#^fet4*vt- (ft, o ,J INTRODUCTORY LECTUKB TO THE COURSE OF MATERIA MEDICA AND THERAPEUTICS, IN THE MEDICAL DEPARTMENT PENNSYLVANIA COLLEGE. For the Session of 1848-49* BY HENRY S. PATTERSON, M.D. PUBLISHED BY THE CLASS. L(+ PHILADELPHIA: KING & BAIRD, PRINTERS, No. 9 GEORGE ST. 1848. « 4 CORRESPONDENCE. Philadelphia, November 2d, 1848. Prof. H. S. Patterson. Dear Sir: At a meeting of the gentlemen composing the Medical Class of Pennsylvania College, the undersigned were appointed a committee to solicit, for publication, a copy of your interesting and truly eloquent Introductory Address. In communicating their wishes, permit us, Sir, to add our personal solicitations, and hope that you will comply with the request. Yours, very respectfully. JAMES HUNTER, New Brunswick. HENRY D. GRAHAM, Delaware. GEORGE MURRAY, Nova Scotia. CHARLES LEIB, Pennsylvania. GEORGE W. PATRICK, Indiana. W. L. ROBINSON, Canada. J. F. MUSSELMAN, Ohio. JOHN G. STETLER, Pennsylvania. R. BENJ. BERKEY, New York. JACOB D. WHITE, N. Brunswick. J. E. WAFFORD, South Carolina. GEORGE S. GOODHART, Illinois. EPHRAIM DETWEILER, Pennsylvasia. ALLEN WARD, New Jersey.' A. B. WILLIAMS, Michigan. J. F. ADOLPHUS, Jamaica (W. I.). THOMAS A. PIERCE, Maine. LUTHER A. WINTER, Virginia. W. H. H. MILLER, Pennsylvania. November 3rd, 1848. Gentlemen : Your kind note of yesterday, asking a copy of my Introductory Lec- ture for publication, is received. Were I to consult my own wishes alone, I should reply in the negative. I am, however, in the habit of deferring to the opinions of my friends in regard to matters of this kind. If you think the Lecture worthy, and will take the responsibility of its publication, it is at your disposal. With sentiments of high regard and esteem, I am, Sincerely your friend, HENRY S. PATTERSON. To Messrs. Hunter, Graham, Murray,) Commit(ee Leib, and others. J INTRODUCTORY LECTURE. The world rolls round in the old fashion, and the years come and go and return, and the world's work is before us ever to be done over again. No rest and no pause while new need brings new demand! The duty accomplished gives way to the duty to be done, and thus they pass on in their endless series, until the Master calls the weary to repose, and other workmen take their place. The teacher can cast but a glance after the retiring form of the pupil who goes forth to test the value of his labors, ere another comes to fill the vacancy ; and the lips, that but yesterday bade the mournful good-bye, are called upon to frame the more cheerful welcome. It is but a little while, since, with mingled hope and fear, we sent forth a band of alumni whose future course is to stamp us with ignominy, or to crown us with the meed of praise ; and already you appear before us, to fill their vacant seats upon our benches, and also their place in our hearts. The custom of the occasion requires from us a word of greeting. To all then, we extend a most cordial welcome. We rejoice to see you here for many reasons, but, most of all, because we feel that your presence here confirms and sanctions our past labors. Those who are overshadowed and protected by the prestige that attaches to a great and time-honored institution,—those who can fall back upon the authority of illustrious and revered predecessors,— those who, instead of being forced to stand, each upon his own narrow individual basis, form a constituent part of some venerable ideal—may not feel thus. But we, who had the foundation to lay, the edifice to raise, and the reputation to make, feel acutely the satisfaction thus afforded. Your pre- sence seems to say to us ;—well done, good and faithful! Your approving countenances lend new strength to us, and we can gird ourselves again to the labour of the session with energies refreshed by your smiles. We therefore again welcome you— you who have been a part of our little family before, and you, also who for the first time trust yourselves to our care. We sincerely hope and confidently believe that you will never have reason to consider that trust ill-founded, but that, when your immediate predecessors have passed from this narrow stage of action, to a wider, you may again be seen here, demanding from us the evidence of your proficiency in the honors of the doctorate. To the latter classjp-those who are with us now for the first 6 time,—I would say a word or two in the outset. You have already committed yourselves, in a measure, to the profession of medicine, by placing yourselves under the care of a precep- tor, and entering upon the study of the rudiments of our science. You are now taking another step in advance, committing your- selves more fully, by entering your names as matriculants of a medical school. The months of study will flit lightly by, another session will come and go with unerring speed, and you will stand before the public, commissioned to practise the heal- ing art. By your own act and ours, you will be pledged to heal the sick—will be called on to take upon yourselves all the responsibilities connected with assuming the care of the health and lives of your fellow men. Have you thought of