Jg - j: ■^^^■^WT /^^.*^ ^ ^-^^v-^^_^ ^ ____.,__ LECTURE -' • ON MEDICAL OBEDIENCE, INTRODUCTORY TO THE COURSE THEORY AND PKACTICE OF MED1CIRK IN Till; MEDICAL DEPARTMENT OF PENNSYLVANIA COLLEGE, PHILADELPHIA. FOR THE SESSION OP 1845-46. hy- BY WILLIAM DARRACH. M. D. 3, NOVEMBER, 1 8 1 o . PHILADELPHIA: BARRETT & JONES, PRINTERS, 34 CARTER'S ALLEY. 1845. LECTURE OH MEDICAL OBEDIENCE, INTRODUCTORY TO THE COURSE OF THEORY AND PRACTICE OF MEDICINE IN THE MEDICAL DEPARTMENT OF PENNSYLVANIA COLLEGE, PHILADELPHIA. FOR THE SESSION OF 1845-46. BY WILLIAM DARRACH, M. D. PUBLISHED BY THE MEMBERS OF THE CLASS. NOVEMBER, .1845. p-T> A TV \' <„» PHILADELPHIA: BARRETT & JONES, PRINTERS, 34 CARTER'S ALLEY. 1845. CORRESPONDENCE. Philadelphia, Nov. 10th, 1845. Dear Sir :—The students in the Medical Department of Pennsylvania College have appointed us a committee to request that you will favor them with a copy of your Introductory Lecture, in the confident hope that the publication of the senti- ments, which you have therein so ably and eloquently sustained, will, if adopted, be attended by the happiest consequences to all who shall stand in the relation of physician and patient. With much respect we remain yours, &c. BENJAMIN F. CHATHAM, New Jersey. HENRY S. HUBER, Illinois. WILLIAM TERRY, Connecticut. F. D. DELLINGER, Missouri. N. CHAPMAN SKINNER, N. Carolina. JOHN L. HILL, Ohio, DAVID P. HAYS, Virginia. DRAPER W. NEWTON, New York. A. MACDONALD, Nova Scotia. BARTON C. LLOYD, Penna. E. C. LUZENBERG, Louisiana. JOHN E. WHITESIDE, Penna. J. THORP, Delaware. JACOB S WEAVER, Penna. WILLIAM W. ESTABROOK, N. Brunswick. Prof. W. Dabrach. Philadelphia, Nov. 29th, 1845. Gentlemen :—Accept of my thanks for the honor you confer on me, by your request, on behalf of the Class, to which I cordially accede; notwithstanding my consciousness of the many imperfections of style in the Lecture in question, and of the lack of that purity of spirit with which it becomes one to be endowed, who would venture to enforce the Divine Command, « Go ! Heal the Sic&." Very affectionately and respectfully your humble servant, „ , W. DARRACH. To Messrs. Chatham. Huber, ? _ and others, J Committee. INTRODUCTORY. Gentlemen : Although you are personally strangers to each other, a common object has brought you together, and that from various parts of our common country; and, indeed, from beyond its limits; and here bind you now to each other as medical brethren. The homes, of some of you at least, are separated by hundreds of miles, may I not, indeed, say thousands; and your long travels to this city, with perils and hazards, have been made at much expense— expense of money and of time—expense, also, of feelings—feelings of home, the charmed spot and its dear ones, " Where centre all the joys your lives have seen— Where days are ever bright, and nights serene." Why, gentlemen, such expenditure ? You answer that Human Sicknesses have awakened undying sympathy, and created in you a ruling passion to heal the sick; and to fit you thereunto, you have come here, from your homes, to our medical schools. Such, gentlemen, I may fairly understand to be your common object. Our's shall be, whilst we welcome you to our city, and to all its medical appliances, to aid you in every way in its accom- plishment. The object is truly worthy of all your self-denial. And it ought to be a source of constant satisfaction, that it is conformed to an ancient command, which was originally written as follows: "nopvusOi" " Aadevowtas e^aTtvttt"—and is well translated into our own language in these words, " Go! Heal the Sick." Let us spend a few moments together in a practical consideration of these imperative words. They were spoken by one, lowly in spirit, who did himself that which he meekly ordered others to do. During the whole of his manhood, until his death, this Benefactor of mankind went about and healed the sick. Who among us, gentlemen, would not most willingly recognise the .