IMPEDIMENTS
)
«                     TO THE

       STUDY OF MEDICINE;

                 A LECTURE,
             INTRODUCTORY TO THE COURSE
                       OF
          PRACTICE  OF  MEDICINE,

                       BY
             J. K. MITCHELL, M. D.,
               FKOFESSOR IN' THE JEFFERSON MEDICAL COLLEGE.
Delivered on the 18th of November, 1850.
PUBLISHED BY THE CLASS.
 
 
IMPEDIMENTS
STUDY  OF  MEDICINE;

           A LECTURE,

      INTRODUCTORY TO THE COURSE
PRACTICE  OF  MEDICINE,
BY
             /
J.  K. MITCHELL, M. D.,
 PROFESSOR IN THE JEFFERSON MEDICAL COLLEGE.
Delivered on the 18th of November, 1860.
         w Li^r.Aiiy. *?     \

        P II I L Al> E L P H I A :
T. K. AND P. G. COLLINS, PRINTERS.
             1850. 
 
CORRESPONDENCE.
                                         Philadelphia, October 26th, 1850.
Professor J. K. Mitchell:—
  Dear Sir—In  compliance with the  instructions of the  Jefferson Medical Class,
we, a committee appointed by them, most respectfully solicit for publication a copy
of your Introductory Lecture, delivered on the 14th inst.
                          Yours, most respectfully,
Jas. H. Macket, President.
J. H. Brinton, Secretary.
Jno. G. Brooks, Maine.
Aug. B. Hott, N. H.
H. W. Smith, Vt.
Chs. S. Wood, Conn.
I. L. Moore, Mass.
T. Romeyn Huntington, N. Y,
Jno. B. Richmond, N. J.
Chs. Neff, Pa.
Jno. Y. Taylor, Del.
Thos. H. Jackson, Md.
Saml. Walsh, Va.
Walter S. Golding,  N. C.
Chs. H. Green,  S. C.
Wm. A. B. Lamm, Ga.
J. E. Doke Prince, Ala.
Jas. T. Lester, Miss.
Reuben H. Carnal, La.
J. Henry Lewis, Texas,
F. H. Milligan, Mo.
Thos. H. Moody, Tenn.
Robt. H. Gale, Ky.
Jos. C. Rowland, Ohio.
Abram V. Brewer, Indiana.
Christian Hershe, Iowa.
R. H. Tipton, Illinois.
J. W. H. Lovejoy, D. C.
Jno. Howitt, Canada.
J. da Costa, W. Indies.
Theodore Walser, Switzerland.
  Gentlemen—The request you do  me the  honor to make, of a copy of my recent
Introductory Lecture for publication, is cheerfully complied with.
  Oblige  me by offering my regards to the class you represent, and for yourselves
accept the respects of
                                 Yours, faithfully,
                                                     J. K.  MITCHELL.
  To Messrs. J. H.  Mackey, President,
            J. H.  Brinton, Secretary,
            Jno. G.  Brooks, &c,
                                 Committee, i$c. 
 
INTRODUCTORY   LECTURE.
Gentlemen of the Class—Students  of Medicine :—
  It is only here, or in places like this, that men ever meet
such an  assemblage as  now rests before  me.  There are here
none who have not reached the period at least of incipient man-
hood, and there are only a very few in this vast audience who
have learned the sober lessons  of active life.   You are yet fresh
and vigorous, young, ardent  and inexperienced.  The stars  of
hope yet  glitter in your orient, unobscured  by a single cloud, and
untarnished by the exhalations of the misty world.   You look
on the past  and the present without a sigh or a tear, and the
beautiful future teems in your  sanguine imagination with plea-
sures and honors,  unabated by satiety, and unblighted by envy.
How I wish that it might ever be so with you.  How I would de-
light in believing,  if I could, that you would  falsify the mournful
truth  that "man is born to trouble, as  the sparks fly upwards,"
and live a cloudless life of  peace and tranquillity ;  looking on the
past with complacency, on the  present with comfort, and on the
future  with the fondest hopes—as the most ardent of English
poets has beautifully expressed it—
           The mild majesty of private life,
           Where peace with ever-blooming olives crowns
           The gate ; where honor's liberal hands efiPusc
           Unenvied treasures, and the snowy wings
           Of Innocence and Love protect the scene.
                                            Akensioe. 
»>
introductory lecture.
  But perhap> nru m>/<\ on the  very threshold of young life,
some of you begin to feel what all  must  finally know,

          " That not in humble or  in brief delight,
            Power's purple robe or pleasure's flowery lap.
            The soul shall find contentment."

  The soul  of man is  in this world, like the dove over the wide
waters of  the flood, without a resting-place.   There is  no point
of repose,  and perhaps as sorrow and trouble are progressive,  the
surest way to escape them is to be ourselves ever in motion.   The
most active is  therefore commonly  the most happy man.   Labor
i> often its own best reward, but the labor of  the student, while
it  enjoys  the common benefit,  is additionally repaid  by that
knowledge which is an earnest of good for the future.
  One would scarcely suppose that the quiet life of the candi-
date for future  action is liable  to any serious evils—but, like
every other being, even the student is necessarily and profession-
ally exposed  to  difficulties and dangers.  To some of  these, it
is now my purpose to direct your attention, with the hope of
being able to suggest remedies or prophylactics.
  At the  very threshold of professional life, the student is, in
this country at least,  subjected to  some inconvenience from  the
want of preliminary instruction.   Sometimes, misconceiving  the
true value of his previous attainments, or mistaking the bent of his
genius, he longs to enter upon  the study of an art  which most
of  all demands a good education and a sound and discriminating
judgment, talent to acquire knowledge, memory to  retain,  and
tact to apply it; and that kind of moral ascendency which inspires
confidence in one's self, and  an almost implicit faith in  others.
It is true, and I have  seen some fine examples of it, that perse-
verance and enterprise conquer all such difficulties, and enable a
noble spirit to retrieve his case by attaining at one and the same
time the elements of language and philosophy, and the soundest
principles of the schools of medicine.
  That those who  are thus deficient may not despair, let me offer
you the following narrative.  One  of my earliest pupils  had been
an  apprentice to a sign painter.   His mother, a widow, in bad
health,  labored hard to furnish him with the usual elementary 
                   INTRODUCTORY LECTURE.                  7

