SCIENCE AND  SUCCESS.
VALEDICTOEY ADDEESS
DELIVERED TO THE
gWiical <iratoate of farbartr Snibersifjj,
ANNUAL  COMMENCEMENT,
Wednesday, March 9, 1859.
By HENRY JACOB BIGELOW, M.D
PROFESSOR .OF StJRGERT.
-</
£

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        B 0 S T 0 N 7
DAVID CLAPP......184 WASHINGTON ST,
    MEDICAL AND SURGICAL JOCRN4L OFFICE.
           1859,
 
Boston, March 9th,  1859.
Prof. H. J. Bioelow —
      Sear  Sir :
  At  a meeting of the Graduating Class, the undersigned were appointed a committee to
request a copy of your address for publication.
                               Your obedient Servants,
                                                           J. T. G.  NICHOLS,
                                                           F. H. KREBS,
                                                           C H. BURBANK.
Boston, March 10th, 1859.
    Gentlemen :

It gives  me great pleasure to  accede to the request contained in your note of yesterday.
                           Your obedient Servant,
HENRY  J.  BIGELOW.
To  Messrs. J. T.  G. Nichols,
           F. H. Krebs,
           C. H. Bcrbane.
) 
ADDRESS.
   When, after a protracted  and prosperous  voyage,  the
 good ship has made the land, and is skirting along the
 familiar objects of the shore,  the passengers elated with
 the  prospect of a speedy release,  the officers  divested
 of anxiety, it is customary to  devote an interval as now
 to an interchange of kindly feeling  and of mutual good
 wishes.   With your permission, I will endeavor to beguile
 our  yet remaining minutes in attempting to convey to you
 my own impressions of the shore on which you are about to
 disembark, and something of the country beyond it.   The
 history  of late years  has been  instructive to those, who
 in pursuit of wealth,  or  of a  new  field of enterprise or
 distinction, have  invaded an  unknown  territory, coura-
 geously but unadvisedly;  without an adequate  knowledge
 of the difficulties to be met;  with enthusiasm,  perhaps,
 and  high aspiration, destined only to be wasted in misdi-
 rected effort or frittered in unprofitable industry.
   Whether you are here in the fulfilment of a long cher-
ished plan, the dream  of  earlier years, or whether by the
 trivial influence of some little circumstance you have been
 switched upon a new track in life,  and whirled far  from
the  scene  of earlier  associations;  each  of you is   now
bending  earnest steps  to a new  field of labor, determined
 to convert his store  of knowledge into a means of credita- 
4
ble livelihood;  to earn an honorable position in the place
of his  adoption,  and perhaps  distinction in the world of
science.
  No profession tends like  ours, to confuse the different
phases of worldly distinction; moral excellence, for  ex-
ample, with  medical attainment;  intellectual  ability  or
cultivation, with  success  in business.   Let me at the out-
set explode any lingering belief that what is usually called
eminence in  science, necessarily  produces  medical prac-
tice ;  or  that large  medical practice implies anything in
respect of medical science.  Inquire in any  considerable
metropolis for the physicians in extensive practice.  You
will hear some  of their  names for the  first time. Ask
about  the practice of a man whose scientific name is a
household word, and it is often inconsiderable.  The quali-
ties of a good practitioner need no encomium of mine.
Far be it from me,  even to seem to undervalue  them.
But I shall endeavor  to show that the  pursuit of medical
science and the practice of medical art are often  uncon-
genial occupations which lead the  mind in different  direc-
tions ; and that a taste for science is  on one side of and
collateral  to the  qualities which ensure  an  extensive
business.   It is true that there is  no absolute incompati-
bility  in these pursuits.  Hunter, indeed, left the dissect-
ing-table unwillingly to seek the necessary guinea, but, on
the other hand, practical study must have been a congenial
occupation to the mind of Sir Astley Cooper. He himself
told me that he rose at an early hour of the morning for
this sort of work, digesting his morning  studies while he
afterwards visited his patients, and writing his   results
each  evening.   The names of Brodie and  of Lawrence
are equally familiar to us as reaping largely and early, in
the field of science, while their medical  practice was lu-
crative.   In  fact, the reputation which  accrues from such
distinction is justly  more  available than any other in in- 
1
                             5

  viting that confidence which in its turn leads to practice.
  But to develope  and retain this practice, demands other
  qualities,—and I shall presently allude to them,—which of
. themselves may  be sufficient to insure  to some individual
  profoundly ignorant of common medical truths, an extensive
  business, never indeed  of the best class, but among peo-
  ple more or less  intelligent  in  other matters.   And this
  is because one who possesses the practical and efficient
  industry alluded to, must in time, by a familiar intercourse
  with disease, acquire a certain rule of thumb appreciation
  of it.