( 4 ) authority of such a benevolent, gentle, and efficient physician ? Who, of us, will not gladly submit himself to his mild command—Go! Heal the Sick. What better topic can I have for an introduc- tory to ray coming Course of Lectures, on the Theory and* Practice of Medicine, than that suggested by this command ; and what better title to the subject which it affords, than that of Medical Obedience: that is, an unqualified, implicit obedience, on the part of physicians, to the Divine command, "Go! Heal the Sick!" The subject which I have thus brought before you, has been im- pressed upon me by an examination into the true import of the Medi- cal Diploma. If we avoid the extremes into which our age runs, of " despising forms, or regarding them every thing," and consider well the new and responsible position of the graduate in medicine—that the important powers of that position are not presumptuously assumed ; but, on the contrary, that they are conferred through his Alma Mater by that high ordaining power which says, " Go! Heal the Sick"—we shall then be convinced that the conferring of the medical degree is a ceremony of high import, putting its subject under orders, imposing on him a most important commission, and setting him apart to the exer- cise of medical skill, humanity, and a life of self-denial. Such consi- derations, and the duty imposed on me by the Faculty, of annually conferring the Doctorate in Medicine, urges me to the exposition of the Great and Benificent command, and thereunto to enforce Medical obedience. The more I have thought on this command, the more it has spread, and risen, and occupied my mind. Other subjects, it is true, have since obtruded themselves as topics for my introductory, perhaps to tempt me from my purpose, accumulating upon me, indeed. But they have all passed away, and now leave my mind solely occupied and deeply impressed with the noble, royal injunction, as the eye of the poet or painter is impressed with the mid-day heaven,when every cloud is away. Such like is my subject, high, clear, and broad in every direction. How, gentlemen, shall I treat it ? Will all receive it ? May I not, without intention, rouse a feeling which had better not be awakened ? For it is common fame that physicians have taught them- selves to believe that the Bible contains no word of command to them —critics of Revelation! There are some such, false as fair. But the mass of medical practitioners in this country, and also throughout Great Britain, are now not so. They submit themselves to the ordi- nances of Christianity, and do not judge it unprofessional, unscientific, to obey the command, and bow in the presence of Him who not only went about all the cities and villages, healing every sickness, and (5) every disease among the people, but who also conferred his healing power on others, and will confer it on you. Surely He is worthy of our medical homage! Hippocrates, and Galen, and Sydenham, and other such, have cured their thousands, but He, the Son of David, has cured his tens, and tens, and tens of thousands. His words are not now disregarded. Nevertheless, gentlemen, to be candid, at least with ourselves, on this subject, there does yet exist an imported medical atmosphere of miasmatic materialism and scepti- cism—French, Italian, German, and into it the medical student of this Christian republic comes to the injury of his manly anglo-saxon cha- racter. Parents too often perceive, with regret, that their sons have imbibed, with their medical education, a spirit of free-thinking and cowardly doubting. It is our deep anxiety that no such infusion shall be from this school; and in accordance with it, I shall the more press obedience to the command, "Go! Heal the Sick." "nogevec-di"— " Af$evovvTct<; Qt^et.'irtviTi." This medical ordinance suggests four important questions, viz: 1st. What is sickness ? 2d. Who are sick ? 3d. Can they be healed ? 4th. Who shall heal them ? Let us answer each of these questions. First. What is sickness ? What is the amount and diversity of human sickness ? See you that individual out at midnight, in the solitary street, wrapped in his win- ter cloak, against the North wind, and its rain, or snow, or hail. He is a physician, a busy practitioner. Ask him what is in that dimly- lighted chamber ;—he is going there. He answers, that it is sickness, with its untimely watchings and anxieties. How many of such items of sickness, gentlemen, do you think that there are on this yet suffering earth ? Be carried, by your fancy, from city to city—town—village—from country to country ; and, Howard- like, acquaint yourselves with their many ailments, disorders, and dis- eases. Spread out before you Mercator's chart, and ascertain the localities of endemics, the broad fall of epidemics, and the trail and mortality of the pestilence. Analyze sickness into its elements. Atten- tively consider one of these elements, for example, pain. Pain! It is the beginning, and very often, the end of life, or what means the cry of the new-born infant, heard amidst the sorrow and anguish of the mother, and what means often the struggles of the dying hour—the struggle into, and out of life, is with pain. It is the doom, that in sorrow shalt thou bring forth children ; in sorrow, and in the sweat of thy face, shalt thou eat of the cursed thorn and thistle—bearing earth until thou return unto the ground. The white lines which proceed right and left from the spinal marrow, in numerous cords, and spread and permiate every where into the flesh and bone, may have pain, (6) darting, twitching, gnawing pain!