this matter seriously ? Have you ascertained well and pon- dered wisely the character and extent of the study you have chosen, and the duties to which you commit yourselves ? Gentlemen, I would not have you deceive yourselves. I would not have you suppose that you are entering upon a flowery and easy path, a path of pleasantness and peace in any other sense than that in which those of wisdom and duty always are, in their ultimate results. I would raise, even yet, the voice of warning, and tell you that, if yon look forward to a life full of repose of body and ease of mind, you have mis- taken your vocation. I would have you know, before it is too late, that the path on which you enter is hard and rugged and thorny, beset with difficulties and troubles, and demanding the utmost effort of body and of mind; that it is blessed and lovely only in its results, and requires in him who w^ould walk it worthily the martyr-spirit that bears the toil and sorrow, that he may wear the crown of rejoicing in the end. The study of medicine, rightly considered and with consci- entious thoroughness pursued, is one at which a bold man might hesitate. It does not consist in the perusal of a few text-books and a lazy listening to any number of lectures. It demands the undivided energies of the student, and is never completed. He who supposes that he will "finish his educa- tion" in a few months or years is guilty of a capital error— one that, if not remedied, will doom him to ahelpless twaddling mediocrity, or an ignorance so profound as to be self-compla- cent. It has been said that the lawyer requires an acquaint- ance with all sciences, but the same is more emphatically true of the physician. All that the legal man must have, outside of his professional learning, is ali array of facts in regard to some special case, which his Encyclopaedia will always give him. The medical man needs that familiarity with science which will enable him to rise to the comprehension of broad and far- reaching general principles. Dealing, as he constantly does, with man in all the complicated relations of his inner and outer ■% 7 life, he must understand the influences that move and modify him, as well as he does the intricate structure acted upon. He should be able to appreciate those psychological conditions, which so affect the bodily state. He must enter into the nice questions that concern the relations of spirit to matter, studying them, not in the subjective mode of the speculative metaphysi- cian, who sports with the tints in the kaleidoscope of his own consciousness, but objectively, as they manifest themselves in the changing phenomena of the health and disease they so intimately affect. It is no contemptible degree of psychological knowledge that will suffice for this; and yet, he who is in- competent to it, will not be able to say, among the multiform appearances of disease, which are due to body and which to mind. The material causes of morbid action are also innume- rable and often obscure. The thousand-fold influences of earth, and air and water, act upon the human body for weal or woe. The great German pathologist, Schoenlein, would divide the material universe, in reference to this point, into two great principles, the egoistic, which defends, maintains, preserves the individualism, and the planetary principle, (or sum of the na- tural influences,) which tends constantly to its dissolution, and the destruction of its form. Foreign as this view may be to our modes of expression, it is nevertheless true. Every thing in nature ministers to the wants of man or operates his de- struction ; and the knowledge of their relations is essential to the complete physician. He cannot guard his patient against morbific causes or prevent their operation unless he has it. He must know what lethal influence distils in the midnight dew, or beams in the noon-day sun. He must know what functions fail before the arctic breeze, or are driven to fatal excess under the tropic heat. He must know what seeds of death are borne on the winds from the restless sea, and what from the mountain height. He must know what poisonous exhalations rise from the crowded city, and what from the putrid marsh. He must learn the effects of season and of cli- mate. He must probe the secrets of the animal and vegetable kingdom to ascertain the influence upon men of their almost endless varieties of food. He must search these, together with the mineral kingdom, for his remedial agents. He must go far back into the dim recesses of a history too little written and too little understood, in order to comprehend not only the course of epidemics, as erratic in appearance as the comet's orbit, and yet in fact as constant and sure, but also the curious facts which prove that the general phasis of disease to-day, is far other than that of a century ago. To do this, he must be a scholar in the highest sense of the term. He must be a man of studious and meditative habits, of varied and extensive read- ing, of profound and comprehensive thought. In addition, he 8 must have a knowledge of the world and of man in