©Bosses 
DELIVERED BEFORE THE 
PHIZADEZFHIA MEDICAl SOCIETY, 
PURSUANT TO APPOINTMENT. 
BY J. K. MITCHELL, M. IL 
ONE OF THE CORRESPONDING SECRETARIES OF THE SOCIETY. 
February 23, 1825. 
PUBLISHED BY THE SOCIETY 
PHILADELPHIA : 
PRINTED BY I. ASHMEAD & Co. 
1825. AN 
Although encouraged by your flattering invitation to ap- 
pear before you on this occasion, I feel heavily the burden of 
the task which that invitation requires me to perform.-To 
do justice to any subject, before such an audience, demands 
powers which it were presumption in me to claim : and yet, to 
fall far short of your expectations, were to throw discredit on 
your discernment in the selection you have made. Believing, 
however, that I owe this enviable station chiefly to your per- 
sonal regard, I am less unwilling to deliver to you as friends, 
what I should fear to expose to you as critics. 
The progress of Medicine during the past year, does not pre- 
sent a spectacle sufliciently striking to occupy your time to ad- 
vantage. I have, therefore, preferred the more useful theme of 
medical ethics. 
As it is my design to devote the greater part of the time 
allotted me, to the consideration of the abuses which prevail in 
the profession, I shall be denied the pleasure of dwelling at 
length on the more pleasing subject of professional intelli- 
gence and virtue. I do not prefer this course from a belief 
that censure is more useful than praise; but because the gen- 
tlemen who have preceded me in office, have dwelt chiefly on 
the fair side of the medical character, and have left unnoticed 
many of the spots which sully its brightness. 
It is conceded that no other profession demands greater ori- 
ginal intellectual powers, or a more studious mental cultiva- 
tion than the science of medicine. Nor is there any other art 
which in its turn tends to improve the mind more than the 
daily exercise of medical duties. Knowledge and the inteller- 4 
tual faculties are, in the mind of an enlightened physician, in 
a constant state of action and reaction, and must, according to 
an immutable law of nature, increase the energy of the think- 
ing principle. I might, in this place, paint in the glowing 
colours of truth, the great intellectual dignity of our art, and 
enumerate the high pre-requisites, and the elaborate cultivation, 
necessary to the successful and honourable pursuit of the prac- 
tice of medicine. But this has been already performed by a 
more skilful hand. 
It remains for me to view, in a cursory manner, the natural 
influence of the study and practice of medicine on the sentiments, 
and to expose the evil tendency of professional abuses. 
There is a sickliness of sentimentality, which weeps over a 
tale of misery, and yet turns with disgust from the sight of 
real suffering, or bribes it to depart from the view. Such can- 
not long continue to be the feeling of the physician. " Passive 
impressions become progressively weaker by frequent recur- 
rence;" hence, our horror, disgust, and morbid sensibility at 
spectacles of squalid misery, are repressed and almost extin- 
guished. But as active propensities are cultivated and confirm- 
ed by the frequent repetition of the circumstances which excite 
them, the natural tendency of our profession must be favoura- 
ble to the dev elopement of the most exalted species of benevo- 
lence. So necessary did the great Hippocrates conceive the 
virtue of humanity to the character of the physician, that he 
inquired, respecting the student of medicine, " Does he suffer 
with the sufferings of others ? Does he naturally feel the ten- 
derest commisseration for the woes incident to his fellow mor- 
tals? If so, you may reasonably infer that he will be-passion- 
ately devoted to an art, that will instruct him in what manner 
to afford them relief." 
In most countries physicians have charge of the poor solely 
in hospitals and other public institutions; and such are usually 
intrusted to the management of men who have attained to emi- 
nence. But in this country, the youngest practitioner of me- 
dicine enjoys the high privilege of healing the wounds, and 
administering to the wants of those who have an omnipotent 5 
and liberal paymaster. He is called by his interest and desire 
for improvement to offer his services to the poor, among whom 
he may acquire skill and knowledge, whilst he is smoothing 
the pillow of disease, and lightening the load of misery.-- 
" Sickness, complicated with poverty, has pleas, that to a feel- 
ing heart, are irresistible." Obeying the generous impulse of 
nature, supported in the fatiguing and often loathsome task by 
sense of duty and love of knowledge, he may exclaim with the 
orator, " Nihil habet fortuna majus quam ut possim, nec for- 
tuna melius quam ut velim servare quamplurimos." 
" Where'er his Maker's image dwells. 
In gilded roofs or smoky cells, 
The same his zeal; o'erjoy'd to save 
His fellow creatures from the grave ; 
For well his soul can understand 
The poor man's call is God's command." 
Somerviile. 
Nor is the duty of serving the poor contemptible or ignoble. 
The only miracle having reference to money, is that by which 
tribute was given to Csesar-and no miracle is recorded by 
which any one was raised to rank or distinction. The great 
pattern of moral excellence, whilst employed in affording mi- 
raculous proofs of his power and goodness, directed them to 
the relief of the physical and mental diseases chiefly of the 
poor. Never then turn a deafened ear to the cry of sickness 
loaded with poverty, but remember, that although the feeble 
voice of the friendless beggar may not reach the ear of the 
public, God looks on the deed, and views with abhorrence 
him who adds to sickness and want the bitterness of unmerited 
neglect. But why should I caution you against such enormi- 
ty? The history of medicine affords abundant proof of the 
unceasing exertions of physicians in the service of the poor. 
Galen speaking of Hippocrates observes, " There was but one 
sentiment in his soul, and that was the love of doing good, and 
in the course of his long life but a single act, and that was the 
relieving the sick." Sydenham practiced chiefly among the 6 
poor; and Boeerhaaveused to say that he esteemed the poor his 
best patients, " for God is their paymaster." Why should I 
not hold forth to your noblest emulation, the examples of Rush, 
of Wistar, and the many other medical worthies who have 
employed their best talents in acts of benevolence, and have 
been characterized as the friends of the poor. That great 
ethical writer, Dr. Samuel Johnson, used to say, " that physi- 
cians did more good to mankind, without a prospect of reward 
than any profession of men whatever." 
