of unusual character, he would ponder over it, mute and absorbed in thought, comparing, con- trasting, weighing, and combining its symptoms and THE TRUE PHYSICIAN. 27 appearances, for days together, until at length the ray of light broke in upon him, as upon Archimedes of old, when, no longer silent, he would expatiate upon the facts before him, and explain to the stu- dents the route which he had traversed before arriv- ing at the truth, believing that he served them more effectually in expounding to them his mental opera- tions than the operations of his hand. Sydenham, being requested to name a proper text-book for the student of medicine, is said to have recommended Don Quixote. This he might have intended as a sarcasm against the miserable writers of his day, or as an intimation that book- learning is of no great value in comparison with practical training. It leads also to the remark that for the physician there are other studies than such as fall strictly within the pale of the profession, and that among these is the study of human nature. Knowledge of the world is as necessary for the cure of the sick as for the procuring of practice. Those who look only at the physical organization, and for- get the intricate and subtile influences of the mind, are at every turn liable to be misled. The astute inquirer is ever on the alert for useful hints beyond the precincts of professional authority, as well as within these, and is as familiar with the whims and caprices of the sick as with the science of anatomy. A jockey washing to dispose of his horse was observed by the gentleman in treaty for him to be gently tapping the animal with the whip as they were approaching Harlem River. " He is young and spirited," says the trader, " and must have something 28 THE TRUE PHYSICIAN. else to think of, or he will take alarm at the water." This remark of the jockey applies to many of our patients, who, like the young and fitful animal, too often give way to unnecessary alarm, and must have something new to think about before getting over the water. A gentleman in great despondency from mercan- tile embarrassment summoned his physician, who amused him with the gossip of the day, and related to him the humorous story of the Old Clock. The sick man was thrown into a convulsion of laughter, and his cure was accomplished before the narrative w^as closed. " You tell me you were hurt," said Dupuytren to a sensitive lady with a dislocated shoulder, " but you forgot to tell me that you had been drinking: this I have had to ascertain from your son." The unexpected affront caused the patient to swoon, and, while the muscles were relaxed, the dislocation was adjusted; whereupon he resumed, "My dear madam, I know you drink nothing but water ; this, too, I have learned from your son." The success of the maneuver of course obliterated all recollection of the offence. A curt and unfeeling manner, as at the com- mencement in this instance, by disturbing the pa- tient's equanimity, or exciting the emotion of dis- gust, may occasionally be justifiable. We can make allowance, too, for the petulant reply which im- presses upon some patients a proper sense of their own unreasonableness. Matthew Baillie was re- markable for a placid, deliberative, and tolerant dis- position, for great benevolence, and for willingness THE TRUE PHYSICIAN. 29 to listen to whatever his patients were disposed to say to him, and yet withal was at times a little irri- table. In the hurry of business, when his bodily strength was hardly equal to his labors, he was one day annoyed by a lady whose ailments were too insignificant to interfere with her evening recrea- tions. He had hardly withdrawn, when he was again requested to come up stairs to inform her whether, on returning from the opera, she might eat some oysters. " Yes, madam," said Baillie, " shells and all." But in most instances a manner the reverse of this is the correct one. To secure confidence and be of greatest service, the practitioner must show that he can sympathize with the sick. Examine a patient with as little regard to his sensibility as if he were a bale of merchandise, and there will be difficulty in eliciting the truth from him, even while he knows that the admission of it is essential to his cure. A persuasive manner unlocks the recesses of the heart even of the culprit, who, in return for our sympathy is ready to sacrifice self-love, and sometimes the hope of safety. A young laundress was brought to Salpetriere as a lunatic, having long been in the habit of crying out suddenly to those about her, " Why do you call me a thief ?" Taking her gently aside, Pariset proffered to restore her to liberty and health if she would consent to give back to her friends what she had secretly taken from them. She promised to do so, and was re- leased. Some months afterwards, meeting Pariset in the street, she came up to him, seized him by the 30 THE TRUE PHYSICIAN. hand, and, with tears in her eyes, declared that she had complied with his injunction and was cured. It is the duty, and it should be the constant study of the physician, to acquaint himself with the habits, sympathies, and antipathies of those who rely upon him for advice. The skillful use of such knowledge may be of the greatest moment to the sick. " During the time I passed at a country school in Cecil County, in Maryland," says Rush, in one of his Introductory Lectures, " I often went on a holi- day, with my schoolmates, to