society. No one requires so nice a discrimination of character as the physician, because no one is so liable to be deceived or imposed upon, or stands so much in need of maintaining a cordial rela- tion with those who come under his care. In short, he must combine all those qualities which go to make up the accom- plished gentleman and the ripe scholar. Kindly feeling, cour- teous demeanour, quick discernment and profound learning are essential to the complete fulfilment of his duties. The learning here indicated is not easily acquired. It requires the labor of a long and devoted life. It demands books without end, and that study, which is a weariness to the flesh. It is not gained without the consumption of much midnight oil. He who acquires it will outwatch the Pleiades, and often see the gray dawn come to extinguish the pale flicker of his waning lamp. And not only in books must he seek it, but in field and forest, on the lonely hill-top, among the busy haunts of men, in the hovels of the destitute, amid the horrors of the loathsome charnel-house, in the groaning wards of the populous hospital, or watching for weary hours by the bed of languishing. He must be able to say to nature, in the words of Shelley's Alastor. I have loved Thee ever and thee only; I have watched Thy shadow, and the darkness of thy steps, And my heart ever gazes on the depths Of thy deep mysteries. I have made my bed In charnels and on coffins, where black death ' Keeps record of the triumphs won from thee, Hoping to still these obstinate questionings Of thee and thine. I know, gentlemen, that there are few—very few—that ever attain this degree of knowledge. I know also, and confess with sorrow, that the general scholarship of our profession is far below this standard. I bow my own head in shame before the picture 1 have drawn. But my object has been to place before you, in a few hurried dashes of the pencil, the ideal of a perfect study of medicine in all its relations. This is the study to which you pledge yourselves. No falling short of it, but what is inevitable, will stand excused before God or man. By the very fact of becoming students of medicine, you are bound to a hearty, devoted, self-sacrificing and untiring effort for the attainment of all I have depicted. When you have done your utmost that circumstances will permit, you will stand acquitted, and not before. It is not to be the business of this session or the next, but of your life to its latest hour. Are you prepared for this ? Have you questioned your own hearts, to know whether you have the constant energy to enter on so hard a task? If not, it is not yet too late to recede. If, however, in the solemn silence of your souls you can answer 9 yes to this questioning, then we say to you—come on, brothers, and God speed you in the good work. We will put you in the way. We will see that your feet are placed upon the straight path, and that your faces are turned toward the goal. We will give you all we can—all that has been given to us. We will furnish you with all the material for your labor that we have been able to gather for our own use, and, when this is done, we will point out the road, and send you forth on your journey with heartfelt blessings on your heads, and anxious prayers that you may be preserved and guided by that Power in whose hands alone are the issues of life. But there is still another point for you to consider. Hard as is the thorough study of oiir science, it is easy and light in comparison with the practice of our art. This is a truth for which you ought to be prepared now, before you are called upon to learn it from that hardest of schoolmasters—experience. I do not wish that any of you shall be deceived with vain anti- cipations of a life of ease and comfort in our profession. I remember well, that when I first went to place myself under the preceptorship of the late venerable Dr. Parrish, he made me listen to a detailed, and by no means flattering statement of the hardships of a physician's life, and then dismissed me, to meditate upon it before I made my final choice. I look back with gratitude for that kindly and paternal warning, for it pre- pared me for difficulties and trials which I could not otherwise have anticipated. Regarding, as I did, all that came from my good old master as the oracles of truth, I stored the friendly lesson in my memory, and it has been a blessing to me. The same lesson I would now enforce upon you. Do not, I reite- rate the warning, do not flatter yourselves with expectations of ease and pleasure, or your disappointment will be deep and bitter. So soon as you enter upon practice, you absolutely resign the command of your entire time. No moment of it is your own, to use as you please. Semper paratus is the motto of the good physician. He is ever at his post. The cry of suf- fering is hardly raised, before he is ready to respond. Night and day are all one to him. Winter's cold and summer's heat make no difference. He is as prompt in the howling tempest as in the spring sunshine. Whether he be at the festive board, in the society of friends, on his