education of his station, and to keep him supplied with a decent
dress for Sundays and holidays.  It was not without a farther sacri-
fice of physical health that the poor wTomanthus gratified a mother's
fondness and a parent's pride.   During her long and painful ill-
ness, I formed an acquaintance with her son, and marked his devoted
kindness and untiring  service to her, who was  to him  as father,
mother and friend.  His manners, his faithfulness, his tact, won
both my attention and esteem, and I longed to draw him to my own
profession, in which I knew he would find the only fitting scope for
his gentle  and winning qualities.   I shall never forget,  gentle-
men, the angel-like smile of his mother, when  I laid before him,
in her presence, my scheme for his advancement to a  more en-
larged and suitable sphere of action. She wanted no other medi-
cine.  The ministration to the  mind struck like the touch of  the
angel-troubled waters  of Bethesda  on  the  fading form of that
fond parent, and although her malady was organic and incurable,
she resolved, in that moment, to live to  see her son a physician.
It was not  alone a moral, it was  also a physical resolve.  Her
frame felt the searching power of a mother's love, and she knew
that the mighty principle would carry her to the bright period
which lay far  beyond her apparent term of life.
   Thus stimulated,  the widow's  son began  his medical career.
His  master, who valued his services highly, canceled reluctantly
his indenture, making a condition,  for which  I was his surety,
that he should not enter into competition with him in his business
as an artist.   Within three years  from that time, my pupil made
himself master of Latin and Greek, became a competent natural phi-
losopher, and so qualified himself in chemistry as to subsequently
teach, with credit, in a  Southern college, that difficult  science.
He wrote a commendable thesis, graduated with much credit, and
displayed subsequently in a wride field of usefulness, the estima-
ble  qualities  for  which he  was,  in  his apprenticeship, dis-
tinguished.
   As the period of his probation approached its end, and there
rested no longer a doubt upon his full and final success, his mother
began to lose,  along with the excitement  of hope and  suspense,
the health which these corroborants  afforded  to her frail being ;
and just a month after the honors of the profession were his, my 
8                  INTROIU'CTORY LECTURE.

