WB ,4558 '^C3 c< «, <«: c c -w, «cc cc c: CC c c d re <■ < < C < C. C fc«_ C < C C ■ CC~ c < c c < t t « < < <•<: c ccc CC-c c.c •• «r c *:<■ ««Cc ?.<=< < <- 4 c< «T< .< ! < C C , ........ AN INTRODUCTORY LECTURE A COURSE OF LECTURES THEORY AND PRACTICE OF MEDICINE, IN THE UNIVERSITY OF PENNSYLVANIA: DELIVERED AT THE OPENING OP THE SESSION OP 1838-39. BY N. CHAPMAN, M. D. Professor, fyc. PHILADELPHIA: J. G. AUNER, 331 MARKET STREET. PRINTED BY L. R. BAILEY, 26 NORTH FIFTH STREET. 18 38. 7 «7& o C/MU / S38 CORRESPONDENCE. Philadelphia, November 21st, 1838. Professor N. Chapman, Dear Sir.—We, the undersigned, a Committee appointed in be- half of the Medical Class of the University of Pennsylvania, to request of you for publication, a copy of your highly appropriate and eloquent Introductory Lecture, take great pleasure in the performance of this trust. Hoping that you will comply with our request, we are, with sen- timents of esteem, Respectfully, your's, II. RlDGELY, William A. Hill, Thomas Sappington, B. Bardwell, A. W. Read, Thomas J. P. Stokes, Lucas Gee. Philadelphia, November 21st, 1838. To Messrs. H. Ridgely, William A. Hill, Thomas Sappington, B. Bardwell, A. W. Read, Thomas J. P. Stokes, Lucas Gee: Gentlemen.—Though not aware, that the Lecture with which I opened the present Course of medical instruction, is deserving of the compliment you design it, I am at all times so unwilling to disappoint your wishes, that I now send you the manuscript, subject to your disposition of it. With sincere attachment, and very high respect, I am, gentlemen, most faithfully, Your friend, N. Chapmax. INTRODUCTORY LECTURE. Gentlemen of the Medical Class— We are once more brought together, to renew the relations between us, which for a season have been suspended. During the vacation, I have carefully revised, and otherwise endeavour- ed to improve my lectures, and now commence the Course with renovated spirits, resolved to dedicate my best efforts to your service. Following the example of your predecessors, those of you who have entered the temple of medical science for the first time, I trust bring with you pledges to diligence and fidelity. The ministry to which you are henceforward to belong, is one of the most arduous and responsible of human engagements. To define its objects and to vindicate its high pretensions, will now occupy our attention for a few minutes. Man, in his primeval state, enjoyed entire felicity. De- scended immediately from the Creator, in his own image, he partook of the divine purity, and was placed in a position exempt from care, and where all his wants, were spontaneously supplied. Even by those nations who had no access to the sacred records, such a view of our original condition, seems to have been, at least, vaguely entertained. It was an ingre- dient in the religious creed of some of the more ancient,—and the poets of the classic times, delighted to celebrate the beauty, order, and beatitude of the golden age. But this blessed existence was of no long continuance. By the violation of the covenant, under which it was held, all its privileges were forfeited, and annulled. Exiled from paradise, ( « ) the parents of our race, in quitting its scenes of peace, innocence, and tranquillity, had to encounter themselves, and entailed on posterity the miseries of their degradation. Moral evil, at once, made .its appearance, and was soon followed by the lengthened train of physical calamities, or, as has been finely imaged, the casket of Pandora was emptied on the world! Yet, though fallen from this " high estate," mankind were not left without resources. Conformably to the general benevo- lence of the providence of God, in which is always mingled even with the severest dispensations, some lenitive or relief, we had still superior faculties reserved to us, to mitigate our destiny. These, among other applications of them, were directed to the cure or alleviation of disease, and, hence arose the art of medi- cine. Commencing when knowledge was slender, and reason feeble, its progress was slow,—obscured by the darkness of the thnes, and deformed by ignorance and superstition. It emerged, however, with the rise of intellectual light—has never lingered behind the career of improvement, and now claims an equality with the speculative and useful sciences,—the whole harmoni- ously administering to the advance of intelligence, and the ul- timate sovereignty of mind. In the ordinary estimate of our profession, much too narrow a view is taken of its scope and purposes. Man may be contemplated, either in his physical or moral nature, and in both relations ought to be the subject of our at- tention. But the preservation of health, and the removal of disease, are our primary and leading duties. To attain the skill to effect these ends, nearly every province of science must be invaded, each carefully explored, and rendered tributary to the design. Circumscribing our pursuits to those strictly technical branches only, which enter