see an eagle's nest upon the summit of a dead tree in the neighborhood of the school, during the incubation of that bird. The daughter of the farmer in whose field this tree stood, and with whom I became acquainted, married and settled in this city, about forty years ago. In our occasional interviews we now and then spoke of the innocent pleasures and rural haunts of our youth, and, among other things, of the eagle's nest in her father's field. A few years ago I was called to visit this woman, in consultation with a young physi- cian, in the lowest stage of a typhus fever. Upon en- tering her room I caught her eye, and, with a cheerful tone of voice, said only, ' The eagle's nest!' She seized my hand, without being able to speak, and discovered strong emotions of pleasure in her coun- tenance, probably from the sudden association of all her early domestic connections and enjoyments with the words I had uttered. From that time she began to recover. She is now liying, and seldom fails, when we meet, to salute me with the echo of ' The eagle's nest.'" THE TRUE PHYSICIAN. 31 To the discerning, the shadow of an emotion is often as suggestive as the most eloquent discourse. The wasting illness of Antiochus was a mystery to his attendants, until Herophilus detected, by his accelerated pulse on the approach of Stratonice, that love lay at the bottom of it. Aptitude for thus seizing upon the more delicate manifestations of disease, for detecting its true char- acter amid deceptive appearances, for deriving from its antecedents the readiest means of prevention, or from its early symptoms the surest indications of relief,—is a faculty attainable to any marked extent only by those whose powers of discrimination are prompt as well as accurate. It is a faculty, how- ever, susceptible of cultivation, in keeping with the habits of its possessor, and with the circumstances under which it is exercised. The untutored eye sees the floating speck upon the waves; but in this speck the mariner has already recognized the distant sail, and is able to declare the character, capacity, and nature of the craft that bears it. The microscopic eye of the engraver measures shades and shapes ; and the trained ear of the musician, harmonies and discords imperceptible to the ordinary observer. So, also, of the mental faculties. What to others was the isolated and shapeless bone, Cuvier could clothe with flesh and blood, and adjust to the assemblage of parts to which it originally belonged, assigning to the animal, though fossil, extinct, or hitherto unknown, its appro- priate rank in the order of nature and its epoch in the march of ages. 32 THE TRUE PHYSICIAN. The tourist wandering from civil life, though cog- nizant of every object, and of every incident befall- ing him in the depths of the wilderness, has not at once the ready skill of detecting their significance, and wonders at the shrewd perceptive powers of the savage, whose faculties have been quickened by the frequent sense of danger, and to whom the ruffling of a green bough, the upturning of withered leaves, the flight of a bird, or the scent of an unseen animal, is the every-day signal of warning or deliverance. " I was one day traveling the desert between Loberah and Senar," says a recent tourist, "when, observing on the sand the traces of two camels, I asked one of my guides what he thought of them. ' The camels,' said he, ' are ridden by a Turkish fam- ily, accompanied by an Arab servant who has hurt his foot. The family is composed of a Turk of the inferior class, with either his wife or a slave girl, and a child which cannot be more than two years old.1 Astonished at these details, I asked him where he had seen these people. He could not withhold a smile. ' I never saw them,' he said; ' but there must be two mounted persons, and a servant besides ; for, otherwise, the lame servant would ride, instead of trailing a bandaged foot after him in the sand. As to the child—we may spare the indications. But I have not seen its foot-marks, and presume, therefore, that it is carried in the arms.' ' Very well; but how do you know they are Turks V * Turks or Egyptians,' said he, 'for they have spread a carpet to rest upon; the Numidians and Arabs sit on the bare sand; besides, they wear shoes; the servant THE TRUE PHYSICIAN. 33 only is barefoot. Their poor equipage shows the class to which they belong; they travel with two camels, have no tent, and only a single servant. The Turk is at most a government official of low rank.' It turned out, in effect, that the travelers exactly an- swered the description,—the principal being an Egyptian Copt in government employ." * The medical inquirer, accustomed to analyze the sources of his own knowledge, finds himself now and then led, as if by instinct, into a train of useful dis- covery, from appearances as trifling to the common observer as those from which the Arab guide de- rived these numerous particulars. Taking advan- tage of these intimations, they serve him as the finger in the sky, pointing him to action, while others are waiting listlessly for the rising of the waters. Thus he penetrates deeply into the essential history of his cases, or puts a timely and efficient bar upon their progress ; while the practitioner, not in the exercise of a cultivated sagacity, fails to elicit facts which he could hardly be suspected of overlooking. Galen, from the cup of hysop tea on the shelf, saw, at a glance, that the ailment had been misunderstood. In our intercourse with the sick we are often left to discover, as best we may, what it would wound their sense of self-esteem to acknowledge. We must sometimes take for granted what they wish us to divine, but are unwilling to confess. We are not called upon to demand the confidence which they reserve. Yet in guarding their feelings, we must so * Edinburgh Rev., Oct., 1854. 