—pulsating pain!—dull, yet lasting, periodical, yet sharp pain!—diffused and burning! Who can esti- mate the amount of pain on this earth at any one moment; and guage that which has been in all generations, and which shall be. Often it assumes a pathognomic importance; the toothache, for example; the intolerable tic-doloreux, and all the neuralgia, the bilious cholic, the gout, the nocturnal rheumatism, the chronic headache, the gnawing hip disease, the fit of the stone. Indeed, there are few diseases in which pain is not an element. Such is pain ! To these various morbid conditions of the nerves of sensation, add those of the motor nerves, the rigors, the convulsions, the tetanic rigidity, the spasm, the jirk. Add to all these sicknesses the exhausting paroxysm of chill, fever, and sweat, the remitting exacerbations, the rise acme, and decline of continued fever, the depression, excitation, and collapse of typhus, the destructive primary stage of yellow fever, and its subsequent delusive calm and sinking. , . Consider, next, in the cabinet of human maladies, the various dis- ordered and arrested functions from congestion and irritation, and the lesons from acute and chronic inflammation. Consider, also, the hor- rors of dyspepsia, asthma, dropsy, carcinoma, struma, and anemia; the cerebral affections, apoplexy, palsy, and fits ; the disturbance and loss of the senses; the mental disorders, mania, and melancholy. Sad picture! I have said enough. An adequate answer could not be expected to the question, what is human sickness? Its variety is legion. Glance the eye over the Praxis Medica of Plater, the Nosologica Methodica of Sauvage, the Catalogue of Plouquet, the Synopsis of Cullen, and the Nosology of Good: look upon the vast muster of fevers, inflammations, chronic diseases, and nervous affections, mar- shaled out under their classes, orders, genera, species and varieties, and then exclaim with M. de Ratte, " Quel nombre prodigeux d' enemes " and ask who are so afflicted ? who have such sicknesses ? This is the second question which I proposed to answer, viz.: WTho are sick? I answer first that the rich are sick. It is true that wealth is a blessing to its faithful steward—buys many home comforts, re- lieves the poor, and diffuses Christianity. Honest enterprise gives health and long life. But the chronic care of the hoarder emaciates and induces premature old age; and the prodigal expenditure of the licentious heir creates many diseases. He fares sumptuously every day, stays long at the wine, is late to his downy, yet too restless bed, and so becomes plethoric, fat and inactive. His blood has too little (7) fibrin, and too much of the red globules. Vertigo affects his head, dyspnoea his chest, indigestion his stomach, colic and constipation his bowels, and to these fruits of sensual indulgence are added gout, gravel, calculus, and chalk-stones. And now he is in the hands of the merciless quack, or under the daily prescriptions of an apothecary or some popular doctor. Surely, the rich are sick! The poor are sick. The poor man is badly off for daily food, clothing, and shelter. He is exposed to arid heat and damp cold. He inhales the gaseous filth and carbonaceous air about the nuisances of his own comfortless dwelling, and adjacent factories, so that he inspires not his due quantity of oxygen for his animal heat, nor of nitrogen for his muscular power. And often, through ignorance and bad example, he daily takes in excess the carbonaceous intoxicating drink. His blood, consequently, becomes watery, carbonaceous, and cold. He becomes pale, chilly, emaciated, dropsical, tuberculous, and strumous. Numerous and incurable eruptions appear. The dogs may lick the running ulcers of his legs, and plague, ravaging among the gloomy dirty shanties of many such, kills them off. Such are the sicknesses of the rich and the poor. For clinical illustration, I refer you to the tyrannical dynasties where the oppress- ing rich become richer, and the oppressed poor become poorer: and for contrast with this mass of sickness, I point you to the health of the free-born of