unavoidably into the constitution of our studies, the range will still be found wide and diversified! But in an expansive scheme of medical education, what is there that is excluded? Enlightened by the rays of every science, medicine reflects its own on the sources whence it borrows, and by this reciprocal interchange of lights, contributes its fair proportion ( 7 > to that aggregate illumination of mind, which has received the appellation of philosophy. Notwithstanding its manifest claims to regard, and the rank it has so long maintained, there are not wanting some to decry our profession, as defective in certainty and usefulness. Cavil- lers of this description, are usually to be met with among per- sons of vigorous constitutions, and unimpaired health, prone to sallies of wit, or the indulgence of sarcasm, too often at the expense of truth,—who, however, in the season of distress, are prompt to call on us for succour, and most confident in its efficacy. Did objections to it, proceed only from such critics, which cannot be affirmed, I should not condescend to vindicate its titles or assert its merits. Devoted to the more exact sciences, cer- tain philosophers have occasionally united in this clamour, and denounced medicine as " a deceitful art, the empire of which is founded solely on credulity and weakness." Conceding this to be a just estimate of its character and pretensions, every liberal incentive to its cultivation would be withdrawn, and, released from an illusion so long cherished, we must acquiesce in the degradation of the profession into a low art, to be pursued only by the vulgar and the mercenary. It hence behooves us to examine the reasoning, by which this charge is endeavoured to be sustained, in order to decide on the degree of its validity and correctness. Divested of weak and irrelative matter, the case against us, may really be reduced into very small dimensions. I. We are told, that the vital principle, which exercises such controlling influence over all the actions of the animal economy, in a sound as well as deranged state, has hitherto eluded our researches, and remains unknow7n. But, is it necessary to the investigation of its phenomena, or its laws, that we should be conversant with its nature? Numerous are the instances, in every department of science, where the immediate motive of events is inscrutably concealed—and still, we are made suffi- ciently acquainted, for all practical purposes, with its character and tendencies, by accurate observation of its effects. As little ( a ) is known of the essence of caloric, of electricity, of galvanism, and of the various affinities, as of the principle of animation. But these are the great agencies of the phenomena of the uni- verse, which have been determined precisely by the same course we have adopted as to vitality. Did Newton profess to be more intimately acquainted with attraction, repulsion, gravitation, when he produced the most splendid series of generalizations which philosophy claims? No difference, therefore, can be dis- covered, in this respect, in the physical sciences. Let it be confessed, humiliating as it may be to our pride, that, of causation, even as to many of the most familiar occur- rences, we are ignorant. It is the prerogative of a more exalted intelligence, which has never been conceded to us—and all our attempts to pry into the mystery have been rebuked. The study of facts, and the establishment of their relations, are given only, as best suited to our finite powers and temporal condition. To know the cause of things, is one of the reservations for a future existence, where all will be revealed, to form, probably, not the least of its charms and felicities, by the indulgence of a rational curiosity. II. It is further alleged, that diseases arc so various, so com- plicated, so fluctuating, and the properties and mode of opera- tion of remedies, so obscure and defectively ascertained, that it is impossible to frame any certain, or definite rules of practice. Candour will compel us to acknowledge, that the subject is re- plete with difficulties and embarrassments. These should be avowed, to prepare you to encounter them, and to inspire new and invigorated efforts for their diminution or removal. As, in the former instance, we pretend to no ac- quaintance with the essence of disordered action—we are ignorant of that of health, and equally so, as modified by mor- bid impressions. Each is the study of phenomena. Diseases, however, are not so changeable as has been represented. The histories of them, transmitted by the primitive writers, continue to be received, as pretty exact descriptions of their physiogno- my, or external characteristics, and, whenever varied by cli- mate, the states of society, the peculiarities of locality,—epi- ( * ) demic, or other influences—have proved so retentive of their distinctive features, as to be easily recognised. Every morbid affection to which we are exposed, exhibits, with more or less