    Study   is  generally  the  chief occupation  of earlier
  professional life, and if  not at that period, never.   It af-
  terwards gives way gradually to practice;  and this, per-
  haps, is the  usual life  of the  physician.  But the man who
  gives himself up to science is to that extent a recluse, im-
  patient of interruption, while  the  exclusive practitioner
  has  barely time to read  the newspapers, much less  the
  medical  literature of  the day.
    In considering first  the science, then the art of medicine,
  let us  look for instruction, if there be any, not  in the cus-
  tomary eulogy of an ideal  excellence, but from such a con-
  sideration of our subject as might be suggested  by obser-
  vations of daily life.  We are most of us charlatans when
  we are sick ourselves.   It is rare that a sagacious, at once,
  and prejudiced man, dies like Spurzheim, proof to the last
  against the incantations of our art.  Let us then embrace
  this moment, with our faculties yet undepleted by disease,
  the mind unclouded, and the eye tolerant of light, whether
  it be colorless as truth,  or tinged if you prefer  to  call it
  so  with  scepticism, to  view it  for  a  short time,  with a
  steady gaze; in its beauties, in its  defects; not unmind-
  ful of  the  one, nor flattering ourselves in ignorance of the
  other.
    It need  not be  urged that medicine is a  composite  sci- 
6
 ence, and that its advance is dependent, not only upon the
 knowledge of its immediate and  intrinsic elements, of the
 symptoms of disease, of their usual sequences and combi-
 nations, of the appearances of diseased parts, but also upon •
 that of Physiology, Anatomy and  even Chemistry.   To
 identify disease, we must know health.  To repair the ma-
 chine, we must understand its structure and  its working.
 But the student of Physiology or  Chemistry may insensibly
 wander far from the field of pathological research, absorbed
 or beguiled by  endless and ever-varying phenomena, which
 are at each  step  less  immediately applicable to  his own
 peculiar  science, especially to the  details  of his daily vo-
 cation.   He becomes bewildered in the interpretation of
 equivocal appearances, and his mark may be effaced by the
 next wayfarer in the same direction.   On  the other hand,
 let  him linger  nearer home, and the paths are worn and
 barren.  Earlier explorers have left  little to reward his
 industry.  The chiffonier in science, no matter how indus-
 trious, piles  his basket with material of inconsiderable
 value.
  Yet most  of us must be  content to accept one or the
 other of these alternatives.  He  who climbs the tree of
 knowledge either  lingers among its larger and unproduc-
 tive stems, or follows some inviting branch, in  its divisions
 and subdivisions,  till he finds himself far to one side of
 the main current of its life, perplexed  in studying a hand-
 ful of its ever sub-dividing fibres, and his sky darkened by
 the crowding  foliage.    It is reserved for the gigantic ca-
pacity of the few, to grasp, in one  comprehensive  glance,
all  its outspreading branches, from the single leaf to the
massive trunk, in all the  complexity of their relations; to
 discern the fruit and to garner the abundant harvest.
  It  should not be  inferred that  he  who   has  earned
the highest place by  scientific acquisition,  is  most likely
to make  on  that  account a great discovery;  remarkable 
7
for its novelty and brilliancy, or for its utility.   The cul-
tivation of knowledge does not always seek direct utility,
or immediate application, but sometimes only to extend
the range of human comprehension, to enlarge the sphere
of human intellect.   Intellectual ability, in any direction,
commands respect, whether like that of Leverrier, or our
own Pierce, in a pursuit which lays up facts and developes
knowledge which may be turned to use in sailing  over  or
measuring the  surface of the earth, or  in  weighing its
atoms, or in adjusting the complicated curve of mechanism;
or whether it is simply an exhibition of gigantic and un-
fruitful capacity  like that of Morphy.  It is,  however, a
mistaken zeal which  would monopolize  for  the votaries
of abstract science a large  share in fashioning the ma-
terial  world to the  direct comfort  and  welfare of the
human race; which always points to  the  scientific  pedi-
gree,  for example, of the safety  lamp, as  if it were not
at every moment offset by  the  protean phases of India-
rubber, or of the sewing machine, or yet even of a com-
mon apple-parer;  all  of the plebeian birth of art, but all
intrinsically  involving a more complicated  mental  com-
bination.