pupil followed to the tomb one Avho would not have  discredited
any station, one who beautifully illustrated  the power and prin-
ciple of maternal love.
  Now, gentlemen, there are, no doubt, among you, some whose
opportunities, like his, commence but now and here ;  whose fate
it has  been to lack  the  instruction and habits  of study which
smooth  and adorn the  pathway of professional  labor, and leave
no other impediments but such as are the ordinary obstacles  of
the course.   Such may see in  the case  I  have  cited  that the
ornaments as well as the indispensables  of our  science may  be
won by all who will believe that the task can be done, and who
are not  unwilling to make the creditable experiment.  If not for
your own sakes, if not for the sake of the honor of the reputable
profession to which you are to be devoted, if not  for  the sake of
the alma mater which now receives you to its  bosom,  at least for
the sake of those who gave you being,  and who have spent many
anxious years in an unrequited service, go  back  to them, fitted
for the unalloyed exercise of your calling, and richly  repay them
by your honors and  accomplishments  for the love that knew  no
bounds, and the care that was ever a pleasure to  them.  How
delightful  must it be, my young friends,  to produce, at such
sweet meetings, the  successive riches  of well-stored minds,  to
brighten anew the home and  the hearth, and to  see  in the
mother's tender smile, and to feel in  the father's manly grasp,
the outward expression of the measureless joy that fills to over-
flowing the bosoms of these changeless friends !
  While the example cited shows that  our  profession may  be
gained,  and even  exalted  by one who  has  not had favorable
opportunities, I do not mean  to be understood  as encouraging
persons to enter upon the study of medicine without suitable pre-
liminary learning.   It is so multifarious and vast a science as to
task fully the time and  the capacity of the finest intellect and
the most accomplished scholar.  No man can reason justly on the
circulation  of the  blood, or the mechanism of  respiration, who
dues  not comprehend the laws of hydraulics and pneumatics :
and he who does not understand  the  French and  Gorman lan-
guages  is denied access to some of the richest stores of medical
literature.   ,So, a man of defective mental powers cannot be sup- 
INTRODUCTORY LECTURE.
0
 posed to be able to disentangle  the  complicated elements of an
 obscure and multiform case.   Yet, as you well know, there exists
 a very general impression that of all the departments of learning,
 that of medicine  exacts the least amount either of education or
 capacity.
   When myself  a  student,  I had cause to ride  through  a
 part of the professional district  of my  preceptor in Virginia,
 and  visited among others a  widow lady of estimable character
 and respectable position in society, when the following conversation
 occurred.  " So you are a student of medicine ?"  " Yes ma'am."
 " I  am glad of that, for I am  about  to send a son of  mine to the
 doctor's to get his profession, and I wish you to give him a little
 help.   He's mighty dull at learning, and not  too ready to take
 up a book; but  I think he'll make a fine doctor.   He sets the
 chickens' legs now ! and only the other day he mended the spoke
 of a cart-wheel, just as I once saw the doctor set my man Hominy's
 arm ; two sticks and  a rope did the  business.  He'll make a good
 doctor, rely on it."
   " Has he been well  educated, madam ?  Does he read Latin and
 Greek ?  Is he master  of mechanics, and chemistry, and"----
 " Stop, stop a little ;  you put  me in a fright ! Why, I tell you he
 is just able to read  and write, and as to ciphering,  the master
 said he always found tit tat too and never any sum  on his slate
 —he never did a sum ;  but you know, doctors don't want figures
 except for their accounts, and somehow or other  I find they all
 manage that part."
   " But, madam, medicine is  a  very comprehensive and difficult
 science, demanding—"  " Oh, as for  that, it's just the degree, and
 calomel and a blister  or  two ! Why, I think myself a very good
 doctor, and I  know nothing about Latin and Greek, and  mathe-
 matics.  I know a doctor or two hereabouts who can't sign their-
 own names—and one  of them kept me waiting a whole day for  a
 remedy, which should have been given immediately, because he
couldn't go home himself for it, and he didn't know how to write
 for it to his student.  The  man  got well, after the medicine did
come, and what more  do you want ?   My eldest son is a shrewd
fellow, speaks fluently, and argues  ably;  he is to be a lawyer.
My second son is industrious and careful;  he'll  take care of the 
10
INTRODUCTORY LECTURE.
farm.  As for ■/<»: if I don't make him a doctor, what on earth
can I do with him ?"
  You may well suppose, gentlemen, that I felt not a little mor-
tified at a conversation which the  good lady did not suppose
offensive, inasmuch as it was a current notion to which she gave
vent.   I took good care to put my able and estimable preceptor
in possession of the news of the qualities of his promised pupil,
and he astounded the lady by telling her to make her young hope-
ful a tailor or a shoemaker.
  Now, why did this  lady, and why do ten thousand other people,
entertain such an estimate of the pre-requisites for medical studies?
Because  students take so little pains to do more than acquire
the mere elements of a medical  education; because regular medi-
cine  is so full of imbeciles.  While the profession is rich in  fine
examples to the contrary, no one can doubt that by far too many
look  on medicine as a  mere trade—so much  work against so
many dollars—and as they know little themselves, they are dis-
posed to undervalue learning in others, and thus by precept and
example aid in disseminating  notions not  only derogatory to
medicine as a science, but destructive to it as an art.
  In the earlier periods of our national existence, this evil  wa>
a necessary  consequence of the state of society.   Refined  and
well-educated men  could not often consent to  bury themselves
in the woods  to earn amidst hardships and  privations a scanty
subsistence.   The  higher  qualities of the  profession could not
be often used, and  were more seldom properly appreciated.  In-
deed, few students of medicine  could find means of obtaining a
good  preliminary education, or of following out in foreign  uni-,
versities a complete  system  of instruction.  Hence  society was
compelled to take the best accessible adviser, and habit reconciled
it to what was a necessary evil.  It is so no !o>t</cr!   The love of
learning is a characteristic of the people of this land of ours.
Schools are everywhere !  The common  school, the  academy,
the lyceum and the college,  follow to the boundaries of society
the woodman and the hunter ; and  no student  is debarred from
scholastic attainments  either  by remoteness  or poverty.   If
want of health or  the negligence of others have straitened his
means.of acquirement, let him now retrieve his loss, and endeavor 
INTRODUCTORY LECTURE.
11
as much as possible  to prevent the perpetuation of the degrada-
tion of one of the noblest of the professions.  It is a sad draw-