In the faithful discharge of the duties of his profession, the 
practitioner is often compelled by the urgent wants of his pa- 
tients to extend to them pecuniary assistance. Acts of charity 
become a necessary part of his daily avocations, and an habitual 
liberality characterizes his conduct. Whatever may be the 
•natural tendency of his mind, the physician who gives time 
must give money also to the poor, and if he were disposed to 
avarice, must suffer his original propensity to fade before the 
cultivated influence of an habitual virtue. He who is com- 
pelled by any cause whatever, to make very frequent disburse^ 
ments in early life, is in little danger of sinking into the sordid 
mire of covetousness, whilst one having but little natural ten- 
dency to cupidity, may, no appeals being made to his liberality, 
become a very miser. As this absorbing vice, always a har- 
dener of the heart, fades not like other passions in the dim 
twilight of life, but glows most fiercely in the bosom of age, 
we should rejoice that in the ordinary duties of our profession 
we are furnished with means of quenching its ardour, and of 
finally extinguishing it. 
" For Oh ! what man's condition can be worse 
Than his whom plenty starves and blessings curse. 
The beggar does a common fate deplore. 
The rich poor man's emphatically poor." 
Cowley. 
There is also a natural tendency in medical duties to sustain 
and increase our affection for our fellow creatures. Ethical 
writers present no truth more readily adopted4than that which 7 
affirms that man is disposed to love objects on which he has 
expended much labour. The affection of parents for their 
children is augmented as they advance in life, chiefly by the con- 
stant habit of bestowing kindness. It is the highest and purest 
species of affection, and one which may reasonably be supposed 
to reside in the bosom of the " Giver of all good gifts.*' 
" But Godlike his unwearied bounty flows, 
He loves to do, then loves the good he does." 
Denham. 
The usual pursuits of a physician, are acts of benevolence: 
his time is spent in soothing sorrow, allaying pain, bestowing 
health and all the joys of health ; in giving the child to its 
parents, the parent to his children ; in restoring the strength 
of the many links of affection which, but for his instrumentali- 
ty, had been broken forever. If the man who pursues such a 
course have not his affections softened, improved, and purified 
by his duties, then is he formed of sterner stuff than common 
mortals, and loses the sweetest and purest of enjoyments, 
" The luxury of doing good." 
Some clouds it is true are thrown over the brightness of this 
prospect by the certainty that we must often meet with an 
unworthy return for our greatest kindness. " Hippocrates 
complained of the fatigues of his profession, the unjust cen- 
sures to which it exposed him, and of the ingratitude of the public 
towards those who exercise it with most zeal and ability. He 
declares, that in the course of a long life which had been devo- 
ted to the service of his fellow creatures, and which had not 
passed without some degree of renown, he had been oftener 
blamed for misconduct than praised for success." Dr. Rush 
used to say that those persons seldom employed him in their 
subsequent prosperity, who had been obliged to him for the 
gratuitous exertion of his skill, in hours of adversity. Be it 
so, and fair indeed must have been the lot of that man among 
you who has not had often to lament ill-requited good offices, 8 
and forgotten kindness. But shall we suffer ourselves to be 
seduced into neglect of duty by the ingratitude of the world? 
Surely not! More disinterested will he be who, in his painful 
professional labours looks not for even this reward. Although 
this pleasing recompense be denied him, he has yet to experi- 
ence the approbation of his own conscience, the applause of 
good men, and when acting from proper motives, the ap- 
proving smile of heaven. If these be not noble and delightful 
objects for which to contend, what is there on earth that can 
offer a suitable incentive to action ? 
Nearly all the writers on medical ethics concur with the 
world in fixing, on our profession the brand of irreligion. The 
more, however, we reflect on the education and ordinary duties 
of the physician, the more must we be surprised at this charge, 
since we cannot help perceiving that they ought to produce the 
opposite effect. I cannot believe truth to be seen less clearly 
by men whose minds have been expanded by knowledge and 
strengthened by exercise,-whose highest sentiments have been 
refined and exalted, whose lives are devoted to the service 
of humanity, and who are tempted rather to good than to evil. 
Can he have less exalted views of the glory and grandeur of 
the Deity, who is engaged in contemplating the wonders of 
the starry heavens, the secrets of the mighty deep, the beauty 
and usefulness of the productions of the earth ? Can true phi- 
losophy, which consists in a more intimate acquaintance with 
the works of God, lessen our conceptions of his greatness, or 
our gratitude for his goodness ? Can the physician who has 
studied with deep attention the wonderful frame which contains 
his soul-the most complex of the works of the Creator-be- 
lieve, that its numerous and intricate organs were united in 
their efforts for the support of life, by the " fortuitous con- 
course of atoms ?" If his hearth e not steeled against the 
evidence of truth, he must behold in the existence of re- 
medies for the many terrible physical evils which man 
drags down upon himself, substantial proofs that God is merci- 
ful as well as powerful, good as well as great. 9 
That such is the natural tendency of the profession of medi- 
cine may be made evident by reflecting that those who have 
been justly celebrated for their philosophical skill and medical 
usefulness have been very commonly humble and sincere be- 
lievers. What names stand preeminent in the history of medicine? 
are they not the names of Parre, Sydenham, Boeerhaave, Botal- 
lus, Cullen, Cheselden, Fothergill, Rush, Hoffman, Stahl, Hart- 
ley, Percival, &c. &c. And were not these great men as much 
distinguished for piety as for skill and talent ? Dr. Rush, in 
speaking of the religion of physicians, makes the remark, 
" that the weight of such names alone in favour of revelation, 
is sufficient to turn the scale against all the infidelity that has 
ever dishonoured the science of medicine." We should be 
wary then of admitting this unfounded charge against the 
character of our art, lest we unjustly impair the reputation of 
a science w ith which are associated our fondest hopes and our 
dearest interests. We should also rejoice to learn, that to 
enter, in a proper spirit, on the pursuit of our profession, to 
cultivate knowledge with diligence, and to apply it with skill 
and industry, is to increase our reputation and real respecta- 
bility, to enhance our virtue, to enlarge our understanding, and 
to lead us to more sublime conceptions of the glory, and more 
heartfelt admiration of the goodness of God. 
