V • ¥ ^j^|,'J'' Y-. :*£?■■&- >***:'*.. ^r* ✓f- «•* M; Surgeon General's dffice N< frc^o Oju aQGCTaaQOOiaQoagaoaQox: ~^ THE ^^ILWI^ GREAT MEDICAL. REPUTATION, SUGGESTIONS FOR ITS ATTAINMENT: A LECTURE, INTRODUCTORY TO THE SUMMER COURSE OF THE MEDICAL INSTITUTE. Br JOHN K. MITCHELL, M. D. LECTURER ON MEDICAL CHEMISTRY IN THE PHILADELPHIA MEDICAL INSTITUTE, &.C. &C. ■ ■ PHILADELPHIA: PRINTED BY J. R. A. SKERRETT. 1834. V w \t3f RESPECTFULLY DEDICATED TO MY FRIEND AND PRECEPTOR, tf. CHAPMAN, M. D. PROFESSOR OF THE THEORY AND PRACTICE OF MEDICINE IN THE UNIVERSITY OF PENNSYLVANIA: FOUNDER, AND PERPETUAL PRESIDENT, OF THE PHILADELPHIA MEDICAL INSTITUTE. Philadelphia, February, 1834 To PROFESSOR CHAPMAN. Dear Sin, There is a strict propriety in dedicating the following pages to you. When I had, for the first time, the honour of saluting you, you took the obscure student of medicine by the hand, and, reciting some instances of kindness shown to you by his deceased father, declared your satisfaction in meeting with the opportunity of returning them to his son. Many important services— ceaseless acts of kindness—have evinced the full redemption of that pledge, founded on a sentiment at once honourable to yourself, and most grateful to me. To your good offices, I owe the very station in which it became my duty to deliver the following introductory. The Medical Institute originally existed as your private class, and, as you saw occasion, its instructors were increased in number, until acquiring the form and consequence of a regular school of medicine, it assumed the title and functions of the Philadelphia Medical Insti- tute. Whatever therefore of consideration is attributable to my connexion with our summer-school, is due to your kindness, and to the labours of the eminent colleagues with whom I am there associated. In my private, as well as public professional course, I have ever found, in my preceptor, a firm and judicious friend and adviser,—one who knows well how to make impressive the lessons of knowledge and virtue, and to render palatable the voice of admonition. That you may long continue to live, a fine example of grave science soften- ed by eminent social qualities, is the sincere wish of your friend and respectful servant, JOHN K. MITCHELL. THE VALUE OF A GREAT MEDICAL REPUTATION, «jc. No man succeeds in his profession without possessing the con- fidence of the community in which he resides. In many occupations, little talent, and less knowledge, are requisite for their successful cultivation. But even in the humblest of the mechanic arts, we ob- serve that those individuals most command patronage and support, who are in highest esteem for the extent and accuracy of their knowledge, and the practical talent which gives to knowledge the most efficient application. The orator of the pulpit, with all the richness and fluency of Cicero, the force and majesty of Demosthenes, the fire of Henry, and the grace of Lee, would not long command at- tention, if unskilled in divinity, and of dubious moral reputation. Men soon become sated with an eloquence to no end, and an energy to no purpose; and hence some of the most popular and fashionable preachers have been finally abandoned to neglect and contempt. Compare the lawyer, of ready elocution and eloquent expression, destitute of acquaintance with the more recondite mysteries of his trade, with one of the same profession, who, though rude of speech, displays a deep and accurate knowledge of judicial lore. The first will, in the beginning of his career, attract a crowd of clientsj but after a few years, the docket of the other will be enriched at his ex- pense, and public confidence will finally most reward him who most deserves it. But to no man is public confidence so important as to the phy- sician. Whatever may be the fact, with respect to a few peculiar in- dividuals, we do not doubt, that the greater part of mankind look upon life as the greatest of blessings. What is there which men do not bear, rather than part with life ? Disgrace, poverty, servitude, evil in its most hideous shape, assail, and yet the wretch lives and endures. It is true that men will risk the chances of death, for the 8 removal of such evils; but they will not commonly rush on a certain destruction, rather than continue to bear " the ills that flesh is heir to." Suicidal acts have never been therefore very frequent, even in those countries where self-destruction was not esteemed a crime, although in them, unbridled rule, and reckless license, produced the most harrowing illustrations of moral and physical misery. The veriest wretch on earth, clings with unabated energy to the principle of life; yes! even when not a reasonable hope of improvement in his destiny can come to his consolation; when the path which he treads leads from sunset to twilight, and from twilight to the blackness of a night without a moon, and unfriended by a star. How much more must the prosperous man value the boon of life, which is to him a stream of enjoyment. He has within his reach moral pleasure, and physical good, friends and relatives, who reflect back on him his hap- piness, and concentrate it into a focus more intense by participation. To the hands of a physician, every individual must, at least