back to the zeal, enulation, and industry of one who enters with
laudable spirit on his course of study, to find himself side by side
with those who  care for  little beyond the mere  routine of the
trade.   But let  the  noble aspirant for distinction and usefulness
remember that  it is only he, and such as he, who can wipe out
this popular stain on the profession, and bring it to  its proper
purity and honor.
   Another impediment in the way of a student is found in the
course of study  itself.  Supposing him  thoroughly prepared to
enter on his quiet pursuit  of professional love, he is  often seri-
ously at a loss  as to his  choice of books  and the  order  of his
reading, while he is puzzled and  alarmed at the vast array of
authors and subjects.   Unfortunately, he feels  these  difficulties
the most at the  very outset of his career, and arrives  sometimes
even at his collegiate course without settled views or well-direct-
ed efforts.   Unfortunately for him also, his preceptor is too often
unfitted to be  his guide.   His many engagements, irregular as
to time and imperative as to necessity, disqualify him for  study,
and make broken arrangements with his pupils a  common  affair.
For both reasons, he is a  bad guide. His library is often scantily
supplied with  good  books, plates and preparations, and  the
novice finds in the few volumes he does see catalogues and com-
mendatory notices of those which he sighs in vain to  see.  His
aspirations after knowledge are thus unsatisfied even at  the out-
set, and he is often  condemned to pore over obsolete notions and
antiquated lore,  because his preceptor has  ceased to purchase as
he is unable to read.   The text-books  of the last  era,  with their
exploded doctrines and rejected terminology, too often constitute
the stock in trade of a country  physician; and  the  pupil Avho
comes up to a large city for his farther attainments, too often finds
that he has been wasting  time and opportunity in useless or even
hurtful studies.
   Even the journals of the progress of medicine, these newspapers
of the profession, go out to but a small proportion  of the phy-
sicians of the  country, so that when a  student  does  reach the
city he finds much to learn that might have been more thoroughly 
12                 INTRODUCTORY LECTURE.
acquired elsewhere.  This is an evil  that  needs only to be men-
tioned to be corrected ;  for I  do  not suppose  that many of the
excellent men who practice in the country wilfully expose their
students to these evils.  When they  do, the student may, at very
little cost, supply,  himself, the deficiency,  since there arc many
publishers and booksellers ever ready to duly fulfil an order  from
a distance ;  and the few new books absolutely required are cheap
and intelligible.
  The greatest merit of very recent works  is that they are not
filled  with  speculative  notions  and metaphysical distinctions,
which formed in the last age so large a share of medical litera-
ture.   That was the age of system and hypothesis, this of proofs
and tables.  In  that, the author selected his theory, and, like  a
feed lawyer, set himself to the task of  enforcing its  truth by
argument and  sophistry.  It was  a point  to be made !   In  this
age, an author's opinion follows a long course of observation and
experiment.  It is the result of his labor, not of  his genius, and
if, as  usually happens, he  cites his facts,  we are  able  to  sit in
judgment on his deductions.   Under this system, the taste for
hypothesis  is dying, and a treatise which  professes not to  be  a
compilation or an experimental induction  is now seldom treated
with much  respect.
  But as the student  is young, and  ardent, and  imaginative, he
is too much disposed to  be charmed by the  a priori  philosophy
of the old schools of medicine ; and the Bocrhaaves, the Darwins,
the Browns, and  Broussais  of  a former era  are preferred to
the Cliapinans,  the Dunglisons, the  Woods, the  Dicksons, the
Bells, and  the Bartletts of our own times.
  An argument is, too,  something like a  fight.  It arrests atten-
tion at least, and whether we agree  or dissent, we take a  side;
and party zeal is always enchanting.  On the other hand,  when
an author begins by sotting down his cases and  arranging and
classifying his phenomena, the reader is  called upon to exercise
solely his patience and  memory at first, and that is  neither ex-
citing nor  racy.   A library, consisting exclusively of old books,
is, therefore, in medicine, a very dangerous neighbor to a student
of  genius, since it augments  to a fatal degree the natural  tend-
ency  of youth to  avoid the detail so necessary to sound conclu- 
INTRODUCTORY LECTURE.
13
sions, and causes him to overlook the only true  basis of know-
ledge,  well-observed  and  well-arranged phenomena.   It  also
gives him a  taste for brilliant ratiocination and sophistry, which
are mistaken for truth, and which confer reputation at the ex-
pense only of an agreeable mental  effort.  It seems to me that
our immediate predecessors in medicine were  more  solicitous to
invent than to build  systems,  and  plausibility  of explanation
was accepted as settled truth.   And to an ardent youth, plausi-
bility is commonly conclusive.
   In looking at the general works on the science and art of medi-
cine published in  our  own day, we are forcibly struck with their
dissimilarity to those of the times gone by.  No respected author
of  such works now pretends to present himself as a sole or even
as a predominant authority in  every page or chapter.   He de-
signs to give to his readers the  accepted  medical  literature of
the day, that which is sanctioned by the highest  names of the
profession in every country; and so far from wishing to dogma-
tize, he is properly pleased when he is able to cite  other authori-
 ties, especially when the sentiments are not in  contradiction to the
 philosophy  of medicine.  The great peculiarity of these works is
 the variety  of sources from which the information they contain is
 drawn, and the  readiness with  which  they accredit the lesser
 names of the profession for the  truths which have been by them
 presented.   Such works are good digests  of  the present state of
 medicine, and resemble those admirable compilations which have
 been much  longer known and  valued in  the  departments of law
 and divinity.  Like those of the law, these  fine aggregations of
 knowledge  are indebted to their authors  for their  arrangement,
 their proportions, their style,  and  the  not  infrequent decision
 where conflicting opinions or opposing phenomena might puzzle
 and perplex the inexperienced reader.  They often contain, too,
 novelties of fact, or  principle,  or  practice,  the offering to the
 general store, from the authors  themselves, and the Avise caution
 against  a too ready admission of opinions, which, though sanc-
 tioned by eminent names, are not in accordance with the correct
 truths of the science.
    Among the books of this class. I have recommended to those
 who follow my lectures to  prefer that of Professor  Dunglison, 
14
INTRODUCTORY LECTURE.
 as being the most complete and comprehensive work of its kind
 extant.  It is  an elegant, well-proportioned, miniature likenesn