34 THE TRUE PHYSICIAN. act as not to overlook the truth, and so advise as to lead them to forsake their errors. In the time of the civil war of England a Puri- tan soldier, evidently a man of rank, called upon Hamey for advice. After modestly attending to the long preface with which the circumstances of the case were introduced, Hamey assured him of his con- fidence, and gave him hopes of relief. The generous soldier drew from his pocket a bag of gold and offered it in a lump to his physician. This extraor- dinary fee was surprising to Hamey ; and, pressing as were his pecuniary affairs at the time, it was mod- estly declined. But the grateful patient, grasping in his hand as much coin as he could hold in his fist, put it into the doctor's pocket, and took his leave. This fee was doubtless intended, in part at least, as the price of secrecy. But with Hamey this precaution was unnecessary, as it always ought to be with the members of a profession, the very essence of which is honor and confidence. The name of this generous soldier, as we are told by the author of " The Gold- Headed Cane,"—a work which I am disposed to at- tribute to Sir Henry Halford—is never once men- tioned in the life of Hamey, though there is.good reason to believe he was no other than Ire ton, the son-in-law of Cromwell. Again, we are called upon to respect not merely the secret disclosures of our patients ; their individ- ual peculiarities, their feelings, habits, and propensi- ties, are also to be met with becoming deference. Is the patient a man of piety ? The physician is a man of probity, and can respect, if he cannot participate, THE TRUE PHYSICIAN. 35 to the full extent, in his religious aspirations. Is he himself religiously inclined ? He is not thereby the censor of others; and, while he uses his privilege in assuaging suffering, or in mitigating the sorrows of the sick, or soothing their pillow on the bed of death, he is no instigator of useless discussions, and, least of all, of sectarian disputes. Heberden, from his youth, was religiously disposed, and by the sweetness of his manners, as much as by his consummate skill, had secured the esteem of all who knew him. When the widow of Middleton, the author of the Life of Cicero, called upon him with a manuscript of her late hus- band, to consult about the propriety of its publica- tion, Heberden examined the work, which was on the Inefficacy of Prayer. He told the lady that however much it might redound to her husband's reputation as a scholar, it would add nothing to his credit as a man. But as the proceeds might be of importance to her, he promised to inquire what might be the publisher's estimate of the copyright. This he ascertained to be one hundred and fifty pounds; and, paying the widow out of his own pocket two hundred pounds, he consigned the man- uscript to the flames. Ambrose Pare was a Hugue- not, and pious man. When requested by his sov- ereign to conform to the religion of the state, he modestly, but firmly, refused; and yet, amid the most virulent epoch of religious dissentions, he so conducted as to secure the love and respect of all parties. And when Charles IX. gave Orders for the general massacre of the Protestants throughout the whole of France, Pare was the only exception made, 36 THE TRUE PHYSICIAN. by express command of that infatuated monarch, during the fatal night of St. Bartholomew. Pinel does not appear to have been distinguished as a religious man; and yet he was more than a philoso- pher. " I am preparing a new edition of my Dic- tionary of Atheists," said Laland, a popular writer, to him, " and in it you may expect to see your name fitly complimented. " And I, too," rejoined Pinel, " am about to issue a new edition of my treatise on Imbecility, in which I will not fail to assign to you a proper place. The man of capacity, properly measuring his own forces, with a definite object in view, steadily pur- sued, is apt to reach that object in the end. This truth is admirably illustrated in the life of Portal. Quitting Montpelier at the close of his classical studies, Portal directed his steps to Paris, and on the journey thither fell in, first, with Treillard, and after- wards with Maury,—youths, like himself, on their way to the capital in pursuit of fortune. In the easy familiarity of early life, they soon became inti- mate, and communicated to each other their respect- ive objects of ambition. Treillard already felt within himself he would one day be Attorney General; Maury, on the other hand, would be a member of the French Academy ; and Portal, an associate of the Academy of Sciences. On reaching the heights that overlook the city, they stood for a moment con- templating the spectacle, and at that instant caught the distant boom of the cathedral clock. " Hark !" cried the would-be Attorney General to Maury, THE TRUE PHYSICIAN. 