ADDRESS DELIVERED BEFORE THE jjilflMjijlia fentij JMiral iuriettn BY THOS. F. BETTON, M.D., M.A.N.S., FELLOW OF THE COLLEGE OF PHYSICIANS, PHILADELPHIA; PRESIDENT OF THE SOCIETY. December 13, 1854. " Homines ad Deos, nulla re proprius accedunt, qnam salutem hominibus, dando.' PUBLISHED BY THE SOCIETY. PHILADELPHIA: T. K. AND P. G. COLLINS, PRINTERS. 1854. ADDRESS. GENTLEMEN OF THE PHILADELPHIA COUNTY MEDICAL SOCIETY:— The position, in this Society, to which I have been elevated by a most flattering voice of its members, imposes upon me a duty, which I am herd this evening to attempt to fulfil, as far as my abilities will permit. It is the fashion, but a custom more honored, in my opinion, in the breach than in the observance, to apologize for one's inability and stupidity, in order to deprecate censure, and assure a more favorable reception of one's performance. I shall avoid this example, for, in this address, the insufficiency to discharge worthily and satisfactorily the last official duty of the chair in a manner commensurate with its grave importance, will only be too self-evident to require any heralding on my part. To follow, where much more highly gifted men have preceded, allows but slight hope that aught of novelty remains to be gleaned; to address those who give this society its rank and strength by the professional eminence which they have attained, the speaker should at least be nearly equal, if not superior, in years and attainments. Imagine, there- fore, the feelings of one whose life has been comparatively obscure and secluded, engaged in the toilsome avocation of a country prac- titioner, and separated from the agreeable and instructive com- panionship of his more fortunate brethren of this metropolis of medical science, and who now, for the first time, ventures to address an assemblage of the most distinguished and learned of the profes- sion in that metropolis. " Our profession is coeval with the distresses and sufferings of the human race, and its respectability is as universal as the benefits it is capable of conferring, when rightly administered; those engaged in the discharge of its duties having been always tacitly considered by their fellow-men as beings peculiarly set apart from the rest of man- 4 kind, and worthy of an estimation not conceded to persons employed in merely secular affairs." Homines ad Deos, nulld re proprius accedunt, quarn salutem hominibus, dando. The real excellence and usefulness of our art—when worthily practised—have always tended to increase the confidence and admiration of the public; and, if medicine have not attained a degree of perfection and immunity from censure equal to its venerable age and importance to society, this results from circumstances which, however they may have in- jured, are entirely extrinsic to the profession. " We form but a low and grovelling estimate of our high destina- tion, of the duties of our dignified vocation, if we conceive that our operations are limited to the successful application of mere physical agents. God forbid that we should thus vilify ourselves, and de- grade our noble science!" "A physician," says Schiller, "whose horizon is bounded by an historical knowledge of the human machine, and who can only distinguish terminologically and locally the coarser wheels of this piece of intellectual clockwork, may be, perhaps, idolized by the mob, but he will never raise the Hippocratic art above the narrow sphere of a mere bread-earning craft.'' " The character of a truly good physician is one of surpassing excellence, and his reputation is the most exalted we can hope for. He is the friend of the wretched and woe-worn, the cheerer of the despondent, the solacer of the broken-hearted. His soul is the em- pire of benevolence, his actions the result of a principled charity, and unaffected good-will. He is a blessing conferred on the society in which he lives, and an honor to the human race. Wherever the afflicted dwell, wherever the voice of suffering is heard, he is to be found. The diseased find cheering and consolation from his pre- sence, and the sounds of sorrow are stilled. Even when hopes of life can no longer be given, he calms the tumultuous grief of rela- tives by recalling their thoughts to that better world ' where the wicked cease from troubling, and the weary are at rest.'" " Such are the common offices and frequent exercises in which he is engaged. His character, even under ordinary circumstances, may be contemplated with gratifying emotions. But there are conditions in which he is presented in a more sublime aspect. When the lurid breath of pestilence scatters destruction, desolation, and dismay throughout the land, and death tramples with relentless and indis- criminate fury over the people; when the ties of relationship and friendship and affection are sundered by fear, and utter selfishness 5 seizes on the hearts of men, then the physician, unmoved by such examples, untouched by terror, regardless of himself, is seen actively discharging every duty. Then he becomes the father, brother, and friend of the destitute; his steadfast attention smooths the pillow of the dying; he inspires the desolate with hope; and, like a benefi- cent angel, wherever he goes, is a dispenser of good. Who can estimate the feelings, or measure the fame of such a man ? What is there in death's most frightful forms that could withhold us from attempting to deserve it ? It is a glorious privilege which our pro- fession confers, of inscribing our memories, not on perishable marble, but in the living affections