 of the  medicine of the day.  It contains such a  reference  to
 authorities as to enable you to extend your reading  on any of its
 multifarious departments in safe directions.   While its judicious
 author carefully guards his readers  against  doubtful authorities
 and hazardous  experiments, he does not obtrusively throw himself
 into the scale of opinion ;  yet he has added much by original
 suggestion to the value  of the Avork,  and the greater part  of the
 skilfully compounded formularies are of his own construction.
  The  work of the judicious and industrious Stokes has been
 greatly improved  by the labors and learning of my friend  Dr.
 John  Bell, who has highly elaborated those parts  of  the book
 which refer to the diseases  most incident to our own country.   I
 hazard nothing in  asserting that its value to the American reader
has been  more  than doubled by  the skilful additions  and able
 annotations of  the American  editor.
  Were I  not  afraid of overloading your book shelf, I  would
 recommend also the able works  of  Watson and Wood, both of
 them  elegant, elaborate and judicious.
  The two first-named works, those of Dunglison and Bell, have
 been selected as my text-books;  and, if properly studied,  afford
 an excellent view of existing medicine.   Yet,  almost daily, cases
reach us from  the suburbs and the  country  which show that
either such books form no part of the physician's library, or that
 they have not been read with attention. Even yet, notions found-
ed on the exploded  doctrines of older  times  occasionally allay
a medical  correspondence, and produce regret that a rapidly pro-
gressive science is limited to  so few of  the  profession.
  The practical effect of this incuriosity is often disastrous.   In
a country  town (I believe it is called a city) of considerable popu-
lation and scientific opportunities, no case of typhoid fever had
been diagnosticated at the time when one of its oldest and most
respectable physicians visited this  city.  At the hotel  at  which
he had stationed himself, a case of that disease, of a well-marked
character, presented itself.    As he was requested to look at the
case, he, in polite terms, and no doubt with good intentions, found
fault both with  the diagnosis and practice, insisting that it was 
INTRODUCTORY LECTURE.
15
a bilious fever, having for its basis a disease of the liver.   The
patient died,  and at the autopsy he was very much surprised
to see  a perfectly healthy liver and an ulcerated ileum.  " No
such fever,"  said he, "was ever seen in our place."  A pupil
from this school, who is now  a resident there, writes me that
there is there seldom any other fever, and that his post-mortem a
exhibit the lesion which typhoid symptoms led him to expect.
   Now, this evil rises  solely from the want of attention to the
new publications, which from  time to time report the progress
of our art and science; or from the indifference or aversion to
the novelties which the medical journals furnish.   This evil ex-
tends to the pupils, and as our first impressions are too often in-
effaceable, the proclivity to error, created at the  outset of pro-
fessional life, too often tinctures fatally  the Avhole course of exist-
ence, and gives to a medical tyro an antiquated mode of thinking.
   Whatever may be the difficulties by  which, in the country,  a
student is beset,  they are of no less magnitude Avhen  he arrives
in a great  city  to  complete his course of professional  study.
Many have left home then for the first  time, to be intrusted with
what Byron calls that " dangerous heritage, the lordship of him-
self."   Amidst an  almost boundless population, to which he is
commonly an entire stranger, he has to find his path  with but
little experience in the ways of the world, and without that dis-
trust which is the safeguard of those who have long held com-
munion with mixed society on a large scale.  In the country, the
position of every one is known, and caution or reserve follows an
antecedent knowledge of the persons by whom we are addressed;
or we give our confidence to those whom we know to deserve it.
There, too, dress and manners  are seldom assumed to carry on a
fraud or intrigue, since they cannot disguise those who are already
known to every one.   A young and inexperienced student, there-
fore, is very apt  to  be entrapped by a pleasing  exterior, or  a
Avinning address,  and to take as true the well-told tale of sorrow
or wrong.  There is but one way to avoid this danger, and that
is by studiously shunning the acquaintance of unknown persons,
who are lavish of professions of regard,  and seem imbued with
an extraordinary spirit of benevolence.  Love  or friendship  at
first sight is a rare event, even for a woman, and  we should not 
16
INTRODUCTORY LECTURE.
let our too favorable opinion of ourselves inveigle us into the be-
lief that our extraordinary merit has attracted and justified a
violent and sudden  regard.  Persons who thus approach you do
it to deceiA-c, and I have had more than once to Avitness the sad
consequences of a too ready confidence in strangers.
  I should be sorry, however, to fill your minds Avith vague and
general distrust, a very ungraceful and unamiable quality ;  but 1
would have you, while you receive such advances with propriety,
to Avait until you know something of their character before yon
unbosom yourselves to others, or give yourselves up  to their guid-
ance.    Some  seek  your acquaintance to live  on your bounty,
some to invite you to games of chance, and  others  to allure you
to the haunts of vice and  intemperance;  where  your purses,
your health, and your character  are in danger of irretrievable
ruin.   Left to himself, a student, however  inexperienced, is  in
little  danger;  but when led  on by a  practiced  deceiver, he
may find  himself, by almost imperceptible steps at least in  a
perilous proximity to ruin.  It is better, therefore, to be guarded
in forming your acquaintance here;  and it is especially necessary
to receive with caution the professions of regard from unaccredited
strangers who profess too much.
  Supposing the  student exempted, by caution of character  or
knowledge of the world, or impregnable virtue,  from the dangers
to which I have alluded, he is still liable to other evils.   Amonu
these,  one of the most common is  a careless  method  of study
at the outset of his first course.   If a man  of  ready talent, he
is liable to the risk of postponing his efforts to  some future time,
when he promises to himself an  active and productive course  of
study.   Such a postponement, by increasing the work to be done,
lessens still farther the desire to encounter the  task, until at last
the  approaching period for graduation produces violent and hurt-
ful exertion,  often repaid by  failure and disgrace.  This fatal
procrastination is too often the  consequence of  a  desire to  see
the  city and its hundred curiosities, to mingle with its society,
and to enjoy its amusements.  All that is laudable  enough, save
when indulged in at the expense of future honor and usefulness.
Yet I would not discountenance  proper and innocent recreation.
He  who studies always,  and plays never, will not make as much 
INTRODUCTORY LECTURE.
17