once, confide this life, this precious, and most valued of the gifts of nature. On the judgment and skill of a single being, often hangs either our own fate, or the fate of some one who is dear to us as our life, dearer than our fortune. It seems natural that when so much is at hazard, we should carefully scrutinize the qualifications of him to whom we are about to intrust so important a deposit; and, if our- selves incapable of estimating his desert, look to the opinion of him entertained by those whose means of observation are more ample, and on whose higher judgment reliance can be founded. Failing such sources of intelligence, we insensibly adopt the common rumour, and go with the crowd. The selection of a physician will, therefore, usually, in perilous cases, at least, be decided by general repute; because our intimacy is seldom such as to afford us personal means of estimation; and most of us have readier access to public rumour than to good private sources of intelligence. That too, which we hear from every one around us, asserted by all, and controverted by none, weighs often more with us than it is worth, and is according to the nature of the human mind, readily received, and reluctantly relinquished. Without such an ascendancy of general opinion, there would soon cease to be uniformity of sentiment and action in any community. Although the selection of the physician, because of his superior reputation, cannot fail to prove flattering to his pride of character, that reputation affords him during his course of attendance much 9 more substantial advantages. The man so selected, and so esteemed, enters the chamber of disease without an unnecessary deduction from his efficiency; the confidence which he feels in himself, is con- firmed by the hopeful expression of welcome, beaming with delight- ful significance in the eyes of the patient and his friends. He does not perceive that lynx-eyed distrust which is ever ready to distort and misconstrue. He observes a tendency to approve and to favour, and feels that, let the issue be fair or foul, he is safe in his reputa- tion and his business. Fear for self does not paralyze his under- standing, or enfeeble his application. Measures adequately vigorous are unhesitatingly adopted, and steadily pursued. The morbid enemy is not left without an opposer, nor consigned to a feeble com- batant, while the distrusted, and consequently hesitating practitioner, is sighing for courage to resort to more potent, but more readily mis- interpreted measures of cure. Confiding, because confided in, he pursues an uncompromising treatment, or still bolder, dares when necessary, to withhold every usual remedy, and by judicious delay, makes surer his aim, and more certain his wholesome conclusion. In either case hope follows his decision, and he dreads not the charge of rashness on the one hand, or of imbecility on the other. When a return to health ensues, the event expected from the inter- position of his skill, adds a new leaf to his medical chaplet. When death conquers art, it is one of the consolations of the mourners, that God had willed the failure of all human effort and ability, and the event is met with the fortitude and resignation which follow in- evitable issues. When really skilful, a physician of good general reputation is af- forded, in most cases, the great advantage of a fair and faithful trial of the means at his disposal. Every order is scrupulously and hope- fully obeyed. Remedies are properly timed, and administered with expressions of encouragement, which augment their usefulness. A distrustful feeling brings not only reluctance, but delay, deceit, mis- application and inaction. The reputable physician not only enjoys the full value of his skill, but is credited for all the prosperous acci- dents of the 'case; the physician of lesser fame is denied the fair trial of the ability he really possesses, and is blamed commonly for untoward events of an inevitable character. This affords a remarkable exemplification of an adage usually difficult to explain—" For he that hath, to him shall be given; and he that hath not, from him shall 2 10 be taken even that which he hath."* That man among you, my young friends, will be singularly fortunate, who shall escape, in the commencement of his medical life, the withering influence of such distrust; and he who once feels its blighting power, will more earnestly labour to reach that enviable elevation which places medi- cal character above its mildew. When possessed of the confidence of the public, and his patients, a physician is suffered to appropriate to himself the credit of his cures. If the case be one, which, though tedious, promises to his judgment a final victory, he is not, when on the eve of conquest, thrown into the shade by the impatient introduction of a senior, who swallows the fame of success, and is discharged from the obloquy of failure. He is suffered to proceed alone, or at his own discretion, to share fame and responsibility with a friend of his choice, who will neither sully his reputation, nor defraud him of his just meed of praise. Perhaps there is no professional evil of more universality, and of deeper inveteracy, than that which is the offspring of medical rivalry and jealousy. From some