of our fellow men." Medicine, in the words of the Coan sage, is the most excellent of all arts; but, on account of the ignorance of some who practise it, and of others who rashly judge, it is esteemed among the lowest. This error appears to arise chiefly from this cause: it is peculiar to medicine that it has no punishment but disgrace, which affects not those who spring from ignominy. Physicians of this kind are very like the mutes which are introduced in tragedies. As these have indeed the figure, dress, and appearance of players, though they are none, so there be many persons, both by title and reputation, phy- sicians, while there are very few such in reality. Whoever wishes to devote himself truly to the science of medicine, should strive to fit himself for the study, both in disposition, learning, and place; by early education, attention, industry, and time. The first requisite is certainly disposition, or nature; for, should this be repugnant, the rest are vain: but, when disposition urges us on the way, the most excellent learning of the science may be attained. It is necessary to evoke this disposition prudently, so that it may flow from early education, in a place naturally accommodated for such disposition. But the greatest industry should be exerted, and that for a long time, to the end that discipline may be ingenerated and changed to nature, and produce fruit happily and copiously. The same consideration may be applied to the study of medicine, as to things which are produced by the earth. Our nature is the soil, the precepts of nature are the seed. Education squares with the comparison in this, that the seed should be sown at a proper time. The place in which the discipline is pursued is like the ambient air, affording nutriment to the plants springing from the earth. Study is cultivation; lastly, time strengthens the whole, that they may be perfectly matured. Were these circumstances 6 observed in relation to medicine, and properly engaged in its study, we should then have walking in our cities, physicians, not only in name, but in truth. Unskilfulness is a bad treasure, and an unfor- tunate opulence; those who possess either the reputation or reality of it, being devoid of tranquillity and ease of mind, as it is the nurse both of timidity and audacity. Timidity argues weakness, and audacity ignorance of our art. Science and opinion are two; the former instructs, while the latter makes us ignorant. Such is the character, drawn by a master-hand, of our profession and its true followers. Let us, for a moment, inquire if the same eulogy is applicable now—if the objects of this Society, viz., the advancement of knowledge upon all subjects connected with the heal- ing art, the elevation of the character, and the protection of the proper rights and interests of those engaged in the practice of medi- cine, and the study of the means calculated to render the medical profession most useful to the public, and subservient to the great interests of humanity, have been faithfully carried out; and, if not, what have been the causes of its downfall, and by what means it can be restored to its pristine excellence. That it has declined from its once high estate is so true as not to admit of argument; else why does hydra-headed quackery, in the shape of Homoeopathy, Thom- sonianism, and a thousand other forms, so far beneath contempt as to render them unworthy of notice, stalk through the land with unblush- ing front, and annually consign thousands to an untimely grave? Why is it that every newspaper teems with advertisements of nostrums and remedies warranted to cure all the diseases that flesh is heir to—many, by far too many, of which announcements are indorsed and certified by members of a learned profession, who have always been considered as worthy recipients and proper objects of our gra- tuitous services, which they rather claimed as a right than as a free' will offering to the fellow-servants of that same Great Master before whom all men are equal, and obey the same great and unerring laws? Many of these public notices are of such a filthy and immoral character that they defile the columns of the periodical in which they appear, and render them unfit for admission into any family in which there are young persons; and, to the high praise of some of the leading English newspapers be it said, they are not allowed to appear in their sheets; would that I could, with truth, make the same remark of those of our own country. Chief among the causes of the decline of our profession stands 7 the deficiency of preliminary education among those who engage in its study. How few students of medicine are good English scholars; and the number is infinitesimally small of those who understand thoroughly the Classics, or even some of the most prominent and important of the modern languages! I am conscious of advancing an opinion which, in this utilitarian age, is diversely opposed to notions which, of late, have become very general and fashionable, but for the truth of which I would merely appeal to some works written by men high in the profession, to a large proportion of the theses annually presented to the numerous colleges, and to the prescription files of all the druggists throughout the land. It is not too much to assert that three-fourths of all the prescriptions daily written in Latin or in English, contain errors of orthography or termination. It is easier, however, to declaim against the ancient languages than to learn and employ them ; as to the indolent, it is far more agreeable