 solid progress as if he  were to  occasionally and frequently un-
 bend and refresh a fatigued mind by agreeable relaxations.  The
 late Dr. Gregory, of Edinburgh, whom when a literary student
 I consulted in  my  own case, told  me that four hours of grave
 study was as much  as most  minds could  bear in one day, for  a
 succession of many days, and that he had ascertained that those who
 spent more time than that at their  books  did not profit so much
 as those who made that time their limit.   But, said he, the habit,
 to be profitable, should be daily.   You  have here,  then, a rule
 by an  eminent scholar and great physician,  which, Avhile it
 Avill afford you  the  richest results, leaves you time  for exercise
 and amusement.   Begin,  then,  on  the first day, to  review your
 subjects of study, and  never suffer your  task to grow large by
 neglect.
   Students sometimes fall into an opposite evil.  Ardent in the
 pursuit of knowledge, and solicitous to  earn a degree with dis-
 tinction, they enter upon  a collegiate course with too much zeal
 and persistency, leaving  themselves too  little time for food or
 rest,  and none for recreation or  exercise.   Some of them  having
 pursued such a course in the country Avith impunity, believe that
 they  may without injury continue the ceaseless efforts here.  But
 you should know that while such an exertion is rife with  hazard
 anywhere, it is particularly so in a  great city, whose atmosphere
 is less pure and sustaining.  The change of residence, and the
 period of life, are also deleterious elements in such cases, and
 render  the  experiment  additionally hazardous.   Hence we see
 that many hard students  yield  to the pressure  of their  labors,
 and lose by failing, health more opportunity for improvement
 than is gained by their  supererogatory efforts.
  Another  set of students spend  much  time over  their books
 without learning in proportion to the period consumed.   Those
 are they who, having failed  in  earlier life to acquire  habits of
 study, have not the power of fixing  attention, and read therefore
 listlessly and unprofitably.  There is but one  mode  of  curing
 this evil.  It is by studying, pen in hand,  and taking short notes
 of the purport of the book.  This is a certain remedy, and will
not only temporarily, but permanently cure the malady ;  for in
a few weeks the earnest student will find  himself able  to  fix his
    2 
18
INTRODUCTORY LECTURE.
 attention, even amidst the noise and bustle of a busy household.
 I  Avould not advise  a student Avhose  powers of  attention flag
 through exliaustion to make such an experiment, lest he produce
 a  prolonged mental  or physical debility.   Whenever the atten-
 tion of a trained  student begins to flag, and he finds  that he
 cannot by the usual effort command it, he should desist at once,
 and seek either repose or recreation, as  the hour and  opportunity
 may  determine.   The  same  abandonment is profitable  when
 after  an effort or two a difficult subject  seems still  cloudy and
 perplexing.   That which appears  obscure  at  one  time is  often
 astonishingly intelligible at another, and therefore time and labor
are saAed by turning, for an hour or  tA\o, the attention to some-
 thing else.
   The arrangements  of  this school of  medicine offer for study
two hours (from 8 to  10) in the morning, and an hour after din-
ner (3 to 4), so that there is required but one hour in  the evening
 or at  night to complete the term of mental labor  suggested by
 Dr. Gregory.  Some  of you, who have friends or acquaintance,
may prefer the evening for recreation ;  others, who require vigor-
ous exercise, may choose to find amusement during  daylight, and
devote the evening to study.  But all of you may have as much
daily exemption from the labors  of severe study as any reason-
able man can desire, and  thus preserve,  by the judicious inter-
mixture of  action and repose, that good health which you bring
with you from your parental roofs, and preserve that freshness
of mind  which receives forcibly and retains tenaciously all its
impressions.
  In the class of which I was a member, there  was a  young gen-
tleman of liberal education and sound understanding, who thought
all recreation a waste  of time, and A\ho was so ardently desirous to
graduate with especial distinction that  he never lost a moment.
As the course advanced, his health became disordered, and there
was perceived an obvious deterioration of his  memory.   These
impediments only added to his zeal and perseverance ; but zeal
and industry could  not overcome them,  and he  at  length broke
down under the effort to master the muscles of the spinal column.
During this, his last desperate struggle, some of his companions^
passing his  lodgings  late at  night, saw for weeks  his ceaseless 
INTRODUCTORY LECTURE.
19
lamp  burning over  his  painful  toil,  and  they endeavored  to
laugh him out of his fit, as they termed it, by calling out to him,
" Study the muscles, boy."  All his acquirements soon became to
him a confused heap of unassorted rubbish ; and after obtaining
a degree, granted rather to his industry and character  than to
his power of winning it by an exhibition of knowledge, he retired
to his once happy home  sick and mortified.   His eyes gradually
failed him, and he at length lost his sight through a chronic in-
flammation,  originating   in  his   protracted nocturnal  studies.
Others of inferior capacity, who studied fairly, and rested judi-
ciously, made better  exhibitions  under examination, and  are,
many of them, now among the most respected practitioners of
the day.
   The most propitious period of the day for  study depends some-
thing on temperament, not a little on health, and a great deal on
habit.   Sometimes, too,  family arrangements make the selection
of the time of study rather a matter of necessity than free choice.
It is not often in good taste to  cite one's self as an example or
illustration, yet  in such  a case as this I may be pardoned  for
saying that from my youth  I  have  ever found the hours  after
ten at night most propitious to intellectual effort.   I study then
not only more easily but more intensely, and the acquirements
then made remain longer in my possession.   One of my friends
can do most in a given time early  in the morning, while  another
feels himself in the highest capacity in that sleepy period  the
afternoon.   In general,  those  who  digest  well study easily at
any  time,  whilst those  who have gastric  disorders  are either
unable to make extraordinary mental exertion  during the first
digestive period, or  are  then injured  by successful intellectual
efforts.   It is far from being a matter of little moment to dis-
cover at what time, and  under  what  circumstances, one may
study to the best effect,  since it is usually  demonstrable that a
great economy of time  and labor may result from  a judicious
choice of hours.   Each  student must  make this discovery  for
himself.   It is enough that I should indicate the general truth.
Its special  application must be left to you.
  Among the errors into which many students fall in the pursuit
of a medical  education,  none  is  more  common than an undue 
20                 INTRODUCTORY LECTURE.