  Are you ambitious  for the fame of a discoverer ?   The
not untrodden paths  which led to a knowledge of the cir-
culation  of the blood, of vaccination, of the  properties of
ether, and which will  bear to a remote posterity the names
attached to them, as they have already done to every cor-
ner of the civilized world, were open to the  ordinary  ca-
pacity, as well as to the ordinary cultivation of man.  But
beyond the requisite devotion or  distortion of  your  daily
life to an idea  in the possible realization of which you
believe, he who expects to draw the prize must have good
fortune.   In such lotteries there  are  many blanks.   The
distinction which the  world concedes to  an exertion, per-
haps in  no  way commensurate with its  great result,  is 
8
testimony to the rarity of such fruition, if not to its dis-
proportionate  reward.   A witty friend of mine once said,
that sweeping the sky  for asteroids and comets was like
sweeping the street for sixpences.   A man might find one,
but this  good fortune does  not explain why he should
receive a silver medal  also.   We  might almost dispute
the justice of the lottery which seems sometimes to  over-
look the toil  of cultivated genius  to bestow a  discovery
of immense utility, on some  importunate laborer, whose
chief claim was, that he believed the prize was there, and
that he was determined  to possess  it.   The  discovery of
facts  which promote the temporal welfare of.  our  race,
seems  to  be distributed in a way  almost as arbitrary as
the wealth which can command the comfort that grows out
of them.
  Again, a medical discovery may be made by some person
of extravagant views in medicine,  perhaps,  on the whole,
ignorant of disease and  pf  its treatment,  a man of one
idea, whose  life may be collectively of more harm  than
good to the community; and yet while the individual  may
be justly  appraised  and ranked by his contemporaries,
or those who know him in all his qualities, his name attach-
ing to the discovery is an  abstraction which  posterity
and foreign nations may honor with unqualified distinction.
  It is no part of  my present purpose to subject any  real
or alleged medical discovery  to a cynical and cold-blooded
scrutiny, but rather to direct attention  to the little  that
we may  know or even care to know of an individual, of
his life, or of his views of the rest  of science, beyond his
name; which stands as the barren and algebraic exponent
of the recognition by the world of  a received value.
  Just fifteen hundred  years ago,  there lived  a man of
servile origin,  who, his employment being mean,  rendered
it infamous.   He was a  worthless parasite;  a vile inform-
er ; and then, a tyrant;  each moment of whose reign was 
9
polluted by cruelty  and avarice; a plunderer of temples,
and, it is said, a ravisher of women.  " This odious stran-
ger," says the historian,* " disguising every circumstance of
time and place, assumed the mask of a martyr, a saint,
and a christian hero; and the infamous George of Cappa-
docia has been transformed into the renowned St. George
of England, the patron of arms, of chivalry, and" somewhat
oddly "of  the garter."
   There is another phase of scientific fame of which we
sometimes  hear,  approaching indeed  much nearer to the
solid substance of intellectual cultivation, of large and la-
borious acquisition.  Men who have studied are tenacious
of their so-called scientific reputation;  which I suppose
to  mean, an acknowledgment  by  other  men  of similar
pursuits of their degree of commendable  attainment, and
of the actual progress in knowledge they may have made.
And yet you might occasionally suppose that there existed
a monopoly of some nebulous and  ill-defined  variety of
greatness among the votaries of physical  science; a supe-
riority of sentiment which  conceded little to the energy,
the  wide-spreading  contemporaneous knowledge  of the
merchant,  for example, to  the perfection which the prac-
tice of the law impresses on  the higher  intellectual ma-
chinery, or even to the statesman; while  the investigator
of a microscopic species or  the finder of a new insect may
expand at leisure and by right, within his mystic  circle.
   You will also hear of a pure and dispassionate  atmos-
phere of science, remote from the conflict and  struggle of
busy life.  Without insisting that our own National Medi-
cal Convention is its exclusive and peaceful asylum, I have
yet to learn that we  have reached that ideal stillness when
the  passionless form of truth is simultaneously contem.
plated by two  naturalists,  who  have stumbled upon  the

            • Gibbon. Decline and Fall. Chap. 23.
             2 
10
 same stone or  fish or  flower;  or even,  that  it hovers
 around the mutually impinging tubes of any two astrono-
 mers.
   The wisdom and excellence of  the world  is not vested
 wholly in those with whose names and reputation you are
 most familiar; nor can  we suppose, that those of whom
 we know comparatively little, have been shut out from  all
 participation in the divine gifts to man.
   The noble character of a whole contemporaneous peo-
 ple is unwritten, save in the casual testimony of some vis-
 itor  to a distant shore, where the race was not as yet de-
 moralized  and asphyxiated  by the invading wave of new
 and  uncongenial forms, some one whose own large intel-
 lect, whose sense  of justice, and whose warm and gener-
 ous impulses could elicit a like response from stoicism and
 reserve.  We  cannot suppose that Solomon monopolized
 the discretion  of his generation,  nor yet that Celsus, Ga-
len or Hippocrates were the only and best family practi-
tioners  of  their respective  dates.   There  is a machinery
to fame.  It is one  thing that a quality  should  exist, and
another that it should come to be known. In civilized cen-
tres, talent and attainment generally  make their mark;
but sterling sound  sense and excellent medical acquisition
may  be sown through every  village in the  land, unambi-
 tious and unobtrusive, while on the other hand, men  upon
whose medical judgment  you might justly hesitate to rely,
may by adventitious circumstance or a thirst for notoriety
 or gain, be urged into a really conspicuous position.