But whilst the study of nature enlarges our conceptions of 
the greatness and pow er of the Ruler of the universe, it repres- 
ses superstition. Why are mankind less superstitious in our 
time, but because they are better instructed than their progeni- 
tors ? So, the more enlightened we become, the less liable are 
w e to the intrusion of idle dreams and visionary fears. 
Time will not permit a full display of the many virtues 
which are cultivated by the pursuits of the physician. Secrecy, 
honourable integrity, great self-denial, patience, decision of 
character, and mildness of manner, are demanded by the pub- 
lic, in the character of the practitioner of medicine. His in- 
terest, in these things, coincides with his duty. His very sel- 
fishness can be gratified only by acting well; and should he 10 
begin to pursue such a course without good motives, the 
habitual performance of useful actions could scarcely fail 
to repress evil and nurture good principles. " A physi- 
cian," says Hippocrates, "should be decent in his external 
deportment, his manner should be grave, and his conduct 
moderate. In the intimate relations in which he is placed 
by his profession with regard to the sex, it is incumbent on him 
to show great reserve and respect, and to have the sanction of 
his functions constantly before his eyes. He ought not to be 
envious nor unjust towards his brethren, nor absorbed in the 
love of gold. He ought to be modest, sober, patient, dexterous, 
anti ready to perform every office appertaining to his art, 
without feeling in the least discomposed. He ought to be pious 
without superstition, and honest in all the affairs of common 
life, as well as in the exercises of his profession. In short, he 
ought to be a perfectly good man; and join to the purity of an 
upright heart, prudence, genius, talent, knowledge, and ad- 
dress, which alone can render the practical application of the 
rules of his art productive of real utility." 
I stand not here as the unqualifying eulogist of our profes- 
sion. Highly as I value its dignity and usefulness, its intel- 
lectual character, and its moral influence, still let me not be 
blinded to its faults. Like every sublunary institution, that of 
medicine is subject to evils, many of them common to it with 
other professions, and others which pertain exclusively to it- 
self. Of these, some have of late become so burdensome as to 
attract the attention of the Society, and others are growing up 
into a consequence which threatens death to the future respec- 
tability of the profession. 
I enter on this part of the subject with a full sense of 
the danger which I shall encounter of wounding the feel- 
ings of many, whom it will be far from my purpose to 
offend. But let me once for all declare, that in speaking 
of the errors and faults into which the profession is most 
liable to fall, I shall not point at any individual, nor give 
to any of my strictures a personal direction. Nor can I myself 
pretend to claim exemption from similar charges, since I can- 
not be certain that I do not unwittingly expose myself to cen- 11 
sure from others for like transgressions. But if we are to be 
reminded of our faults solely by those who are free from blame, 
where shall we hear the voice of reproof, or from whom shall 
we receive the lessons of virtue. The light of heaven, however 
dimmed and discoloured by the media through which it passes, 
is still light, and truth remains truth when proclaimed even by 
an unworthy herald. 
The increasing facilities for the acquisition of medical know- 
ledge, by greatly increasing the number of well educated phy- 
sicians, exposes the profession to some evils, which, although 
they may, at first sight, appear undeserving of notice, are yet, 
likely, if unchecked, to entirely destroy professional dignity 
and usefulness. It cannot escape your observation, that in 
many places, not increased in population or wealth, several 
physicians are competitors for the business which formerly oc- 
cupied but one. Aud in places which have advanced in wealth 
and population, the number of practitioners of medicine has 
been augmented in a tenfold proportion. At all times desirous 
of an opportunity to employ his talent and learning for the be- 
nefit of his fellow creatures, the young physician may, in such 
situations, from the heedless ardour of his disposition, forget 
the justice which is due to his equals, and the deference and 
respect which it becomes him to pay to his professional su- 
periors. The long probation, the tedious uniformity of a 
life of mere study, and a longing for active usefulness, are 
incentives to honourable competition; and when the desire for 
employment is aggravated by pecuniary distress, it demands 
unusual care and resolution, to avoid improper means of ob- 
taining business. 
Among the arts which have been used to obtain employ- 
ment, may be mentioned that of labouring for a reward 
greatly disproportionate to the value of the services. In 
this manner self-constituted physicians and quacks, have, in 
all ages, endeavoured to recommend themselves to the notice 
of the public; but only recently have we learned that similar 
means have been resorted to by regularly educated practition- 
ers of medicine. A vile system of underbidding begins to taint 12 
the profession, and to rob it of its just and necessary reward. 
If persevered in, it will end in the total destruction of profes- 
sional respectability, in our day, and will, in future, deter 
men of education and talent from entering into a profession 
which has been degraded into a mere trade, laborious, disgust- 
ing, and vexatious. Where is the profession most respected ? 