source lying near the foundations of the human heart, issue streams of contention, of whose waters, I regret to admit, physicians have in all ages drank too deeply. In every city they combine into hostile parties, and in almost every village personal and intense rivalry disturbs the naturally troubled waters of medical practice. Every physician must therefore, wherever situated, expect to suffer in some degree from the malevolence of rivals and the slander of competitors; who, unhappily, exert over his reputation a power, the greater because it is more instructed and more valued. There is, I fear, but one way to escape from this unhappiness:—we must rise above it. Until human nature is fun- damentally altered, or until our art becomes more perfect and insus- ceptible of dispute, we must not look for the extinction of this greatest of professional evils. Each of us can cure it, as to its bear- ing on himself, by securing, through great labour and study, such a character as will repel the shafts of calumny, and drive them back to wound the hand from which they issue. In this view, a sound and great medical reputation is inestimable. The peace purchased by inefficiency and useless obscurity none of you will covet, and be- tween that point and the lofty walks of medical philosophy there is * St. Mark, IV. 25. 11 no unassailed resting-place. Detractors seldom rise to particular distinction, and he who reaches an elevated station in public estima- tion, will soar beyond the reach of their envenomed arrows. In the more enlarged experience afforded by high public estima- tion, the physician finds the means of still greater professional ad- vancement. While a greater number and variety of cases present themselves to his observation, he is not deceived in the details of the treatment of any one of them. The wide display of well-ascertained facts, not only familiarizes his mind to the action of every remedial agent, but enables him to arrange, classify, and concentrate his knowledge, and form for himself safe inductive precepts for future guidance. The generalities deducible from a few facts can never be trusted, and perhaps no generality is indisputable but such as re- sults from a knowledge of every species of fact on which it is found- ed. The nearer we approach to such a totality, the more can we rely on our conclusions, and the less are we left on the restless ocean of empiricism. Therefore, to our highest usefulness, to our best interests, to our mental quietude, a sound professional reputa- tion is indispensable. There are many other and great benefits produced by a good ge- neral medical reputation, which might, did time permit, advantage- ously offer themselves to our consideration, but I shall conclude this part of my subject by presenting only one. No man of sound social structure, desires to leave his name to "dumb forgetful ness." There is implanted in every virtuous soul, an useful longing after immor- tality of this world's fame. Every generous mind desires to couple his name with something which will buoy it up above the absorbing tide of time, and appeal to the interest and happiness of the gene- rations yet unborn. Every one admires the exertion of parental love. It is beautiful because it is useful. It is noble because it is disinterested. It is a stream which flows outwards never to return. It is Godlike—" First does the good, then loves the good it does." Now, the noble principle which looks to remote posterity, is a mag- nificent extension of the parental sentiment. It is the creatures best, highest effort for his share of the conveyance of happiness to others. It is his offering to the general weal of the universe. How can the physician best perform his part of this illustrious duty? Sydenham has answered, in these memorable words—"Neverthe- less, I have always thought it a greater happiness, to discover a cer- tain method of curing even the slightest disease, than to accumulate 12 the largest fortune: and whoever compasses the former, I esteem, not only happier but better and wiser too. For can a person give a stronger proof of his benevolence and wisdom, than by endeavour- ing always to promote the public good, rather than his private inter- est, as he makes so small and inconsiderable a part of the whole? And in reality, as it is the part of a wicked man to destroy his fel- low creatures, so it is the duty of a good man to preserve them, and instruct others how to save them from death, even after his own decease. "* An enlarged medical reputation puts all such power of doing good more readily within reach of its possessor. He is taught more know- ledge, and has consequently more knowledge to convey to others. His communications are generally immediately and extensively ac- cepted by the profession, and their usefulness is not postponed to some distant period. His discoveries are not consigned to dust and oblivion, to be again put forth as new by a more fortunate successor. His contributions to humanity and happiness are immediate, exten- sive, prolonged; and he usually enjoys in his lifetime a view of the good which is to be ascribed to him in all future time. Let any one turn to Dr. Barron's most interesting historyt of the struggle for existence itself, made by vaccination, in