bed of rest, or in the house of prayer, he is at the command of ihe sick. He can fix no time for the enjoyment of social pleasures, or for engaging in any other pursuit. There can be no ten-hour law to regulate his time of labor. He must become familiar with sleepless nights and days of fasting. No matter what the time and place, the moment duty calls he must arise, leave all and go. The bodily fatigue and exhaustion incident to this mode of life is very 10 great,—greater than that of most mechanical pursuits. It does not require Herculean strength or much expense of muscle, but it needs a passive force, a power of endurance. The in- cessant exposure to vicissitudes of temperature and inclement weather bring a danger of bodily disease. He is also exposed to constant perturbations of spirit, to anxiety and fear, and to a heavy sense of responsibility, which weighs his spirit down with leaden dulness. His mental powers are kept upon a con- stant stretch, exhausting him even more than bodily effort. And there is no escape from his labor on this side the grave, if he be a successful and eminent practitioner. The sick can- not and will not spare him, and if he be a conscientious man, he will feel that he cannot be spared. He must.die with har- ness on his back. The great Boerhaave shut himself up, almost a prisoner in his own house, in his old age, so that no one could gain admission to him except by the intercession of especial friends, or by bribing his servants. Even then he was harassed and worn out with incessant consultations. The man who knows that he can relieve suffering, and feels the obligation to do so, cannot be deaf to the call for his aid. Only when the solemn close of life comes to the good physician, can we say that at last his long day's work is done. Blessed be God that we also know that he is then called home to take his wages. Another feature of our professional life, for which you should be prepared, is constant familiarity with suffering and misery. The physician dwells under the cloud. Bright glimpses of sunshine may sometimes beam upon his path, but the gloom of sorrow rests over almost all his intercourse with men. He goes from one house of mourning to another. The wail of grief and the deep sob of anguish are ever in his ears. The scenes that crowd upon his memory, when he sits do\vn to review the labors of the day, are of human forms writhing in agony, loved ones pining away in the midst of weeping friends, strong men stricken down in their pride, little children wailing for a help he too often cannot give, and patient sufferers whose wan composure is more touching than the noisiest sorrow: He lays his head upon his pillow amid recollections of misery, and is roused from it by the cry of distress. If he have the sympa- thies of a human heart, he must take part in all this. But you will say, he becomes used to it, callous and unfeeling, the moment he does so, let him give up his office and depart. He is no longer fit for his duty. Let him carry his heart of steel into some other, less beneficent, calling. I know that the physi- cian should not have the weak sympathies of the child,—that he should possess energy and firmness to do and to bear all that is to be done or borne. But he must do it lovingly and kindly, must enter into the feelings of his patient, and be keenly 11 sensitive to his suffering. All his life long he must be in daily acquaintance with grief, and his familiarity with the gloomier portion of man's lot on earth will cast its shadow over his countenance before his prime. But, some one will say, all these things are as nothing com- pared with the physician's great reward ! Do not deceive yourselves again, gentlemen. Have you rightly considered that reward ? What have you conceived it to be ? I fear lest the enthusiasm of youth may draw a picture too fair for the stern reality. Is it wealth? He who seeks a money-making pursuit must go elsewhere. Look around upon the profession and tell me where are the wealthy men, as the world esteems wealth, who have made it by the practice of medicine. Rightly pursued, it must always yield a support, and perhaps a compe- tence for old age, but rarely, if ever, more. I know that under circumstances of peculiar eminence, especially in surgery, it may lead to a golden harvest, but the cases are few and far between. I know also that it may be prostituted to purposes of gain by unholy acts, but woe to the man who so abuses his office. Contempt shall follow him to an unhonored grave. Is it worldly honor, and a place in the mouths of men ? There is small scope in our profession for the energies of an ambitious man. Let him attain its pinnacle, and his fame is local, circumscribed and temporary. If his name lives half a century after him, it is only in the memory of the professional men who read old books. Many of his contemporaries will live to see him for- gotten or contemned. Under no circumstances can he hope for a wide-spread reputation. The emptiest babbler on the politi- cal stump will take precedence of him, and when he swells and spreads his peacock's feathers