Is it in countries where its services are justly appreciated, and 
properly rewarded, where the recompense is such as to tempt 
into its ranks minds of the highest order, strengthened by exer- 
cise, and improved by cultivation ; or where the w ages of the 
trade cannot afford even a comfortable subsistence. Where the 
whole soul is " swallowed in one low want," and to satisfy the 
cravings of hunger, the whole time must be passed in the active 
drudgery of business ? In Spain, physicians are in less esteem 
than the bleeders, leechers, and cuppers of this country, or than a 
cow-doctor in a village. " In point of honour," says a modern 
traveller, " no class of citizens meets with less respect than the 
physicians. The science and practice of medicine are at the low- 
est ebb. The emoluments of the Spanish physician are as low as 
the rank in which he is held. Even in the present day, the fee 
of the physician is two pence from the tradesman, ten pence 
from the man of fashion, and (even here mark the liberality of 
the profession) nothing from the poor. Some of the noble fa- 
milies agree with a physician by the year, paying him annually 
fourscore reals, that is, sixteen shillings, for his attendance on 
them and their families. Of threescore physicians, settled at 
Barcelona, the two already named, are the most distinguished, 
and have the most extensive practice. One of them favoured 
me with a sight of his list. He had visited more than forty 
patients in the morning, and he was to see as many more before 
lie went to bed. Among these were many merchants, manu- 
facturers, and officers; yet he did not expect to receive a hun- 
dred reals, that is, twenty shillings, for the whole practice of 
the day." What could science expect from a man so harassed, 
and so occupied ? or what improvement may we anticipate from 
Spanish physicians ? Have you ever heard of a good medical 
work, or valuable medical discovery, by a Spanish physician ? 13 
Believe not that the low and inadequate charges which you 
make when young, may be augmented as you advance in skill 
and experience. Those who have preceded you in this course, 
have not been able to obtain such an augmentation. Their own 
custom has been appealed to by their patients, who too often 
object to giving a moderate reward for services, which, when 
rendered, were esteemed of inestimable value. 
Being exempted from pecuniary cares by the possession of 
ample fortunes, some physicians, from love of popularity, or 
from a careless habit, give, either gratuitously, or for an in- 
adequate recompense, their services to the rich. By so doing, 
they compel their poorer and less eminent brethren, to follow 
their example, and without cause they inflict a severe wound 
on the profession. If they desire not a recompense beyond that 
afforded by the reflection that they have been usefully and hu- 
manely employed, let them give their time, their skill, and 
their superfluity to the poor, and they will enjoy a reward 
which every good man ought to covet. 
To make extravagant demands on our patients, would be 
more degrading than to remain contented with a paltry pecu- 
niary compensation. To preserve the profession from falling 
into either extreme, the college of physicians has adopted a 
rate of charges, which is thought to be as far removed from 
meanness on the one hand, as from extravagance on the other. 
It is also distinguished by liberally permitting a reduction ac- 
cording to the pecuniary circumstances of the patient, and in 
no case prohibits members from bestowing gratuitous services 
on the poor. 
Another artifice for obtaining employment is the concealing 
and appropriating to one's exclusive benefit valuable medicinal 
remedies. 
" The worst avarice is that of sense." 
No man enjoys the right to suffer useful knowledge in the 
science of medicine, either to lie concealed in his own bosom, 
or to perish. The antimonial febrifuge of the celebrated James, 
of London, was concealed for sordid purposes, and has, not- 14 
withstanding its wonderful utility, been, it is feared, lost forever. 
Can any good physician withhold an invaluable gift from 
mankind, lest peradventure the disclosure of his secret should 
rob him of some advantages over his professional brethren. 
He must have degrading views of reputation, who is contented 
to be admired as the sole owner of a good medicine, rather 
than, by publishing his discovery, to obtain the approbation of 
his own conscience, and the honest fame arising from a great 
and disinterested action. I speak not to those who have not 
been admitted within the pale of professional privilege. With 
quacks I have no concern. The profession, or this Society, can- 
not exercise a control over men who are not members of either. 
It is also vain to contend against nostrums. There will always 
be charlatans while there is ignorance or superstition. The 
rage for novelty and the love of mystery must be gratified by a 
succession of" balms of Gilead." 
"Il y'a a quelque chose singulierement piquant dans le mystere." 
I have heard such concealment defended on the ground of 
professional competition. The disclosure of peculiar knowledge 
destroys, it is said, all claims to superiority; and, if not reci- 
procated, advances the interests of the artful and designing, to 
the disparagement of those of the candid and high-minded 
practitioner. Were all this true, a good man would prefer the 
path of rectitude, although leading through grounds roughened 
with rocks, interrupted by torrents, and beset with briers.- 
But, happily, no such difficulties or dangers encumber the way 
of truth and honour. Limited as is the sphere of my observa- 
tion, I have been taught to believe that reputation must finally 
reward, and success follow the man, who, in our profession, 
acts on the broadest and soundest principles of virtue. A pro- 
per disregard of selfish ends, a fair and liberal behaviour to 
members of the profession, a ready communication of usefbl 
knowledge, tend to endear a man to his associates, and enforce 
respect and consideration even from his competitors. With 
whom would you prefer to associate and consult ? With him 15 
who exhibits no social feeling, no candour, no liberality; who 
is enveloped in the mists of prejudice, and degraded by vicious 
principles-Or with him who in his whole professional deport- 
ment evinces how dearly he prizes the privilege of doing good, 
how earnestly he longs to acquire and distribute knowledge, and 
how solicitous he is to uphold the character of his brothers in me- 
dicine ? "It is not acting," says Sydenham, " the part of a good 
man to convert to his private advantage what might prove emin- 
ently serviceable to the public, nor of a wise man to deprive him- 
self of the blessing he might justly expect from heaven, by en- 
deavouring to promote the public good." 
In the ardour of medical competition, physicians have been, 
in some cases, associated collusively with apothecaries,nin the 
pursuit of gain. I need scarcely dwell on the evils which may 
spring from such a combination. Associations of this kind can 
be formed but for interested purposes. The physician must 
either share in the profits of the sale of drugs, or find a com- 
pensation in the business which he acquires by the exertions 
and eulogies of the apothecary. In the one case, he is tempted 
by interest and a desire to perform his part of the compact, to 
prescribe, in part at least, for the purse of the apothecary 
rather than foi* the disease of the patient; in the other, he sub- 
mits to the indignity of being patronized, and that too, not from 
superior merit, but superior cupidity. Why did our medical pre- 
decessors discontinue the custom of keeping and vending medi- 
cine? Were they not convinced of the hurtful tendency of the 
practice ? Did they not discover that to acquire a knowledge of 
the sensible qualities of medicine, and to prepare them for use, 
demanded such time and attention as could not be reasonably ex- 
pected from them. Did they not know that a separation of phar- 
macy from the practice of medicine tended to simplify prescrip- 
tions, to save time and labour, and to afford to the patients, 
fresher and more efficient medicines ? 