to demolish a noble edifice than to erect even a comfortable cottage. A classical education is one of the best methods for disciplining and developing the intellectual powers, and indispensable to the cor- rect understanding of not only our technical phrases, but even of our mother tongue itself. " The character of a physician ought to be that of a gentleman, which cannot be maintained with dignity but by a man of literature. He is much in the world, and mixes in society with men of every description. He ought, therefore, to be well acquainted with men and manners. If a gentleman engaged in the practice of physic be destitute of that degree of preliminary and ornamental learning which is requisite to act with dignity and propriety in his profession, he will be in danger of exposing himself, as well as his profession, to ridicule, if not to contempt. Such a one, for instance, if he do but speak on any subject either of history or phi- losophy, is immediately out of his depth, his thoughts are confused, his language incorrect, and his conclusions weak and erroneous; or, if he attempt to set down his thoughts on paper, he will probably be so defective in grammar and expression, that a school-boy would be ashamed of his writing."* I shall not apologize for presenting to you the views, clothed in his own language, far better than any of my own, of a highly gifted physician of this city, who, like Bichat, died too soon; both for his * Withers. 8 own fame and the advancement of science, and who was a bright exemplar well worth imitation. He says: "But it is with man that physicians have to do, in all his varieties, his excellence, his errors, and his sufferings; it is with the hidden springs of the passions and emotions of our race that we wish to become acquainted; it is with the defaced, not destroyed, image of the Creator, that we are to be continually engaged. We cannot comprehend man better than by understanding the manner in which he communicates his sensations and wishes to those around him, learning from the context of his thoughts and modes of expression the nature of the mind whence they spring; and having gained thus much, become better able to make ourselves and our profession more useful and acceptable. " We can neither acquire nor impart knowledge without the use of words. These, however imperfect, are the signs of our ideas; hence, he who is acquiring a language, is, at the same time, accumu- lating a vast store of objects for the future exercise of his intellect, and is also forming habits of reflection and discrimination rarely to be attained in any other way. " The languages of Greece and Rome are particularly worthy of regard, as containing the most sublime exertions of genius, the most valuable body of truth; and moreover as being the fountain whence the now widely flowing streams of knowledge gushed forth to adorn and animate the world after the prolonged and dreary periods of its cheerless gloom. In the Greek, we see language refined to its highest degree, and are furnished, through it, with models in almost every exercise of human intellect. It is not only the tongue by which the invaluable observations of the primitive father of our science have been preserved, but we have also delivered to us, in the same language, the words of Him who spoke ' as never man spake.' In the Latin, we have an inexhaustible storehouse of intellectual gratification; it is, moreover, the true language of science ; the ideas attached to the words being fixed, and freed from the mutations to which a living language must always be subject; it is the key to a great number of living dialects; forms a large part of the body and substance of our own tongue, and constitutes, along with the Greek, almost the whole mass of the language consecrated to the use of our profession. Hence, those who enter upon the study of medicine without having learned either of these languages, must necessarily meet with numerous difficulties which the instructed have not to 9 encounter; and even with the most assiduous attention, a large amount of their professional reading must remain unintelligible."* To be competently skilled in the ancient languages, says Harris, in his Hermes, is by no means a work of insuperable pains; the very progress itself is attended with delight, and resembles a journey through some pleasant country, where every mile we advance some new charms arise. It is certainly as easy to be a scholar as a gamester, or many other characters equally illiberal and low. The same application, the same quantity of habit, will fit us for one as for the other. And as to those who tell us, with an air of seeming wisdom, that it is men, not books, we must study, to become know- ing, this, I have always remarked from repeated experience, to be the common consolation and language of dunces. They shelter their ignorance under a few bright examples, whose transcendent abilities, without the common helps, have been sufficient of themselves to great and important ends. But, alas! Decepit exemplar, vitiis imitabile. How, then, shall we begin to restore the palmy days of our pro- fession, and see them shine with the same refulgence that illuminated them in the days of Rush, Shippen, Wistar, Physick, and a host of other departed worthies ? How shall we exterminate quackery, and all its attendant evils ? Not by opposition, nor by ridicule, nor by satire, nor even by legislative enactments, were it possible to obtain them—for, like the rebel flower, it grows most luxuriantly when most trampled upon—but by elevating