the hands of the obscure country surgeon, and he will more fully estimate the value of a high reputation. A blunder of an eminent London practitioner, gave cur- rency to this first of discoveries, which its own able but unknown author could not before find any means of diffusing. If my recol- lection may be trusted, the first vaccination in London was per- formed to create an issue in a case of hip disease, and the protection being found adequate to Jenner's expectation, his medical friend of the metropolis gave to it immediate currency. Had Jenner possessed the station and fame of Hunter, ten thousand lives would have been saved in England alone, at a period antecedent to the first success- ful vaccination. With all due deference to the highest authority, I cannot but dissent from the sentiment which Sydenham expresses relative to fame. To him who desires to do good, a high reputation and extended renown afford the noblest opportunities, and the most inviting prospects. Next to a desire to serve that great intelligence to which we owe life and talent, and opportunity to use them, stands the love of a sound, honest, lofty reputation. I cannot but pity the • Sydenham's Answer to Dr. Brady, 2d paragraph. f Barron's life of Jenner. 13 man, and despise him too, who covets not a reputation fraught with so rich a share of the truly valuable things of life. Laborious as must be the toil of him who " struggles up the steep ascent of fame,"it is but a small price paid for an inestimable good. But with all its apparent hardship, the indefatigable pursuit of know- ledge is attended with many enjoyments. Perhaps we can form no idea of happiness superior to that of progression in knowledge. After satisfying animal wants, a task which employs but a small part of our time, we are by our own instinctive impulse, urged on in the pursuit of knowledge, and by different paths, and for various ends, men are actively engaged in the acquisition of new ideas. The gossip labours as hard in the busy haunts of men in seizing and re- tailing the idle news of the hour, as does the botanist in his flower garden, the mineralogist on the mountain, or the conchologist on the margin of the sea. The politician, the banker, the ship owner, the mere lounger, are occupied almost unceasingly in acquiring new ideas, and often with considerable, but pleasurable effort. It is one of the fundamental laws of human nature, illustrated in every child, and therefore to be obeyed, but obeyed with reference to the pro- duction of elevated enjoyment in ourselves and others. In the pur- suit of professional learning, the physician unquestionably rightly consults those desirable ends. In what manner can be obtained that enlarged and useful reputa- tion, so fruitful in the means of virtue and happiness, is therefore a question of no common interest. The first step in this important undertaking is to lay well the foundations of elementary medical knowledge. It is scarcely necessary to point out to you the various branches of a medical education. Such information is familiar to you. You know the importance of a close and accurate knowledge of the human fabric, of its parts, and the relations of parts. It is the foundation of physiology, and the parent of pathology. But t6o often, like the miser, the student mistakes the means for the end, and leaves college thoroughly ignorant of that for which alone he should have pursued the culture of anatomy. The functions of the parts have been overlooked. The carcass has been studied, but the living actions have been unnoticed. The machinery has been care- fully inspected, but the machine is not understood. Its movements, its uses, and its ends, are seldom the subject either of interest or study. Without a tolerable knowledge of mechanical philosophy, very 14 little can be clearly comprehended by the student of anatomy. The arm is a lever with its power and its weight. The heart is a potent forcing-pump with its varied appendages. Mastication, deglutition, the peristaltic action, are mechanical movements. Respiration is depend- ent on atmospheric pressure; so that without a tolerably clear idea of pneumatics, the mechanism of the respiratory organ is studied in vain. What can the student profit, by the minutest acquaintance with the delicate and beautiful structure of the eye, if he remain ignorant of the laws which regulate the refraction of light. The ear demands for its study an acquaintance with acoustics, and he must know something of hydraulics who intends to comprehend the circu- lation of the blood. It is in vain, gentlemen, to expect the kind of reputation of which I have spoken, without following up your know- ledge to philosophic foundations. You must have a clear, to have a useful comprehension of your subject. Until recently, the important bearing of chemistry on the science of medicine was not fully understood. " I need not," says the cele- brated Thomson, " observe to those gentlemen who have paid atten- tion to the subject, that by far the most likely means of improving physiology, is a cautious application of chemistry to the investiga- tion of the different constituents of the human body. An accurate knowledge of the chemical composition of every organ, and of the alterations produced on that