This evil, new to us, and perhaps as yet remediable, has, 
in many parts of the old world, become so burdensome as to 
elicit the strong animadversions of the best medical writers. 16 
In England these associations existed, and were felt as evils, 
even in the lifetime of Chaucer, for that poet says, 
" Full ready had he his apoticaries 
To send him drugges and his lectuaries. 
For each made other for to winne 
Their friendship was not new to beginne. 
Prologue to Canturbury Tales. 
One contemptible artifice, which has originated in such com 
pacts, is the writing prescriptions in cypher, so as to prevent 
any one but the favoured apothecary from reading them. Such 
prescriptions I have myself seen, and I know that the advice, 
in the case to which they related was given gratuitously to 
appearance, but was well paid for in the price of the medicine. 
In alluding to such combinations, an eminent professor in 
Edinburgh, advises the introduction of the undertaker also. 
He says," I trust my learned brethren whose fingers itch for 
the pestle and mortar, will not condemn me for extending my 
views to the shroud, the coffin, and the hearse, for when the 
physician and apothecary combine, 
" Ultima, mors coit in dulce sodalitium." 
"In regard to Pharmacy," says the eloquent and amiable Gre- 
gory, " it were much to be wished, that those who make it 
their business, should have no connexion with the practice of 
physic, or that physicians should dispense their own medicines, 
and either not charge the expense at all, or charge it at prime 
cost. It is only in one or other of these ways that we can ever 
hope to see that simplicity of prescription take place in the 
practice of medicine, which all who understand its real in- 
terests so ardently desire. And it is only from such an ar- 
rangement that we can expect to see physicians placed in that 
honourable independence which subjects them to no attentions 
but such as tend to the improvement of their art." 
Not contented with the great profits which are obtained by 17 
the sale of medicines, nor satisfied with the easy and lucrative 
trade which has been abandoned to them by the physicians, 
some apothecaries have recently commenced the practice of 
medicine. If it be deemed unworthy of the dignity, and dan- 
gerous to the integrity of educated physicians to act as their 
own apothecaries, what should be said of the apothecary, who 
ventures to throw into a system of which he knows nothing, 
medicnes of whose virtues he knows as little. 
•' So modem'pothecaries, taught the art 
By doctor's bills to play the doctor's part, 
Bold in the practice of mistaken rules, 
Prescribe, apply, and call their masters fools." 
Pope. 
From files a random recipe they take, 
And many deaths of one prescription make." 
Dryden; 
From such beginning arose the practice, now nearly uni- 
versal in England, of employing apothecaries in all common 
cases of disease. In more important and dangerous maladies 
the physician is summoned, and intrusts to the apothecary 
directions as to the management of the patient. As the 
apothecary is always the first in attendance, he is commonly 
permitted to select the consulting physician, and therefore ex- 
ercises, over the professional men in his neighbourhood, no in- 
considerable influence. If not possessed of great eminence, a 
physician is, in some parts of England, entirely dependent for 
employment on the good will of the apothecaries, and must 
therefore form his prescriptions so as to favour the interest of 
his patrons, or live and die unknown and in poverty. Yielding 
to such stern necessity, the English physicians recommend ex- 
ceedingly complex formulae, as may be seen by referring to 
*( Thomas's Practice," and other British publications. Recent 
events inspire me with a belief that we are in danger of falling 
into a similar degradation ;-And, for our own sakes, as well 
as for the interests of society, and the dignity of the profes- 
sion, we should earnestly seek for a remedy. As far as its 18 
influence extends the College, of Pharmacy has, with great 
propriety, discountenanced collusion between physicians and 
apothecaries, and the application, by its members, of medicines 
to diseases. Without an effort, however, on the part of the 
profession, to repress these evils, they will inevitably sap the 
foundations of professional dignity and usefulness. But if we 
1'esolve to give countenance to no collusion between physicians 
and apothecaries, and refuse to send prescriptions to those 
who administer medicines without proper qualifications, we 
shall crush the evil in its germ, and rescue the profession and 
society from a fatal disorder. If this be not done, then must 
we endure the lesser evil, and rather than suffer apothecaries 
to become incompetent physicians, let physicians become incom- 
petent apothecaries. It might be supposed that the good sense 
of the public would prevent the extension of the evils com- 
plained of, and that the educated part of the community would 
prefer, the skill which has been acquired, by years of en- 
lightened application. Men trust not themselves to the pilot 
who has not served an apprenticeship to his trade, nor will 
they consign their fortunes to the management of a skillcss 
lawyer: but their lives, they are not unwilling to place in 
the hands of mountebanks and pretenders to medicine.f< Nay," 
says the shrewd and observant Lord Bacon, "we see the 
weakness and credulity of men is such, as they will often pre- 
fer a mountebank or witch before a learned physician. And 
therefore the poets were clear sighted in discerning this folly 
when they made JEsculapius and Circe brother and sister, 
both children of the sun. 
Ipse repertorem medicinx talis et artis 
Fulmine Phoebigenam Stygias detrusit ad undas. 
TEn. vir. 772. 
And again. 
Dives inaccessos ubi solis filia &c. 
In. vii. 11. 
For in all times in the opinion of the multitude, witches and 19 
old women, and impostors have had a competition with physi- 
cians ; and what followeth ? Even this ; that physicians say 
to themselves, as Solomon expresseth it upon a higher occasion; 
< If it befall to me, as befalleth to fools, why should I labour 
to be more wise.' " 
The slow progress of the medical art, is a subject of wonder 
and regret, not only to the profession itself, but also to evei'y 
thinking mind. Distinguished among the sciences for its lofty 
aims, its high requirements in its cultivators, and its conse- 
cration to the service of humanity, and the security of life, why 
is not its advancement equal to that of the other branches of 
natural knowledge ? Are not its votaries learned, scientific, 
industrious, zealous and observant ? Do they not pursue their 
investigations, in the midst of pestilence, and in the abodes of 
wretchedness ? From the dark recesses of the tomb, they strive 
to elicit the light of truth, and to bring death himself to the 
bar of observation, to give evidence by which his future rav- 
ages may be prevented, 
" Hie locus est ubi mors gaudet succurrere vitx." 