the tone and standard of ourselves, and of those who are to succeed us. Let us actively set about and demand a radical improvement in the course of medical instruction in this country; not by extending the term of lectures, nor by increasing the number of subjects now taught, but by exact- ing a more thorough preliminary education of those who enter the portals of our medical schools. Any one who mixes much with his medical brethren must be pained to find the lamentable ignorance displayed by many of all the branches of polite learning so necessary to form the character of a physician and a gentleman. Let it be required of all wrho present themselves as pupils, to possess, at least, a correct knowledge of their own language, and such attainments in the classics as to enable them to construe the easier authors; or, at all events, write correctly the common apothecary Latin of the day. * Godman. 10 An acquaintance sufficient to read it, with the French language, is indispensable. The French are a learned and polished people, and the value of their medical and surgical publications is too well known to need repetition. It is likewise of singular advantage in foreign travel, and is a passport to polite society throughout the world. A young man cannot spend his time more profitably than in the acquisition of German, particularly at this time, when the tide of emigration is setting in so strongly from that country. It is a comfort to the poor wretch who may fall under our care, stricken by disease, far from his father-land, to hear the voice of kindness whispered in his native accents;' it cheers his heart, inspires him with confidence in our skill, and increases in a tenfold degree his chances of recovery. German opens an inexhaustible treasure-house of literature and science, especially in those branches requiring accurate and minute observation and investigation. A knowledge of logic and rhetoric is likewise highly essential; the former teaches us the art of arranging our thoughts to the best advantage, in order that we may be able to deliver them in writing or conversation with full force; for want of this knowledge we frequently observe a good cause weakly defended, and strong arguments brought forward in a very imperfect manner, so as to produce no adequate effect. The latter makes us acquainted with the principles and origin of true taste. It will instruct us in the foundations of universal gram- mar, and lead us into all the beauties, elegance, and correctness of style in every species of composition. Philadelphia has justly reason to be proud of her medical schools, and points to them with a degree of self-satisfaction that does her and them honor. In no part of our country can there be found a more intelligent, erudite, and liberal body of men than those who occupy the chairs of our regular colleges, and under whose auspices the present system of medical education, faulty as it is, is made to yield to the student all that can be expected of it. In this day, when the almighty dollar is all-powerful, it is hardly reasonable to suppose that any radical change which would increase the labor of the student, and decrease the number of the class, can be hoped for; but I cannot let this opportunity (my first, and most probably my last effort in public) pass, without throwing out such suggestions as have presented themselves to my mind as the result of some reflec- tion on the subject. They will, of course, be received for what they are worth, and, in all likelihood, have a correspondingly low value 11 attached to them. But, as I am "nullius addictus in verba jurare magistri,"* and bound to no party—as I have no interests to serve save what I deem to be those of the profession, and no personal reflections to make—I shall venture, with great humility, to expose my own views. In the first place, it must be evident to every one who has given the subject a moment's consideration, that the union of teacher and examiner, of judge and jury in one and the same professor, is un- wise, and but ill calculated to answer the end designed. Professors are but men, and as such possessed of all the failings and passions of our race. The ties of consanguinity and friendship are too powerful to be lightly forgotten, and many a man receives a diploma which would have been denied him had he been subjected to a more severe ordeal, and a more impartial tribunal. Rivalry has also some share in diminishing the standard of graduation, in the anxiety to surpass a kindred institution in the number presented to an admir- ing public on commencement-day. The power of granting medical diplomas should be taken from Universities and Colleges, which should be restricted to their legitimate calling, that of teaching. There is no more agreeable nor instructive mode of imparting know- ledge than by lectures, and it would be impertinent, and very far from the truth, were I to say that I did not think that the medical courses delivered in this city, as far as they go, were equal to those in any part of the world. The proper source from which should emanate the certificate of proficiency in our science would be a Board composed of the most eminent of the profession in our midst—impartial, unbiased, and free. Let the student appear before them and undergo his examination, without regard as to where he obtained his information, whether he has observed the allotted number of courses of this or the other school, or of any school at all, provided he possess the knowledge necessary to enable him to practise with honor to himself, and