How to Study Medicine. 
AN INTRODUCTORY LECTURE 
BY 
DAVID W. CHEKVER, M.D. AN INTRODUCTORY LECTURE, 
Delivered before the Medical Class of Harvard University, October 2, 1871 
By DAVID W. CIIEEVER, M.D., 
Adjunct Professor of Clinical Surgery. 
Gentlemen of the Medical and Dental 
Schools :— 
On this eighty-eighth anniversary of the 
opening of our Medical College, it is my 
peculiar privilege to welcome you to the 
old School, with its mode of instruction re- 
formed, amplified, systematized, made pro- 
gressive. 
Here in America nothing is allowed to 
grow old. Change, and that change often 
progress, attacks every art, every calling, 
every institution. As the human body is 
itself subjected to a constant interchange of 
atoms, and dies at last through incessant 
use, so the art of medicine changes season 
by season ; is modified by fashion, or the 
progress of the sister sciences. The medi- 
cal knowledge and the medical practice of 
to-day are not those of twenty years ago ; 
neither should the medical education of to- 
day be that of former years. 
With no abatement of deference and of 
gratitude for all that the Medical Depart- 
ment of Harvard University has taught us 
in the past, it is not assumption to hope 
that its progress in the future will be still 
more marked. For in this ancient and sta- 
ble University there has come to pass a 
change in medical education, more radical, 
more thorough, and, as we believe, more 
beneficial in its effects on the future of our 
profession, than any other since the founda- 
tion of our college. 
When, seventeen years ago, I sat upon 
these benches as a medical student at my 
first course of Lectures, how well I remem- 
ber my confusion as to what I had better 
do. Aghast at the multitude of subjects of 
study ; overwhelmed by the numerous lec- 
tures poured into my ears each hour by a 
fresh professor ; with no one to guide, no 
rule to follow, no law. of selection to con- 
sult, no classification of terms, or years or 
capabilities whatever, what wonder that we 
all underwent a mental surfeit, whose con- 
sequences tortured our future rest with a 
nightmare of unassimilated knowledge! 
Four busy months the course went on with 
unabated ardor, and then the bulk of the 
class dispersed, to follow out, with intermit- 
tent and languid diligence, their studies 
during the remainder of the year. The first 
year’s student pursued here the same stu- 
dies as the third year’s one; and if he 
finally learned what branches to select, it 
was only at the expense of many wasted 
weeks, or months. 
Any one department of medicine, as 
anatomy for instance, crowds the beginner 
with such a mass of isolated facts, that 
it is several years before he can assort and 
generalize them for use. But the unfortu- 
nate student of former times had all de- 
partments thrust upon him, at once, to 
choose from without a guide, and to con- 
fuse him with their multifarious details. 
The changes in the mode of instruction 
tb which all new students who enter for our 
medical degree will be subjected, and in 
which we cordially invite all students who 
have partially completed their studies, here 
or elsewhere, to join, are chiefly these:— 
Instruction will be uniform and continu- 
ous throughout the entire year ; and pro- 
gressive throughout three years. 
Studies and students will be classified, 
and divided into a three years course. 
Examinations will be distributed through- 
out the three years. 
The mode of teaching will be more de- 
monstrative, practical and experimental, 
and less didactic, than formerly. 
Lectures, recitations and practical exer- 
cises will, as heretofore, all be used as 
modes of instruction. But the proportion 
of recitations to lectures will be larger than 
before; while demonstrative and experi- 
mental study, in the Dissecting Room, the 
Chemical Laboratory, the Microscope Room, 
the Physiological Laboratory and the Au- topsy Rooms ; and clinical study in the 
Hospitals and Dispensaries, will be very 
greatly increased, and supplant, to a certain 
degree, the college lecture rooms. 
This is not the hour in which to discuss 
the merits of demonstrative and experimen- 
tal as compared with didactic instruction ; 
clinical teaching with prepared and syste- 
matic lectures ; or recitations, in which the 
student takes the active part, with lectures 
ex cathedra, where he merely listens and re- 
ceives ideas. 
There can be but little doubt that what 
we do is fixed by the doing more firmly in 
the memory, than what we see others do ; 
that what we see makes more impression 
than what we hear; that what we learn 
to express in our own language is retained 
better, than what we are taught by listening 
to others. 
To assure this advantage of the demon- 
stration, the experiment, the clinical study 
and the recitation over the lecture, it is es- 
sential that all the class take active part in 
those exercises. And this they will be ex- 
pected to do, since every student will have 
his place and time in the anatomical, physio- 
logical. and chemical laboratories, and in 
the microscope room ; and laboratory work 
will be as much required of him as attend- 
ance at lectures. 
We would, however, by no means do 
away with the old lecture system. The 
lecture brings the teacher face to face with 
the whole class ; gives a living significance 
to the dry teaching of medical treatises ; 
enables the lecturer to select only those 
parts of written medicine which are valua- 
ble ; and to add and enforce much practi- 
cal wisdom that is not found in books. 