AVhy then is our art yet so imperfect; our science so little de- 
serving of the name ? Many useful medical discoveries have 
been made by chance ; and have been brought into repute by 
the prattle of old women, or the puffs of quacks. Some, and 
these but few, have been presented to the art, by the hand of 
philosophy ; and for these gifts, doubly valuable, because they 
give promise of a richer harvest, we are indebted chiefly to the 
present age. To discover the cause of this lamentable condi- 
tion of our art, it will be useful to revert to the early periods 
of medical history. Anterior to the era of Hippocrates, we 
know scarcely any thing concerning the state of medicine. The 
little we do know, gives reason to suppose, that this useful art 
was intrusted to the hands of women, priests, and warriors* 
who could learn nothing beyond the empirical application of a 
few remedies. In the hands of Hippocrates, the science sprang 20 
into a consequence and usefulness, the more remarkable, be- 
cause of its previous insignificance, and its subsequent re- 
tardation. By what means was this highly distinguished 
physician enabled to produce so prodigious a result? By 
means exceedingly simple and natural. Founded on experi- 
ence and observation, medicine can be successfully cultivated, 
only by the patient interrogation of nature. But to extort con- 
fessions from nature, the mind must be previously prepared 
both to inquire aright and to understand with facility. Edu- 
cated in all the knowledge of the time, and having his mind 
acuminated by the intellectual philosophy of Greece, Hippocra- 
tes sat himself down to patiently observe, and record, the phe- 
nomena of disease. In that country, and at that period, his 
was no easy task. His cotemporaries, enchanted with the 
gorgeous visions of genius, dwelt in the airy regions of con- 
jecture. The purely intellectual sciences were their delight; 
and them they carried to a distinguished degree of excellence. 
But in the departments of knowledge, which are founded on 
observation, and slow and painful induction, they chose rath- 
er to think, than to observe. They disdained to interrogate 
nature ; and preferred rather to dictate to her. They were 
less desirous of deducing principles from facts, than of infer- 
ing facts from principles. They assumed the office of the Crea- 
tor, and said, " let such things be," and to the intellectual 
darkness of the age, they hung aloft the light of a ruinous 
sophistry. The father of medicine, though infected in some 
degree, with the conjecturing spirit of the times, was most 
commonly employed in observation and experiment. It had 
been well for his fame, and the advancement of medicine, if his 
powerful talents had always been employed in the humble, but 
instructive task of listening to nature, whose testimony is ever 
to be trusted. He did not often search for truth with the fee- 
ble taper of conjecture, but delighted to view her in the less 
deceptive light of observation. Hence his pictures of disease 
shine even yet in the fresh and glowing colours of truth, and 
have faded only where they have been touched by the unreal 
pencil of conjecture. But having proved himself capable of 21 
deducing sublime truths from the great phenomena of nature, 
he sometimes voluntarily closed his eyes, and preferred splen- 
did dreams to useful, but less imposing realities. It was 
preconception, sitting incubus-like on the bosom of philosophy. 
Let us not however be wanting in charity to this failing of 
genius. Preconception rules with tyrannic sway in even the 
noblest minds. Socrates himself, sacrificed a cock to 2Escu- 
lapius. 
That fatal philosophy which sometimes dimmed the mind of 
the sage, shed its baneful influence on the art, in succeeding 
time. As long as it kept possession of the schools, so long 
did our useful art groan under its impairing influence. That 
philosophy has, thanks be to heaven, perished, and medicine 
has claimed for itself the privilege of a separate existence. 
But is it no longer the subject of preconception ? Do we not 
suffer facts to be distorted, as seen through the medium of pre- 
judice, and are we not ever employed in system building ? The 
toilsome path of induction, suits neither the indolence nor the 
vanity of man : and even the greatest physicians, have been 
guilty of erecting hypotheses on unlawful grounds, and forcing 
or suborning facts, to give evidence in their favour. But 
for this wresting from their proper purpose, the phenomena 
of nature, and distorting them hideously and fatally by re- 
flection from the delusive mirror of fancy, it would be a waste 
of time to quarrel with the dreams of physicians. When how- 
ever we see our noble and useful science retarded; when we see 
the most highly gifted mortals, wasting time and energy, in 
concealing truth and disguising knowledge; when the youthful 
pupil wades amidst a mingled mass of truth and falsehood, 
without any discriminating guide, and the practiced physician 
reads, with a wholesome and cautious scepticism, have we not 
reason to lash the odious spirit which broods over, and binds 
in chains, the fair form of truth? 
Shall we not then be permitted to reason in medicine ? Are 
we to be denied the privilege of thinking ? By no means! To 
practice medicine well, it must be practiced rationally. 22 
" Medicine without principles is an humble art, and a degrading occupa- 
tion." Rush. 
No man can carry in his mind all the facts of his science, 
but must be permitted to deduce principles, which, when pro- 
perly formed, are but general facts including a number of par- 
ticular facts. The science is not yet prepared for a more ex- 
tensive system, and we must yet confine ourselves to short and 
simple trains of inductive reasoning. 
Men sufficiently gifted to invent and support medical hypo- 
theses, are not numerous, although their influence is commonly 
extensive 5 but there are other motives for falsifying, which 
are felt by a much greater number of physicians. Among these, 
interest and vanity are the most powerful and injurious. The 
most contemptible practitioner may be a boaster, and even a 
publisher of falsehoods, not to advance or adorn a hypothesis, 
but to obtain reputation and profit. Who is there among you 
who has not been bitterly disappointed by the effects of some 
highly vaunted remedy ? And have not those who are instruct- 
ed by long experience, been taught to apply new medicines, or 
modes of practice, with extreme doubt and jealous circumspec- 
tion. How few of the many boasted remedies of the day have 
been found useful, and how many of them have been sent on 
errands of destruction. Nor have we to complain alone of the 
positively injurious influence of such medicines; they more fre- 
quently do injury by superseding and excluding, better estab- 
lished methods of cure, and by delay, often cause the death of 
the patient. It is time to find some remedy for this growing 
evil, and to purge the profession of that "perilous stuff" 
which weighs most heavily on its reputation and its usefulness. 