37 " you are summoned to the Archbishopric of Paris!" " Yes," replied the latter, " when you become minis- ter of state !" " And what of me ?" asked Portal. " You," exclaimed the other two, " first physician to the king!" It is needless to ask what prompted these predictions. It was force of character that led to their fulfillment. Portal was afterwards founder of the Old Academy of Medicine. On the accession of Louis XVIII., he became first physician to the king,—a post which he held also under Charles X. It was in the latter reign, adds his biographer, that Treillard and Maury severally reached the goal of their ambition,—the first as a statesman among the chiefs of France; the other, as a cardinal among the princes of the church. The trials and afflictions which the physician, in his round of daily duties, is called upon to witness, tend to impress upon him an air of seriousness. Be- yond this they should not be suffered to carry him. In order to resist such emotions as weigh upon his spirit, it is his duty, at times, to seek the exhilaration and enjoyment of miscellaneous and refined society. But in participating in the gayeties of life he is not to pursue them with the ardor of an habitue, nor to allow himself thereby to be carried away from the graver duties of his calling ; and many of the frivoli- ties of what is sometimes called good society he may venture to forego. The life of Portal, on this point, also, is worthy of notice. His experience of the world, his familiarity with men and manners, had supplied him with a rich and varied fund of anec- 38 THE TRUE PHYSICIAN. dote, which he well knew how to reason with Attic wit, to the delight of the savans, literary men, trav- elers, magistrates, and foreign embassadors, that held their weekly reunions at his residence,—a select and brilliant academy, of which his conversational talent was the greatest ornament. With what irresistible humor, says M. Pariset, would he recount his inter- view with Yestris, the once famous dancing master. " Monsieur Portal!" says the latter, " I am pro- foundly sensible of my obligations to you; I bear in my heart the everlasting recollection of your at- tentions to me. My respect for your delicacy of feeling is too great to permit me to offer you a fee. Among artistes like ourselves, affairs of this sort are of no account. But, Monsieur, I have something better to offer you. I have noticed, permit me to say, that on entering a room you have not that grace, that elegant grace which should give you per- fect freedom of carriage, and render you at all points an accomplished man. Now, this grace, sir, I pro- pose to give you." Whereupon, taking him by the hand, Vestris would have placed Portal in the atti- tude of the first position. But Portal quietly excused himself, and never learnt the graces of the dancing- master. Again, in order to high attainments, it is the part of the physician to hold up to himself some laudable object of ambition. Without this, as a student, he loses his steadiness of purpose, opportunities are wasted, nothing is effected, and he drifts about with- out advancement, like some helmless bark, the THE TRUE PHYSICIAN. 39 sport of wind and wave. If endowed with natural energy, the laws of his organization impose upon him the necessity of seeking some object of excitement, something upon which to fasten his affections and occupy his thoughts. And where the love of science is unable to supply this, it is too apt to be supplied with the love of gain,—a love in itself neither enno- bling nor commendable, though its indulger, like Dr. Radcliffe, might thereby secure the means of found- ing, after his departure, colleges, libraries, infirma- ries, or other institutions of benevolence, to perpetu- ate his name. We rejoice at the success of the deserving. Increase in the comforts and elegancies of life is one of the legitimate rewards of honorable enterprise. But when in the breast of the medical man the love of money supplants the love of usefulness, no matter wThat his rank or talents, they are reduced to the devices of the charlatan. The uneducated pretender who boldly announces that his object is to make the most he can of human credulity, is not the offender against whom the imprecations of the public should be deepest. His effrontery is so apparent that we can affect to make merry with it. But the man of education, who uses the privileges of his profession as false signals to decoy the unwary, is far more repre- hensible. It is said of Richard Mead that, of all the physi- cians of his time, he gained the most, spent the most, and enjoyed the highest reputation. But his success was the legitimate result of honorable exertion, and was not above his merits. In the midst of his own 40 THE TRUE PHYSICIAN. extensive occupations he never lost an opportunity to confer a benefit upon the deserving. When his learned associate, Dr. Freind, for his freedom of speech in the House of Commons had been commit- ted to the Tower, he made every exertion for his lib- eration, attended to his practice, and gained access to his prison, where he found him engaged on the History of Physic, a work which has since rendered the name of Freind known in all nations. When Sir Robert Walpole, then prime minister, sent for Mead, the latter took occasion to plead the prisoner's cause, and after urging every other proper argument, refused to prescribe for Walpole without first receiv- ing a promise that Freind should be set at liberty. The promise was made and kept. On the evening after this event there was a gathering of the profes- sion at the house of Mead ; and after the party had broken up, when Freind was about to retire with the rest, he was invited into the private study, and there he received from the hand of his host five thousand guineas, the proceeds of Mead's attendance upon his patients during the period of his imprisonment. Well might the poet, Pope, in speaking of Mead, say, " I heartily esteem and love that worthy man, whose unaffected humanity and benevolence have stifled much of that envy which his eminence in his profession would otherwise have drawn out. And, indeed, I ought to speak well of the profession, for there is no end of my kind treatment from the faculty. They are, in general, the most amiable companions, and the best friends, as well as the most learned men I know." THE TRUE PHYSICIAN. 