A i 0 V V~v> l»U THE XJl^S ^.ND DOWNS OP A DOCTOR'S LIFE, BEING THE CLOSING LECTURE OF THE COURSE DELIVERED IN THE HAHNEMANN MEDICAL COLLEGE FOR THE Session of 1863-64. f BY R. LUDLAM, M. D., Professor of Physiology aud Pathology, etc. PUBLISHED FOR THE CLASS. CHICAGO: 0 S. HALSEY, NO. 138 CLARK STREET 1864. THE UPS AND DOWNS OF A DOCTOR'S LIFE. By ft. Ludlim, M. Q. Gentlemen : The life of man is made up of vicissitudes. His history is one of detailed contingencies, of ups and downs, of mutabilities in fortune, fame and friendship. While his lot is viewed as a common inheritance, his experience is that of nations, classes, and individuals. It would indeed be strange if the physician alone should prove an exception to this rule. The doctor, too, has his share of variety, of incident, of prosperity and of adversity. I pro- pose to direct your attention to a few points which may influ- ence your future experience, as they have done that of your professional predecessors. I shall speak plainly of those small matters which, from their being frequently overlooked, are really the more important. The function of the physician is to do good to others. If this duty is rightly performed it will not fail to open a deep and perennial well-spring of happiness to his own mind. In 4 the old Greek story, Achilles, when disguised as a woman, was discovered by what he selected from the pedler's pack. The physician's experiences will vary with the course he elects to pursue toward those among whom his lot is cast. However various the schools of medical belief, there are really hut two classes of physicians—those who work, and those who shirk, or those who think in person, and those who think by proxy. A friend suggests a third class—those who never think at all! Now, as honest, manly toil sweetens the bread of the laborer, so the straight-forward, educated energy of the good physician brings the glow of contentment and the bright gold of a clear conscience. As the common idler, by his neg- lect of duty, entails misfortune upon himself and upon others, so is it with the professional idler. He is an adulteration, an alloy, a counterfeit. As there are pinchbeck patriots in our day, so there are and have always been physicians who do not give out the ring of the true metal. They are slow to volun- teer, they dodge the draft, shrink from assuming responsibili- ties, have no purse or principle, part or lot in the issue, unless it be to croak and to hold fat contracts. The patriot may turn politician, the physician become an unscrupulous speculator upon the misfortunes of his fellow men. To-morrow will be Commencement day. Some among you are to graduate, to receive your diplomas, the authority to go forth to the world as accredited physicians. The knowledge which you have acquired as students will soon be brought into requisition. The genius you possess for the active duties of your profession is as yet undeveloped. The twin-sisters Talent and Tact are to make or mar your fame and fortune, to shape your experience as medical men. The ups and downs of your life will depend upon the manner in which you use these two principal elements of success. The obstacles to be encountered in "getting into practice" will soon have to be met. Your claims to the public confidence will be in pr6portion to your improvement of the advantages which you have enjoyed in this Institution and elsewhere. If the talent with which you are entrusted is placed at a good interest, your reward will be certain 5 to follow. There is much of comfort for you in the homely old maxim: "The Lord helps those who help themselves." If you are qualified, earnest, prudent and patient, your success is certain. Let me counsel you, therefore, to be social and manly; in plain Saxon, to mind your own business, and to occupy your intervals of leisure in storing your minds with useful informa- tion. Every hour's study is qualifying you for the high and responsible duties which are yet to devolve upon you. Self- culture is self-perpetuating. A physician's knowledge is his stock in trade. Each day's labor will bring its own reward. By and by you will revert to these early endeavors as bright spots in your professional career. Never fear but your zeal will be appreciated. There is a species of Free Masonry among the really intelligent whereby you will be recognized and your resources made available to the sick and the needy. \our worth will certainly make itself manifest. The germ is within you, and it is left for you to supply the conditions of its devel- opment. Many of the annoyances and perplexities of the young doc- tor spring from impatience. He desires a large practice at once, and will not be content with a gradual increase of his popularity and usefulness. The golden stream must be quick and violent. Pray do not be precipitate in this matter. A hot-house reputation of this sort is neither enduring nor desir- able. Were the forms of beauty which are carved along the wild forest and up and down the aisles of earth the work of a day ? Can you hasten the process of crystallization ? The best interests of patient and physician are promoted by a gradual requisition upon and unfolding of professional re- sources. -Better on the heath with an old cart than at sea in a new ship." Talent alone is not all that you will need. The tact which comes with experience is perhaps equally im- portant. For this lesson the old women of both sexes, in the profession and out of it, will be your instructors. Is it requi- site that a soldier, however conversant with military affairs, shall have the tact to adapt himself to circumstances in order 6 to deal the right blow in the right place for his country ? ",70f how much greater importance is it, in dealing with