We intend, therefore, to offer you full 
courses of lectures on all those subjects 
which cannot be made wholly demonstra- 
tive, or experimental; and some of which, 
as the anatomical,- surgical and pathologi- 
cal departments, possess a wealth of illus- 
tration in plates, preparations and cabinet 
specimens. 
It is sufficient for me, in these few pre- 
fatory remarks, to have glanced at the 
changes with which you will become fa- 
miliar as the term goes on : and addressing j 
myself now to the new members of our 
medical class, I propose to answer the first 
question which every student puts to his 
teacher, 
How to Study Medicine? 
A preliminary education is the first re- 
quisite. For the mind which has lain fal- 
low during the impressionable years of 
youth is ill adapted to c.akc4*»,; .eas. It 
is sluggish to learn, tardy to acquire, and 
does not know how to use its faculties, 
although its memory may be retentive and 
its powers of observation acute. As a rule, 
men beginning a profession under the draw- 
back of want of training do not arrive at 
distinction. It is rare to step directly from 
the plough or the workbench to professional 
eminence. Such cases are instances of 
genius, which would rise to the surface in 
spite of any obstacles^ 
The average mind, then, needs culture and 
training before beginning to study medi- 
cine. This preliminary education, however, 
need not be either academic, or collegiate. 
In fact, the strictly classical courses of 
many colleges are ill adapted to prepare 
the mind for medicine. 
In our profession two qualities are espe- 
cially needful, a quick perception and a 
well-balanced mind. Observation and judg- 
ment constitute the true physician. No 
other learning can compensate for the lack 
of these ; and with these, a relatively igno- 
rant man will succeed. We cannot read the 
sick by book-knowledge ; we must study 
them as children learn, by observation. The 
diagnosis and the treatment of disease are 
a balance of probabilities, and cannot be 
successfully carried out without judgment, 
or common sense. 
Whatever studies, then, cultivate the 
perception and the judgment constitute the 
best preliminary education for the medical 
profession. The natural sciences, chemis- 
try, physics, natural history, mathematics, 
educate these faculties more than lan- 
guages, literature or history ; for the latter 
are better adapted to fluent speech, good 
memory and elegant tastes. The classics, 
however, are not to be thrown aside ; since 
a fair knowledge of Latin and Greek is of 
inestimable value to the reader of medical 
literature ; but such modern languages as 
the French and German, teeming with sci- 
entific research and medical publications, 
are, beyond doubt, the most directly useful 
to the physician. 
Scientific schools, and schools of tech- 
nology supply the kind of preliminary know- 
ledge the medical student needs. 
The academic department of our own 
University has been so far modified, of 
late, as to very well meet these require- 
ments. But such is not the case in the 
undergraduate curriculum of most other 
colleges. 
The natural sciences, the dead languages 
to a certain degree, and the modern lan- 
guages are, then, to be especially cultivated 3 
by the j who means to study medi- 
cine. 
Professional Studies. 
We come now to the professional studies ; 
the point at which you have arrived, who 
sit here for the first time. 
The profession of medicine embraces 
both a Science and an Art. 
A Science, based on certain fixed and 
definite branches of knowledge, as Chemis- 
try, Anatomy, Physiology, Pathology. 
An Art, consisting in the application of 
this knowledge to the treatment of disease, 
in the practice of Medicine, Surgery and 
Obstetrics. 
In the purely scientific parts of medicine 
lie its only fixed principles and immutable 
laws. All else is changeable, uncertain, 
subject to modification from advancing sci- 
entific knowledge, and even from caprice. 
He therefore who would build the super- 
structure of his profession on a sound basis 
can only do so by a profound acquaintance 
with Chemistry, Anatomy, Physiology and 
Pathology. 
These constitute his earliest studies ; and 
to three of them his first year’s course is 
limited. 
Chemistry. 
Chemistry is the science of the funda- 
mental structure of both the inorganic and 
organic worlds. Anatomy deals with com- 
pound bodies, though they be but atoms; 
chemistry deals with the ultimate elements 
of matter. It is the farthest depth to which 
we can conduct material investigations into 
the arcana of nature. 
Chemistry concerns man both in his own 
structure and in everything that surrounds 
him ; both in the discharge of his vital 
functions and in the changes of his body 
after death. To seek to know the human 
body in health, or to minister to it in dis- 
ease, without chemical knowledge of its 
composition, or its forces, is to be merely a 
sciolist. 
There was no chemical knowledge of 
oxygen, carbonic acid and the changes in 
respiration in the middle ages, and the 
smallpox patient of that time was shut up 
in a room with closely-drawn red curtains, 
the windows battened and the keyholes 
stopped ; while those who had the miliary 
fever, or sweating sickness—a disease ob- 
solete now—were put between two feather 
beds, and overlaid, until many expired in 
great agony.* 
It is not too much to say that chemistry 
deserves the credit of a very large propor- 
tion of the advances in the medical know- 
ledge and practice of late years. Its re- 
form of our pharmacopoeia has been equally 
radical, and startlingto old authorities. Inert 
and incompatible remedies have been dis- 
solved by it into their naked uselessness; 
the active principles of drugs have been 
eliminated from their crude and bulky en- 
velopes of wood and bark, mucilage and 
fibre. The nurse’s dogma, and even the 
poor Indian, have been pushed aside in its 
relentless progress. 
