WHAT THE PHYSICIAN SHOULD BE. ' AN ADDRESS DELIVERED AT THE COMMENCEMENT OF THE MEDICAL SCHOOL OF HARVARD UNIVERSITY, AT THE MEDICAL COLLEGE, IN BOSTON, March 9, 1870. By ANDREW P. PEABODY. Published by request of the Faculty. CAMBRIDGE : WELCH, BIGELOW, AND COMPANY, PRINTERS TO THE UNIVERSITY. 1870. WHAT THE PHYSICIAN SHOULD BE. AN ADDRESS DELIVERED AT THE COMMENCEMENT OF THE MEDICAL SCHOOL OF HARVARD UNIVERSITY, AT THE MEDICAL COLLEGE, IN BOSTON, March 9, 1870. By ANDREW P. PEABODY. Published by request of the Faculty. CAMBRIDGE : WELCH, BIGELOW, AND COMPANY, PRINTERS TO THE UNIVERSITY. 1870. ADDRESS. GENTLEMEN, — It would ill become me to at- tempt, on this occasion, the treatment of a sci- entific or professional subject. In science I could only illustrate, by contrast, what needs no such il- lustration,— the surpassing ability and culture of your teachers ; while in matters appertaining to the details of your profession I should but furnish a new commentary on the maxim borrowed from the greatest artist of classic antiquity, Ne sutor supra crepidam, “Let the shoemaker stick to his last.” But one cannot have lived with open eyes for more than half a century without knowing that a great revolution has taken place in the science and the practice of medicine. Formerly the administration of drugs deemed specifics, and the abstraction of blood, were the chief functions of the physician. He fought disease as fiercely as firemen fight a con- flagration; and as under their hands a house often sustains more damage from water than from fire, so, under his, the patient not infrequently recovered 4 of the disease, but never recovered of the medicine. There were here and there to be seen wrecks of men, — gaunt, colorless, toothless, of uncertain gait and tremulous hand and husky voice,—who were pointed out as monuments of a professional skill which had only almost killed them in curing them; and it was not infrequently urged in favor of the family physician, in preference to a new practi- tioner, “He knows how much we can bear.” There were, indeed, at that time, some deep- seeing and far-seeing men whose implicit faith in drugs had become enfeebled, and who administered as little medicine as they could, and live. There were also a few who did not live, financially, because they openly avowed a higher esteem for the vis medicatrix of nature than for their own, — men who were absolutely scorned, vilipended, and thrown aside for maintaining the need and the paramount efficacy in sickness of pure air, pure water, and good nursing. But the delusion which then prevailed so exten- sively was the defect of the times, not of the men. There were in your profession — even among those most unsparing and heroic in the use of opium, calomel, and lancet — not a few men of the highest order of nobility, mental and moral, uniting learning and skill, tenderness and intrepidity, the amenities that adorn and the virtues that glorify humanity. 5 Indeed, no profession in New England has been more, or more worthily, honored in its members than yours. Yet half a century ago success in it did not demand any higher qualities than success in homoeopathy — its caricature — does now. Medical practice then consisted mainly in the observation of symptoms, and the exhibition of the supposed specifics in quantities, not too small. It required good perceptive powers, cool judgment, and a care- ful hand,— not much more. It was for the most part a mechanical business, — of the higher sort, indeed, and differing from other similar vocations in its being expected to repair machines while in motion, yet still a handicraft that by no means de- manded the superior endowments of mind and char- acter with which it was often associated; and if not in our larger towns, there were in our rural districts, and even in the suburbs of Boston, physicians of very high reputation and extensive practice who possessed none of the attributes of a scholar, a gen- tleman, or a Christian. Nothing has so tended to elevate your profession as the decline of medicine. Formerly the healing art was not an inappropriate designation for it; in its decay as an art it has become a science, or, rather, the science of sciences. The cure of the sick is more than ever a real work, more than ever a great and high calling in its demands on intellect 6 and culture, more than ever a successful enterprise. But its methods, instead of lying in the apothecary’s shop, are derived from every realm of nature and of human experience, —from the study of the mind and soul no less than of the body, from psychology no less than from anatomy, from the clinics of the shop, office, church, theatre, ball-room, no less than of the hospital. In fine, the physician’s range of in- quiry now embraces all that man is, and all that may have a bearing on his condition or character. Permit me to choose a few topics in this wide range, while I endeavor to show you, in part, what a physician ought to be. Let me speak, at the outset, of the intense im- portance of what you are, even more than of what you know. Except in the manipulation of brute matter, what a man can accomplish depends mainly on what he is. He can never transcend his own mental and moral stature. He can endow his words, however wise, only with a power commensurate with his own character of mind and heart. Show your- self vain and conceited, or shallow and superficial; make yourself a village gossip and news-monger; be coarse and slovenly in speech and garb and man- ners ; forfeit respect and confidence by frivolity, or by vice, or by that close contact and sympathy with vice which feeds the mental debauchery of one whom nothing but cowardice keeps from gross dis- 7 sipation, — the good you can do will be limited to the