those who have rebelled against the constitution and laws of health, that we have the tact to cure and not to kill! Most failures in life depend upon the want of a proper adjustment of means to ends. I have known a chorister who, on his way to church, would select tunes for the service according to their metre, with entire disregard of sentiment in the sacred song. That man has his counterpart among phy- sicians. Some of you may imagine that you are armed and equipped against any form of disease which you may encounter. But you shall soon discover the error in a want of harmony between agencies and their expected results. The patient fails to convalesce, and you are, or should be, convinced that you have not selected the most appropriate treatment—that, like my friend the chorister, you may have chosen the tune before reading the hymn. Every physician must take a course of object-lessons in human nature. He should be philosophical enough to accord with community, especially the two classes thereof in which he is more immediately interested—his patients and his professional brethren. With the former his face soon becomes familiar, and may as soon be forgotten. In adversity he will be regard- ed as a friend, in prosperity he may seem to be overlooked; in storm an anchor, in sunshine superfluous. Many call* upon him as they do upon Providence—when in trouble, which being removed, is deemed sufficient cause for his dismissal from serv- ice, and perhaps from memory also. The ingratitude of those who have reaped of your benefac- tions; the feeling which implies that it is not "for value re- ceived" when your bill is presented, will sometimes afford you no slight measure of annoyance. But the sources of pain and of pleasure lie very near to each other in this life. Our pro- fessional nerves, like those of our physical bodies, may convey the most pleasant or the most painful sensations. They may become so morbidly sensitive and irritable as to occasion much of suffering; may be benumbed, blunted and paralyzed, or, by 7 careful training, we may develop in them a sense of grateful and appreciative perceptions. " Plant blessings, and blesaintrs will bloom ; Plant hate, and bate will gTOw; You can sow to-day—to-morrow shall bring The blossom that proves what sort of thing Is the seed, the seed that you sow." Let us in imagination visit a few patients. Permit me to remain invisible. It is a beautiful day, and we ride for pleasure —the pleasure of doing good. The first call made—we must see those most ill early in the morning—is upon a little boy of three years who has diphtheria. We find the patient where we left him late last evening, id est, in his mother's arms. She has waited and longed for your arrival, fearing that a change in his symptoms betokens a fatal result. A glance arouses suspicions that she is correct, and these are confirmed by a careful examination. The fond mother would know the worst, and in as tender tones as you can command, she is told that her last-born must die. The effect upon her and upon the family—for the reflex of sympathies is through the mother always, is consoling and encouraging, or painful to the family and calamitous to the patient. If your advice has been sought because of a well-grounded confidence in professional skill; if the choice of the physician has not been made in extremity, or because he lived just around the corner and was therefore most convenient; if the family is educated and well organized; everything will go on quietly, and every effort be made to afford the patient the best possible chance for recovery. Oth- erwise distraction and disorder, while they seal the doom of the patient by subtracting from your undivided interest in the case, will sow the seeds of bitter reflections, and unkind, because unnecessary, regrets. Here, however, the patience of the parent is your stay and encouragement. You are stimulated to noblest endeavor, and will at least have the satisfaction which springs from appreciation, the reflection that parent and physician have done their duty. » From a good home it is not far to heaven." Before you come again, that little patient 8 may have mad« the passage, but but he will not have left the one or crossed the threshhold of the other in a tempest! The doctor's feelings on leaving such a scene will vary with the conviction that, while he has acted uprightly in every re- spect, those most interested in the little sufferer have not with- held their fullest confidence and support. The next patient we visit has been an invalid for some weeks. We enter the house, the parlor en transitu, the sick chamber. Everything wears an air of neatness and refinement. Only a thin window-pane separates winter from summer, for, although it is frosty without, there are flowers within. Here, at least, is one who does not think it all of one's duty in life to cultivate the practical and not the poetical, hops and not hyacinths. The patient is delicate in person, and of cultivated taste; has a greater admiration for depth of character than for dis- patch, and would certainly be disgusted with any display of professional pyrotechnics. That politeness which old Dr. Johnson styled "benevolence in trifles" is most current in this atmosphere, as indeed it should be everywhere. A few queries disclose a temporary discouragement. There are clouds in the horizon of her hopes for recovery. She has been weeping, or, technically speaking, trying the effect of counter-irrigation! You have the disposition and the ability to dispel those clouds. If the sunshine came in at the door when you entered, the vapors will soon be dissipated. You may take a hint from that sunshine, which is ever calm and strong, and pure and joyous. The prescription is made in