   Briefly, then,  immediate usefulness is but a collateral
 object in the pursuit of science in its higher aspects.   We
 rather look to the  exercise it gives the human intellect,
 and the field which it lays open for the progress  of the
 mind.  Science explores, points out the way, invades and
 annexes  new  districts, suggests their capabilities; and in
 their loftier and remoter regions much that you find may 
11
be at present unproductive territory and only an addition
to the domain of present knowledge;  but  soon the flood
of living  industry pours  in, clusters  about its most pro-
ductive spots, and tills the soil or digs the gold.
   Knowledge advances by slow and little steps; and the su-
pervision of its progress  is allotted among many individu-
als.   The  almost useless iodine; the curious collodion;
the  daguerreotype;  the  stereoscope,  which  conjures to
your fireside the living apparition of every image created
on this earth by God or man, and of whose  future we do
not  yet dream; a common adhesive strap in the hands of
a  New Hampshire surgeon,  and an apparatus of fracture
extension for which no European  potentate could at need
command an equal substitute; the old familiar ether  bot-
tle on the shelf, and anaesthesia;  all these are examples of
this  subdivision.   Then  let  each contribute  something.
Utility does not demand great intellect; the gigantic feats
of intellectual  force  do  not  ensure utility.   The prizes
fall  to  industry; and sometimes  to a tenacious, I had al-
most said, insane pursuit  by each of his own chimera.
   But I hasten  to the  more  attractive  theme of art; of
therapeutics and of daily  life; the field of practice, where,
in the imagination of the  student, the laurel wreathes the
surface and the gold embarrasses the soil.
   Still  referring you to  the abounding annual harvest of
medical introductory or  valedictory literature for the re-
iterated inculcation  of honorable  motive  and profound
learning;  and yielding to no one in a just appreciation of
the  importance of holding constantly  in view a standard
of attainable perfection,  I shall venture, perhaps in hum-
ble imitation of those divines who seek instruction from
the contemplation of  man in  his imperfect state, briefly to
speak of medical practice as it sometimes  is.  And first,
of the power of remedies; meaning, of course, that thera-
peutic region which is still open to discussion;  with  sedu- 
12
lous respect, at the same time, for the fixed and imperisha-
ble boundaries of that large domain which therapeutic art
has distinctly  and forever subjugated.
   This is neither the time nor place to heed the clamor of
the benighted, no matter how honest, votaries of prepos-
terous medical theories, who from their orbit in the  outer
darkness, cry, Lo!  the whole science  of medicine is  yet
imperfect; our special knowledge  is  yet  imperfect;  not
the less is it a part of a true science.   Let us, when it
pleases  us to  do  so, look at facts; and leave others, at
their leisure, to distribute their consolatory syllogisms.
   It was a singular reflection upon  the life of some physi-
cians of great eminence, fifty  years ago,  that  their lives
might have been, on the whole, productive of more  harm
than good, I do not say to the happiness, but to the physi-
cal welfare of their  patients.
   How  is it  that the treatment of disease has varied so
widely from one epoch to  another, and that diametrically
opposing methods have been successively approved ? How
does it happen that inside of certain general  limits,  there
is  no fixed standard of therapeutic infallibility,  or even
excellence ? Among physicians  in large practice anywhere,
who knows or cares  exactly  what are the  therapeutic
views of any one of them; whether he may deem it  pro-
per, during the progress of a typhoid fever, to administer
a whole dispensatory, or whether he allows the patient to
go  on without remedial interference ?  One of  these sys-
tems is the better, and if so, which, and why  is  the  truth
not hailed by acclamation ?
   Or let a middle therapeutic course be chosen, and let a
medical jury of conceded weight and high position be select-
ed, each to dictate, without the knowledge of the rest, some
therapeutic course for a particular case.   What a farrago
should we have of calomel  and opium, of gum-water and
ptisans,  of " favorite  medical  prescriptions," all possibly 
13
compatible with the recovery of the patient, and some  of
them promoting it, but more  of them unquestionably re-
tarding it I
   The therapeutics of England, of France, of Germany
and of America, probably  differ much  more widely  than
the diseases do, not only among standard and written au-
thorities, but still more among the mass of general practi-
tioners ;  partly because one thing often does  as well as
another, both being superfluous and neither positively in-
jurious ;  but also because even when there is a real necessity
for active interference, the patient has no guarantee, beyond
his own  personal belief, that his physician shall either en-
tertain or adhere to any standard views in science. In other
walks of life, people  can  judge  of work.  In  the  other
learned  professions—for example, at the bar—there is a
public tribunal where a standard of right is upheld and
the  advocate  is tested; but the medical man both argues
and adjudicates in private, being himself examining coun-
sel, jury  and judiciary, and the patient relies upon him alone.