It is chemistry, and not homoeopathy, 
which has dissolved the nauseous dose into 
the minute and cleanly alkaloid ; reduced 
the bulk of remedies, and taught the abuse 
of drugs. 
This science is eminently one of experi- 
ment. It advances by questioning nature. 
It is to be learned by practical work in the 
laboratory, more than by lectures ; the 
latter serving either to condense and reca- 
pitulate previous knowledge, or to illus- 
trate, on a large scale, the effects of re- 
agents on each other. Your first months 
of study should be passed in learning gene- 
ral chemistry at your desk in the laboratory, 
with reagents, blowpipe and test-tube. In 
the basement story we have now arranged 
ample facilities for the practical pursuit of 
chemistry, where one hundred desks, with 
apparatus, have been prepared for the use 
of the class. 
Anatomy. 
Anatomy, the cutting apart or dissecting 
of organized beings to learn how and of 
what they are made, is the most direct and 
fundamental, though it was not the earliest 
mode of understanding the human frame. 
Oracles, spiritualists, augurs, seers, priestly 
jugglers were the first authorities in medi- 
cal matters; while Aristotle or Galen were 
still permitted to dissect only horses or 
dogs. 
The self-sacrifice of Vesalius and other 
noble martyrs of anatomical science, and, 
among others, the life-long labors of Hunter, 
finally accumulated such a mass of informa- 
tion, and so conclusively proved its value, 
that the world got habituated to dissections, 
and allowed them to be peaceably pursued. 
Here in Massachusetts, the enlightened 
public opinion of the Commonwealth has 
legalized the practice of human dissection ; 
a credit not yet shared, we regret to say, 
by many others of the United States. 
It would be an idle abuse of our time to 
delay you with an explanation of the car- 
dinal importance of anatomy to the medical 
student. The fact is self evident that this 
science is the very foundation of all his 
* Ileckcr’s “Epidemics of the Middle Ages.” other knowledge. It is, too, an exact and 
assured science ; capable of demonstration ; 
unchanged in its essentials for years past; 
occasionally altered in nomenclature and 
enlarged by new facts, but never losing a 
single approved truth, as laid bare by the 
scalpel. Its changes have been chiefly 
those of histology; while its grosser facts 
remain as fresh as in the days of Albinus. 
It is equally capable of proof how di- 
rectly surgery springs from, and is depend- 
ent on, anatomy. Surgical diagnosis is, to 
a great degree, anatomy applied; surgical 
operations are dissections on the living sub- 
ject. Of this one fact you may be quite 
sure, that no man ever was an eminent sur- 
geon who was not a good anatomist; and, 
also, that no surgeon was ever a good ope- 
rator without having been first a neat dis- 
sector. The pains-taking, conscientious 
student who haunts the dissecting room in 
his leisure hours, to watch others if not to 
work himself, is, in nine cases out of ten, 
the one who becomes a good surgeon or a 
good physician. To neglect anatomy is to 
throw away everything. It should occupy 
all the time that you can possibly devote 
to it. Fortunate if you have already ac- 
quired a sufficient knowledge of general 
chemistry, before coming to the' medical 
school, to enable you to give all your first 
year to anatomy, and its directly related 
science, physiology. 
Of the dire effects of the lack of anatomi- 
cal knowledge in the surgeon, hear John 
Bell 
“ If a surgeon, ignorant of the parts of 
the human body, should be called to per- 
form even an established and regular ope- 
ration, which he has often seen performed, 
how must he tremble at the thoughts of 
what he has to do ! Acting only as he has 
seen others act, he is interrupted, startled, 
perplexed, with every new occurrence. He 
has foreseen nothing, provided for no acci- 
dent, and every accident alarms him. He 
moves timorously onwards, like a blind man 
who walks with an air of confidence on an 
accustomed read, but when any new object 
presents itself, or the road is changed, is 
bewildered and lost. 
“ We see untaught men operating upon 
their fellow-creatures in cases of life and 
death without the slightest knowledge of 
the anatomy of the parts, much less any 
right ideas of their conditions, and new re- 
lations to each other in the state of disease. 
“ But such operators are seen agitated, 
miserable, trembling—-hesitating in the 
midst of difficulties—turning round to their 
friends for that support which should come 
1 from within—feeling in thr a _,r things 
1 they do not understand—holding consulta- 
tions amid the cries of the patient; and 
thus, while they are making ungenerous 
struggles to gain a false reputation, they 
are incurring reproaches which attend them 
throxigh life.” 