due season—"business before pleasure"—a little conversation, not gossip, is had, and we are again on the wing. What a self-registering thermometer is the doctor. His ups and downs are literally influenced by every change of atmos- phere and surroundings. His scale, which is that of Celsus, and not of Celsius, is graduated upon his physiognomy, and not upon porcelain. Let us skip a few names on the list, for it is vulgar to parade one's professional popularity, and look in upon our bachelor friend. This is his elysium. The old fellow's world is a hemi- 0 ' sphere, and chaos is come again. Pain may have been the fir^t successful surgeon in healing wounds and fractures among savages, but our patient is satisfied it will never cure the rheu- matism. He is more cross than complimentary, and growls because of the lateness of your visit. Why leave him to die of neglect? No one ever suffered like himself, and none were so unfortunate. Really, if you do not attend upon him a little more closely, he will feel himself compelled to try some quack nostrum, or somebody's else physician. Mr. So-and-so was cured of this disease in ten days, and it seems more than strange, it is needless, that he of all others should be thus vic- timized. His answers are as crisp as his toast, and he would prefer medicines as strong as his tea. You must look to your laurels, or yours will be the vision of Jonah en route for the dry land! He is extremely irritable, and, by reason of infir- mity, not independent—a type of men everywhere, and you do not feel improved in temper by your visit. You select the remedies, and petition heaven with a prescription for patience and forbearance suited to both parties. I have a word concerning this class of patients. It is the most pleasant, as well as the most politic, always to be in good humor toward them. Nothing is more absurd and suicidal than for the physician to permit himself to be vexed at trifles. Remember that those of your patients who really suffer have the worst of it. You may as well be kind and obliging. What would you think of a conductor upon one of our street railways who persisted in running his car in such a manner as always to discommode the passengers? Above all, if such crusty old fossils infect your spirits, give them a thorough ventilation as you would your clothing if they had the small-pox, before visiting the next patient, and do not inoculate a third party with the bad humor. Beside the eruptive fevers, there are other affections which are contagious, the nidus of which is sometimes conveyed by the doctor from house to house. In a small tenement on the next street is another represent- ative patient. Here everything betokens poverty and want A poor soldier's widow is ill, and you have come to her relief. 10 She is cheerful in her affliction, and salutes you with the grate- ful assurance that your last remedies were well chosen. You find her convalescent, and feel yourself in a very different at- mosphere from that which you have but just left. Her hus- band, a true man and a patriot, has gone to his reward. The double motive to take care of the poor, and to help those who have sacrificed so much for our common weal, is presented in her case. The medicine is not all you will leave her, nor is money the great desideratum. A loyal word, a gleam of hope to lighten her cares, and lift the clouds from her little horizon, must be elements in your prescription. When you take the hand of her little one you have taken hold upon her heart. Children are apt interpreters of character, and it is a bad sign for them to hold you in fear. Beside, a few words of the right kind in their ear is good seed sown upon good ground that may bear fruit when the physician and his grateful patient in this little family have passed away. You may save ink and paper, credits and collections on such visits. There is a pay-as-you- go feeling which discharges the debt when the door has closed upon you. Be kind to the poor. Remember the saying of Boerhaave— " God is their paymaster." No legislative enactment, no selfish and intolerant exclusion from field or hospital duty can deprive you of the prerogative of serving your God and your country. lou need not wait for surgical sanction, or shoulder-straps, but lift the burdens of the sick and the sorrowing in the ranks of civil life, and the blessing of the widow and the fatherless to the remotest generation shall be yours. "They also serve who only stand and wait." One more call, and our round of visits is made. We enter a neat little cottage whose very look is natty and Quaker-like. This home has its attractions in those who inhabit it; its pic- tures are living, breathing personifications of domestic happi- ness; its furniture is not fashionable, its pretensions are few and not striking. The mutabilities of life have crept into this usually quiet household. Yesterday it was in peril, to-day it is a paradise; the pictures looked anxiously, but now they are 11 more than pleased; the whole house was disturbed, now it has assumed its primitive order. When the drapery of night fell about this cottage there came a little stranger to claim a place in the hearts and affections of the household. Look upon that boy, and realize with Richter, " The smallest are nearest God, as the smallest planets are nearest the sun." Wrho shall say what elements of happiness are wrapped in that blanket, or what traits of character are bound up in that boy ? But now we are at home again, and you are prepared to appreciate the influence of the physician's daily experience upon his life's record. No one is more familiar with marked vicissitudes. He deals in antitheses. His own feelings act and react upon those of his patients. He meets with every