advantage to the public, the most noble and godlike of all sciences. Let him be examined practically on all those branches which admit of such a test—as for instance, in anatomy, he should make a dissection on the subject; and in surgery, perform such operations as might be required; in materia medica, be able to distinguish the various drugs displayed before him, and decide upon their quality and power; for, under the present system, a good memory is all sufficient; and I have known of a diploma being conferred on one whose hand never 12 touched a dissecting knife. We might imitate, in this, with great advantage, the example of our army and navy medical boards ; and I appeal to any one to say, where there is to be found a more highly educated and scientific body of men than the members of the medical staff of either branch of our public service. How many graduate at our schools, and are found unable to pass the trying ordeal of those boards, and are consequently rejected ! As before stated, no student should be admitted into the office of his preceptor without some preliminary education. Let the colleges make such knowledge an indispensable and imperative condition, and we shall be spared the annual announcement " that general bad spelling in a thesis will preclude the candidate from graduation." We then shall have the pleasure of seeing prescriptions written in a dead language (the one now generally used never having had any existence at all) at least equal to that of the doctors in the Malade Imaginaire. Their advice finds an apposite place here:— " Doncque il est nostra sapientiss, Boni sensus, atque prudentise, De fortement travaillare A nos bene conservare In tali credito, voga, et honore: Et prendere gardam a non recevere In nostro docto corpore Quam personas capabiles, Et totas dignas remplire Has placas honorabiles." The whole scene, which will amply repay perusal, portrays, with some exaggeration by the wit and satire of the poet, the mode of making doctors some two hundred years since; the picture is but slightly overcolored for this day. How few medical men can understand or construe the very di- ploma which grants them the highest honors of the profession, and certifies them to be " omnium suffragiis, in artis medicse scientia plenius instructos?" Our next step should be to abolish humbug and quackery from ourselves, and to ourselves be true. I do not mean by quackery the employment of nostrums and secret remedies, but that quackery still more contemptible and reprehensible, of practising an art for which we are unqualified, and affecting a knowledge which we do not pos- sess ; it is literally obtaining money under false pretences, and as such should be indictable. It is vain to expect the destruction of 13 that arch-humbug homoeopathy, which deludes so many well-informed persons by its pseudo-appearance of philosophy and science, so long as we combat it with no other arms than those of ignorance and ridi- cule. Elevate our profession, increase the amount of general and scientific knowledge among its members, bind them more rigidly to the good old school of etiquette and good breeding, and that, like all other kindred quackeries, will disappear like the mists of the morn- ing before the rising splendor of the God of day. There is among ourselves too great a desire to be able to exhibit a numerous " clientelle," and boast of the numberless, in some cases innumerable visits daily paid. Our motto seems to be that of the Yankee to his son, " Get money, honestly if you can, but get money." With us, it is changed into " Get patients, honorably if you can, but get patients." There are men who stoop to any means to attain this end, and, if called to a house, they ask no questions, lest they should be informed that some other medical man had been in attendance; and thus their consciences are saved. I have known such cases; others, in which a physician has visited a patient during the temporary absence of and for a medical brother, and the latter has found, after a time, that the family have changed him for his friend. There are men whom it is dangerous to call into consulta- tion, lest by insinuation, innuendo, or even more direct means, you should find yourselves supplanted by your colleague in the good graces of your patient. Others will examine the prescription file of some friendly druggist, and comment, generally not to the advantage of the prescriber, on the formulae and practice of a rival. Some have a favorite apothecary, perhaps an interest in his shop, and write their orders in cabalistic and secret signs, intelligible to him alone. Such conduct is most unworthy our high calling; and no one possessing the least claim to the noble title of a true physician would ever be guilty of it. Such were not the rules that governed our fathers in the profession; if they erred, it was on the side of nicety and scru- pulous honor. They were men who would have felt a stain as a wound, and who never descended to any of the little usages which are now but too much in vogue. We have, however, the consolation to know that some of their spirit still survives, and that we have yet among us men with minds as lofty, with intelligence as rare, and as keen a sense of honor as ever graced the ranks of the profession at any time, or in any country. They are the few who redeem our 14 calling from the slough of despond in which it wallows, and to whom we may confidently look for its ultimate regeneration. The plan of clinical teaching in our medical schools, specious as it may at first