at the widest, the crowd will turn aside to gaze at the silliest literary butterfly that , dances in the sun. The quiet triumphs of medical art are not those calculated to captivate and inflame the public mind. I know no more absurdly pitiable spectacle than a physician smitten with the lust of a noisy popular applause. He makes himself ridiculous, and is disappointed after all. When he has done his utmost, and thinks that now the thundering acclama- tions will surely rise at his approach, he suddenly finds himself left alone in astonished neglect, while the throng rushes off to wonder at some learned pig, or follow with shouting in the train of a dancing woman. And this is not the worst. The insane desire has led him most probably to unworthy courses, and he has sacrificed the respect of his brethren while he has injured the character of his profession by his derelictions. Well has a wise man said,"0 foulest Circaean draught of popular applause, there is madness in thee and death, thy end is igno- miny and the grave !" To the medical man it is truly so. The true reputation of the physician consists in the love of his little 12 circle, the esteem of his professional brethren, the reverence of his pupils, and the respect of the community in which he lives. More than this he need not ask, more than this he cannot have. It is all that the good man will wish for, but it is not enough for the proud. But it may be said, these are low and unworthy objects; we aim at a nobler recompense in the love and grati- tude of our patients; smiles will welcome our approach; the voice of thanks will never be silent in our ears; blessings will follow our retiring footsteps; we will be received as messengers of mercy, and allowed to depart with reluctant affection : men will hold us in honor, and meet us ever with kind words and hearty benedictions. It is a lovely picture, and I would it were not air-drawn. No deeper disappointment awaits the young practitioner than to see it fading away. Yet fade it must and will. Men are selfish and exacting. The sick are proverbially peevish and dissatisfied. Your best endeavors will too often meet with fretful complaints or sour discontent. You will be blamed for not doing the impossible. Whispered doubts of your competency will rise into murmurs of disaffection, and you will be subjected to the disgrace of a discharge from the case, when you had done all that art could do The tongue of slander may be busy with your fair fame. The unfriendly faces of the bereaved will intimate suspicions that you, or others, might with greater skill have prevented the fatal catastrophe. You will be constantly misunderstood, and often misrepre- sented. Surrounded by those who cannot comprehend the processes of reasoning by which you arrive at your conclusions, you will feel keenly the utter solitariness of your position. None of the anxious friends that watch so closely around the bed of sickness can enter into your views or feelings, and, see- ing only results, will draw false inferences as to your course. No explanation or defence will serve you, for they cannot appreciate your simplest data. The unhesitating confidence, which resigns the life of a dear one into the hands of a physi- cian as into those of a superior being, comes only after long and arduous service, and justly so. Before that period arrives for you, you will have many hard experiences of distrust and ingratitude. When you have done your utmost, and success has crowned your efforts, you willbe coldly dismissed with the careless thought that you have performed merely a common every-day duty, or the half-concealed impression that your services have been more than remunerated by the fee you have received. Men of business will weigh your labor in the world's balances, and laugh at you, if you ask any thing more than the amount of silver it commands in the professional market. Some- times indeed you will meet with the warmth of affection and gratitude your imagination depicts, but the cases will be rare, though, for this reason, all the more precious and consoling. 13 Where then, you will ask, is the physician's reward ? I answer —in himself—in the deep conviction that he has been the in- strument of good and has obeyed the commands of the Master who sent him forth to heal the sick—in the comforting smiles of an approving conscience. If these do not suffice him he will find all the rest but dust and ashes—will but add another echo of the old burden—vanity of vanities, all is vanity. Admitting, moreover, that you are willing to encounter all that I have described, I ask you again to examine yourselves, and see what motives have led you to seek admission to the profession of medicine. It is an important query. Our art is plainly not one to be adequately pursued, except under the influence of some overpowering motive. Many shrink from it at the outset, and many fail by the way, long before their life- task is accomplished. I would not that such should be the history written of any of you, and therefore it is that I ask you to be satisfied that you have the principle that will