regularity, under every aspect, a set of steady, uniform, con- sistent signs or symptoms, presenting a portrait to our senses. Contemplating this, in its frequent recurrences, we acquire a readiness of perception, approaching to intuition, enabling us to detect its absolute identity, or as altered by the attendant inci- dents. Taught by long and concurrent experience, that, in such a case, relief is to be afforded by certain measures, these are resorted to, regulated in their application by discrimination and judgment. Nor does it appear to he very material, in the administration of a remedy, previously to ascertain its occult qualities, or the mode in which it operates. As a fact, in most cases, we are aware of its efficacy, and little more is required, than to learn its appropriate adaptation. Being, however, a new article, it is subjected to every process calculated to shed light on its properties—and finally, we try it on the human body, in a dis- eased condition, as the only true way of arriving at just con- clusions. Thus, by observation of their effects only, informa- tion is gained as to our remedial means—and what would it avail, could we penetrate into their more intimate nature ? Con- fessedly ignorant as we are, on this point, do we not, among other examples, successfully resort to opium to allay pain, or sooth irritation—to the bark to cure intermittents—to mercury to stifle the foulest disorders, and to antimony to arrest con- tinued fevers—with adequate precision in their use, and with no distrust of their powers 1 III. Not the least plausible of the objections preferred against our science, is derived from the variable and transitory charac- ter of its theories, and methods of practice. Did medicine rest on a solid foundation, it is said, that its principles would be permanent, conducting to one uniform plan of managing dis- eases. We do not deny, that, in the progress of the science, it has undergone revolutions, though fewer than might be pre- sumed, and, at the present moment, it is marked by very slight ( io ) shades of difference, as it exists in the more civilized sections of the world. To upbraid us with the conflicting absurdities of the infancy, or the immature stages of our science, is neither generous nor honest. Examining the records of the other phy- sical sciences, it will be perceived, that they are no less dis- figured by idle hypotheses. Nor is every difference of medical opinion, a deviation from principle, leading to opposite and contradictory practice. Diseases, we see habitually treated by similar remedies, though the rationale of their operation may not be the same. That medicine, like the other sciences, is unremittingly progressive, and hence liable to innovations, ought to be recollected. Theory is the interpretation only of the ac- cumulated and combined facts of the time—and as we advance in our inquiries, the horizon widens, lets in a brighter light, and more distinct views—productive of consequent changes. IV. It is stated, finally, as an objection, that every animated being is possessed of a conservative principle, which, in most instances, is adequate to the protection of its economy against injuries—or, when incapable of resisting morbid aggressions, calls on its recuperative resources to redress the mischief, and reinstate the order of health. As a corollary from these pre- mises, it is declared, that any artificial interference, proves pre- judicial, by disturbing, or otherwise affecting, the sanative energy of this inherent faculty. To the existence and attributes of such a power, we must give a qualified assent. Com- mencing with the dawn of medicine, the recognition of it may be traced successively throughout its annals—and, at all times, has influenced our reasonings and practice. Granting to it, as much as can reasonably be claimed, surely we should not exclusively confide in its resources. No doubt, more actively efficient, in the simple, unsophisticated state of nature, it does not, however, adequately succeed under these circumstances, as is de- monstrated in the diseases of savages, and of the brute creation. Civilization, and its associate habits, luxuries, and refinements, cause such changes in the living system, that comparatively little can be expected from natural efforts. What might have been presumed in speculation, we have ( 11 ) seen amply verified on trial. More than once, it has been a favourite dogma with medical sects, in their renunciation of re- medial measures, to insist on the competency of the vis medi- catrix naturae, for all curative purposes. The result proved the folly of such views. Constantly vigilant of the indications of nature only, these votaries received the name of expectants, and their practice the significant designation of a " meditation on death" But, in abandoning one, let us not run into an opposite extreme. Nature is not to be disregarded, or, in the language of my late illustrious predecessor, " driven from the chamber when the