our own country, who live and let live on her moun- tains slopes, in her vallies, and throughout her prairies. The blood of such flows warm and rich, and equably. The east wind cannot penetrate them. Their thirst demands water; their hunger plain food ; their limbs rejoice in muscular efforts ; and their mind in truth. Sleep rests them; and their waking eyes behold the early light of another cheerful, useful day. Have these noblemen of nature, then, no sickness ? They have it. The ploughing of the virgin soil is the cause of their endemics. The agencies of heat and moisture on decomposible vegetation produces miasm, which the winds spread over the land ; and the people sicken and die of paroxysmal disease. The facts in proof are numberless, but none more striking and recent than that given by Parker, in his journal of an exploring tour beyond the Rocky Mountains. Doctor McLaughlin states, says he, " that seven-eighths or nine-tenths of the Indian population, below the falls of the Columbia, have been swept away, principally by fever and ague, since the year 1829 ; and it was precisely that year in which the fields were ploughed for the first time." Let us pass to the consideration of the third question, viz.: Can human sickness be healed ? (8) Can human sickness be cured ? or must man sicken, suffer pain, and die ; and that without remedy, alleviation, or prevention ? It is true that man is mortal, and that, owing to many diseases, he lives not out one-half his few and evil days. Fevers, with few exceptions, depress his strength, ultimately shorten life, and degenerate his race. Some of them, like the tempest and hurricane, quickly destroy: one- half of the human family, like the blossom of the fruit trees, drop to the earth in early infancy: consumption, like a worm on the leaf, the green and tender leaf, withers the youth ; and inordinate sensuality hastens decrepitude. Some of the phlegmasia?, it is true, terminate in resolution, without injury to the constitution or part affected; but extensive inflammations, and those of important organs, greatly hazard life ; and so it is with a vast majority of human maladies. Is there no cure for them ? There is a remedy for man's moral evils, is there not one also for his diseases ? Yes! What says even heathen mythology on this subject ? The all-gifted girl, Pandora, as her name imports, was brought by Mercury, as is the story, to the dwelling of Epimetheus. In his dwelling stood ajar, which he had been forbidden to touch. Pandora, Eve-like, under the influence of female curiosity, disregarding the injunction, raised the lid, and all the evils hitherto unknown to man poured out, and spread themselves over the earth. In terror at the sight of the monsters— fevers, inflammations, chronic diseases, nervous affections, and all else that is evil,—in terror, I say, at such a sight, she shut down the lid, and happily just in time to prevent the escape of Hope, which thus remains to man his chief support and comfort. Hope! Then there is hope! Yes, gentlemen! higher authority than heathen mythology promises the cure of human sickness. He that says, " Go, heal!" that healed, and gave his power to others, still bestows that healing power. History shows that, with the progress of Christianity, diseases are alleviated, and cured, and prevented. In proof of this position, con- trast the disorganization, deformity, and sudden and enormous mor- tality in Pagan lands from unchecked disease—from an aggravating or a death-permitting practice—with the preventions and prompt and easy cures of the most fatal complaints which occur in Christendom. For example: how many weakening paroxysms of intermittent fever, which in heathen lands are permitted to be repeated until they have produced parabisraic tumors and dropsy, have been quickly arrested since the Countess of Cinchon introduced her powder into Europe ? How many continued fevers which, in those benighted nations, are permitted to depress the strength, are soon and safely brought to an artificial crisis, since Sir George Fordyce has established the agency of antimony ? How many catarrhs, and instances of ca» (9) tarrhal consumption have now no fatal issue, since Laennec's practice has been adopted ? How horrible is syphilis in Patagonia! and how its horrors have been abated in Europe by the Hunterian use of mer- cury. How shall we duly estimate the instrumentality of Lady Wortley Montague, and Jenner ? We have no records of the supposed ravages of small-pox among the millions of Asia. We can trace it only to the siege