organ by disease, would probably throw new and unexpected light upon the nature and treatment of many diseases. Physiology hitherto has been handled almost exclusively by the anatomists. These gentlemen have acted with a zeal and in- dustry that cannot be too much admired. They have examined the anatomical structure of every organ of the human body; ascertained the changes to which it is liable from disease; and compared it with the analogous organs of all the inferior animals. A great deal of im- portant knowledge has been the result of this active examination. Yet after the anatomists have exhausted all their ingenuity, it must be admitted, that our knowledge both of the organs and functions is still very imperfect. A new and more subtile species of anatomy remains still to be applied. Where the labours of the anatomist ter- minate, those of the chemist must begin." The analysis of the scalpel having been carried to its final term, that of a more minute and pe- netrating character must come to the aid of our investigations; and at length, we must look to that science which teaches of the action of the invisible particles of matter, for an exposition of the secrets 15 of the wonderful laboratory whose master spirit is the principle of life. By those who despise that of which they are ignorant, it has been said that chemistry tends to darken our knowledge of functions, because chemists conduct their processes in inorganic vessels, while far absent is the subtile power which, in the living tubes and cavities, always alters, often reverses, the laws by which matter is usually governed. This is an invalid objection. Galvanism exerts over molecular matter as modifying an influence as the principle or powers of life, ever changing, often reversing the laws of affinity and repulsion: but can any one but the scientific chemist study success- fully, observe beneficially, or report philosophically, the phenomena which arise out of the mutations of galvanism; and so is it equally necessary for the physiologist and pathologist, to bring the knowledge of the chemist to the aid of his difficult and important investigations. We have much to hope from such pursuits so conducted. Every one admits that we want only a knowledge of the transactions of the particles of matter, to explain at once and fully, the phenomena of living action. Such knowledge has been acquired relative to in- organic matter. It is but a few brief years since the genius of Dalton unfolded the secrets of atomic philosophy, and already we have been taught the proportional weight of particles which will perhaps for- ever elude the organ of vision. The atoms of the invisible gases themselves have been not only weighed but measured. Until recently we supposed ourselves possessed of a knowledge of all the motive powers, and felt prepared to bring to the explana- tion of living movements, the well-developed doctrines of mechanical philosophy. The industry and perspicacity of Oersted have, how- ever, suddenly produced on this department of science a most re- markable revolution. Agents productive of motion have been at work in the organic world, of whose interposition we had not even dreamed. Motions are created through the conjoint agency of elec- tricity, and much abused magnetism, which are inexplicable on any former principle of natural philosophy. In that way masses and par- ticles are set in motion, and effects produced which promise to us a rich harvest of useful knowledge. These chemical discoveries of Dalton and ffirsted are yet to be brought to the investigation of the phenomena of physiology; and potent engines of discovery will they prove. They promise too to bring back to the aid of the physician, that singular magnetic power, which we must now admit to possess 16 a curious and extensive influence over the movements and combina- tions of the animal economy. Its banishment, produced by the mys- tification of empirics, and the pride of a dogmatic philosophy, must now be deplored, since it has become evident that it is an agent of no ordinary power, and of almost infinite diffusion. In the practical departments of medicine and surgery, those to which all others are subsidiary, you have most enviable opportunities for improvement; and they are such as you can never again enjoy. Until the close of your collegiate career, you are privileged to listen to those who have studiously selected out of the mighty stores of human learning, the things which it is most desirable for you to receive with the force and tenacity of original impression. These teeming germs of future fructification are carefully ingrafted by hands skilled by long practice and varied study: and while you are observing the process, you have the advantage of corrective interro- gation, to dissipate error or unfold more fully the truth. Immediate personal access to the author, empowers you to extend, correct, and define your impressions; a privilege which you will scarcely ade- quately value, until it is gone forever, and you are left to the task of collecting knowledge from books alone. That you may be better prepared to enter on the arduous task of practice, let me advise you to attend with special diligence the cli- nical instruction of the Alms-house and Hospital. Knowledge