give you strength for your labors, before you enter upon them. And what- is that principle ? It is not the desire of wealth or fame, for I have shown you how delusive the lust of them is. Is it an innate love of the pursuit? There is such a feeling, a scientific interest which will make its possessors bear the hardest privations and perform the most unpleasant offices. The poetic furor will clothe the garret walls with beauty, and sweeten the scanty crust of poverty. The enthusiasm of the scholar will deaden him to the sense of want and the weariness of unending labor. Ardent explorers of nature have gone to seek-death among the poisonous effluvia of tropic marshes, or left their forms embalmed in the arctic ice. In like manner, the pro- fessional ardor of the physician will make his toil more easy and his burden light. Indeed, a measure of this spirit is indes- pensable to great success in practice. But it will not suffice alone. It may even be associated with a moral constitution which will render the man an unworthy member of the frater- nity, and a curse to the community. He may be callous and hard-hearted. He may be a mere butcher and vivisector. He may be an extortioner and speculator upon the miseries of his fellow-men. He lacks that which is the marrow of the good physician. Do you ask me what that is? I answer—it is the simple, sincere, resolute and immovable determination to be the instrument, under Providence, in relieving the sufferings of humanity and healing the sick. Like all great truths it is sim- ple to the comprehension of a child. Have you that resolution ? Consider to what it calls you. You are to love your neighbor as yourself, and as a neighbor you are to regard every member of the great family of men. You are to esteem your own interests subordinate to those of your fellow-beings. You are to believe that you are sent here, not simply to take care of 14 yourselves, but to help others. You are to know that while all the community around you is engaged in its heartless struggle for wealth and power, you are to stand apart in the fulfilment of a purely beneficent office. There is to be no muck-rake in your hands. You are to count your gains, not by dollars, nor by acres, nor by votes, but by lives saved, and health restored, and pain removed, and hopes revived. You are to be ready at all times to sacrifice your own ease and comfort, and it may be to peril health and life to protect those of others. You are to go wherever suffering humanity calls you. Your profession knows nothing of the distinctions of society ; it regards not rich or poor, bond or free, black or white. The one sole and suffi- cient claim to its aid is our common humanity. It entertains no question of desert. It is all free grace. King and beggar, saint and sinner, pharisee and publican, honored ruler and trampled slave, haughty lady and weeping Magdalen, mitred bishop and death-doomed felon—each must be to you nothing but a suffering human form. Lordliest robes or filthiest rags must be unable to conceal that from you. To this extent at least you must be the veriest sans-culotte. No accident or investment of the man must clothe him with new interest, or hide his brotherhood from you. Homo sum, must be the stern whisper of your heart when you would turn away from pain or suffering. You must have and exercise the largest charity. You are to suffer long and be kind. You are to hope all things and bear all things. Esteeming yourself as nought, you are to go forth as the messengers of mercy to bless all men with your presence, trusting to the kind heavens that you shall be blessed in return. When the epidemic scourge comes, and all men flee from it, you are to stand fast. You are to take your lives in your hands, if needs be, and contend against the de- struction that wasteth in darkness, and the pestilence that walketh at noon-day. You are the only bulwark against its ravages, and you must not be absent from your post. Curtius- like, you must be ready to throw yourselves into the gulf that gapes under the city. Even should friends remonstrate and your nearest and dearest implore you to escape,you must place yourselves immovably on your professional responsibility, and say, as said stout Martin Luther on another occasion : " Hier stehe ich. Ichkann nicht anders. Gott hilf mir!" And now, gentlemen, I ask you again : Are you ready to enter upon these labors? Do you believe that you possess or can attain this spirit? I trust so. I believe so. There are some among you for whom I can answer, and in all, as far as I know you or of you, I have unbounded confidence. If I am not mistaken in this conviction, then may we extend to you a yet heartier greeting. We welcome you not only as pupils, but as friends and brethren, engaged in the one great pursuit, 15 striving for the accomplishment of the same beneficent object. We welcome you, as those who are soon to stand side by side with us, as our professional peers, or perhaps to out- strip us in the path of a noble emulation ; as those who will sit for a season at the board we are able to spread for you, but who