You must take the knife into your own 
hand if you want to learn and remember 
anatomy. There is no royal road to this 
knowledge. Lectures, recitations, plates, 
books, all assist, but none can .take the 
place of the dead body, in pursuing this 
science. * You must dissect con amove; 
and, strange as this may sound to you, 
you will find it, in a few weeks, a fascinat- 
ing pursuit. The marvellous machinery of 
life which you unfold layer by layer; the 
ideas you will receive ; the analogies, not 
only to the rest of organic nature, but even 
to all the nicer mechanical laws and appli- 
ances ; the pleasure of manipulating and 
seeing for yourself all that you have read in 
books ; the combination of bodily and men- 
tal occupation, and the stimulus of the oc- 
casional discovery of anomalies and varia- 
tions, all will lead you on, until you will 
find that nowhere do the hours fly so fast 
as in the dissecting room, and to no hours 
will you look back with a greater pleasure 
or satisfaction. 
An experience of eight years as demon- 
strator has taught me—and you will see in 
the preface of my predecessor’s Manual of 
Dissections that he shares the same views— 
that systematic treatises, illustrated dissect- 
ors, or plates, are a positive evil while dis- 
secting. One simple book of dissections, 
like Harrison’s, or Hodges’s, or Ellis’s De- 
monstrations, is all that is best. 
Plates distract your attention from the 
dead subject; lead you to anticipate na- 
ture, and deceive you into thinking you 
have mastered the points thus illustrated, 
before you really know them. The whole 
subject-matter of your morning’s or eve- 
ning’s dissection should be thoroughly 
“ read up” before you enter the dissecting 
room ; you must anticipate mentally what 
you are going to find under each covering 
of cellular tissue or fascia, and not turn to 
the book to see what it is after you have 
laid it bare. The mind must go before the 
eye, and the eye before the knife. Thus 
doing, you will find the country-lad, with 
his single worn copy of Wilson, surpass in 
anatomical knowledge him who pursues a 
more indolent course of dissections with 
the text-book of Bray and the plates of 
Bourgery. 
The anatomical lecture is a daily lesson of extt\ uc, It condenses and illus- 
trates by housand analogies, diagrams 
or specimens, all that you labor out by 
yourselves. It explains to you, also, very 
many parts of anatomy that you cannot 
dissect. By no means neglect to follow it 
diligently ; but also read, recite, and, above 
all, dissect, if you wish to know anatomy. 
Recitations held over the dissected sub- 
ject have seemed to me to fill a very useful 
place since I introduced them here some ten 
years ago. And you will find them con- 
tinued now, even more fully than before. 
As much time as you can spare must also 
be given to the microscope. It is in this 
direction that anatomical and pathological 
science are now making their chief advances. 
Fortunately the cost of these instruments 
is now reduced, so that the majority of 
students can afford to own one. 
Finally, there is regional, or surgical ana- 
tomy, which is yet another department of 
this science. This you will learn in your 
second year. By it you are taught to mass 
your anatomical details into regions or 
groups, just as they exist in nature ; as, for 
instance, in the anatomy of the neck, the 
axilla, or the groin. This is the form of 
anatomy you will use and mentally refer to, 
in the actual practice of your profession. 
Physiology. 
We now pass on to the remaining study 
of the first year, viz., Physiology. By this 
we mean the study of the functions of the 
body in health ; as anatomy was the study 
of its structure. 
Physiology, comparatively a modern sci- 
ence, has made great advances of late 
years, and is still in a transition state. As 
influencing and correcting the practice 
of medicine it is the most important of 
either the departments. Without the 
truths which it has taught us of the func- 
tions of different organs in health, in dis- 
ease and under the influence of various 
medicinal agents, the science and practice 
of medicine would sink back a century. 
The physiological effect of various le- 
sions and the physiological action of drugs, 
are the modes of studying this department 
most directly conducive to practical results. 
Experiments have also often been verified 
by the absence or modification of certain 
functions in disease. We may all of us 
conduct a series of harmless experiments 
on ourselves in health. By Dr. Hammond 
in this country, and by numerous experi- 
menters abroad, very useful results have 
been arrived at in this way. 
Physiology is learned, like chemistry, 
only by experiment. It is to be pursued in 
a laboratory, and chiefly by experiments on 
the lower animals. The study by vivisec- 
tion of the humbler members of the animal 
kingdom appears a very cruel one. And so 
it may, thoughtlessly, be made. We depre- 
cate unnecessary repetitions of experiments; 
carelessness in causing pain, or consecutive 
mutilations of the same animal. But for the 
necessity and propriety of physiological vivi- 
sections, poisonings and medications of the 
lower animals, we would put in an earnest 
plea. By this path alone can therapeutics ad- 
vance in certain knowledge. Experiments on 
the vital functions, and on the action of drugs 
are of the last importance to the well-being 
of man. We do not hesitate to use the 
lower animals for food. Why should we 
not use them to teach us to avoid pain, or 
disease ? A swarm of insects would be 
ruthlessly destroyed that one man might 
sleep. Are a hundred or a thousand batra- 
chian lives to be counted in the balance of 
human suffering? 