physician enters." It were well had he remembered the maxim of Horace: " Naturam expellas furca, tamen usque recurret." Consulted properly, her oracles sometimes disclose information to relieve our perplexities, and she as often proves an important auxiliary to our endeavours, in ambiguous or refractory cases. Left to herself, she may be unavailing from feebleness, or be- come detrimental, by an irregular and disproportionate exertion. Neither unduly confiding nor distrustful, it is incumbent on us to watch her manifestations, to control the inappropriate and co-operate with her best designs. It will be perceived, that while its existence is conceded, I assign no mean office to this mysterious faculty of the animal economy. To discredit it, with such evidence as it constantly exhibits, seems to me an unwarrantable species of scepticism. As reason regulates the moral, so is the vis medicatrix probably intended to preside over our physical organization—and the perversions to which each is liable, may and ought to be cor- rected. Extraordinary is it, that it does not occur to those who enter- tain such silly prejudices against medicine, that since it is an art founded in the strongest of our propensities, the desire of pre- serving life, or seeking relief from suffering, and which has from the earliest times, and must forever continue to be practised, that it is better to give to it an enlightened cultivation, than to re- sign it to a blind, ignorant, and audacious quackery. To cal- ( 12 ) culate on suppressing the art altogether, is the most empty and fallacious of expectations.* It follows, from the preceding exposition, that medicine is a science of observation and induction. Cultivated cautiously, as definite conclusions may probably be reached in it, as in several other departments of physical knowledge. To accomplish this, how7ever, we must carefully attend to the phenomena in the sound and morbid states of the body, as well as to those of our remedies—to mark the order in which they occur, and their mutual relations—and so to arrange them, that this order and these relations may be clearly perceived. To what point of excellence medicine is destined to be car- ried, I shall not venture to predict. The human mind is en- dowed with such powers of improvement, that bounds can scarcely be assigned to it, and which will be best appreciated by a retrospect of its attainments. Cast originally on the world, destitute and helpless, with literally no other provision than his intellectual energy, we are astonished by a survey of the result of the labours of man, and become lost in the contemplation of the future.. Determining then, from the past, our anticipations can- not be otherwise than sanguine. The march of intellect is in a geometrical proportion. Difficulties, which always intercept or obstruct the first steps of its career, being overcome, it presses forward with incalculable celerity. Many of these obstacles are now removed. Nor have we to apprehend the loss of any part of our acquisitions, by those great moral and political con- vulsions, which overthrew the enlightened ages of antiquity, extinguished the lights of learning, and left the species for a time, to grope afresh in darkness and ignorance. The attain- ments of the human mind, prior to the invention of the art of printing, when committed to tradition merely, or were endea- voured to be preserved by other means, scarcely less precarious or perishable, like the trees that grew around the tomb of an * Cabanis has anticipated me in much of the above argument, in a work " Oil the Certainty of Medicine," of the highest merit, and to which every one who haa ■ubsequently treated the subject is largely indebted. ( 13 ) ancient hero, could reach only a certain height, and then with> ered into decay—or, as those described in another legend, the fruits of which no sooner approached maturity, than they were transformed into birds, and flew away. Catastrophes of the kind to which I have just alluded, cannot, however, again recur— and we have the fairest promise, that human affairs hereafter will constantly tend to melioration, guided and controlled by a higher mental influence. Yet it is no less true, that there are limits to our acquisitions. " Thus far shalt thou go, and no far- ther," is a mandate which cannot be resisted, aifd our aspirations after perfectibility,, are vain, unphilosophical, and perhaps, wick- ed. By the hand of the Creator, the tree of knowledge as well as that of life, itself, is planted in security against the intrusions of a too eager inquisitiveness, and daring indeed were he, who would venture to invade the hallowed sanctuary, and attempt to disarm the guardian cherubim of his flaming sword. Cer- tainty of knowledge, is not the order of our present condition, which is one, for the wisest ends, dependent and imperfect. As much as is consistent with this intention, will be granted to us, and when, in a spirit of arrogance, we dare to emulate the attributes