medicines which you actually prescribe ; your most judicious advice will be unheard or forgotten ; you can perform absolutely no efficient ministry to the patient’s own mind, nor can you inspire his friends or attendants with discretion, fortitude, or hope. But if, both in mind and in heart, in quality and in quantity of being, you are worthy of your calling, your words will all carry weight, your ad- vice will be command, your mere presence will be a tonic, you will give effective relief whenever it can be given, and will sustain patience and courage when science and skill can do no more. But enough of generalities. Let me, in specify- ing the aims to be held in view, speak first of the necessity that you be lifelong students in your own profession. This is necessary, were it only to keep pace with the actual progress of knowledge. The physical sciences with which you are particularly concerned have, in new instruments and methods of investigation, and in theories that have just begun to be tested and verified, work enough before them for more than one generation; and you can be even with your times only by an open eye and ear, and a mind both hospitable in its reception, and vigilant and active in its treatment, of new facts, fresh theo- ries, aggressive speculations. There never was an age when scientific knowledge grew stale and obso- 8 lete so fast as it does now. The accomplished scholar of to-day who rests contented with his present at- tainments will be an ignoramus five years hence. Not only those who are destined for general prac- tice, but equally those who mean to be specialists, should start on their career with a profound sense of the importance of broad and comprehensive profes- sional and scientific knowledge. There is not an organ or function of the human body which has not almost cosmopolitan relations and dependences. To the dentist, for instance, no department of hy- giene can be indifferent ; chemistry, metallurgy, me- chanics, toxicology, are within his legitimate scope ; and microscopic analysis may have in store for him revelations of prime importance, both in theory and in practice. Then, too, it concerns the specialist to maintain his specialty as in the highest sense a liberal profes- sion, instead of suffering it to lapse into a mere art. This he can do only as he renders honor and hom- age to his profession by his own large and generous culture ; for it must never be forgotten that it is not the profession that ennobles the man, but the man that ennobles the profession. The collective or relative rank in the public esteem which shall be held by the general practice and the special depart- ments of medicine and surgery will depend on no a priori considerations, but on the genius, learning, 9 and breadth of intellect manifested by their respec- tive practitioners. You may be surprised that I enumerate genius among the endowments which the student is to seek. I do this because I believe that genius is as often acquired as native; that in either case it is cultivable; and that, when it is native, to leave it uncultivated is to lose it. Genius is the power of diligent, loyal, concentrated work in a department which one loves. Such work develops brilliancy, organizes success, earns distinction. There are those occupying the highest ranks in your own and in every profession, whose youth was marked by no precocious promise, but whose life-motto has been, “ This one thing I do,” and who have become great by doing it. To your professional knowledge you need to add general culture as wide and thorough as your special studies and labors will permit. You owe this to yourselves, to your brethren, to your calling. You owe it to yourselves; for the man who confines himself to a single department, however noble it may be, sacrifices his own intellectual manhood, moves, not in a self-returning circle, but in a con- stantly diminishing spiral, and from year to year becomes less, and not beautifully less. You have a vital interest in poetry, literature, and art, — in all that is beautiful and grand in the works of God and man. You need them for recreation, solace, 10 growth. You need them to bring you into due relation with the cultivated minds around you. You need them even for the highest professional success and reputation. No man can be great in his own profession who has not a vigorous intel- lectual life outside of it, beyond it, above it. No mere lawyer was ever a great lawyer. The men who have won the highest fame at the bar and on the bench have, with rare exceptions, been dis- tinguished scholars in other departments. The mere slave of his profession is a man of techni- calities, narrow views, inveterate prejudices. The elements of his knowledge are never flexible, elastic, modifiable. His mind grows, if it grows at all, as a house is built, brick upon brick, each successive brick laid in insoluble cement. But a man returns from other departments to his own with a vision clarified and intensified. The objects with which he is peculiarly conversant present themselves in new lights, in more comprehensive views, and in those relations with other objects and with the whole realm of truth, apart from which there can be neither just appreciation nor accurate knowledge. Then, too, you are unfit for your profession unless you know how to minister to a mind diseased; and a very large part of the physician’s office consists in the action of mind upon mind. For such action 11 there can be no doubt that extensive knowledge and enlarged culture give both freedom and power. One who would obtain influence over the minds of other men must occupy a position in which he can cope with the best of them, and challenge their respect and confidence. Men will trust your advice only when