admiration of one  branch  and dangerous  neglect  of another.
Each, according to  his taste or bias, is disposed to a system of
favoritism, and Avhile he makes, like a  partial guardian, a pet of
one branch, is apt to treat the rest with cold neglect.  One, ena-
mored of  the beautiful theories and admirable processes taught
by the physiologist, abandons himself too exclusively to the cul-
tivation of physiology.   Devoting to it an undue proportion of
time,  and  bestowing on the hours given to less favored branches
less of pleasurable excitement, he becomes insensibly little more
than a physiologist.
  Another, captivated by the art of the surgeon, attaches himself
so exclusively to its simple reasonings and its brilliant operations
as to  lose  sight of that part of medicine and obstetrics to wThich
he is  to be practically called  more frequently and often more
profitably. So, one may find so much pleasure in the difficult diag-
nosis  of internal diseases, and the reasoning toAvards indications
and remedies, as to forget that his first case may be a broken limb
or a strangulated hernia.  HeAvho means to reside in a populous
city, where the profession is broken up into departments, may in
this manner select the part to Avhich  he designs to devote himself
with more appearance of reason; but even he will soon learn that
a bad physician never makes a  good surgeon, and that a physician
who is ignorant at least of the principles of surgery  is often
placed in trying and sometimes in  painful surgical positions.
Much more is the exclusive student at fault in a small toAvn or in
the country.   He may practice for years without seeing a single
important surgical case, or he  may find his  hopes of professional
success and reputation at once and for ever blasted by encounter-
ing an operation in ordinary or obstetrical  surgery  to which his
competency has been prevented by injudicious inattention, when a
student, to the less  favored branch of medicine.
  These sentiments, gentlemen, are not the offsprings of imaoi-
nary evils.  The examination of candidates for degrees proves too
often that there has not  been  wanting in those who  fail to reach
the sought-for honor the capacity to acquire, or the willingness
to study,  so much  as the well-proportioned direction  of atten-
tion.   Students admirably prepared on some  branches show an
utter  ignorance of others ; and I am sorry to say that on the 
INTRODUCTORY LECTURE.
21
practical subjects, to Avhich all others are subsidiary, there is too
often displayed  a deficiency indicative of great thoughtlessness,
or of culpable disregard of the awful responsibilities of the pro-
fession.  We who have passed through the studies and ordeals of
the profession, know that there is time for the student of ordinary
capacity to learn all that he is expected to acquire, and they who
examine students discover  that the error usually lies in the  dis-
proportionate attention given by them to particular departments
of the science.   I express these things from no personal motive,
since I am happy to  say that the branch of  medicine which  I
have the honor to teach in this place has been  studied of late
by the pupils  of the  school  Avith commendable success.  Give
ear  to  me, then, my young friends, Avhen I entreat you to  dis-
tribute your time and attention so as to carry forward equably
all your studies,  assured that the parts of medical science  are
mutually dependent,  reciprocally illustrative.   You  may  hope,
indeed, at some future time to retrieve the inequality, and thus
console  yourselves for present neglect  by  promises  of future
compensation ;  but it  is commonly in the very nature  of dispro-
portion to continue and to augment itself; and if with the incen-
tives to equability here and now offered you become irregular or
eccentric, Avhat  is there in the unknoAvn " to come"  that may
present higher or better motives ?
   Medicine has become a science.  It could not be so much before
our day.  The sciences upon which it is built Avere themselves too
imperfect to afford it a solid basis until now.   The physical and
chemical sciences being now highly matured, much that was once
obscure or unintelligible in medicine is clearly understood, and
the refined principles of those departments of knowledge may be
often applied to the explanation of medical truth.   The anatomist
has discovered nearly  all that the scalpel and the microscope can
reveal,  and the  physiologist  is  employed in  the  daily task of
Avidening the already ample domain of his knowledge.   Although
from its complexity and variety  medicine must for ages, if  not
for ever, be a progressive art, its great principles are, many of
them at least, apparently permanently settled.   To these princi-
ples  I would  direct the attention  of the  learner in an especial
manner.   Without them, what is any physician but a routinist
                              2* 
22
INTRODUCTORY LECTURE.
or a quack, who gives  medicine  by a rule and not by a reason,
and who can treat with even endurable correctness only obvious
and ordinary cases of disease.
   Among the evils incident  to the student's course is a disposi-
tion to learn by rote;  to charge  rather the  memory than the
reason, and to overlook in his collection of phenomena and formu-
laries  the  classifications and  principles which can alone make hie
knoAvledge permanent and available, and without which he must
remain on the ground acquired during his probation, or improve
only by rare accidents.   It is this bad habit of overlooking the
principles which makes a student so often follow the practice of
the shop in which he received his  first impressions.   As he did
not reason then, nothing subsequently heard is  rationally com-
pared Avith his  earliest medical conceptions,  and he  too  often
relapses at home into the errors and prejudices of his first teacher.
A traditional medicine thus infests whole districts of country,
and in many places,  in which avc might look  for better things,
the principles  and  the  remedies of the last century remain
masters of the  field,  from which have passed  aAvay the  ancient
roads and boats, and carts, and ploughs and flails. Nothing remains
of that forgotten time but its calomel and its bile.    Bile to cause,
and calomel to cure,  everything.   Look, then,  my young friends
to the neAV principles and the neAv remedies which  a progressive
science brings to the aid of the physician.  Endeavor to  com-
prehend the nature,  organic and functional, of disease, and the
reasons for the  indications as well as the modus  operandi of the
remedies.   Take care not to burden your memories with formu-
laries  adapted  to diseases by name or by stage, but learn to
compound your medicines according to the aggregation and pro-
gression of symptoms,  modifying them  according  to pathology,
age, sex,  temperament, epidemic influence,  and climatic  experi-
ence.   Learning in this way, you Avill be able to  practice ration-
ally, successfully, and improvingly.  You will  make discoveries,
and assign reasons for  them.  You will encounter new diseases,
or new forms of old maladies, without  doubts and fears ;  and
having always a reason for the faith that is in  you, you will not
only be bold yourselves, but the giver of confidence to those Avho
inA-oke your assistance. 
INTRODUCTORY LECTURE.
23
  Unless you pass through facts to principles, you cannot advance
one step beyond your usual  ground without danger of defeat and
disgrace.   I will tell you an incident illustrative of this truth in
another science.   You know that in hydrostatics it  is a  law,
deduced from experiment and accounted for by reason, that a
fluid presses on a given area directly as its depth.  Not seeing
the reason  for this law, a  teacher of natural philosophy in an
eminent college endeavored, when on a visit to Philadelphia, to
demonstrate the  force of his  lungs, of Avhich he was vain, by
showing that he  could blow through a tube plunged more than
three feet under water, " and that too," said he, " although  the
surface of the trough which held  the water was very large."  The
listeners, men of science, wondered why he mentioned the size of
the surface; and one of them said, " Why,  you could do that as
well in a lake or  an ocean."   That  he thought impossible, and
by his denial betrayed his ignorance  of one of the best known of
the principles of the art which he taught.   It is needless to  say
that he lost caste at once, and Avas no longer esteemed by us as a
philosopher.  The intention to make him a member of our learned
societies was abandoned, and the consequences of his ignorance
were felt by him even until his death.
   A more  amusing illustration  of  ignorance of  a principle is
found in the following  anecdote.   A practitioner  who Avas in
attendance on a rather  curious  patient was asked  by him how
the food found its way to the anus Avhile the water  escaped by the
bladder.   Having  forgotten, if he ever knew, the philosophy of
absorption  and of elimination by the kidneys, the doctor said
that there were two tubes at the back of the mouth, with a valve
between them, which shut down  over one to exclude a solid, and
over the other to reject a liquid;  by which contrivance the liquids
and solids were enabled to take their respective routes to the anus
and  bladder.  That  explanation seemed  at  first  satisfactory,
but after a pause,  the patient  inquired at what rate  the clapper
worked when a man was eating mush and milk.
   A physician in  a small  country town, being  sent for  by an
intelligent  traveler, declared him sick of a fever, and proposed
to give him some  pills.  The stranger, being of a cautious and
inquiring character, demanded  the  practitioner's views of the 
24
INTRODUCTORY LECTURE.
nature of  his malady, and  some account of the quality of the
medicine offered to him.  " Fever," said the physician, "is caused
bv the closure of the pores of the skin, and the effort of the blood-
vessels to open them."   " Nature," he said, " possesses no other
mode of redress, and  the confined humors usually throAvn off by
that oro-an assisted in exciting the vessels to greater  efforts than