of Mecca in the year 572, when it destroyed an invading army. Subsequently it followed the Arabs and Saracens in their successful western expedi- tion, and afflicted Spain, Sicily, Italy, France, and then the entire globe—causing a general mortality of 25 per ct. of the human family. How different now! That once fearful disease is now, by means of inocculation and vaccination, as fearlessly met by a physician as would Franklin the forked lightening with his pointed rod, and Davy, with his safety-lamp, the fatal damps of the coal-pits. Nothing, perhaps, can better exemplify the position in question than the following fact: In the year 1837 the small-pox broke out in the Eastern State Peni- tentiary, and only 2 of 80 cases of the disease died; whereas, among the Indian tribes of the Rocky Mountains attacked with the disease about the same time, scarcely 2 of 80 survived. In further proof that through the benign influence of Christianity dis- eases can be cured, I will instance the plague. This offspring of pov- erty, filth, and idio-miasm, is not found among a people who enjoy the benefits of Quarentine, Hospitals, Boards of Health, and the health- giving comforts of life. What words can exhibit this scourge of the East and of Europe in by-gone centuries, with its train of moral evils, trampling over all of every age and of every condition of people. In the 4th century, under the name of black-death, it destroyed, in the short space of four years, 25,000,000 of human beings. In 1720 it killed one-half of the inhabitants of Marseilles; and more than this at Moscow in 1771. The four years' plague of London in the 17th cen- tury, swept off 156,300. One thousand per diem died of it at Morocco ; twelve and fifteen thousands in the cities of old and new Fez. Di'abet, one of the small villages of the province of Morocco, lost 100 of 133 inhabitants. In three other villages, of 400, 500, 600 population, there were only 7, 8 and 4 survivors. And, says Jack- son in his description of the plague of Morocco, " here and there I saw many uninhabited ruins which before I witnessed to be flourish- in^ villages." What an evil is plague! It exists with ignorance, gross sensuality, and idleness; and is not to be found in Christian lands where the blessings of education, home comforts, contentment, ( 10 ) dispensatories, hospitals, alms-houses, grand-juries, boards of health, and quarantines, are poured upon a virtuous people from the full and large horn of free institutions. One more disease in proof, a most striking proof, and I will pass to the consideration of another topic :—Asiatic cholera! the modern pestilence! worse than plague and small-pox. It has killed more and quicker—continued longer, and trailed across almost every latitude and longitude. The cholera commenced at Jessore in August, 1817. A Hindoo there was attacked with vomiting and purging, and died the following day in extreme anguish, when 17 more expired as suddenly of the same symptoms; and then the disease became general throughout the town. It subsequently passed from town to town, and reached Cal- cutta—pervaded the provinces of Northern and Eastern Bengal, and became stayed, for a while, at the confluence of the Ganges and Jumna. It afterwards appeared at Benares, on the Sinde, and along the Nerbuddah and Kistna; thus traversing Hindostan. In 1819 it existed in Ceylon, Malacca, Java, and Siam. In 1820 it invaded Cochin—China, and Tonquin. In 1821 it was at Muscat, Bassora, and Bagdad. In 1822 it showed itself in Turkey, along the Caspian, and at Astracan. In 1830 it visited Poland, Austria, Russia, and the coast of the German Ocean. In 1831 it reached Hamburg and Eng- land. And in 1832 it passed into Scotland, Ireland, France, and crossed over to this continent. Suuh is the zig-zag tract of the cholera. And now mark the difference of its mortality in Heathen and Chris- tian countries. In India 40,000,000 died of it in three years; one-tenth of the population of Jessore in two months; one-third of the inhabitants of the towns of Arabia and Persia; 102,000 in the island of Java. At Bassora 1000 died daily for 15 days; at Bagdad 30,000 perished ; at Benares 15,000 in 7 weeks ; 6000 at Muscat in a few hours—the bodies were sowed up in mats and turned adrift into the harbour ; 20,000 died of it in Bancock. At Pekin in 1822 and '23, the num- ber of deaths exhausted all the means of sepulture. Such are the frightful ravages of cholera in the panic, ignorance, and superstition of heathen countries. They are in glaring contrast with its moderate