Most opportunely, at the very time when 
we were obliged to look around for some 
way of teaching physiology in accordance 
with the new system of study, the thought- 
ful benefaction of one of your number, re- 
cently deceased—Dr. George Woodbury 
Swett—has given us the means to fit up a 
physiological laboratory, with microscope- 
rooms adjoining, in the upper story of this 
building. 
Physiology may be advantageously fol- 
lowed, not only throughout the whole 
course, but even in the earlier years of 
practice. Experiments on one’s self, espe- 
cially in diet, regimen, or the taking of 
drugs, may often be carried on without in- 
terrupting the business of life. In no sci- 
ence does it hold so true that the student, 
of to-day, is the discoverer, of to-morrow. 
Pathology. 
Fourth and last of the group of pure sci- 
ences is Pathology: the study of the changes 
in the organs produced by disease ; or, as 
it has been appropriately called, morbid, 
anatomy. This is the only sound basis for 
the study of the natural history of organic 
disease, and is the final test of diagnosis. 
The facilities for making autopsies are 
but grudgingly allowed by the general 
public. We cannot hope, under our form 
of government, for those far-reaching sci- 
entific edicts which enable a despotism to 
regulate the disposal of its subjects’ re- 
mains as strictly as it regulates their lives. 
Popular prejudice and public opinion are 
sad stumbling blocks to be overcome. You will, during your student years, have 
better facilities for pursuing pathology than 
you can enjoy in after life. 
Let me urge you, then, never to neglect 
going to an autopsy. You will realize ten 
years hence, when settled, perhaps in a 
community that will rarely permit them, 
how great a boon a post-mortem examina- 
tion of an obscure case would be to you. 
You will, I regret to say, see such exami- 
nations sometimes made in an imperfect 
manner through ignorance.’ You will even 
see the course of justice rendered uncer- 
tain by the incongruous results of coroners’ 
inquests conducted by incompetent men. 
As soon as you have acquired sufficient 
knowledge of healthy anatomy to appre- 
ciate morbid changes, frequent the autopsy 
room of the hospitals. Learn how to make 
an autopsy patiently and thoroughly. Fol- 
low out the case with care. Compare its 
past symptoms \<dth the evidences of dis- 
ease now patent to your eyes. Neglect 
almost anything else rather than miss an 
autopsy. It is worth more to ywu than a 
field-day of capital operations in the amphi- 
theatre, or the most eloquent lecture on 
disease. 
Neither does pathological research stop 
now with the ordinary post-mortem investi- 
gation. On the contrary, it has only just 
begun. The microscope takes up the in- 
quiry when the eye fails ; and the most 
important discoveries of morbid changes 
are now. made through its aid. Micro- 
scopical sections of diseased organs are a 
necessary sequence of the post-mortem ex- 
amination. In such sections, and in the mi- 
nute study of tissues, rather than cells, we 
see a partial return tothe doctrines of Bichat. 
Microscopical sections reveal to us the 
pathology of tumors ; the organic changes 
of the kidney, the brain or the heart. 
The discovery by microscopists of the cells 
of the connective tissue has overturned the 
older pathology, and substituted a clearer 
one. The microscope room, therefore, 
should be your resort during all the years 
of your study ; since you will there seek 
to unravel the complexities of both healthy 
and morbid anatomy. 
Finally, pathology is to be studied not 
only in the dead-house, but also in the Mu- 
seum. That precious collection, brought 
together and cared for by the life-long de- 
votion of the senior member of this faculty, 
is a monument of scientific industry. You 
will find the description and exhibition of 
morbid specimens, there collected, of ines- 
timable value to you: and I venture to say 
that every physician who L wishes 
that he could enjoy those priv». Des now. 
Chemistry, or the elements; Anatomy, or 
the healthy structure; Physiology, or the 
functions, of the human body, comprise the 
total of what you should seek to master 
during your first year of medical study. 
Pathology, or the morbid changes of the 
body through disease, should follow next; 
and completes the purely scientific part of 
your profession. We pass now to the art ; 
or to science applied to the treatment of 
disease. 
Surgery. 
Surgery should be studied next, and be- 
fore the other branches of medicine. We 
place it first, for two reasons : it is the di- 
rect outgrowth of anatomy ; and it consti- 
tutes a sort of external pathology. Frac- 
tures, wounds and tumors can be seen, re- 
cognized and studied more easily than dys- 
pepsia, gastro-enteritis, or cirrhosis. It is 
in great part, also, a demonstrative study, 
to be taught in hospital wards and operat- 
ing theatres. 
Every young student would be a sur- 
geon. Every young student, too, thinks 
more of operations, than of surgical 
pathology and practice. They get over 
both these errors in a few years. In reality 
operative surgery is not worthy of the at- 
tention that surgical diagnosis and treat- 
ment are. So, too, minor surgery is slighted 
for capital and bloody operations. As the 
Roman mob was attracted to the Flavian 
Amphitheatre only by hecatombs of vic- 
tims, so the medical classes crowd our am- 
phitheatres on field days of amputations, 
and desert their seats when nothing js to 
be done greater than a felon, a fistula or a 
hydrocele. In five years they find out 
their mistake ; there is no audience so pa- 
tient, on minor days in the hospitals, as one 
of young physicians. 