species of reception and of recognition, and is happy or miser- able in proportion to the spirit and determination with which he enters upon and discharges his most important mission. He knows that one of the happiest effects of doing good is that it begets a spirit of benevolence; and also that a well-ordered benevolence is not incompatible with one's pecuniary interest. He is to community what the margin of cilia is to the oyster, which, by maintaining little currents of water, serves to keep the creature in health. Other organs may appropriate more of the pabulum, but he lies nearest the confines of the social mi- crocosm, is more delicate and sensitive, and could by no means be spared from his place. " Why should he not make his labors of life redolent of truth, and simplicity, and kindness?" The relations of medical men to each other influence their ideas and experience greatly. It is considered a family failing that doctors shall disagree. If this were done quietly, and without a species of inquisition into conscience, all might be well. But it is not so. Bigots abound among us. The schools are intolerant, and there is little doubt but real progress has long been delayed by a waste of time upon polemics. The question at issue is one of boundary lines, and not of the fer- tility of fields which are to be enclosed. This is all wrong. There is too great a disregard of the philosophy set forth in the Spanish proverb—"Seek not to set every man's sun-dial 12 by thine own watch." We are prone to forget that principle and prejudice are incompatible, and that an infraction of the ninth commandment must still be regarded as a crime against the decalogue. While Raphael was engaged in painting his celebrated frescoes, he was visited by two cardinals, who began to criticise his work, and found fault with it without under- standing it. "The apostle Paul has too red a face," said one. "'Tis because he blushes in heaven to see into what hands the church has fallen," said the indignant artist. You will recall this anecdote by-and-by, when you encounter the opposition which will be the lion in your way. But you are not to hold your convictions with a contentious spirit. You will discover that tho>e physicians who devote themselves to the advocacy of distance and separatism, who spend their breath in abuse, have not outgrown the small-clothes of an ignorant prejudice. A beautiful writer has said: "You seldom hear a painter heap generous praise on anything in his special line of art; a sculptor never has a favorable eye for any marble but his own." The only method by which you can prosper safely and satis- factorily is to permit those around you to think as they please, and to act accordingly. It is not expedient to attempt a sud- den divorce of the world from its old ways of thinking and forms of belief. When one said to Copernicus—"If the world were constituted as you say, Venus would have phases like the moon—she lias none, however; what have you to say to that?" he answered—" I have no reply to give, but (Jod will be so good as that an answer to this difficulty will be found." You can afford to labor and to wait, although, like Copernicus, you may have departed when the answer has come. You will sometimes be annoyed by the persecutions of those who differ from you in medical sentiment. One will treat you in the spirit of a certain Duke of Somerset who deigned to pity Adam because he had no ancestors! Another will attempt to drown you with the muddy torrent of invective. A third ne a blacksmith, will exercise "a little brief authority" in discrediting your professional certificates, and mayhap 13 send you an ungentlemanly message into the bargain. In many ways you may find that your brethren are given to ignore the requirements of good breeding, and of that good taste which "wounds no feelings, infringes on no decorums, and respects all scruples." The best course of procedure is the plainest, if not the most easy one. Toleration is in great part a thing of temperament, but it is also a fruit, as well as the index of a thorough educa- tion. The outward touch does not soil the sunbeam. "The snail, to be rid of annoyances, bartered its eyes for horns." The fire-fly may flourish his insignificant lantern, but it needs darkness to make it visible, and he will never set the world on fire. " Not a truth has to art or to science been given But brows have ached for it, and souls toiled and striven: And many have striven, and many have tailed, And many died, slain by the truth they assailed." Depend upon it, gentlemen, the people, the laity, those most interested in our labors, care precious little for our professional squabbles. It makes little difference to the patient whether the surgeon about to amputate his limb holds the catlin in the left or the right hand, so that the operation is safely and prop- erly performed. It is well enough, indeed there must in the nature of things be differences of opinion and various schools of belief, among medical men. "A land-mark is well placed between two brothers' fields." But that land-mark is, or should be, set up as a means of peace and not of warfare, to save trouble, and not to make it. Because I am an ingrain Presbyterian, does it follow that 1 am licensed to deny the benefit of clergy to my neighbor who differs from me in his religious tenets? Would community es- timate the depth of my character and the purity of my life by my zeal in propagandism ? Is the religious journal, the organ 7a particular society, most esteemed for its polemical articles, or because of its richness and depth of learning, its varied re- sea h and the cropping out of a fervent piety tha adorns ach page? You are organs of a particular belief in Medicine. 