mortality in Christendom. In Paris it was 15,000 ; in Great Britain 20,000; in London only 5000. And in its extensive traversing in Canada and the United States, it produced a yet smaller mortality. Medical in'elligence quickly discovered this formidable disease to be an alvine reduction of the serum of the blood, thereby clotting it and collapsing the system; and the indication to be the (11) timely arrest of this serous abstraction, and the means to be used, revulsive bleeding and sweating, and large doses of calomel. Thus panic ceased, premonetory symptoms treated, and the blue stage and death prevented. The next and last inquiry involved in the exposition of the great medical ordinance is—"who shall heal the sick?" Who shall heal the sick? Shall he heal the sick who submits his medical capabili- ties to the examination of no ordaining power, but ventures, self- taught and self-commissioned, to take upon himself the treatment of disease—making, to all cases, a general application of one or more physical agents, of which he has no definite experience, and to rea- soning on which he, as an empiric, is professionally opposed ? Will he heal ? No! Shall the healer of sickness then be he who collates a theory from books, reasons where facts fail, and imposes his dogmas on others, having no more sympathy for the sick than the novelist or reader of novels has for real evil ? or shall it be he who, after having contracted a studio-sedentary habit by years of monastic life, to obtain a baca- loriate, and as many for the medical degree, settles himself in an office at ease—at ease as one who has put off the harness of life ? Such an one doubtless has worth and talents, but will his sedentary office-life make him a busy practitioner ? I doubt it. He will not heal the sick because he obeys not the command, " to go where sickness is." Nor will he heal the sick, who, though he is always on the go, and always among the sick, is full of false pretensions, violates medical ethics and rules, and subordinates the healing of the sick to cupidity and profes- sional fame. Who, then, will meet the requirement in question? I answer,—he who, duly commissioned, goes to the sick and kindly and faithfully makes an application of medical principles deduced from experience; he will heal the sick. Such an one is a physician. He yields unqualified implicit obedience to the Divine command, " go heal the sick." He stands side by side with him who lifts oppression from the oppressed, and with him who publishes the glad-tidings of an endless life and of happiness. He is your model. His life is one of constant activity, mental and bodily. He is engaged unremittingly in the accu- rate observation of medical phenomena ; he reads, experiments, rea- sons, converses, and writes. At the call of sickness, he is going at all times, any where, and every where. When the people are undisturbed at their meals, he also may be feeding, but not always. They enjoy their mid-night sleep, but his slumbers are often broken. They are at their galas and at their home fire-sides, in the midst of the sweet charities of social life, whilst he is on the go, in the storm ( 12 ) when he and dogs are only out. The people assemble for worship, Sabbath after Sabbath, but his seat in the sanctuary is vacant, and he is in the quiet street. Such is not a too-highly drawn picture of the physician's self-denial and activity. It accords well with my impression of Rush and Phy- sick, more recently of Parrish, Otto, Ruan, Clapp, and Neill; and of our living practitioners. The more youthful of them are burdened with our medical charities; those more established sustain the respon- sibilities of private practice ; and our fathers, with their well-earned honors and the love of their brethren and the community, are yet active, especially as counsellors in the more difficult cases of sickness. If such be the self-denying activity of the city practitioner, what is its degree in the country physician ? The medical character in Europe is equally distinguished for mental and bodily activity. Scarpa, the late distinguished surgeon of Italy, is a noble example. On a visit of respect to him in 1821, he told me that he had been constantly in the labour of his profession of 62 years, and that he still loved it. He was then at the age of 80 years, and had just published a folio volume of observations and recent experi- ments on the proper method of tying arteries. And, said he, in the course of conversation, at 18 years of age I, on a medical tour, was the means of introducing