In truth, the operative part of surgery is 
a very small part of that science. To di- 
agnosticate an intra-capsular fracture of 
the shoulder or hip, or an abdominal tumor, 
is a far greater test of the surgeon. 
Systematic courses on the principles and 
practice of surgery are necessary to the 
student. They teach us by experience; 
collate cases; illustrate by plates, models 
and specimens, and lay down for us the 
rules of surgical practice. The greater 
part, however, of practical surgery is taught 
clinically, in the hospitals : either by visits 
in the wards; by visits to a few cases, fol- 
lowed by a lecture; or by bringing each 
case before the audience and lecturing upon it sep1 ich mode possesses certain 
advafita;, CliuicaVfiurgery, then, should 
occupy a due share of \ our attention. 
The time has now arrived, in your second 
year, when you should begin to visit the hos- 
pitals. During the first year you had better 
remain in the dissecting room and the labo- 
ratories. We advise you to begin your clini- 
cal studies in the surgical part; and to de- 
vote your time, at first, to the dispensary and 
to the out-patient department pf the hospi- 
tals. Here you will see minor surgery, and 
large classes of the more easily understood 
surgical cases. After three months spent 
there, and in the amphitheatres, seeing ope- 
rations and listening to clinical lectures, 
you should begin to visit the wards, and 
continue your visits faithfully, as often as 
possible, until you graduate. 
When you have once acquired knowledge 
enough to profit by hospital visits, you can- 
not spend too much time in them. But to 
see cases of fracture before you have stu- 
died the anatomy of the bones, or injuries 
and wounds before you can distinguish one 
tissue from another, is worse than a waste 
of time, since you are deluded into a false 
knowledge. 
Materia Medica. 
Before going into action the soldier must 
be taught the use of his arms: equally, be- 
fore combatting disease, the student must 
become familiar with his weapons. All 
the medicinal agents of his armamentarium 
are included in Materia Medica. This 
should be studied under four heads, in a 
natural sequence, thus :— 
Botany; 
Pharmacy; 
Physiological action of drugs ; 
Therapeutical action of drugs. 
Botany, though insisted on in European 
schools, is greatly neglected in this coun- 
try. It should form a part of the prelimi- 
nary education of the medical student. 
And, during his second summer in the medi- 
cal school, he should cultivate medical 
botany. This really forms a pleasant re- 
laxation from his heavier studies ; and a fa- 
miliar acquaintance with the native materia 
medica of his neighborhood will give him a 
wider field from which to cull his remedies. 
Pharmacy, the compounding and dis- 
pensing of drugs, can be properly studied 
only in an apothecary’s shop. Practical 
instruction should be particularly insisted 
on in this department, for in none is the 
ignorance of the profession so prevalent or 
so disgraceful. Many physicians do not 
know the drugs they are giving, by sight; 
still less do they understand compounding 
them. Incompatible messes that cannot be 
made to run from the bottle, and others 
that decompose instantly on exposure to 
the sunlight, are daily prepared under the 
physician’s prescription. There were lately 
prepared for a sick person powders con- 
taining the same materials which, in the 
ordnance department, are used to fill per- 
cussion shells. They require trituration 
with great care ; and it is fortunate if they 
explode in the mortar of the compounder, 
rather than in the stomach of the patient. 
The adulteration of drugs, which the 
physician, unacquainted with botany and 
practical pharmacy, may fail to recognize ; 
and the combining of incompatible and 
nauseous doses, are fertile sources of scep- 
ticism as to the influence of any medicine 
in disease. 
Botaijy and practical pharmacy should 
divide the second summer with pathology 
and hospital work. The study of the phy- 
siological action of drugs should be car- 
ried on in the laboratory, and in experiments 
on each other. 
Medical chemistry will here demand a 
good share of attention, under its three 
chief divisions of incompatibles, toxicolo- 
gy, and urinary analysis. 
According to the scheme of examina- 
tions, pathology, materia medica and medical 
chemistry terminate with the second year. 
Surgery, and the remaining studies to be 
named, extend through both the second 
and third years, and form the subjects of 
the final examination. 
Theory and Practice. 
We come now to Theory and Practice, 
as it used to be called, or, more properly, 
the Science and Practice of medicine. This 
embraces the natural history of disease, 
clinical medicine and therapeutics. 
In this department your attention should 
be equally given to full and careful courses 
of lectures detailing the history of medi- 
cine, and to the observation and treatment 
of the sick, clinically. 
In pursuing clinical medicine, or surgery, 
and studying the symptoms and changing 
aspects of disease at the bedside, all the 
higher faculties of observation, comparison, 
deduction and judgment will come into use. 