they feel that you are on their own intellectual plane. The uncultivated physician may win and merit a high reputation among the ignorant, but in the upper strata of society, how- ever great his skill, he will be regarded with sus- picion and distrust, — and often deservedly; for in our age of intense mental activity the cases are multiplied in which physical disease or derange- ment is due chiefly to mental causes, and demands for its treatment the keen analysis of those causes to which only a mind of wide scope and generous nurture is adequate, and the use of a regimen of which those causes furnish the chief index. I know well how engrossing are the claims of an extensive practice, and how few are the intervals for general literature and learning which such a career affords. But the first years of a physician’s life are — unfortunately, it is generally believed; fortunately, it ought to be — years of abundant leisure, and he may then lay the foundation and acquire the taste for attainments in general culture, which, thus begun and enjoyed, will not fail to 12 find its oases and feeding-times even in the busiest after-life. You owe diligent and advanced self-culture to your professional brethren no less than to your- selves. Your profession is, as I have said, in the public esteem, just what its members make it, and every member bears some part in the making of it, and has his dividend of the reputation thus created. Yours has been respected in this country as a learned and liberal profession, because the great majority of its members have been comparatively learned men, and men of broad views and sympa- thies. It is for you to sustain this prestige. It would be easy for you to destroy it. I dread the irruption of illiterate men into these several call- ings for which a superior education has hitherto been deemed requisite. The honor of my own profession is thus sadly impaired and imperilled, and it already furnishes a smaller proportion than formerly of influential and guiding minds. The physician, equally with the clergyman, has before him, apart from the stated duties of his profession, a sphere of public service for which a well-trained and well-furnished mind alone can fit him. He ought not to confine himself to the care of the sick. He has, at the same time, a preventive, hygienic ministry. His voice should have con- trolling influence in sanitary measures; in the 13 management of all eleemosynary, reformatory, and penal institutions; in such public improvements as have the recreation, refreshment, and comfort of the citizens for their object; and nowhere more than in our schools, academies, and colleges, in which there are constantly arising questions of prime importance as to the health of body and mind, on which educators may be guided by the judgment of their intellectual peers, but not by that of men of inferior culture, even though they were loaded down with diplomas. Such services the public needs and claims of its physicians. There is not one of you who will not be in a position to render them. There is not one of you who ought not to be ashamed of lacking the culture which will fit him to bestow them. There is that in the present condition of our community which demands more than ever before such wise and cogent influence as can come best — I might almost say, can come only—from the medi- cal profession. The rapid growth of our cities; the crowding of our poorer population into streets and dwellings that are hot-beds of disease and conta- gion; the haste to be rich, which is so prone to encroach on light and air and water, and which -looks on every inch of ground, actual or potential, solely in its gain-producing capacity; habits and fashions in higher circles that set all sanitary laws 14 at defiance; unwholesome excesses of work, of pleasure, of amusement, not to say of vice, — all claim at your hands the effort and the power of character which not a merely technical education, but a truly liberal culture alone, will enable you to exert at once wisely and efficiently. I pass to another point, on which I would lay the strongest emphasis. The physician should be a gentleman. By a gentleman I mean, not a person who in certain circles conforms to the conventional canons of good-breeding, but one whose genuine kindness of heart never fails of its due expression in courteous speech and manner on all occasions and toward all descriptions of persons. The brusque- rie and rudeness, sometimes native, yet curable; sometimes undoubtedly assumed to hide a tender- ness of feeling which it would be graceful and beneficent to show; and sometimes copied from some honored and eminent senior by an imitator who has tact enough to reproduce only the defects and faults of his model, — are of incalculable injury. A coarse nature here and there may enjoy and commend them; to others they are a bane and a torment. Think into what intimate relations you are brought with persons of the most delicate nurture, and of sensibilities made doubly keen by disease, — with persons themselves incapable and intolerant of an ungentle word or deed, — with 15 persons of true innate refinement, and under cir- cumstances, under exposures, wThich only hard neces- sity could make endurable, at critical moments when a harsh word or a rough manner must be excru- ciating. You may acquire a skill which will bring your services into demand, even though you have the almost mythical rudeness of an Abernethy; but "the beloved physician” you will never thus be- come. Sought for your uses, like the worm which has, by an untasteful metaphor, furnished your pro- fession with one of its names, you will be, like the leech, loathed the moment you cease to be needed. I have known the patients of such a physician, whose