the use of the catheter from Paris into Lon- don, and the practice of dispensing with the charpee from London into Paris. The Baron Larrey is another example for us of unabating medical zeal and industry. The French campaigns, in the events of which he was identified, were ended, Napoleon in exile, and he and his Sire in disgrace. In accordance with political feeling and fashion he might, with perfect good faith, have sought and enjoyed a dignified retire- ment; but Larrey continued to be active. A command, higher than that of his Sire, urged him to staunch the blood and bind up the wounds of the fallen, and to amputate limb after limb with a soldier's manly and feeling heart, amidst the din of battles yet in their heat, and as the Emperor's surgeon in chief, to erect and attend upon hospitals. This same command he still felt when glory and profit were gone. It was Larrey's instinct to go and heal the sick among his fellow-crea- tures ; and he had the tenderness of woman. I saw him at the closing period of his military life. Though aged, he was yet erect; his black hair was thick and bushy, and but slightly grey, and flowed down from his well-formed cranium like love-locks upon his shoulders. I saw him, not moody and indolent, but spiritedly engaged in hospital duties. He was surrounded by students—a diseased soldier was seat- ed in the operating chair—the veteran surgeon of the grand army pierced under the deltoid, made the upper and under flap, and thus most dexterously amputated the arm at the shoulder-joint. After that ( 13 ) ^ skillful act I heard him in lively debate in one of the medical societies against Beclardand Breschet, presenting in proof of his posi- tion, at every point of the argument, specimen after specimen which he had preserved from his own military surgery. Larrey spoke in this debate with the terseness and directness of one who had not read only but who had seen and done. Broussais, Andral and Louis, Aberne- thy, Cooper and Brodie, are other instances of men obedient to the command in question. But the most remarkable instance that I have ever witnessed was in the late distinguished surgeon of the Hotel de Dieu, Baron Dupuytren. For more than a year I followed his clinic ; during which time I may have been occasionally from my post as a pupil; but be assured that he, as a minute man, was always at his. At early dawn, and when the days were short, before the sun at can- dle-light, he was always in the hospital passing from bed to bed, where were students stationed who were interested in special indivi- dual cases. He conducted the treatment of the numerous patients of three surgical wards of the largest size, manipulated in every case of fracture, passing every catheter and bougie, opening every abscess, reducing every dislocation ; and, before a class of about two hundred students assembled in the medical amphitheatre of the hospital, he fre- quently performed the capital operations of stone, cataract, hernia, aneurism, and amputations, demonstrated the autopsies, and lectured on the most interesting cases of the wards; after which he prescribed for a crowd of dispensary patients. Such were his daily hospital duties—from 5 or b\ to 10 o'clock in the morning. He then break- fasted and performed a heavy city practice. Every Thursday after- noon he visited the hospital to examine into and admit new cases. Hie labor hoc opus est! Truly, very truly, a physician is an active being. He does not rust out his existence ; he wears out. The palm of his hand is not, it is true, hard, like that of the manual laborer; nor is his face anil neck and chest tanned as those of the sailor and farmer, but his brow has the deep and fixed wrinkle of constant thought, and his cheek the premature furrow of anxiety, making his marred look unpleasant, was it not for a general expression of benignity which is spread over his worn face and person. He may have attained wealth and honor, and his family may enjoy the gaities and fashion of life, if that be their way, he, nevertheless, under all circumstances, continues to be the busy practitioner. Grey-headed in the service, self-denial having become his second nature, he still goes the rotine errants of mercy. Pity him not. He enjoys these habitual self-denials. He feasts on the luxuries of healing the siek. Sever him from these constant goings, and these acts of healing, and you render him unhappy, nay ! more! they are the stimuli of his life. ( 14) Such is true medical character. It disdains inglorious ease, and has for its motto, " self-denying