Such a remedy cannot be found in legislative enactments, nor 
in the regulations of any ordinary medical association. But 
might be obtained by an institution whose members should 
pledge themselves solemnly to support a just and upright cha- 
racter, and to which should be given the power of inflicting 
the severe penalty of degradation and professional outlawry. 
No man can advantageously publish a medical discovery, 23 
until its value has been tested by an extensive series of obser - 
vations. Before, therefore, it is placed, by its discoverer, in the 
eye of the public, it is commonly known to many professional 
men, and is in danger of being claimed by some one who is 
desirous of reputation at any cost. The plundering of his re- 
putation a man who is alive and able to assert his right, is not, 
however, so contemptible a crime as the descending into the 
tomb, and robbing the illustrious dead of their honours. The 
almost daily contentions for the honour of discoveries, evinces 
that in some cases, we snatch the laurels from each other. The 
frequent restoration of the credit of a discovery to some de- 
parted being, shows either a culpable degree of ignorance, or 
a base desire to wear honours justly due to another. But there 
is allied nearly to this evil, one much more common and much 
more injurious to the progress of the science of medicine. I mean, 
a restless and heartless jealousy of those who make discoveries. 
There must be some enthusiasm in an inventor, to enable him 
to overcome the many inevitable difficulties in the way of a 
new conception. But a much more serious obstacle is present- 
ed by the envy of professional competitors. At first, the dis- 
covery is undervalued, and ruthless endeavours are made to 
strangle it in embryo. When, by the zeal, talent, and courage 
of its owner, it is forced into estimation, it is subjected to an- 
other assault. Either it is claimed by some impudent preten- 
der, or it is traced to an unintelligible passage in some worm- 
eaten folio, whose author had as clear a conception of the fact, 
as he had of the nature of the soil in the moon. 
I am willing to believe, that the greater part of my brethren 
are not tainted with this odious and blighting vice. Some there 
are who are ever ready to cheer and guide the young adventu- 
turer in his path to fame and usefulness, and who are above 
all jealousy of their associates $ who disdaining 
"To crush young genius bursting from the shell," 
Would exclaim, even of a rival and an enemy, 24 
''Freely let him wear 
The wreaths which genius wove and planted there, 
Foe as I am, should envy tear it down, 
Myself would labour to replace the crown." 
There are gentlemen in our profession, whose chief delight 
consists in urging onward the young adventurer, and who 
strive to " Strew with flowers the thorny ways of truth." If 
I could think otherwise, I should be forgetful of kindness and 
assistance, which I could not forget without dishonour. 
But, ,my time and your patience are too nearly exhaust- 
ed to permit the farther disclosure of the evils prevalent 
in the profession. It is at best an ungrateful and invi- 
dious task, and one, which, I fear, will accomplish little good. 
But odious as it is, let me not be understood to express regret 
at the exposure. Love of approbation is among the most deeply 
rooted and wide-spreading of sentiments, and therefore men 
usually conform their conduct to the opinions of the community 
to which they belong. Raise the tone of moral sentiment, and 
there is produced a proportional elevation of the conduct of 
those who are actuated, not by reason or religion, but who 
swim with the general current of society, either to evil or to 
good. My feeble voice may not be listened to by many, and 
fewer still may give heed to my counsel, or regard my reproach- 
es; but public sentiment being produced by the aggregation 
of individual opinion, it becomes the imperious duty of even the 
most insignificant, to give his suffrage to the authority of 
truth, and to the elevation of virtue. 
If then the influence of the sentiments of those who are in 
obscurity, may be felt by the medical community.; how great 
must be the responsibility of those whose genius, talent, age, 
and experience, have elevated them to the highest pinnacle of 
public observation. To them are most specially intrusted the 
interests of the profession, and their example must regulate, in 
a great measure, the conduct and character of those who are 
to follow them. Their actions are not alone a personal con- 
cern, nor are they entitled to exercise a discretion founded 
solely on their own interest and that of their patients. The 25 
general welfare of the society should be consulted by every in- 
dividual ; and no man should forget the obligations imposed on 
him by the claims of the profession to which he belongs. In this 
latter particular, more than in any other, do physicians fail in 
their duty. While the members of the profession are ever 
ready, by individual exertion, to advance the cause of virtue 
and the interests of humanity, how seldom do we find them 
united in schemes for the improvement of either. Look at the 
many medical associations which have sprung into existence, 
enjoyed a short and sickly career, and perished. Even this 
useful Society, before which I now stand, once dignified by the 
presence, and graced by the genius and eloquence of the Hip- 
pocrates and Sydenhams of our country; once enlightened 
by the knowledge, and improved by the experience of the 
greatest men of the profession, is now abandoned to the feeble, 
but still zealous support of those, who, too inexperienced to sus- 
tain it in all its greatness, hope that its sun of glory, obscured 
for a season, may again shine forth in its wonted splendour. 
Reflecting on the injustice of withholding from their brethren, 
the valuable knowledge which accumulates in their enlightened 
minds, eminent physicians will, once more, we trust, delight 
the Medical Society, by the lessons of skill and the precepts of 
wisdom. Knowledge, exhibited in books, is, no doubt, useful; 
but with much greater force and impressiveness does it flow 
from the eloquent lips of a living speaker. 
The greater part of my audience consists of gentlemen who 
are not yet admitted into the ranks of the profession. In proper 
time, all of you will, I fondly trust, receive the honourable dis- 
tinction of a degree in medicine, and feel that you deserve it. 