visits were at once longed for because of his reputed skill, and yet awTaited with an agony of dread. But my conversance has been chiefly, and my personal and domestic experience wholly, with physicians whose presence was a benediction, whose gentleness soothed and reassured even wThen their skill was baffled, whose courtesy and tenderness only brought out in stronger relief their firmness and energy in times of peril, and whose delicate sympathy can never fade from fond and grateful remembrance. Nor is it merely the refined and the gently nur- tured that need the services of a gentleman. A long professional life brought me into intimate inter- 16 course with the poor, and it led me to the belief that you can hardly go so low in the social scale as not to find those whom coarseness repels and disgusts, and who appreciate to the full the politeness of word and manner that has a heart always kind for its fountain. Among the poor you will no doubt perform many gratuitous services. Charity, whether of gift or deed, rudely bestowed, scorches and blisters the heart of the recipient; lovingly rendered, it is doubly blessed and doubly efficient. The line of Young, "A Christian is the highest style of man,” has passed into a proverb almost too trite for repetition; yet it is by no means true of such unfinished products of religious culture as are too often called by that most sacred of appellatives. It is true of a gentleman; and the Christian does not begin to deserve to be so termed unless he be virtually a gentleman. He is not half regenerated, unless the grace of God in his heart manifest itself in unfeigned gentleness, courtesy, and kindness in every relation, and in the whole intercourse of life. Let me next urge you to guard your humanity, to beware how you look on suffering with coldness and indifference, to take heed lest by familiarity with distress and pain you lose your quick and ready sympathy. I know well how much there is in the discipline of the dissecting-room, and even more, perhaps, in the necessity of treating the 17 living body as a mere material substance, that tends to sear the sensibilities. All this experience ought, indeed, to do its full work on your physical consti- tution, to quell nervous agitation, to make the eye clear and the hand firm. But this may be without any callousness of heart. The feeling of reverence and awe with which for the first time you look on the body which has been the abode of an immortal soul, and the noblest work of God, should never be defloured by levity in the presence of death, or even of the dismembered, once living frame. The irreverent, careless handling of what death places at your disposal can hardly fail to transfer itself to the living tissue, and to make you reckless of suffering, if science may only have its due, — of crucial ex- periments, if they may only reveal the life-secrets. Remember that you are men even more than phy- sicians or surgeons, — that you have no property which you ought to hold dearer than the sympathies which ally you to your race, and which should make everything that is human precious to you. Eminent and affluent example has shown you that firmness and tenderness can coexist. None have been more resolute and unflinching in the infliction of needed suffering, in exploring with healing touch the inmost seats of life, than those who have keenly felt all the pain they gave, and whose whole pro- fessional career has been a conscious and uninter- 18 mitted mission of mercy. It is the distinguishing honor of your profession that it deals, not with brute matter, but with sentient humanity, — with matter that is the life’s shrine, the soul’s temple. The moment you lose thought of this, your high calling becomes a mere handicraft. I have said that you should guard your humanity for your own sake ; for you have no more vital interest than this. It is not without profound sig- nificance that men, who, in forming words, have al- ways “ budded better than they knew,” have termed this virtue humanity ; for to deprive one’s self of it is self-mutilation, nay, absolute suicide, as to all that a man ought to take pride or pleasure in being. I believe that if the man, of whatever vigor of intel- lect, or dexterity of hand, or science-guided skill, who had utterly divested himself of fellow-feeling in the handling of human flesh and bones, could see his own moral countenance as he can see his face, he would behold nothing on the earth more loath- some than himself. I cannot for a moment think that this abnegation of human sympathy stands in the relation of either effect or cause to surpassing ability in surgical practice. If there have been instances that would seem to prove the contrary, remember (and none have more occasion to remem- ber this maxim than you will have every day of your lives),—remember that instances are not proofs, 19 that single cases do not determine laws. In the very nature of things, the more arduous branches of your profession can have no so sure and efficient stimulus to discovery, invention, improvement, self- culture in body and in mind, as is furnished by the hope of relieving human suffering, and conferring substantial and enduring benefit; while, conversely, it is hard to imagine that a type of excelling genius and ability which is among the choicest agencies of divine benignity upon the earth can be conjoined with a maimed and truncated moral nature. Yet one topic more. There underlie disease, suf- fering, and the death-agony the profoundest spiritual experiences, — needs, cravings, fears, hopes, joys,— an inward life, which is not indeed formally commit- ted to your care, yet which craves your deep interest, your earnest thought, your diligent investigation. For this spiritual life there