sight appear, and attractive, as it certainly is, to the newly initiated student, anxious to witness, for the first time, the shedding of human blood, or wronder at the coolness and dexterity of the surgeon, is, at best, but little better than an advertisement. It does not teach operative surgery, for that can be learned practically only in the dissecting-room on the subject. It diverts clinical teach- ing from its proper channel of hospitals, almshouses, and infirmaries, and is a direct injury to the profession at large, more especially to the junior members of it, by monopolizing practice which would otherwise fall under their hands. Who would not, very naturally and wisely, prefer submitting to a surgical operation at the hands of distinguished professors, eminent for their experience and skill, rather than to be subjected to the knife of a tyro, no matter what may be his talents and qualifications; particularly when all these advantages are accompanied by the magical inducement, that the relief is afforded gratuitously ? It is underselling others, and many resort to the public clinics who would willingly and readily afford some compensation, thereby taking it from the pocket of some deserving and aspiring young man, to whom, in all probability, it would have been of importance; and depriving him, moreover, of the opportu- nity of gaining that skill and experience which would give him high rank in his profession. In bygone days, students never received any public clinical instruction in the amphitheatre of the schools, and were it allowable, we could point out many physicians as learned, and surgeons as dexterous, as any that have graduated under the modern and so-called improved system. That it attracts pupils and increases the size of the class, I believe there can be no doubt; that, perhaps, is all that is required. That it fails to instruct the pupil in an adequate degree, and that it is unjust to the profession gene- rally, I believe there can be equally none. The members of our profession are subjected to many temptations from ambition which are scarcely to be resisted. Few, perhaps none of us, are willing to look upon our art as a mere mode of obtaining subsistence. Whatever be our situations, we hope to gain a reputa- tion or fame, by the exercise or improvement of it; and this is the unseen but ever operative cause which urges us forward in our va- riously deviating careers. This desire of fame; this hungering after 15 the approbation of the wise and good of our species; this wish to be singled out and placed above the great mass of our fellow creatures, is a perfectly natural feeling, and of kin to immortality. To this cause we are indebted for the noblest exertions of human genius; it was this feeling which incited all the great of former days to the actions which still live on the page of history; and the same breath will continue to enkindle from their ashes, fires which shall warm, cherish, and enlighten universal society. There are two kinds of fame, between which it is necessary for us to draw a distinction. The first and only excellent is that which tempts the wise and good man to become great; whose influence is felt not only during the life of the possessor, but leaves behind it a holy light, undimmed and undiminished by the lapse of ages. This fame is built upon the solid basis of usefulness, genuine worth, and high desert. Its growth is not rapid, but its maturity is perfect. At first, it is the applause of those who are emphatically called "the few." It is not gained until many privations and toils have been endured; yet, like the ascending sun, it surely attains a meridian altitude, and disperses, by the potency of its irradiation, all clouds which would obscure or intercept its brightness. The other kind of fame is base, common, and popular. It is never the result of great intellectual exertion—often it is produced by acci- dent—and it frequently is awarded to great vice. At first, it may appear bright and dazzling, but this light is only the phosphorescent gleam hovering over putrefying substances, compared with the in- tense, steady, and sun-like ray of that first mentioned. This second fame is the clamorous plaudit of the deceived or ignorant crowd; it is sustained solely by the breath of the vulgar herd, and would sink forever in a purer atmosphere.* The ephemeral fame of the columns of a newspaper is by many regarded with great complacency, and eagerly sought after. It is natural to us, I think, to like to see ourselves in print; the letters of our name form a graceful combination most pleasing to behold, par- ticularly if connected with some wonderful cure, some heroic and bloody surgical achievement, or even as a certificate to the excellence of some article of diet, or patented contrivance for the relief of some bodily ailment. These advertisements are generally more or less laudatory of the person who has furnished the certificate desired. * Godman. 16 As, for example: "The following eminent physicians state so and so ;" "Mr.----, or Mrs.----has the pleasure of referring to the distinguished Dr.