It will be fortunate for you if the percep- 
tive powers have been carefully trained 
by your previous study of the purely sci- 
entific branches of medicine Sharpen your 
wits; use your eyes; keep always alert, 
and never neglect the slightest indication 
which points to a change in the delicate 
barometer of disease. Here is the true field of your future labors, and by your 
skill in diagnosis, you will be judged all 
through life. I remember well the remark 
of my teacher, once, as we were passing 
the open door of a long ward of fever 
cases : “ Nolan is better to-day,” said he, 
glancing in, and alluding to a patient with 
severe typhoid, placed at the farther end 
of the room. “ How do you judge ? ” ask- 
ed I, surprised. “ lie has turned upon his 
side,” was the quiet rejoinder. And so it 
proved; for the first signs of convalescence 
had come on. 
Nothing is too trivial to be noticed in a 
case of acute disease ; and from the mi- 
nuteness and accuracy of description of the 
older observers, from Hippocrates or Syd- 
enham down, we may well believe, that 
without any of the appliances of modern 
science by which we test the working of 
the thoracic or urinary organs, or the tem- 
perature of the body, they arrived at nearly 
as correct a notion of acute disease and of 
prognosis as we can do now. By all means 
study, and avail yourselves of every instru- 
ment and every aid to diagnosis which sci- 
ence puts in your hands ; but beware that 
your eyes are not blinded, or your ears 
closed by authority, habit, tradition or 
purely scientific accuracy, to the faint 
symptoms of the expression, the breathing, 
the position or the voice of the very sick. 
As an example ; to uncover the abdomen 
and look at the play of the diaphragm in a 
child gasping for breath will tell you whe- 
ther you have to deal with croup or pneu- 
monia. Do not repeat the mistake made 
by a young medical philosopher in my stu- 
dent days, who, when asked what he 
thought of a dying man by whose bedside 
he was standing, replied, that he would say 
“ after he had examined his urine.” 
Do not neglect common cases for the rare 
ones, and do not overlook a chronic dis- 
ease ; for it is the common cases that will 
fill your practice, and the chronic ones that 
will prove your trial, through life. Work 
up your cases for the clinical conference. 
Get a case to treat yourselves, when you 
can. How that first case sinks into the 
memory ! As years go on it is overlaid by 
a hundred others, but it is never blotted 
out. The first case of each disease stands 
to you as a clear-cut proto-type, to which 
to refer, and with which to compare, all the 
rest, forever. 
Obstetrics. 
In your third year you will come to the 
eighth and last great department of your 
profession, Obstetrics: and in this are usu- 
ally included the diseases on* and 
children. 
Equally important with others, the 
of midwifery will lead you into a somewhat 
different field. An accurate knowledge of 
anatomy will stand you in good stead here. 
Study thoroughly the position and the rela- 
tions of the female pelvic organs in the 
dead subject. Lectures, experiments with 
the manikin and actual cases of labor are 
equally needful to you to master this branch 
of medicine. 
Medical Jurisprudence is a subdivision 
of our art about which we should know 
something, as those learn to their cost who 
are called into court to testify. Most col- 
leges give a short course on it. It is natu- 
rally divisible into two parts. 
First, The rules of expert testimony and 
the practice of courts of law, which would 
be best taught by lectures from a jurist. 
Second, Expert testimony in toxicology, 
in surgery, in anatomy, in psychology and 
in obstetrics, which would be better learned 
in connection with each of those depart- 
ments. 
Finally, we have specialties; of which 
psychology, the eye, the ear, the skin, and 
syphilis are the chief, but by no means all. 
We have neither time nor occasion to dwell 
on them. We feel that we ought to utter 
one word of caution, however. Do not un- 
dertake the study of a specialty, until you 
have finished a complete medical education. 
And, if you practise a specialty, beware lest 
you lose sight of the general symptoms of 
your patient. 
To recapitulate the order in which we 
would advise you to study medicine :— 
Chemistry, anatomy, physiology. 
Pathology, surgery, materia medica, me- 
dical chemistry. 
Science and practice of medicine, thera- 
peutics, obstetrics. 
Medical jurisprudence, specialties. 
We have thus provided a three years’ 
course. Would that it could be made a 
four years’ one. At present, however, this 
is as long as many of you can devote to 
professional study. For the more fortunate 
few who have a fourth year at their dis- 
posal, there are two ways in which it can 
be profitably spent; either in a hospital 
here, or by studying in Europe. If you 
can live a year in a hospital as house-physi- 
cian or surgeon, you will gain more practi- 
cal knowledge than you can possibly do in 
an equal time abroad, because you will here 
treat cases, and therefore remember them. 
Where but one can be had, we should pre- 
fer the year in hospital at home, to Europe. 9 
v> oe enjoyed, a year or two 
abroad ™ely valuable. It enables 
you to p. j one or more special branches 
farther than you can in this country. Your 
medical education, so far from being fin- 
ished, is only begun when you get your 
degree. We all regard ourselves as fellow- 
students of a science to be followed through 
life. 