usual."   "Well, sir," said the patient, "Avhat  is your medicine,
and  how does it  act in such a case?''  " My medicine,  sir,"
replied the physician,  " is a  secret ; that is my chief remedy in
all  diseases, and so I keep it for  my OAvn benefit exclusively.   I
call my pills stretching pills; they stretch the pores Avide open,
and hold them so till the fever gets out."  It is needless, perhaps,
to add that the traveler preferred nature  to  the doctor, and
suffered himself to get avcII Avithout a stretching.
  These  are doubtless extreme cases of ignorance, but the want
of a knoAvledge of what may be esteemed the accredited princi-
ples of medicine is  betrayed even now in so many and hurtful
modes as to AA'arrant me  in dwelling  emphatically on this  part
of my subject.   Nothing  but such a defect can explain the ad-
herence to the antiquated notion that medicine, like  a cloud,
changes its shape as it changes its place, until in its progress it
becomes incognizable to its first acquaintance.   The laws of me-
chanics, and hydraulics, and  hydrostatics, and  chemical affinity,
are  everywhere the same; vitality is invariably  the same princi-
ple in every place; tartar emetic vomits alike a Chinese and  a
ChippeAva; salts purge equally avcII a Samoide and a Patagonian,
and the negro  of New Guinea suffers under the force of an epis-
pastic that which  a blister inflicts on a Swede or Norwegian.
Such exclusive notions are the relics  of the dark ages  of medi-
cine, or are transplanted from barbarous regions.   Well do  I re-
member the ansAver of a  Chinese  mandarin, Avhen I proposed  to
secure from an epidemic  small-pox his only son  by the introduc-
tion of vaccine virus.   "  My  physician tells me," said he, " that
the  new art is perfectly  adapted to its proposed object in the
persons of fanyuis (foreign barbarians, strange  devils literally),
but  as the Chinese are differently constructed, and live in a differ-
ent  climate, disastrous and not beneficial consequences must flow
from its  application to them."   The  vaccination was  not  per- 
INTRODUCTORY LECTURE.
25
 formed—the fine boy Avas unprotected from variolous contagion,
 and fell finally a victim to sectional medical dogmatism.
   An eminent surgeon in the service of the East India  Company
 brought some years ago to this city a Chinese  servant, who, in
 consequence of a severe railroad injury, was sent to the Pennsyl-
 vania Hospital.  The surgeon of the house  deemed it proper to
 bleed him, to the great distress of his  master, who contended
 that the Chinese were sure to die  if bled after  accidents.  The
 man did die; and that which was obviously the result of an irre-
 parable injury seemed to his prejudiced eye a consequence of
 one phlebotomy.   Yet that very surgeon, in conjunction with the
 celebrated American Missionary, Doctor Parker, had performed
 Avith  wonderful success  on  the Chinese  the most terrible and
 bloody operations.   Admit, if you please, that race, and  habits,
 and climate, produce modifications of disease, and call  for occa-
 sional deviations from a general rule or standard of practice,  as
 must happen in the  same place from temperament, age, sex, epi-
 demy and season;  but  deny that the  established principles of
 diagnosis and therapia are  inapplicable anywhere, or  that  the
 well-educated and judicious  physician is incapable of moulding
 his knowledge to the Avants  of his cases  at any time or  in any
 place.
   Gentlemen, I have been a traveler in my day, in many regions
 and in all climates.  I have  visited colder  lands than this, and
 have  reposed for  many tedious months beneath  the burning sun
 of the tropics. I have prescribed for Indians, negroes, Malays and
 Chinese, Portuguese, and SandAvich Islanders, with the result that
 in three voyages  to  the oriental world I lost but one man; and
 he  died during  chronic  dysentery by  a  surfeit of raw pork,
 which he stole from the  cook "to spite the  doctor," as he said*
 " for dieting him on bread and arrow-root."   I hope you will not
 suppose that I take any credit to  myself for a result, a natural
 result of the application  of principles of practice learned here,
 and adhered to in all climates and in every zone.   Let the honor,
if any, be given to my eminent master Dr. Chapman, Avho taught
me  these principles,  and instructed me to adhere to them  with a
firm reliance  everyAvhere.
  So  soon as you leave the quiet scenes of your college-studies, 
26                 INTRODUCTORY LECTURE.
and embark, as I doubt not you will do with honor, on the great
sea of manlv enterprise and useful employment, you will encoun-
ter many trials and vexations.  Not the least important of these
will appear in the shape of u sectional medicine," thrust in your
faces  as an  objection to the knowledge  which you will carry
from this great centre  of  American medicine.   This  sectional
medicine is usually but the traditional practice and theory of the
place, followed almost as mechanically  as  it has been  derived
doo-matically.   Let not your equanimity, therefore, be ruffled, or
your faith and courage impaired by the unfounded clamor of sec-
tional mediciners.   Pursue the even tenor of your Avay by  the
light hence derived, and it will happen to you, as it has already
happened to hundreds of the  alumni of these schools, that while
you Avill secure to yourselves reputation and competency, you will
drive before you the dark spirit of sectional empiricism, and thus
do a permanent and public  good, for  your own time, and  for
future ages.
   Should you encounter the mysterious and shadowy pretensions
Avhich, in the shape of secret  remedies, or  of Homoeopathy, Hy-
dropathy, Animal  magnetism and Thompsonianism, assail and
perplex  the  profession,  how can you  without  sound  medical
knowledge, philosophically founded, encounter or dissipate them ?
If you have nothing but opposing phenomena, or unassorted facts
by Avhich to refute  phenomena and alleged facts, you stand  but
on the same level with the empiric and the juggler, and instead
of a philosophical victory you may have but a disgraceful objur-
gation.
   The physician who does not endeavor  to found his knoAvledge
philosophically, is in danger,  not only of suffering error  to pre-
vail, but to be carried away by it himself.   Were  this not so,
should Ave see medical men, who have enjoyed good educational
opportunities, plunging, often honestly, I trust  and  believe, into
a belief in the infinitesimals of  Homoeopathy, or  the Protean
miracles of Mesmerism ?  Looking at those who lapse into such
errors, you may commonly discover that they are men who are
incapable by  nature of seizing upon ample classifications or  ex-
tended generalities, and who consequently believe in phenomena
of the most incompatible character. 
INTRODUCTORY LECTURE.                 27
  A physician educated here,  but who lapsed through  a pro-
clivous nature into Homoeopathy, came to me once for a motto for
a book which he was preparing  on Homoeopathy.  As he usually
consulted me when  himself  sick, and yet gave his microscopic
doses to others, I felt no reluctance to give him a blow, so I said
that once when a ranting lover on the stage  cried out to his mis-
tress, " My wound  is great because 'tis small"—the witty Duke
of Buckingham added  from a  side box—" Then 't had been
greater were it none at all."  Now, Doctor, said I, you can put
that together thus—
             " My Physic's great because 'tis small,
              And would be greater were it none at all."
That is the whole argument of homoeopathy in a couplet.
  I have thus, my young friends, endeavored to  give you a cau-
tionary view of such of the evils to which in your course of study
you may be exposed as are not commonly dwelt upon by teachers
or authors.  The catalogue, for want of time, is necessarily incom-
plete, but enough has been  said, I hope, to  show you how much
of your current comfort, and of your future usefulness and happi-
ness, depends upon the use you now make  of what I may be per-
mitted to call most favorable opportunities.   The  experience of
the past entitles me to  predict that very many (may I not say
all) of you will go forth from this place, at a proper period, enti-
tled to the fullest confidence of the public  ; accomplished for the
prolonged guidance or the sudden discomfiture of disease, ready
for  the obscure chronic malady, or the imminent and terrible con-
vulsion of the frame—alike  fitted  to cure sickness or confound
empiricism—self-poised and philosophically armed—the hope and
the rescue of the sufferer, and the  terror  and the  vanquisher of
the ignorant pretender.
  Go then,  gentlemen, to your  noble work, remembering that on
your present attention depend  the  comfort, the health, nay, the
lives of thousands yet unborn ; that he who means to ascend the hill
of knowledge may find guides but not carriers—companions by the
way, but not harnessed servitors: the path is steep and rugged,
but yet there  grow by  the Avay flowers of fancy  and fruits  of
sentiment.   On the glorious summit of the Mount  of  Science 
0$                  INTRODUCTORY LECTURE.

reposes the sublime statue of Truth, chiseled into form and beauty,
from the rough  material  of nature, by the hand of  philosophy.
Waiting below, to see you reach the coveted pinnacle, stand with
strained eves and  beating hearts the loved  ones of home, the
authors of your being,  and the friends of  your childhood.  Me-
thinks I hear the warm  shout  of triumph, as they witness  the
last elastic spring which  plants you on the highest foothold, and
entitles you to the  honors and the duties of a noble science.   Is
is not worth some sacrifice
                           " To run
           The great career of honor ; to exalt
           Your generous aim to all divinest deeds,
           To chase each partial purpose from your breast,
           And, through the mists of passion and of sense,
           And through the tossing  tide of chance and pain,
           To hold your course unfaltering, while the voice
           Of truth  and virtue, up the steep ascent
           Of Nature, calls you to your last reward,
           The applauding smile of Heaven?"—Akenside.