may, at no distant period, ask us in return to " a feast of fat things," as the result of your medical industry and energy. Such things have been, and such things may well be again. Time, resolution and perseverance will accomplish much— almost every thing. Rely upon it, that when that day comes, we will attend the feast in no spirit of reluctant jealousy, but with grateful rejoicings that the seed we sow has been blessed to bear such a bountiful harvest, thereby asserting our faithful- ness, and placing the approving seal upon our work. In all that I have said to-day, gentlemen, my object has not been to scare you with dreary predictions of the future, but to prepare you for a truthful conception of your chosen calling. Every word I have said seems to me as true as Holy Writ. But now that you are thus prepared, indulge me with your attention a little longer, and I will show you another aspect of the matter. There are two sides to all things in human life as in nature. Providence is not prodigal of either hardships or blessings alone. The path of duty is never without an occa- sional blossom to cheer it. It is the way of the transgressor that is hard indeed. " Medio de fonte leporum Surgit amari aliquid!" is the plaintive moan of the heathen poet, and must ever be the complaint of the sensualist, but it is equally true that in the bitterest cup of tribulation ever presented to human lips there have been some drops of sweetness. Our profession is no ex- ception to this rule. To him who pursues it rightly, it offers many and precious delights. Its adequate study is as laborious as I have represented it. Jirs longa, vita brevis, judicium difficile: are the solemn words with which the Father of Medicine commences his oracular aphorisms. But the study itself will become a delight and the toil a pleasure. It regards topics the most attractive and interesting. The intricate struc- ture of man's frame, its relations to surrounding objects, the manner in which it is affected by these, and the connate sciences necessary to the elucidation of such abstruse topics, present a field of inquiry in which the most active mind may expatiate with endless gratification. Certaminis gaudia—the rapture of the strife—was the strong expression of the blood-stained hero of a hundred fights, which none can appreciate but those who, like him, have rejoiced in the Berserker rage of the old contest, hand to hand, and sword to sword. In like manner, none can 16 understand the calm but intense joy of study but the student himself. No eager alchymist ever watched the bubbling of his crucible with a more rapturous interest than the enthusiastic anatomist feels, as his knife follows nerve and blood-vessel to their minutest ramifications, or the therapeutist experiences when the vital actions are changed, and functions return to their normal order, under the influence of his remedies. The copious literature of our profession also furnishes" a mine of research, in which the most ardent bookworm may dig all his days and never weary. Neither is the practice of our art a whit less difficult and exhausting than I have depicted it. But it still has its satisfaction and its recompense. It does not bring wealth, but it will yield enough of the world's goods, and, to the man of moderate wants, somewhat to spare. It offers no inducements to the grasping and avaricious, but it is sufficient for the generous and easily-contented spirit. It is not the road to a vain-glorious and noisy fame, but it leads to the kind regard and sincere re- spect of the worthy, to an honored life and a regretted death. He who follows it will not meet with loud demonstrations of enthusiastic gratitude, but he will win a place in the deepest affections of a wider circle of friends than falls to the lot of most. It is in the very wprk itself, however, that the chief pleasure will be found. To do good, to relieve suffering, to extinguish pain, to cure disease, and to save life—that is joy enough for the good and generous soul. Opiferqueper orbem dicor, was the proudest word that Ovid could put in the mouth of the tutelary god of medicine. All the deep content that filled the breast of John Howard in his labor of love, as with a peace that passeth all human understanding, may be felt by the humblest practitioner of medicine, if he is faithful to the duties of his narrow sphere. But it is only by him who pur- sues his vocation in that right spirit I have endeavored to illus- trate, that this can be experienced. Sell all thou hast and give thy goods to the poor, then come and follow me: was the command of the Master to one who wou'd fain have held both to him and the sensual world at once. Renounce thyself, and do good to all as thou canst: is equally his command to you. He who does this is already following him who all his days on earth " went about doing good." On his head will the supernal influences distil gently as the dew on Hermon, and he will walk in the light and joy of the Christian life. That such, gentlemen, shall be the lot of each of you, shall be our earnest effort as it is our ardent prayer.