is, as I trust few of you will deny, a divinely given repertory of relief, cure, nutriment. To this the physician, if wise, will have recourse for himself as a mortal and as an im- mortal being; and if for himself, why not for those under his charge ? Do not think that I introduce this subject as a pro forma decency due to my profession. Far from it. But I do introduce it because I want to give utterance to what was forced upon my mind during many years of constant professional conversance 20 with sickness and death. On the part of the sick or their friends, there is commonly a desire for spirit- ual counsel, help, or comfort. This the clergyman is expected to give. He may, or he may not, be well fitted to give it. Many excellent ministers are very ill adapted to this office, in consequence of a want of tact, excessive diffidence, or unreadiness in conversation. Then, too, the clergyman’s visits, however judiciously managed, may occasion undue excitement and alarm; there are many cases in which it is undoubtedly perilous for the patient to receive such visits; and the clergyman is in this matter sacredly bound to yield to what should be, and generally is, the sounder judgment of the phy- sician. The physician, if himself a man of serious thought and of strong religious convictions, is incomparably the best minister to the spiritual as well as to the bodily health of his patient. I wTould not, indeed, encourage homiletic habits in your profession; in my own I know of no occasion out of the pulpit when they are not a hinderance and a nuisance. Still less would I have you give utterance to what you do not believe and feel. But with the sick and dying there is intense power in the mere suggestion — brief and informal, but sincere and earnest — of the infinite, eternal themes which are our treasury of trust and consolation. If the physician who has 21 these themes near his heart will not shrink from giv- ing them utterance, he may often meet a far deeper want than that for which his services are sought. And ldt me ask, To whom should these subjects be so familiar as to men whose life-work brings them into perpetual interview with that night side of human experience, which is unutterably depressing and dispiriting unless one can trace the dawn, and in assured faith apprehend the rising of the unset- ting sun upon these night shadows ? I am perfectly aware, gentlemen, that I have been urging upon you only obvious, self-justifying views of your obligations. But it is obvious duties that most need and claim presentation. They are ob- vious because they are the nearest, and for their very nearness we are prone to overlook them. In science, he best serves you who adds to your knowl- edge ; in practical life, he who reminds you of what you knew before. I cannot close without expressing my great grati- fication in the prosperity of this department of our University. I lament, in common with the Medical Faculty, the inadequacy of your present accommo- dations, and I earnestly hope that more room will be provided at no very distant time. But there is only one way in which you can secure room enough; and that is, by replacing the present Faculty by 22 their inferiors. They are wholly to blame for the overcrowding of these halls. I find by the Cata- logue that almost half the Medical students are from homes out of this State, and a full half from homes nearer to other medical schools than they are to this. Had you more room and the same teachers, there would still be the same illustration of the Malthusian theory, — the pressure of population upon supplies. But it is eminently desirable that wdtli the interior growth there should be a corre- sponding exterior enlargement, and pre-eminently desirable that the collections of priceless value in the hall above should be placed beyond the hazard to which they are now exposed. There is reason for special satisfaction in the establishment and high promise of the Dental School, and in the intimate relation in which it stands to the Medical School,— independent, indeed, but at once enriched by the resources of the elder institution, and in its turn enhancing the repu- tation and influence of the elder by its own new corps of able, accomplished, and earnest professors and lecturers. The science of medicine, healing, and hygiene, in all its branches, is one. Its several departments have, or ought to have, more in common than of their own separate property. The only foundation for success in either is a thorough knowledge of the 23 human microcosm in all its members, functions, and liabilities. The departments all have the same end, — the preservation or restoration of the sound body for the indwelling of the sound mind. Each is concerned in the fair fame and successful exercise of every other. Each suffers by ignorance or char- latanry in any other. Subdivision of labor is the necessity at once of growing population and of the increased demands upon the science and skill of every practitioner; but there is still a close com- munity of interests which should manifest itself in every form of mutual fellowship and co-operation. The graduates of the day will accept my fervent godspeed on their several careers of service. Gen- tlemen, Providence will leave you for the most part the artificers of your own fortune. Your seeming opportunities will at the outset vary very widely; but your ultimate success depends less on oppor- tunity than on the preparation of mind and char- acter with which you meet it. In every profession, however crowded the lower ranks may be, there is vacant room in the higher ranks. Probity, diligence, and enterprise will not fail of their recognition and reward. Deserve what you aspire to, and you will in due time attain what you deserve.