mental and bodily activity." I have thus made an exposition of the great command. There is and always has been sickness. I dare not presume to say that the human family will always be so afflicted. Man now fades as a leaf. It may be that he shall endure as a tree, and that there shall be no more sickness—no more pain! But now it is multiform and multitudinous, and a shortener of life ; the rich as well the poor, but mostly the latter, are liable to it. Yet has it not also been shown that it has greatly diminished with the progress of Christianity ? One other position I have also endeavoured to sustain, viz. that it is the obedient physician who shall be the successful practitioner. A few more words on this point. A physician is not at liberty to do and think as he may please on medical doctrines and practice. He is a servant! He obeys a com- mand, and lives up to all its requisitions. It is a common adage, that as parent so child—like priest like people. It is equally true, that as is the physician so is the patient, and nurse, and friends. If he is obedient to the great command they will be obedient to him ; and thus shall be obtained the co-operation which Hippocrates urges so much in his first aphorism, and on which depends so much the success of medical treatment. Gentlemen, if what has been said be true, then the three following corollaries are tenable, viz: 1st. The healing of the sick is the object, the chief and only object of your life. Your aim must not be scientific acquirement, nor a vain reputation—far less the acquisition of wealth. These by-ends, as supreme, degrade the medical character, decoy and disappoint like the Will-of-the-Wisp ; but if resisted and put back, they become obedient slaves to do your biddings, as happiness which always follows self- denying duties, fully and heartily done. 2d. You must be fitted for this great object of life, by a knowledge of the science of Medicine in all its branches, of Anatomy, Physiology, Chemistry, Materia Medica, Therapeutics, and Pharmacy, with the practical ones of the Theory and Practice of Medicine, Surgery, and Obstetrics. 3d. You must be commissioned. In the early period of our coun- try it was the imperative call of humanity to practice medicine with- out the formality of a diploma; and the same necessity often exists in our border sections. Such are commissioned; but not they who from sordid motives ignorantly and cruelly assume the duties of a physician. Our Medical State Societies, Medical Colleges, and Universities, are the established and proper media of commissioning qualified persons to go and heal the sick. < 15 ) Such are the corollaries. Obedience to them is medical obedience. Be persuaded to medical obedience, and be dissuaded from medical willfulness; this indulged in, will be followed with disaster and dis- appointment—the former with success and happiness. The one will meet the down-cast, sad glance of the widow and orphan; the other the joyful welcome and gratitude of the rescued husband, wife, child, friend, stranger, and the warm respect of the people. Your name shall live, good and great. The hero fills the world with his exploits, and is greeted by the acclamation of the multitude—he is ennobled whilst living, and his name descends with lustre to posterity. The statesman, historian, and poet, by brilliancy of imagination, or vigor of intellect, attain to honor of a purer and higher kind. The physician holds a yet more exalted position. He moves and shines in an orbit different from any of the above. His excellence consists, like that of the Saviour of the world, in a renunciation of himself and a compassionate love of mankind. Entertain, then, gentlemen, the humane purpose of "healing the sick," as the chief end of your life,and thereunto be qualified and commissioned. Then go! instinctively go ! go!—as the warrior to the battle—fearlessly go! go! as the stream from the hill, not to return again, but to accomplish its course; go forth to heal the sick—for humanity's sake, and for his sake whose command makes healing a duty. Stay not among the wealthy and healthy, but go to the poor and sickly—to the destitute portions of our cities—to the destitute parts of our common country— to the heathen, where unchecked disease is aggravated by ignorance, cruelty, and superstition. Go, then, as Sovxot, iqoov and, when expe- rience fails and judgment is difficult, lift the mind to its source, and be gratefully surprised at the success in practice which shall ever follow a professional life so devoted and so humble. L