enters through the eye with peculiar distinctness, and the impressions thus received are least susceptible of obliteration. You there behold theory reduced to practice, and learn by personal observation the relative value of medicaments and theories, without the hazard and anxiety of personal responsibility. In a few months you may there visit a greater number of patients than can be seen by you for many subsequent years, and behold those rare cases which seldom present themselves in private practice, but which are often peculiarly illus- trative of important principles, about which, without such evidence> you might ever remain in injurious uncertainty. In following your clinical instructor, let me intreat you not to chain down your atten- tion to a mere detail of facts. If you do, you will fall into an in- curable empiricism, and drivel on through life a mechanical routinist. Endeavour always to look to the principle of practice, avoiding on the one hand an unassorted catalogue of facts, and on the other a too general classification of them. Neither particularity nor uni- versality belongs to our science. It is, as yet, but a collection of 17 short inductive links of reasoning, which will one day be formed into a lengthened chain, embracing in its golden grasp the thousand morbid "ills that flesh is heir to." There is another inestimable privilege attached to your hospital studies. In public institutions, the death of the patient does not conclude the lesson presented by him. But there, where in coun- try practice at least, the instruction is at an end, the most useful knowledge is yet to be collected. Autopsic investigation comes to clear up doubts, confirm conclusions, or correct erroneous diagnoses. Pathological anatomy unlocks the richest stores of medical truth, and her greatest treasury is found in hospitals, to which most of you will have access only for the brief period of a student's preparation. As the geology of a mountain can be best studied where destructive processes have brought on its dissolution, so the true history of dis- ease is most clearly read when the subject has been exposed to the criticism of the scalpel and the microscope. To this source of know- ledge, therefore, give your most zealous attention. Lose no oppor- tunity of witnessing for yourselves the results of morbid actions, so that you may not only assure yourselves of the true causes of the external phenomena, the symptoms, but be able to discriminate in after-times between healthful structures, and those which have been modified by morbid agency. One suggestion on this subject yet remains for your instruction, and to it let me invoke all the attention it is possible for you to give. It would be difficult for me adequately to express to you the extent of the deficiency of the knowledge of the great mass of practi- tioners of this country, on the most interesting of all the subjects committed to our care. Mere diseases of the body are diligently studied, but those mysterious complications where mind and body are alike involved, are to them, for want of opportunity, almost a terra incognita. Hence we seldom receive a lunatic from a distance whose case has not been misunderstood, and whose treatment has not been erroneous. The success of our management of recent cases of insanity, warrants the belief that the greater portion of those who are sent hither from a distance, and who are too often when received beyond the hope of improvement, might, by judicious treatment, have been restored to themselves, to their relatives, and to society. Now, this sad issue is to be prevented only by seizing the present oppor- tunity of acquiring information relative to this most interesting class of diseases. Be assured too, of a great reward in the delightful 3 18 contemplation of a mind rescued from a condition worse than death. It is a restoration almost equivalent to a resurrection. It is a heart resuscitated, an intelligence rekindled. The habit of diligent application, and of discriminating and philo- sophic observation, having been once acquired, will not desert you, it is to be hoped, when, in the active scenes of life, such qualities become more diffusively valuable. Such a habit is soon perceived in you by those who are better judges of that than of actual acquire- ment in medical knowledge. Men of other professions, who feel in their own affairs its acquisitive importance, will estimate your attain- ments, rather by calculating the potency of the principle, than by measuring its actual results; and credit will be given to you for skill in those deeper mysteries of our art, where none but a cultivated physician himself could fairly appreciate its amount. Thus prepared to enter on the busy theatre of life, the young phy- sician reaches perhaps the most trying point of his career. It is easy to find a place of settlement, but to obtain the only legitimate object of his ambition, an honourable and useful reputation, is a question usually esteemed of no ordinary difficulty. A curious observer of the usual professional course, will soon perceive how much of oppor- tunity is suffered to pass without profit or improvement, and how large a share of ordinary failure must be ascribed to negligence and deficiency of enterprise. In