Suppose your  roof should leak;  and  that a  carpenter,
when sent for, should make his  diagnosis and then stop the
hole; and that at another time, you should in like manner
send for a different mechanical practitioner, who on hear-
ing of the  anasarca which pervades your  house,  should
fumigate the  entries and  rub  agreeable preparations on
the walls, promising to call again next day.   Even though
the  rain should then  cease  and your house be soon dry,
there is  no certainty that you would prefer  the first inele-
gant prescriber, who merely stopped the leak.   Thus it is
that because people are not  gratified themselves to be
judges of a  lesion, they  must sometimes accept on faith,
and  be as well content with the one  treatment as with
the other.
   Practice is business.  Pardon me if I treat this some-
what homely  subject  in an informal manner.   From Sir 
14
Astley Cooper down to " Old Dr. Jacob Townsend," what-
ever else of truth or error, of honest and learned labor or
of arrant deception may go with it, large practice  cannot
exist without industry and regularity and assiduity and long-
winded steadiness  of purpose;  qualifications which  give
success, even though the scientific capital be limited, and
which, strange  as it  may be, sometimes replace it.   I  do
not speak of a scientific, nor of a desirable position in any
sense; nor of the respect of educated men; nor of that of
the intelligent world; but of a certain practice;  and if in
a metropolis, as large  and possibly as lucrative  as  that
which is attracted by  the  most  popular  medical fallacy,
not to  say  nostrum of the day.  A  step  further.  Only
throw overboard  honesty;  wholly abandon  the  truth;
and the practitioner must have a singular want of business
faculty, relating to a subject about which people  know so
little, and of which they need so much which fails of tole-
rable pecuniary success.   In fact this is one  of the few
modes of getting money by unblushing false  pretences, of
which the law does not  in  the  United States  take cogni-
zance.
  Such medical practice may come quickly, but it also goes
quickly.  The weathercocks whose equilibrium is easily dis-
turbed, will turn again at the next breath from any other
quarter; and in this way the practice of pretenders and of
the medically incompetent,  tends, in  various  degrees,  to
that rapid  rise, culmination and decline, which in all ages
characterize the traffic in nostrums.
  With honesty of  character and purpose,  there accrues a
better sort of practice and one of more enduring nature;
and although engrafted  upon business habits,  which have
been  already pointed out as necessary to it; and some-
times, even, mistaken for its chief essential, yet added  to
these,  we may   now observe a great variety of attributes
conducing to the  same  end.   Perhaps  the practitioner 
15
deceives himself.  Does he believe himself successful, for
example, in our autumnal fevers, which  never stop  for
treatment, he is, as he is persuaded, engrossed with  the
disease in a hand to hand combat, in which victory rewards
only superhuman  efforts.  Is he good for a chronic case,
he is fertile in expedients, assiduous and long suffering.
Among the higher qualities distinctly collateral to science,
an acknowledged rectitude and firmness of general purpose,
usually called character  and principle,  stand first;  and
then the  social attributes, a ready and  genial sympathy,
good feeling, all  in themselves essential or  conducive  to
perfecting the obvious and intimate relations in which you
stand to the  members of the human family.  Again,  as col-
lateral to medical knowledge we recognize as instruments
of success, a cultivated intellect, force of will, some know-
ledge  of the world, not  in its objectionable sense, but
rather a knowledge of  what men want both at the  time
and  on  the whole; and with it a readiness to serve them,
and  an understanding how to do it; tact, or  more largely,
judgment, and so on without end.
   Thus it is  that practice accrues  alike to  the medical
man in Paris, whose toil has lifted him to some lofty emi-
nence, a man known mainly it may be as the occupant of a
distinguished office, whose name is only  an illustrious ab-
straction, to most of those who call for  his  professional
services,  and to  the  excellent  physician of the country
village, whose attractive helpmate may have  won his prac-
tice, which may again be  determined, even by the meeting-
house he goes to.