41 This portrait, as cited in The Gold-Headed Cane, was true of the men to whom it applied ; and it may still be applied to no inconsiderable portion of the profession, even of our own country, at the present day. But, unfortunately, there are in every country practitioners looked upon as men of rank and influ- ence, who place the emoluments of the profession before every other consideration. Of the example of such, whatever external show of merit be attached to them, the young practitioner can- not be too much upon his guard. " The sur- geon," says Guido de Cauliaco, " should be courte- ous and condescending; bold in security, cautious in time of danger, avoiding impracticabilities, compas- sionate to the infirm, benevolent to his associates, circumspect in prognostication, chaste, sober, pious, and merciful, not greedy of gain, no extortioner, but looking for his fee in moderation, according to the extent of hi3 services, the ability of his patient, the result of his treatment, and a proper sense of his own dignity." Golden words these !—as true at the present hour as when uttered by that brave old prince of surgery, five hundred years ago ! The late Richard Keate was a surgeon after this model. Associated with St. George's Hospital, for more than fifty years, he had risen to the highest posts of office in the profession. He had held the appointment of Surgeon to William IV. and Queen Adelaide, and afterwards that of Sergeant Surgeon to Queen Victoria. He died, three years ago, at the 4 42 THE TRUE PHYSICIAN. advanced age of eighty-one. By his courteous man- ners and upright conduct he had secured the esteem of all who knew him. There are few forms of dis- ease with which he was not familiar. He was ready and skillful in the use of remedies; neat and accurate in his operations; prepared for every emer- gency, cool and self-possessed; thinking only to do the best that could be done for his patient; without display; without troubling himself about what others thought of him ; thoroughly honest; a thor- ough gentleman; never guilty of an illiberal or unkind act; free from vanity and self-conceit; assuming nothing that did not belong to him ; and, adds his biographer, if he had any fault in this re- spect, it was, that he rather underestimated his own abilities. Again, the meritorious are not the first to com- plain of ill success. Speaking of himself, the mor- alist Johnson tells us that he never knew a man of merit neglected, and that all the accusations against the world for the failure of the deserving are unjust. This may not be universally applicable. But, as observed by one of his recent reviewers, it is certain that those who whine the most deserve the least. The man that cries out, u I am neglected," usually merits the neglect he meets. " I hate a complainer," was another aphorism of this distinguished moralist. Men of Johnson's stamp are, indeed, " superior to fortune, and, as he has said of Shakspeare in his low THE TRUE PHYSICIAN. 43 estate, shake off its incumbrances like dew-drops from the lion's mane."* Daniel Webster, when asked by a young friend if the legal profession were not already overcrowded, is said to have replied to him, " There is plenty of room up stairs." The intimation is applicable also to our own calling. Of the crowds that are yearly ushered into its portals, only the smallest number ultimately reach its highest honors ; but for such as are qualified for these there is yet room. Finally, the meritorious shun that notoriety which comes from eccentricity of manner, or peculiarity of equipage or costume,—holding obliquity of conduct to be associated with obliquity of judgment. The man of affected, no less than of unaffected eccentri- cities, is rarely a safe adviser, however brilliant he may be on particular occasions. And the man of sinister motives who assumes these, and whose heart is taken up with his own aggrandisement, is unwor- thy of acknowledgment as a physician ; who, like Hamey, should be " a scholar, without pedantry ; a philosopher, without taint of infidelity; learned, without vanity ; grave, without moroseness; solemn, without preciseness ; pleasant, without levity; regu- lar, without formality; nice, without effeminacy; generous, without prodigality; and religious, with- out hypocrisy." In a word, his ruling principles, his hopes and aspirations, should be elevated, and of such a nature as to call forth his talents to their full effect. Thus moving, his course is safest as Avell as * London Quarterly Review, January, 1859. *4 THE TRIE PHY8ICIAN. best. For at every step he is reaping new install- ments of his reward, and gathering, as he advances in life, the honors for which he was led to look, and which stimulated him to exertion in his earlier ' years. 4