of that Being, from whom all is derived, we may experience the fate of him, who presumptuously attempted to draw down celestial fire, to vivify and complete the work of his own hands. More, perhaps, than in some other pursuits, will the-culti- vators of medicine be rebuked in their endeavours at perfection. Distinct altogether from the peculiar difficulties of the subject, other barriers are erected to their progress, that cannot be over- come. Disease, the tornado, the earthquake, and other desola- ting occurrences, are part of the machinery of the divine government of the world, instituted wisely, and must endure forever. These, which to a limited view, seem to be enormous evils, are really blessings in disguise. Calculated to elevate our notions of the Deity, they, at the same time, inspire us with a sense of humility, and absolute dependence. Even their des- trucUveness is beneficial, by thinning population, which, permit- ted to accumulate, as it would, without such outlets, must have ( 14 ) proved an overwhelming calamity. But above all, they serve as incitants of curiosity and study,—give to us occupation— and raise us in the scale of intellectual excellence. To what else do we owe some of the highest achievements of science and philosophy, and especially our own glorious profession, which in accordance with the benevolence of Providence, per- mits us to mitigate, though not entirely to stay some of the hea- viest afflictions of humanity? Ceasing then to murmur at ordinances, which must be deem- ed wise, and the indulgence of any vain estimate of our powers, let us be grateful for our lot, and " vindicate the ways of God to man." It may be safely affirmed, that, even in its present defective state, our profession renders the most essential services. The advantages of surgery and midwifery, which, as appealing to the senses, are allowed by universal consent. Yet it must not be concealed, that, with the exception of the executive parts, each of these branches borrows all its titles to a science—its principles, its remedies, the instructions for their use—from medicine strictly defined. To operate in either case, is the last alternative—always resorted to reluctantly, by well edu- cated men, as denoting a want of curative skill. Contracted, therefore, within their own proper confines, they can really claim little more than manipulatory adroitness, having hands to perform, without a head to direct their proceedings. Can it be disputed, that medicine has a complete command over one of the most loathsome diseases, which for a century desolated the fairest portions of the earth—or, that it is entitled to a discovery, promising the extermination of a species of pestilence, long the terror of mankind. These instances are cited, as striking proofs of its utility. But, its titles to regard, rest on broader grounds. Not further to descend into details, I shall state, only, that, from recent statistical reports of several of the European cities, it appears, that, by the improved mode of treating diseases, and the more regular attendance on the poor, the bills of mortality have decreased one third in the last twenty years. ( 15 ) No fact seems to me to be better established, than the ad- vance of our profession. Disorders, which, in my own recol- lection, were slow of cure, or utterly intractable, are now sub- missive to our remedies. The catalogue of opprobria medico- rum, is sensibly diminished, and, I confidently believe, will be still more reduced, at no distant period. Even admitting, how- ever, that we are still to bow to the supremacy of certain in- domitable forms of disease, let us not be dispirited, or unite with the vulgar in impeaching the powers and utilities of our noble profession. We have already done much, and have the hopes of accomplishing more, for the sufferings of humanity. Navigation, though pronounced, and with justice, to be one of the most exact and perfect of the sciences, its followers too, are liable to accidents and miscarriages. When the storm rages vehemently, and the billows beat in their utmost fury, the art is nugatory—and should the ship be dashed on rocks, or lost in quicksands, or sunk in the " bosom of the vasty deep," who censures the hapless seaman, or questions his skill or the value of his art ? Doubtless, with some good intention, which we cannot divine, the tempest is raised, in each instance, and equally sets at naught, the feeble endeavours of the physician and the mariner, to avert its disastrous consequences. An enumeration of the causes of disease, would impressively show, by how frail a tenure we hold our existence. Life is only sustained, as it were, by a victory over the elements, and other morbid agents, which surround us. The earth, the sea, the air, our aliments, our drinks, our employments, our amuse- ments, even our passions and mental exertions, seem to conspire for our destruction. We frequently hear the expression of surprise, that consider- ing the complicated