   The exclusive  practitioner, whose only aspiration is to
enlarge his daily round;  who divides  the world into two
groups,  the  first  his patients, and the  second those who
are  not his patients; who watches  like  a shepherd  over
his  own flock,  and lest  they  should stray, gathers to his
fold, as opportunity may offer, the lambs of other  shep- 
16
 herds;  who  is always  ready  with a prescription, about
 which it has  been well  said, that in a community  where
 great stress is laid on therapeutics, the comprehension of
 disease  will be found to be in an inverse ratio, not only
 teaches a lesson in his fidelity and regularity, but something
 also of more importance. He perhaps appreciates the length
 of time nature sometimes requires to do her work, and just
 as the dial measures the passing hour, by tangible intervals
 of space, so  he materializes, by the art of the apothecary,
 months of time,  and pharmaceutically marks  their daily
 progress.  The  epigastric tympany which so afflicts the
 maid of Erin chained to her laborious routine, or yet that
 evil  demon  of the sewing girl, the stitch begotten of the
 stitch, these are  maladies rarely to be solaced by a blank
 three months of active exercise.   But let some  salutary
 discipline, alternately with therapeutic duties, beguile the
 tedious  convalescence and justify improvement, while you
 inculcate the necessary diet and fresh  air, and the dyspep-
 sia and  the spasm will forthwith abate.  So in grave dis-
 ease, when the excito-motors of the mind are  polarized,
 when the sensibilities are tense and vibrating, people must
 do something  commensurate  with the  occasion.   The
 treatment of the  patient is then in part the management
 of friends.   The  active inflammation  demands  depletion
 and evacuation, but equally the patient's  mind, as well  as
 that of  the friends and sometimes of  the neighbors must
 have  a vent  for capabilities  pent up and condensed.  All
 this we  learn much of in following the  daily rounds of the
 practitioner.
   Thus we have learned a valuable lesson.  But in address-
 ing vicarious remedies to the mental for the physical sys-
 tem,  let us not confound the two.  There is need to dis-
 criminate and to separate what is done for the disease.
 For just as  in a necessarily doubtful diagnosis a positive
man  will be  right once  in  several cases, and the wrong 
                           17

guesses will be  forgotten both by himself and other peo-
ple ; so in therapeutics he who prescribes for everything,
will, with nature on his side, so often see  the patient get-
ting well, that  he will  come  inevitably to attach impor-
tance to his remedies.  If it be necessary for the patient's
welfare, to occupy his mind, let  the  practitioner not de-
ceive  himself  in  this  respect,  abandoning the scientific
sense, and blunting the whole judgment.   " You may talk
in this manner," says Dr. Johnson, " it is a mode of talk-
ing in society;  but do not think foolishly."
   It should  not be  supposed that this current of remark
can have any injurious tendency.   No patient will believe
it possible that he himself can come within this category,
or if he concedes this  point  it is because he is a philoso-
pher ;  and he will then  thank us for any appropriate reme-
dy for his ailments, whether bodily or mental.
   Let us not deceive ourselves.  Heaven knows that it is
difficult, in any calling,  to  maintain the  ideal  equilibrium
of perfect right.  It was a pardonable  Confusion of pro-
fessional  ideas that  once escaped an  excellent friend of
mine in the  remark, " I cannot  make  this patient fewer
visits,  for  my  family needs all  I  earn."   It was, on the
other hand, a Spartan trait in one of the-most unblushing
but successful pill venders of his day, and one which shall
preserve his name inviolate, that he could exclaim, " God
forbid!   Indeed I gain my money in  that way, but no
friend of mine  shall take  my pills!"
   Few young  men escape unscathed from the ordeal of a
hospital life,  or of a protracted attendance upon hospital
service, at home or  abroad, without  having sacrificed to
some  extent,  to  the engrossing  interest of  a  disease,
their nicer appreciation  of the  claims of the individual.
It is a paradox that a medical student, with a considerable
medical knowledge  laboriously acquired, may  be yet not
wholly qualified to deal with common and familiar cases
             3 
18
 of disease; that he may have still something to learn, and
 something to unlearn : and yet it is so.   He has hitherto
 treated  disease.  He is  now  to  treat  men and women.
 Let the young practitioner erect, upon the sound basis of
 thorough medical acquirement, something of the qualities
 which ensure success not only in the law, but in mercan-
 tile and in social  life;  and if he really  desire  it, if
 he determine to pursue to-morrow what he has begun to-
 day, he may in time acquire a practice of which his health
 and life  will be the only measure.
   In  a successful specialty, organization, business faculty,
 equally  vitalize medical  proficiency.   Specialties  belong
 to large  communities, or for a short time to smaller ones;
 and by arresting attention, may become the familiar engines
 of ignorance and empiricism.   An educated man, by a suc-
 cessful specialty,  may become a skilful one, in concentra-
 ting his sphere of observation, and  enlarging his  field of
 study. And yet the local disease occasionally then suffers,
 for the want of  an adequate appreciation  of its relations
 to the condition of the whole system.   And another ob-
jection lies against the tendency  of special studies to ex-
 aggerate particular lesions, and  to protract  a case  with
 unnecessary treatment, without which the patient might
 do as well and perhaps better.  How often is the probang
 officiously  and uselessly intruded  into the throat!   You
 might suppose, of late years,  that all the  diseases of the
 viscera had finally entrenched themselves at the  fauces
 and the os uteri, and that against  these fortified recesses,
 the crusading knight (or nitrate) had sworn extermination.