14 You are grounded in the faith, and your works must follow you. The true patriot discards party issues to save his coun- try when it is endangered. The true physician devotes himself to the welfare of his patients. His most efficient weapons against disease are not found in the paltry politics of his craft, but in resources which have been gathered from all quarters, in the fruits of his own and of others' labors. Every ship should have its flag-staff", but the colors are not the compass. Truth should sit at the helm, and truth is im- personal. Popular sentiment is a fickle breeze that, but for the guidance of truth, may drift us ashore. The flag is an em- blem of nationality. There are nationalities in science. When the foreigner changes his residence, he is not absolved from those mutual responsibilities which every mortal inherits. So when men of science shift position in the realm of letters, their new papers of naturalization do not afford a Avarrant for outlawry on either hand. The inborn gentleman is a gentleman everywhere and always. The refined and educated German, the gay and frivolous Frenchman, the slow-paced Englishman, have no need to specify their nativity upon their door-plates. So, in the practice of an honorable profession, you need not flaunt your banner as a gift of birthright or of adoption, but take rank as men of culture and of refined sensibility in the realm of science able to make due allowance for differences of opinion, and to appreciate real sincerity and worth wherever you may find it. It is no compromise of one's faith to be charitable; no crime against one's nativity to be cosmopolitan. But, being at peace, you owe other duties to the med- ical profession. You are to contribute your mite towards the general advancement. It is a law of our mental and moral natures that we grow as we give, and are happy in proportion as we make others so. He who identifies himself with the literature of his profession is a producer, and the reflex of his labors will be felt in his own enjoyment and experience, as well as m that of others. I had rather define the sphere and mode of action of a new and valuable remedy, analyze a diseased state so that it may always be recognized and understood, solve 15 some physiological problem hitherto inexplicable, than be the author of the most popular history or poem ever written. It is impossible to estimate the influence you may exert in this direction. None of us are independent. As well might the Beveral organs in our bodies declare themselves free of sympathy in labor and feeling with one another, as for you to claim ex- emption from duties of this nature which devolve upon all. Think what a degree of benevolence may be attained by this means. As the light of other and remote days, through a spe- cies of crystallization thereof in the coal we burn, is brought to warm and cheer our homes, so the rays you may shed upon the path of your fellow may be transmitted to the latest gener- ation, an influence at once beneficent and beautiful. Consider what a kind Providence has done for man, and re- Bolve that you also will accomplish something for his welfare. "For him the earth teems with fruit and flower, with the rich harvest and the golden grain. For him the fresh fountains leap from the solid rock, and the cattle feed on a thousand hills. To lull him to repose the solid earth turns away from the too brilliant sun, and the gentle stars light the nocturnal sky. To wake him to vigor, the morning dawns, and the light of day, tempered by a provision of admirable efficiency, swells gently into brighter and still brighter effulgence, until the full-orbed sun bursts in splendor upon the world." The compensating relations of Nature are truly wonderful. He is a Christian philosopher who leaves her to adjust the reward of devotion to the welfare and prosperity of the race .What more could be desired ? What better evidence of duty well done than the testimony of an approving conscience ? What more grateful memory as an incense to God for a life of well-spent endeavor ? " Up and away, like the dew of the morning, Soaring from earth to its home in the sun,— So let me steal away, gently and lovingly, Only remembered by what I have done. « My name, and my place, and my tomb, all forgotten, The brief race of time well and patiently run, So let me pass away, peacefully, silently, Only remembered by what I have done. 16 " Up and away, like the odors of sunset, That sweeten the twilight as darkness comes on,— So be my life,—a thing felt but not noticed, And I but remembered by what I have done. " Yes, like the fragrance that wanders in freshness, When the flowers that it came from are closed up and gone, So would I be to this world's weary dwellers, Only remembered by what I have done. " Needs there the praise of the love-written record, The name and the epitaph graved on the stone? The things we have lived for—let them be our story, We ourselves but remembered by what we have done. " I need not be missed, if my life has been bearing (As its summer and autumn moved silently on) The bloom, and the fruit, and the seed of its season; I shall still be remembered by what I have done. " I need not be missed if another succeed me, To reap down those fields which in spring I have sown: He who ploughed and who sowed is not missed by the reaper, He is only remembered by what he has done. " Not myself, but the truth that in life I have spoken, Not myself, but the seed that in life I have sown, Shall pass on to ages,—all about me forgotten, Save the truth I have spoken, the things I have done. '* So let my living be, so be my dying; So let my name lie, unblazoned, unknown; Unoraised and unmisse 1, I shall still be remembered Yes,—but remembered by what I have done."