And when that eventful hour has come 
that you begin your career as a doctor, 
what more is needed ? Practice, certainly ; 
and it will be slow to come. Earlier in the 
country village than in the town ; earlier 
in the town than in the city ; while in a 
metropolis like London, an average life- 
time is two-thirds spent before the harvest 
season can be reached. Slow enough and 
hard enough anywhere ; yet, if you perse- 
vere, it will come at last. But whether in 
your earlier and poorer, or your later and 
successful years, you will need something 
more than practice. 
Medicine is not a trade, and if you make 
it one you will bitterly repent it. It is not 
a calling in which to grow rich. It can 
never command the enormous income of 
the eminent lawyer, even when the practice 
lies in a large- and wealthy community ; 
while the ventures and receipts of business 
men dwarf our year’s earnings by one 
happy speculation, or one large sale. If 
you seek for wealth you have mistaken 
your avocation. The majority of you will 
earn a respectable livelihood, after from 
five to ten years of waiting and poverty. 
Add to this delay the outlay of your educa- 
tion, and the return for your investment 
will be very small. 
Whatever your success, you will abso- 
lutely want something more to make your 
profession even tolerable to you. Bear 
in mind that ours is the most laborious 
and wearisome of callings ; the slowest 
to rise; the easiest overthrown by ill 
reports; dependent on the caprice of wo- 
men ; subjected to the indignities of doubt 
and rejection by patients ; full of responsi- 
bilities, which grow the faster as yom as- 
cend the social scale. The Doctor is the 
bearer of other people’s burdens ; the con- 
fidant and adviser in other people’s sins and 
woes; the anxious watcher, whose mind is 
never free from a round of sick cases; the 
man who can never be his own master. 
For years, while you still trudge on foot, 
you will be covered with the dust of the 
charlatan, who rolls by you in his chariot. 
For years after you have begun to lose a 
little, week by week, of the buoyancy of 
youth, you shall be stigmatized as “ such a 
very young man !” The older you grow, 
the harder you shall work ; and your ofnce- 
bell shall never cease to call you until your 
ears are closed in death. For your hands 
will be reserved tasks before which a sca- 
venger would recoil. For you, other peo- 
ple’s sufferings shall be constantly your 
own. Your cruel calling shall compel you 
secretly to watch the progress of hopeless 
disease, while you must sustain hope till 
the last. You must not only witness the 
sad partings of death, but on you will de- 
volve the duty of telling friends or patients 
that all chance of life is past. To you, in 
your rides, shall come home that terrible 
question, after a sudden and unexpected 
fatal result, “could 1 have known more, or 
done more ?” To you may sometimes come 
the harder reflections of friends, that you 
mistook the case. And to you it shall often 
happen, after success has crowned your 
efforts, and your patient has got well 
against hope, to meet with the lowest in- 
gratitude, and to have your bill disputed in 
the end. 
In spite of all this, the tide of students 
never ceases, and the profession is crowded 
with young doctors, year after year. What 
feeling calls them ? \Yhat sentiment can 
sustain them in after life ? Money is not to 
be largely got. Practice alone is not enough. 
There must be something more, and some- 
thing higher. 
That something is a loveof your profession; 
a passion for science for its own sake; a 
broad humanity, which covers all the sick 
with a mantle of charity. Hold fast to 
that love and that science, if you would 
not sink from weariness in your earlier 
years, or find the fruits of success but 
chaff, in your old age. Never lose sight 
of that motive, for if it once takes flight, 
your profession is reduced to a trade, and 
there is absolutely nothing left. As long 
as you can keep alive the sacred flame of 
this early passion which first called you to 
embrace the medical profession, so long 
shall you be warmed, sustained, upheld 
amid disappointment, unjust treatment or 
reverses. 
In the admirable introductory address, 
delivered here one year ago by the Adjunct 
Professor of Chemistry, many of the changes 
were foreshadowed which have since come 
to pass in this school. The key-note was 
struck then, which brought all the wander- 
ing strains of opinion on reform and advance 
in education, into one accord. 
This Faculty, in listening to what they 
believe to be the need of the times, have 
adopted those changes, and made them as thorough as they can do, now. Foreseeing 
that they have done so, probably, at the 
risk of a loss in the number of their stu- 
dents, for the time, at least, they cannot be 
accused of having taken up this new sys- 
tem with any expectation of individual 
benefit, but quite the reverse. For it can- 
not be too plainly stated, that this depart- 
ment of Harvard University is not endowed; 
and that a sufficient amount of receipts 
from the classes, to meet its current ex- 
penses, is indispensable to its existence as 
a medical school. 
The Faculty have initiated these advances 
in medical education because they believe 
them right, and proper, and demanded. 
Because they, an* every t a in this 
room, can see, that the position ot’ our no- 
ble profession in the community of to-day 
is not what it should be, and not what it 
was fifty years ago. That there is a lower 
standard of respect and of knowledge creep- 
ing in ; that quackeries increase ; and that 
one Doctor is thought as good as another, 
because a Degree, in America, can be too 
easily acquired. 
We believe that there is but one remedy. 
To RAISE THE STANDARD OF MEDICAL EDU- 
CATION is the only way to recover the posi- 
tion which our Fathers held, and which we 
should retain.