   Permit me to add here a word or two of promiscuous ad-
 vice.  Our time is brief, and I will not detain you with a refer-
 ence to  quackery, which is best let alone; for just as the
 soil accumulates after  an interval, a certain element, out
 of which springs a fungous organization, which afterwards
 again gives place to sounder vegetation, so quackery is a 
19
parasitic and perverted but a natural growth,  drawing its
food  from the  unsounder and exceptional organisms of
every large community.  Nor yet will I refer to your attitude
towards  patients, for nothing can be simpler than the ob-
servances commended in the last code of  ethics of our
American  Medical  Association,  which   advises  physi-
cians  to " study  in their deportment so to unite tenderness
with  firmness, and condescension with authority, as to in-
spire  the minds  of their patients  with  gratitude, respect
and confidence."  As this was printed in 1857, I can refer
you to no later prescription to inspire these simultaneous
emotions.
  Do not think  I have treated  this whole  subject either
lightly  or  irreverently.   Yourself the   invalid,   with
what  expectation do you anticipate the daily visit!  The
vaunted  philosophy succumbs to each mysterious detail of
alleviation,  burthened with  its indisputable logic.   The
tedious hour beguiled, the restless and perverted judgment
satisfied, the irritable caprice soothed, the  unstrung intel-
lect  harmonized,  thus and  then only can a master of his
art guide you through the hour of danger,  summoning to
your aid the  aggregated learning of  ages  of research, to
fortify the frail tenement against the passing storm, and
then,  if need be, to repair  it  for  your  comfortable habi-
tation.
  In every department of medicine and surgery, there has
been accumulated an incredible amount of sound and pre-
cise knowledge,  which time  cannot modify  nor dissipate,
bearing especially upon the exact character and usual ten-
dencies of disease and injury, and amounting in the aggre-
gate to a huge pile of which a common  three years  term
of study can do hardly more than to investigate the large
foundations.
  In therapeutics there is a series  of material agencies or
remedies  which, skilfully directed, arrest  and neutralize 
20
certain diseases, as if their co-existence in the human sys-
tem were  materially and  mutually incompatible.   These
diseases can be cut short by  skilful  treatment.  At the
opposite extreme  there  lies a group of maladies, against
which, intrinsically, art can  do nothing;  but  which are
usually  associated  with common febrile  symptoms, with
derangements of local mechanism which can be  set right,
or with suffering  that can be  more or less abated.  Be-
tween these outside categories there lies an infinite varie-
ty of imperfect and  perverted function, which may be
generally  influenced by skilful interference for  the better,
or by incompetent and solemn meddling for the worse.  It
would indeed be little loss if that system of prescription
of which the Dispensatories are the exponents, were re-
duced in  bulk by  nineteen  twentieths, but it  would be
equally a disastrous day for mankind if our actual accumula-
tion  of sound medical and surgical  therapeutics  were
stricken from the page of human wisdom.
   Go into the field, armed with a detailed and thorough
knowledge of lesion and disease in all its phases; of sur-
gical expedients j of the few specific remedies, and of their
uses; of  the  miraculous  power of air and exercise, and
proper food;  of the applicability and agency of stimulus;
of local and general depletive  measures;  of applications
cold and warm, stimulant  and emollient;  of counter-irrita-
tion ; and  perhaps of a dozen of the most efficient drugs not
specifics.   These are  more than you will be likely to re-
quire for a considerable  period and  a common practice,
and  with  them you will  do as much service to your pa-
tients as  you would  be  likely to  effect with an entire
apothecary's shop, and with prescriptions  two inches and
a half in length.
   If I have been fortunate in clearly  expressing my  con-
victions,  no  one,   for a  moment, will suppose that  the
science  of medicine necessarily or  intrinsically involves 
21
anything of unsoundness, or that its true practice is  un-
congenial to a straightforward simplicity of character.  It
would ill become one who is surrounded by the brightest
examples  of professional acquirement, in  a medical com-
munity characterized, if by any eminence, by a high stan-
dard of honorable conduct, not only among the elder  but
among its rising members, to leave, by negligence or by
imperfect statement, any false impressions of our true re-
lations to our science, to each other or to the community.
Equally unpardonable would it be, if in attempting to  dis-
pel the refracting atmosphere  which hovers about our  art,
I should seem to imply that it is  vulnerable to attacks
from  those who live by  inculcating, whether honestly or
fraudulently, the medical delusions  of the day, and whose
practice always aims at concealing  their ignorance of  the
actual characters of disease,  under  a cloud  of thera-
peutics.