nature, and the exquisite delicacy of the structure of man, his health should be so seldom deranged, and his life so long protracted. But, how much more should we be astonished, did we advert to the numerous and powerful sources of disease, to which this frail and delicate being is ex- posed. That man, hardly less perishable than the flower of the spring, should thus endure amidst the conflict of so many hos- < 16 ) tile causes, is, surely, the highest homage to the resources of our art—and ought, at the same time, to encourage us to pro- ceed with its cultivation, so as to render it still more creditable to ourselves, and richer in benefits to our kind. Much remains to be effected. The inheritance we have re- ceived, it is due to posterity to enlarge and enrich, by new ac- cessions and further improvements. To us especially, does this obligation apply. It is our fortune to live in times, and in a country, singularly propitious to the movements of intellect, and schemes of amelioration of every kind. The mighty im- pulse, which so long excited and shook the moral world, seems now to be turned from the theatre of war and desolation, to seek refuge in the peaceful abodes of philosophy. An enjoy- ment of political institutions, which leaves our minds free, unre- strained, and disinthralled, is our peculiar felicity. We have caught the impulse, to which I have referred, and are advancing to distinction in the several departments of letters. The mind of our people is aroused, and seems disposed to exchange, in part, the sordid occupations by which it had been engrossed, for more liberal and enlightened pursuits. Education, heretofore neglected, is now sedulously and systematically acquired. The press teems with valuable productions, the earnest of higher achievements—and soon we shall seize some of those glittering prizes, which incite and remunerate a laudable ambition. This may be a vision only, of an enthusiasm too ardently indulged, never to be realized in my time. Be it as it may, I will cling to it as one of the comforts of my soul. But, shall I not hope, that there are some, among those I now address, to whom it is reserved, to assert the moral ascendency, and intellectual glory of their country ? It is such anticipations, which constitute the best reward of my labours, and draw from me the expression of a grateful sense, that it has pleased my God to enable me, by the position I oecupy, to conduce, in a slight degree, to so delightful a result. Commencing here in this venerable Institution, which has re- cently been regenerated, and strengthened by a vast accession of talent, and furnishes every facility, I trust that you will enter on ( 17 ) your studies with zeal and industry, and so deport yourselves, as may be consistent with your high calling, and the realization of the fond hopes of those friends who have sent you hither at much expense, and are now filled with the deepest solicitude for your welfare and succe??. This is a most touching consideration, which can scarcely fail to affect every pure and honourable mind. By such devotion, can you only expect to mitigate the toils, and overcome the obstacles otherwise to retard your advancement. To some of you, the subjects which you have to embrace, may be, at first, dark, entangled, and difficult. Be not disheart- ened. Did you never survey the skies, on a dim, though se- rene evening, when, on a hasty glance, only a single star could be discerned, and by further contemplation, another appeared— and so in succession, till the entire concave of the heavens became illuminated ? Exactly in this way, by attention, will light be gradually shed on your investigations, obscurities dissipated, intricacies removed, and the whole as by a revelation, seem clear, obvious, and intelligible. Believe me, that it is the com- mencement, which will prove rugged and discouraging, and where vigilance and resolution are most severely tried. Con- quering by perseverance the leading impediments, the track, as you proceed, will be smoother, and the prospects brighter, till you arrive at the ultimate point of your destination, with honour, and in triumph. Waste, however, time, or withhold any of your talents or endowments, and you must inevitably, in these times of general competition, be driven into the recess- es of life, there to languish in humble mediocrity, or, perhaps, indigence, neglected and despised. Every man, in this country, either makes or mars his fortune—and, he, who relies on his own steady exertions, has a patron of the noblest and most effi- cient kind, who will never disappoint, deceive, or desert him. It is the advice of a writer of antiquity, distinguished, perhaps, more than any other, by the wisdom of his precepts, that, in entering on an enterprise, we should always raise our aspirations to the highest pitch of excellence—and, even, if this be not reached, 3 ( 18 ) we cannot, with so daring a spirit, and such an elevated aim, sink to any subordinate level. It is