the first years of his practical course, are presented to the physician the means of laying deeply and solidly the foundations of his future elevation. True skill will finally com- mand attention, and obtain its reward: but skill results from learn- ing combined with patient observation, and carefully conducted ex- periment. No man can acquire knowledge in any art or science so rapidly as from the ample magazines of written truth: but no medi- cal reading proves salutary without adequate collegiate preparation, and unless well-digested, and subjected to experimental ordeals. Read, therefore, while there is leisure to read; for soon, generally too soon, there comes active employment of some kind to interfere with the acquisition of knowledge from authors. Every one conver- sant with the profession soon perceives the vast difference between the man, who adds to his own peculiar knowledge all that flow9 from the observation of those who have gone before him; and him who trusts to the feeble light which his own unaided talent thrown on the phenomena of disease. The one stands on a lofty monument erected by the successive labours of all the great men who have, in every 19 age, graced the annals of our art; and from his advantageous eleva- tion the better observes the grand features of the landscape, and the relations of the objects around him. The other, in the narrow vate of original observation, sees but a few objects, and discerns badly the relation of these to each other, and to the whole. His prospect is contracted as well as erroneous. There is no falser or more bane- ful dogma than that which teaches us the greater perfection of know- ledge by narrower limitation. It is not so. Knowledge sheds light on knowledge. Analogies give lustre to truth, and he who knows many things well, knows each the better for the irradiation of the rest. A splendid analogy unfolded the platinum of the Uralian moun- tains, and developed the diamonds of Siberia. A mere miner would not have dreamt of them. A very limited science would never have led Servetus to his almost miraculous detection of the lesser circu- lation, or given to Harvey the honour of laying the great corner- stone of the temple of physiology. The greatest men have been of the most diversified attainments. Hauy did not confine his studies to minerals, and Cuvier and Humboldt drew a thousand illustrations of their favourite pursuits, from remote and often opposite sciences. Without much labour and study therefore, no man can reasonably hope, in our enlightened age, to reach a very high reputation, or to command very extensive public confidence. The value of the ac- quisition is still worth more than the effort costs; and he who fully appreciates the thousand benefits of the attainment, will not hesitate to press on towards so noble a prize. If, however, hope will not stimulate him, surely he will find a motive for strenuous exertion in the fear of falling short of an imperious duty, and of doing harm where he professes to labour after good. There scarcely can be con- ceived a more terrible and trying situation than that of the physician who becomes conscious of culpable ignorance, at the moment when the fate of a fellow-being hangs by his judgment and science, and there is left no leisure for research, and no time for consultation. In the tempestuous emergency, when he should stand erect in the calm dig- nity of conscious knowledge, and controul the elements of confusion, he is struck dumb, betrays his luckless impotency, and enhances the terror which it is his duty to allay. Such scenes are not imaginary. They do occur: and woe betide the man whose heart has not been agonized when put to such a trial. In striving to acquire a sound and great professional reputation, let the physician remember that he is not to succeed in his object, 20 unless he pursue it with a tender regard to the just interests and fair fame of his medical brethren. / have never seen a man rise to par- ticular distinction in our profession, who was a slanderer of others, and most of those who have been placed in its foremost rank, have been carefully just towards all fair and honourable pretension. Such a course disarms hostility, excites favourable impressions, and reacts with beneficial power on the fortune and reputation of him who pursues it. Besides, there is a confidence in oneself, implied in the act of approving the medical course of another, which augurs favourably of him who expresses approbation, and insures for his own conduct a more partial opinion, and a more decided commendation. In conclusion therefore, gentlemen, let me express the earnest hope, that you will strive hard to accumulate now the materials for future fame and usefulness, press them in due season into active and extensive service, and, whilst labouring up the steep ascent of renown, have no regret at the sight of equal attainment, equal reputation, and equal success; but prove to the doubting world, that our noble science is compatible with love, and that philosophy carries not neces- sarily in her bosom, the rankling venom of distrust and jealousy. THE END. ^^ .*v, ;v 1 ^ V.T- .*. i i *V ~ . r r •/ irr#- - ■■ ' 5^| i :m '•• • i c t ^» #*-*«# -*= a' ' * *- •• •j - \ - *" *-JJi i J #•■■' r* - \lf'i w \ 1