   If any conclusion has been especially elicited from  the
views which have been briefly presented  to you, it will
have struck you forcibly, that the public at large are whol-
ly  incapable  of judging the  relative  merits of medical
practitioners.  They indeed may recognize some general
distinctions,  of prominent position, extensive  practice,
conceded eminence;  they can identify  the  man who best
persuades or satisfies them; to whom  they may entrust
themselves  because  of his general force  and weight of
character, or  of his moral excellence,  or of his fidelity,
or it may be by a mere affinity, because they like him.
   But at what tribunal accessible to the  public does the
physician testify to his scientific  knowledge ?   In what
healthy forum does he  establish  his  medical  opinions?
What can the sick  man  know of his knowledge  of  dis-
ease ?   Shall  he look at  the condition of  the ship which
has survived  the storm ?   I reply, that  it is absurd to
form an opinion of the merit of the physician by  what  you 
22
may think to be  his  usual  success in practice.   Do you
trust to his general good judgment in other matters ?  As
well might you predicate the professional ability of the
lawyer or of the merchant, on his possession of  a tolera-
bly well-balanced  mind.   If it is on the whole true, that
no  quality is more essential to  sound medical practice
than a sound judgment; it is still further true that an en-
lightened judgment is  as  necessary  as an informed con-
science;  for  if  a  man's convictions are based upon  be-
nighted or erroneous premises, it matters little that they
are logical or honest.  They might  as well be those of a
conscientious  New Zealander as of a determined practi-
tioner of medicine, so  long as he feels it equally  his duty
to pursue  a  course which is conducive  neither  to your
comfort or your safety.
  The hygienic safety of the public lies in the sound and
thorough  education  of the medical  student;  in  the ade-
quate support of medical  schools; in seeing to it, that the
best institutions of medical learning, each in its own com-
munity, shall  be  so far  well nourished that  they shall not
dwindle  and  degenerate;  but that they shall possess the
vigor without which they cannot hold their way  with the
onward march of solid knowledge.
  The question to  the public  is, will  you admit within
your confidence, to navigate the  household  ship in time of
peril, responsible  to no  one but himself, with no eye of
scrutiny  upon him,  one who, not knowing  what the exact
nature of the danger  is,  seeks to engross equally your
mind and his  own,  by a routine of  incessant effort, putting
the helm first up,  then down, and so compelling the good
ship  to  struggle at once  against the tempest  and an offi-
cious, or, to say  the least, a futile interference ?  Or will
you rather rely upon  one who  undertakes to know, first,
all that  can be  known, of the conditions of disease; and
who then endeavors to  discriminate among  remedial  mea- 
23
sures, which are of sure, which are of probable, and which
only are of possible salutary influence ?   The broad foun-
dations of this ample structure must be laid, at an early
period of life, in a sound medical education.
   Our investigation ranges over a large area, embracing
at  one view the  numberless  expedients of art, and the
broadest generalizations of abstract science.  Chemistry
and Physiology,  the science of the atom and of  the cell,
is each spread out, even beyond the grasp of any single
human intellect.   The  deviations of Pathology  have as
significant a bearing upon physical life in its  perfection,
as the aberration of a planet or an asteroid upon the laws
of gravitation.
   But it is also ours to claim a daily usefulness, compared
with  which the province of an abstract science is but a
gymnastic of the brain;  and of which the actual  measure
is within  the knowledge  and the intimate experience of
every member of a civilized community.
   Let us avow with pride that our lot has been cast among
a people sensible to the importance both of science and of
art.  If their just munificence has testified to a high estimate
of one whose reputation is known wherever science has
been  cultivated,  whose  capacious intellect and whose ge-
nial temper are familiar to us all,  and who has deserved
largely of  our own community in  opening attractive and
new paths in natural science, where  the  expanding  intel-
lect may gain health and vigor, and by which  the  bounda-
ries of human knowledge have  been borne  onward and
extended;  if the claims of science have been listened to;
an  equal  liberality is at this very time responding to the
exigencies of our' own art, at the appeal of one who knows
its actual requirements, the honored patriarch of our noble
calling; himself ever a bright example of its  learning and
its virtues, whose right is undisputed whether to sway the
judgment  or to lead the  hearts of the  community;  whose 
24
elevating influence radiates  both from liis own and from a
transmitted excellence, briefly though it shone amongst us.
   Let us emulate this  doubly bright example, and cherish-
ing a memory identified with all the more exalted aspects
of the healing art, let this our institution bear within its
walls, to a remote posterity, his name, joined to that other,
which ever kindles  all our loyalty and our affection, and
whose undimmed escutcheon is this day entrusted to your
care.