honourable to excel under all circumstances, however trifling the rivalry, or valueless the palm of victory. But how much more so, in your own great undertaking, where the most momentous interests are embarked? Medical science is not an inheritance, or like poetry or elo- quence, the gift of nature. Whoever acquires a proficiency in it, must undergo a slow, toilsome, and arduous probation. Euclid, being asked by a monarch, his pupil, who became restive under the tedium of attention, whether he could not ex- plain his art in a more compendious manner? No, was the manly reply, there is no royal road to geometry! Many other things may be seized by might, or purchased with money, but know- ledge is to be gained only by study, faithfully and diligently pursued ?* Eminence in medicine especially, is a lofty summit, and the path which leads to it, winds in tedious tortuosities, narrow, intricate, and perplexed,—strewed at its different stages with flowers to tempt, and hung at its termination with fruits to re- ward. Not many reach it. The majority of those who set out on the enterprise, too soon become exhausted, and either linger by the way, or are lost in the mazes of the route. Now is the period for those among you, who feel themselves incompetent to this great effort to retire, or, arousing their en- ergies, enter resolutely on it. But it must not be forgotten, that the castle of indolence requires steadily to be assaulted, before its towers shall fall to the ground—and let not the attacks be re- mitted till this end is effected. Cherish as an incentive, the maxim, "that a youth of labour is an age of ease." Commence instantly your' exertions, and postpone not till to-morrow the work of this day. * Dr. Johnson has a passage somewhere to this purport, which not being able to find, I fear I do not quote correctly. ( 19 ) " Sapere ande, Incipe. Vivende recti qui prorogat horam, Rusticus expectat dum defluat amnis; at ille Labitur, et labetur in omne volubilis Eevum."—Hor.* Considerations, however, of a more obligatory character, than any heretofore mentioned, demand of you, a faithful dedi- cation, of every effort, to your profession. This is a matter of positive, and sacred duty, allowing of no compromise or relaxa- tion. To the community, are our services voluntarily tendered, and, confiding in our skill and attention, they commit to our care the preservation of their health and lives. Can there be a temporal charge more sacred, or a ministry more awfully responsible ? Cicero tells us, " that man approaches to the Gods, in nothing so much as in giving health to man." Called into those troubled scenes, where all hopes are centered in us,—to wipe away the tears of sorrow, and to heal hearts rent with affliction,—to convert the anguish of despair into the raptures of joy, by rescuing some beloved object, the apparent victim of death,—the imagination of attendant friends, warmed with gra- titude, really confers on us the attributes of a tutelary divinity. Whatever others may think, I would not exchange the pure feelings on such an occasion, for all the rank, the distinction, and glories which might otherwise be won or received. Contrast this elevated estimate, and the sensibilities it creates, with that of the common empiric, or mere practitioner of rou- tine, ignorant or incompetent, who like a demon of destruction, may be tracked along the course of his business, by the mor- tality he inflicts, and the domestic calamities of which he is productive! Meditate this picture, which is delineated in no exaggerated colours, and never cease to remember, that, for any professional demerits, you cannot escape from the reproach- es of conscience, the penalties of public reprobation, or the ulti- mate decree of the retributive justice of God himself. * " Begin, be bold, and venture to be wise: He who defers his work from day to day Docs on a river's bank expecting stay, 'Till the whole stream which stopp'd him, should be gone That runs, and as it runs, for ever will it run." s ;s >&W::::¥::: >» - » » » >3> _ T» W» Ti )» ri > >•... > )' J 3 >,. ~> t V > > A J ■¥»*.•' >■;*.' > _>"> j^ » :>> > ;> > Z>J )^> v >^> } ~> > -» > > > > ;».> ~3 > ?> ->} »> »Z>> >1» > ^»^ ~>> ~> s>^> :»D »:»•.> »o 3»^^> »» uTaE' » > 3Nf-? ;»> *>^»-t i»'3> ^ ;S* ,V :» ;> > ->rr» > ^ • ■> >-> "\> »" >» ":> j> ;> }> £> » t> >_» o> >i> >> *> » » ».> ...s Sxs -> > > \Z> »>. > '-* -i^^ »' >> :')> i5 >»> >> »» s> ' * ^ *L^ » > T>> >> t* T>"^ »>>» ► '-* ">J ,_a>^ ^> »:> ■•■->;7> :a»>-5> 3? ^ V ^?V * ^ V %^i£ >^ > 3) ^> ^» 3 > »» > T> -> , -"">•; > >5 ) *5 ^ 3i 3 ? • J> J> j ^ > _->*.>» >3 * » 5> 2> , » ^»>» j> ■> > - f > ) • 0 V > > . -i ^ ^ -> O ^>3 !>>TB > !» Jt> : _ >■ ?> » j3 ^^ ^ J> »^ ■»f3> ^> s> > v.>:x> ~> ?> ^ ".» x>z> Ji^» >»2>^ 3£> ^ ^>>J>^> 3S> ^5 * a ^_ > » ■» t>' »^ >> Zl »3» Dl3 3^ ~I > > a ^^z^ 37) 3 >TgaT» > > ~1 ~> '~> 2 ^ 2j^^ ^> >> £> .ijs^fe >> 3 > >> -*!>^J >> ->> v«^g? ,J>> v»^st *s>*;> i *<) l^fc !»!> ^ 1H^^''" *JL> ^^S^ J».» W/t 3 J8> >J9 > »>■» :»> > >