----for the efficacy of his or her instrument," &c. Depend upon it, it is a most ignoble ambition, unworthy of scientific men, and should be as severely censured by us as has lately been done by an English non-professional journal, the Spectator, which says:— "The newspaper is the worst of all mediums for prescribing physic. We are surprised that medical men should not see the per- fect absurdity of letting patients into their consultations. Surely, a man who can put M. D. or M. R. C. S. after his name, should know that a knowledge of drugs is a very small part of a physician's qualifications. A book knowledge of the stated symptoms, indeed, together with therapeutics, does not form the half of what the medi- cal man must know. It is the power of discriminating similar symp- toms that is the true diagnosis of diseases; the striking out, by a clear-headed, inventive activity, an equation of the sum of all the symptoms, which, in conjunction with the sum of the patient's con- stitution and condition, suggests the treatment. But this demands practised observation, habitual discrimination, and expertness, so to speak, in the algebra of medicine. There is no universal suffrage in medical government. " But it is indiscreet for medical men even to discuss their own first ideas in the unprofessional public journals. A most respectable physician has been prescribing castor-oil in cholera, with an appa- rent success, but in a very limited experience. Several others copy him; and at last the Board of Health puts the prescription to a more rigid test. Out of 89 cases, the remedy proved undecided in 6, still under treatment; successful in 15; fatal in 68. Was not the rash adoption of the drug the result of newspaper consultation ? Does its consequence not amount to something like manslaughter? If, in this formal inquiry, some portion of the sixty-eight patients died for their country's good, there have been others who died for the curiosity—it was little better—of the gentlemen who adopted, as a suggestion, that which ought only to have been a question. Have not the sixty-eight, and their companions in the grave, some claim for damages upon those medical men who have used their 'corpora' for experiment?" The fame that we should desire to win is that which rewards the exertion of generous minds. But, we should not only feel the pro- 17 per emulation; we must be aware of the best mode of attaining our object. Let the intellectual capacity be what it may, or the impulse of ambition never so strong, much time may be wasted in ill-directed and desultory efforts without the proper training and preparation; even giant strength may be rendered worse than useless for want of skill to direct its exertions. In conclusion, whilst thanking you, Gentlemen, for the high honor you have conferred on me by selecting me to preside over your body for the past year—an event which I shall ever cherish with lively emotions as one of the most pleasing and personally gratifying occurrences of my life—I cannot but be sensible of the inadequate and imperfect manner in which I have fulfilled the last and highest obligation of the office. I feel that I have, perhaps, erred in attempt- ing a task which would have been better executed in abler hands; but I shall be amply repaid if I have only laid the corner-stone, and willingly leave to those of more learning, and greater powers of argument, the care of rearing the superstructure. Our position as medical philosophers, occupied in the investigation of the phenomena of mind and of disease, entails upon us anxious, solemn, and responsible duties. In the hour of pain, when the spirit is humbled by suffering—in the day of distress—in the solemn mo- ment of dissolution, it is our high and noble privilege, like guardian angels, to hover about the couch of the sick and dying. We enter the chamber of the man writhing with agony, bereft, perhaps, of that which alone makes existence pleasurable—the right exercise of the mental powers—-and loud and affectionate demands are made upon our sagacity and skill. Life—the silken thread, the silver cord of life—depends upon our rapid appreciation of the phenomena of disease, and ready administration of remedial agents for its relief and cure. Our profession is a noble one, a most dignified, exalted, and honorable calling.* The skill of the physician puts in requisi- tion the highest faculties of the human intellect, as its administration calls forth the tenderest sympathies of the human heart. The able and kind physician is a human benefactor. He garners up treasures of learning and experience that he may dispense them again to his suffering brethren. He comes with his timely succor, cheering both body and spirit with the single boon of health. He raises the sick man from his couch of pain, and sends him forth, elate and vigorous, * Winslow. 2 18 for fresh employment. He restores the ailing, and rejoices their despondent friends. He gives new life to the sick, and revives the hopes of those who depend on the sick man's recovery for their sub- sistence.* While feeling that the best of our works are Imperfect, and that we must rely for our future happiness upon the great mercy of God, and not upon our own merits, I cannot be forgetful how great is our responsibility for the right use of our talents, and the faithful dis- charge of our anxious and solemn duties; and I would therefore venture, with all deference and respect, to address to each of my professional brethren the admonition of one of America's most gifted poets :—f So live, that when thy summons comes to join The innumerable caravan that moves To that mysterious realm, where each shall take His chamber in the silent halls of death, Thou go not, like a quarry-slave at night, Scourged to his dungeon; but, sustained and soothed By an unfaltering trust, approach thy grave Like one who wraps the drapery of his couch About him, and lies down to pleasant dreams. * Mrs. Mary Cowden Clarke, " Girlhood of Shakspeare's Heroines." f W. C. Bryant.