Let me entreat you, before your minds are burdened with, what 
may be termed, habitual professional faults, to resolve to enter 
on the high and responsible duties of your art, in the true spirit 
of philanthropy, illuminated by philosophy. The fate of the 
physician is often determined by the manner in which he com- 
mences his career. If he fail to attain to respect and use- 
fulness, he may usually reproach only himself. Unless some 
unforeseen and unusual occurrence blast his prospects, and con- 26 
trol his destiny, the man who acts well his part, must obtain 
competency, reputation, a wider and wider field of usefulness, 
and a loftier and still loftier elevation of character. 
If, seduced by the restlessness and impatience of youth, the 
sordid love of gain, or the inordinate desire for reputation, the 
young physician evince no regard to the reputation, interest, 
and feelings of his professional brethren, he will soon discover 
that he has, like the Laplander, unchained a tempest which he 
cannot allay, and which will eventually overwhelm himself. 
Let him not extenuate his fault by pleading the irksomeness 
of inaction, and the desire to be usefully employed. He should 
not remain inactive, nor should he seat himself, and wait with 
folded arms for the hour of exertion in the field of practice. 
One or two trials of his skill will convince him, that he has 
learned little more than the names of the tools of his trade. It 
will be necessary for him to study, and that profoundly too, 
their uses. That leisure which is found so often burdensome, 
is for this purpose, inestimable. Let him employ it in laying 
more firmly the foundations of medical knowledge, by consult- 
ing and comparing the opinions of illustrious men in all ages, 
and storing his mind with the accumulated experience of cen- 
turies. Let him associate with his seniors, and consult them, 
in a spirit of proper deference, on points not well explained by 
writers. 
In the experimental investigation of physiology, he . may often 
find a noble resource against the tedium of inaction. That 
department of science is yet in its infancy, though destined to 
become the parent of pathology. In its cultivation may be ac- 
quired the calmness and dexterity so essential to the surgeon, 
the knowledge of the natural condition of organs and functions, 
so useful to the pathologist, and a reputation greater than 
can be obtained by any other medical pursuit. It possesses 
also the merit of being accessible in every place. Animals are 
easily found, and the apparatus for the investigation is simple. 
Let not your thirst for knowledge be repressed by the common 
cant, against the cruelty of such pursuits. Animals do suffer 
under the knife of the physiologist, but useful knowledge is 27 
promoted by their sufferings. Only useless or unnecessary in- 
fliction of pain should be branded with the name of cruelty.- 
The lower animals were given to man for his use ; and do we 
not use them more comformably to the will of the Giver, when 
we extract from them knowledge, than when, to gratify a low 
and pampered appetite, we crush millions of them at a mouth- 
ful ? 
The detection of the useful proximate principles of our best 
remedies has of late greatly improved our means of cure, and 
given a particular brilliancy to the French School of Medicine. 
These astonishing effects have been produced by means easy 
of attainment, and of great simplicity. Every physician may 
learn to perform the necessary processes, and may discover in 
our wide savannas, and interminable forests, an exhaustless 
field of research. Here he may find a. refuge from ennui, and 
a cure for impatience; useful employment and valuable know- 
ledge, personal improvement and professional greatness. 
Nor should he be entirely debarred from the practical ap- 
plication of his knowledge. If the wealthy will not employ 
him, let him seek in the abodes of poverty for opportunities of 
exercising his benevolence, and correcting by practice, the er- 
rors in his medical reasonings. 
The rich stores of knowledge which must open before the 
eyes of men thus employed, should not be hoarded for mean or 
selfish ends. Let them go forth to the world.'-Lose a tem- 
porary and immediate advantage, to gain a distant, but an 
imperishable renown ! Let not enlightening views of science, 
given as a distinction to the man, and as a blessing to society, 
be hoarded in a selfish mind, to sit at no distant period, " hea- 
vy on the soul." 
Above all, gentlemen, cultivate a constant and friendly in- 
tercourse with all worthy physicians. Lay the foul fiend of 
professional rivalry and medical jealousy. Know your broth- 
ers in medicine, and you will love them. Promote such insti- 
tutions as have a tendency to bring you together, and to unite 
you in a common cause. A litte resolution, a little forbear- 
ance will be necessary to commence the great work of medical 28 
reformation: but once fairly begun, it will, I trust, advance as 
near to perfection as is consistent with our fallen nature. 
Already may be perceived an improvement in professional 
character. The great political institutions of our country 
leave us to the unfettered pursuit of virtue and knowledge. 
No hereditary aristocracy frowns on plebeian merit; no solitary 
master scatters around him honours won and worn by fawn- 
ing sycophants and flattering minions. The streams of 
knowledge are not directed solely to the palace. They over- 
flow the land. He who drinks deeply of the inspiring beverage, 
shall not complain that his aspirations after fame are repress- 
ed by the hand of power, or his desire to rush into the field of 
useful virtue thwarted by the arm of privilege. 
Such blessings were not given to us, I trust, in vain. The 
institutions under which we live demand from us an adequate 
return. Our minds were not liberated from the fetters of ty- 
rannic authority, to be enthralled by indolence, enslaved by 
passion, and dishonoured by cupidity. The profession has also 
its claims. The souls of our brethren were not ennobled by 
liberty, expanded by science, and softened by the hourly exer- 
cise of humanity, to make them less worthy of our confidence, 
less deserving of our affection, and less amiable as friends and 
associates. Shall the ministers of differing sects combine in a 
common cause? Shall men, of other professions, be distin- 
guished for great esprit de corps, and physicians alone be dis- 
graced by disunion ? Henceforth let us act in unison, and 
unite in efforts to elevate and dignify our art. Let us oppose 
with the whole weight of the profession, the infringement of the 
rules of virtue, and the principles of honour. Let us encourage 
a generous emulation in the cultivation of science, and whilst 
solicitous to become ourselves distinguished, be ever ready to 
do justice to the merit of others, and to assert their lawful 
claims to distinction.